Clinical Trials /

APG-2575 Single Agent or in Combination With Ibrutinib or Rituximab in Patients With Waldenström Macroglobulinemia

NCT04260217

Description:

Phase Ib/II study of safety, tolerability, efficacy and PK of APG-2575 as a single agent or in combination with other therapeutic agents including ibrutinib or rituximab.

Related Conditions:
  • Waldenstrom Macroglobulinemia
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: APG-2575 Single Agent or in Combination With Ibrutinib or Rituximab in Patients With Waldenström Macroglobulinemia
  • Official Title: A Phase Ib /II Open-label, Multi-center Study to Evaluate the Safety, Tolerability and Efficacy of APG-2575 Single Agent or in Combination With Ibrutinib or Rituximab in Patients With Waldenström Macroglobulinemia (MAPLE-1)

Clinical Trial IDs

  • ORG STUDY ID: APG2575WU101
  • NCT ID: NCT04260217

Conditions

  • Waldenstrom Macroglobulinemia

Interventions

DrugSynonymsArms
APG2575 400 mgAPG2575 400 mg
APG2575 600 mgAPG2575 400 mg
APG2575 800 mgAPG2575 400 mg

Purpose

Phase Ib/II study of safety, tolerability, efficacy and PK of APG-2575 as a single agent or in combination with other therapeutic agents including ibrutinib or rituximab.

Detailed Description

      This is an open-label, multi-center Phase Ib/II study of safety, tolerability, efficacy and
      PK of APG-2575 as a single agent or in combination with other therapeutic agents including
      ibrutinib or rituximab. The study consists of the dose escalation and the dose expansion
      phases. The clinical trial will have multiple arms with ability to subsequently add more
      treatment arms based upon clinical activity of APG2575 in WM. Initially the study will
      contain 3 arms noted below, all the arms are independent.

      Arm A: APG-2575 will be administered as a single agent to determine the MTD/RP2D in subjects
      who are relapsed/resistant or intolerant to ibrutinib or other BTK inhibitors.

      The Dose escalation phase of APG-2575 as monotherapy will use mTPI-2 design. The starting
      target dose (using ramp-up if needed) is 400 mg (dose level; DL1) and will be increased to
      600 mg (DL2), 800 mg (DL3) accordingly. Doses can be increased to higher level depending on
      safety and PK results based on discussions of the Investigators and Sponsor. APG-2575 will be
      administered orally once daily until time of progression or unacceptable toxicity. After the
      MTD/RP2D is determined, up to 12 additional patients will be enrolled at RP2D in
      dose-expansion phase to further evaluate safety and efficacy of APG-2575.

      Arm B: APG-2575 will be administered in combination with ibrutinib in subjects with
      previously untreated WM.
    

Trial Arms

NameTypeDescriptionInterventions
APG2575 400 mgExperimentalAPG2575 400mg ramp up arm
  • APG2575 400 mg
  • APG2575 600 mg
  • APG2575 800 mg
APG2575 600 mgExperimentalAPG2575 600 mg ramp up arm
  • APG2575 600 mg
  • APG2575 800 mg
APG2575 800 mg armExperimentalAPG2575 800 mg arm ramp up
  • APG2575 800 mg

Eligibility Criteria

        Inclusion Criteria:

          -  Criteria for inclusion:

        Patients must meet all of the following inclusion criteria to be eligible for participation
        in this study:

          1. Local confirmed clinicopathological diagnosis of WM in accordance with the consensus
             panel of the Second International Workshop on WM (Owen 2003).

          2. WM patients with symptomatic and measurable disease (defined as presence of serum
             immunoglobulin M (IgM)>0.5g/dL), requiring treatment as per mSMART guidelines (Kyle
             2003): with B symptoms (fever, night sweats, fatigue, night sweats weight loss),
             progressive lymphadenopathy or splenomegaly, anemia (hemoglobin value of <10 g/dL) or
             platelet count <100*109/L due to marrow infiltration. Complications such as
             hyperviscosity syndrome, symptomatic sensorimotor peripheral neuropathy due to WM,
             systemic amyloidosis related to WM, renal insufficiency related to WM, or symptomatic
             cryoglobulinemia may also be indications for therapy.

          3. For Arm A only: Have received at least one prior therapy for WM. Patient must have
             either failed (defined as progressing while on or within 6 months of treatment with
             ibrutinib treatment) or intolerant to ibrutinib.

          4. For Arm B only: Previously untreated WM.

          5. For Arm C only: Have received at least one prior therapy, relapsed or refractory WM.

          6. Adequate hematologic function defined as:

               1. ANC ≥1.0 x 109/L independent of growth factor support within 7 days of the first
                  dose with study drug.

               2. Hemoglobin ≥9 g/dL without transfusion or growth factor support within 7 days of
                  the first dose of study drug.

               3. Platelet count ≥ 75 x 109/L without transfusion support within 7 days of the
                  first dose of study drug.

          7. Adequate hepatic and renal function defined as:

               1. AST and ALT < 2.5 x ULN (upper limit of normal)

               2. Glomerular filtration rate (GFR) >30mL/min

               3. Bilirubin< 1.5 x ULN

          8. PT/INR ≤1.5 x ULN and PTT (aPTT) ≤1.5 x ULN.

          9. ≥18 years of age.

         10. Eastern Cooperative Oncology Group (ECOG) ≤1.

         11. Life expectancy≥3 months.

         12. Female subjects who are of non-reproductive potential (i.e., post-menopausal by
             history-no menses for ≥2 year; OR history of hysterectomy; OR history of bilateral
             tubal ligation; OR history of bilateral oophorectomy). Female subjects of childbearing
             potential must have a negative serum pregnancy test upon study entry.

         13. Male and female subjects who agree to use highly effective methods of birth control
             (e.g.,condoms, implants, injectables, combined oral contraceptives, some intrauterine
             devices[IUDs], sexual abstinence, or sterilized partner) during the period of therapy
             and for 30 days after the last dose of study drug and 90 days (males) after the last
             dose of study drug.

        Symptomatic disease meeting at least 1 of the recommendations from the Second International
        Workshop on Waldenström Macroglobulinemia for requiring treatment (Kyle 2003):

          1. Constitutional symptoms documented in the subject's chart with supportive objective
             measures, as appropriate, defined as one or more of the following disease-related
             symptoms or signs:

               1. Unintentional weight loss ≥10% within the previous 6 months prior to Screening

               2. Fevers higher than 100.5°F or 38.0°C for 2 or more weeks prior to Screening
                  without evidence of infection

               3. Night sweats for more than 1 month prior to Screening without evidence of
                  infection

          2. Clinically relevant fatigue which is not relieved by rest due to WM

          3. Symptomatic hyperviscosity or serum viscosity levels greater than 4.0 centipoises

          4. Lymphadenopathy which is either symptomatic or bulky (≥5cm in maximum diameter)

          5. Symptomatic hepatomegaly and/or splenomegaly and/or organ tissue infiltration

          6. Peripheral neuropathy due to WM

          7. Symptomatic cryoglobulinemia

          8. Cold agglutinin anemia

          9. IgM related immune hemolytic anemia and/or thrombocytopenia

         10. Nephropathy related to WM

         11. Amyloidosis related to WM

         12. Hemoglobin ≤10g/dL

         13. Platelet count <100 x109/L

         14. Serum monoclonal protein >5g/dL, with or without overt clinical symptoms.

         15. Any other condition or circumstance that would, in the opinion of the investigator,
             make the patient unsuitable for participation in the study.

        Exclusion Criteria:

          -  Criteria for exclusion:

        Patients who meet any of the following exclusion criteria are not to be enrolled in this
        study:

          1. For Arm A only: Patients who have never been treated with ibrutinib.

          2. For Arm B only: Patients who have previously received any treatment for WM.

          3. For Arm C only:

               1. Patients who have previously been treated with ibrutinib or other BTK inhibitor.

               2. Disease that is refractory to the last prior rituximab based-therapy defined as
                  either Relapse after the last rituximab-based therapy (<12 months since last dose
                  of rituximab), OR Failure to achieve at least a MR after the last rituximab-based
                  therapy.

               3. Rituximab treatment within the last 12 months before the first dose of study
                  drug.

               4. Known anaphylaxis or IgE-mediated hypersensitivity to murine proteins or to any
                  component of rituximab.

          4. Patients with central nervous system involvement (Bing-Neel syndrome), active
             infection (including active hepatitis B or C virus infection, known human
             immunodeficiency virus (HIV) positive) or any other serious (unresolved) medical
             condition.

          5. Plasmapheresis <35 days prior to the initiation of study drug. (Note: Subjects with
             high IgM values or hyper-viscosity symptoms during screening may receive
             plasmapheresis prior to initiating study drug if the previous plasmapheresis was
             performed >35 days before the plasmapheresis performed during screening (in order to
             obtain a true baseline IgM value for efficacy evaluations).

          6. Failure to have fully recovered (i.e., ≤Grade 1 toxicity) from the reversible effects
             of prior treatment for WM.

          7. Significant screening electrocardiogram (ECG) abnormalities including left bundle
             branch block, 2nd degree atrioventricular (AV) block type II, 3rd degree block, or
             corrected QT interval (QTc) ≥470 msec.

          8. Unable to swallow tablets or malabsorption syndrome, disease significantly affecting
             gastrointestinal function, or resection of the stomach or small bowel, symptomatic
             inflammatory bowel disease or ulcerative colitis, or partial or complete bowel
             obstruction.

          9. History of active or chronic infection with hepatitis C virus (HCV) or hepatitis B
             virus (HBV) defined by positive polymerase chain reaction (PCR).

         10. Currently active, clinically significant cardiovascular disease, such as uncontrolled
             arrhythmia or Class 3 or 4 congestive heart failure as defined by the New York Heart
             Association Functional Classification; or a history of myocardial infarction, unstable
             angina, or acute coronary syndrome within 6 months prior to randomization.

         11. Major surgical procedure within ≤14 days prior to initiating study treatment, or
             anticipation of the need for major surgery during the course of the study treatment,
             radiotherapy ≤14 days prior to initiating study treatment, systemic treatment within
             14 days before the first dose of APG-2575.

         12. Recent infection requiring systemic treatment that was completed≤14 days before the
             first dose of study drug.

         13. Any uncontrolled active systemic infection.

         14. Any concurrent malignancy.

         15. Concomitant use of warfarin or other Vitamin K antagonists (eg. phenoprocoumon).

         16. Requires treatment with a strong cytochrome P450 (CYP) 3A inhibitor.

         17. Known bleeding disorders (eg, von Willebrand's disease) or hemophilia.

         18. History of stroke or intracranial hemorrhage within 12 months prior to enrollment.
      
Maximum Eligible Age:95 Years
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Primary Toxicity Endpoint: dose limiting toxicity (DLT)
Time Frame:42 days
Safety Issue:
Description:DLT will be defined based on the rate of drug-related grade 3-5 adverse events experienced within the first 6 weeks (2 cycles) of study treatment. These will be assessed via CTCAE version 5.0

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Ascentage Pharma Group Inc.

Last Updated

July 12, 2021