Clinical Trials /

A Phase 1 Trial of the p97 Inhibitor CB-5339 in Patients With Advanced Solid Tumors and Lymphomas

NCT04449562

Description:

Background: - Due to its critical role in protein homeostasis pathways, p97 is a promising target for the treatment of malignancies; tumor cells are considered to be dependent on components of the protein degradation machinery to maintain homeostasis and survive. - The p97 inhibitor CB-5339 has been well characterized in in vitro and in vivo studies and had demonstrated induction of an unfolded protein response, decreased cell viability, and apoptosis. Primary Objective: -To establish the safety, tolerability, and recommended phase 2 dose (RP2D) of CB-5339 administered orally on a schedule of once daily, 4 days on and 3 days off, in patients with advanced solid tumors and lymphomas Secondary Objectives: - To evaluate the pharmacokinetic profiles of CB-5339 - To assess the preliminary antitumor activity of CB-5339 in patients with advanced solid tumors and lymphomas - To determine the effects of CB-5339 on the ubiquitin proteasome system and markers of cell death in pre- and post-treatment tumor biopsies and peripheral blood mononuclear cells (PBMCs) Exploratory Objectives: -To evaluate potential associations between CB-5339 activity and genomic alterations assessed in circulating tumor DNA Eligibility: Patients >= 18 years of age must have histologically documented solid tumors whose disease has progressed on standard therapy or for which there is no available standard therapy or therapy known to prolong survival; or aggressive lymphoma who have refused or have no remaining curative options. Patients with indolent lymphomas must have undergone 3 or more prior regimens of therapy Study Design: - CB-5339 will be administered orally on a schedule of once daily, 4 days on and 3 days off, in 28-day cycles. - The trial will follow an accelerated titration design, changing to a traditional 3+3 dose escalation design (3-6 patients per cohort) once specified toxicity criteria are met. A separate 15-patient expansion cohort will further explore pharmacodynamic endpoints and obtain additional pharmacokinetic data at the RP2D. - Once pharmacodynamic data are available at the RP2D, additional expansion cohorts may be considered to explore pharmacodynamic endpoints at lower dose levels (a protocol amendment will be submitted for these changes to the trial design). - Blood samples will be obtained for pharmacokinetic and pharmacodynamic analyses and to isolate circulating tumor DNA. Tumor biopsies will be collected at baseline and 4-6 hours after drug administration in the expansion cohort only; an optional biopsy may be collected at disease progression. - Pharmacodynamic effects of CB-5339 will be assessed through a panel of markers including accumulation of lysine-48 (K48) specific polyubiquitinated substrates in the cytosol, upregulation of transcription factor CHOP in nucleus, and appearance of cleaved caspase-3 in the cytosol.

Related Conditions:
  • Lymphoma
  • Malignant Solid Tumor
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: A Phase 1 Trial of the p97 Inhibitor CB-5339 in Patients With Advanced Solid Tumors and Lymphomas
  • Official Title: A Phase 1 Trial of the p97 Inhibitor CB-5339 in Patients With Advanced Solid Tumors and Lymphomas

Clinical Trial IDs

  • ORG STUDY ID: 200135
  • SECONDARY ID: 20-C-0135
  • NCT ID: NCT04449562

Conditions

  • Advanced Solid Tumors
  • Advanced Lymphomas

Interventions

DrugSynonymsArms
CB-53391

Purpose

Background: - Due to its critical role in protein homeostasis pathways, p97 is a promising target for the treatment of malignancies; tumor cells are considered to be dependent on components of the protein degradation machinery to maintain homeostasis and survive. - The p97 inhibitor CB-5339 has been well characterized in in vitro and in vivo studies and had demonstrated induction of an unfolded protein response, decreased cell viability, and apoptosis. Primary Objective: -To establish the safety, tolerability, and recommended phase 2 dose (RP2D) of CB-5339 administered orally on a schedule of once daily, 4 days on and 3 days off, in patients with advanced solid tumors and lymphomas Secondary Objectives: - To evaluate the pharmacokinetic profiles of CB-5339 - To assess the preliminary antitumor activity of CB-5339 in patients with advanced solid tumors and lymphomas - To determine the effects of CB-5339 on the ubiquitin proteasome system and markers of cell death in pre- and post-treatment tumor biopsies and peripheral blood mononuclear cells (PBMCs) Exploratory Objectives: -To evaluate potential associations between CB-5339 activity and genomic alterations assessed in circulating tumor DNA Eligibility: Patients >= 18 years of age must have histologically documented solid tumors whose disease has progressed on standard therapy or for which there is no available standard therapy or therapy known to prolong survival; or aggressive lymphoma who have refused or have no remaining curative options. Patients with indolent lymphomas must have undergone 3 or more prior regimens of therapy Study Design: - CB-5339 will be administered orally on a schedule of once daily, 4 days on and 3 days off, in 28-day cycles. - The trial will follow an accelerated titration design, changing to a traditional 3+3 dose escalation design (3-6 patients per cohort) once specified toxicity criteria are met. A separate 15-patient expansion cohort will further explore pharmacodynamic endpoints and obtain additional pharmacokinetic data at the RP2D. - Once pharmacodynamic data are available at the RP2D, additional expansion cohorts may be considered to explore pharmacodynamic endpoints at lower dose levels (a protocol amendment will be submitted for these changes to the trial design). - Blood samples will be obtained for pharmacokinetic and pharmacodynamic analyses and to isolate circulating tumor DNA. Tumor biopsies will be collected at baseline and 4-6 hours after drug administration in the expansion cohort only; an optional biopsy may be collected at disease progression. - Pharmacodynamic effects of CB-5339 will be assessed through a panel of markers including accumulation of lysine-48 (K48) specific polyubiquitinated substrates in the cytosol, upregulation of transcription factor CHOP in nucleus, and appearance of cleaved caspase-3 in the cytosol.

Detailed Description

      Background:

        -  Due to its critical role in protein homeostasis pathways, p97 is a promising target for
           the treatment of malignancies; tumor cells are considered to be dependent on components
           of the protein degradation machinery to maintain homeostasis and survive.

        -  The p97 inhibitor CB-5339 has been well characterized in in vitro and in vivo studies
           and had demonstrated induction of an unfolded protein response, decreased cell
           viability, and apoptosis.

      Primary Objective:

      -To establish the safety, tolerability, and recommended phase 2 dose (RP2D) of CB-5339
      administered orally on a schedule of once daily, 4 days on and 3 days off, in patients with
      advanced solid tumors and lymphomas

      Secondary Objectives:

        -  To evaluate the pharmacokinetic profiles of CB-5339

        -  To assess the preliminary antitumor activity of CB-5339 in patients with advanced solid
           tumors and lymphomas

        -  To determine the effects of CB-5339 on the ubiquitin proteasome system and markers of
           cell death in pre- and post-treatment tumor biopsies and peripheral blood mononuclear
           cells (PBMCs)

      Exploratory Objectives:

      -To evaluate potential associations between CB-5339 activity and genomic alterations assessed
      in circulating tumor DNA

      Eligibility:

      Patients >= 18 years of age must have histologically documented solid tumors whose disease
      has progressed on standard therapy or for which there is no available standard therapy or
      therapy known to prolong survival; or aggressive lymphoma who have refused or have no
      remaining curative options. Patients with indolent lymphomas must have undergone 3 or more
      prior regimens of therapy

      Study Design:

        -  CB-5339 will be administered orally on a schedule of once daily, 4 days on and 3 days
           off, in 28-day cycles.

        -  The trial will follow an accelerated titration design, changing to a traditional 3+3
           dose escalation design (3-6 patients per cohort) once specified toxicity criteria are
           met. A separate 15-patient expansion cohort will further explore pharmacodynamic
           endpoints and obtain additional pharmacokinetic data at the RP2D.

        -  Once pharmacodynamic data are available at the RP2D, additional expansion cohorts may be
           considered to explore pharmacodynamic endpoints at lower dose levels (a protocol
           amendment will be submitted for these changes to the trial design).

        -  Blood samples will be obtained for pharmacokinetic and pharmacodynamic analyses and to
           isolate circulating tumor DNA. Tumor biopsies will be collected at baseline and 4-6
           hours after drug administration in the expansion cohort only; an optional biopsy may be
           collected at disease progression.

        -  Pharmacodynamic effects of CB-5339 will be assessed through a panel of markers including
           accumulation of lysine-48 (K48) specific polyubiquitinated substrates in the cytosol,
           upregulation of transcription factor CHOP in nucleus, and appearance of cleaved
           caspase-3 in the cytosol.
    

Trial Arms

NameTypeDescriptionInterventions
1ExperimentalCB-5339 will be administered orally on a schedule of once daily, 4 days on and 3 days off, in 28-day cycles.
  • CB-5339

Eligibility Criteria

        -  INCLUSION CRITERIA:

          -  Patients with histologically documented metastatic or locally advanced (not amenable
             to surgery) solid tumors whose disease has progressed on standard therapy or for which
             there is no available standard therapy or therapy known to prolong survival; or
             aggressive lymphoma who have refused or have no remaining curative options (e.g., stem
             cell transplant). Patients with indolent lymphomas must have undergone 3 or more prior
             24 regimens of therapy.

          -  Any prior therapy must have been completed >=4 weeks (6 weeks for nitrosoureas and
             mitomycin C) or, if known, >=5 half-lives of the prior agent (whichever is shorter)
             prior to enrollment on protocol (minimum of 1 week between prior therapy and study
             enrollment), and the participant must have recovered to eligibility levels from prior
             toxicity. Prior definitive radiation should have been completed >=4 weeks or
             palliative radiation should have been completed >=2 weeks prior to study enrollment
             and all associated toxicities resolved to eligibility levels (patients on study may be
             eligible for palliative radiotherapy to non-targeted lesions after 2 cycles of therapy
             at the PI s discretion). Patients must be >=2 weeks since any investigational agent
             administered as part of a Phase 0 study (where a sub-therapeutic dose of drug is
             administered) at the PI s discretion and should have recovered to grade 1 or baseline
             from any toxicities.

          -  Patients who have had prior monoclonal antibody therapy must have completed that
             therapy >=6 weeks (or 3 half-lives of the antibody, whichever is shorter) prior to
             enrollment on protocol (minimum of 1 week between prior therapy and study enrollment).

          -  Age >=18 years. Because no dosing or adverse event data are currently available on the
             use of CB-5339 in patients <18 years of age, children are excluded from this study,
             but will be eligible for future pediatric trials.

          -  ECOG performance status <=2 (Karnofsky >=60%, see Appendix A) and life expectancy > 3
             months,

          -  Patients must have adequate organ and marrow function as defined below:

               -  absolute neutrophil count >= 1,500/mcL

               -  platelets >=100,000/mcL (solid tumor patients); >=75,000/mcL (lymphoma patients)

               -  total bilirubin <= 1.5 x institutional upper limit of normal (ULN)

               -  AST(SGOT)/ALT(SGPT) <=3 (SqrRoot) institutional ULN

               -  creatinine <= 1.5 x institutional ULN OR >=60 mL/min/1.73 m^2 for patients with
                  creatinine levels above 1.5X institutional normal

          -  The effects of CB-5339 on the developing human fetus are unknown. For this reason and
             because p97 inhibitors agents may be teratogenic, women of child-bearing potential and
             men must agree to use adequate contraception (hormonal or barrier method of birth
             control; abstinence) prior to study entry and for the duration of study participation
             and for 4 months afterwards. Should a woman become pregnant or suspect she is pregnant
             while she or her partner is participating in this study, she should inform her
             treating physician immediately. Men treated or enrolled on this protocol must also
             agree to use adequate contraception prior to the study, for the duration of study
             participation, and 4 months after completion of CB-5339 administration.

          -  Ability to understand and the willingness to sign a written informed consent document.

          -  Subjects on the expansion cohort must also be willing to undergo two core biopsy
             procedures and have a lesion amenable to biopsy.

          -  Left ventricular ejection fraction (Bullet) the lower limit of normal by ECHO at
             entry.

          -  Mean QT interval corrected for heart rate (QTc) <470 ms using Fridericia's Correction.

        EXCLUSION CRITERIA:

          -  Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for
             nitrosoureas or mitomycin C) prior to entering the study.

          -  Patients who have not recovered from adverse events due to prior anti-cancer therapy
             (i.e., have residual toxicities > Grade 1) with the exception of alopecia.

          -  Patients who are receiving any other investigational agents.

          -  Patients with clinically significant illnesses which would compromise participation in
             the study, including but not limited to active or uncontrolled infection, immune
             deficiencies, Hepatitis B, Hepatitis C, active tuberculosis, uncontrolled asthma,
             symptomatic congestive heart failure, unstable angina pectoris, uncontrolled cardiac
             arrhythmia, myocardial infarction within the past 6 months, cerebral vascular
             accident/stroke within the past 6 months, or psychiatric illness/social situations
             that would limit compliance with study requirements.

               -  Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral
                  therapy with undetectable viral load within 6 months are eligible for this trial.

               -  For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV
                  viral load must be undetectable on suppressive therapy, if indicated.

          -  Patients with known brain metastases or carcinomatous meningitis are excluded from
             this clinical trial, with the exception of patients whose brain metastatic disease
             status has remained stable for >= 4 weeks after treatment of the brain metastases.
             Patients on anti-seizure medications may be enrolled at the discretion of the
             Principal Investigator providing that these patients are taking non-enzyme- inducing
             anti-seizure medications or can be converted to these.

          -  Pregnant women are excluded from this study because CB-5339 may have the potential for
             teratogenic or abortifacient effects. Because there is an unknown but potential risk
             for adverse events in nursing infants secondary to treatment of the mother with this
             agent, breastfeeding should be discontinued if the mother is treated with CB-5339.

          -  Current or previous history of sight-threatening retinal disease, including (but not
             limited to) proliferative diabetic retinopathy, severe retinal vascular disease, and
             advanced age-related macular degeneration.

          -  Patients with a history of QT-prolongation or of Torsades de pointes (TdP), or of
             taking QT-prolonging drugs, are not eligible.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:To establish the safety, tolerability, and recommended phase 2 dose (RP2D) of CB-5339 administered orally on a schedule of once daily, 4 days on and 3 days off, in patients with advanced solid tumors and lymphomas
Time Frame:cycle 1
Safety Issue:
Description:Adverse event descriptions and grading scales from the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 will be utilized for AE reporting.

Secondary Outcome Measures

Measure:To evaluate the pharmacokinetic profiles of CB-5339
Time Frame:cycles 1 and 2
Safety Issue:
Description:Measurement of levels of CB-5339 in each patient s blood and urine (i.e., metabolism) at each dose level
Measure:To assess the preliminary antitumor activity of CB-5339 in patients with advanced solid tumors and lymphomas.
Time Frame:1 year
Safety Issue:
Description:Measurement of changes in tumor size by CT imaging
Measure:To determine the effects of CB-5339 on the ubiquitin proteasome system and on markers of cell death in preand post-treatment tumor biopsies and PBMCs
Time Frame:cycle 1
Safety Issue:
Description:The pharmacodynamic effects of CB-5339 will be assessed through accumulation of lysine-48 (K48) specific polyubiquitinated substrates in the cytosol, upregulation of transcription factor CHOP in nucleus, and appearance of cleaved caspase-3 in the cytosol

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:National Cancer Institute (NCI)

Trial Keywords

  • Protein Homeostasis

Last Updated

July 7, 2020