Clinical Trials /

Testing the Addition of an Anti-cancer Drug, BAY 1895344, to Usual Chemotherapy for Advanced Stage Solid Tumors, With a Specific Focus on Patients With Small Cell Lung Cancer, Poorly Differentiated Neuroendocrine Cancer, and Pancreatic Cancer

NCT04514497

Description:

This phase I trial investigates the side effects and best dose of BAY 1895344 when given together with usual chemotherapy (irinotecan liposome or topotecan) in treating patients with solid tumors that have spread to other places in the body (advanced), with a specific focus on small cell lung cancer, poorly differentiated neuroendocrine cancer, and pancreatic cancer. BAY 1895344 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Chemotherapy drugs, such as irinotecan liposome and topotecan, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Adding BAY 1895344 to irinotecan liposome or topotecan may help to slow the growth of tumors for longer than seen with those drugs alone.

Related Conditions:
  • Malignant Solid Tumor
  • Neuroendocrine Carcinoma
  • Pancreatic Adenocarcinoma
Recruiting Status:

Not yet recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Testing the Addition of an Anti-cancer Drug, BAY 1895344, to Usual Chemotherapy for Advanced Stage Solid Tumors, With a Specific Focus on Patients With Small Cell Lung Cancer, Poorly Differentiated Neuroendocrine Cancer, and Pancreatic Cancer
  • Official Title: BAY1895344 Plus Topoisomerase-1 (Top1) Inhibitors in Patients With Advanced Solid Tumors, Phase I Studies With Expansion Cohorts in Small Cell Lung Carcinoma (SCLC), Poorly Differentiated Neuroendocrine Carcinoma (PD-NEC) and Pancreatic Adenocarcinoma (PDA)

Clinical Trial IDs

  • ORG STUDY ID: NCI-2020-05958
  • SECONDARY ID: NCI-2020-05958
  • SECONDARY ID: 10402
  • SECONDARY ID: 10402
  • SECONDARY ID: UM1CA186689
  • NCT ID: NCT04514497

Conditions

  • Metastatic Lung Small Cell Carcinoma
  • Metastatic Malignant Solid Neoplasm
  • Metastatic Neuroendocrine Carcinoma
  • Metastatic Pancreatic Adenocarcinoma
  • Stage III Lung Cancer AJCC v8
  • Stage III Pancreatic Cancer AJCC v8
  • Stage IIIA Lung Cancer AJCC v8
  • Stage IIIB Lung Cancer AJCC v8
  • Stage IIIC Lung Cancer AJCC v8
  • Stage IV Lung Cancer AJCC v8
  • Stage IV Pancreatic Cancer AJCC v8
  • Stage IVA Lung Cancer AJCC v8
  • Stage IVB Lung Cancer AJCC v8
  • Unresectable Lung Small Cell Carcinoma
  • Unresectable Malignant Solid Neoplasm
  • Unresectable Neuroendocrine Carcinoma
  • Unresectable Pancreatic Adenocarcinoma

Interventions

DrugSynonymsArms
ElimusertibATR Inhibitor BAY1895344, ATR Kinase Inhibitor BAY1895344, BAY 1895344, BAY-1895344, BAY1895344Cohort I (BAY 1895344, irinotecan liposome)
Irinotecan SucrosofateIrinotecan Liposome, MM-398, nal-IRI, Nanoliposomal Irinotecan, Nanoparticle Liposome Formulation of Irinotecan, Onivyde, PEP02Cohort I (BAY 1895344, irinotecan liposome)
Topotecan HydrochlorideHycamptamine, Hycamtin, SKF S-104864-A, Topotecan HCl, topotecan hydrochloride (oral)Cohort II (BAY 1895344, topotecan)

Purpose

This phase I trial investigates the side effects and best dose of BAY 1895344 when given together with usual chemotherapy (irinotecan liposome or topotecan) in treating patients with solid tumors that have spread to other places in the body (advanced), with a specific focus on small cell lung cancer, poorly differentiated neuroendocrine cancer, and pancreatic cancer. BAY 1895344 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Chemotherapy drugs, such as irinotecan liposome and topotecan, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Adding BAY 1895344 to irinotecan liposome or topotecan may help to slow the growth of tumors for longer than seen with those drugs alone.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To assess safety and tolerability of each of the ATR kinase inhibitor BAY1895344 (BAY
      1895344) plus topoisomerase 1 (top1) inhibitor (liposomal irinotecan [irinotecan liposome]
      [nal-IRI] or topotecan hydrochloride [topotecan]) combinations.

      II. To estimate maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D) of each of
      the combinations.

      SECONDARY OBJECTIVES:

      I. To observe and record anti-tumor activity. II. To estimate objective response rate (ORR),
      progression free survival (PFS), overall survival (OS) and duration of response (DOR) in
      patients treated with each combination.

      III. To estimate plasma pharmacokinetic (PK) characteristics of BAY 1895344 plus each top1
      inhibitor (nal-IRI or topotecan) when used in combination.

      IV. To estimate changes in pharmacodynamic (PD) markers of deoxyribonucleic acid (DNA) damage
      (gamma-H2AX, pS343-NBS1) elicited by each combination from on-treatment tumor biopsies (in
      dose expansion cohorts only).

      EXPLORATORY OBJECTIVES:

      I. To estimate response outcomes (ORR, PFS, OS, DOR) in study patients by tumor ataxia
      telangiectasia mutated (ATM) expression loss (assessed by immunohistochemistry [IHC]).

      II. To estimate response outcomes (ORR, PFS, OS, DOR) in study patients with tumor DNA damage
      response (DDR) mutations (assessed by whole exome sequencing [WES] and ribonucleic acid [RNA]
      sequencing [RNA Seq]).

      OUTLINE: This is a dose-escalation study of BAY 1895344. Patients are assigned to 1 of 2
      cohorts.

      COHORT I: Patients receive BAY 1895344 orally (PO) twice daily (BID) on days 1 and 2 and
      irinotecan liposome intravenously (IV) over 90 minutes on day 1. Cycles repeat every 14 days
      in the absence of disease progression or unacceptable toxicity.

      COHORT II: Patients receive topotecan IV over 30 minutes on days 1-5 and BAY 1895344 PO BID
      on days 2 and 5. Cycles repeat every 21 days in the absence of disease progression or
      unacceptable toxicity.

      After completion of study treatment, patients are followed up for 6 months.
    

Trial Arms

NameTypeDescriptionInterventions
Cohort I (BAY 1895344, irinotecan liposome)ExperimentalPatients receive BAY 1895344 PO BID on days 1 and 2 and irinotecan liposome IV over 90 minutes on day 1. Cycles repeat every 14 days in the absence of disease progression or unacceptable toxicity.
  • Elimusertib
  • Irinotecan Sucrosofate
Cohort II (BAY 1895344, topotecan)ExperimentalPatients receive topotecan IV over 30 minutes on days 1-5 and BAY 1895344 PO BID on days 2 and 5. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
  • Elimusertib
  • Topotecan Hydrochloride

Eligibility Criteria

        Inclusion Criteria:

          -  DOSE ESCALATION COHORTS: Patients must have a biopsy-proven solid tumor that is
             metastatic or unresectable and has progressed on at least one line of standard therapy

          -  DOSE EXPANSION COHORTS: Patients must have biopsy proven metastatic or unresectable
             small cell lung cancer (SCLC), poorly differentiated neuroendocrine carcinoma (PD-NEC)
             (any extrapulmonary neuroendocrine carcinoma with small cell or large cell histology)
             or pancreatic adenocarcinoma (PDA) and have progressed on at least one line of
             standard therapy

          -  DOSE EXPANSION COHORTS: Patients must have at least one measurable lesion outside of
             the lesion to be biopsied

          -  Patients must be able to swallow pills

          -  Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)

          -  Hemoglobin > 9 g/dL

          -  Leukocytes >= 3,000/mcL

          -  Absolute neutrophil count >= 1,500/mcL

          -  Platelets >= 100,000/mcL

          -  Total bilirubin =< 2 x institutional upper limit of normal (ULN)

          -  Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase
             [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT])
             =< 3 x institutional ULN

          -  Glomerular filtration rate (GFR) >= 60 mL/min/1.73 m^2

          -  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 a history of hepatitis C virus (HCV) infection must have been treated
             and cured. For patients with HCV infection who are currently on treatment, they are
             eligible if they have an undetectable HCV viral load

          -  Patients with treated brain metastases are eligible if follow-up brain imaging after
             central nervous system (CNS)-directed therapy shows no evidence of progression.
             Furthermore, these patients must be asymptomatic from previously treated brain
             metastases (e.g. not on steroids for neurologic symptoms within 30 days of study
             enrollment)

          -  Patients with a prior or concurrent malignancy whose natural history or treatment does
             not have the potential to interfere with the safety or efficacy assessment of the
             investigational regimen are eligible for this trial

          -  Patients with known history or current symptoms of cardiac disease, or history of
             treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac
             function using the New York Heart Association Functional Classification. To be
             eligible for this trial, patients should be class 2B or better

          -  The effects of BAY 1895344 on the developing human fetus are unknown. For this reason
             and because DNA-damage response inhibitors as well as other therapeutic agents used in
             this trial are known to 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 6
             months after completion of BAY 1895344 administration. 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 6 months after completion of BAY 1895344
             administration

          -  Patient must have the ability to understand and the willingness to sign a written
             informed consent document. Participants with impaired decision-making capacity (IDMC)
             who have a legally-authorized representative (LAR) and/or family member available will
             also be eligible

        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

          -  The investigator(s) must state a medical or scientific reason if patients who have
             brain metastases will be excluded from the study

          -  History of allergic reactions attributed to compounds of similar chemical or biologic
             composition to BAY 1895334 or other agents used in study

          -  Patients receiving any medications or substances that are substrates of CYP3A4 with a
             narrow therapeutic window, or strong inhibitors/inducers of CYP3A4 are ineligible, if
             they cannot be transferred to alternative medication. Because the lists of these
             agents are constantly changing, it is important to regularly consult a
             frequently-updated medical reference. As part of the enrollment/informed consent
             procedures, the patient will be counseled on the risk of interactions with other
             agents, and what to do if new medications need to be prescribed or if the patient is
             considering a new over-the-counter medicine or herbal product

          -  Patients with uncontrolled intercurrent illness

          -  Patients with psychiatric illness/social situations that would limit compliance with
             study requirements

          -  Pregnant women are excluded from this study because BAY 1895344 is agent with 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 BAY 18953354, breastfeeding should be discontinued if the mother is
             treated with BAY 18953354. These potential risks may also apply to other agents used
             in this study

          -  Patients with an uncontrolled infection requiring IV antibiotics will not be eligible
             to participate in the study

          -  Patients who have previously been treated with any of the study compounds will not be
             eligible to participate in the study
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Maximum tolerated dose (MTD) (Dose Escalation Phase)
Time Frame:Up to 21 days
Safety Issue:
Description:Defined by occurrence of >= 2 dose limiting toxicities (DLTs) defined as grade 4 neutropenia lasting >= 7 days, grade 4 thrombocytopenia, grade 4 anemia, grade 3 neutropenia with fever, grade 3 thrombocytopenia with bleeding, any grade 3 hematologic toxicity lasting >= 7 days (counting from first day of toxicity grade recognition) or any non-hematologic grade >= 2 adverse events (AEs) lasting >= 7 days (with the exception of grade 2 [G2] fatigue, G2 nausea or G2 diarrhea) (counting from first day of toxicity grade recognition) in any dose level during cycle 1 (C1) of treatment. DLTs will be graded by Common Terminology Criteria for Adverse Events (CTCAE) version (v)5.0.

Secondary Outcome Measures

Measure:Objective response rate (ORR)
Time Frame:Up to 12 weeks
Safety Issue:
Description:Will be estimated by measuring the number of patients who achieve complete response or partial response by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria on 12-week restaging computed tomography (CT) scans from the total number of patients who received the study treatment.
Measure:Duration of response (DOR)
Time Frame:From when a patient achieves disease control (complete response, partial response, stable disease) on a restaging scan to the time of radiographic progression, assessed up to 6 months post-treatment
Safety Issue:
Description:DOR will be estimated by the Kaplan-Meier method.
Measure:Progression-free survival (PFS)
Time Frame:From when a patient starts treatment to when they demonstrate radiographic progression or succumb to the disease, assessed up to 6 months post-treatment
Safety Issue:
Description:PFS will be estimated by the Kaplan-Meier method.
Measure:Overall survival (OS)
Time Frame:From when a patient starts treatment to the date they succumb to the disease, assessed up to 6 months post-treatment
Safety Issue:
Description:OS will be estimated by the Kaplan-Meier method.
Measure:Maximum concentration (Cmax)
Time Frame:Cycle 1, days 1, 2, 3, and 4
Safety Issue:
Description:Will be estimated for each study drug based upon plasma collections from cycle 1 in all study patients.
Measure:Area under the concentration-time curve (AUC)
Time Frame:Cycle 1, days 1, 2, 3, and 4
Safety Issue:
Description:Will be estimated for each study drug based upon plasma collections from cycle 1 in all study patients.
Measure:Changes in tumor expression patterns of gamma-H2AX
Time Frame:Baseline up to cycle 1, day 6
Safety Issue:
Description:Will be estimated for expansion cohort only study patients.
Measure:Changes in tumor expression patterns of pS343-NBS1
Time Frame:Baseline up to cycle 1, day 6
Safety Issue:
Description:Will be estimated for expansion cohort only study patients.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:National Cancer Institute (NCI)

Last Updated

February 11, 2021