Summary

for people ages 18 years and up (full criteria)
at San Francisco, California
study started
estimated completion
Collin Blakely

Description

Summary

This is a phase I/Ib, open-label, single-center, single-arm study of alisertib and osimertinib for patients with stage IV EGFR-mutated lung cancer, incorporating both a dose escalation and dose-expansion phase

Official Title

A Phase I/Ib Study of Alisertib in Combination With Osimertinib in Metastatic EGFR-mutant Lung Cancer

Details

The dose-escalation phase will consist of a modified 3+3 dose escalation and will be open to patients with metastatic lung cancer with an activating EGFR mutation who have progressed on and are currently receiving osimertinib therapy. The dose-escalation and expansion phases will be open to patients who have received any number of therapies as long as they are currently being treated with and tolerating osimertinib 80 mg orally once per day, and who have demonstrated radiographic progression by RECIST 1.1 criteria on their most recent scan.

Primary Objective:

To determine the safety and tolerability of the combination osimertinib + alisertib in patients with advanced EGFR-mutant NSCLC and identify a recommended phase II dose.

Secondary Objectives:

  1. To evaluate the clinical efficacy of adding alisertib to osimertinib compared to "historical" data of platinum doublet chemotherapy in patients who have progressed on osimertinib monotherapy.
  2. To explore tumor biomarkers, including TPX2, that predict response to osimertinib + alisertib.
  3. To evaluate alisertib and osimertinib pharmacokinetics
  4. To evaluate the CNS response rate of alisertib + osimertinib

Patients may continue treatment indefinitely until disease progression, intolerance, or other contraindication to study treatment.

Keywords

Lung Cancer Metastatic EGFR Gene Mutation Lung Neoplasms Osimertinib Alisertib

Eligibility

You can join if…

Open to people ages 18 years and up

  1. Patients must have histologically confirmed stage IV lung cancer (patients with both non-small cell lung cancer and cancer that has transformed to small cell lung cancer at osimertinib progression will also be considered eligible if osimertinib treatment is planned to continue post-progression).
  2. Male or female patients ≥18 years of age
  3. Eastern Cooperative Oncology Group (ECOG) performance status of 0-1 (see Appendix 1).
  4. Documented activating Epithelial Growth Factor Receptor (EGFR) mutation (Exon 19 deletion, G719X, S768I, V769L,T790M, L833F, L858R, or L861Q) on tumor sample or cell-free DNA sample performed in Clinical Laboratory Improvement Amendments (CLIA)-approved laboratory.
  5. Measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria.
  6. Clinical laboratory values as specified below within 7 days before the first dose of study drug (if applicable):
  7. Absolute neutrophil count (ANC) > 1500/mm³
  8. Absolute lymphocyte count > 500 mm3
  9. Platelets > 100,000/mm³
  10. Hgb > 9 g/dL. Values must be obtained without need for red blood cell transfusion support within 14 days. However, erythrocyte growth factor is allowed as per published American Society of Clinical Oncology (ASCO) guidelines.
  11. Total bilirubin ≤ 1.5 x upper limit of normal (ULN), or direct bilirubin ≤ 1.5 x ULN for patients with Gilbert's syndrome.
  12. Serum glutamic-oxaloacetic transaminase (SGOT) / aspartate aminotransferase (AST) and serum glutamic-pyruvic transaminase (SGPT) / alanine aminotransferase (ALT) < 2.5 x ULN. AST and/or ALT may be up to 5 x ULN if with known liver metastases.
  13. Renal function as defined by calculated creatinine clearance ≥30 ml/min (Cockcroft-Gault Formula).
  14. Willing to provide blood and tissue for correlative research purposes
  15. Willing to undergo pre-treatment research biopsy
  16. Female patients who:
  17. Are postmenopausal (see Appendix 6) for at least 1 year before the screening visit, OR
  18. Are surgically sterile, OR
  19. If they are of childbearing potential, agree to practice 1 highly effective method of contraception and 1 additional effective (barrier) method at the same time (see Appendix 6), from the time of signing the informed consent through 180 days after the last dose of study drug, OR
  20. Agree to practice true abstinence, when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence [e.g., calendar, ovulation, symptothermal, post-ovulation methods], withdrawal, spermicides only, and lactational amenorrhea are not acceptable methods of contraception. Female and male condoms should not be used together.)
  21. . Male patients, even if surgically sterilized (i.e., status post-vasectomy), who:
  22. Agree to practice effective barrier contraception during the entire study treatment period and through 120 after the last dose of study drug, OR
  23. Agree to practice true abstinence, when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence [e.g., calendar, ovulation, symptothermal, post-ovulation methods], withdrawal, spermicides only, and lactational amenorrhea are not acceptable methods of contraception. Female and male condoms should not be used together.)
  24. . Voluntary written consent must be given before performance of any study-related procedure not part of standard of care, with the understanding that consent may be withdrawn by the patient at any time without prejudice to future medical care.
  25. . Currently receiving and tolerating osimertinib 80 mg PO daily with no current grade 2 or greater AE attributable to osimertinib.
  26. . Evidence of disease progression on imaging (computerized tomography (CT) scan, magnetic resonance imaging (MRI), or Positron Emission Tomography (PET) CT within the last 30 days.
  27. . Resolution of all acute toxic effects of prior chemotherapy, immunotherapy, radiotherapy or surgical procedures to less than or equal to grade 2 per the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0.

You CAN'T join if...

  1. Radiation therapy to more than 25% of the bone marrow. Whole pelvic radiation is considered to be over 25%.
  2. Prior allogeneic bone marrow or organ transplantation 3. Known Gastrointestinal (GI) disease or GI procedures that could interfere with the oral absorption or tolerance of alisertib. Examples include, but are not limited to partial gastrectomy, history of small intestine surgery, and celiac disease 4. Inability to swallow oral medication or inability or unwillingness to comply with the administration requirements related to alisertib.
  3. Known history of uncontrolled sleep apnea syndrome and other conditions that could result in excessive daytime sleepiness, such as severe chronic obstructive pulmonary disease; requirement for supplemental oxygen.
  4. Requirement for constant administration of proton pump inhibitor, Histamine 2 (H2) antagonist, or pancreatic enzymes throughout the study.

The intermittent use of H2-antagonists and antacids (including carafate) is only allowed within these guidelines:

  1. H2 antagonists until Day -1 and after the dosing of alisertib is done
  2. Antacid formulations until 2 hours before dosing and after 2 hours following dosing.
  3. Proton Pump Inhibitor (PPI) is allowed until Day -5 of first alisertib dose. PPIs are prohibited throughout the study.
  4. Myocardial infarction within 6 months prior to enrollment or has New York Heart Association (NYHA) Class III or IV heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities. Prior to study entry, any electrocardiogram (ECG) abnormality at Screening has to be documented by the investigator as not medically relevant.
  5. QT interval corrected (QTc) using Fridericia's method (QTCF) > 470 msec 9. Female subject who is pregnant or breast-feeding. Confirmation that the subject is not pregnant must be established by a negative serum beta-human chorionic gonadotropin (Beta-hCG) pregnancy test result obtained during screening. Pregnancy testing is not required for post-menopausal or surgically sterilized women. 10. Female patient who intend to donate eggs (ova) during the course of this study or 4 months after receiving their last dose of study drug(s).
  6. . Male patients who intend to donate sperm during the course of this study or 4 months after receiving their last dose of study drug(s).
  7. . Other severe acute or chronic medical or psychiatric condition, including uncontrolled diabetes, malabsorption, resection of the pancreas or upper small bowel, requirement for pancreatic enzymes, any condition that would modify small bowel absorption of oral medications, or laboratory abnormality that may increase the risk associated with study participation or investigational product administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the patient inappropriate for enrollment in this study.
  8. . Diagnosed or treated for another malignancy within 3 years of enrollment, with the exception of complete resection of basal cell carcinoma or squamous cell carcinoma of the skin, an in situ malignancy, or low-risk prostate cancer or breast cancer after curative therapy.
  9. . Patients who are currently receiving treatment with contraindicated QTc prolonging medications or potent CYP3A4 inducers/inhibitors, as listed in the protocol, if that treatment cannot be either discontinued or switched to a different medication prior to first day of study treatment. The washout period for the medication is provided in the protocol 15. Patients with central nervous system (CNS) metastases who are neurologically unstable (as defined by need for steroids in last 14 days). 16. Known leptomeningeal carcinomatosis.

Location

  • University of California, San Francisco accepting new patients
    San Francisco California 94143 United States

Lead Scientist

  • Collin Blakely
    Dr. Blakely is a medical oncologist specializing in the treatment of lung cancer. He received his Bachelor of Science degree in Molecular and Cellular Biology from the University of Washington and attended the Perelman School of Medicine at the University of Pennsylvania in the Medical Scientist Training Program.

Details

Status
accepting new patients
Start Date
Completion Date
(estimated)
Sponsor
Collin Blakely
ID
NCT04085315
Phase
Phase 1
Study Type
Interventional
Last Updated