Clinical Trial of Lurbinectedin (PM01183) in Patients With Advanced Solid Tumors

Phase 1

• Conditions: Advanced Solid Tumors
• Interventions: Drug: Lurbinectedin alone; Drug: Lurbinectedin+Itraconazole co-administration

• Registration Number: NCT05063318
• Lead Sponsor: PharmaMar

Brief Summary

Prospective, open-label, two-way crossover, phase Ib drug-drug interaction study in patients with advanced solid tumors

Detailed Description

Prospective, open-label, two-way crossover, phase Ib drug-drug interaction study in patients with advanced solid tumors.

The study will include a pre-treatment (screening) phase (within 14 days before the first lurbinectedin or itraconazole administration) followed by a treatment phase consisting of two lurbinectedin cycles, one cycle in combination with itraconazole and one cycle as single agent (in different order depending on the study sequence), and one additional third cycle of lurbinectedin as a single agent for patients who meet the continuation criteria and obtain a clinical benefit after the first two cycles, and then follow-up of adverse events if any.

Study Timeline

• Study Start: 2020-10-07
• Status Verified: 2021-09
• Study First Submitted: 2021-09-02
• Study First Submitted QC: 2021-09-27
• Last Update Submitted: 2021-09-27
• Study First Posted: 2021-10-01
• Last Update Posted: 2021-10-01
• Primary Completion: 2022-11-01
• Study Completion: 2022-12-01

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 11

Inclusion Criteria

1. Voluntary signed and dated written informed consent prior to any specific study procedure.
2. Male or female with age ≥ 18 years.
3. Eastern Cooperative Oncology Group (ECOG) performance status (PS) of ≤ 1 (App. 1).
4. Life expectancy > 3 months.
5. Pathologically confirmed diagnosis of advanced solid tumors [except for primary central nervous system (CNS) tumors], for which no standard therapy exists.
6. Recovery to grade ≤ 1 from drug-related adverse events (AEs) of previous treatments, excluding alopecia and grade 1/2 asthenia or fatigue, according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCICTCAE v.5).
7. Laboratory values within fourteen days prior to Day 1 of Cycle 1
8. Left ventricular ejection fraction (LVEF) by echocardiography (ECHO) or multiple-gated acquisition (MUGA) within normal range (according to institutional standards).
9. Evidence of non-childbearing status for women of childbearing potential (WOCBP). WOCBP must agree to use a highly effective contraceptive measure up to six months after treatment discontinuation. Valid methods to determine the childbearing potential, adequate contraception and requirements for WOCBP partners are described in App. 2. Fertile male patients with WOCBP partners should use condoms during treatment and for four months following the last investigational medicinal product (IMP) dose.

Exclusion Criteria

1. Concomitant diseases/conditions:

   1. History or presence of unstable angina, myocardial infarction, congestive heart failure, or clinically significant valvular disease within last year.
   2. Symptomatic arrhythmia or any uncontrolled arrhythmia requiring ongoing treatment.
   3. Known cirrhosis, alcohol induced steatosis, or chronic active hepatitis. For hepatitis B, this includes positive test for both Hepatitis B surface antigen (HBsAg) and quantitative Hepatitis B polymerase chain reaction (PCR or HVB-DNA+). For hepatitis C, this includes positive test for both Hepatitis C antibody and quantitative Hepatitis C by PCR (or HVC-RNA+).
   4. History of obstructive cholestatic liver disease (suitable for stenting procedure) or biliary sepsis in the past 2 months.
   5. Known of active COVID-19 disease (this includes positive test for SARS-CoV- 2 in nasopharyngeal/oropharyngeal swabs or nasal swabs by PCR).

2. Symptomatic, progressive or corticosteroids-requiring documented brain metastases or leptomeningeal disease involvement. Patients with asymptomatic documented stable brain metastases not requiring corticosteroids during the last four weeks are allowed.

3. Use of (strong or moderate) inhibitors or inducers of CYP3A4 activity within three weeks prior to Day 1 of Cycle 1.

4. Use of CYP3A4 substrates such as HMG-CoA reductase inhibitors such as atorvastatin, lovastatin and simvastatin for which concomitant administration with strong CYP3A4 inhibitor is contraindicated (App 3).

5. Treatment with any investigational product within the 30 days before Day 1 of Cycle 1.

6. Women who are pregnant or breast feeding and fertile patients (men and women) who are not using an effective method of contraception (see App 2).

7. Psychiatric illness/social situations that would limit compliance with study requirements.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: CROSSOVER

Arm && Interventions

Group	Intervention	Description
Sequence TR	Lurbinectedin alone	Sequence 1 (TR) * Cycle 1: Itraconazole + lurbinectedin 0.8 mg/m² * Cycle 2: Lurbinectedin alone 3.2 mg/m² * Cycle 3: Lurbinectedin alone 3.2 mg/m² (optional) PART A The dose of lurbinectedin when given in combination with itraconazole for the initial three patients in Part A will be 0.8 mg/m². In Part A, all patients will receive itraconazole plus lurbinectedin in Cycle 1 and lurbinectedin alone in Cycles 2 and 3 (this last cycle being optional). PART B Randomization will apply for study Part B only. In Part B is susceptible to be adjusted properly if deemed necessary based on exposure and safety experience in Part A. In Part B, patients will be randomly assigned to the corresponding sequences.
Sequence TR	Lurbinectedin+Itraconazole co-administration	Sequence 1 (TR) * Cycle 1: Itraconazole + lurbinectedin 0.8 mg/m² * Cycle 2: Lurbinectedin alone 3.2 mg/m² * Cycle 3: Lurbinectedin alone 3.2 mg/m² (optional) PART A The dose of lurbinectedin when given in combination with itraconazole for the initial three patients in Part A will be 0.8 mg/m². In Part A, all patients will receive itraconazole plus lurbinectedin in Cycle 1 and lurbinectedin alone in Cycles 2 and 3 (this last cycle being optional). PART B Randomization will apply for study Part B only. In Part B is susceptible to be adjusted properly if deemed necessary based on exposure and safety experience in Part A. In Part B, patients will be randomly assigned to the corresponding sequences.
Sequence RT	Lurbinectedin alone	Sequence 2 (RT): * Cycle 1: Lurbinectedin alone 3.2 mg/m² * Cycle 2: Itraconazole + lurbinectedin 0.8 mg/m² * Cycle 3: Lurbinectedin alone 3.2 mg/m² (optional)
Sequence RT	Lurbinectedin+Itraconazole co-administration	Sequence 2 (RT): * Cycle 1: Lurbinectedin alone 3.2 mg/m² * Cycle 2: Itraconazole + lurbinectedin 0.8 mg/m² * Cycle 3: Lurbinectedin alone 3.2 mg/m² (optional)

Primary Outcome Measures

Name	Time	Method
Pharmacokinetic Analysis: AUC(0-∞)	Day 1, 2, 3, 5, 8, 11, 15, 22 (Cycle 1,2,3) (each cycle is 21 days)	The primary parameter of interest for the statistical analysis will be plasma doseadjusted AUC(0-∞)

Secondary Outcome Measures

Name	Time	Method
Pharmacokinetic Analysis: AUC(0-t)	Day 1, 2, 3, 5, 8, 11, 15, 22 (Cycle 1,2,3) (each cycle is 21 days)	The area under the concentration-time curve (AUC) will be calculated using the linear-log trapezoidal rule with extrapolation to infinity.
Pharmacokinetic Analysis: Cmax	Day 1, 2, 3, 5, 8, 11, 15, 22 (Cycle 1,2,3) (each cycle is 21 days)	The maximum plasma concentration (Cmax) will be obtained directly from the experimental data.
Pharmacokinetic Analysis: T1/2	Day 1, 2, 3, 5, 8, 11, 15, 22 (Cycle 1,2,3) (each cycle is 21 days)	Terminal half-life (T1/2) will be obtained from the terminal rate constant calculated by linear regression using at least 3 observations.
Pharmacokinetic Analysis: Volume of distribution	Day 1, 2, 3, 5, 8, 11, 15, 22 (Cycle 1,2,3) (each cycle is 21 days)	Volume of distribution (both at steady state and based on the terminal phase) (Vss and Vz, respectively): Vss is an estimate that equals mean residence time times total body clearance. Vz, calculated dividing the administered dose by the product of the AUC with extrapolation to infinity by the terminal rate constant
Pharmacogenetics	Before treatment start along with PK sample on Day 1 of Cycle 1 (each cycle is 21 days)	A genotype evaluation in genes relevant for lurbinectedin metabolism and transport will be investigated and reported in an independent report in order to determine whether the observed differences between patients in PK parameters are related to these genetic features.
Pharmacokinetic Analysis: Total body clearance	Day 1, 2, 3, 5, 8, 11, 15, 22 (Cycle 1,2,3) (each cycle is 21 days)	Total body clearance (CL), calculated by dividing the administered dose by the AUC with extrapolation to infinity.

Trial Locations

Locations (2)

Fundacion Jimenez Diaz; 🇪🇸 Madrid, Spain

Hospital HM Sanchinarro; 🇪🇸 Madrid, Spain