Pharmacokinetic and Safety Study of Lower Doses of Ceritinib Taken With a Low-fat Meal Versus 750 mg of Ceritinib in the Fasted State in Adult Patients With (ALK-positive) Metastatic Non-small Cell Lung Cancer (NSCLC)

Phase 1

Completed

Brief Summary: A Phase I study to assess the systemic exposure, effiacy, and safety of 450 mg ceritinib taken with a low-fat meal and 600 mg ceritinib taken with a low-fat meal as compared with that of 750 mg ceritinib taken in the fasted state in adult patients with ALK rearranged (ALK-positive) metastatic non-small cell lung cancer (NSCLC)

Detailed Description: This was an open-label, randomized, multi-center, parallel design, Phase I study in which the systemic exposure, efficacy and safety of ceritinib administered at 450 mg or 600 mg with a low-fat meal vs 750 mg in the fasted state was assessed in subjects with ALK+ NSCLC following multiple oral daily dosing of ceritinib. Subjects were randomized in a 1:1:1 ratio to once daily doses of oral ceritinib (450 mg following a low-fat meal, 600 mg following a low-fat meal or ceritinib 750 mg administered on an empty stomach). Randomization was stratified by brain metastases at Screening (presence or absence) and by prior treatment (prior crizotinib use with ALK+ determined by Fluorescent in situ hybridization (FISH); crizotinib-naïve but could be previously treated with other systemic anti-cancer therapy with ALK+ determined by FISH, or treatment-naïve subjects with ALK+ by IHC).

Recruitment & Eligibility

Inclusion Criteria

Histologically or cytologically confirmed diagnosis of stage IIIB (and is not a candidate for definitive multimodality therapy) or IV ALK-positive NSCLC.
Patients may have received one prior treatment regimen with crizotinib (all other ALK inhibitors are excluded).
Patients may have received prior chemotherapy, biologic therapy, or other investigational agents. ALK inhibitors other than crizotinib are excluded.
Patient has a World Health Organization (WHO) performance status 0-2.

Exclusion Criteria

Prior treatment with an ALK inhibitor other than crizotinib.
History of carcinomatous meningitis.
Presence or history of a malignant disease other than an ALK-positive advanced tumor that has been diagnosed and/or required therapy within the past 3 years.
Clinically significant, uncontrolled heart disease and/or recent cardiac event (within 6 months)
Patient has history of interstitial lung disease or interstitial pneumonitis, including clinically significant radiation pneumonitis (i.e., affecting activities of daily living or requiring therapeutic intervention).
Patient has other severe, acute, or chronic medical conditions
Patient is currently receiving treatment with warfarin sodium (Coumadin®) or any other coumarin-derivative anticoagulants.

Arm && Interventions

Group	Intervention	Description
ceritinib 600 mg with a low-fat meal	ceritinib	Oral ceritinib QD (21 days/ cycle) at a dose of 600 mg (4×150 mg/capsule) administered in the morning immediately (within 30 minutes) following a low-fat meal.
ceritinib 750 mg on an empty stomach	ceritinib	Oral ceritinib QD (21 days/ cycle) at a dose of 750 mg (5×150 mg/capsule) administered in the morning on an empty stomach (i.e., fasted from food and drink except water)
ceritinib 450 mg with a low-fat meal	ceritinib	Oral ceritinib QD (21 days/ cycle) at a dose of 450 mg (3×150 mg/capsule) administered in the morning immediately (within 30 minutes)following a low-fat meal.

Primary Outcome Measures

Name	Time	Method
Plasma concentration of ceritinib	Study Day 22	Pharmacokinetics (PK) parameters, including but not limited to AUClast, AUC0-24h, Cmax, Tmax, Tlast, Racc, and CLss/F

Secondary Outcome Measures

Name	Time	Method
Plasma concentration of ceritinib	Study Day 1	PK parameters, including but not limited to AUClast, AUC0-24h, Cmax, Tmax, Tlast, Racc, and CLss/F
Objective response rate (ORR)	Tumor assessments every 6 weeks until cycle 9. At least every 12 weeks thereafter until progressive disease.	Recist v1.1; Cycle = 21 days
Safety profile	The primary analysis will be based on data from all patients, up to the time at which all randomized patients have completed at least 12 weeks of ceritinib treatment or have discontinued study treatment, whichever is earlier.	Gastrointestinal (GI) Adverse Events (AEs), all Serious Advers Events (AEs), vital signs, electrocardiograms (ECGs) and laboratory abnormalities
Duration of response (DOR)	Tumor assessments every 6 weeks until cycle 9. At least every 12 weeks thereafter until progressive disease.	Recist v1.1

Locations (8): Goshen Center for Cancer Care IU Health - SC
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Indianapolis, Indiana, United States
Loma Linda University
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Loma Linda, California, United States
Utah Cancer Specialists Dept.of Utah Cancer Spec. (3)
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Salt Lake City, Utah, United States
Novartis Investigative Site
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Newcastle Upon Tyne, Newcastle, United Kingdom
Maryland Oncology Hematology, P.A. SC-2
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Rockville, Maryland, United States
Essex Oncology of North Jersey PA SC
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Belleville, New Jersey, United States
Highlands Oncology Group
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Fayetteville, Arkansas, United States
Greenville Health System SC
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Greenville, South Carolina, United States