A Phase 1/2 First in Human Study of the Menin-MLL(KMT2A) Inhibitor KO-539 in Patients With Relapsed or Refractory Acute Myeloid Leukemia
试验速览
- 阶段
- 1 期
- 状态
- 进行中（未招募）
- 入组人数
- 263
- 试验地点
- 96
- 主要终点
- Sub-study 3: Minimum biologically effective dose (MBED) and/or the recommended Phase 2 dose (RP2D)
研究概览
简要总结
In this trial, ziftomenib, a menin-MLL(KMT2A) inhibitor, will be tested in patients for the first time. The trial includes a Main Study and four sub-studies. In the Main Study (including Phase 1a, Phase 1b, and Phase 2 portions), ziftomenib will be evaluated in patients with relapsed or refractory (R/R) acute myeloid leukemia (AML). The main study has completed enrollment.
In Sub-studies 1 and 2, the effects of taking ziftomenib and other common drugs at the same time will be investigated in AML patients. In Sub-study 3, ziftomenib will be evaluated in patients with R/R acute lymphoblastic leukemia (ALL). In Sub-study 4, ziftomenib will be evaluated in patients with R/R AML with certain genetic mutations.
详细描述
This first-in-human (FIH), open-label study will assess ziftomenib, a menin-MLL(KMT2A) inhibitor, in patients with relapsed or refractory (R/R) acute myeloid leukemia (AML). The trial includes a Main Study and four sub-studies.
The Main Study is a Phase 1/2 dose-escalation and dose-validation/expansion study to assess ziftomenib in patients with R/R AML. The dose-escalation part of the study (Phase 1a) will determine the maximum tolerated dose (MTD) and/or the recommended Phase 2 dose (RP2D). The dose-validation/expansion part of the study (Phase 1b) will determine the safety, tolerability, and minimal biologically effective dose (MBED) of ziftomenib in biomarker-specific dosing cohorts from among doses that demonstrated early biological activity and are determined to be safe in the dose-escalation phase. The Phase 2 portion of the study will determine the safety, tolerability, and anti-leukemia activity of ziftomenib in patients with nucleophosmin 1-mutant (NPM1-m) AML.
In Sub-study 1, the effects of co-administration of ziftomenib on the pharmacokinetics (PK) of midazolam will be studied in patients with R/R AML with certain genetic mutations.
In Sub-study 2, the effects of co-administration of itraconazole on the PK of ziftomenib will be studied in patients with R/R AML with certain genetic mutations.
In Sub-study 3, the safety, tolerability, and MBED/RP2D of ziftomenib will be studied in patients with R/R KMT2A-rearranged (KMT2A-r) ALL (Phase 1a dose escalation). These parameters will be investigated further for the RP2D in a Phase 1b dose-validation/cohort expansion part of the sub-study.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients with refractory or relapsed AML defined as the reappearance of ≥ 5% blasts in the bone marrow and who have also failed or are ineligible for any approved standard of care therapies, including HSCT.
- •Patients with a documented lysine[K]-specific methyltransferase 2-rearrangement (KMT2A-r), or
- •Patients with a documented nucleophosmin 1 mutation (NPM1-m)
- •Patients with a documented nucleophosmin 1 mutation (NPM1-m)
- •Sub-studies:
- •Sub-studies 1 and 2: Patients with R/R AML with NPM1-m or other mutations associated with MEIS1 overexpression.
- •Sub-study 3: Patients with R/R Acute Lymphoblastic Leukemia (ALL) with KMT2A-r.
- •Sub-study 4: Patients with R/R AML with mutations associated with MEIS1 overexpression.
- •≥ 18 years of age.
- •Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2, and a life expectancy of at least 2 months.
- •Adequate liver and kidney function according to protocol requirements.
- •Peripheral white blood cell (WBC) counts ≤ 30,000/μL. Patients may receive hydroxyurea to control and maintain white blood cell count prior to enrollment.
- •Women of childbearing potential must be willing to use a highly effective method of contraception throughout the study and for at least 187 days after the last dose of study treatment.
- •Males with female partners of childbearing potential must agree to use a highly effective method of contraception throughout the study and for at least 97 days after the last dose of study treatment.
排除标准
- •Diagnosis of acute promyelocytic leukemia.
- •Diagnosis of chronic myelogenous leukemia in blast crisis.
- •Donor lymphocyte infusion < 30 days prior to study entry.
- •Clinically active central nervous system (CNS) leukemia.
- •Undergone HSCT and have not had adequate hematologic recovery.
- •Receiving immunosuppressive therapy post HSCT within 2 weeks of Cycle 1 Day
- •Grade ≥ 2 active graft-versus-host disease (GVHD), moderate or severe limited chronic GVHD, or extensive chronic GVHD of any severity.
- •Received chemotherapy immunotherapy, radiotherapy, or any ancillary therapy that is considered to be investigational (i.e., used for non-approved indications(s) and in the context of a research investigation) < 14 days prior to the first dose of ziftomenib or within 5 drug half-lives prior to the first dose of study drug.
- •Not recovered to < Grade 2 (National Cancer Institute Common Terminology Criteria for Adverse Events v5.0) from all acute toxicities or deemed back to a stable baseline.
- •Treatment with concomitant drugs that are strong inhibitors or inducers of cytochrome P450-isozyme 3A4 (CYP3A4), as follows:
- •Phase 1a, 1b, 2, and sub-studies 3 and 4: with the exception of antibiotics, antifungals, and antivirals that are used as standard of care or to prevent or treat infections and other such drugs that are considered absolutely essential for the care of the patient.
- •Sub-studies 1 and 2: No exceptions will be allowed except for the use of moderate CYP3A4 antifungal prophylaxis such as fluconazole or isavuconazole which is at steady state on Cycle 1 Day 1 and will continue through the completion of PKs on Cycle 1 Day 15 (for sub-study 1) or Cycle 1 Day 18 (for sub-study 2).
- •Detectable viral load for human immunodeficiency virus, hepatitis C, or hepatitis B surface antigen indicative of active infection. Patients with controlled disease will not be excluded from study enrollment.
- •Pre-existing disorder predisposing the patient to a serious or life-threatening infection (e.g. cystic fibrosis, congenital or acquired immunodeficiency, bleeding disorder, or cytopenias not related to AML).
- •Active uncontrolled acute or chronic systemic fungal, bacterial, viral, or other infection.
- •Significant cardiovascular disease including unstable angina pectoris, uncontrolled hypertension or arrhythmia, history of cerebrovascular accident including transient ischemic attack within the past 6 months, congestive heart failure (NYHA Class III or IV) related to primary cardiac disease, ischemic or severe valvular heart disease, or a myocardial infarction within 6 months prior to the first dose of study treatment.
- •Mean QTcF >480 ms on triplicate ECG.
- •Major surgery within 4 weeks prior to the first dose of study treatment.
- •Women who are pregnant or lactating. All female patients with reproductive potential must have a negative serum pregnancy test within 72 hours prior to starting treatment.
- •For sub-studies 1 and 2: Any intake of grapefruit, grapefruit juice, Seville oranges, Seville orange marmalade, or other products containing grapefruit or Seville oranges within 7 days of the first administration of ziftomenib until the end of Cycle
- •For sub-studies 1 and 2: Moderate (Child-Pugh class B) or severe (Child-Pugh class C) hepatic impairment.
研究组 & 干预措施
Sub-study 2
R/R AML patients with mutations associated with MEIS1 overexpression will receive ziftomenib + itraconazole
干预措施: Ziftomenib (Drug)
Phase 1a - Dose Escalation
AML patients will receive multiple doses of ziftomenib
干预措施: Ziftomenib (Drug)
Sub-study 2
R/R AML patients with mutations associated with MEIS1 overexpression will receive ziftomenib + itraconazole
干预措施: Itraconazole (Drug)
Sub-study 3
Part 1a: KMT2A-r R/R ALL patients will receive multiple ziftomenib doses
Part 1b: KMT2A-r R/R ALL patients will receive ziftomenib
干预措施: Ziftomenib (Drug)
Sub-study 4
R/R AML patients with mutations associated with MEIS1 overexpression will receive ziftomenib
干预措施: Ziftomenib (Drug)
Phase 1b - Dose-Validation Expansion
Cohort 1: KMT2A-r / NPM1-m R/R AML patients will receive ziftomenib
Cohort 2: KMT2A-r / NPM1-m R/R AML patients will receive ziftomenib
干预措施: Ziftomenib (Drug)
Phase 2
NPM1-m R/R AML patients will receive the recommended phase 2 ziftomenib dose
干预措施: Ziftomenib (Drug)
Sub-study 1
R/R AML patients with mutations associated with MEIS1 overexpression will receive ziftomenib + midazolam
干预措施: Ziftomenib (Drug)
Sub-study 1
R/R AML patients with mutations associated with MEIS1 overexpression will receive ziftomenib + midazolam
干预措施: Midazolam (Drug)
结局指标
主要结局
Sub-study 3: Minimum biologically effective dose (MBED) and/or the recommended Phase 2 dose (RP2D)
时间窗: During treatment and up to approximately 28 days after treatment discontinuation, or until immediately before the initiation of another anticancer therapy, whichever occurs first
Assessed by the number of patients that experience Adverse Events (AEs) and Serious Adverse Events (SAEs) per NCI-CTCAE v5.0
Sub-study 4: Complete remission (CR) and complete remission with partial hematologic recovery (CRh)
时间窗: For at least 12 months following end of treatment
To assess the CR+CRh rate
Phase 1a: Maximum tolerated dose (MTD) and/or the recommended Phase 2 dose (RP2D)
时间窗: Dose Limiting Toxicities (DLTs) will be evaluated during the first 28 days (1 cycle)
MTD is defined as the highest dose that is not expected to cause dose limiting toxicity (DLT) in more than 20% of patients.
Phase 1b: Number of patients who experience Adverse Events (AEs) and Serious Adverse Events (SAEs)
时间窗: During treatment and up to approximately 28 days after treatment discontinuation, or until immediately before the initiation of another anticancer therapy, whichever occurs first.
Assessed by NCI-CTCAE v5.0
Phase 1b: Minimum biologically effective dose
时间窗: For at least 12 months following end of treatment
Minimum biologically effective dose in dosing cohorts which have demonstrated biological activity and have been determined to be safe as a part of Part 1a
Phase 1a, 1b, and 2: Evidence of anti-leukemia activity
时间窗: For at least 12 months following end of treatment
Assessed by the CR + CRh rate
Sub-study 1: Time to observed maximum plasma concentration (Tmax) of ziftomenib and midazolam
时间窗: Cycle 1 on Days 1 and 15 at predose and postdose
Tmax of ziftomenib, its metabolites, midazolam, and 1-hydroxymidazolam
Sub-study 1: Area under the plasma concentration-time curve from time 0 to time t (AUC0-t) of ziftomenib and midazolam
时间窗: Cycle 1 on Days 1 and 15 at predose and postdose
AUC0-t of ziftomenib, its metabolites, midazolam, and 1-hydroxymidazolam
Sub-study 1: Maximum observed plasma concentration (Cmax) of ziftomenib and midazolam
时间窗: Cycle 1 on Days 1 and 15 at predose and postdose
Cmax of ziftomenib, its metabolites, midazolam, and 1-hydroxymidazolam
Sub-study 2: Time to observed maximum plasma concentration (Tmax) of ziftomenib and itraconazole
时间窗: Cycle 1 on Days 1, 15, and 22 at predose and postdose
Tmax of ziftomenib, its metabolites, and itraconazole
Sub-study 2: Area under the plasma concentration-time curve from time 0 to time t (AUC0-t) of ziftomenib and itraconazole
时间窗: Cycle 1 on Days 1, 15, and 22 at predose and postdose
AUC0-t of ziftomenib, its metabolites, and itraconazole
Sub-study 2: Maximum observed plasma concentration (Cmax) of ziftomenib and itraconazole
时间窗: Cycle 1 on Days 1, 15, and 22 at predose and postdose
Cmax of ziftomenib, its metabolites, and itraconazole
Sub-study 3: Minimum biologically effective dose (MBED) and/or the recommended Phase 2 dose (RP2D)
时间窗: For at least 12 months following end of treatment
Assessed by CR
Sub-study 3: Change in Eastern Cooperative Oncology Group (ECOG) status
时间窗: Timeframe: from Baseline to End of Treatment
To assess the change in ECOG status
Sub-study 3: Time to observed maximum plasma concentration (Tmax) of ziftomenib
时间窗: Postdose on Cycle 1 Day 1 and Cycle 2 Day 1. Predose at Cycle 2 onwards
Tmax of ziftomenib
Sub-study 3: Area under the plasma concentration-time curve from time 0 to time t (AUC0-t) of ziftomenib
时间窗: Postdose on Cycle 1 Day 1 and Cycle 2 Day 1. Predose at Cycle 2 onwards
AUC0-t of ziftomenib
Sub-study 3: Maximum observed plasma concentration (Cmax) of ziftomenib
时间窗: Postdose on Cycle 1 Day 1 and Cycle 2 Day 1. Predose at Cycle 2 onwards.
Cmax of ziftomenib
次要结局
- Phase 1a: Tmax(Cycle 1 and Cycle 2. Each cycle is 28 days.)
- Phase 1a: AUC(0-t)(Cycle 1 and Cycle 2. Each cycle is 28 days.)
- Phase 1a: Cmax(Cycle 1 and Cycle 2. Each cycle is 28 days.)
- Phase 1a and 2: Number of patients that experience Adverse Events (AEs) and Serious Adverse Events (SAEs)(During treatment and up to approximately 28 days after treatment discontinuation, or until immediately before the initiation of another anticancer therapy, whichever occurs first.)
- Sub-study 4: Transfusion independence (TI)(For at least 12 months following discontinuation of treatment)
- Phases 1a, 1b, and 2: Complete remission (CR) and complete remission with partial hematologic recovery (CRh) measurable residual disease (MRD) negativity(For at least 12 months following discontinuation of treatment)
- Phases 1a, 1b, and 2: Duration of response (DOR)(For at least 12 months following discontinuation of treatment)
- Phases 1a, 1b, and 2: Transfusion independence (TI)(For at least 12 months following discontinuation of treatment)
- Phases 1a, 1b, and 2: Overall response rate (ORR)(For at least 12 months following discontinuation of treatment)
- Phases 1a, 1b, and 2: Event-free survival (EFS)(For at least 12 months following end of treatment)
- Phases 1a, 1b, and 2: Overall survival (OS)(For at least 12 months following end of treatment)
- Phases 1a, 1b, and 2: Composite complete remission (CRc)(For at least 12 months following discontinuation of treatment)
- Phases 1b and 2: Composite complete remission (CRc) measurable residual disease (MRD) negativity(For at least 12 months following discontinuation of treatment)
- Phases 1b and 2: Overall response rate (ORR) measurable residual disease (MRD) negativity(For at least 12 months following discontinuation of treatment)
- Sub-study 2: Corrected QT (QTc) intervals(During Cycle 1)
- Sub-study 3: Complete remission (CR) measurable residual disease (MRD) negativity(For at least 12 months following discontinuation of treatment)
- Sub-studies 3 and 4: Composite complete remission (CRc)(For at least 12 months following discontinuation of treatment)
- Sub-study 3: Duration of response (DOR)(For at least 12 months following discontinuation of treatment)
- Sub-studies 3 and 4: Overall survival (OS)(For at least 12 months following discontinuation of treatment)
- Sub-studies 3 and 4: Event-free survival (EFS)(For at least 12 months following discontinuation of treatment)
- Sub-studies 3 and 4: Overall response rate (ORR) measurable residual disease (MRD) negativity(For at least 12 months following discontinuation of treatment)
- Sub-study 4: Number of patients that experience Adverse Events (AEs) and Serious Adverse Events (SAEs)(During treatment and up to approximately 28 days after treatment discontinuation, or until immediately before the initiation of another anticancer therapy, whichever occurs first.)
- Sub-study 4: Duration of response (DOR)(For at least 12 months following discontinuation of treatment)
- Sub-study 4: Time to observed maximum plasma concentration (Tmax) of ziftomenib(Postdose on Cycle 1 Day 1 and Cycle 2 Day 1. Predose on Cycle 2 onwards)
- Sub-study 4: Area under the plasma concentration-time curve from time 0 to time t (AUC0-t) of ziftomenib(Postdose on Cycle 1 Day 1 and Cycle 2 Day 1. Predose on Cycle 2 onwards)
- Sub-study 4: Maximum plasma concentration (Cmax) of ziftomenib(Postdose on Cycle 1 Day 1 and Cycle 2 Day 1. Predose on Cycle 2 onwards)