A Phase 1/2, Open-Label, Safety, Tolerability, Pharmacokinetics, and Anti-Tumor Activity Study of Repotrectinib in Pediatric and Young Adult Subjects With Advanced or Metastatic Malignancies Harboring ALK, ROS1, NTRK1-3 Alterations
试验速览
- 阶段
- 1 期
- 状态
- 招募中
- 入组人数
- 75
- 试验地点
- 136
- 主要终点
- Dose limiting toxicities (DLTs) (Phase 1)
研究概览
简要总结
Phase 1 will evaluate the safety and tolerability at different dose levels of repotrectinib in pediatric and young adult subjects with advanced or metastatic malignancies harboring anaplastic lymphoma kinase (ALK), receptor tyrosine kinase encoded by the gene ROS1 (ROS1), or neurotrophic receptor kinase genes encoding TRK kinase family (NTRK1-3) alterations to estimate the Maximum Tolerated Dose (MTD) or Maximum Administered Dose (MAD) and select the Pediatric Recommended Phase 2 Dose (RP2D).
Phase 2 will determine the anti-tumor activity of repotrectinib in pediatric and young adult subjects with advanced or metastatic malignancies harboring ROS1 or NTRK1-3 alterations.
详细描述
Enrollment of subjects into Phase 1 will proceed concurrently by age as follows:
- Subjects <12 years old will initially be enrolled in the Phase 1 part to determine the pediatric RP2D for this age group; once the pediatric RP2D is determined, subjects age <12 years old may be enrolled into the Phase 2 part of the study.
- Subjects 12 to 25 years old will be directly enrolled into the Phase 2 part concurrent with Phase 1 enrollment.
Phase 1:
Approximately 12 pediatric subjects with locally advanced or metastatic solid tumors, including a primary central nervous system (CNS) tumor, or anaplastic large cell lymphoma (ALCL), with disease progression or who are non-responsive or intolerant to available therapies and for which no standard or available curative therapy exists.
Phase 2:
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- — 至 25 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Documented genetic ROS1 point mutation, fusion, or amplification or NTRK1-3 fusion as identified by local testing in a Clinical Laboratory Improvement Amendments (CLIA) laboratory in the US or equivalently accredited diagnostic lab outside the United States (US) is required.
- •Phase 1: Age <12 years; Phase 2: Age 12- 25 years
- •Prior cytotoxic chemotherapy is allowed.
- •Prior immunotherapy is allowed.
- •Resolution of all acute toxic effects (excluding alopecia) of any prior anti-cancer therapy to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version 4.03 Grade less than or equal to
- •All subjects must have measurable disease by RECIST v1.1 or Response Assessment in Neuro-Oncology (RANO) criteria at time of enrollment.
- •Subjects with a primary CNS tumor or CNS metastases must be neurologically stable on a stable or decreasing dose of steroids for at least 7 days prior to enrollment.
- •Subjects must have a Lansky (< 16 years) or Karnofsky (≥ 16 years) score of at least
- •Life expectancy greater than or equal to 12 weeks, in the investigator's opinion.
- •Adequate hematologic, renal and hepatic function.
- •Phase 2 Inclusion Criteria:
- •Cohort Specific Inclusion Criteria:
- •Cohort 1: Subjects with NTRK fusion gene positive (NTRK+) advanced solid tumors (including primary CNS tumors), that are tropomyosin receptor kinase (TRK) TKI naïve;
- •Cohort 2: subjects with NTRK+ advanced solid tumors (including primary CNS tumors), that are TRK TKI pre-treated;
- •Cohort 3: subjects with advanced solid tumors with ROS1 gene fusions or other ROS1 aberrations (including amplifications and point mutations) with measurable disease.
- •Subjects in Cohorts 1 and 2 must have prospectively confirmed measurable disease by BICR prior to enrollment.
排除标准
- •(Phase 1 and Phase 2):
- •Subjects with neuroblastoma with only bone marrow disease evaluable by bone marrow aspiration only.
- •Major surgery within 14 days (2 weeks) of start of repotrectinib treatment. Central venous access (Broviac, Mediport, etc.) placement does not meet criteria for major surgery.
- •Known active infections requiring ongoing treatment (bacterial, fungal, viral including HIV positivity).
- •Gastrointestinal disease (e.g., Crohn's disease, ulcerative colitis, or short gut syndrome) or other malabsorption syndromes that would impact drug absorption.
- •Any of the following cardiac criteria:
- •Mean resting corrected QT interval (ECG interval measured from the onset of the QRS complex to the end of the T wave) for heart rate (QTc) > 480 msec obtained from three ECGs, using the screening clinic ECG machine-derived QTc value
- •Any clinically important abnormalities in rhythm, conduction, or morphology of resting ECG (e.g., complete left bundle branch block, third degree heart block, second degree heart block, PR interval > 250 msec)
- •Any factors that increase the risk of QTc prolongation or risk of arrhythmic events such as heart failure, congenital long QT syndrome, family history of long QT syndrome, or any concomitant medication known to prolong the QT interval
- •Peripheral neuropathy of CTCAE ≥grade
- •Subjects being treated with or anticipating the need for treatment with strong CYP3A4 inhibitors or inducers.
- •Any potential allergies to repotrectinib and/or its excipients.
研究组 & 干预措施
Repotrectinib (TPX-0005)
Phase 1
Oral repotrectinib (TPX-0005):
Safety and tolerability at different dose levels
Phase 2
Oral repotrectinib (TPX-0005): 3 cohorts
Cohort 1: TKI-naive NTRK fusion Cohort 2: Prior TKI NTRK fusion Cohort 3: ROS1 gene fusions or other ROS1 aberrations
干预措施: Oral repotrectinib (TPX-0005) (Drug)
结局指标
主要结局
Dose limiting toxicities (DLTs) (Phase 1)
时间窗: Within 28 days of the first repotrectinib dose
Define the dose limiting toxicities (DLTs) (Phase 1)
Pediatric Recommended Phase 2 Dose (RP2D) (Phase 1)
时间窗: Within 28 days of the last patient dosed in escalation
To determine the pediatric RP2D (Phase 1)
Overall Response Rate (ORR) (Phase 2)
时间窗: Two to three years after first dose of repotrectinib
To determine the confirmed ORR of repotrectinib (TPX-0005) as assessed by Blinded Independent Central Review (Phase 2)
次要结局
- Time to response (TTR) (Phase 1 and Phase 2)(Approximately three years)
- Central Nervous System Progression-Free Survival (CNS-PFS) (Phase 2)(Approximately three years)
- Overall Response Rate (ORR) (Phase 1)(Approximately three years)
- Clinical Benefit Rate (CBR) (Phase 1 and Phase 2)(Approximately three years)
- Duration of response (DOR) (Phase 1 and Phase 2)(Approximately three years)
- Progression-free survival (PFS) (Phase 2)(Approximately three years)
- Intracranial objective response rate (IC-ORR) (Phase 1 and Phase 2)(Approximately three years)
- Overall survival (OS) (Phase 2)(Approximately three years)
- Maximum concentration of repotrectinib in plasma (Cmax)(Pre-dose and up to 24 hours post-dose on Day 1 and Day 15 in Cycle 1 (each cycle is 28 days))
- Area under the concentration versus time curve of repotrectinib in plasma (AUC)(Pre-dose and up to 24 hours post-dose on Day 1 and Day 15 in Cycle 1 (each cycle is 28 days))