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A Phase 2 Study of Amrubicin in Relapsed or Refractory Thymic Malignancies

Primary Purpose

Thymoma, Thymus Cancer, Thymic Carcinoma

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Amrubicin
Sponsored by
Heather Wakelee
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Thymoma

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Histologically or cytologically confirmed invasive or metastatic thymoma or thymic carcinoma. Locally invasive disease is acceptable, provided it is not resectable.
  • Previous treatment with at least one prior chemotherapy regimen.
  • Documented progressive disease after the most recent chemotherapy regimen.
  • Presence of measurable disease on imaging within 4 weeks prior to first dose
  • Completion of prior systemic therapy at least 4 weeks prior to first dose.
  • Any prior immunotherapy therapy completed at least 8 weeks prior to first dose.
  • Any prior surgery completed at least 4 weeks prior to first dose, with adequate recovered from surgery.
  • Any prior radiation therapy must have no residual toxic effects of therapy. Chest radiotherapy with curative intent to the primary disease complex must have been completed ≥ 28 days prior to first dose. Cranial radiation must have been completed ≥ 21 days prior to first dose. Radiotherapy to all other areas must have been completed ≥ 7 days prior to first dose.
  • Age ≥ 18 years.
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
  • Leukocytes ≥ 3000/mm³
  • Absolute neutrophil count ≥ 1500/mm³
  • Platelets ≥ 100,000/mm³
  • Hemoglobin ≥ 9 g/d
  • Serum bilirubin < 1.5 x institutional upper limit of normal (ULN)
  • Aspartate transaminase (AST) and alanine transaminase (ALT) ratio < 3 x ULN
  • Serum creatinine < 1.5 times institutional upper limit of normal if serum creatinine above institutional upper limit of normal, calculated serum creatinine clearance by the Cockcroft Gault method > 60 mL/min
  • Left ventricular ejection fraction (LVEF) ≥ 50% by transthoracic echocardiogram (TTE) or multiple gated acquisition scan (MUGA)
  • For females of childbearing potential, negative serum pregnancy test within 4 weeks of first dose.
  • For males and females of childbearing potential, use of effective contraceptive methods during the study.
  • Ability to understand and willingness to sign a written informed consent document.

Exclusion Criteria:

  • Current use, or use within 4 weeks prior to first dose, of any other investigational agents.
  • Known history of allergic reactions attributed to compounds of similar chemical or biologic composition to amrubicin.
  • Active malignancy requiring treatment other than thymic malignancy.
  • Pregnant or nursing females due to unknown toxic effects of amrubicin on the developing fetus or in breast milk. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
  • Symptomatic central nervous system metastatic disease. Patients with asymptomatic brain metastases allowed. If treated with surgical resection or radiation therapy, the patient must be stable for >= 2 weeks after completion of therapy. If the patient is on corticosteroids, the dose of corticosteroids, the dose of corticosteroids must have been stable for >= 2 weeks prior to first dose of study treatment, or be in the process of being tapered.
  • Concurrent severe or uncontrolled medical disease (including but not limited to active systemic infection, diabetes, hypertension, coronary artery disease, congestive hear failure and mental illness) that in the opinion of the investigator would compromise the safety of the patient or compromise the ability of the patient to complete the study.
  • Known history of seropositive human immunodeficiency virus (HIV) or use of immunosuppressive medications for other conditions that would, in the opinion of the investigator, increase the risk of serious neutropenic complications.

Sites / Locations

  • Stanford University School of Medicine
  • Indiana University

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Amrubicin

Arm Description

Amrubicin 35mg/m2 IV days 1-3 every 3 weeks

Outcomes

Primary Outcome Measures

Overall Response Rate (ORR)
Participants received amrubicin 35 mg/m2 IV days 1 to 3, every 3 weeks, until progression or toxicity. Tumor response rate was assessed radiographically by the Response Evaluation Criteria In Solid Tumors (RECIST), and the overall response rate (ORR) was expressed as the sum of the Complete Response (CR) rate and the Partial Response (PR) rate. RECIST criteria define when cancer patients improve ("respond"); stay the same ("stable"); or worsen ("progression") during treatments. The criteria presume that linear measures are an adequate substitute for 2-dimensional (2D) methods and includes 4 response categories: CR = Disappearance of all target lesions PR = 30% decrease in the sum of the longest diameter of target lesions Progressive disease (PD) = 20% increase in the sum of the longest diameter of target lesions Stable disease (SD) = Small changes that do not meet above criteria

Secondary Outcome Measures

Median Progression-free Survival (PFS)
Median Progression-free survival in patients with thymic malignancies treated with amrubicin
Disease Control Rate (DCR)
Disease control rate (DCR) is the sum of Complete Response (CR) rate + Partial Response (PR) rate + Stable Disease (SD) rate , and is expressed here as the sum of the Overall Response Rate (ORR = CR + PR) plus the Stable Disease (SD) rate, ORR + SD. Response was assessed by the RECIST criteria, elaborated above.

Full Information

First Posted
May 31, 2011
Last Updated
April 5, 2019
Sponsor
Heather Wakelee
Collaborators
Celgene
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1. Study Identification

Unique Protocol Identification Number
NCT01364727
Brief Title
A Phase 2 Study of Amrubicin in Relapsed or Refractory Thymic Malignancies
Official Title
A Phase II Study of Amrubicin in Relapsed or Refractory Thymic Malignancies
Study Type
Interventional

2. Study Status

Record Verification Date
April 2019
Overall Recruitment Status
Completed
Study Start Date
June 2011 (Actual)
Primary Completion Date
July 2014 (Actual)
Study Completion Date
December 31, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Heather Wakelee
Collaborators
Celgene

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
A research study of the drug amrubicin in patients with cancer of the thymus (thymoma or thymic carcinoma). We hope to learn whether this drug is an effective and safe treatment for thymic cancers.
Detailed Description
Amrubicin, a synthetic 9-aminoanthracycline, is structurally similar to doxorubicin, but has a different primary mode of action. It acts primarily as an inhibitor of DNA topoisomerase II, exerting its cytotoxic effects by stabilizing a topoisomerase II mediated cleavable complex. This inhibition is significantly more than that seen in doxorubicin, which, in contrast, tends to demonstrate more DNA intercalation than amrubicin. It has not yet been evaluated for use in thymic malignancies, but given its efficacy in NSCLC and small cell lung cancer (SCLC), as well as the known efficacy of other anthracyclines and topoisomerase II inhibitors in first-line thymoma treatment, it warrants study for use in the second line and beyond in refractory or relapsed patients. Unlike doxorubicin, amrubicin has had minimal cardiotoxicity even with ongoing use, which also makes it a promising agent for use in the second line even for patients who have previously been exposed to, and potentially helped by, doxorubicin.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Thymoma, Thymus Cancer, Thymic Carcinoma

7. Study Design

Primary Purpose
Other
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
33 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Amrubicin
Arm Type
Experimental
Arm Description
Amrubicin 35mg/m2 IV days 1-3 every 3 weeks
Intervention Type
Drug
Intervention Name(s)
Amrubicin
Other Intervention Name(s)
Calsed
Intervention Description
35 mg/m2; IV on days 1-3 each 3 week cycle
Primary Outcome Measure Information:
Title
Overall Response Rate (ORR)
Description
Participants received amrubicin 35 mg/m2 IV days 1 to 3, every 3 weeks, until progression or toxicity. Tumor response rate was assessed radiographically by the Response Evaluation Criteria In Solid Tumors (RECIST), and the overall response rate (ORR) was expressed as the sum of the Complete Response (CR) rate and the Partial Response (PR) rate. RECIST criteria define when cancer patients improve ("respond"); stay the same ("stable"); or worsen ("progression") during treatments. The criteria presume that linear measures are an adequate substitute for 2-dimensional (2D) methods and includes 4 response categories: CR = Disappearance of all target lesions PR = 30% decrease in the sum of the longest diameter of target lesions Progressive disease (PD) = 20% increase in the sum of the longest diameter of target lesions Stable disease (SD) = Small changes that do not meet above criteria
Time Frame
2 years
Secondary Outcome Measure Information:
Title
Median Progression-free Survival (PFS)
Description
Median Progression-free survival in patients with thymic malignancies treated with amrubicin
Time Frame
2 years
Title
Disease Control Rate (DCR)
Description
Disease control rate (DCR) is the sum of Complete Response (CR) rate + Partial Response (PR) rate + Stable Disease (SD) rate , and is expressed here as the sum of the Overall Response Rate (ORR = CR + PR) plus the Stable Disease (SD) rate, ORR + SD. Response was assessed by the RECIST criteria, elaborated above.
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically or cytologically confirmed invasive or metastatic thymoma or thymic carcinoma. Locally invasive disease is acceptable, provided it is not resectable. Previous treatment with at least one prior chemotherapy regimen. Documented progressive disease after the most recent chemotherapy regimen. Presence of measurable disease on imaging within 4 weeks prior to first dose Completion of prior systemic therapy at least 4 weeks prior to first dose. Any prior immunotherapy therapy completed at least 8 weeks prior to first dose. Any prior surgery completed at least 4 weeks prior to first dose, with adequate recovered from surgery. Any prior radiation therapy must have no residual toxic effects of therapy. Chest radiotherapy with curative intent to the primary disease complex must have been completed ≥ 28 days prior to first dose. Cranial radiation must have been completed ≥ 21 days prior to first dose. Radiotherapy to all other areas must have been completed ≥ 7 days prior to first dose. Age ≥ 18 years. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. Leukocytes ≥ 3000/mm³ Absolute neutrophil count ≥ 1500/mm³ Platelets ≥ 100,000/mm³ Hemoglobin ≥ 9 g/d Serum bilirubin < 1.5 x institutional upper limit of normal (ULN) Aspartate transaminase (AST) and alanine transaminase (ALT) ratio < 3 x ULN Serum creatinine < 1.5 times institutional upper limit of normal if serum creatinine above institutional upper limit of normal, calculated serum creatinine clearance by the Cockcroft Gault method > 60 mL/min Left ventricular ejection fraction (LVEF) ≥ 50% by transthoracic echocardiogram (TTE) or multiple gated acquisition scan (MUGA) For females of childbearing potential, negative serum pregnancy test within 4 weeks of first dose. For males and females of childbearing potential, use of effective contraceptive methods during the study. Ability to understand and willingness to sign a written informed consent document. Exclusion Criteria: Current use, or use within 4 weeks prior to first dose, of any other investigational agents. Known history of allergic reactions attributed to compounds of similar chemical or biologic composition to amrubicin. Active malignancy requiring treatment other than thymic malignancy. Pregnant or nursing females due to unknown toxic effects of amrubicin on the developing fetus or in breast milk. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately. Symptomatic central nervous system metastatic disease. Patients with asymptomatic brain metastases allowed. If treated with surgical resection or radiation therapy, the patient must be stable for >= 2 weeks after completion of therapy. If the patient is on corticosteroids, the dose of corticosteroids, the dose of corticosteroids must have been stable for >= 2 weeks prior to first dose of study treatment, or be in the process of being tapered. Concurrent severe or uncontrolled medical disease (including but not limited to active systemic infection, diabetes, hypertension, coronary artery disease, congestive hear failure and mental illness) that in the opinion of the investigator would compromise the safety of the patient or compromise the ability of the patient to complete the study. Known history of seropositive human immunodeficiency virus (HIV) or use of immunosuppressive medications for other conditions that would, in the opinion of the investigator, increase the risk of serious neutropenic complications.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Heather A. Wakelee
Organizational Affiliation
Stanford University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Stanford University School of Medicine
City
Stanford
State/Province
California
ZIP/Postal Code
94305
Country
United States
Facility Name
Indiana University
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46202
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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A Phase 2 Study of Amrubicin in Relapsed or Refractory Thymic Malignancies

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