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Safety and Efficacy Study of PRI-724 Plus Gemcitabine in Subjects With Advanced or Metastatic Pancreatic Adenocarcinoma

Primary Purpose

Advanced Pancreatic Cancer, Metastatic Pancreatic Cancer, Pancreatic Adenocarcinoma

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
PRI-724
Sponsored by
Prism Pharma Co., Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Advanced Pancreatic Cancer

Eligibility Criteria

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

Inclusion Criteria:

  1. Male or female patients, > 18 years of age.
  2. Patients with a documented (histologically- or cytologically-proven) epithelial cell/adenocarcinoma of the pancreas that is relapsed, locally advanced, or metastatic.
  3. Patients with measurable or evaluable disease according to the response evaluation criteria in solid tumors
  4. Patients eligible for second-line therapy after failing first-line therapy with the regimen FOLFIRINOX.
  5. Patients with a malignancy that is currently not amenable to surgical intervention, due to either medical contraindications or non-resectability of the tumor.
  6. Patients with a Karnofsky Performance Status of 70% to 100% (or equivalent, Eastern Cooperative Oncology Group [ECOG] performance status of 0 or 1); Performance Status Evaluation), and an anticipated life expectancy of ≥ 3 months.
  7. Patients, both male and female, who are either not of childbearing potential or who agree to use a medically effective method of contraception during the study and for 3 months after the last dose of study drug.
  8. Patients with the ability to understand and give written informed consent for participation in this trial, including all evaluations and procedures as specified by this protocol.

Exclusion Criteria:

  1. Women who are pregnant or lactating. Women of child-bearing potential (WOCBP) and fertile men with a WOCBP partner, not using adequate birth control.
  2. Patients with islet cell tumors or other non-epithelial cell malignancies of the pancreas.
  3. Patients with known CNS (or leptomeningeal) metastases not controlled by prior surgery or radiotherapy, or patients with symptoms suggesting CNS involvement for which treatment is required.
  4. Patients with an active second malignancy within the last 2 years with the exception of:

    • Treated, non-melanoma skin cancers
    • Treated CIS of the breast or cervix
    • Controlled, superficial bladder carcinoma
    • T1a or b prostate carcinoma involving < 5% of resected tissue and PSA within normal limits (WNL) since resection
  5. Patients with any of the following hematologic abnormalities at baseline:

    • Hemoglobin < 9.0 g/dL
    • Absolute neutrophil count (ANC) < 1,500 per mm3
    • Platelet count < 100,000 per mm3
  6. Patients with any of the following serum chemistry abnormalities at baseline:

    • Total bilirubin > 1.5× the ULN for the institution, unless considered due to Gilbert's Syndrome
    • AST or ALT > 3× the ULN for the institution (> 5× ULN if due to hepatic involvement by tumor)
    • Serum albumin < 2.5 g/dL
    • Serum creatinine > 1.5× ULN (or a calculated creatinine clearance < 60 mL/min/1.73 m2)
  7. Patients with a significant cardiovascular disease or condition, including:

    • Congestive heart failure (CHF) currently requiring therapy
    • Need for anti-arrhythmic therapy for a ventricular arrhythmias
    • Severe conduction disturbances
    • Angina pectoris requiring therapy
    • Left ventricular ejection fraction (LVEF) < 50% by MUGA or echocardiogram
    • QTcF interval > 450 msec (males) or > 470 msec (females)
    • Uncontrolled hypertension (per Investigator's discretion)
    • Class III or IV cardiovascular disease according to the New York Heart Association's (NYHA) Functional Criteria.
    • Myocardial infarction (MI) within 6 months prior to first study drug administration
  8. Patients with known osteopenia or osteoporosis.
  9. Patients with a known or suspected hypersensitivity to either gemcitabine or any of the components of PRI-724.
  10. Patients with a history of human immunodeficiency virus (HIV) or active infection with hepatitis B virus (HBV) or hepatitis C virus (HCV).
  11. Patients with any other serious/active/uncontrolled infection, any infection requiring parenteral antibiotics, or unexplained fever > 38ºC within 2 weeks prior to first study drug administration.
  12. Patients with inadequate recovery from acute toxicity associated with any prior antineoplastic therapy
  13. Patients with inadequate recovery from any prior surgical procedure, or patients having undergone any major surgical procedure within 1 month prior to first study drug administration.
  14. Patients with any other life-threatening illness, significant organ system dysfunction, or clinically significant laboratory abnormality, which, in the opinion of the Investigator, would either compromise the patient's safety or interfere with evaluation of the safety of the study drug
  15. Patients with a psychiatric disorder or altered mental status that would preclude understanding of the informed consent process and/or completion of the necessary studies
  16. Patients with the inability, in the opinion of the Investigator, to comply with the protocol requirements

Sites / Locations

  • USC Norris Comprehensive Cancer Center
  • University of California, San Francisco
  • Massachusetts General Hospital Cancer Center
  • Mayo Clinic
  • University of Washington Seattle Cancer Care Alliance

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

PRI-724 and Gemcitabine

Arm Description

This study will have one arm: all enrolled subjects will be treated with both PRI-724 and Gemcitabine.

Outcomes

Primary Outcome Measures

The Maximum Tolerated Dose (MTD) of PRI-724 + Gemcitabine measured by the number of dose limiting toxicities (DLTs) that occur.
If no DLT occurs in the first 3 patients of a cohort, the dose will be escalated to the next dose cohort. If 1 DLT occurs in the first 3 patients of a cohort, that cohort is expanded to 6 patients. If more than 1 DLT occurs in a 6 patient cohort, escalation is stopped & next lower dose is expanded to 12 patients to confirm the MTD.

Secondary Outcome Measures

Pharmacokinetic parameters of C max , T max , AUC (tau), and t ½.
The secondary outcome measures of PKs, PDs, MMP7, hair follicle sampling, and Response Criteria by RECIST comprise the correlative studies of this trial and are designed to evaluate PK profiles, assess and evaluate the utility of potential biomarkers, and evaluate antineoplastic activity of PRI-724 + Gemcitabine.
Pharmacodynamic mRNA expression of survivin
The secondary outcome measures of PKs, PDs, MMP7, hair follicle sampling, and Response Criteria by RECIST comprise the correlative studies of this trial and are designed to evaluate PK profiles, assess and evaluate the utility of potential biomarkers, and evaluate antineoplastic activity of PRI-724 + Gemcitabine
Evaluation of antineoplastic activity of PRI-724 + gemcitabine per RECIST 1.1 criteria
The secondary outcome measures of PKs, PDs, MMP7, hair follicle sampling, and Response Criteria by RECIST comprise the correlative studies of this trial and are designed to evaluate PK profiles, assess and evaluate the utility of potential biomarkers, and evaluate antineoplastic activity of PRI-724 + Gemcitabine
MMP7 levels in blood as ng/ml
The secondary outcome measures of PKs, PDs, MMP7, hair follicle sampling, and Response Criteria by RECIST comprise the correlative studies of this trial and are designed to evaluate PK profiles, assess and evaluate the utility of potential biomarkers, and evaluate antineoplastic activity of PRI-724 + Gemcitabine.
Gene expressions in hair follicle epithelial cells
The secondary outcome measures of PKs, PDs, MMP7, hair follicle sampling, and Response Criteria by RECIST comprise the correlative studies of this trial and are designed to evaluate PK profiles, assess and evaluate the utility of potential biomarkers, and evaluate antineoplastic activity of PRI-724 + Gemcitabine

Full Information

First Posted
December 12, 2012
Last Updated
August 16, 2017
Sponsor
Prism Pharma Co., Ltd.
Collaborators
inVentiv Health Clinical
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1. Study Identification

Unique Protocol Identification Number
NCT01764477
Brief Title
Safety and Efficacy Study of PRI-724 Plus Gemcitabine in Subjects With Advanced or Metastatic Pancreatic Adenocarcinoma
Official Title
Phase Ib Multicenter, Cohort Dose Escalation Trial to Determine the Safety, Tolerance and Preliminary Antineoplastic Activity of Gemcitabine Administered in Combination With Continuous Intravenous Doses of PRI-724, a CBP/ β- Catenin Inhibitor, to Patients With Advanced or Metastatic Pancreatic Adenocarcinoma Eligible for Second-Line Therapy After Failing First-Line Therapy With FOLFIRINOX (or FOLFOX)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2015
Overall Recruitment Status
Completed
Study Start Date
April 2013 (undefined)
Primary Completion Date
October 2015 (Actual)
Study Completion Date
October 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Prism Pharma Co., Ltd.
Collaborators
inVentiv Health Clinical

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Laboratory studies suggest that the study drug may stop cancer cells from growing by affecting an interaction between proteins in the cells referred to as cAMP-response element-binding protein and ß-catenin. The purpose of this research study is to determine the highest safe dose of study drug that may be used when it is given together with a chemotherapy drug to patients with cancer of the pancreas.
Detailed Description
PRI-724 is a small molecule antagonist that binds to the co-activator CBP thereby specifically inhibiting the subset of Wnt/β-catenin-driven genes that are up-regulated in cancer cells. PRI-724 is being developed as a potential antineoplastic agent. Purpose: To determine the safety, tolerability, dose-limiting toxicities (DLTs), and maximum tolerated dose (MTD) of sequential escalating doses per cohort of PRI-724 administered in combination with gemcitabine to patients with adenocarcinoma of the pancreas that is locally advanced, metastatic, or otherwise inoperable, who are candidates for second-line therapy after failing first-line therapy with FOLFIRINOX (i.e., folinic acid [leucovorin], fluorouracil, irinotecan, oxaliplatin) PRI-724: 320, 640, 905 mg/m2/day, continuous intravenous (CIV) infusion over 24 h, daily × 7 days, 1 week on with 1 week recovery × 2 (4 weeks equals 1 cycle) Gemcitabine: 1000 mg/m2 IV over 30 minutes; 3 weeks on with 1 week recovery (4 weeks equals 1 cycle) Patients with documented, measurable or evaluable adenocarcinoma of the pancreas that is locally advanced, metastatic, or otherwise inoperable, who are candidates for second-line therapy after failing first-line therapy with FOLFIRINOX, will be entered into this phase 1b, multicenter, open-label, non-randomized, dose-escalation per cohort study. The trial is designed to evaluate the safety, tolerability, DLT(s), and MTD of escalating doses of PRI-724, a CBP/ β- catenin inhibitor, when administered in combination with a standard dose of gemcitabine. Correlative studies include characterization of the PK profiles of PRI-724 and gemcitabine, evaluation of the utility of potential PD markers of PRI-724 activity, as well as preliminary assessment of the antineoplastic activity of PRI-724 plus gemcitabine in this patient population.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Advanced Pancreatic Cancer, Metastatic Pancreatic Cancer, Pancreatic Adenocarcinoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
20 (Actual)

8. Arms, Groups, and Interventions

Arm Title
PRI-724 and Gemcitabine
Arm Type
Experimental
Arm Description
This study will have one arm: all enrolled subjects will be treated with both PRI-724 and Gemcitabine.
Intervention Type
Drug
Intervention Name(s)
PRI-724
Intervention Description
Gemcitabine: 1000 mg/m2 IV over 30 minutes; once weekly dosing; 3 weeks on with 1 week recovery (4 weeks per cycle) PRI-724: Cohort 1: 320 mg/m2/day; Cohort 2: 640 mg/m2/day; Cohort 3: 905 mg/m2/day; Continuous IV over 24 hours; daily x 7 days; 1 week on with 1 week recovery × 2 (4 weeks per cycle)
Primary Outcome Measure Information:
Title
The Maximum Tolerated Dose (MTD) of PRI-724 + Gemcitabine measured by the number of dose limiting toxicities (DLTs) that occur.
Description
If no DLT occurs in the first 3 patients of a cohort, the dose will be escalated to the next dose cohort. If 1 DLT occurs in the first 3 patients of a cohort, that cohort is expanded to 6 patients. If more than 1 DLT occurs in a 6 patient cohort, escalation is stopped & next lower dose is expanded to 12 patients to confirm the MTD.
Time Frame
18 months. DLTs will be measured as they occur throughout the patients' time on study.
Secondary Outcome Measure Information:
Title
Pharmacokinetic parameters of C max , T max , AUC (tau), and t ½.
Description
The secondary outcome measures of PKs, PDs, MMP7, hair follicle sampling, and Response Criteria by RECIST comprise the correlative studies of this trial and are designed to evaluate PK profiles, assess and evaluate the utility of potential biomarkers, and evaluate antineoplastic activity of PRI-724 + Gemcitabine.
Time Frame
C 1 D 1 hrs 0, 1, 2, D 8 hrs 0, :15, :30, 1, 2, 4, 6, D 9 hrs 24, D 15 at hrs 0
Title
Pharmacodynamic mRNA expression of survivin
Description
The secondary outcome measures of PKs, PDs, MMP7, hair follicle sampling, and Response Criteria by RECIST comprise the correlative studies of this trial and are designed to evaluate PK profiles, assess and evaluate the utility of potential biomarkers, and evaluate antineoplastic activity of PRI-724 + Gemcitabine
Time Frame
C 1 D 1, D 8, D 15, D 22, All Cycles D 22, end of treatment
Title
Evaluation of antineoplastic activity of PRI-724 + gemcitabine per RECIST 1.1 criteria
Description
The secondary outcome measures of PKs, PDs, MMP7, hair follicle sampling, and Response Criteria by RECIST comprise the correlative studies of this trial and are designed to evaluate PK profiles, assess and evaluate the utility of potential biomarkers, and evaluate antineoplastic activity of PRI-724 + Gemcitabine
Time Frame
Screening, end of C 2, every 2 cycles, end of treatment
Title
MMP7 levels in blood as ng/ml
Description
The secondary outcome measures of PKs, PDs, MMP7, hair follicle sampling, and Response Criteria by RECIST comprise the correlative studies of this trial and are designed to evaluate PK profiles, assess and evaluate the utility of potential biomarkers, and evaluate antineoplastic activity of PRI-724 + Gemcitabine.
Time Frame
C 1 Wk 1, Wk 4, Wk 4 all cycles, end of treatment
Title
Gene expressions in hair follicle epithelial cells
Description
The secondary outcome measures of PKs, PDs, MMP7, hair follicle sampling, and Response Criteria by RECIST comprise the correlative studies of this trial and are designed to evaluate PK profiles, assess and evaluate the utility of potential biomarkers, and evaluate antineoplastic activity of PRI-724 + Gemcitabine
Time Frame
Screening, C 1 D 14, C 2 Wk 4, end of treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female patients, > 18 years of age. Patients with a documented (histologically- or cytologically-proven) epithelial cell/adenocarcinoma of the pancreas that is relapsed, locally advanced, or metastatic. Patients with measurable or evaluable disease according to the response evaluation criteria in solid tumors Patients eligible for second-line therapy after failing first-line therapy with the regimen FOLFIRINOX. Patients with a malignancy that is currently not amenable to surgical intervention, due to either medical contraindications or non-resectability of the tumor. Patients with a Karnofsky Performance Status of 70% to 100% (or equivalent, Eastern Cooperative Oncology Group [ECOG] performance status of 0 or 1); Performance Status Evaluation), and an anticipated life expectancy of ≥ 3 months. Patients, both male and female, who are either not of childbearing potential or who agree to use a medically effective method of contraception during the study and for 3 months after the last dose of study drug. Patients with the ability to understand and give written informed consent for participation in this trial, including all evaluations and procedures as specified by this protocol. Exclusion Criteria: Women who are pregnant or lactating. Women of child-bearing potential (WOCBP) and fertile men with a WOCBP partner, not using adequate birth control. Patients with islet cell tumors or other non-epithelial cell malignancies of the pancreas. Patients with known CNS (or leptomeningeal) metastases not controlled by prior surgery or radiotherapy, or patients with symptoms suggesting CNS involvement for which treatment is required. Patients with an active second malignancy within the last 2 years with the exception of: Treated, non-melanoma skin cancers Treated CIS of the breast or cervix Controlled, superficial bladder carcinoma T1a or b prostate carcinoma involving < 5% of resected tissue and PSA within normal limits (WNL) since resection Patients with any of the following hematologic abnormalities at baseline: Hemoglobin < 9.0 g/dL Absolute neutrophil count (ANC) < 1,500 per mm3 Platelet count < 100,000 per mm3 Patients with any of the following serum chemistry abnormalities at baseline: Total bilirubin > 1.5× the ULN for the institution, unless considered due to Gilbert's Syndrome AST or ALT > 3× the ULN for the institution (> 5× ULN if due to hepatic involvement by tumor) Serum albumin < 2.5 g/dL Serum creatinine > 1.5× ULN (or a calculated creatinine clearance < 60 mL/min/1.73 m2) Patients with a significant cardiovascular disease or condition, including: Congestive heart failure (CHF) currently requiring therapy Need for anti-arrhythmic therapy for a ventricular arrhythmias Severe conduction disturbances Angina pectoris requiring therapy Left ventricular ejection fraction (LVEF) < 50% by MUGA or echocardiogram QTcF interval > 450 msec (males) or > 470 msec (females) Uncontrolled hypertension (per Investigator's discretion) Class III or IV cardiovascular disease according to the New York Heart Association's (NYHA) Functional Criteria. Myocardial infarction (MI) within 6 months prior to first study drug administration Patients with known osteopenia or osteoporosis. Patients with a known or suspected hypersensitivity to either gemcitabine or any of the components of PRI-724. Patients with a history of human immunodeficiency virus (HIV) or active infection with hepatitis B virus (HBV) or hepatitis C virus (HCV). Patients with any other serious/active/uncontrolled infection, any infection requiring parenteral antibiotics, or unexplained fever > 38ºC within 2 weeks prior to first study drug administration. Patients with inadequate recovery from acute toxicity associated with any prior antineoplastic therapy Patients with inadequate recovery from any prior surgical procedure, or patients having undergone any major surgical procedure within 1 month prior to first study drug administration. Patients with any other life-threatening illness, significant organ system dysfunction, or clinically significant laboratory abnormality, which, in the opinion of the Investigator, would either compromise the patient's safety or interfere with evaluation of the safety of the study drug Patients with a psychiatric disorder or altered mental status that would preclude understanding of the informed consent process and/or completion of the necessary studies Patients with the inability, in the opinion of the Investigator, to comply with the protocol requirements
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Robert R. McWilliams, M.D.
Organizational Affiliation
Mayo Clinic
Official's Role
Principal Investigator
Facility Information:
Facility Name
USC Norris Comprehensive Cancer Center
City
Los Angeles
State/Province
California
ZIP/Postal Code
90033
Country
United States
Facility Name
University of California, San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
94115
Country
United States
Facility Name
Massachusetts General Hospital Cancer Center
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Facility Name
Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Facility Name
University of Washington Seattle Cancer Care Alliance
City
Seattle
State/Province
Washington
ZIP/Postal Code
98109
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Safety and Efficacy Study of PRI-724 Plus Gemcitabine in Subjects With Advanced or Metastatic Pancreatic Adenocarcinoma

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