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Study of Minnelide™ in Patients With Advanced GI Tumors

Primary Purpose

Advanced Gastrointestinal Tumors

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Minnelide™ 001
Sponsored by
Minneamrita Therapeutics LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Advanced Gastrointestinal Tumors focused on measuring gastrointestinal tract, GI tract, advanced gastrointestinal tumors, gastrointestinal tumors, GI tumors, biliary, gallbladder,, colorectal,, gastric,, hepatocellular, esophageal, pancreatic

Eligibility Criteria

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

ELIGIBILITY CRITERIA:

Inclusion Criteria:

  1. Histologically or cytologically confirmed gastrointestinal (GI) carcinoma, which has progressed on standard therapies (surgery, radiotherapy, endocrine therapy, chemotherapy), for which effective therapy is not available or for which patients are not a candidate for or intolerant of such therapies.
  2. Have one or more metastatic tumors measurable on CT scan or locally advanced measurable disease that has clearly progressed after prior treatment per RECIST criteria.
  3. Male and female patients at least 18 years of age
  4. Laboratory data as specified:

    • Hematology: ANC >1500 cells/mm3, platelet count > 150,000 cells/mm3 and Hemoglobin > 9 g/dL
    • Hepatic: Direct bilirubin ≤1.5 X ULN; alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≤ 2.5 X ULN. For patients with known liver metastases or liver neoplasms, then ALT or AST ≤ 5.0 X ULN is allowed
    • Renal: serum creatinine WNL or calculated creatinine clearance ≥ 50 mL/min/1.73m2 for patients with creatinine levels above institutional normal
    • Urinalysis: No clinically significant abnormalities
    • Coagulation: INR within normal limits, PTT within normal limits
  5. Estimated life expectancy of at least 3 months
  6. Karnofsky Performance ≥ 70%
  7. A negative serum pregnancy test (if female)
  8. For men and women of child-producing potential - willingness to employ appropriate contraceptive methods (including abstinence) during the study.
  9. Ability to understand the requirements of the study, provide written informed consent and authorization of use and disclosure of protected health information, and agree to abide by the study restrictions and to return for the required assessments.

Exclusion Criteria:

  1. Women who are pregnant or nursing. NOTE: Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; or abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
  2. New York Heart Association Class III or IV, cardiac disease, myocardial infarction within the past 6 months, unstable arrhythmia, or evidence of ischemia on ECG.
  3. Baseline QTc exceeding 450 msec (470 msec for females) using the Bazetts formula and/or patients receiving class 1A or class III antiarrythmic agents.
  4. Active, uncontrolled bacterial, viral, or fungal infections, requiring systemic therapy.
  5. Treatment with radiotherapy, chemotherapy or investigational therapy within 1 month (or 5 half lifes for cytotoxics) prior to study entry (6 weeks for nitrosoureas or Mitomycin C).
  6. Known HIV, Hepatitis A, B or Hepatitis C infection
  7. Serious nonmalignant disease (e.g., hydronephrosis, liver failure, or other conditions) that could compromise protocol objectives in the opinion of the investigator and/or the sponsor.
  8. Participation in concurrent study of an investigational agent or device.
  9. Unwillingness or inability to comply with procedures required in this protocol.
  10. Any other condition including but not limited to major co-morbidities, which in the opinion of the investigator would render the patient ineligible.

Sites / Locations

  • Virginia G. Piper Cancer Center at Scottsdale Healthcare
  • University of Minnesota Masonic Cancer Clinic

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Minnelide™ 001

Arm Description

A Phase 1, Multi-Center, Open-label, Dose-Escalation, Safety, Pharmacokinetic and Pharmacodynamic Study of Minnelide™ given daily for 21 days followed by 7 days off schedule in patients with Advanced GI Tumors

Outcomes

Primary Outcome Measures

To determine the maximum tolerated dose (MTD) and the dose limiting toxicities (DLT) of Minnelide™
The MTD will be determined using a 3 + 3 design and will continue until 2 patients at any dose level experience a DLT. A DLT will be defined as Grade 4 neutropenia lasting ≥ 5 days or Grade 3 or 4 neutropenia with fever and/or infection;Grade 4 thrombocytopenia (or Grade 3 with bleeding);Grade 3 or 4 treatment-related non-hematological toxicity (Grade 3 nausea, vomiting or diarrhea that last > 72 hours despite maximal treatment constitutes a DLT, insufficient treatment will not constitute an exception to the DLT criteria, as this would constitute inadequate conduct of the study); Dosing delay greater than 2 weeks due to treatment-emergent AEs or related severe laboratory abnormalities.
To establish the dose of Minnelide™ recommended for future phase 2 protocol
Once the MTD has been determined this will be the dose going forward in phase 2 studies

Secondary Outcome Measures

To determine the pharmacokinetics of Minnelide™
Plasma concentration data will be used to determine the following PK parameters: AUC Area under the concentration curve Cmax Maximum plasma concentration Tmax Time to maximum plasma concentration t1/2 Terminal phase half life CL/F Total body clearance Vd/F Apparent volume of distribution
To observe patients for any evidence of antitumor activity of Minnelide™ per RECIST criteria
Objective measurements of tumor size will be recorded from PET, CT scan and other measures.
To determine pharmacodynamic effect of Minnelide™ on HSP70 levels. And to explore pharmacodynamics effect of Minnelide™ on PET Scans and using Choi criteria on the CT scans.
As part of exploratory PD, the following assessments will be performed: Biomarkers including CA19-9 (or CA125, CEA if non-secretors for pancreas cancer), CEA and CA125 as applicable, any tumor marker appropriate to the given cancer or that is known to be elevated in a given patient will be evaluated according the Investigator's discretion, prior to every Cycle. Serum HSP70 levels PET Scans Evaluation of CT scans using Choi criteria

Full Information

First Posted
August 19, 2013
Last Updated
March 2, 2017
Sponsor
Minneamrita Therapeutics LLC
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1. Study Identification

Unique Protocol Identification Number
NCT01927965
Brief Title
Study of Minnelide™ in Patients With Advanced GI Tumors
Official Title
A Phase 1, Multi-Center, Open-Label, Dose-Escalation, Safety, Pharmacokinetic, and Pharmacodynamic Study of Minnelide™ Given Daily for 21 Days Followed by 7 Days Off Schedule in Patients With Advanced GI Tumors.
Study Type
Interventional

2. Study Status

Record Verification Date
March 2017
Overall Recruitment Status
Completed
Study Start Date
August 2013 (undefined)
Primary Completion Date
October 2016 (Actual)
Study Completion Date
December 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Minneamrita Therapeutics LLC

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The primary objective of this study is to determine the maximum tolerated dose (MTD) and the dose limiting toxicities (DLT) of Minnelide™ and to establish the dose of Minnelide™ recommended for future phase 2 protocol
Detailed Description
This is a Phase 1, open label, multicenter, dose-escalation study of safety, pharmacokinetics, and pharmacodynamics of Minnelide™ Minnelide™ will be given as a single agent intravenously as a 30-minute infusion daily x 21 days followed by a 7-day rest period. One cycle will equal 28 days. Dose escalation will follow a modified Fibonacci design.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Advanced Gastrointestinal Tumors
Keywords
gastrointestinal tract, GI tract, advanced gastrointestinal tumors, gastrointestinal tumors, GI tumors, biliary, gallbladder,, colorectal,, gastric,, hepatocellular, esophageal, pancreatic

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Minnelide™ 001
Arm Type
Experimental
Arm Description
A Phase 1, Multi-Center, Open-label, Dose-Escalation, Safety, Pharmacokinetic and Pharmacodynamic Study of Minnelide™ given daily for 21 days followed by 7 days off schedule in patients with Advanced GI Tumors
Intervention Type
Drug
Intervention Name(s)
Minnelide™ 001
Other Intervention Name(s)
Minnelide
Intervention Description
Minnelide™ will be given as a single agent intravenously as a 30-minute infusion daily x 21 days followed by a 7-day rest period. One cycle will equal 28 days.
Primary Outcome Measure Information:
Title
To determine the maximum tolerated dose (MTD) and the dose limiting toxicities (DLT) of Minnelide™
Description
The MTD will be determined using a 3 + 3 design and will continue until 2 patients at any dose level experience a DLT. A DLT will be defined as Grade 4 neutropenia lasting ≥ 5 days or Grade 3 or 4 neutropenia with fever and/or infection;Grade 4 thrombocytopenia (or Grade 3 with bleeding);Grade 3 or 4 treatment-related non-hematological toxicity (Grade 3 nausea, vomiting or diarrhea that last > 72 hours despite maximal treatment constitutes a DLT, insufficient treatment will not constitute an exception to the DLT criteria, as this would constitute inadequate conduct of the study); Dosing delay greater than 2 weeks due to treatment-emergent AEs or related severe laboratory abnormalities.
Time Frame
24 months
Title
To establish the dose of Minnelide™ recommended for future phase 2 protocol
Description
Once the MTD has been determined this will be the dose going forward in phase 2 studies
Time Frame
24 months
Secondary Outcome Measure Information:
Title
To determine the pharmacokinetics of Minnelide™
Description
Plasma concentration data will be used to determine the following PK parameters: AUC Area under the concentration curve Cmax Maximum plasma concentration Tmax Time to maximum plasma concentration t1/2 Terminal phase half life CL/F Total body clearance Vd/F Apparent volume of distribution
Time Frame
24 months
Title
To observe patients for any evidence of antitumor activity of Minnelide™ per RECIST criteria
Description
Objective measurements of tumor size will be recorded from PET, CT scan and other measures.
Time Frame
24 months
Title
To determine pharmacodynamic effect of Minnelide™ on HSP70 levels. And to explore pharmacodynamics effect of Minnelide™ on PET Scans and using Choi criteria on the CT scans.
Description
As part of exploratory PD, the following assessments will be performed: Biomarkers including CA19-9 (or CA125, CEA if non-secretors for pancreas cancer), CEA and CA125 as applicable, any tumor marker appropriate to the given cancer or that is known to be elevated in a given patient will be evaluated according the Investigator's discretion, prior to every Cycle. Serum HSP70 levels PET Scans Evaluation of CT scans using Choi criteria
Time Frame
24 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
ELIGIBILITY CRITERIA: Inclusion Criteria: Histologically or cytologically confirmed gastrointestinal (GI) carcinoma, which has progressed on standard therapies (surgery, radiotherapy, endocrine therapy, chemotherapy), for which effective therapy is not available or for which patients are not a candidate for or intolerant of such therapies. Have one or more metastatic tumors measurable on CT scan or locally advanced measurable disease that has clearly progressed after prior treatment per RECIST criteria. Male and female patients at least 18 years of age Laboratory data as specified: Hematology: ANC >1500 cells/mm3, platelet count > 150,000 cells/mm3 and Hemoglobin > 9 g/dL Hepatic: Direct bilirubin ≤1.5 X ULN; alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≤ 2.5 X ULN. For patients with known liver metastases or liver neoplasms, then ALT or AST ≤ 5.0 X ULN is allowed Renal: serum creatinine WNL or calculated creatinine clearance ≥ 50 mL/min/1.73m2 for patients with creatinine levels above institutional normal Urinalysis: No clinically significant abnormalities Coagulation: INR within normal limits, PTT within normal limits Estimated life expectancy of at least 3 months Karnofsky Performance ≥ 70% A negative serum pregnancy test (if female) For men and women of child-producing potential - willingness to employ appropriate contraceptive methods (including abstinence) during the study. Ability to understand the requirements of the study, provide written informed consent and authorization of use and disclosure of protected health information, and agree to abide by the study restrictions and to return for the required assessments. Exclusion Criteria: Women who are pregnant or nursing. NOTE: Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; or abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately. New York Heart Association Class III or IV, cardiac disease, myocardial infarction within the past 6 months, unstable arrhythmia, or evidence of ischemia on ECG. Baseline QTc exceeding 450 msec (470 msec for females) using the Bazetts formula and/or patients receiving class 1A or class III antiarrythmic agents. Active, uncontrolled bacterial, viral, or fungal infections, requiring systemic therapy. Treatment with radiotherapy, chemotherapy or investigational therapy within 1 month (or 5 half lifes for cytotoxics) prior to study entry (6 weeks for nitrosoureas or Mitomycin C). Known HIV, Hepatitis A, B or Hepatitis C infection Serious nonmalignant disease (e.g., hydronephrosis, liver failure, or other conditions) that could compromise protocol objectives in the opinion of the investigator and/or the sponsor. Participation in concurrent study of an investigational agent or device. Unwillingness or inability to comply with procedures required in this protocol. Any other condition including but not limited to major co-morbidities, which in the opinion of the investigator would render the patient ineligible.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mohana Velagapudi, MD
Organizational Affiliation
Minneamrita Therapeutics LLC
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Linda Vocila, BSN
Organizational Affiliation
Translational Drug Development
Official's Role
Study Director
Facility Information:
Facility Name
Virginia G. Piper Cancer Center at Scottsdale Healthcare
City
Scottsdale
State/Province
Arizona
ZIP/Postal Code
85258
Country
United States
Facility Name
University of Minnesota Masonic Cancer Clinic
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55455
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
19628086
Citation
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Results Reference
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PubMed Identifier
16556893
Citation
Carter BZ, Mak DH, Schober WD, McQueen T, Harris D, Estrov Z, Evans RL, Andreeff M. Triptolide induces caspase-dependent cell death mediated via the mitochondrial pathway in leukemic cells. Blood. 2006 Jul 15;108(2):630-7. doi: 10.1182/blood-2005-09-3898. Epub 2006 Mar 23.
Results Reference
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PubMed Identifier
12826269
Citation
Choi YJ, Kim TG, Kim YH, Lee SH, Kwon YK, Suh SI, Park JW, Kwon TK. Immunosuppressant PG490 (triptolide) induces apoptosis through the activation of caspase-3 and down-regulation of XIAP in U937 cells. Biochem Pharmacol. 2003 Jul 15;66(2):273-80. doi: 10.1016/s0006-2952(03)00282-x.
Results Reference
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PubMed Identifier
15184078
Citation
Liu Q, Chen T, Chen H, Zhang M, Li N, Lu Z, Ma P, Cao X. Triptolide (PG-490) induces apoptosis of dendritic cells through sequential p38 MAP kinase phosphorylation and caspase 3 activation. Biochem Biophys Res Commun. 2004 Jul 2;319(3):980-6. doi: 10.1016/j.bbrc.2004.04.201.
Results Reference
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PubMed Identifier
17909050
Citation
Phillips PA, Dudeja V, McCarroll JA, Borja-Cacho D, Dawra RK, Grizzle WE, Vickers SM, Saluja AK. Triptolide induces pancreatic cancer cell death via inhibition of heat shock protein 70. Cancer Res. 2007 Oct 1;67(19):9407-16. doi: 10.1158/0008-5472.CAN-07-1077.
Results Reference
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PubMed Identifier
9029176
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Shamon LA, Pezzuto JM, Graves JM, Mehta RR, Wangcharoentrakul S, Sangsuwan R, Chaichana S, Tuchinda P, Cleason P, Reutrakul V. Evaluation of the mutagenic, cytotoxic, and antitumor potential of triptolide, a highly oxygenated diterpene isolated from Tripterygium wilfordii. Cancer Lett. 1997 Jan 15;112(1):113-7. doi: 10.1016/S0304-3835(96)04554-5.
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PubMed Identifier
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Results Reference
background
Links:
URL
http://www.eurekalert.org/pub_releases/2012-10/uoma-uom101712.php
Description
Minnelide™ 001 Press Release Oct 2012
URL
http://www.td2inc.com/
Description
Translational Drug Development (TD2)

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Study of Minnelide™ in Patients With Advanced GI Tumors

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