search
Back to results

Oral STAT3 Inhibitor, TTI-101, in Patients With Advanced Cancers

Primary Purpose

Breast Cancer, Head and Neck Squamous Cell Carcinoma, Non Small Cell Lung Cancer

Status
Active
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
TTI-101
TTI-101
Sponsored by
Tvardi Therapeutics, Incorporated
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Breast Cancer focused on measuring STAT3, cancer, inhibitor, advanced cancer

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria

All of the following inclusion criteria must be fulfilled for eligibility:

  1. Age ≥18 years;
  2. For patients with solid tumors (not unresectable HCC): Patients with histologically confirmed diagnosis of locally-advanced, inoperable, metastatic and/or treatment refractory solid tumors for whom there are no available therapies that will confer clinical benefit;
  3. For patients with unresectable HCC: Patients with histologically confirmed diagnosis of locally advanced, inoperable, unresectable HCC who have failed first and second lines of therapy and Child-Pugh is A or beyond second line if the performance status is preserved and Child-Pugh is A.
  4. Eastern Cooperative Oncology Group Performance status 0-1;
  5. Hemoglobin ≥9.0 g/dL, neutrophil count ≥1.0 x 109/l, platelets ≥75 x 109/L;
  6. Adequate renal function capability, as calculated by creatinine clearance >40 ml/min using the Cockroft-Gault formula;
  7. Adequate liver function defined as total bilirubin <1.5 x ULN, and aspartate aminotransferase (AST)/alanine aminotransferase (ALT) <3 x ULN. For subjects with liver involvement, AST/ALT <5 x ULN; For subjects with liver involvement, AST/ALT <5 x ULN;
  8. Measurable disease using clinically appropriate criteria for the type of malignancy, RECIST v 1.1 for solid tumors;
  9. Negative pregnancy test at the screening visit for women of childbearing potential, defined as: female subjects after puberty unless they have been postmenopausal for at least two years, are surgically sterile, or are sexually inactive and will remain so for the course of the trial;
  10. Willingness to avoid pregnancy and breast feeding beginning two weeks before the first TTI-101 dose and ending three months after the last trial treatment. Male subjects with female partners of childbearing potential and female subjects of childbearing potential must use adequate contraception in the judgment of the Investigator, such as a two-barrier method or a one-barrier method with spermicide or intrauterine device during trial treatment dosing and for 3 months after the last dose of the study; and
  11. Ability to read and understand the informed consent form and willingness and ability to give informed consent and demonstrate comprehension of the trial before undergoing any trial activities.

Exclusion Criteria

Subjects are ineligible to enroll in this trial if they fulfill any of the following exclusion criteria:

  1. Previous therapy with:

    1. Standard therapy including chemotherapy, immunotherapy, biologic therapy, or any other anticancer therapy within 28 days (or five elimination half-lives for non-cytotoxic drugs, whichever is shorter) of Day 1 of trial drug treatment (6 weeks for nitrosureas or mitomycin);
    2. Any investigational agent within 28 days of Day 1 of trial drug treatment or 5 half-lives for a small molecule/targeted therapy;
  2. Extensive prior radiotherapy on more than 30% of bone marrow reserves, or prior bone marrow/stem cell transplantation within 5 years from enrollment; Ongoing toxicity (except alopecia) due to a prior therapy, unless returned to baseline or Grade 1 or less;
  3. Major surgical intervention or participation in a therapeutic clinical trial within 28 days from Day 1 of the first dose of TTI-101;
  4. Significantly impaired cardiac function such as unstable angina pectoris, congestive heart failure with New York Heart Association (NYHA) class III or IV, myocardial infarction within the last 12 months prior to trial entry; signs of pericardial effusion, serious arrhythmia (including QTc prolongation of >470 ms and/or pacemaker) or prior diagnosis of congenital long QT syndrome or left ventricular ejection fraction <50% on screening echocardiogram;
  5. History of cerebral vascular accident or stroke within the previous 2 years;
  6. Uncontrolled hypertension (>160/100mm Hg);
  7. History of Grade 3 or 4 allergic reactions attributed to compounds of similar chemical or biologic composition as TTI-101 (hydroxyl-naphthalene sulfonamides);
  8. Known active metastases in the central nervous system (unless stable by brain imaging studies for at least 1 month without evidence of cerebral edema and no requirements for corticosteroids or anticonvulsants);
  9. History of difficulty swallowing, malabsorption, or other chronic gastrointestinal disease or conditions that may hamper compliance and/or absorption of the investigational product;
  10. Known human immunodeficiency virus (HIV);
  11. Subjects with chronic hepatitis B virus (HBV) infection, unless screening viral load <100 IU/mL on stable doses of antiviral therapy. Note: Subjects with chronic HCV infection are allowed to enroll in the study but do not have a defined maximum viral load requirement for study entry;
  12. Legal incapacity or limited legal capacity;
  13. Pregnant or lactating women;
  14. Any other condition, which in the opinion of the investigator, might impair the subject's tolerance of trial treatment, the safety of the individual subject, or the outcome of the trial;
  15. Previous treatment of the current malignancy with a STAT inhibitor.

Sites / Locations

  • The University of Texas MD Anderson Cancer Center
  • Mays Cancer Center at University of Texas Health Science Center SA

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Experimental

Arm Label

Dose escalation study

Dose expansion study

Food effect study

Dose expansion, cross-over study

Arm Description

Participants will receive up to 4 dose levels of TTI-101 to determine RP2D

Enrollment in the dose expansion may commence with approval from the safety review committee. Participants will be enrolled and treated at the RP2D of TTI-101

Participants will be treated with TTI-101 at the RP2D under fed and fasted conditions to assess the bioavailability of TTI-101 and to determine the best conditions for taking the study drug

Participants will be administered different formulations of TTI-101 to compare bioavailability.

Outcomes

Primary Outcome Measures

Maximum Tolerated Dose of TTI-101
To determine the maximum tolerated dose (MTD), dose-limiting toxicities, and tolerability of TTI-101 administered orally to patients with advanced breast cancer and other solid tumors. Dose-limiting toxicity is defined as a Grade 3 or above adverse event (using CTCAE v5.0) within the first treatment cycle (28-days).
Pharmacokinetics - Cmax
Cmax(obs) will be determined by direct inspection of the plasma drug concentration versus time data point values.
Pharmacokinetics - Tmax
Tmax(obs) will also be determined by direct inspection of the plasma drug concentration versus time data point values.
Pharmacokinetics - AUC(0-t)
AUC(0-t) (where t = the time point for the last sample on the pharmacokinetic profile in which quantifiable drug was detected) will be estimated using linear or linear/log trapezoidal calculation.

Secondary Outcome Measures

Pharmacodynamics of TTI-101 in patients
Levels of pY-STAT3 measured before and before and after receiving TTI-101 will be measured.
Complete Response (CR) - Target Lesions
Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm.
Partial Response (PR) - Target Lesions
Partial Response (PR): At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
Progressive Disease (PD) - Target Lesions
Progressive Disease (PD): At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).
Stable Disease (SD) - Target Lesions
Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.
Complete Response (CR) - Non-target Lesions
Complete Response (CR): Disappearance of all non-target lesions and normalization of tumor marker level. All lymph nodes must be non-pathological in size (<10 mm short axis).
Non-CR/Non-PD - Non-target Lesions
Non-CR/Non-PD: Persistence of one or more non-target lesion(s) and/or maintenance of tumor marker level above the normal limits.
Progressive Disease (PD) - Non-target Lesions
Progressive Disease (PD): Unequivocal progression of existing non-target lesions. (Note: the appearance of one or more new lesions is also considered progression).
Best Overall Response
The best overall response is the best response recorded from the start of the study treatment until the end of treatment, taking into account any requirement for confirmation. The patient's best overall response assignment will depend on the findings of both target and non-target disease and will also take into consideration the appearance of new lesions.

Full Information

First Posted
June 9, 2017
Last Updated
October 18, 2022
Sponsor
Tvardi Therapeutics, Incorporated
Collaborators
M.D. Anderson Cancer Center
search

1. Study Identification

Unique Protocol Identification Number
NCT03195699
Brief Title
Oral STAT3 Inhibitor, TTI-101, in Patients With Advanced Cancers
Official Title
Phase I Study of TTI-101, an Oral Inhibitor of Signal Transducer and Activator of Transcription (STAT) 3, in Patients With Advanced Cancers
Study Type
Interventional

2. Study Status

Record Verification Date
October 2022
Overall Recruitment Status
Active, not recruiting
Study Start Date
November 15, 2017 (Actual)
Primary Completion Date
October 1, 2023 (Anticipated)
Study Completion Date
October 1, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Tvardi Therapeutics, Incorporated
Collaborators
M.D. Anderson Cancer Center

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
Many patients have cancers that have increased activity of a protein called STAT3 that contributes critically to the development and growth of their cancer. Despite our knowledge of STAT3's importance to cancer, scientists and doctors have not developed a drug that targets it and that patients can take to treat their cancer more effectively than treatments that are now available. Tvardi Therapeutics, Incorporated has developed a compound, TTI-101, which can be given by mouth and acts as a direct inhibitor of STAT3. Administration of TTI-101 to mice demonstrated that it blocked growth of cancers of the breast, head and neck, lung, and liver and it was safe when administered at high doses to mice, rats, and dogs. In this application, Tvardi is proposing to further develop TTI-101 for treatment of solid tumors for which the prognosis is dismal. The investigators will determine how safe it is when administered to patients with cancer, determine whether an adequate dose can be administered to patients with cancer that will block STAT3 in their cancer, and determine whether treatment with TTI-101 leads to reduced growth of their cancer.
Detailed Description
Signal transducer and activator of transcription 3 (STAT3) is a member of a family of seven closely related proteins responsible for transmission of peptide hormone signals from the extracellular surface of cells to the nucleus. STAT3 is a master regulator of most key hallmarks and enablers of cancer, including cell proliferation, resistance to apoptosis, metastasis, immune evasion, tumor angiogenesis, epithelial mesenchymal transition (EMT), response to DNA damage, and the Warburg effect. STAT3 also is a key mediator of oncogene addiction and supports the self-renewal of tumor-initiating cancer stem cells that contribute to cancer initiation, cancer maintenance, and relapse in several types of tumors. STAT3 activity is increased in ~50% of all cancers, due either to naturally occurring STAT3 mutations, as have been demonstrated in human inflammatory hepatocellular adenomas and large granular lymphocytic leukemia, or, more commonly as a result of activation of signaling molecules upstream of STAT3, including receptor tyrosine kinases (RTK; e.g. epidermal growth factor receptor, EGFR), tyrosine kinase-associated receptors (e.g. the family of IL-6 cytokine receptors or G-protein coupled receptors, GPCR), and Src kinases (e.g. Src, Lck, Hck, Lyn, Fyn, or Fgr). Thus, STAT3 is an attractive target for drug development to treat many types of cancer including breast cancer, head and neck squamous cell carcinoma (HNSCC), non-small cell lung cancer (NSCLC), hepatocellular carcinoma (HCC), colorectal cancer (CRC), gastric adenocarcinoma and melanoma.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Cancer, Head and Neck Squamous Cell Carcinoma, Non Small Cell Lung Cancer, Hepatocellular Cancer, Colorectal Cancer, Gastric Adenocarcinoma, Melanoma, Advanced Cancer
Keywords
STAT3, cancer, inhibitor, advanced cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Dose escalation study
Arm Type
Experimental
Arm Description
Participants will receive up to 4 dose levels of TTI-101 to determine RP2D
Arm Title
Dose expansion study
Arm Type
Experimental
Arm Description
Enrollment in the dose expansion may commence with approval from the safety review committee. Participants will be enrolled and treated at the RP2D of TTI-101
Arm Title
Food effect study
Arm Type
Experimental
Arm Description
Participants will be treated with TTI-101 at the RP2D under fed and fasted conditions to assess the bioavailability of TTI-101 and to determine the best conditions for taking the study drug
Arm Title
Dose expansion, cross-over study
Arm Type
Experimental
Arm Description
Participants will be administered different formulations of TTI-101 to compare bioavailability.
Intervention Type
Drug
Intervention Name(s)
TTI-101
Intervention Description
Oral capsule
Intervention Type
Drug
Intervention Name(s)
TTI-101
Intervention Description
Oral tablet
Primary Outcome Measure Information:
Title
Maximum Tolerated Dose of TTI-101
Description
To determine the maximum tolerated dose (MTD), dose-limiting toxicities, and tolerability of TTI-101 administered orally to patients with advanced breast cancer and other solid tumors. Dose-limiting toxicity is defined as a Grade 3 or above adverse event (using CTCAE v5.0) within the first treatment cycle (28-days).
Time Frame
28 days
Title
Pharmacokinetics - Cmax
Description
Cmax(obs) will be determined by direct inspection of the plasma drug concentration versus time data point values.
Time Frame
18 months
Title
Pharmacokinetics - Tmax
Description
Tmax(obs) will also be determined by direct inspection of the plasma drug concentration versus time data point values.
Time Frame
18 months
Title
Pharmacokinetics - AUC(0-t)
Description
AUC(0-t) (where t = the time point for the last sample on the pharmacokinetic profile in which quantifiable drug was detected) will be estimated using linear or linear/log trapezoidal calculation.
Time Frame
18 months
Secondary Outcome Measure Information:
Title
Pharmacodynamics of TTI-101 in patients
Description
Levels of pY-STAT3 measured before and before and after receiving TTI-101 will be measured.
Time Frame
18 months
Title
Complete Response (CR) - Target Lesions
Description
Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm.
Time Frame
18 months
Title
Partial Response (PR) - Target Lesions
Description
Partial Response (PR): At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
Time Frame
18 months
Title
Progressive Disease (PD) - Target Lesions
Description
Progressive Disease (PD): At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).
Time Frame
18 months
Title
Stable Disease (SD) - Target Lesions
Description
Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.
Time Frame
18 months
Title
Complete Response (CR) - Non-target Lesions
Description
Complete Response (CR): Disappearance of all non-target lesions and normalization of tumor marker level. All lymph nodes must be non-pathological in size (<10 mm short axis).
Time Frame
18 months
Title
Non-CR/Non-PD - Non-target Lesions
Description
Non-CR/Non-PD: Persistence of one or more non-target lesion(s) and/or maintenance of tumor marker level above the normal limits.
Time Frame
6 months
Title
Progressive Disease (PD) - Non-target Lesions
Description
Progressive Disease (PD): Unequivocal progression of existing non-target lesions. (Note: the appearance of one or more new lesions is also considered progression).
Time Frame
18 months
Title
Best Overall Response
Description
The best overall response is the best response recorded from the start of the study treatment until the end of treatment, taking into account any requirement for confirmation. The patient's best overall response assignment will depend on the findings of both target and non-target disease and will also take into consideration the appearance of new lesions.
Time Frame
18 months
Other Pre-specified Outcome Measures:
Title
Explore association between biomarkers and antitumor efficacy and survival outcome based on RECIST 1.1 for uHCC patients.
Description
Assess the association between STAT3 inhibition, fibrosis (if applicable), antitumor activity and survival outcomes after receiving TTI-101. Tissue and blood immune monitoring will be based on 2 biopsies. Association between biomarkers including pY-STAT3, PD1, and PD-L1 proteins expression by IHC, gene expression profiling, and antitumor efficacy and survival outcome of TTI-101 based on RECIST 1.1.
Time Frame
18 months
Title
Assess the effect of food on bioavailability
Description
Assess the effect of food on bioavailability of TTI-101 in the dose expansion phase
Time Frame
18 months
Title
Assess the bioavailability between different formulations of TTI-101
Description
Assess the bioavailability between different formulations of TTI-101 in the dose expansion phase
Time Frame
18 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria All of the following inclusion criteria must be fulfilled for eligibility: Age ≥18 years; For patients with solid tumors (not unresectable HCC): Patients with histologically confirmed diagnosis of locally-advanced, inoperable, metastatic and/or treatment refractory solid tumors for whom there are no available therapies that will confer clinical benefit; For patients with unresectable HCC: Patients with histologically confirmed diagnosis of locally advanced, inoperable, unresectable HCC who have failed first and second lines of therapy and Child-Pugh is A or beyond second line if the performance status is preserved and Child-Pugh is A. Eastern Cooperative Oncology Group Performance status 0-1; Hemoglobin ≥9.0 g/dL, neutrophil count ≥1.0 x 109/l, platelets ≥75 x 109/L; Adequate renal function capability, as calculated by creatinine clearance >40 ml/min using the Cockroft-Gault formula; Adequate liver function defined as total bilirubin <1.5 x ULN, and aspartate aminotransferase (AST)/alanine aminotransferase (ALT) <3 x ULN. For subjects with liver involvement, AST/ALT <5 x ULN; For subjects with liver involvement, AST/ALT <5 x ULN; Measurable disease using clinically appropriate criteria for the type of malignancy, RECIST v 1.1 for solid tumors; Negative pregnancy test at the screening visit for women of childbearing potential, defined as: female subjects after puberty unless they have been postmenopausal for at least two years, are surgically sterile, or are sexually inactive and will remain so for the course of the trial; Willingness to avoid pregnancy and breast feeding beginning two weeks before the first TTI-101 dose and ending three months after the last trial treatment. Male subjects with female partners of childbearing potential and female subjects of childbearing potential must use adequate contraception in the judgment of the Investigator, such as a two-barrier method or a one-barrier method with spermicide or intrauterine device during trial treatment dosing and for 3 months after the last dose of the study; and Ability to read and understand the informed consent form and willingness and ability to give informed consent and demonstrate comprehension of the trial before undergoing any trial activities. Exclusion Criteria Subjects are ineligible to enroll in this trial if they fulfill any of the following exclusion criteria: Previous therapy with: Standard therapy including chemotherapy, immunotherapy, biologic therapy, or any other anticancer therapy within 28 days (or five elimination half-lives for non-cytotoxic drugs, whichever is shorter) of Day 1 of trial drug treatment (6 weeks for nitrosureas or mitomycin); Any investigational agent within 28 days of Day 1 of trial drug treatment or 5 half-lives for a small molecule/targeted therapy; Extensive prior radiotherapy on more than 30% of bone marrow reserves, or prior bone marrow/stem cell transplantation within 5 years from enrollment; Ongoing toxicity (except alopecia) due to a prior therapy, unless returned to baseline or Grade 1 or less; Major surgical intervention or participation in a therapeutic clinical trial within 28 days from Day 1 of the first dose of TTI-101; Significantly impaired cardiac function such as unstable angina pectoris, congestive heart failure with New York Heart Association (NYHA) class III or IV, myocardial infarction within the last 12 months prior to trial entry; signs of pericardial effusion, serious arrhythmia (including QTc prolongation of >470 ms and/or pacemaker) or prior diagnosis of congenital long QT syndrome or left ventricular ejection fraction <50% on screening echocardiogram; History of cerebral vascular accident or stroke within the previous 2 years; Uncontrolled hypertension (>160/100mm Hg); History of Grade 3 or 4 allergic reactions attributed to compounds of similar chemical or biologic composition as TTI-101 (hydroxyl-naphthalene sulfonamides); Known active metastases in the central nervous system (unless stable by brain imaging studies for at least 1 month without evidence of cerebral edema and no requirements for corticosteroids or anticonvulsants); History of difficulty swallowing, malabsorption, or other chronic gastrointestinal disease or conditions that may hamper compliance and/or absorption of the investigational product; Known human immunodeficiency virus (HIV); Subjects with chronic hepatitis B virus (HBV) infection, unless screening viral load <100 IU/mL on stable doses of antiviral therapy. Note: Subjects with chronic HCV infection are allowed to enroll in the study but do not have a defined maximum viral load requirement for study entry; Legal incapacity or limited legal capacity; Pregnant or lactating women; Any other condition, which in the opinion of the investigator, might impair the subject's tolerance of trial treatment, the safety of the individual subject, or the outcome of the trial; Previous treatment of the current malignancy with a STAT inhibitor.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Apostolia Tsimberidou, MD, PhD
Organizational Affiliation
The University of Texas MD Anderson Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
The University of Texas MD Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
Mays Cancer Center at University of Texas Health Science Center SA
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78229
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Oral STAT3 Inhibitor, TTI-101, in Patients With Advanced Cancers

We'll reach out to this number within 24 hrs