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PLX038 (PEGylated SN38) and Rucaparib in Solid Tumors and Small Cell Cancers

Primary Purpose

Small Cell Lung Cancer, Extra-Pulmonary Small Cell Carcinomas

Status
Active
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
PLX038
Rucaparib
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Small Cell Lung Cancer focused on measuring PARP Inhibitor, Chemotherapy, DDR Inhibitor

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers
  • INCLUSION CRITERIA:
  • Subjects with:

    • histologically confirmed solid tumors (Phase I), OR
    • histologically or cytologically confirmed SCLC (Phase II), OR
    • histologically or cytologically confirmed extra-pulmonary small cell carcinomas (Phase II).
  • Age greater than or equal to 18 years. Because no dosing or adverse event data are currently available on the use of PLX038 in combination with rucaparib in participants <18 years of age, children are excluded from this study, but will be eligible for future pediatric trials.
  • Subjects must have progressed on or after standard first-line systemic chemotherapy and have no effective treatment options.
  • Participants must have disease that is not amenable to potentially curative resection.
  • Participants must have measurable disease per RECIST 1.1.
  • Participants with asymptomatic brain metastases and treated brain metastases are eligible.
  • ECOG performance status less than or equal to 2.
  • Adequate hematological function defined by:

    • white blood cell (WBC) count greater than or equal to 3 x 10^9/L,
    • absolute neutrophil count (ANC) greater than or equal to 1.5 x10^9/L,
    • platelet count greater than or equal to 100 x 10^9/L,
    • Hgb greater than or equal to 9 g/ dL
  • Adequate hepatic function defined by:

    • a total bilirubin level less than or equal to 1.5 x ULN,
    • an AST level less than or equal to 2.5xULN, (less than or equal to 5X ULN if liver metastasis)
    • an ALT level less than or equal to 2.5 xULN, (less than or equal to 5X ULN if liver metastasis).
  • Adequate renal function defined by:

    • Creatinine OR Measured or calculated creatinine clearance (CrCl) (eGFR may also be used in place of CrCl): < 1.5x institution upper limit of normal OR greater than or equal to 45 mL/min/1.73 m^2 for participant with creatinine levels greater than or equal to 1.5 X institutional ULN.

Note: Creatinine clearance (CrCl) or eGFR should be calculated per institutional standard.

  • The effects of the study treatment on the developing human fetus are unknown; thus, women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study treatment and up to 6 months after the last dose of the study drug (s). Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately.
  • Subjects must be able to understand and willing to sign a written informed consent document.

EXCLUSION CRITERIA:

  • Participants who are receiving any other investigational agents.
  • Systemic anti-cancer treatment or major surgery within 2 weeks prior to enrollment.
  • Radiotherapy within 24 hours prior to enrollment.
  • Participants who require treatment with strong inhibitors or inducers of CYP3A or with UGT1A1 inhibitors during the planned period of investigational treatment with PLX038.
  • Participants with known Gilbert s syndrome.
  • Participants homozygous for the UGT1A1*28 variant allele with severely reduced UGT1A1 activity.
  • Participants with known HIV, HCV, HBV status on antiviral drugs are excluded due to the absence of previous experience with concurrent use of antiviral medications and the investigational drug product to be evaluated in the current study and possible for adverse pharmacokinetic and/or pharmacodynamic interactions.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to PLX038 or rucaparib.
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that may impair the participants tolerance of study treatments.
  • Pregnant women are excluded from this study because PEGSN38 and rucaparib potential for teratogenic or abortifacient effects are unknown. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with PEGSN38 and rucaparib, breastfeeding should be discontinued if the mother is treated with study drugs.

Sites / Locations

  • National Institutes of Health Clinical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

1/Arm 1

2/Arm 2

Arm Description

Escalating doses of PLX038 and rucaparib

MTD of PLX038 and rucaparib

Outcomes

Primary Outcome Measures

Phase II: Clinical benefit rate
Assess the efficacy with respect to clinical benefit rate (CBR) (CR+PR+SD) for 4 months according to Response Evaluation Criteria (RECIST 1.1) of a combination of PLX038 and rucaparib in previously treated participants with small cell lung cancer and extra-pulmonary small cell carcinomas.
Phase I: MTD
Identify the maximum tolerated dose (MTD) of PLX038 in combination with rucaparib.

Secondary Outcome Measures

Toxicities
The safety of the treatment will be monitored, and any toxicities identified will be reported by type and grade.
Progression-free survival
Among participants in the phase IIA cohort, median progression free survival (PFS) will be calculated from the on-study date using the Kaplan-Meier method, along with 95% confidence intervals on the median PFS.
Overall survival
Among participants in the phase IIA cohort, median overall survival (OS) will be calculated from the on-study date using the Kaplan-Meier method, along with 95% confidence intervals on the median OS.
Clinical response rate
The fraction of participants who experience a clinical response (CR+PR) will be reported along with a 95% confidence interval.

Full Information

First Posted
December 21, 2019
Last Updated
October 20, 2023
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT04209595
Brief Title
PLX038 (PEGylated SN38) and Rucaparib in Solid Tumors and Small Cell Cancers
Official Title
Phase I/II Trial of PLX038 (PEGylated SN38) and Rucaparib in Solid Tumors and Small Cell Cancers
Study Type
Interventional

2. Study Status

Record Verification Date
October 19, 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
April 8, 2020 (Actual)
Primary Completion Date
August 13, 2021 (Actual)
Study Completion Date
December 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

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

5. Study Description

Brief Summary
Background: Drugs known as PARP inhibitors are known to help stop tumor growth in patients with breast, ovarian cancers and many other cancers including prostate and pancreatic cancers. Many research studies done in animals and human cells have shown that these type of drugs can improve how well chemotherapy works. Standard chemotherapy can be too toxic to be combined with PARP inhibitors. In this study, we use a new form of chemotherapy called PLX038 to see if it can be safely combined with PARP inhibitors to shrink tumors. Objective: To find a safe combination of PLX038 and rucaparib, and to see if this mix will cause tumors to shrink. Eligibility: People age 18 and older with solid tumors, SCLC, or small cell cancer outside their lungs. Design: Participants will be screened with: Physical exam Blood tests Records of their diagnosis (or they will have a tumor biopsy) A review of their symptoms and medications A review of their ability to perform their normal activities Electrocardiograms to measure the electrical activity of the heart Computed tomography (CT) scans of the chest, abdomen, and pelvis. CT scans are a series of X-rays. Participants will get PLX038 by intravenous catheter on Day 1 of each cycle (1 cycle = 21 days). For this, a small plastic tube is put into an arm vein. They will take rucaparib twice daily by mouth on Days 3 to 19 of each cycle. They will keep a medicine diary. Participants may give a hair sample. They may have optional tumor biopsies. Screening tests are repeated throughout the study. About 30 days after treatment ends, participants will have a safety follow-up visit. They will give blood samples, talk about their health, and get a physical exam. Then they will be called or emailed every 6 months....
Detailed Description
Background: We hypothesize that a dose-escalation strategy that incorporates tumor targeted DNA-damaging chemotherapy and DNA-damage response (DDR) inhibitors could allow safe and effective administration of DDR inhibitor-chemotherapy combination. PLX038 is a PEGylated conjugate of SN38 with improved properties including increased solubility, higher exposure and longer half-life. SN-38 is the active metabolite of CPT-11 (irinotecan) that inhibits topoisomerase 1 (Top1) and causes DNA strand breakage. As a specific DNA damaging agent, SN-38 enhances cell kill in tumors deficient in the DNA-damage response and when combined with inhibitors of the DDR. Rucaparib is a potent oral poly ADP ribose polymerase (PARP) inhibitor that is approved for the maintenance treatment of participants with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in a complete or partial response to platinum-based chemotherapy. We hypothesize that the combination of PLX038 plus rucaparib is more efficacious than either agent alone. Objectives: Phase I: To identify the maximum tolerated dose (MTD) of PLX038 in combination with rucaparib. Phase II: To assess the efficacy with respect to clinical benefit rate (CBR) (CR+PR+SD) for 4 months according to Response Evaluation Criteria (RECIST 1.1) of a combination of PLX038 and rucaparib in participants with small cell lung cancer and extra-pulmonary small cell carcinomas. Eligibility: Subjects with histologically confirmed solid tumors (Phase I) OR histologically or cytologically confirmed small cell lung cancer (SCLC) (Phase II) OR histologically or cytologically confirmed extra-pulmonary small cell carcinomas (Phase II). Age greater than or equal to 18 years Subjects must have evaluable or measurable disease. ECOG performance status less than or equal to 2 Adequate organ function Design: This is an open label Phase I/II trial accruing initially one cohort to determine maximum tolerated dose (MTD) of combined treatment of PLX038 and rucaparib (Phase I); and to examine the safety and efficacy of PLX038 in combination with rucaparib in the following cohort (Phase II). PLX038 will be administered by IV infusion on day 1 of every 21-days cycle, rucaparib will be administered PO twice daily on days 6 to 19 of every cycle. Treatment will continue until progression or unacceptable toxicity. Biomarkers of participant response to treatment will be investigated in an exploratory manner pre and post-treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Small Cell Lung Cancer, Extra-Pulmonary Small Cell Carcinomas
Keywords
PARP Inhibitor, Chemotherapy, DDR Inhibitor

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
10 (Actual)

8. Arms, Groups, and Interventions

Arm Title
1/Arm 1
Arm Type
Experimental
Arm Description
Escalating doses of PLX038 and rucaparib
Arm Title
2/Arm 2
Arm Type
Experimental
Arm Description
MTD of PLX038 and rucaparib
Intervention Type
Drug
Intervention Name(s)
PLX038
Intervention Description
Phase I: Dose escalation will follow the classical 3+3 trial design by Fibonacci sequence. Phase II: MTD identified in phase I. PLX038 will be administered as a 1 hour (-10 minutes / +30 minutes) IV infusion on Day 1 of each cycle (21 days).
Intervention Type
Drug
Intervention Name(s)
Rucaparib
Intervention Description
Phase I: Dose escalation will follow the classical 3+3 trial design by Fibonacci sequence. Phase II: MTD identified in phase I. Rucaparib will be given orally at designated dose twice a day on days 5 to 19 of every 21-day cycle.
Primary Outcome Measure Information:
Title
Phase II: Clinical benefit rate
Description
Assess the efficacy with respect to clinical benefit rate (CBR) (CR+PR+SD) for 4 months according to Response Evaluation Criteria (RECIST 1.1) of a combination of PLX038 and rucaparib in previously treated participants with small cell lung cancer and extra-pulmonary small cell carcinomas.
Time Frame
Disease progression
Title
Phase I: MTD
Description
Identify the maximum tolerated dose (MTD) of PLX038 in combination with rucaparib.
Time Frame
Phase I
Secondary Outcome Measure Information:
Title
Toxicities
Description
The safety of the treatment will be monitored, and any toxicities identified will be reported by type and grade.
Time Frame
Phase I and phase II
Title
Progression-free survival
Description
Among participants in the phase IIA cohort, median progression free survival (PFS) will be calculated from the on-study date using the Kaplan-Meier method, along with 95% confidence intervals on the median PFS.
Time Frame
Disease progression
Title
Overall survival
Description
Among participants in the phase IIA cohort, median overall survival (OS) will be calculated from the on-study date using the Kaplan-Meier method, along with 95% confidence intervals on the median OS.
Time Frame
Death
Title
Clinical response rate
Description
The fraction of participants who experience a clinical response (CR+PR) will be reported along with a 95% confidence interval.
Time Frame
Disease progression

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: Subjects with: histologically confirmed solid tumors (Phase I), OR histologically or cytologically confirmed SCLC (Phase II), OR histologically or cytologically confirmed extra-pulmonary small cell carcinomas (Phase II). Age greater than or equal to 18 years. Because no dosing or adverse event data are currently available on the use of PLX038 in combination with rucaparib in participants <18 years of age, children are excluded from this study, but will be eligible for future pediatric trials. Subjects must have progressed on or after standard first-line systemic chemotherapy and have no effective treatment options. Participants must have disease that is not amenable to potentially curative resection. Participants must have measurable disease per RECIST 1.1. Participants with asymptomatic brain metastases and treated brain metastases are eligible. ECOG performance status less than or equal to 2. Adequate hematological function defined by: white blood cell (WBC) count greater than or equal to 3 x 10^9/L, absolute neutrophil count (ANC) greater than or equal to 1.5 x10^9/L, platelet count greater than or equal to 100 x 10^9/L, Hgb greater than or equal to 9 g/ dL Adequate hepatic function defined by: a total bilirubin level less than or equal to 1.5 x ULN, an AST level less than or equal to 2.5xULN, (less than or equal to 5X ULN if liver metastasis) an ALT level less than or equal to 2.5 xULN, (less than or equal to 5X ULN if liver metastasis). Adequate renal function defined by: Creatinine OR Measured or calculated creatinine clearance (CrCl) (eGFR may also be used in place of CrCl): < 1.5x institution upper limit of normal OR greater than or equal to 45 mL/min/1.73 m^2 for participant with creatinine levels greater than or equal to 1.5 X institutional ULN. Note: Creatinine clearance (CrCl) or eGFR should be calculated per institutional standard. The effects of the study treatment on the developing human fetus are unknown; thus, women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study treatment and up to 6 months after the last dose of the study drug (s). Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Subjects must be able to understand and willing to sign a written informed consent document. EXCLUSION CRITERIA: Participants who are receiving any other investigational agents. Systemic anti-cancer treatment or major surgery within 2 weeks prior to enrollment. Radiotherapy within 24 hours prior to enrollment. Participants who require treatment with strong inhibitors or inducers of CYP3A or with UGT1A1 inhibitors during the planned period of investigational treatment with PLX038. Participants with known Gilbert s syndrome. Participants homozygous for the UGT1A1*28 variant allele with severely reduced UGT1A1 activity. Participants with known HIV, HCV, HBV status on antiviral drugs are excluded due to the absence of previous experience with concurrent use of antiviral medications and the investigational drug product to be evaluated in the current study and possible for adverse pharmacokinetic and/or pharmacodynamic interactions. History of allergic reactions attributed to compounds of similar chemical or biologic composition to PLX038 or rucaparib. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that may impair the participants tolerance of study treatments. Pregnant women are excluded from this study because PEGSN38 and rucaparib potential for teratogenic or abortifacient effects are unknown. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with PEGSN38 and rucaparib, breastfeeding should be discontinued if the mother is treated with study drugs.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Anish Thomas, M.D.
Organizational Affiliation
National Cancer Institute (NCI)
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institutes of Health Clinical Center
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
.All IPD recorded in the medical record will be shared with intramural investigators upon request. In addition, all large scale genomic sequencing data will be shared with subscribers to dbGaP.
IPD Sharing Time Frame
Clinical data available during the study and indefinitely.@@@@@@Genomic data are available once genomic data are uploaded per protocol GDS plan for as long as database is active.
IPD Sharing Access Criteria
Clinical data will be made available via subscription to BTRIS and with the permission of the study PI. @@@@@@Genomic data are made available via dbGaP through requests to the data custodians.
Links:
URL
https://clinicalstudies.info.nih.gov/cgi/detail.cgi?B_2020-C-0013.html
Description
NIH Clinical Center Detailed Web Page

Learn more about this trial

PLX038 (PEGylated SN38) and Rucaparib in Solid Tumors and Small Cell Cancers

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