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DRP-104 (Glutamine Antagonist) in Combination With Durvalumab in Patients With Advanced Stage Fibrolamellar Carcinoma (FLC)

Primary Purpose

Fibrolamellar Hepatocellular Carcinoma

Status
Not yet recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Durvalumab
DRP-104
Sponsored by
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Fibrolamellar Hepatocellular Carcinoma focused on measuring Fibrolamellar Carcinoma (FLC), Durvalumab, DRP-104 (glutamine antagonist), Immunotherapy, Anti PD-L1, PD-L1, Carcinoma, Glutamine antagonist

Eligibility Criteria

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

Inclusion Criteria: Must have histologically confirmed FLC (Fibrolamellar Carcinoma) that is metastatic or unresectable. Presence of DNAJB1-PRKACA fusion transcript, assessed by RNA-sequencing, DNA-sequencing, or in situ hybridization in the archival tissue. Must have demonstrated radiographic progression on prior or current immunotherapy. Age ≥ 12 years. Patients < 18 years old must have a body weight ≥ 40 kg. Eastern Cooperative Oncology Group (ECOG) performance status of ≤2 Patients must have adequate organ and marrow function defined by study-specified laboratory tests. Patients must have adequate kidney and liver function defined by study-specified laboratory tests. Must have measurable disease per RECIST 1.1 Willingness to provide tissue and blood samples for mandatory translational research. Women of childbearing potential (WOCBP) must have a negative urine or serum pregnancy test. For both Women and Men, must use acceptable form of birth control while on study. Ability to understand and willingness to sign a written informed consent document. Exclusion Criteria: Must have had chemotherapy or other systemic therapy or radiotherapy, as follows: Patients who have had chemotherapy, biological cancer therapy, or radiation 21 days prior to the first dose of study drug. Patients who have had surgery within 28 days of dosing of investigational agent, excluding minor procedures. Patients who have received other approved or investigational agents or device within 21 days of the first dose of study drug. Patients who have not recovered from acute adverse events to grade ≤1 or baseline due to agents administered, with exception of grade 2 fatigue, rash, and endocrinopathy successfully managed hormone replacement therapy, or alopecia or stable neuropathy, unless approved by the investigational new drug (IND) Sponsor. Patients with corrected QT interval (QTc) prolongation > 470 ms according to Fridericia formula. Patients receiving potent inducers of Cytochrome P450 3A (CYP 3A4/5) (including apalutamide, carbamazepine, enzalutamide, mitotane, phenytoin, rifampin and St. John's Wort) that cannot be discontinued at least 14 days prior to Cycle 1 Day 1. Known sensitivity to or history of allergic reactions attributed to compounds of similar chemical or biologic composition of DRP-104 or durvalumab. Subjects with interstitial lung disease that is symptomatic or may interfere with the detection or management of suspected drug-related pulmonary toxicity. Has a pulse oximetry of <92% on room air or is on supplemental home oxygen. Active or untreated brain metastases or leptomeningeal metastases. Uncontrolled intercurrent active medical and/or psychiatric illness/social psychosocial problems that that would limit compliance with study requirements. Uncontrolled intercurrent illness including, but not limited to, uncontrolled infection, symptomatic congestive heart failure, unstable angina, cardiac arrhythmia, metastatic cancer, or psychiatric illness/social situations that would limit compliance with study requirements. Pregnant or breastfeeding. Has a known history of Human Immunodeficiency Virus (HIV)/AIDS. Has active hepatitis B. Patients with chronic or acute hepatitis B virus (HBV) infection . Have had evidence of active or acute diverticulitis, intra-abdominal abscess, or GI obstruction which are known risk factors for bowel perforation should be evaluated for the potential need for additional treatment before coming on study. Patient is unwilling or unable to follow the study schedule for any reason. Patient is at the time of signing informed consent a regular user (including "recreational use") of any illicit drugs or had a recent history (within the last year) of substance abuse (including alcohol). Evidence of clinical ascites. Participants a with history of prior unacceptable and/or life-threatening toxicities attributed to anti-programmed death-receptor 1 (PD1) or anti-PD-L1 (anti-programmed death-receptor 1) therapy. Has active autoimmune disease that has required systemic treatment in the past 2 years. Prior allogeneic stem cell transplantation or organ transplantation. Has a diagnosis of immunodeficiency. Systemic corticosteroids at immunosuppressive doses.

Sites / Locations

  • Johns Hopkins SKCCC

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Durvalumab and DRP-104

Arm Description

Outcomes

Primary Outcome Measures

Number of participants experiencing drug-related adverse events (AEs) requiring treatment discontinuation
When calculating the incidence of AEs, each AE (as defined by NCI Common Terminology Criteria for Adverse Events [CTCAE] v5.0) will be counted only once for a given subject.
Objective response rate (ORR) using immune Response Evaluation Criteria for Solid Tumors (RECIST 1.1)
ORR is defined as the percentage of patients achieving a complete response (CR) or partial response (PR) to DRP-104 (glutamine antagonist) in combination with duvalumab, based on the Response Evaluation Criteria in Solid Tumors (RECIST 1.1) at any time during the study. CR = disappearance of all target lesions, PR is =>30percent decrease in sum of diameters of target lesions, progressive disease (PD) is >20percent increase in sum of diameters of target lesions, stable disease (SD) is <30percent decrease or <20percent increase in sum of diameters of target lesions.

Secondary Outcome Measures

Progression-free Survival (PFS)
PFS is defined as the number of months from the date of first treatment to disease progression (progressive disease [PD] or relapse from complete response [CR] as assessed using RECIST 1.1 criteria) or death due to any cause. Progression will be censored at the date of the last scan for subjects without documentation of disease progression at the time of analysis. Per RECIST 1.1 criteria, CR = disappearance of all target lesions, Partial Response (PR) is =>30% decrease in sum of diameters of target lesions, Progressive Disease (PD) is >20% increase in sum of diameters of target lesions, Stable Disease (SD) is <30% decrease or <20% increase in sum of diameters of target lesions. Estimation based on the Kaplan-Meier curve.
Overall survival (OS)
OS is defined as the number of months from the first dose of study treatment to death from any cause or end of follow-up. OS will be censored on the date the subject was last known to be alive for subjects without documentation of death at the time of analysis. Estimation based on the Kaplan-Meier curve.

Full Information

First Posted
August 30, 2023
Last Updated
August 30, 2023
Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
Dracen Pharmaceuticals, Inc., Fibrolamellar Cancer Foundation
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1. Study Identification

Unique Protocol Identification Number
NCT06027086
Brief Title
DRP-104 (Glutamine Antagonist) in Combination With Durvalumab in Patients With Advanced Stage Fibrolamellar Carcinoma (FLC)
Official Title
A Phase 1b/2 Study of Glutamine Antagonist DRP-104 in Combination With Durvalumab in Patients With Advanced Stage Fibrolamellar Hepatocellular Carcinoma (FLC)
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
January 1, 2024 (Anticipated)
Primary Completion Date
January 1, 2027 (Anticipated)
Study Completion Date
January 1, 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
Dracen Pharmaceuticals, Inc., Fibrolamellar Cancer Foundation

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
The purpose of this study is to determine whether the combination of subcutaneous DRP-104 in combination with intravenous Durvalumab is safe and yields a clinically compelling antitumor activity measured as based on objective response rate (ORR, assessed by RECIST 1.1). Secondary objectives include progression-free survival (PFS) and overall survival (OS).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Fibrolamellar Hepatocellular Carcinoma
Keywords
Fibrolamellar Carcinoma (FLC), Durvalumab, DRP-104 (glutamine antagonist), Immunotherapy, Anti PD-L1, PD-L1, Carcinoma, Glutamine antagonist

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
27 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Durvalumab and DRP-104
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Durvalumab
Other Intervention Name(s)
IMFINZI
Intervention Description
Patients will receive treatment on Day 1 of each cycle. Durvalumab (1500 mg) will be administered IV on Day 1 of each cycle every 28 days.
Intervention Type
Drug
Intervention Name(s)
DRP-104
Intervention Description
Patients will receive treatment twice a week of each cycle. DRP-104 (145 mg,125mg, 105mg, 85mg or 65mg) will be administered subcutaneous injection twice a week of each 28 day cycle.
Primary Outcome Measure Information:
Title
Number of participants experiencing drug-related adverse events (AEs) requiring treatment discontinuation
Description
When calculating the incidence of AEs, each AE (as defined by NCI Common Terminology Criteria for Adverse Events [CTCAE] v5.0) will be counted only once for a given subject.
Time Frame
4 years
Title
Objective response rate (ORR) using immune Response Evaluation Criteria for Solid Tumors (RECIST 1.1)
Description
ORR is defined as the percentage of patients achieving a complete response (CR) or partial response (PR) to DRP-104 (glutamine antagonist) in combination with duvalumab, based on the Response Evaluation Criteria in Solid Tumors (RECIST 1.1) at any time during the study. CR = disappearance of all target lesions, PR is =>30percent decrease in sum of diameters of target lesions, progressive disease (PD) is >20percent increase in sum of diameters of target lesions, stable disease (SD) is <30percent decrease or <20percent increase in sum of diameters of target lesions.
Time Frame
4 years
Secondary Outcome Measure Information:
Title
Progression-free Survival (PFS)
Description
PFS is defined as the number of months from the date of first treatment to disease progression (progressive disease [PD] or relapse from complete response [CR] as assessed using RECIST 1.1 criteria) or death due to any cause. Progression will be censored at the date of the last scan for subjects without documentation of disease progression at the time of analysis. Per RECIST 1.1 criteria, CR = disappearance of all target lesions, Partial Response (PR) is =>30% decrease in sum of diameters of target lesions, Progressive Disease (PD) is >20% increase in sum of diameters of target lesions, Stable Disease (SD) is <30% decrease or <20% increase in sum of diameters of target lesions. Estimation based on the Kaplan-Meier curve.
Time Frame
4 years
Title
Overall survival (OS)
Description
OS is defined as the number of months from the first dose of study treatment to death from any cause or end of follow-up. OS will be censored on the date the subject was last known to be alive for subjects without documentation of death at the time of analysis. Estimation based on the Kaplan-Meier curve.
Time Frame
4 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
12 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Must have histologically confirmed FLC (Fibrolamellar Carcinoma) that is metastatic or unresectable. Presence of DNAJB1-PRKACA fusion transcript, assessed by RNA-sequencing, DNA-sequencing, or in situ hybridization in the archival tissue. Must have demonstrated radiographic progression on prior or current immunotherapy. Age ≥ 12 years. Patients < 18 years old must have a body weight ≥ 40 kg. Eastern Cooperative Oncology Group (ECOG) performance status of ≤2 Patients must have adequate organ and marrow function defined by study-specified laboratory tests. Patients must have adequate kidney and liver function defined by study-specified laboratory tests. Must have measurable disease per RECIST 1.1 Willingness to provide tissue and blood samples for mandatory translational research. Women of childbearing potential (WOCBP) must have a negative urine or serum pregnancy test. For both Women and Men, must use acceptable form of birth control while on study. Ability to understand and willingness to sign a written informed consent document. Exclusion Criteria: Must have had chemotherapy or other systemic therapy or radiotherapy, as follows: Patients who have had chemotherapy, biological cancer therapy, or radiation 21 days prior to the first dose of study drug. Patients who have had surgery within 28 days of dosing of investigational agent, excluding minor procedures. Patients who have received other approved or investigational agents or device within 21 days of the first dose of study drug. Patients who have not recovered from acute adverse events to grade ≤1 or baseline due to agents administered, with exception of grade 2 fatigue, rash, and endocrinopathy successfully managed hormone replacement therapy, or alopecia or stable neuropathy, unless approved by the investigational new drug (IND) Sponsor. Patients with corrected QT interval (QTc) prolongation > 470 ms according to Fridericia formula. Patients receiving potent inducers of Cytochrome P450 3A (CYP 3A4/5) (including apalutamide, carbamazepine, enzalutamide, mitotane, phenytoin, rifampin and St. John's Wort) that cannot be discontinued at least 14 days prior to Cycle 1 Day 1. Known sensitivity to or history of allergic reactions attributed to compounds of similar chemical or biologic composition of DRP-104 or durvalumab. Subjects with interstitial lung disease that is symptomatic or may interfere with the detection or management of suspected drug-related pulmonary toxicity. Has a pulse oximetry of <92% on room air or is on supplemental home oxygen. Active or untreated brain metastases or leptomeningeal metastases. Uncontrolled intercurrent active medical and/or psychiatric illness/social psychosocial problems that that would limit compliance with study requirements. Uncontrolled intercurrent illness including, but not limited to, uncontrolled infection, symptomatic congestive heart failure, unstable angina, cardiac arrhythmia, metastatic cancer, or psychiatric illness/social situations that would limit compliance with study requirements. Pregnant or breastfeeding. Has a known history of Human Immunodeficiency Virus (HIV)/AIDS. Has active hepatitis B. Patients with chronic or acute hepatitis B virus (HBV) infection . Have had evidence of active or acute diverticulitis, intra-abdominal abscess, or GI obstruction which are known risk factors for bowel perforation should be evaluated for the potential need for additional treatment before coming on study. Patient is unwilling or unable to follow the study schedule for any reason. Patient is at the time of signing informed consent a regular user (including "recreational use") of any illicit drugs or had a recent history (within the last year) of substance abuse (including alcohol). Evidence of clinical ascites. Participants a with history of prior unacceptable and/or life-threatening toxicities attributed to anti-programmed death-receptor 1 (PD1) or anti-PD-L1 (anti-programmed death-receptor 1) therapy. Has active autoimmune disease that has required systemic treatment in the past 2 years. Prior allogeneic stem cell transplantation or organ transplantation. Has a diagnosis of immunodeficiency. Systemic corticosteroids at immunosuppressive doses.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Colleen Apostal, RN
Phone
410-614-3644
Email
GIClinicalTrials@jhmi.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Joann Santmyer, RN
Phone
410-614-3644
Email
GIClinicalTrials@jhmi.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Marina Baretti, MD
Organizational Affiliation
SKCCC • Johns Hopkins Medical Institution
Official's Role
Principal Investigator
Facility Information:
Facility Name
Johns Hopkins SKCCC
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21231
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Colleen Apostal, RN
Phone
410-614-3644
Email
GIClinicalTrials@jhmi.edu
First Name & Middle Initial & Last Name & Degree
Joann Santmyer, RN
Phone
410-614-3644
Email
GIClinicalTrials@jhmi.edu
First Name & Middle Initial & Last Name & Degree
Marina Baretti, MD

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

DRP-104 (Glutamine Antagonist) in Combination With Durvalumab in Patients With Advanced Stage Fibrolamellar Carcinoma (FLC)

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