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Phase II Study of Pacritinib in Kaposi Sarcoma Herpesvirus (KSHV)-Associated Multicentric Castleman Disease and KSHV-Associated Inflammatory Cytokine Syndrome (KICS)

Primary Purpose

KSHV Inflammatory Cytokine Syndrome (KICS), Kaposi Sarcoma Herpesvirus -Associated Multicentric Castleman Disease

Status
Not yet recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Pacritinib
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for KSHV Inflammatory Cytokine Syndrome (KICS) focused on measuring JAK2, Interleukin-1, interleukin 6 receptor, Lymphoproliferative Disorder, HIV

Eligibility Criteria

18 Years - 120 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

INCLUSION CRITERIA: Participants must meet KSHV-associated Inflammatory Cytokine Syndrome (KICS) criteria or have histologically or cytologically confirmed Kaposi sarcoma herpesvirus -multicentric Castleman disease (KSHV-MCD) confirmed by the CCR, Laboratory of Pathology (LP), NCI Age >= 18 years At least one clinical symptom attributed to KSHV-MCD or KICS, as follows: Intermittent or persistent fever for at least 1 week (>38 degrees C) Fatigue (CTCAE - Grade >=2) Gastrointestinal symptoms (e.g., nausea and anorexia - CTCAE Grade >=1) Respiratory symptoms (e.g., cough and airway hyperreactivity - CTCAE Grade >=1) At least one laboratory abnormality attributed to KSHV-MCD or KICS, as follows: Anemia (hemoglobin [Hgb] 7.0 - 12.5gm/dL) Thrombocytopenia (50,000 - 150,000/mm^3) Hypoalbuminemia (<3.4 g/dL) Elevated C-reactive protein [CRP] (>3mg/L) No life or organ-threatening manifestations of KSHV-MCD, KICS or Kaposi Sarcoma (KS) Eastern Cooperative Oncology Group [ECOG] performance status <= 3 (Karnofsky >=60%) Cardiac ejection fraction >=45% by echocardiogram at screening Participants must have laboratory parameters as defined below: Total bilirubin <=1.5 X upper limit of normal (ULN) AST(SGOT)/ALT(SGPT) <=2.5 X ULN PT/PTT/INR <=1.5 X ULN Creatinine within normal institutional limits OR Creatinine clearance >=45 mL/min/1.73 m^2 as estimated by either Cockcroft-Gault or 24-hour urine collection for participants with creatinine levels above ULN Participants with HIV should be receiving and willing to continue or willing to initiate an effective antiretroviral therapy (ART) regimen that excludes strong/ moderate CYP3A4 inducer or inhibitors. For participants with evidence of chronic hepatitis B virus (HBV) infection, participants must be on suppressive therapy. Participants with a history hepatitis C virus (HCV) infection must have completed treatment with evidence of sustained virologic response for a period of at least 3 months. Participants with KSHV-MCD (Cohort 2) or KICS (Cohort 3) who have received prior therapy, such as rituximab or other monoclonal antibodies, must have a wash out period of at least 3 weeks. Participants receiving medications or substances that are substitutes of strong CYP3A4 inhibitors must have a washout period of at least 5 half-lives of the drug prior to enrollment on study. People of child-bearing potential and those who can father children must agree to use adequate contraception (hormonal or barrier method of birth control) prior to treatment initiation and for the duration of study participation and for 3 months after the last dose. Ability of participant to understand and the willingness to sign a written informed consent document. EXCLUSION CRITERIA: Symptomatic visceral KS (except for non-ulcerating disease restricted to the oral cavity). History of allergic reactions attributed to compounds of similar chemical or biologic composition to pacritinib. Participants receiving any medications or substances that are moderate or strong inhibitors or inducers of CYP3A4 or strong inducers of CYP450. Lists including medications and substances known or with the potential to interact with the specified CYP3A4 isoenzymes Participants with evidence of ongoing hemorrhage, active signs/symptoms of bleeding, or history of severe bleeding complications in the one year prior to enrollment. Any history of CTCAE grade >= 2 symptomatic non-dysrhythmia cardiac conditions or cardiac dysrhythmia within the last 6 months. History of thrombosis, troponin-positive (Tpos) or myocardial infarction within the last 6 months Participants with moderate (Child-Pugh Score B) or severe hepatic impairment (Child-Pugh Score C) Diagnosis of primary effusion lymphoma [PEL] or another lymphoma. Participants with a prior or concurrent malignancy whose natural history or treatment that has potential to interfere with the safety or efficacy assessment of the regimen. Pregnant individuals as evaluated by a positive serum or urine beta-hCG at screening. There is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the nursing person with pacritinib. Breastfeeding should be discontinued if the nursing person is treated with pacritinib. Participants with the following cardiac conditions at screening: symptomatic congestive heart failure unstable angina pectoris uncontrolled cardiac dysrhythmias QTc(Fredericia) prolongation >480 ms or other factors that increase the risk for QT prolongation (i.e., heart failure, or a history of long QT interval syndrome). Left ventricular ejection fraction <= 50% by transthoracic echocardiogram (TTE) at screening. Uncontrolled bacterial, mycobacterial, or fungal infection at screening. Uncontrolled intercurrent illness that would limit compliance with study requirements, including results of hematology and chemistry testing, infection disease (etc.)

Sites / Locations

  • National Institutes of Health Clinical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Arm 1

Arm Description

Treatment with pacritinib

Outcomes

Primary Outcome Measures

Clinical benefit
Percentage of participants with the best overall response of CR or PR to therapy.

Secondary Outcome Measures

Safety of pacritinib
Adverse events (AEs) will be reported by type and grade of toxicity
Time to treatment failure and duration of benefit
The interval between initiating therapy and the earliest of clinical progression and and the time from to disease progression or death in patients who achieve CR, PR, or SD.
Effect of pacritinib on concurrent diagnosis of Kaposi sarcoma (KS)
Fraction of participants who have a coexisting diagnosis of KS and who develop a response of any degree (PR; SD)

Full Information

First Posted
September 22, 2023
Last Updated
October 24, 2023
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT06052618
Brief Title
Phase II Study of Pacritinib in Kaposi Sarcoma Herpesvirus (KSHV)-Associated Multicentric Castleman Disease and KSHV-Associated Inflammatory Cytokine Syndrome (KICS)
Official Title
Phase II Study of Pacritinib in Kaposi Sarcoma Herpesvirus (KSHV)-Associated Multicentric Castleman Disease and KSHV-Associated Inflammatory Cytokine Syndrome (KICS)
Study Type
Interventional

2. Study Status

Record Verification Date
September 25, 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
October 30, 2023 (Anticipated)
Primary Completion Date
January 1, 2033 (Anticipated)
Study Completion Date
January 1, 2034 (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: Kaposi sarcoma herpesvirus (KSHV)-associated inflammatory cytokine syndrome (KICS) and KSHV-multicentric Castleman disease (MCD) occur in people living with HIV. These diseases cause severe inflammation that can be fatal if not treated. Objective: To test a drug (pacritinib) in people with KSHV-associated KICS or MCD. Eligibility: People aged 18 years and older with KSHV-associated KICS or MCD. They must have at least one symptom. Design: Participants will be screened. They will have a physical exam with blood tests and tests of their heart function. They will have imaging scans. Their ability to perform everyday tasks will be reviewed. In some participants who have Kaposi sarcoma (KS) with KICS or MCD, these individuals may need a bronchoscopy and/or endoscopy of the upper or lower intestine: A flexible tube with a camera and a light source will be inserted through the mouth or anus to see these structures and assess any KS. Pacritinib is a capsule taken by mouth. Participants will take the drug twice a day, every day, for up to 24 weeks. They will write down each dose in a diary. Participants will visit the clinic 3 times in the first 4 weeks. Their visits will taper to once every 4 weeks. Imaging scans, blood tests, and other tests will be repeated during these visits. Participants will give samples of saliva. They may opt to allow tissues samples to be taken from their skin and lymph nodes. Participants will have follow-up visits 7 days and 30 days after their last dose of pacritinib. After that, they will visit the clinic every 3 months for up to 1 year. The physical exam and blood, heart, and imaging tests will be repeated at these visits.
Detailed Description
Background: Pacritinib, is a JAK2/tyrosine kinase 3 inhibitor with negligible activity against JAK1 that also suppresses the interleukin-1 (IL-1) directed inflammatory pathway via inhibition of interleukin 1 receptor associated kinase. Phase III studies of patients with myelofibrosis treated with pacritinib have demonstrated safety and efficacy as compared with best available treatment. Pacritinib at 200mg twice daily emerged as the recommended dose in the treatment of myelofibrosis. Through its activity on JAK2 and IRAK1, pacritinib blocks signaling through the interleukin 6 receptor (IL-6R); this should also include signaling through gp130 mediated by KSHV vIL-6. In preliminary unpublished results, the Yarchoan lab has found that pacritinib is highly active against primary effusion lymphoma (PEL) cells in vitro. PEL is caused by Kaposi sarcoma-associated herpesvirus (KSHV), and most PEL affected patients are co-infected with Epstein-Barr virus (EBV). Like the plasmablasts of KSHV- multicentric Castleman disease (MCD), PEL cells are KSHV-infected B cells and thus can be a model for KSHV-MCD. Given the overlapping cytokine profile between KSHV-MCD and KSHV-associated inflammatory cytokine syndrome (KICS) and elevated levels of IL6, we expect that pacritinib will have therapeutic effect in this disorder that is associated with excess inflammation. Objective: -To evaluate the clinical benefit of pacritinib in participants with symptomatic KSHV-MCD or KICS using a modified KSHV-MCD/KICS Clinical Benefit Response Criteria Eligibility: -Pathologically confirmed MCD or evidence of KICS Age >=18 At least one clinical symptom and at least one laboratory attributable to KSHV-MCD or KICS ECOG performance status <= 3 No life- or organ-threatening manifestations of MCD or KICS No concurrent diagnosis of PEL No symptomatic pulmonary or visceral Kaposi Sarcoma (KS) Design: Open label, single center pilot Phase II study. Eligible participants receive pacritinib orally 200mg twice daily until progression or up to 6 cycles. Participants will be divided by prior therapy for KSHV-MCD (no prior therapy or prior therapy) and by diagnosis of KICS. KICS and KSHV-MCD responses will be evaluated by KSHV-MCD Clinical Benefit Response Criteria every 4 weeks. Interruptions to pacritinib will be permissible for treatment of worsening KS that develops on study and such interruptions may last up to 12 weeks. Radiological assessment using PET-CT and CT will be used to assess response at 1, 3 and 6 months on study. Total maximum number of evaluable participants to be enrolled is 54, with accrual ceiling set at 65 participants.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
KSHV Inflammatory Cytokine Syndrome (KICS), Kaposi Sarcoma Herpesvirus -Associated Multicentric Castleman Disease
Keywords
JAK2, Interleukin-1, interleukin 6 receptor, Lymphoproliferative Disorder, HIV

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Arm 1
Arm Type
Experimental
Arm Description
Treatment with pacritinib
Intervention Type
Drug
Intervention Name(s)
Pacritinib
Intervention Description
Pacritinib is administered orally as 200 mg twice daily for a total of 6, 28-day cycles
Primary Outcome Measure Information:
Title
Clinical benefit
Description
Percentage of participants with the best overall response of CR or PR to therapy.
Time Frame
Prior to each cycle and at EOT and 1 year post treatment
Secondary Outcome Measure Information:
Title
Safety of pacritinib
Description
Adverse events (AEs) will be reported by type and grade of toxicity
Time Frame
Prior to each cycle, at EOT, and safety visit.
Title
Time to treatment failure and duration of benefit
Description
The interval between initiating therapy and the earliest of clinical progression and and the time from to disease progression or death in patients who achieve CR, PR, or SD.
Time Frame
Prior to each cycle and at EOT and 1 year post treatment
Title
Effect of pacritinib on concurrent diagnosis of Kaposi sarcoma (KS)
Description
Fraction of participants who have a coexisting diagnosis of KS and who develop a response of any degree (PR; SD)
Time Frame
Prior to each cycle

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
120 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: Participants must meet KSHV-associated Inflammatory Cytokine Syndrome (KICS) criteria or have histologically or cytologically confirmed Kaposi sarcoma herpesvirus -multicentric Castleman disease (KSHV-MCD) confirmed by the CCR, Laboratory of Pathology (LP), NCI Age >= 18 years At least one clinical symptom attributed to KSHV-MCD or KICS, as follows: Intermittent or persistent fever for at least 1 week (>38 degrees C) Fatigue (CTCAE - Grade >=2) Gastrointestinal symptoms (e.g., nausea and anorexia - CTCAE Grade >=1) Respiratory symptoms (e.g., cough and airway hyperreactivity - CTCAE Grade >=1) At least one laboratory abnormality attributed to KSHV-MCD or KICS, as follows: Anemia (hemoglobin [Hgb] 7.0 - 12.5gm/dL) Thrombocytopenia (50,000 - 150,000/mm^3) Hypoalbuminemia (<3.4 g/dL) Elevated C-reactive protein [CRP] (>3mg/L) No life or organ-threatening manifestations of KSHV-MCD, KICS or Kaposi Sarcoma (KS) Eastern Cooperative Oncology Group [ECOG] performance status <= 3 (Karnofsky >=60%) Cardiac ejection fraction >=45% by echocardiogram at screening Participants must have laboratory parameters as defined below: Total bilirubin <=1.5 X upper limit of normal (ULN) AST(SGOT)/ALT(SGPT) <=2.5 X ULN PT/PTT/INR <=1.5 X ULN Creatinine within normal institutional limits OR Creatinine clearance >=45 mL/min/1.73 m^2 as estimated by either Cockcroft-Gault or 24-hour urine collection for participants with creatinine levels above ULN Participants with HIV should be receiving and willing to continue or willing to initiate an effective antiretroviral therapy (ART) regimen that excludes strong/ moderate CYP3A4 inducer or inhibitors. For participants with evidence of chronic hepatitis B virus (HBV) infection, participants must be on suppressive therapy. Participants with a history hepatitis C virus (HCV) infection must have completed treatment with evidence of sustained virologic response for a period of at least 3 months. Participants with KSHV-MCD (Cohort 2) or KICS (Cohort 3) who have received prior therapy, such as rituximab or other monoclonal antibodies, must have a wash out period of at least 3 weeks. Participants receiving medications or substances that are substitutes of strong CYP3A4 inhibitors must have a washout period of at least 5 half-lives of the drug prior to enrollment on study. People of child-bearing potential and those who can father children must agree to use adequate contraception (hormonal or barrier method of birth control) prior to treatment initiation and for the duration of study participation and for 3 months after the last dose. Ability of participant to understand and the willingness to sign a written informed consent document. EXCLUSION CRITERIA: Symptomatic visceral KS (except for non-ulcerating disease restricted to the oral cavity). History of allergic reactions attributed to compounds of similar chemical or biologic composition to pacritinib. Participants receiving any medications or substances that are moderate or strong inhibitors or inducers of CYP3A4 or strong inducers of CYP450. Lists including medications and substances known or with the potential to interact with the specified CYP3A4 isoenzymes Participants with evidence of ongoing hemorrhage, active signs/symptoms of bleeding, or history of severe bleeding complications in the one year prior to enrollment. Any history of CTCAE grade >= 2 symptomatic non-dysrhythmia cardiac conditions or cardiac dysrhythmia within the last 6 months. History of thrombosis, troponin-positive (Tpos) or myocardial infarction within the last 6 months Participants with moderate (Child-Pugh Score B) or severe hepatic impairment (Child-Pugh Score C) Diagnosis of primary effusion lymphoma [PEL] or another lymphoma. Participants with a prior or concurrent malignancy whose natural history or treatment that has potential to interfere with the safety or efficacy assessment of the regimen. Pregnant individuals as evaluated by a positive serum or urine beta-hCG at screening. There is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the nursing person with pacritinib. Breastfeeding should be discontinued if the nursing person is treated with pacritinib. Participants with the following cardiac conditions at screening: symptomatic congestive heart failure unstable angina pectoris uncontrolled cardiac dysrhythmias QTc(Fredericia) prolongation >480 ms or other factors that increase the risk for QT prolongation (i.e., heart failure, or a history of long QT interval syndrome). Left ventricular ejection fraction <= 50% by transthoracic echocardiogram (TTE) at screening. Uncontrolled bacterial, mycobacterial, or fungal infection at screening. Uncontrolled intercurrent illness that would limit compliance with study requirements, including results of hematology and chemistry testing, infection disease (etc.)
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Irene Ekwede, R.N.
Phone
(240) 760-6126
Email
irene.ekwede@nih.gov
First Name & Middle Initial & Last Name or Official Title & Degree
Ramya M Ramaswami, M.D.
Phone
(240) 506-1088
Email
ramya.ramaswami@nih.gov
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ramya M Ramaswami, 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
Facility Contact:
First Name & Middle Initial & Last Name & Degree
National Cancer Institute Referral Office
Phone
888-624-1937
First Name & Middle Initial & Last Name & Degree
Irene Ekwede, B.S.N.
Phone
(240) 760-6126
Email
irene.ekwede@nih.gov

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
.All collected IPD will be shared
IPD Sharing Time Frame
Data from this study may be requested from other researchers after the completion of the primary endpoint.
IPD Sharing Access Criteria
Data from this study may be requested by contacting the PI.
Links:
URL
https://clinicalstudies.info.nih.gov/cgi/detail.cgi?B_001537-C.html
Description
NIH Clinical Center Detailed Web Page

Learn more about this trial

Phase II Study of Pacritinib in Kaposi Sarcoma Herpesvirus (KSHV)-Associated Multicentric Castleman Disease and KSHV-Associated Inflammatory Cytokine Syndrome (KICS)

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