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Milademetan in Combination With Atezolizumab in Patients With Advanced Solid Tumors With CDKN2A Loss

Primary Purpose

Advanced Solid Tumor, CDKN2A, NSCLC

Status
Withdrawn
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
Milademetan
Atezolizumab
Sponsored by
Rain Oncology Inc
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Advanced Solid Tumor focused on measuring CDKN2A, WT TP53, Advanced Solid Tumor, Wild-type P53

Eligibility Criteria

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

Key Inclusion Criteria: Has a histologically confirmed, advanced solid tumor that has progressed on prior therapy with an anti-PD-1/L1 inhibitor administered as either monotherapy or in combination with other therapies Has documented homozygous CDKN2A loss and Wild-Type TP53 Confirmation of available tumor tissue collected within 5 years of enrollment Measurable tumor lesions per RECIST 1.1 Estimate life expectancy of at least 6 months ECOG PS of 0 or 1 Resolution of clinically relevant toxic effect of prior anti-cancer therapies Note: AEs from prior therapy must resolve to Grade ≤ 1 per the NCI CTCAE version 5.0, except for peripheral neuropathy, which must resolve to Grade ≤ 2, and alopecia Adequate bone marrow, renal and hepatic function Key Exclusion Criteria: Has received prior treatment with any MDM2 inhibitor; prior treatment with atezolizumab is allowed except if the patient discontinued due to toxicity Has a history of any Grade 3 or 4 immune-related toxicities to a prior checkpoint inhibitor treatment or history of treatment discontinuation with prior checkpoint inhibitor use due to toxicity Endocrinopathies which are stable with appropriate hormonal supplementation consistent with other eligibility parameters Dermatologic events which have resolved to Grade ≤ 1 on stable medication, as appropriate, and consistent with other eligibility parameters Treatment with systemic immunosuppressive medication, including but not limited to, corticosteroids, cyclophosphamide, azathioprine, methotrexate, thalidomide, and antitumor necrosis factor agents, within 2 weeks prior to the first dose of study treatment or anticipation of need for systemic immunosuppressive medication during the course of the study Has an uncontrolled infection within the 7 days prior to Screening Has undergone treatment with therapeutic oral or IV antibiotics within 2 weeks prior to first dose of study treatment Has known active central nervous metastases and/or carcinomatous meningitis. Note: Patients who require steroids for brain metastases must be on a stable or tapering dose of corticosteroids for at least 2 weeks before the first dose of study treatment. If applicable, patients must complete stereotactic radiosurgery 7 days before, and spinal or whole brain radiotherapy 21 days before, their first dose of study treatment Has as other primary malignancies that have required systemic antineoplastic treatment within 2 years prior to Screening, except for localized cancers that have apparently been cured (eg, nonmelanoma skin cancer, superficial bladder cancer, or carcinoma in situ of the prostate, cervix, or breast) and will not interfere with the study outcomes Has uncontrolled or significant cardiovascular disease

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Milademetan (RAIN-32) in Combination With Atezolizumab

    Arm Description

    Milademetan (RAIN-32): 260 mg orally on 3 consecutive day sets with a minimum of 14 days and a maximum of 21 days between the first day of each 3- day dosing set. Atezolizumab: Atezolizumab IV infusion is to be administered on Day 1 of each 28- day cycle.

    Outcomes

    Primary Outcome Measures

    The number of participants with treatment related AEs meeting DLT-defined criteria assessed by CTCAE v5.0 when receiving milademetan in combination with atezolizumab in patients with advanced solid tumors with HZ CDKN2A loss and WT TP53
    The appropriate dose of milademetan in combination with atezolizumab based on the number of participants with DLT-defined adverse events assessed by CTCAE v5.0 criteria
    Treatment emergent AE of the identified RP2D of milademetan in combination with atezolizumab in patients with advanced solid tumors with HZ CDKN2A loss and WT TP53

    Secondary Outcome Measures

    Objective response rate (ORR)
    ORR, defined as the percentage of patients who achieve a confirmed CR or PR
    Duration of response (DOR)
    DOR, defined as the time from the date of first response (CR or PR) to the date of radiologically demonstrated disease progression, or death due to any cause
    Disease control rate (DCR)
    DCR, defined as the percentage of patients who achieve CR, PR, or SD for ≥ 16 weeks
    Progression Free Survival (PFS)
    PFS, defined as the time from the date of first dose to the earliest date of the first objective documentation of radiographic disease progression, or death due to any cause
    Growth Modulation Index (GMI)
    GMI: The GMI will be determined using the ratio of time to progression (TTP) with nth line of therapy (TTPn; here defined milademetan plus atezolizumab) to the most recent prior line of therapy (TTPn-1)
    Pharmacokinetics Cmax
    PK: maximum plasma concentration (Cmax) of milademetan
    Pharmacokinetics AUC
    PK: area under the plasma concentration-time curve (AUC)
    Pharmacokinetics Tmax
    PK: Time to reach maximum plasma concentration of milademetan

    Full Information

    First Posted
    November 14, 2022
    Last Updated
    October 16, 2023
    Sponsor
    Rain Oncology Inc
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    1. Study Identification

    Unique Protocol Identification Number
    NCT06090318
    Brief Title
    Milademetan in Combination With Atezolizumab in Patients With Advanced Solid Tumors With CDKN2A Loss
    Official Title
    A Phase 1b/2Study of Milademetan in Combination With Atezolizumab in Patients With Advanced Solid Tumors With CDKN2A Loss (MANTRA-4)
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    October 2023
    Overall Recruitment Status
    Withdrawn
    Why Stopped
    Sponsor Decision
    Study Start Date
    May 19, 2023 (Actual)
    Primary Completion Date
    May 30, 2023 (Actual)
    Study Completion Date
    May 30, 2023 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Rain Oncology Inc

    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
    This is an open-label, single-arm, Phase 1b/2 study designed to evaluate the safety, tolerability, and preliminary efficacy of milademetan in combination with atezolizumab in patients with advanced solid tumors with confirmed homozygous CDKN2A loss and WT TP53 who have progressed on or are refractory to prior PD-1/PD-L1 inhibitor therapy and who, in the opinion of the Investigator, are unlikely to tolerate or derive clinically meaningful benefit from other therapy. This study will determine the recommended dose of milademetan when given in combination with atezolizumab (the combination RP2D) using a dose de-escalation safety assessment cohort (Phase 1b). Following identification of the combination RP2D, the safety profile and preliminary anti-tumor activity of the combination RP2D will be evaluated in a larger population in a dose expansion cohort (Phase 2).
    Detailed Description
    Up to 30 patients will be enrolled, 3 to 18 patients in the safety assessment cohort and 12 to 27 patients in the dose expansion cohort.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Advanced Solid Tumor, CDKN2A, NSCLC, Urothelial Carcinoma Bladder, Melanoma, Pancreas Adenocarcinoma, HNSCC, Renal Cell Carcinoma, Mesothelioma, Gastric Cancer
    Keywords
    CDKN2A, WT TP53, Advanced Solid Tumor, Wild-type P53

    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
    0 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Milademetan (RAIN-32) in Combination With Atezolizumab
    Arm Type
    Experimental
    Arm Description
    Milademetan (RAIN-32): 260 mg orally on 3 consecutive day sets with a minimum of 14 days and a maximum of 21 days between the first day of each 3- day dosing set. Atezolizumab: Atezolizumab IV infusion is to be administered on Day 1 of each 28- day cycle.
    Intervention Type
    Drug
    Intervention Name(s)
    Milademetan
    Other Intervention Name(s)
    RAIN-32
    Intervention Description
    260 mg once daily orally on 3 consecutive day sets with a minimum of 14 days and a maximum of 21 days between the first day of each 3- day dosing set.
    Intervention Type
    Drug
    Intervention Name(s)
    Atezolizumab
    Other Intervention Name(s)
    TECENTRIQ
    Intervention Description
    1680mg administered every 4 weeks
    Primary Outcome Measure Information:
    Title
    The number of participants with treatment related AEs meeting DLT-defined criteria assessed by CTCAE v5.0 when receiving milademetan in combination with atezolizumab in patients with advanced solid tumors with HZ CDKN2A loss and WT TP53
    Time Frame
    4 months
    Title
    The appropriate dose of milademetan in combination with atezolizumab based on the number of participants with DLT-defined adverse events assessed by CTCAE v5.0 criteria
    Time Frame
    4 months
    Title
    Treatment emergent AE of the identified RP2D of milademetan in combination with atezolizumab in patients with advanced solid tumors with HZ CDKN2A loss and WT TP53
    Time Frame
    24 months
    Secondary Outcome Measure Information:
    Title
    Objective response rate (ORR)
    Description
    ORR, defined as the percentage of patients who achieve a confirmed CR or PR
    Time Frame
    24 months
    Title
    Duration of response (DOR)
    Description
    DOR, defined as the time from the date of first response (CR or PR) to the date of radiologically demonstrated disease progression, or death due to any cause
    Time Frame
    24 months
    Title
    Disease control rate (DCR)
    Description
    DCR, defined as the percentage of patients who achieve CR, PR, or SD for ≥ 16 weeks
    Time Frame
    24 months
    Title
    Progression Free Survival (PFS)
    Description
    PFS, defined as the time from the date of first dose to the earliest date of the first objective documentation of radiographic disease progression, or death due to any cause
    Time Frame
    24 months
    Title
    Growth Modulation Index (GMI)
    Description
    GMI: The GMI will be determined using the ratio of time to progression (TTP) with nth line of therapy (TTPn; here defined milademetan plus atezolizumab) to the most recent prior line of therapy (TTPn-1)
    Time Frame
    24 months
    Title
    Pharmacokinetics Cmax
    Description
    PK: maximum plasma concentration (Cmax) of milademetan
    Time Frame
    Initiation of study treatment through milademetan dose 13, an average of 3 months
    Title
    Pharmacokinetics AUC
    Description
    PK: area under the plasma concentration-time curve (AUC)
    Time Frame
    Initiation of study treatment through milademetan dose 13, an average of 3 months
    Title
    Pharmacokinetics Tmax
    Description
    PK: Time to reach maximum plasma concentration of milademetan
    Time Frame
    Initiation of study treatment through milademetan dose 13, an average of 3 months

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Key Inclusion Criteria: Has a histologically confirmed, advanced solid tumor that has progressed on prior therapy with an anti-PD-1/L1 inhibitor administered as either monotherapy or in combination with other therapies Has documented homozygous CDKN2A loss and Wild-Type TP53 Confirmation of available tumor tissue collected within 5 years of enrollment Measurable tumor lesions per RECIST 1.1 Estimate life expectancy of at least 6 months ECOG PS of 0 or 1 Resolution of clinically relevant toxic effect of prior anti-cancer therapies Note: AEs from prior therapy must resolve to Grade ≤ 1 per the NCI CTCAE version 5.0, except for peripheral neuropathy, which must resolve to Grade ≤ 2, and alopecia Adequate bone marrow, renal and hepatic function Key Exclusion Criteria: Has received prior treatment with any MDM2 inhibitor; prior treatment with atezolizumab is allowed except if the patient discontinued due to toxicity Has a history of any Grade 3 or 4 immune-related toxicities to a prior checkpoint inhibitor treatment or history of treatment discontinuation with prior checkpoint inhibitor use due to toxicity Endocrinopathies which are stable with appropriate hormonal supplementation consistent with other eligibility parameters Dermatologic events which have resolved to Grade ≤ 1 on stable medication, as appropriate, and consistent with other eligibility parameters Treatment with systemic immunosuppressive medication, including but not limited to, corticosteroids, cyclophosphamide, azathioprine, methotrexate, thalidomide, and antitumor necrosis factor agents, within 2 weeks prior to the first dose of study treatment or anticipation of need for systemic immunosuppressive medication during the course of the study Has an uncontrolled infection within the 7 days prior to Screening Has undergone treatment with therapeutic oral or IV antibiotics within 2 weeks prior to first dose of study treatment Has known active central nervous metastases and/or carcinomatous meningitis. Note: Patients who require steroids for brain metastases must be on a stable or tapering dose of corticosteroids for at least 2 weeks before the first dose of study treatment. If applicable, patients must complete stereotactic radiosurgery 7 days before, and spinal or whole brain radiotherapy 21 days before, their first dose of study treatment Has as other primary malignancies that have required systemic antineoplastic treatment within 2 years prior to Screening, except for localized cancers that have apparently been cured (eg, nonmelanoma skin cancer, superficial bladder cancer, or carcinoma in situ of the prostate, cervix, or breast) and will not interfere with the study outcomes Has uncontrolled or significant cardiovascular disease

    12. IPD Sharing Statement

    Learn more about this trial

    Milademetan in Combination With Atezolizumab in Patients With Advanced Solid Tumors With CDKN2A Loss

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