Dose-Escalation Study of TH-302 in Combination With Doxorubicin to Treat Patients With Advanced Soft Tissue Sarcoma
Primary Purpose
Soft Tissue Sarcoma
Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
TH-302
Sponsored by
About this trial
This is an interventional treatment trial for Soft Tissue Sarcoma focused on measuring TH-302, Advanced Soft Tissue Sarcoma, Doxorubicin, Phase 1/2
Eligibility Criteria
Inclusion Criteria
All Subjects:
- At least 18 years of age
- Ability to understand the purposes and risks of the study and has signed a written informed consent form approved by the investigator's IRB/Ethics Committee
- Pathologically confirmed diagnosis of soft tissue sarcoma of the following subtypes:
- Synovial sarcoma
- High grade fibrosarcoma
- Unclassified, undifferentiated sarcoma
- Liposarcoma
- Leiomyosarcoma (excluding GIST)
- Angiosarcoma (excluding Kaposi's sarcoma)
- Pleomorphic sarcoma/malignant fibrous histiocytoma
- Locally advanced unresectable or metastatic disease with no standard curative therapy available and for whom treatment with single agent doxorubicin is considered appropriate; subjects in the dose escalation cohorts must have progressed since their most recent systemic therapy
- Recovered from reversible toxicities of prior therapy
- Evaluable disease by RECIST criteria (at least one target or non-target lesion for dose escalation cohorts; at least 1 target lesion for dose expansion cohort)
- ECOG performance status of 0 or 1
- Life expectancy of at least 3 months
- Acceptable liver function:
- Bilirubin ≤ 1.5 times upper limit of normal (ULN)
- AST (SGOT) and ALT (SGPT) ≤ 2.5 times ULN
- Acceptable renal function:
- Serum creatinine within normal limits
- Acceptable hematologic status (without hematologic support):
- ANC ≥ 1500 cells/μL
- Platelet count ≥ 100,000/μL
- Hemoglobin ≥ 9.0 g/dL
- Acceptable cardiac function:
- Normal 12-lead ECG (clinically insignificant abnormalities permitted)
- LVEF normal by MUGA or echocardiogram
- Urinalysis: No clinically significant abnormalities
- All women of childbearing potential must have a negative serum pregnancy test and all subjects must agree to use effective means of contraception (surgical sterilization or the use or barrier contraception with either a condom or diaphragm in conjunction with spermicidal gel or an IUD) with their partner from entry into the study through 6 months after the last dose
Exclusion Criteria
Prior therapy:
- Dose escalation cohort: Prior treatment with more than 2 myelosuppressive cytotoxic chemotherapy regimens
- Expanded cohort: Prior systemic therapy for advanced disease (neoadjuvant and adjuvant permitted)
- Low grade tumors according to standard grading systems (eg AJCC Grade 1 and 2)
- Prior therapy with ifosfamide or cyclophosphamide
- Prior therapy with an anthracycline or anthracenedione
- Prior mediastinal/cardiac radiotherapy
- Current use of drugs with known cardiotoxicity or known interactions with doxorubicin (see product label)
- Anticancer treatment with radiation therapy, chemotherapy, targeted therapies (erlotinib, lapatinib, etc.), immunotherapy, hormones or other antitumor therapies within 4 weeks prior to study entry (6 weeks for nitrosoureas or mitomycin C)
- Significant cardiac dysfunction:
- Any history of congestive heart failure
- Any history of transmural myocardial infarction
- Uncontrolled arrhythmias within the past 6 months
- Angina pectoris requiring antianginal medication within the past 6 months
- Clinically significant valvular heart disease
- Poorly controlled hypertension within the last 6 months
- Seizure disorders requiring anticonvulsant therapy
- Known brain metastases (unless previously treated and well controlled for a period of ≥ 3 months) Previously treated malignancies, except for adequately treated non-melanoma skin cancer, in situ cancer, or other cancer from which the subject has been disease-free for at least 5 years
- Severe chronic obstructive or other pulmonary disease with hypoxemia (requires supplementary oxygen, symptoms due to hypoxemia or oxygen saturation <90% by pulse oximetry after a 2 minute walk) or in the opinion of the investigator any physiological state likely to cause normal tissue hypoxia
- Major surgery, other than diagnostic surgery, within 4 weeks prior to Day 1, without complete recovery
- Active, uncontrolled bacterial, viral, or fungal infections, requiring systemic therapy
- Prior therapy with an hypoxic cytotoxin
- Subjects who participated in an investigational drug or device study within 28 days prior to study entry
- Known infection with HIV, hepatitis B, or hepatitis C
- Subjects who have exhibited allergic reactions to a structural compound, biological agent, or formulation (containing solutol and/or propylene glycol) similar to TH-302
- Females who are pregnant or breast-feeding
- Concomitant disease or condition that could interfere with the conduct of the study, or that would, in the opinion of the investigator, pose an unacceptable risk to the subject in this study
- Unwillingness or inability to comply with the study protocol for any reason
Sites / Locations
- Arizona Cancer Center
- Sarcoma Oncology Center
- Stanford University
- H. Lee Moffitt Cancer Center and Research Institute
- Indiana University Cancer Center
- Dana Farber Cancer Institute
- Mayo Clinic Rochester
- Washingon University Siteman Cancer Center
- Mary Crowley Cancer Research Centers
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
1
Arm Description
75 mg/m2 of Doxorubicin administered by bolus injection starting on Day 1 of a 21-day cycle.
Outcomes
Primary Outcome Measures
Maximum Tolerated Dose (MTD) Measured of TH-302 When Used in Combination With Doxorubicin and Prophylactic Growth Factor Support in Subjects With Advanced Soft Tissue Sarcoma
Secondary Outcome Measures
Full Information
NCT ID
NCT00742963
First Posted
August 26, 2008
Last Updated
September 25, 2017
Sponsor
Threshold Pharmaceuticals
1. Study Identification
Unique Protocol Identification Number
NCT00742963
Brief Title
Dose-Escalation Study of TH-302 in Combination With Doxorubicin to Treat Patients With Advanced Soft Tissue Sarcoma
Official Title
A Phase 1/2, Multicenter, Dose-Escalation Study to Determine the Safety, Efficacy and Pharmacokinetics of TH-302 in Combination With Doxorubicin in Patients With Advanced Soft Tissue Sarcoma
Study Type
Interventional
2. Study Status
Record Verification Date
September 2017
Overall Recruitment Status
Completed
Study Start Date
August 2008 (undefined)
Primary Completion Date
July 2013 (Actual)
Study Completion Date
October 2013 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Threshold Pharmaceuticals
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
The purpose of this study is to determine whether TH-302 in combination with Doxorubicin is safe and effective in the treatment of Advanced Soft Tissue Sarcoma.
Detailed Description
A broad range of tumors have been shown to contain significant numbers of hypoxic cells and hypoxia has been shown to be associated with a poor prognosis and an increase in resistance to chemotherapy and radiotherapy (Brizel 1997, Vaupel 2007, Shannon 2003).
It is likely that an agent that could effectively target hypoxic regions in tumors would improve efficacy when combined with standard chemotherapy or radiotherapy. TH-302 is activated at lower oxygen concentrations than other bioreductive prodrugs (Duan 2008) and tirapazamine, a hypoxic cytotoxin that has been extensively studied in both preclinical and clinical studies. This should result in an improved therapeutic ratio (tumor vs normal tissue toxicity) as compared with other bioreductive agents. Because TH-302 is expected to be minimally toxic to aerobic cancer cells, optimal efficacy would be expected when TH-302 is combined with treatments that are most effective under aerobic conditions such as radiotherapy and cytotoxic chemotherapy. Preclinical data have shown at least additive efficacy when TH-302 is combined with chemotherapy. In order to minimize the risk of additive toxicity, TH-302 is not being evaluated in combination with alkylating agents. The study will enroll subjects with advanced soft tissue sarcoma. These tumors have evidence supporting the presence of hypoxia based on pO2 histography, F-MISO and gene expression profiling (Vaupel 2007, Francis 2007, Rajendran 2003).
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Soft Tissue Sarcoma
Keywords
TH-302, Advanced Soft Tissue Sarcoma, Doxorubicin, Phase 1/2
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
107 (Actual)
8. Arms, Groups, and Interventions
Arm Title
1
Arm Type
Experimental
Arm Description
75 mg/m2 of Doxorubicin administered by bolus injection starting on Day 1 of a 21-day cycle.
Intervention Type
Drug
Intervention Name(s)
TH-302
Intervention Description
TH-302 will be administered by IV infusion over 30-60 minutes on Days 1 and 8 of a 21-day cycle.
Dose escalation dose levels:
Dose level -1 (if needed): 180 mg/m2 Starting dose: 240 mg/m2
Primary Outcome Measure Information:
Title
Maximum Tolerated Dose (MTD) Measured of TH-302 When Used in Combination With Doxorubicin and Prophylactic Growth Factor Support in Subjects With Advanced Soft Tissue Sarcoma
Time Frame
Two years
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria
All Subjects:
At least 18 years of age
Ability to understand the purposes and risks of the study and has signed a written informed consent form approved by the investigator's IRB/Ethics Committee
Pathologically confirmed diagnosis of soft tissue sarcoma of the following subtypes:
Synovial sarcoma
High grade fibrosarcoma
Unclassified, undifferentiated sarcoma
Liposarcoma
Leiomyosarcoma (excluding GIST)
Angiosarcoma (excluding Kaposi's sarcoma)
Pleomorphic sarcoma/malignant fibrous histiocytoma
Locally advanced unresectable or metastatic disease with no standard curative therapy available and for whom treatment with single agent doxorubicin is considered appropriate; subjects in the dose escalation cohorts must have progressed since their most recent systemic therapy
Recovered from reversible toxicities of prior therapy
Evaluable disease by RECIST criteria (at least one target or non-target lesion for dose escalation cohorts; at least 1 target lesion for dose expansion cohort)
ECOG performance status of 0 or 1
Life expectancy of at least 3 months
Acceptable liver function:
Bilirubin ≤ 1.5 times upper limit of normal (ULN)
AST (SGOT) and ALT (SGPT) ≤ 2.5 times ULN
Acceptable renal function:
Serum creatinine within normal limits
Acceptable hematologic status (without hematologic support):
ANC ≥ 1500 cells/μL
Platelet count ≥ 100,000/μL
Hemoglobin ≥ 9.0 g/dL
Acceptable cardiac function:
Normal 12-lead ECG (clinically insignificant abnormalities permitted)
LVEF normal by MUGA or echocardiogram
Urinalysis: No clinically significant abnormalities
All women of childbearing potential must have a negative serum pregnancy test and all subjects must agree to use effective means of contraception (surgical sterilization or the use or barrier contraception with either a condom or diaphragm in conjunction with spermicidal gel or an IUD) with their partner from entry into the study through 6 months after the last dose
Exclusion Criteria
Prior therapy:
Dose escalation cohort: Prior treatment with more than 2 myelosuppressive cytotoxic chemotherapy regimens
Expanded cohort: Prior systemic therapy for advanced disease (neoadjuvant and adjuvant permitted)
Low grade tumors according to standard grading systems (eg AJCC Grade 1 and 2)
Prior therapy with ifosfamide or cyclophosphamide
Prior therapy with an anthracycline or anthracenedione
Prior mediastinal/cardiac radiotherapy
Current use of drugs with known cardiotoxicity or known interactions with doxorubicin (see product label)
Anticancer treatment with radiation therapy, chemotherapy, targeted therapies (erlotinib, lapatinib, etc.), immunotherapy, hormones or other antitumor therapies within 4 weeks prior to study entry (6 weeks for nitrosoureas or mitomycin C)
Significant cardiac dysfunction:
Any history of congestive heart failure
Any history of transmural myocardial infarction
Uncontrolled arrhythmias within the past 6 months
Angina pectoris requiring antianginal medication within the past 6 months
Clinically significant valvular heart disease
Poorly controlled hypertension within the last 6 months
Seizure disorders requiring anticonvulsant therapy
Known brain metastases (unless previously treated and well controlled for a period of ≥ 3 months) Previously treated malignancies, except for adequately treated non-melanoma skin cancer, in situ cancer, or other cancer from which the subject has been disease-free for at least 5 years
Severe chronic obstructive or other pulmonary disease with hypoxemia (requires supplementary oxygen, symptoms due to hypoxemia or oxygen saturation <90% by pulse oximetry after a 2 minute walk) or in the opinion of the investigator any physiological state likely to cause normal tissue hypoxia
Major surgery, other than diagnostic surgery, within 4 weeks prior to Day 1, without complete recovery
Active, uncontrolled bacterial, viral, or fungal infections, requiring systemic therapy
Prior therapy with an hypoxic cytotoxin
Subjects who participated in an investigational drug or device study within 28 days prior to study entry
Known infection with HIV, hepatitis B, or hepatitis C
Subjects who have exhibited allergic reactions to a structural compound, biological agent, or formulation (containing solutol and/or propylene glycol) similar to TH-302
Females who are pregnant or breast-feeding
Concomitant disease or condition that could interfere with the conduct of the study, or that would, in the opinion of the investigator, pose an unacceptable risk to the subject in this study
Unwillingness or inability to comply with the study protocol for any reason
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kristen Ganjoo, MD
Organizational Affiliation
Stanford University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Arizona Cancer Center
City
Tucson
State/Province
Arizona
ZIP/Postal Code
85719
Country
United States
Facility Name
Sarcoma Oncology Center
City
Santa Monica
State/Province
California
ZIP/Postal Code
90403
Country
United States
Facility Name
Stanford University
City
Stanford
State/Province
California
ZIP/Postal Code
94305
Country
United States
Facility Name
H. Lee Moffitt Cancer Center and Research Institute
City
Tampa
State/Province
Florida
ZIP/Postal Code
33612
Country
United States
Facility Name
Indiana University Cancer Center
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46204
Country
United States
Facility Name
Dana Farber Cancer Institute
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Facility Name
Mayo Clinic Rochester
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Facility Name
Washingon University Siteman Cancer Center
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
Mary Crowley Cancer Research Centers
City
Dallas
State/Province
Texas
ZIP/Postal Code
75201
Country
United States
12. IPD Sharing Statement
Learn more about this trial
Dose-Escalation Study of TH-302 in Combination With Doxorubicin to Treat Patients With Advanced Soft Tissue Sarcoma
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