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E6201 Plus Dabrafenib for the Treatment of Metastatic Melanoma Central Nervous System Metastases (CNS)

Primary Purpose

Malignant Melanoma, Brain Metastases

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
E6201
E6201 plus dabrafenib
Sponsored by
Spirita Oncology, LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Malignant Melanoma focused on measuring Melanoma, CNS metastases, BRAF V600 mutation, E6201, Dabrafenib

Eligibility Criteria

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

Inclusion Criteria:

  • Males and females ≥ 18 years of age
  • Histologically or cytologically confirmed BRAFV600-mutated melanoma
  • Documented metastasis of the primary tumor to the CNS
  • BRAF-mutation melanoma tumor status will be established prior to entry based on previous BRAF-gene analysis or MEK pathway mutation reports from a CLIA qualified laboratory. If a report is not available, the mutation analysis will be performed at Screening on archival tissue
  • Other metastatic melanoma systemic disease allowed
  • At least one measurable brain metastasis, 0.5 - 3.0 cm, as assessed by MRI ≤ 3 weeks prior to initiation of study treatment, provided neurological sequelae have resolved completely and at least one measurable metastasis with documented disease progression is present on MRI
  • Prior stereotactic radiosurgery and/or excision of up to 3 brain metastases is allowed > 3 weeks before initiation of study treatment, provided neurological sequelae have resolved completely and at least one measurable metastasis with documented disease progression is present on MRI
  • One prior line of immunotherapy for metastatic disease is allowed, if ≥ 2 weeks has elapsed between the end of therapy and initiation of study treatment
  • Prior melanoma adjuvant immunotherapy is allowed, if ≥ 6 months has elapsed between the end of therapy and initiation of study treatment
  • Prior melanoma adjuvant BRAF/MEK inhibitor therapy is allowed, if ≥ 12 months has elapsed between the end of therapy and initiation of study treatment
  • Able to swallow and retain oral medication with no clinically significant gastrointestinal abnormalities that may alter absorption, such as malabsorption syndrome or major resection of the stomach or bowels (Combination Safety Run-in and Expansion Phases of the study only)
  • Asymptomatic or symptomatic CNS metastasis is allowed
  • Stable dose of corticosteroids for CNS metastasis for ≥ 7 days allowed
  • Patients with seizures due to CNS metastases must be controlled with stable anti-epileptic treatment for ≥ 14 days
  • Bisphosphonates and/or denosumab are allowed
  • Adequate performance status: Eastern Cooperative Oncology Group (ECOG) ≤ 2
  • Life expectancy of ≥ 3 months

  • Adequate hematologic parameters without ongoing transfusional support:

    • Hemoglobin (Hb) ≥ 9 g/dL
    • Absolute neutrophil count (ANC) ≥ 1.0 x 10^9 cells/L
    • Platelets ≥ 75 x 10^9 cells/L

  • Adequate renal and hepatic function:

    • Creatinine ≤ 1.5 x the upper limit of normal (ULN), or calculated creatinine clearance ≥ 50 mL/minute x 1.73 m^2
    • Total bilirubin ≤ 2 times the upper limit of normal (ULN) unless due to Gilbert's disease
    • ALT/AST ≤ 2.5 times ULN, or < 5 times ULN for subjects with liver metastases
  • Negative serum pregnancy test within 14 days prior to the first dose of study therapy for women of child-bearing potential (WCBP). Sexually active WCBP and male subjects must agree to use adequate methods to avoid pregnancy throughout the study and for 28 days after the completion of study treatment.
  • Ability to provide written informed consent

Exclusion Criteria:

  • Urgent need of treatment to prevent acute neurologic deterioration, including urgent neurosurgery or radiotherapy
  • Symptoms of uncontrolled intracranial pressure
  • Symptomatic or untreated spinal cord compression
  • Prior treatment with any chemotherapeutic or investigational agent
  • Prior treatment with any BRAF and/or MEK inhibitor for metastatic disease
  • Prior treatment with > 1 line of immunotherapy for metastatic disease
  • Serious cardiac condition within the last 6 months, such as uncontrolled arrhythmia, myocardial infarction, unstable angina or heart disease defined by the New York Heart Association (NYHA) Class III or Class IV
  • QT interval corrected for rate (QTc) > 480 msec for on the ECG obtained at Screening using Fridericia method for QTc calculation
  • Active infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV) requiring systemic antiviral treatment within the last week prior to study treatment
  • Other active infection requiring IV antibiotic usage within the last week prior to study treatment
  • Any other medical intervention or other condition which, in the opinion of the Principal Investigator, could compromise adherence to study requirements or confound the interpretation of study results
  • Pregnant or breast-feeding

Sites / Locations

  • University of Arizona Cancer Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Monotherapy Safety Run-in: E6201

Combination Safety Run-in: E6201 Plus Dabrafenib

Expansion: E6201 Plus Dabrafenib

Arm Description

E6201 320 mg/m^2 administered IV over 2 hours twice weekly on Days 1, 4, 8, 11, 15 and 18, repeated every 28 days (=1 cycle). Dose reductions for toxicity are 240 mg/m^2 (Dose Level -1) and 160 mg/m^2 (Dose Level -2) twice weekly.

Dose Level 1: E6201 320 mg/m^2 twice weekly plus dabrafenib 150 mg BID. Dose Level -1: E6201 240 mg/m^2 twice weekly plus dabrafenib 150 mg BID. Dose Level -2: E6201 240 mg/m^2 twice weekly plus dabrafenib 100 mg BID. Dose Level -3: E6201 160 mg/m^2 twice weekly plus dabrafenib 100 mg BID Dose Level -4: E6201 160 mg/m^2 twice weekly plus dabrafenib 75 mg BID. Dose Level -5: E6201 160 mg/m^2 twice weekly plus dabrafenib 50 mg BID.

A total of up to N=18 will be treated at the E6201 plus dabrafenib combined MTD.

Outcomes

Primary Outcome Measures

Intracranial Disease Overall Response Rate by RANO-BM
CNS disease response will be assessed by Response Assessment in Neuro-Oncology - Brain Metastases (RANO-BM)
Intracranial Disease Overall Response Rate by RECIST 1.1
CNS disease response will be assessed by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1

Secondary Outcome Measures

Intracranial Disease Duration of Response
Length of time from the first evidence of Objective Response (complete response or partial response) to the first evidence of progression
Systemic Disease Overall Response Rate (Other Than in the CNS)
Systemic disease response will be assessed by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1RECIST 1.1.
Progression-Free Survival
Length of time from the date of first administration of study drug to the first evidence of disease progression or death, whichever is earlier
Overall Survival
Length of time from the date of first administration of study drug to the date of death from any cause

Full Information

First Posted
October 30, 2017
Last Updated
March 5, 2022
Sponsor
Spirita Oncology, LLC
Collaborators
University of Arizona
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1. Study Identification

Unique Protocol Identification Number
NCT03332589
Brief Title
E6201 Plus Dabrafenib for the Treatment of Metastatic Melanoma Central Nervous System Metastases (CNS)
Official Title
A Phase 1 Study of E6201 Plus Dabrafenib for the Treatment of Central Nervous System Metastases (CNS) From BRAF V600-Mutated Metastatic Melanoma
Study Type
Interventional

2. Study Status

Record Verification Date
December 2021
Overall Recruitment Status
Terminated
Why Stopped
Single center study: Principal Investigator left institution.
Study Start Date
July 2, 2018 (Actual)
Primary Completion Date
April 30, 2021 (Actual)
Study Completion Date
October 11, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Spirita Oncology, LLC
Collaborators
University of Arizona

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
This is a Phase 1 study of E6201 plus dabrafenib for the treatment of CNS metastases in BRAF V600-mutated metastatic melanoma. A total of up to N=28-34 subjects with melanoma metastasized to the CNS will be included.
Detailed Description
Selected subjects will be: both males and females age ≥18 years; histologically confirmed melanoma with BRAF V600 mutation with CNS metastasis; archived tumor sample from the primary, recurrent or metastatic disease with documented BRAF mutation; recovered from all acute toxicities (≤ Grade 1) due to prior immunotherapy; determined to have adequate renal and hepatic function, and no known history of significant cardiac disease. Monotherapy Safety Run-in Phase: Following screening, a total of up to 4 subjects were enrolled. E6201 was administered by intravenous (IV) infusion over a 2-hour period at a dose of 320 mg/m^2 twice weekly (Days 1, 4, 8, 11, 15 and 18) for three weeks, repeated every 28 days (1 cycle) until progression of disease, observation of unacceptable adverse events, intercurrent illness or changes in the subject's condition that prevents further study participation. Combination Safety Run-in Phase: Following screening, a total of 6-12 subjects are anticipated to establish the recommended doses of E6201 plus dabrafenib. E6201 will be administered by IV infusion over a 2-hour period twice weekly (Days 1, 4, 8, 11, 15 and 18) repeated every 28 days plus dabrafenib orally twice daily (=1 cycle). Dose Level 1: E6201 320 mg/m^2 twice weekly plus dabrafenib 150 mg BID. Dose Level -1: E6201 240 mg/m^2 twice weekly plus dabrafenib 150 mg BID. Dose Level -2: E6201 240 mg/m^2 twice weekly plus dabrafenib 100 mg BID. Dose Level -3: E6201 160 mg/m^2 twice weekly plus dabrafenib 100 mg BID Dose Level -4: E6201 160 mg/m^2 twice weekly plus dabrafenib 75 mg BID. Dose Level -5: E6201 160 mg/m^2 twice weekly plus dabrafenib 50 mg BID. A total of 6 subjects will be treated at the combined MTD doses for both drugs in the Combination Safety Run-in Phase before beginning the Expansion Phase. Expansion Phase: An additional cohort of up to N=18 subjects will be treated at the E6201 plus dabrafenib combined MTD. Subjects treated at the MTD in the Combination Safety Run-in Phase will count towards accrual in the Expansion Phase. CNS disease response will be assessed according to 2 methodologies: Response Evaluation Criteria in Solid Tumors (RECIST v. 1.1) and Response Assessment in Neuro-Oncology - Brain Metastases (RANO-BM). Non-CNS systemic disease will be assessed according to RECIST v. 1.1. Blood for hematology and serum chemistry determinations will be collected and ECGs will be taken during the study. Assessments will be obtained at Week 8 and every 8 weeks thereafter until documented progression of disease (PD). Subjects who demonstrate clinical benefit will be allowed to continue therapy with E6201 until progression of disease, observation of unacceptable adverse events, intercurrent illness or changes in the subject's condition that prevents further study participation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Malignant Melanoma, Brain Metastases
Keywords
Melanoma, CNS metastases, BRAF V600 mutation, E6201, Dabrafenib

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Model Description
4 subjects were treated in the E6201 Monotherapy Safety Run-in Phase. A total of 6-12 subjects are anticipated in the E6201 plus dabrafenib Combination Safety Run-in Phase. Once an MTD of the combination is determined, a total of 6 subjects will be treated at the combined MTD before the Expansion Phase will begin. In the Expansion Phase, an additional cohort of up to N=18 subjects will be treated at the combined E6201 plus dabrafenib MTD. Subjects treated at the MTD in the Combination Safety Run-in Phase will count towards accrual in the Expansion Phase.
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
4 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Monotherapy Safety Run-in: E6201
Arm Type
Experimental
Arm Description
E6201 320 mg/m^2 administered IV over 2 hours twice weekly on Days 1, 4, 8, 11, 15 and 18, repeated every 28 days (=1 cycle). Dose reductions for toxicity are 240 mg/m^2 (Dose Level -1) and 160 mg/m^2 (Dose Level -2) twice weekly.
Arm Title
Combination Safety Run-in: E6201 Plus Dabrafenib
Arm Type
Experimental
Arm Description
Dose Level 1: E6201 320 mg/m^2 twice weekly plus dabrafenib 150 mg BID. Dose Level -1: E6201 240 mg/m^2 twice weekly plus dabrafenib 150 mg BID. Dose Level -2: E6201 240 mg/m^2 twice weekly plus dabrafenib 100 mg BID. Dose Level -3: E6201 160 mg/m^2 twice weekly plus dabrafenib 100 mg BID Dose Level -4: E6201 160 mg/m^2 twice weekly plus dabrafenib 75 mg BID. Dose Level -5: E6201 160 mg/m^2 twice weekly plus dabrafenib 50 mg BID.
Arm Title
Expansion: E6201 Plus Dabrafenib
Arm Type
Experimental
Arm Description
A total of up to N=18 will be treated at the E6201 plus dabrafenib combined MTD.
Intervention Type
Drug
Intervention Name(s)
E6201
Intervention Description
E6201 formulated in cyclodextrin for IV administration.
Intervention Type
Drug
Intervention Name(s)
E6201 plus dabrafenib
Intervention Description
E6201 formulated in cyclodextrin for IV administration. Dabrafenib capsules for oral administration.
Primary Outcome Measure Information:
Title
Intracranial Disease Overall Response Rate by RANO-BM
Description
CNS disease response will be assessed by Response Assessment in Neuro-Oncology - Brain Metastases (RANO-BM)
Time Frame
At the end of Cycle 2 and every 2 cycles through 6 months following last dose of study drug (each cycle is 28 days) up to 1 year.
Title
Intracranial Disease Overall Response Rate by RECIST 1.1
Description
CNS disease response will be assessed by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1
Time Frame
At the end of Cycle 2 and every 2 cycles through 6 months following last dose of study drug (each cycle is 28 days) up to 1 year.
Secondary Outcome Measure Information:
Title
Intracranial Disease Duration of Response
Description
Length of time from the first evidence of Objective Response (complete response or partial response) to the first evidence of progression
Time Frame
At the end of Cycle 2 and every 2 cycles through 6 months following last dose of study drug (each cycle is 28 days) up to 1 year.
Title
Systemic Disease Overall Response Rate (Other Than in the CNS)
Description
Systemic disease response will be assessed by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1RECIST 1.1.
Time Frame
At the end of Cycle 2 and every 2 cycles through 6 months following last dose of study drug (each cycle is 28 days) up to 1 year.
Title
Progression-Free Survival
Description
Length of time from the date of first administration of study drug to the first evidence of disease progression or death, whichever is earlier
Time Frame
From Cycle 1 Day 1 through 6 months following the last dose of study drug (each cycle is 28 days) up to 1 year.
Title
Overall Survival
Description
Length of time from the date of first administration of study drug to the date of death from any cause
Time Frame
From Cycle 1 Day 1 through 6 months following the last dose of study drug or death, whichever is earlier (each cycle is 28 days) up to 1 year.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Males and females ≥ 18 years of age Histologically or cytologically confirmed BRAFV600-mutated melanoma Documented metastasis of the primary tumor to the CNS BRAF-mutation melanoma tumor status will be established prior to entry based on previous BRAF-gene analysis or MEK pathway mutation reports from a CLIA qualified laboratory. If a report is not available, the mutation analysis will be performed at Screening on archival tissue Other metastatic melanoma systemic disease allowed At least one measurable brain metastasis, 0.5 - 3.0 cm, as assessed by MRI ≤ 3 weeks prior to initiation of study treatment, provided neurological sequelae have resolved completely and at least one measurable metastasis with documented disease progression is present on MRI Prior stereotactic radiosurgery and/or excision of up to 3 brain metastases is allowed > 3 weeks before initiation of study treatment, provided neurological sequelae have resolved completely and at least one measurable metastasis with documented disease progression is present on MRI One prior line of immunotherapy for metastatic disease is allowed, if ≥ 2 weeks has elapsed between the end of therapy and initiation of study treatment Prior melanoma adjuvant immunotherapy is allowed, if ≥ 6 months has elapsed between the end of therapy and initiation of study treatment Prior melanoma adjuvant BRAF/MEK inhibitor therapy is allowed, if ≥ 12 months has elapsed between the end of therapy and initiation of study treatment Able to swallow and retain oral medication with no clinically significant gastrointestinal abnormalities that may alter absorption, such as malabsorption syndrome or major resection of the stomach or bowels (Combination Safety Run-in and Expansion Phases of the study only) Asymptomatic or symptomatic CNS metastasis is allowed Stable dose of corticosteroids for CNS metastasis for ≥ 7 days allowed Patients with seizures due to CNS metastases must be controlled with stable anti-epileptic treatment for ≥ 14 days Bisphosphonates and/or denosumab are allowed Adequate performance status: Eastern Cooperative Oncology Group (ECOG) ≤ 2 Life expectancy of ≥ 3 months Adequate hematologic parameters without ongoing transfusional support: Hemoglobin (Hb) ≥ 9 g/dL Absolute neutrophil count (ANC) ≥ 1.0 x 10^9 cells/L Platelets ≥ 75 x 10^9 cells/L Adequate renal and hepatic function: Creatinine ≤ 1.5 x the upper limit of normal (ULN), or calculated creatinine clearance ≥ 50 mL/minute x 1.73 m^2 Total bilirubin ≤ 2 times the upper limit of normal (ULN) unless due to Gilbert's disease ALT/AST ≤ 2.5 times ULN, or < 5 times ULN for subjects with liver metastases Negative serum pregnancy test within 14 days prior to the first dose of study therapy for women of child-bearing potential (WCBP). Sexually active WCBP and male subjects must agree to use adequate methods to avoid pregnancy throughout the study and for 28 days after the completion of study treatment. Ability to provide written informed consent Exclusion Criteria: Urgent need of treatment to prevent acute neurologic deterioration, including urgent neurosurgery or radiotherapy Symptoms of uncontrolled intracranial pressure Symptomatic or untreated spinal cord compression Prior treatment with any chemotherapeutic or investigational agent Prior treatment with any BRAF and/or MEK inhibitor for metastatic disease Prior treatment with > 1 line of immunotherapy for metastatic disease Serious cardiac condition within the last 6 months, such as uncontrolled arrhythmia, myocardial infarction, unstable angina or heart disease defined by the New York Heart Association (NYHA) Class III or Class IV QT interval corrected for rate (QTc) > 480 msec for on the ECG obtained at Screening using Fridericia method for QTc calculation Active infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV) requiring systemic antiviral treatment within the last week prior to study treatment Other active infection requiring IV antibiotic usage within the last week prior to study treatment Any other medical intervention or other condition which, in the opinion of the Principal Investigator, could compromise adherence to study requirements or confound the interpretation of study results Pregnant or breast-feeding
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hani M Babiker, MD
Organizational Affiliation
University of Arizona
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Arizona Cancer Center
City
Tucson
State/Province
Arizona
ZIP/Postal Code
85724
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Links:
URL
http://www.spiritaoncology.com
Description
Sponsor website

Learn more about this trial

E6201 Plus Dabrafenib for the Treatment of Metastatic Melanoma Central Nervous System Metastases (CNS)

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