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Ricolinostat, Gemcitabine Hydrochloride, and Cisplatin in Treating Patients With Unresectable or Metastatic Cholangiocarcinoma

Primary Purpose

Non-Resectable Cholangiocarcinoma, Recurrent Cholangiocarcinoma, Stage III Extrahepatic Bile Duct Cancer

Status
Withdrawn
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Cisplatin
Gemcitabine Hydrochloride
Laboratory Biomarker Analysis
Pharmacological Study
Ricolinostat
Sponsored by
Mayo Clinic
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Non-Resectable Cholangiocarcinoma

Eligibility Criteria

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

Inclusion Criteria:

  • Histological or cytologic confirmation of unresectable or metastatic cholangiocarcinoma (intrahepatic, hilar, extrahepatic bile duct)
  • Measurable disease
  • Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1 or 2
  • Absolute neutrophil count (ANC) >= 1200/mm^3
  • Platelet count >= 100,000/mm^3
  • Total bilirubin < 1.5 x upper limit of normal (ULN), If patient has known Gilbert's syndrome, direct bilirubin < 2.0 x ULN
  • Aspartate transaminase (AST) =< 5 x ULN
  • Alkaline phosphatase =< 5 x ULN
  • Creatinine =< 1.5 x ULN
  • Negative pregnancy test done =< 7 days prior to registration, for women of childbearing potential only
  • Ability to complete a patient medication diary by themselves or with assistance
  • Provide informed written consent
  • Willingness to return to enrolling institution for follow-up (during the active monitoring phase of the study)
  • Willingness to provide tissue and blood samples for correlative research purposes
  • Life expectancy >= 3 months
  • Prior embolization, chemoembolization, or radiofrequency ablation permitted if >= 4 weeks from registration and evidence of new tumor growth is present

Exclusion Criteria:

  • Any of the following

    • Pregnant women
    • Nursing women
    • Men or women of childbearing potential who are unwilling to employ adequate contraception
  • Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
  • Immunocompromised patients and patients known to be human immunodeficiency virus (HIV) positive and currently receiving antiretroviral therapy; NOTE: patients known to be HIV positive, but without clinical evidence of an immunocompromised state, are eligible for this trial
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
  • Central nervous system (CNS) metastasis; NOTE: history of brain metastasis other than locally treatable lesions (i.e., lesions treatable with surgery or radiosurgery); patients with locally treatable disease may be considered for study if they have completed treatment without evidence of CNS progression for > 4 weeks after completion of treatment; patients with a history of brain or other CNS metastases not amenable to local therapy will not be eligible
  • Prior biologic or immunologic therapy =< 4 weeks prior to study entry
  • Prior systemic chemotherapy for cholangiocarcinoma or gallbladder carcinoma; NOTE: adjuvant chemotherapy is allowed if completed > 6 months prior to the start of registration
  • Prior radiation of cholangiocarcinoma or gallbladder carcinoma; NOTE: adjuvant radiation therapy is allowed if completed > 6 months prior to the start of registration
  • Receiving any other investigational agent which would be considered as a treatment for the primary neoplasm
  • Other active malignancy =< 5 years prior to registration; EXCEPTIONS: non-melanotic skin cancer or carcinoma-in-situ of the cervix or breast, or prostatic intraepithelial neoplasm; NOTE: if there is a history or prior malignancy, patient must not be receiving other specific treatment (other than hormonal therapy) for their cancer
  • History of myocardial infarction =< 6 months from registration, or congestive heart failure requiring use of ongoing maintenance therapy for life threatening ventricular arrhythmias

Sites / Locations

  • Mayo Clinic in Arizona
  • Mayo Clinic in Florida
  • Mayo Clinic

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (cisplatin, gemcitabine hydrochloride, ricolinostat)

Arm Description

Patients receive cisplatin IV followed by gemcitabine hydrochloride IV on days 1 and 8, and ricolinostat PO on days 1-14. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

MTD of ricolinostat or a dose up to 240 mg/day whichever is lower, of ACY-1215
PK blood sample
MTD of ricolinostat or a dose up to 240 mg/day whichever is lower, of ACY-1215
PK blood sample
MTD of ricolinostat or a dose up to 240 mg/day whichever is lower, of ACY-1215
PK blood sample
MTD of ricolinostat or a dose up to 240 mg/day whichever is lower, of ACY-1215
PK blood sample
MTD of ricolinostat or a dose up to 240 mg/day whichever is lower, of ACY-1215
PK blood sample
MTD of ricolinostat or a dose up to 240 mg/day whichever is lower, of ACY-1215
PK blood sample
MTD of ricolinostat or a dose up to 240 mg/day whichever is lower, of ACY-1215
PK blood sample
MTD of ricolinostat or a dose up to 240 mg/day whichever is lower, of ACY-1215
PK blood sample
MTD of ricolinostat or a dose up to 240 mg/day whichever is lower, of ACY-1215
PK blood sample

Secondary Outcome Measures

Best Response defined as the best objective status recorded using RECIST version 1.1
Responses will be summarized by simple descriptive summary statistics.
Confirmed response is defined to be a stringent complete response, complete response, very good partial response, or partial response noted as the objective status on two consecutive evaluations using RECIST version 1.1
Will be evaluated using all cycles of treatment. Responses will be summarized by simple descriptive summary statistics delineating complete and partial responses as well as stable and progressive disease in this patient population (overall and by tumor group). The number of responses may indicate further evaluation for specific tumor types in a Phase II setting.
Incidence of adverse events evaluated via the ordinal common toxicity criteria (CTC) toxicity grading of 3+
Overall toxicity incidence as well as toxicity profiles by dose level, patient and tumor site will be explored and summarized. Frequency distributions, graphical techniques and other descriptive measures will form the basis of these analyses.
Time to any hematologic nadirs (ANC, platelets, hemoglobin)
Will be summarized descriptively.
Time to any treatment related grade 3+ toxicity
Will be summarized descriptively.
Time to any treatment related toxicity
Will be summarized descriptively.
Time to progression
Will be summarized descriptively.
Time to treatment failure
Will be summarized descriptively.

Full Information

First Posted
July 14, 2016
Last Updated
May 25, 2017
Sponsor
Mayo Clinic
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT02856568
Brief Title
Ricolinostat, Gemcitabine Hydrochloride, and Cisplatin in Treating Patients With Unresectable or Metastatic Cholangiocarcinoma
Official Title
A Phase Ib, Open-Label, Dose- Escalation Trial of ACY-1215 in Combination With Gemcitabine and Cisplatin in Patients With Unresectable or Metastatic Cholangiocarcinoma
Study Type
Interventional

2. Study Status

Record Verification Date
May 2017
Overall Recruitment Status
Withdrawn
Why Stopped
Site dropped study
Study Start Date
May 1, 2017 (Actual)
Primary Completion Date
October 2021 (Anticipated)
Study Completion Date
October 2021 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Mayo Clinic
Collaborators
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
This phase Ib trial studies the side effects and best dose of ricolinostat when given together with gemcitabine hydrochloride and cisplatin in treating patients with cholangiocarcinoma that cannot be removed by surgery or has spread to other places in the body. Ricolinostat may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as gemcitabine hydrochloride and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving ricolinostat together with gemcitabine hydrochloride and cisplatin may work better in treating patients with cholangiocarcinoma that cannot be removed by surgery or has spread to other places.
Detailed Description
PRIMARY OBJECTIVES: I. To determine the maximum tolerated dose (MTD) or a dose up to 240 mg/day, whichever is lower, of ricolinostat (ACY-1215) in combination with gemcitabine and cisplatin in patients with unresectable or metastatic cholangiocarcinoma. (Cohort I) SECONDARY OBJECTIVES: I. Characterize the safety profile of ACY-1215 in combination with gemcitabine and cisplatin in patients with unresectable or metastatic cholangiocarcinoma. (Both cohorts) II. Determine the single- and multiple-dose pharmacokinetic (PK) of ACY-1215 in combination with gemcitabine and cisplatin in patients with unresectable or metastatic cholangiocarcinoma. (Both cohorts) III. To evaluate tumor response to treatment with ACY-1215 in combination with gemcitabine and cisplatin (per Response Evaluation Criteria in Solid Tumors [RECIST] 1.1 criteria). (Both cohorts) IV. To assess progression-free and overall survival of patients treated with ACY-1215 in combination with gemcitabine and cisplatin. (Both cohorts) TERTIARY OBJECTIVES: I. Both blood and tissue samples will be obtained at baseline and post-treatment cycle 2 for future biomarker development, analysis, and potential blood based molecular/genomic profiling. (Both cohorts) II. Studies on Tissue pre-cycle 1 and post-cycle 2 of therapy will include: phospho extracellular signal-regulated kinases (ERK)1/2; hedgehog-signaling pathways (Gli transcription factors); BIM; histones acetylation; acetylation alpha (a)-tubulin; histone deacetylase (HDAC)6 levels; autophagy markers heat shock protein (HSP)90/70; hypoxia-inducible factor 1 (HIF1)alpha; beclin; microtubule-associated proteins 1A/1B light chain 3 (LC3); Ras homolog gene family member B (RhoB). OUTLINE: This is a dose-escalation study of ricolinostat. Patients receive cisplatin intravenously (IV) followed by gemcitabine hydrochloride IV on days 1 and 8, and ricolinostat orally (PO) on days 1-14. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for up to 1 year.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Non-Resectable Cholangiocarcinoma, Recurrent Cholangiocarcinoma, Stage III Extrahepatic Bile Duct Cancer, Stage III Intrahepatic Cholangiocarcinoma, Stage IIIA Hilar Cholangiocarcinoma, Stage IIIB Hilar Cholangiocarcinoma, Stage IVA Extrahepatic Bile Duct Cancer, Stage IVA Hilar Cholangiocarcinoma, Stage IVA Intrahepatic Cholangiocarcinoma, Stage IVB Extrahepatic Bile Duct Cancer, Stage IVB Hilar Cholangiocarcinoma, Stage IVB Intrahepatic Cholangiocarcinoma, Unresectable Extrahepatic Bile Duct Carcinoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment (cisplatin, gemcitabine hydrochloride, ricolinostat)
Arm Type
Experimental
Arm Description
Patients receive cisplatin IV followed by gemcitabine hydrochloride IV on days 1 and 8, and ricolinostat PO on days 1-14. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Intervention Type
Drug
Intervention Name(s)
Cisplatin
Other Intervention Name(s)
Abiplatin, Blastolem, Briplatin, CDDP, Cis-diammine-dichloroplatinum, Cis-diamminedichloridoplatinum, Cis-diamminedichloro Platinum (II), Cis-diamminedichloroplatinum, Cis-dichloramine Platinum (II), Cis-platinous Diamine Dichloride, Cis-platinum, Cis-platinum II, Cis-platinum II Diamine Dichloride, Cismaplat, Cisplatina, Cisplatinum, Cisplatyl, Citoplatino, Citosin, Cysplatyna, DDP, Lederplatin, Metaplatin, Neoplatin, Peyrone's Chloride, Peyrone's Salt, Placis, Plastistil, Platamine, Platiblastin, Platiblastin-S, Platinex, Platinol, Platinol- AQ, Platinol-AQ, Platinol-AQ VHA Plus, Platinoxan, Platinum, Platinum Diamminodichloride, Platiran, Platistin, Platosin
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
Gemcitabine Hydrochloride
Other Intervention Name(s)
dFdCyd, Difluorodeoxycytidine Hydrochloride, Gemzar, LY-188011, LY188011
Intervention Description
Given IV
Intervention Type
Other
Intervention Name(s)
Laboratory Biomarker Analysis
Intervention Description
Correlative studies
Intervention Type
Other
Intervention Name(s)
Pharmacological Study
Intervention Description
Correlative studies
Intervention Type
Drug
Intervention Name(s)
Ricolinostat
Other Intervention Name(s)
ACY-1215, Histone Deacetylase 6 InhibitorACY-1215
Intervention Description
Given PO
Primary Outcome Measure Information:
Title
MTD of ricolinostat or a dose up to 240 mg/day whichever is lower, of ACY-1215
Description
PK blood sample
Time Frame
Cycle 1, Day 1 pre-dose
Title
MTD of ricolinostat or a dose up to 240 mg/day whichever is lower, of ACY-1215
Description
PK blood sample
Time Frame
Cycle 1, Day 8 pre-dose
Title
MTD of ricolinostat or a dose up to 240 mg/day whichever is lower, of ACY-1215
Description
PK blood sample
Time Frame
0.5 hr after ACY-1215 dosing
Title
MTD of ricolinostat or a dose up to 240 mg/day whichever is lower, of ACY-1215
Description
PK blood sample
Time Frame
24 hr after Cycle 1, Day 1 only
Title
MTD of ricolinostat or a dose up to 240 mg/day whichever is lower, of ACY-1215
Description
PK blood sample
Time Frame
Prior to Cycle 1, Day 2 ACY-1215 dosing
Title
MTD of ricolinostat or a dose up to 240 mg/day whichever is lower, of ACY-1215
Description
PK blood sample
Time Frame
1 hr after ACY-1215 dosing
Title
MTD of ricolinostat or a dose up to 240 mg/day whichever is lower, of ACY-1215
Description
PK blood sample
Time Frame
2hr after ACY-1215 dosing
Title
MTD of ricolinostat or a dose up to 240 mg/day whichever is lower, of ACY-1215
Description
PK blood sample
Time Frame
4 hr after ACY-1215 dosing
Title
MTD of ricolinostat or a dose up to 240 mg/day whichever is lower, of ACY-1215
Description
PK blood sample
Time Frame
6-8 hr after ACY-1215 dosing
Secondary Outcome Measure Information:
Title
Best Response defined as the best objective status recorded using RECIST version 1.1
Description
Responses will be summarized by simple descriptive summary statistics.
Time Frame
Up to 1 year
Title
Confirmed response is defined to be a stringent complete response, complete response, very good partial response, or partial response noted as the objective status on two consecutive evaluations using RECIST version 1.1
Description
Will be evaluated using all cycles of treatment. Responses will be summarized by simple descriptive summary statistics delineating complete and partial responses as well as stable and progressive disease in this patient population (overall and by tumor group). The number of responses may indicate further evaluation for specific tumor types in a Phase II setting.
Time Frame
Up to 1 year
Title
Incidence of adverse events evaluated via the ordinal common toxicity criteria (CTC) toxicity grading of 3+
Description
Overall toxicity incidence as well as toxicity profiles by dose level, patient and tumor site will be explored and summarized. Frequency distributions, graphical techniques and other descriptive measures will form the basis of these analyses.
Time Frame
Up to 1 year
Title
Time to any hematologic nadirs (ANC, platelets, hemoglobin)
Description
Will be summarized descriptively.
Time Frame
Up to 1 year
Title
Time to any treatment related grade 3+ toxicity
Description
Will be summarized descriptively.
Time Frame
Up to 1 year
Title
Time to any treatment related toxicity
Description
Will be summarized descriptively.
Time Frame
Up to 1 year
Title
Time to progression
Description
Will be summarized descriptively.
Time Frame
From registration to documentation of progression, up to 1 year
Title
Time to treatment failure
Description
Will be summarized descriptively.
Time Frame
From registration to documentation of progression, unacceptable toxicity, or refusal to continue participation by the patient assessed up to 1 year
Other Pre-specified Outcome Measures:
Title
Laboratory correlates measured from tissue by western blot
Description
Descriptive statistics and simple scatterplots will form the basis of presentation of these data. Correlations between these laboratory values and other outcome measures like response will be carried out in an exploratory manner.
Time Frame
Up to 1 year
Title
Laboratory correlates measured from tissue by immunofluorescence
Description
Descriptive statistics and simple scatterplots will form the basis of presentation of these data. Correlations between these laboratory values and other outcome measures like response will be carried out in an exploratory manner.
Time Frame
Up to 1 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histological or cytologic confirmation of unresectable or metastatic cholangiocarcinoma (intrahepatic, hilar, extrahepatic bile duct) Measurable disease Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1 or 2 Absolute neutrophil count (ANC) >= 1200/mm^3 Platelet count >= 100,000/mm^3 Total bilirubin < 1.5 x upper limit of normal (ULN), If patient has known Gilbert's syndrome, direct bilirubin < 2.0 x ULN Aspartate transaminase (AST) =< 5 x ULN Alkaline phosphatase =< 5 x ULN Creatinine =< 1.5 x ULN Negative pregnancy test done =< 7 days prior to registration, for women of childbearing potential only Ability to complete a patient medication diary by themselves or with assistance Provide informed written consent Willingness to return to enrolling institution for follow-up (during the active monitoring phase of the study) Willingness to provide tissue and blood samples for correlative research purposes Life expectancy >= 3 months Prior embolization, chemoembolization, or radiofrequency ablation permitted if >= 4 weeks from registration and evidence of new tumor growth is present Exclusion Criteria: Any of the following Pregnant women Nursing women Men or women of childbearing potential who are unwilling to employ adequate contraception Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens Immunocompromised patients and patients known to be human immunodeficiency virus (HIV) positive and currently receiving antiretroviral therapy; NOTE: patients known to be HIV positive, but without clinical evidence of an immunocompromised state, are eligible for this trial Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements Central nervous system (CNS) metastasis; NOTE: history of brain metastasis other than locally treatable lesions (i.e., lesions treatable with surgery or radiosurgery); patients with locally treatable disease may be considered for study if they have completed treatment without evidence of CNS progression for > 4 weeks after completion of treatment; patients with a history of brain or other CNS metastases not amenable to local therapy will not be eligible Prior biologic or immunologic therapy =< 4 weeks prior to study entry Prior systemic chemotherapy for cholangiocarcinoma or gallbladder carcinoma; NOTE: adjuvant chemotherapy is allowed if completed > 6 months prior to the start of registration Prior radiation of cholangiocarcinoma or gallbladder carcinoma; NOTE: adjuvant radiation therapy is allowed if completed > 6 months prior to the start of registration Receiving any other investigational agent which would be considered as a treatment for the primary neoplasm Other active malignancy =< 5 years prior to registration; EXCEPTIONS: non-melanotic skin cancer or carcinoma-in-situ of the cervix or breast, or prostatic intraepithelial neoplasm; NOTE: if there is a history or prior malignancy, patient must not be receiving other specific treatment (other than hormonal therapy) for their cancer History of myocardial infarction =< 6 months from registration, or congestive heart failure requiring use of ongoing maintenance therapy for life threatening ventricular arrhythmias
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kabir Mody
Organizational Affiliation
Mayo Clinic
Official's Role
Principal Investigator
Facility Information:
Facility Name
Mayo Clinic in Arizona
City
Scottsdale
State/Province
Arizona
ZIP/Postal Code
85259
Country
United States
Facility Name
Mayo Clinic in Florida
City
Jacksonville
State/Province
Florida
ZIP/Postal Code
32224-9980
Country
United States
Facility Name
Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Ricolinostat, Gemcitabine Hydrochloride, and Cisplatin in Treating Patients With Unresectable or Metastatic Cholangiocarcinoma

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