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Study of Trametinib and Ruxolitinib in Colorectal Cancer and Pancreatic Adenocarcinoma

Primary Purpose

Colorectal Cancer, Pancreatic Adenocarcinoma

Status
Recruiting
Phase
Phase 1
Locations
Singapore
Study Type
Interventional
Intervention
Trametinib
Ruxolitinib
Sponsored by
National Cancer Centre, Singapore
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Colorectal Cancer

Eligibility Criteria

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

Inclusion Criteria:

  • Patients (male or female) ≥ 21.
  • Patients with histological diagnosis of RAS mutant advanced colorectal and pancreatic adenocarcinoma having received at least 1 prior line of systemic therapy. Pancreatic cancer patients with KRAS mutation detected on plasma profiling having received at least 1 prior line of systemic therapy.
  • Patients must have at least one measurable lesion according to Response Evaluation Criteria in Solid Tumours (RECIST) criteria version 1.1.
  • Life expectancy of at least 3 months.
  • Written informed consent that is consistent with ICH-GCP guidelines.
  • Eastern Cooperative Oncology Group (ECOG) performance score ≤ 2.
  • Have adequate organ and hematologic function, as determined by:

    • Absolute neutrophil count (ANC) ≥ 1,500/μl.
    • Platelets ≥ 100,000/μl.
    • Haemoglobin ≥ 9g/dL.
    • Aspartate Amino Transferase (AST)/ Alanine Amino Transferase (ALT) ≤ 2.5 x upper limit of normal (ULN ≤ 5 x ULN is acceptable if liver metastases are present).
    • Total bilirubin ≤1.5 x ULN (< 3 ULN for patients with Gilbert syndrome).
    • Creatinine clearance ≥ 60ml/min.
    • Prothrombin time and activated partial thromboplastin time ≤ 1.5 x upper limit of normal (ULN) per institutional laboratory normal range.
    • Ejection fraction ≥ 50% with no symptoms attributable to heart failure.
  • Have normal QT interval on screening electrocardiogram (ECG) evaluation, defined as QT interval corrected (Fridericia) (QTcF) of ≤450 ms in males or ≤470 ms in females.
  • For female patients of childbearing potential, a negative pregnancy test must be documented prior to enrolment.
  • Female and male patients who are fertile must agree to use a highly effective form of contraception with their sexual partners throughout study participation.
  • Have the willingness and ability to comply with scheduled visits and study procedures.

Exclusion Criteria:

  • Received cytotoxic chemotherapy, investigational agents, or radiation within 14 days of study drug commencement, or 5 half-lives, whichever is shorter, and with recovery of clinically significant toxicities from that therapy.
  • Received monoclonal antibodies or had surgery within 30 days of the first dose of study drug.
  • Have been diagnosed with another primary malignancy within the past 3 years of study drug commencement (except for adequately treated non-melanoma skin cancer, cervical cancer in situ, or prostate cancer).
  • Have CNS metastases that are symptomatic, neurologically unstable, or requiring an increasing dose of corticosteroids.
  • Have meningeal involvement or spinal cord compression.
  • Have significant, uncontrolled, or active cardiovascular disease, specifically including, but not restricted to:

    • Myocardial infarction (MI) within 6 months prior to the first dose.
    • Unstable angina within 6 months prior to first dose.
    • History of congestive heart failure (CHF).
    • History of clinically significant atrial arrhythmia.
    • Any history of ventricular arrhythmia.
    • Cerebrovascular accident or transient ischemic attack within 6 months prior to first dose.
  • Have history or the presence of pulmonary interstitial disease or drug related pneumonitis.
  • Have an ongoing or active infection.
  • Patients with active HBV and HCV are excluded unless they are undergoing treatment for HBV and HCV.
  • Have a history of or active significant gastrointestinal (GI) bleeding within 3 months of the first dose.
  • Patients who are on immunosuppressive therapy.
  • Patients who have retinal vein occlusion and retinal pigment epithelial detachment.
  • On medications which are potent and moderate inhibitor and inducers of CYP3A4.
  • Patients with moderate to severe hepatic impairment (Child Pugh B and C).
  • Patients with history of severe allergic skin reactions or current skin conditions.

Sites / Locations

  • National Cancer CentreRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Dose Escalation and Expansion

Arm Description

Dose Escalation: Trametinib 2mg daily monotherapy for 14 days. Followed by combination oral trametinb (2mg starting dose) daily and oral ruxolitinib (5mg starting dose) twice daily at assigned doses. Dose Expansion: Combination oral trametinb daily and oral ruxolitinib twice daily at the maximum tolerated dose (MTD) established at the Dose Escalation phase. A cycle of therapy will comprise of 28 days of combination trametinib and ruxolitinib treatment.

Outcomes

Primary Outcome Measures

Maximum Tolerated Dose
Highest dose level at which less than one-third of the patients in the dose level experienced dose limiting toxicities (DLTs) during the first cycle of treatment

Secondary Outcome Measures

Frequency and severity of treatment-emergent Adverse Events and Serious Adverse Events
To assess the safety of the drug combination. During the dose escalation phase, this includes the incidences of dose limiting toxicities during the first 2 cycles of treatment.
Changes between baseline and post-baseline hematology laboratory parameters during treatment - Haemoglobin
Unit of measure: g/dL. To assess the safety of the drug combination
Changes between baseline and post-baseline hematology laboratory parameters during treatment - White blood count, Platelets, Absolute neutrophil count
Unit of measure: x 10^9/L. To assess the safety of the drug combination.
Changes between baseline and post-baseline hematology laboratory parameters during treatment - Neutrophils
Unit of measure: Percentage component of white blood cells. To assess the safety of the drug combination.
Changes between baseline and post-baseline biochemistry laboratory parameters during treatment - Urea, Sodium, Potassium, Chloride, Bicarbonate, Glucose, Magnesium, Calcium, Phosphate, Total cholesterol, High and low density lipoprotein, Triglycerides
Unit of measure: mmol/L. To assess the safety of the drug combination
Changes between baseline and post-baseline biochemistry laboratory parameters during treatment - Uric acid, Creatinine, Total bilirubin
Unit of measure: umol/L. To assess the safety of the drug combination
Changes between baseline and post-baseline biochemistry laboratory parameters during treatment - Total protein, Albumin
Unit of measure: g/L. To assess the safety of the drug combination
Changes between baseline and post-baseline biochemistry laboratory parameters during treatment - Alkaline phosphatase, Alanine transaminase, Aspartate transaminase, Lactate dehydrogenase, Beta-human chorionic gonadotrophin
Unit of measure: U/L. To assess the safety of the drug combination
Frequency of dose interruptions
To assess the tolerability of the drug combination.
Frequency of dose reductions
To assess the tolerability of the drug combination
Pharmacokinetics (PK): Trough concentrations of trametinb
Trough concentrations of trametinb at different cycles of combination treatment with ruxolitinib
Tumour Markers: CEA and CA 19-9 in blood samples
Changes from baseline tumour markers (CEA and CA 19-9) in blood samples
Overall Response Rate
The best overall response is the best response recorded from the start of the treatment until disease progression (PD)/ recurrence (taking as reference for PD the smallest measurements recorded since the treatment started).
Disease Control Rate
Percentage of patients who have achieved complete response, partial response and stable disease in accordance to RECIST 1.1.
Progression Free Survival
Time elapsed between treatment initiation and tumour progression or death from any cause, with censoring of patients who are lost to follow-up.
Overall Survival
Time elapsed between treatment initiation and death from any cause, with censoring of patients who are lost to follow-up.

Full Information

First Posted
September 25, 2018
Last Updated
October 9, 2023
Sponsor
National Cancer Centre, Singapore
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1. Study Identification

Unique Protocol Identification Number
NCT04303403
Brief Title
Study of Trametinib and Ruxolitinib in Colorectal Cancer and Pancreatic Adenocarcinoma
Official Title
Phase Ib Study Evaluating Safety and Tolerability of Combination Trametinib and Ruxolitinib in Patients With Advanced RAS Mutant Colorectal Cancer and Pancreatic Adenocarcinoma
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Recruiting
Study Start Date
July 31, 2018 (Actual)
Primary Completion Date
June 30, 2023 (Actual)
Study Completion Date
March 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Centre, Singapore

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this research study to find out if the drug trametinib in combination with ruxolitinib is safe, tolerable and has beneficial effects in people who has certain type of cancers including the type that you have. Patients with RAS mutant colorectal cancer and pancreatic adenocarcinoma are invited to participate in this study. This is the first time that both trametinib and ruxolitinib are studied in combination. Trametinib is marketed in several countries with the brand name Mekinist® for the treatment of melanoma (a type of skin cancer). Trametinib has been studied extensively in cancer and has been tested in many patients. Ruxolitinib is an oral inhibitor of JAK1 and JAK2 tyrosine kinases and is approved for treatment of adult polycythemia vera and myelofibrosis. Ruxolitinib has been studied extensively in many patients.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Colorectal Cancer, Pancreatic Adenocarcinoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Sequential Assignment
Model Description
The first part of this study will be a standard 3+3 dose-escalating
Masking
None (Open Label)
Allocation
N/A
Enrollment
48 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Dose Escalation and Expansion
Arm Type
Experimental
Arm Description
Dose Escalation: Trametinib 2mg daily monotherapy for 14 days. Followed by combination oral trametinb (2mg starting dose) daily and oral ruxolitinib (5mg starting dose) twice daily at assigned doses. Dose Expansion: Combination oral trametinb daily and oral ruxolitinib twice daily at the maximum tolerated dose (MTD) established at the Dose Escalation phase. A cycle of therapy will comprise of 28 days of combination trametinib and ruxolitinib treatment.
Intervention Type
Drug
Intervention Name(s)
Trametinib
Other Intervention Name(s)
Mekinist
Intervention Description
Taken orally once daily
Intervention Type
Drug
Intervention Name(s)
Ruxolitinib
Other Intervention Name(s)
Jakafi
Intervention Description
Taken orally twice daily
Primary Outcome Measure Information:
Title
Maximum Tolerated Dose
Description
Highest dose level at which less than one-third of the patients in the dose level experienced dose limiting toxicities (DLTs) during the first cycle of treatment
Time Frame
28 days (1 cycle)
Secondary Outcome Measure Information:
Title
Frequency and severity of treatment-emergent Adverse Events and Serious Adverse Events
Description
To assess the safety of the drug combination. During the dose escalation phase, this includes the incidences of dose limiting toxicities during the first 2 cycles of treatment.
Time Frame
From time of first study drug administration until 30 days after last dose of study drug
Title
Changes between baseline and post-baseline hematology laboratory parameters during treatment - Haemoglobin
Description
Unit of measure: g/dL. To assess the safety of the drug combination
Time Frame
From time of first study drug administration until 30 days after last dose of study drug
Title
Changes between baseline and post-baseline hematology laboratory parameters during treatment - White blood count, Platelets, Absolute neutrophil count
Description
Unit of measure: x 10^9/L. To assess the safety of the drug combination.
Time Frame
From time of first study drug administration until 30 days after last dose of study drug
Title
Changes between baseline and post-baseline hematology laboratory parameters during treatment - Neutrophils
Description
Unit of measure: Percentage component of white blood cells. To assess the safety of the drug combination.
Time Frame
From time of first study drug administration until 30 days after last dose of study drug
Title
Changes between baseline and post-baseline biochemistry laboratory parameters during treatment - Urea, Sodium, Potassium, Chloride, Bicarbonate, Glucose, Magnesium, Calcium, Phosphate, Total cholesterol, High and low density lipoprotein, Triglycerides
Description
Unit of measure: mmol/L. To assess the safety of the drug combination
Time Frame
From time of first study drug administration until 30 days after last dose of study drug
Title
Changes between baseline and post-baseline biochemistry laboratory parameters during treatment - Uric acid, Creatinine, Total bilirubin
Description
Unit of measure: umol/L. To assess the safety of the drug combination
Time Frame
From time of first study drug administration until 30 days after last dose of study drug
Title
Changes between baseline and post-baseline biochemistry laboratory parameters during treatment - Total protein, Albumin
Description
Unit of measure: g/L. To assess the safety of the drug combination
Time Frame
From time of first study drug administration until 30 days after last dose of study drug
Title
Changes between baseline and post-baseline biochemistry laboratory parameters during treatment - Alkaline phosphatase, Alanine transaminase, Aspartate transaminase, Lactate dehydrogenase, Beta-human chorionic gonadotrophin
Description
Unit of measure: U/L. To assess the safety of the drug combination
Time Frame
From time of first study drug administration until 30 days after last dose of study drug
Title
Frequency of dose interruptions
Description
To assess the tolerability of the drug combination.
Time Frame
From time of first study drug administration until 30 days after last dose of study drug
Title
Frequency of dose reductions
Description
To assess the tolerability of the drug combination
Time Frame
From time of first study drug administration until 30 days after last dose of study drug
Title
Pharmacokinetics (PK): Trough concentrations of trametinb
Description
Trough concentrations of trametinb at different cycles of combination treatment with ruxolitinib
Time Frame
From cycle 1-6 of study (each cycle is 28 days)
Title
Tumour Markers: CEA and CA 19-9 in blood samples
Description
Changes from baseline tumour markers (CEA and CA 19-9) in blood samples
Time Frame
From cycle 1 up to last cycle of treatment (each cycle is 28 days)
Title
Overall Response Rate
Description
The best overall response is the best response recorded from the start of the treatment until disease progression (PD)/ recurrence (taking as reference for PD the smallest measurements recorded since the treatment started).
Time Frame
From time of first study drug administration until first occurrence of disease progression, up to 2 years
Title
Disease Control Rate
Description
Percentage of patients who have achieved complete response, partial response and stable disease in accordance to RECIST 1.1.
Time Frame
From time of first study drug administration until best overall response, first occurence of disease progression, up to 2 years
Title
Progression Free Survival
Description
Time elapsed between treatment initiation and tumour progression or death from any cause, with censoring of patients who are lost to follow-up.
Time Frame
From time of first study drug administration until first occurence of disease progression, or death from any cause, up to 2 years
Title
Overall Survival
Description
Time elapsed between treatment initiation and death from any cause, with censoring of patients who are lost to follow-up.
Time Frame
From time of first study drug administration to death from any cause, up to 2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients (male or female) ≥ 21. Patients with histological diagnosis of RAS mutant advanced colorectal and pancreatic adenocarcinoma having received at least 1 prior line of systemic therapy. Pancreatic cancer patients with KRAS mutation detected on plasma profiling having received at least 1 prior line of systemic therapy. Patients must have at least one measurable lesion according to Response Evaluation Criteria in Solid Tumours (RECIST) criteria version 1.1. Life expectancy of at least 3 months. Written informed consent that is consistent with ICH-GCP guidelines. Eastern Cooperative Oncology Group (ECOG) performance score ≤ 2. Have adequate organ and hematologic function, as determined by: Absolute neutrophil count (ANC) ≥ 1,500/μl. Platelets ≥ 100,000/μl. Haemoglobin ≥ 9g/dL. Aspartate Amino Transferase (AST)/ Alanine Amino Transferase (ALT) ≤ 2.5 x upper limit of normal (ULN ≤ 5 x ULN is acceptable if liver metastases are present). Total bilirubin ≤1.5 x ULN (< 3 ULN for patients with Gilbert syndrome). Creatinine clearance ≥ 60ml/min. Prothrombin time and activated partial thromboplastin time ≤ 1.5 x upper limit of normal (ULN) per institutional laboratory normal range. Ejection fraction ≥ 50% with no symptoms attributable to heart failure. Have normal QT interval on screening electrocardiogram (ECG) evaluation, defined as QT interval corrected (Fridericia) (QTcF) of ≤450 ms in males or ≤470 ms in females. For female patients of childbearing potential, a negative pregnancy test must be documented prior to enrolment. Female and male patients who are fertile must agree to use a highly effective form of contraception with their sexual partners throughout study participation. Have the willingness and ability to comply with scheduled visits and study procedures. Exclusion Criteria: Received cytotoxic chemotherapy, investigational agents, or radiation within 14 days of study drug commencement, or 5 half-lives, whichever is shorter, and with recovery of clinically significant toxicities from that therapy. Received monoclonal antibodies or had surgery within 30 days of the first dose of study drug. Have been diagnosed with another primary malignancy within the past 3 years of study drug commencement (except for adequately treated non-melanoma skin cancer, cervical cancer in situ, or prostate cancer). Have CNS metastases that are symptomatic, neurologically unstable, or requiring an increasing dose of corticosteroids. Have meningeal involvement or spinal cord compression. Have significant, uncontrolled, or active cardiovascular disease, specifically including, but not restricted to: Myocardial infarction (MI) within 6 months prior to the first dose. Unstable angina within 6 months prior to first dose. History of congestive heart failure (CHF). History of clinically significant atrial arrhythmia. Any history of ventricular arrhythmia. Cerebrovascular accident or transient ischemic attack within 6 months prior to first dose. Have history or the presence of pulmonary interstitial disease or drug related pneumonitis. Have an ongoing or active infection. Patients with active HBV and HCV are excluded unless they are undergoing treatment for HBV and HCV. Have a history of or active significant gastrointestinal (GI) bleeding within 3 months of the first dose. Patients who are on immunosuppressive therapy. Patients who have retinal vein occlusion and retinal pigment epithelial detachment. On medications which are potent and moderate inhibitor and inducers of CYP3A4. Patients with moderate to severe hepatic impairment (Child Pugh B and C). Patients with history of severe allergic skin reactions or current skin conditions.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
David Tai, MD
Phone
+65 6436 8000
Email
david.tai.w.m@singhealth.com.sg
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David Tai, MD
Organizational Affiliation
National Cancer Centre, Singapore
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Cancer Centre
City
Singapore
ZIP/Postal Code
169610
Country
Singapore
Individual Site Status
Recruiting

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Study of Trametinib and Ruxolitinib in Colorectal Cancer and Pancreatic Adenocarcinoma

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