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A Phase Ib/II Study of BYL719 and Cetuximab in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma

This study is currently recruiting participants. (see Contacts and Locations)
Verified October 2014 by Novartis
Sponsor:
Information provided by (Responsible Party):
Novartis ( Novartis Pharmaceuticals )
ClinicalTrials.gov Identifier:
NCT01602315
First received: May 16, 2012
Last updated: October 29, 2014
Last verified: October 2014
  Purpose

This is a multi-center, open-label, Phase Ib dose escalation / Phase II study in recurrent or metastatic head and neck squamous cell carcinoma (RM HNSCC) patients considered to be resistant, ineligible or intolerant to platinum-based chemotherapy. The first aim of the Phase Ib is to determine the Maximum Tolerated Dose(s) (MTD(s)) and/or the Recommended Phase II Dose(s) (RP2D(s)) for BYL719 in combination with cetuximab This part will include two different arms using two different administration methods of BYL719 tablets together with cetuximab as recommended by the label: Arm A - whole tablets will be administered to patients able to swallow the tablets vs. Arm B - a drinkable suspension prepared from crushed tablets will be administered to patients with swallowing dysfunction. The second aim of the Phase Ib is to compare the pharmacokinetics (PK) of the new dispersible tablet formulation of BYL719 in combination with cetuximab. A third arm will be opened: Arm C, which will use a suspension from a dispersible tablet administered via gastric feeding tube (G tube). The safety, tolerability, PK, PD, and efficacy will be investigated separately in the Phase Ib arms. The MTD/RP2D will only be investigated independently for Arm A and B. The one of Arm B will be compared to that of Arm A. If the MTD/RP2D is the same, then both administration methods of BYL719 may be used in Phase II. If the MTD/RP2D is different, then only the administration of BYL719 whole tablets will be allowed in the Phase II. Arm C is an independent relative bioavailability study of the new dispersible tablet formulation of BYL719, which will begin at the starting dose/RP2D identified with a safety cohort followed by an expansion cohort. There will be no dose escalation or de-escalation in this Arm. If either the safety or pharmacokinetic profile of the RP2D of 300 mg QD in Arm C is not comparable with Arm A, then enrollment in Arm C will cease and the dispersible tablet will not be implemented in Phase II.

The Phase Ib dose escalation part is expected to enroll approximately 12 patients for Arm A and B and will be guided by a Bayesian logistic regression model (BLRM). The available safety, tolerability, PK, PD and efficacy data, as well as the recommendations from the BLRM, are used to determine the dose combination for the next cohort(s). The Phase II part of the study will commence upon MTD/RP2D declaration of Arm A in Phase Ib, regardless of the progress of Arm B and C.

The Phase II part will assess the clinical efficacy of BYL719 in combination with cetuximab in two patient populations: patients will be assigned to one of two schemes of enrollment based on prior therapy with cetuximab.

Patients considered cetuximab naïve per protocol will be assigned to Scheme 1. The primary purpose of this scheme is to assess the anti-tumor activity of BYL719 in combination with cetuximab (Arm 1) vs. cetuximab as single-agent (Arm 2) in RM HNSCC patients' naïve to cetuximab. Patients in scheme 1 will be randomized in a 2:1 ratio via IRT in two Phase II arms: BYL719 in combination with cetuximab (Arm 1) vs. cetuximab as single-agent (Arm 2). Patients randomized to Arm 2 (cetuximab monotherapy) will have the opportunity to cross-over to combination treatment with BYL719 + cetuximab after experiencing disease progression. Arm 1 will consist of approximately 66 patients and Arm 2 of approximately 33 patients.

Patients having received prior cetuximab per protocol will be assigned to Scheme 2. The primary purpose of this scheme is to assess the anti-tumor activity of BYL719 in combination with cetuximab in RM HNSCC cetuximab resistant patients (Arm 3). Patients in this scheme will not be randomized. 40 patients will be enrolled. Phase II will further characterize the safety and PK of the drug combination.

Patients will be treated until progression of disease (except for phase II Arm 2), unacceptable toxicity, or withdrawal of informed consent, whichever occurs first. Patients enrolled in Arm 2 experiencing disease progression will have the opportunity to crossover to the combination treatment (Arm 2B) and they will continue until they experience unacceptable toxicity that precludes any further treatment, until disease progression, and/or until treatment is discontinued at the discretion of the Investigator or by patient refusal. In the follow-up period all patients must complete the safety follow-up assessments 30 days after the last dose of the study treatment. Patients who have not progressed at the time of discontinuation of study treatment should be radiologically followed for disease status until disease progression, initiation of subsequent anticancer therapies, or death, whichever occurs first. In addition, all patients enrolled in Phase II will be followed for survival.


Condition Intervention Phase
Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma (RM HNSCC) Patients Who Are Resistant or Ineligible/Intolerant to Platinum-based Chemotherapy.
Recurrent Head and Neck Squamous Cell Carcinoma
Metastatic Head and Neck Squamous Cell Carcinoma
Drug: BYL719 as film-coated (FC) whole tablets
Drug: BYL719 as dispersible tablets (DT)
Biological: cetuximab
Drug: BYL719 as film-coated (FC) drink suspension
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase Ib Dose Escalation/Randomized Phase II, Multicenter, Open-label Study of BYL719 in Combination With Cetuximab in Patients With Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma

Resource links provided by NLM:


Further study details as provided by Novartis:

Primary Outcome Measures:
  • For Phase Ib Arms A and B: Incidence of Dose Limiting Toxicities (DLTs) in Cycle 1 (Cycle 1=28 days) [ Time Frame: approximately 6 months ] [ Designated as safety issue: Yes ]
    Estimation of Maximum Tolerated Doses (MTDs) and/or recommended Phase II doses (RP2Ds) of BYL719 in combination with cetuximab in patients with recurrent or metastatic head and neck squamous cell carcinoma (RM HNSCC) in arm A (BYL719 administered as a whole tablet in patients able to swallow the tablets) and arm B (BYL719 administered as a drinkable suspension in patients with swallowing dysfunction)

  • For Phase II: Arms 1 and 2: Progression Free Survival (PFS) as per RECIST v1.1 [ Time Frame: approximately 6 months ] [ Designated as safety issue: Yes ]
    Assessment of the anti-tumor activity of BYL719 in combination with cetuximab vs. cetuximab as single-agent in RM HNSCC patients naive to cetuximab

  • For Phase II: Arm 3: Progression Free Survival (PFS) as per RECIST V1.1 [ Time Frame: approximately 6 months ] [ Designated as safety issue: Yes ]
    Assessment of the anti-tumor activity of BYL719 in combination with cetuximab in RM HNSCC patients resistant to cetuximab

  • For Phase Ib Arm C: Area under the curve (AUC) 0-24 [ Time Frame: approximately 6 months ] [ Designated as safety issue: Yes ]
    Comparison of single-dose exposure of BYL719 dispersible tablet via G-tube in combination with cetuximab in RM HNSCC to that of Arm A (film-coated tablets)


Secondary Outcome Measures:
  • For Phase Ib: Number of patients with Adverse Events (AEs) [ Time Frame: approximately 6 months ] [ Designated as safety issue: Yes ]
    Characterization of the safety and tolerability of BYL719 in combination with cetuximab in arm A, B and C

  • For Phase Ib Arms A and B: Plasma concentration vs. time profiles, plasma pharmacokinetics (PK) parameters of BYL719 [ Time Frame: approximately 6 months ] [ Designated as safety issue: No ]
    Determination of the single and multiple dose PK profile of BYL719 in combination with cetuximab in arm A and arm B

  • For Phase Ib: Overall Response Rate (ORR) as per RECIST v1.1 [ Time Frame: approximately 6 months ] [ Designated as safety issue: No ]
    Assessment of the preliminary anti-tumor activity of BYL719 in combination with cetuximab in arm A, B and C

  • For Phase Ib: Disease Control Rate (DCR) as per RECIST v1.1 [ Time Frame: approximately 6 months ] [ Designated as safety issue: No ]
    Assessment of the preliminary anti-tumor activity of BYL719 in combination with cetuximab in arm A, B and C

  • For Phase Ib: PFS as per RECIST v1.1 [ Time Frame: approximately 6 months ] [ Designated as safety issue: No ]
    Assessment of the preliminary anti-tumor activity of BYL719 in combination with cetuximab in arm A, B and C

  • For Phase II: ORR as per RECIST v1.1 [ Time Frame: approximately 6 months ] [ Designated as safety issue: No ]
    Scheme 1 (Arms 1 and 2): Further assessment of the anti-tumor activity of BYL719 in combination with cetuximab vs. cetuximab as single-agent in RM HNSCC patients naive to cetuximab

  • For Phase II: DCR as per RECIST v1.1 [ Time Frame: approximately 6 months ] [ Designated as safety issue: No ]
    Scheme 1 (Arms 1 and 2): Further assessment of the anti-tumor activity of BYL719 in combination with cetuximab vs. cetuximab as single-agent in RM HNSCC patients naive to cetuximab

  • For Phase II: Overall Survival (OS) from the date of randomization [ Time Frame: approximately 1 year ] [ Designated as safety issue: No ]
    Scheme 1 (Arms 1 and 2): Further assessment of the anti-tumor activity of BYL719 in combination with cetuximab vs. cetuximab as single-agent in RM HNSCC patients naive to cetuximab

  • PFS as per RECIST v 1.1 [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    Phase II, Scheme 1 (Arm 2B): To further assess the anti-tumor activity of BYL719 + cetuximab in the setting of resistance to single agent cetuximab

  • For Phase Ib: Dose interruptions, reductions and dose intensity [ Time Frame: approximately 6 months ] [ Designated as safety issue: Yes ]
    Characterization of the safety and tolerability of BYL719 in combination with cetuximab in arm A, arm B and C

  • For Phase Ib: Number of patients with Serious AEs (SAEs) [ Time Frame: approximately 6 months ] [ Designated as safety issue: Yes ]
    Characterization of the safety and tolerability of BYL719 in combination with cetuximab in arm A, B and C

  • For Phase Ib: Changes in laboratory values (hematology and chemistry values), vital signs, electrocardiograms (ECGs) [ Time Frame: approximately 6 months ] [ Designated as safety issue: Yes ]
    Characterization of the safety and tolerability of BYL719 in combination with cetuximab in arm A, B and C

  • For Phase II: Dose interruptions, reductions and dose intensity [ Time Frame: approximately 6 months ] [ Designated as safety issue: Yes ]
    Characterization of the safety and tolerability of BYL719 in combination with cetuximab

  • For Phase II: Number of patients with Adverse Events (AEs) [ Time Frame: approximately 6 months ] [ Designated as safety issue: Yes ]
    Characterization of the safety and tolerability of BYL719 in combination with cetuximab

  • For Phase II: Changes in laboratory values (hematology and chemistry values), vital signs, electrocardiograms (ECGs) [ Time Frame: approximately 6 months ] [ Designated as safety issue: Yes ]
    Characterization of the safety and tolerability of BYL719 in combination with cetuximab

  • For Phase II: Number of patients with Serious AEs (SAEs) [ Time Frame: approximately 6 months ] [ Designated as safety issue: Yes ]
    Characterization of the safety and tolerability of BYL719 in combination with cetuximab

  • Phase II, Scheme 2 (Arm 2B): OS from the time of crossing over [ Time Frame: approximately 1 year ] [ Designated as safety issue: No ]
    Phase II, Scheme 1 (Arm 2B): To further assess the anti-tumor activity of BYL719 + cetuximab in the setting of resistance to single agent cetuximab

  • Phase II, Scheme 1 (arm 2B): ORR [ Time Frame: Approximately 6 months ] [ Designated as safety issue: No ]
    Phase II: Scheme 1 (Arm 2B): To further assess the anti-tumor activity of BYL719 + cetuximab in the setting of resistance to single agent cetuximab

  • Phase II, Scheme 1 (Arm 2B): DCR as per RECIST v1.1. [ Time Frame: Approximately 6 months ] [ Designated as safety issue: No ]
    Phase II, Scheme 1 (Arm 2B): To further assess the anti-tumor activity of BYL719 + cetuximab in the setting of resistance to single agent cetuximab

  • Phase II, Scheme 2: (Arm 3): ORR [ Time Frame: Approximately 6 months ] [ Designated as safety issue: No ]
    Phase II, Scheme 2 (Arm 3): To further assess the anti-tumor activity of the BYL719 in combination with cetuximab in RM HNSCC patients who have progressed following treatment with cetuximab and platinum

  • Phase II, Scheme 2: (Arm 3): DCR as per RECIST v1.1 [ Time Frame: Approximately 6 months ] [ Designated as safety issue: No ]
    Phase II, Scheme 2 (Arm 3): To further assess the anti-tumor activity of the BYL719 in combination with cetuximab in RM HNSCC patients who have progressed following treatment with cetuximab and platinum

  • Phase II, Scheme 2 (Arm 3): Overall Survival (OS) [ Time Frame: approximately 1 year ] [ Designated as safety issue: No ]
    Phase II, Scheme 2 (Arm 3): To further assess the anti-tumor activity of the BYL719 in combination with cetuximab in RM HNSCC patients who have progressed following treatment with cetuximab and platinum

  • For Phase Ib Arm C: incidence of DLTs [ Time Frame: approximately 6 months ] [ Designated as safety issue: Yes ]
    Characterization of the safety and tolerability of BYL719 in combination with cetuximab in Arm C

  • For Phase Ib Arm C: Plasma concentration vs. time profiles, plasma PK parameters of BYL719 [ Time Frame: approximately 6 months ] [ Designated as safety issue: No ]
    Determination of the multiple dose PK profile of BYL719 in combination with cetuximab in arm C


Estimated Enrollment: 202
Study Start Date: November 2012
Estimated Study Completion Date: September 2015
Estimated Primary Completion Date: September 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Phase Ib: A-BYL719 FC whole tab+cetux Drug: BYL719 as film-coated (FC) whole tablets
Oral alpha-specific PI3K inhibitor
Other Name: NVP-BYL719
Biological: cetuximab
Recombinant chimeric monoclonal antibody driven against EGFR
Other Name: erbitux
Experimental: Phase II: 2-Cetuximab
Cetuximab in patients naive to cetuximab (phase ll)
Biological: cetuximab
Recombinant chimeric monoclonal antibody driven against EGFR
Other Name: erbitux
Experimental: Phase Ib: B-BYL719 FC drink sus+cetux Biological: cetuximab
Recombinant chimeric monoclonal antibody driven against EGFR
Other Name: erbitux
Drug: BYL719 as film-coated (FC) drink suspension
Oral alpha-specific PI3K inhibitor
Other Name: NVP-BYL719
Experimental: Phase II: 3-BYL719 + Cetuximab
BYL719 + cetuximab in patients resistant to cetuximab. BYL719 can be administered as FC whole/crushed only or DT via G-tube in addition, depending on the Phase Ib results
Drug: BYL719 as film-coated (FC) whole tablets
Oral alpha-specific PI3K inhibitor
Other Name: NVP-BYL719
Drug: BYL719 as dispersible tablets (DT)
New formulation of the oral alpha-specific PI3K inhibitor
Other Name: NVP-BYL719
Biological: cetuximab
Recombinant chimeric monoclonal antibody driven against EGFR
Other Name: erbitux
Drug: BYL719 as film-coated (FC) drink suspension
Oral alpha-specific PI3K inhibitor
Other Name: NVP-BYL719
Experimental: Phase II: 1-BYL719 + Cetuximab
BYL719 + Cetuximab in Patients naive to cetuximab. BYL719 can be administered as FC whole/crushed only or DT via G-tube in addition, depending on the Phase Ib results
Drug: BYL719 as film-coated (FC) whole tablets
Oral alpha-specific PI3K inhibitor
Other Name: NVP-BYL719
Drug: BYL719 as dispersible tablets (DT)
New formulation of the oral alpha-specific PI3K inhibitor
Other Name: NVP-BYL719
Biological: cetuximab
Recombinant chimeric monoclonal antibody driven against EGFR
Other Name: erbitux
Drug: BYL719 as film-coated (FC) drink suspension
Oral alpha-specific PI3K inhibitor
Other Name: NVP-BYL719
Experimental: Phase Ib: C-BYL719 DT+cetux
Via gastrostomy tube (G-tube)
Drug: BYL719 as dispersible tablets (DT)
New formulation of the oral alpha-specific PI3K inhibitor
Other Name: NVP-BYL719
Biological: cetuximab
Recombinant chimeric monoclonal antibody driven against EGFR
Other Name: erbitux

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age ≥ 18 years
  • Patients with histologically/cytologically-confirmed HNSCC
  • Patients must be resistant to platinum-based chemotherapy, or be ineligible (due to medical comorbidities) or intolerant to platinum-based therapy per medical history
  • For Phase Ib, there is no restriction on the number of prior therapies for recurrent or metastatic disease
  • For Phase II, patients may have received a maximum of 1 prior line of therapy for recurrent or metastatic disease
  • For Phase Ib, prior cetuximab or other EGFR-targeted antibody therapy is allowed regardless of the prior treatment settings.
  • For Phase II, Arms 1 and 2, prior cetuximab or other EGFR-targeted antibody therapy is allowed only if administered in the induction setting, or concurrently with radiation in the curative setting, with the last dose of cetuximab administered at least 12 months prior to starting the study treatment. For Arm 3, prior cetuximab must have been administered in the curative, recurrent or metastatic disease setting and disease progression documented within 9 months of the last dose of cetuximab administered in that setting. This regimen (including both platinum and cetuximab) must be the most recent anti-neoplastic treatment regimen administered.
  • Patients with swallowing dysfunction who are unable to swallow BYL719 whole tablets and are not using feeding tubes for study drug administration can participate in the Phase Ib Arm B. For the Phase II, these patients with swallowing dysfunction may participate if able to drink the suspension and results of Arm B confirm the use of this method. Patients with swallowing dysfunction requiring G tube (G/PEG tube) for study drug administration may participate in Phase II if Arm C confirms dispersible tablet via G tube administration is permitted if the administration of drinkable suspension of BYL719 is allowed to be used in Phase II.
  • Availability of a representative tumor specimen. Patients enrolled in Arm 3 of Phase II must have disease sites amenable to biopsy unless prior agreement between Novartis and the Investigator.
  • At least one measurable or non-measurable lesion as per RECIST 1.1 criteria for patients in Phase Ib; Measurable disease as determined by RECIST v1.1 for Phase II patients
  • World Health Organization (WHO) Performance Status (PS) ≤ 2
  • Adequate organ function
  • Negative serum pregnancy test.

Exclusion Criteria:

  • Prior treatment with PI3K-inhibitors
  • Patients with a prior serious infusion reaction to cetuximab
  • Patients with uncontrolled CNS tumor metastatic involvement
  • Clinically significant cardiac disease or impaired cardiac function
  • Patients with diabetes mellitus
  • Impaired GI function or GI disease
  • History of another malignancy within 2 years prior to starting study treatment
  • Pregnant or nursing (lactating) women Other protocol-defined inclusion/exclusion criteria may apply
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01602315

Contacts
Contact: Novartis Pharmaceuticals 1-888-669-6682
Contact: Novartis Pharmaceuticals

  Show 35 Study Locations
Sponsors and Collaborators
Novartis Pharmaceuticals
Investigators
Study Director: Novartis Pharmaceuticals Novartis Pharmaceuticals
  More Information

No publications provided

Responsible Party: Novartis ( Novartis Pharmaceuticals )
ClinicalTrials.gov Identifier: NCT01602315     History of Changes
Other Study ID Numbers: CBYL719X2104, 2011-006017-34
Study First Received: May 16, 2012
Last Updated: October 29, 2014
Health Authority: United States: Food and Drug Administration
Australia: Therapeutic Goods Administration (TGA)
Brazil: Brazilian Health Surveillance Agency (ANVISA)
Canada: Health Canada
France: French National Authority for Health
Hong Kong: Department of Health
Korea: Korea Food and Drug Administration (KFDA)
Netherlands: Dutch Healthcare Authority (Nza)
Singapore: Health Sciences Authority (HSA)
Taiwan: Taiwan Food and Drug Administration (TFDA)

Keywords provided by Novartis:
BYL719
PI3K inhibitor
PIK3CA
cetuximab
EGFR
HNSCC
RM HNSCC
platinum-based chemotherapy
(RM HNSCC) patients
resistant or ineligible/intolerant to platinum-based chemotherapy
swallowing dysfunction
G-tube

Additional relevant MeSH terms:
Carcinoma
Carcinoma, Squamous Cell
Head and Neck Neoplasms
Neoplasms
Neoplasms by Histologic Type
Neoplasms by Site
Neoplasms, Glandular and Epithelial
Neoplasms, Squamous Cell
Cetuximab
Antineoplastic Agents
Pharmacologic Actions
Therapeutic Uses

ClinicalTrials.gov processed this record on November 19, 2014