An Open-Label, Multicenter, Phase 1/2 Study of E7438 (EZH2 Histone Methyl Transferase [HMT] Inhibitor) as a Single Agent in Subjects With Advanced Solid Tumors or With B-cell Lymphomas

This study is currently recruiting participants. (see Contacts and Locations)
Verified March 2016 by Epizyme, Inc.
Sponsor:
Information provided by (Responsible Party):
Epizyme, Inc.
ClinicalTrials.gov Identifier:
NCT01897571
First received: June 21, 2013
Last updated: March 18, 2016
Last verified: March 2016
  Purpose
This is a multicenter, open-label, Phase 1/2 study that is being conducted in two parts. The Phase 1 portion (closed to accrual as of January 25, 2016) comprises dose escalation and establishment of the recommended Phase 2 dose (RP2D) when EPZ-6438 (E7438) is given BID (twice daily) orally on a continuous basis. Additionally, in separate cohorts in Phase 1, the effect of food on the bioavailability of EPZ-6438 as well as the drug-drug interaction (DDI) potential of EPZ-6438 are being evaluated. The Phase 2 part was initiated after determining the RP2D. Phase 2 enrolls subjects with DLBCL and FL for the determination of efficacy and safety of EPZ-6438 in 5 separate cohorts determined by centrally confirmed histology, cell of origin (COO), and EZH2 mutation status.

Condition Intervention Phase
B-cell Lymphomas (Phase 1)
Advanced Solid Tumors (Phase 1)
Diffuse Large B-cell Lymphoma (Phase 2)
Follicular Lymphoma (Phase 2)
Drug: EPZ-6438
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: An Open-Label, Multicenter, Phase 1/2 Study of E7438 (EZH2 Histone Methyl Transferase [HMT] Inhibitor) as a Single Agent in Subjects With Advanced Solid Tumors or With B-cell Lymphomas

Resource links provided by NLM:


Further study details as provided by Epizyme, Inc.:

Primary Outcome Measures:
  • Maximum tolerated dose (MTD) (Phase 1 only) [ Time Frame: 28 day cycle of therapy ] [ Designated as safety issue: No ]
    To determine the maximum tolerated dose (MTD) and/or recommended Phase 2 dose (RP2D) of EPZ-6438 as a single agent administered orally twice daily (BID), continuously in 28-day cycles in subjects with advanced solid tumors or with relapsed and/or refractory B cell lymphomas

  • Objective response rate (ORR; complete response + partial response [CR + PR]) (Phase 2) [ Time Frame: Every 8 weeks or sooner, if clinically indicated, until documentation of disease. ] [ Designated as safety issue: No ]
    To determine the objective response rate (ORR; complete response + partial response [CR + PR]) of EPZ-6438 in subjects with enhancer of zeste homolog 2 (EZH2) gene mutation positive or negative (wild-type) with histologically confirmed diffuse large B cell lymphoma (DLBCL) or follicular lymphoma (FL), with relapsed or refractory disease


Secondary Outcome Measures:
  • The effect of a high fat meal on the bioavailability of EPZ-6438 (Phase 1) [ Time Frame: 28 day cycle of therapy ] [ Designated as safety issue: No ]
  • The effect of EPZ-6438 on exposure of midazolam, a CYP3A4 substrate [ Time Frame: 28 day cycle of therapy ] [ Designated as safety issue: No ]
  • The preliminary assessment of activity of EPZ-6438 (Phase 1) [ Time Frame: 28 day cycle of therapy ] [ Designated as safety issue: No ]
  • The effect of EPZ-6438 on progression-free survival (PFS) (Phase 2) [ Time Frame: From date of enrollment until the date of first documented progression of disease, or date of death from any cause ] [ Designated as safety issue: No ]
  • The effect of EPZ-6438 on duration of response (DOR) (Phase 2) [ Time Frame: From date of enrollment until the date of first documented progression of disease, or date of death from any cause ] [ Designated as safety issue: No ]
  • The safety and tolerability of EPZ-6438 administered BID orally, continuously in 28-day cycles (Phase 1 and Phase 2) [ Time Frame: 28 day cycle of therapy ] [ Designated as safety issue: No ]
  • The pharmacokinetic (PK) profile of EPZ-6438 (Phase 1 and Phase 2) [ Time Frame: 28 day cycle of therapy ] [ Designated as safety issue: No ]
  • The effect of EPZ-6438 on overall survival (OS) [ Time Frame: From the date of first dose until the date of death from any cause. ] [ Designated as safety issue: No ]

Estimated Enrollment: 225
Study Start Date: June 2013
Estimated Study Completion Date: September 2017
Estimated Primary Completion Date: July 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: EPZ-6438 (formerly known as E7438): Phase 1
This portion comprises dose escalation and dose expansion to establish the recommended Phase 2 dose (RP2D) when EPZ-6438 (E7438) is given BID (twice daily) orally on a continuous basis. Additionally, in separate cohorts in Phase 1, the effect of food on the bioavailability of EPZ-6438 as well as the drug-drug interaction (DDI) potential of EPZ-6438 is evaluated.
Drug: EPZ-6438
Other Name: E7438
Experimental: EPZ-6438 (formerly known as E7438): Phase 2
This portion is restricted to subjects with DLBCL or FL for the determination of efficacy and safety or EPZ-6438 in 5 independent cohorts as defined by histology, cell of origin and EZH2 mutation status.
Drug: EPZ-6438
Other Name: E7438

  Eligibility

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

Inclusion Criteria

All Subjects:

  1. Phase 1: Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1.

    Phase 2: ECOG performance status of 0 to 2.

  2. Life expectancy ≥ 3 months before starting EPZ-6438.
  3. Subjects with Hepatitis B or C are eligible on the condition that subjects have adequate liver function as defined by Inclusion Criterion #6 and are hepatitis B surface antigen negative and/or have undetectable HCV RNA.
  4. Adequate renal function defined as calculated creatinine clearance greater than or equal to 50 mL/min per the Cockcroft and Gault formula or the local institutional standard formula.
  5. Adequate bone marrow function:

    1. Absolute neutrophil count (ANC) ≥750/mm3 (≥0.75 x 10^9/L) - Without growth factor support (filgrastim or pegfilgrastim) for at least 14 days
    2. Platelets greater ≥ 75,000/mm3 (≥75 x 10^9/L) - Evaluated after at least 7 days since last platelet transfusion
    3. Hemoglobin greater than or equal to 9.0 g/dL - May receive transfusion
  6. Adequate liver function:

    1. Total bilirubin less than or equal to 1.5 x the upper limit of normal (ULN) except for unconjugated hyperbilirubinemia of Gilbert's syndrome
    2. Alkaline phosphatase (in the absence of bone disease), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) less than or equal to 3 x ULN (less than or equal to 5 x ULN if subject has liver metastases)
  7. Left ventricular ejection fraction (LVEF) greater than 50% on echocardiography or multiple gate acquisition (MUGA) scan.
  8. Time between prior anticancer therapy and first dose of EPZ-6438 as below:

    1. Cytotoxic chemotherapy - At least 21 days
    2. Non-cytotoxic chemotherapy (eg. Small molecule inhibitor) - At least 14 days
    3. Nitrosoureas - At least 6 weeks
    4. Monoclonal antibody (ies) - At least 3 half-lives
    5. Radiotherapy- At least 14 days from local site radiation therapy/At least 6 weeks from prior radioisotope therapy/At least 12 weeks from 50% pelvic or total body irradiation
    6. Investigational agent - At least 30 days or 5 half-lives, whichever is longer
    7. High dose therapy with autologous hematopoietic cell infusion - At least 60 days
    8. High dose therapy with allogeneic transplant - At least 90 days (if graft versus host disease (GVHD) is present, must be < grade 2) and no prohibited medications per exclusion #3)

    Note: Starting at Cycle 1 Day 1, subjects may receive no more than 10 mg of prednisone daily (or equivalent corticosteroid) when used for treatment of lymphoma related symptoms, with the intent to taper by the end of cycle 1.

  9. Males or females aged ≥ 18 years at the time of informed consent (Phase 2). Males and females aged ≥ 16 years at time of informed consent (Phase 1).
  10. Females must not be lactating or pregnant at screening or baseline (as documented by a negative beta-human chorionic gonadotropin [beta-hCG] test with a minimum sensitivity of 25 IU/L or equivalent units of beta-hCG). A separate baseline assessment is required if a negative screening pregnancy test was obtained more than 72 hours before the first dose of study drug. All females will be considered to be of childbearing potential unless they are postmenopausal (at least 12 months consecutive amenorrheic, in the appropriate age group, and without other known or suspected cause) or have been sterilized surgically (ie, bilateral tubal ligation, total hysterectomy or bilateral oophorectomy, all with surgery at least 1 month before dose). Females of childbearing potential must not have had unprotected sexual intercourse within 30 days prior to study entry and must agree to use a highly effective method of contraception, from the last menstrual period prior to randomization, during Treatment Cycles, and for 30 days after the last final dose of study treatment, and have a male partner who uses a condom. Highly effective contraception includes:

    1. Double barrier methods of contraception such as condom plus diaphragm or cervical/vault cap with spermicide.
    2. Placement of an intrauterine device.
    3. Established hormonal contraceptive methods: oral, injectable, or implant. Females who are using hormonal contraceptives must have been on a stable dose of the same hormonal contraceptive product for at least 4 weeks prior to dosing and must continue to use the same contraceptive during the study and for 30 days after study drug discontinuation.

    Female subjects exempt from this requirement are subjects who practice total abstinence or have a male partner who is vasectomized. If currently abstinent, the subject must agree to use a highly effective method of contraception as described above if they become sexually active during the Treatment Cycles, and for 30 days after study drug discontinuation.

  11. Male subjects must have had a successful vasectomy or they and their female partner must meet the criteria above (ie, not of childbearing potential or practicing highly effective contraception and use a condom throughout the study period and for 30 days after study drug discontinuation).
  12. Voluntary agreement to provide written informed consent and the willingness and ability to comply with all aspects of the protocol.

    Phase 1 only:

  13. Histologically and/or cytologically confirmed advanced or metastatic solid tumor or B-cell lymphomas that have progressed after treatment with approved therapies or for which there are no standard therapies available.

    Phase 2 only:

  14. Subjects must satisfy all of the following criteria:

    1. Have histologically confirmed DLBCL (including primary mediastinal B-cell lymphoma), with relapsed or refractory disease following at least 2 lines of prior standard therapy, including alkylator/anthracycline (unless anthracycline-based chemotherapy is contraindicated)/anti-CD20-based therapy (R-CHOP or equivalent) AND must be considered unable to benefit from intensification treatment with autologous hematopoietic stem cell transplantation (ASCT) as defined by meeting at least 1 of the following criteria:

      • Relapsed following, or refractory to, previous ASCT
      • Did not achieve at least a partial response to a standard salvage regimen (eg, R-ICE or R-DHAP)
      • Ineligible for intensification treatment due to age or significant comorbidity
      • Ineligible for intensification treatment due to failure to mobilize an acceptable number of hematopoietic stem cells
      • Refused intensification treatment and/or ASCT

      OR have histologically confirmed FL. Subjects may have relapsed/refractory disease following at least 2 standard prior treatment regimens, including at least 1 anti-CD20-based regimen, as well as alkylating agents (eg, cyclophosphamide or bendamustine), and have no curative option with other available therapies OR have a contra-indication to their use. Subjects with prior ASCT may be included.

    2. Have sufficient tumor tissue available for central testing of EZH2 mutation status and confirmation of DLBCL COO status.
    3. Have measurable disease as defined by International Working Group-Non-Hodgkin's Lymphoma (IWG-NHL [Cheson, 2007]).

Exclusion Criteria

All Subjects:

  1. Prior exposure to EPZ-6438 or other inhibitor(s) of EZH2 HMT.
  2. Subjects with leptomeningeal metastases or brain metastases or history of previously treated brain metastases.
  3. Subjects taking medications that are known potent CYP3A4 inducers/inhibitors (including St. Johns Wort) (see http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/DrugInteractionsLabeling/ucm080499.htm; http://medicine.iupui.edu/clinpharm/ddis/)
  4. Subjects unwilling to Seville oranges, grapefruit juice and grapefruit from their diet.
  5. Subjects who have not recovered from any acute toxicity greater than Grade 0 or 1 related to previous anticancer treatment excluding hematological toxicity as outlined in Inclusion #5.
  6. Major surgery within 4 weeks before the first dose of study drug.

    Note: Minor surgery (eg. minor biopsy of extracranial site, central venous catheter placement, shunt revision) is permitted within 3 weeks prior to enrollment.

  7. Inability to take oral medication, or malabsorption syndrome or any other uncontrolled gastrointestinal condition (e.g., nausea, diarrhea, or vomiting) that might impair the bioavailability of EPZ-6438.
  8. Significant cardiovascular impairment: history of congestive heart failure greater than New York Heart Association (NYHA) Class II, uncontrolled arterial hypertension, unstable angina, myocardial infarction, or stroke within 6 months of the first dose of study drug; or cardiac ventricular arrhythmia.
  9. Prolongation of corrected QT interval using Fridericia's formula (QTcF) to > 480 msec.
  10. Venous thrombosis or pulmonary embolism within the last 3 months before starting EPZ-6438.
  11. Active infection requiring systemic therapy.
  12. Known hypersensitivity to any component of EPZ-6438.
  13. Immunocompromised patients, including patients known to be infected with human immunodeficiency virus (HIV).
  14. Any other major illness that, in the investigator's judgment, will substantially increase the risk associated with the subject's participation in this study.
  15. Females who are pregnant or breastfeeding.
  16. Subjects who have undergone an organ transplant.

    Phase 2 only:

  17. Subjects with active noncutaneous malignancies other than B-cell lymphomas. Exception: Subjects with another malignancy who have been disease-free for 5 years, or subjects with a history of a completely resected non-melanoma skin cancer or successfully treated in situ carcinoma are eligible.
  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: NCT01897571

Contacts
Contact: Maria Roche, NP 855-500-1011 clinicaltrials@epizyme.com
Contact: Peter Ho, MD, PhD 855-500-1011 clinicaltrials@epizyme.com

Locations
Australia
Recruiting
Clayton, Australia
Recruiting
Geelong, Australia
Recruiting
Melbourne, Australia
Canada
Recruiting
Montreal, Canada
France
Recruiting
Bordeaux, France
Recruiting
Caen, France
Recruiting
Creteil, France
Recruiting
Lille, France
Recruiting
Lyon, France
Recruiting
Marseille, France
Recruiting
Montpellier, France
Recruiting
Nantes, France
Recruiting
Pierre Benite, France
Recruiting
Rennes, France
Recruiting
Rouen, France
Recruiting
Villejuif Cedex, France
Italy
Recruiting
Bologna, Italy
Recruiting
Napoli, Italy
United Kingdom
Recruiting
Glasgow, United Kingdom
Recruiting
London, United Kingdom
Recruiting
Manchester, United Kingdom
Recruiting
Southampton, United Kingdom
Sponsors and Collaborators
Epizyme, Inc.
  More Information

Responsible Party: Epizyme, Inc.
ClinicalTrials.gov Identifier: NCT01897571     History of Changes
Other Study ID Numbers: E7438-G000-101 
Study First Received: June 21, 2013
Last Updated: March 18, 2016
Health Authority: France: Agence Nationale de Sécurité du Médicament et des produits de santé
United Kingdom: Medicines and Healthcare Products Regulatory Agency
Australia: Department of Health Therapeutic Goods Administration

Additional relevant MeSH terms:
Lymphoma
Lymphoma, B-Cell
Lymphoma, Follicular
Lymphoma, Large B-Cell, Diffuse
Immune System Diseases
Immunoproliferative Disorders
Lymphatic Diseases
Lymphoma, Non-Hodgkin
Lymphoproliferative Disorders
Neoplasms
Neoplasms by Histologic Type

ClinicalTrials.gov processed this record on May 02, 2016