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A Phase 2, Multicenter, Randomized Study of AP26113 (ALTA)

This study is ongoing, but not recruiting participants.
Information provided by (Responsible Party):
Ariad Pharmaceuticals Identifier:
First received: March 18, 2014
Last updated: November 1, 2016
Last verified: October 2016
The purpose of this study is to evaluate the efficacy and safety of two different dosing regimens of AP26113 in patients with anaplastic lymphoma kinase (ALK)-positive locally advanced or metastatic non-small cell lung cancer (NSCLC) whose disease has progressed on therapy with crizotinib.

Condition Intervention Phase
Non-small Cell Lung Cancer
Lung Cancer
Advanced Malignancies
Drug: AP26113
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Randomized Phase 2 Study of AP26113 in Patients With ALK-positive, Non-small Cell Lung Cancer (NSCLC) Previously Treated With Crizotinib

Resource links provided by NLM:

Further study details as provided by Ariad Pharmaceuticals:

Primary Outcome Measures:
  • Objective response rate (ORR) [ Time Frame: Confirmed ≥4 weeks after initial response. Until discontinuation or the end of the study. ]
    Defined as the composite of complete response (CR) and partial response (PR). To assess objective response rate in the intention to treat population.

Secondary Outcome Measures:
  • Overall survival (OS) [ Time Frame: Until the end of the study or death. ]
    Defined as the interval between enrollment and death due to any cause, censored at the last contact date. To assess OS in the intention to treat population.

  • Progression-free survival (PFS) [ Time Frame: Until the end of the study or disease progression or death due to any cause. ]
    Defined as the duration of time from start of study drug administration to time of objective disease progression or death due to any cause, whichever may come first. To assess PFS in the intention to treat population.

  • Health-related quality of life (HRQoL) [ Time Frame: Until 30 days after the last dose of study treatment. ]
    Defined as the perceived quality of the patient's life, which includes self-reported multidimensional measures of physical and mental health.

  • Safety [ Time Frame: Until the end of the treatment. ]
    Measured by routine physical and laboratory evaluations, ECG, and adverse event (AE) monitoring. To evaluate the safety and tolerability of AP26113 in the intention to treat population.

  • PK parameters of steady-state plasma concentration. [ Time Frame: At designated time points in dosing Cycles 2, 3, 4 and 5. ]
    PK samples will be taken to assess limited elements of PK in the intention to treat population.

Estimated Enrollment: 218
Study Start Date: March 2014
Estimated Study Completion Date: November 2017
Estimated Primary Completion Date: November 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm A:
AP26113 will be administered to eligible patients with locally advanced or metastatic ALK+ NSCLC at a dose of 90 mg QD, continuously.
Drug: AP26113
90 mg tablet, taken orally once daily,continuously in a 28-day cycle
Experimental: Arm B:
AP26113 will be administered to eligible patients with locally advanced or metastatic ALK+ NSCLC at a dose of 90 mg QD for 7 days, then 180 mg QD, continuously.
Drug: AP26113
90 mg tablet, taken orally once daily for a 7 days, then a 180 mg tablet taken orally once daily, continuously in a 28-day cycle

Detailed Description:

This is a randomized, phase 2, open-label, multicenter, international study to evaluate the efficacy and safety of two different dosing regimens of AP26113 in patients with ALK-positive, locally advanced or metastatic NSCLC who have previously been treated with crizotinib.

The primary objective of the study is to determine the efficacy of AP26113, as evidenced by confirmed objective response rate (ORR), as assessed by the investigator, per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Two dosing regimens will be tested. The secondary objectives of the study (for each dosing regimen) include confirmed ORR, as assessed by a central independent review committee (IRC), per RECIST v1.1; CNS response (ORR and progression free survival [PFS]), per RECIST v1.1, in patients with active brain metastases); time to/duration of response; time on treatment; disease control rate, per RECIST v.1.1; PFS; overall survival (OS); safety and tolerability; population pharmacokinetics (PK); and patient-reported symptoms of lung cancer and health-related quality of life (HRQoL). Exploratory objectives (for each dosing regimen) include correlation of AP26113 exposure with both efficacy and safety and correlation of tumor and plasma biomarkers with AP26113 efficacy and safety. It is estimated that accrual will be completed within 18 months; the total estimated duration of the study is 3 years.


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Have histologically or cytologically confirmed locally advanced or metastatic NSCLC that is ALK+.
  2. Must meet one of the following two criteria:

    1. Have documented ALK rearrangement by a positive result from the Vysis® ALK Break-Apart fluorescence in situ hybridization (FISH) Probe Kit; or
    2. Have documented ALK positivity by a different test and tissue available for the Vysis® FISH test. Tissue should be derived preferably from a biopsy taken after progression with crizotinib. If such a sample is not available, testing may be performed with archived tumor tissue.
  3. Had progressive disease while on crizotinib, as assessed by the investigator or treating physician.
  4. Have at least 1 measurable lesion per RECIST v1.1. Note: Previously irradiated lesions may not be used for target lesions, unless there is unambiguous radiological progression after radiotherapy. Brain lesions may not be used as target lesions if they were: 1) previously treated with whole brain radiation therapy (WBRT) within 3 months, or 2) previously treated by stereotactic radiosurgery (SRS) or surgical resection.
  5. Recovered from toxicities related to prior anticancer therapy to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE, v4.0) grade ≤2.
  6. Are a male or female patient ≥18 years old.
  7. Have a life expectancy ≥3 months.
  8. Have adequate organ and hematologic function, as determined by:

    1. Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ≤2.5 x upper limit of normal (ULN; ≤5 x ULN is acceptable if liver metastases are present)
    2. Total serum bilirubin ≤1.5 x ULN (<3.0 x ULN for patients with Gilbert syndrome)
    3. Serum creatinine ≤1.5 x ULN
    4. Serum lipase/amylase ≤1.5 x ULN
    5. Absolute neutrophil count (ANC) ≥1500/µL
    6. Platelets ≥75000/µL
    7. Hemoglobin ≥10 g/dL
  9. Have Eastern Cooperative Oncology Group (ECOG) performance status ≤2.
  10. 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.
  11. For female patients of childbearing potential, a negative pregnancy test must be documented prior to enrollment.
  12. Female and male patients who are fertile must agree to use a highly effective form of contraception with their sexual partners throughout study participation.
  13. Must provide a signed and dated informed consent indicating that the patient has been informed of all pertinent aspects of the study, including the potential risks, and is willingly participating.
  14. Have the willingness and ability to comply with scheduled visits and study procedures.

Exclusion Criteria:

  1. Received any prior ALK-targeted TKI other than crizotinib.
  2. Received crizotinib within 3 days of the first dose of AP26113 (Day 1, Cycle 1).
  3. Received cytotoxic chemotherapy, investigational agents, or radiation within 14 days, except SRS or stereotactic body radiosurgery.
  4. Received monoclonal antibodies or had major surgery within 30 days of the first dose of AP26113 (Day 1, Cycle 1).
  5. Have been diagnosed with another primary malignancy within the past 3 years (except for adequately treated non-melanoma skin cancer, cervical cancer in situ, or prostate cancer, which are allowed within 3 years).
  6. Have symptomatic CNS metastases that are neurologically unstable or require an increasing dose of corticosteroids.
  7. Have current spinal cord compression.
  8. Have significant, uncontrolled, or active cardiovascular disease, specifically including, but not restricted to:

    1. Myocardial infarction (MI) within 6 months prior to the first dose of AP26113
    2. Unstable angina within 6 months prior to first dose
    3. Congestive heart failure (CHF) within 6 months prior to first dose
    4. History of clinically significant (as determined by the treating physician) atrial arrhythmia
    5. Any history of ventricular arrhythmia
    6. Cerebrovascular accident or transient ischemic attack within 6 months prior to first dose
  9. Have a history or the presence of pulmonary interstitial disease or drug-related pneumonitis.
  10. Have an ongoing or active infection. The requirement for intravenous (IV) antibiotics is considered active infection.
  11. Have a known history of human immunodeficiency virus (HIV). Testing is not required in the absence of history.
  12. Have a history of or active significant gastrointestinal (GI) bleeding within 3 months of the first dose of AP26113.
  13. Have a known or suspected hypersensitivity to AP26113 or its excipients.
  14. Have malabsorption syndrome or other GI illness that could affect oral absorption of the study drug.
  15. Have any condition or illness that, in the opinion of the investigator, would compromise patient safety or interfere with evaluation of the drug study.
  16. Be pregnant or breastfeeding.
  Contacts and Locations
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Please refer to this study by its identifier: NCT02094573

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Sponsors and Collaborators
Ariad Pharmaceuticals
  More Information

Responsible Party: Ariad Pharmaceuticals Identifier: NCT02094573     History of Changes
Other Study ID Numbers: AP26113-13-201
Study First Received: March 18, 2014
Last Updated: November 1, 2016

Keywords provided by Ariad Pharmaceuticals:
Non-small cell lung cancer
Non-small cell lung carcinoma
Epithelial lung cancer
Squamous cell carcinoma
Large cell carcinoma
Anaplastic lymphoma kinase (ALK)
Advanced Malignancies
Advanced Cancers

Additional relevant MeSH terms:
Lung Neoplasms
Carcinoma, Non-Small-Cell Lung
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Lung Diseases
Respiratory Tract Diseases
Carcinoma, Bronchogenic
Bronchial Neoplasms processed this record on May 25, 2017