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E6201 for the Treatment of Metastatic Melanoma Central Nervous System Metastases (CNS)

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ClinicalTrials.gov Identifier: NCT03332589
Recruitment Status : Recruiting
First Posted : November 6, 2017
Last Update Posted : November 15, 2018
Sponsor:
Collaborator:
University of Arizona
Information provided by (Responsible Party):
Spirita Oncology, LLC

Brief Summary:
This is a Phase 1 study of E6201 for the treatment of CNS metastases in BRAF or MEK-mutated metastatic melanoma. A total of up to N=24 subjects with melanoma metastasized to the CNS will be included.

Condition or disease Intervention/treatment Phase
Malignant Melanoma Brain Metastases Drug: E6201 Phase 1

Detailed Description:

Selected subjects will be: both males and females age ≥18 years; histologically confirmed melanoma with BRAF or MEK mutation with CNS metastasis; archived tumor sample from the primary, recurrent or metastatic disease with documented BRAF or MEK mutation; recovered from all acute toxicities (≥ Grade 1) due to prior therapy; determined to have adequate renal and hepatic function, and no known history of significant cardiac disease.

Safety Run-in Phase: Following screening, a total of up to 6 subjects will be enrolled. E6201 will be administered by intravenous (IV) infusion over a 2-hour period at a dose of 320 mg/m^2 twice weekly (Days 1, 4, 8, 11, 15 and 18) for three weeks, repeated every 28 days (1 cycle) until progression of disease, observation of unacceptable adverse events, intercurrent illness or changes in the subject's condition that prevents further study participation.Dose reductions for toxicity will be 240 mg/m^2 twice weekly (Dose Level -1) and 160 mg/m^2 twice weekly (Dose Level -2), administered over the same schedule as above, Days 1, 4, 8, 11, 15 and 18 for three weeks, repeated every 28 days.

Once 6 subjects are treated in the Safety Run-in Phase and an MTD is confirmed (e.g., starting dose level, Dose Level -1 or Dose Level -2), the Expansion Phase will be initiated.

Expansion Phase: An additional cohort of up to N=18 subjects will be treated at the MTD. Subjects treated at the MTD in the Safety Run-in Phase will count towards accrual in the Expansion Phase.

CNS disease response will be assessed according to 2 methodologies: Response Evaluation Criteria in Solid Tumors (RECIST v. 1.1) and Response Assessment in Neuro-Oncology - Brain Metastases (RANO-BM). Non-CNS systemic disease will be assessed according to RECIST v. 1.1.

Blood for hematology and serum chemistry determinations will be collected and ECGs will be taken during the study. Assessments will be obtained at Week 8 and every 8 weeks thereafter until documented progression of disease (PD). Subjects who demonstrate clinical benefit will be allowed to continue therapy with E6201 until progression of disease, observation of unacceptable adverse events, intercurrent illness or changes in the subject's condition that prevents further study participation.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 24 participants
Intervention Model: Single Group Assignment
Intervention Model Description: Once 6 subjects are treated in the Safety Run-in Phase and a maximum tolerated dose (MTD) is confirmed the Expansion Phase will begin. An additional cohort of up to N=18 subjects will be treated at the MTD. Subjects treated at the MTD in the Safety Run-in Phase will count towards accrual in the Expansion Phase.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 1 Study of E6201 for the Treatment of Central Nervous System Metastases (CNS) From BRAF or MEK-Mutated Metastatic Melanoma
Actual Study Start Date : July 2, 2018
Estimated Primary Completion Date : January 1, 2021
Estimated Study Completion Date : June 30, 2021

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Melanoma

Arm Intervention/treatment
Experimental: E6201 320 mg/m^2 IV twice weekly

E6201 320 mg/m^2 administered IV over 2 hours twice weekly on Days 1, 4, 8, 11, 15 and 18, repeated every 28 days (=1 cycle).

Dose reductions for toxicity are 240 mg/m^2 (Dose Level -1) and 160 mg/m^2 (Dose Level -2) twice weekly.

Drug: E6201
E6201 for Injection formulated in cyclodextrin for intravenous (IV) administration




Primary Outcome Measures :
  1. Intracranial disease overall response rate by RANO-BM [ Time Frame: At the end of Cycle 2 and every 2 cycles through 6 months following last dose of study drug (each cycle is 28 days) ]
    CNS disease response will be assessed by Response Assessment in Neuro-Oncology - Brain Metastases (RANO-BM)

  2. Intracranial disease overall response rate by RECIST 1.1 [ Time Frame: At the end of Cycle 2 and every 2 cycles through 6 months following last dose of study drug (each cycle is 28 days) ]
    CNS disease response will be assessed by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1


Secondary Outcome Measures :
  1. Intracranial disease duration of response [ Time Frame: At the end of Cycle 2 and every 2 cycles through 6 months following last dose of study drug (each cycle is 28 days) ]
    Length of time from the first evidence of objective response to the first evidence of progression

  2. Systemic disease overall response rate (other than in the CNS) [ Time Frame: At the end of Cycle 2 and every 2 cycles through 6 months following last dose of study drug (each cycle is 28 days) ]
    Systemic disease response will be assessed by RECIST 1.1.

  3. Progression-Free Survival [ Time Frame: From Cycle 1 Day 1 through 6 months following the last dose of study drug (each cycle is 28 days) ]
    Length of time from the date of first administration of study drug to the first evidence of disease progression or death, whichever is earlier

  4. Overall Survival [ Time Frame: From Cycle 1 Day 1 through 6 months following the last dose of study drug or death, whichever is earlier (each cycle is 28 days) ]
    Length of time from the date of first administration of study drug to the date of death from any cause

  5. Safety of E6201 in this patient population [ Time Frame: From Cycle 1 Day 1 through 6 months following the last dose of study drug or death, whichever is earlier (each cycle is 28 days) ]
    Safety assessed through the monitoring of adverse events (AEs) and serious adverse events (SAEs).



Information from the National Library of Medicine

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

Inclusion Criteria:

  • Males and females ≥ 18 years of age
  • Histologically or cytologically confirmed BRAF- or MEK-mutated melanoma
  • BRAF- or MEK-mutation melanoma tumor status will be established prior to entry based on previous BRAF-gene analysis or MEK pathway mutation reports from a CLIA qualified laboratory. If a report is not available, the mutation analysis will be performed at Screening on archival tissue
  • Documented metastasis of the primary tumor to the CNS and not a candidate for surgical intervention nor require immediate radiation therapy to relieve symptoms
  • Other metastatic melanoma systemic disease allowed
  • Minimum intervals required to be off treatment prior to Cycle 1 Day 1:

    • Prior radiotherapy (RT) to current field of CNS disease ≥ 4 weeks
    • Nitrosourea cytotoxic drug ≥ 6 weeks
    • Non-nitrosourea cytotoxic drug or any systemic investigational agent with exception of methotrexate ≥ 4 weeks
    • Approved PD-1/PD-L1 inhibitors, CTLA4 checkpoint inhibitors, or other immunotherapy ≥ 4 weeks
    • Approved BRAF and MEK inhibitors ≥ 3 weeks
    • Methotrexate or non-BRAF/MEK non-cytotoxic anti-tumor drug ≥ 2 weeks
  • Radiographically measurable disease in the CNS documented ≤ 3 weeks prior to starting E6201 treatment
  • Asymptomatic or symptomatic CNS metastasis allowed
  • Previously-treated or untreated CNS metastasis allowed
  • Stable dose of corticosteroids for CNS metastasis for ≥ 7 days allowed
  • Patients with seizures due to CNS metastases must be controlled with stable anti-epileptic treatment for ≥ 14 days
  • Prior treatment with 1 BRAF inhibitor and/or 1 MEK inhibitor allowed
  • Bisphosphonates and/or denosumab are allowed
  • Adequate performance status: Eastern Cooperative Oncology Group (ECOG) ≤ 2
  • Life expectancy of ≥ 3 months
  • Adequate hematologic parameters without ongoing transfusional support:

    • Hemoglobin (Hb) ≥ 9 g/dL
    • Absolute neutrophil count (ANC) ≥ 1.0 x 10^9 cells/L
    • Platelets ≥ 75 x 10^9 cells/L
  • Adequate renal and hepatic function:

    • Creatinine ≤ 1.5 x the upper limit of normal (ULN), or calculated creatinine clearance ≥ 50 mL/minute x 1.73 m^2
    • Total bilirubin ≤ 2 times the upper limit of normal (ULN) unless due to Gilbert's disease
    • ALT/AST ≤ 2.5 times ULN, or < 5 times ULN for subjects with liver metastases
  • Negative serum pregnancy test within 14 days prior to the first dose of study therapy for women of child-bearing potential (WCBP). Sexually active WCBP and male subjects must agree to use adequate methods to avoid pregnancy throughout the study and for 28 days after the completion of study treatment.
  • Ability to provide written informed consent

Exclusion Criteria:

  • Urgent need of treatment to prevent acute neurologic deterioration, including urgent neurosurgery or radiotherapy
  • Symptoms of uncontrolled intracranial pressure
  • Evidence of leptomeningeal metastases
  • Symptomatic or untreated spinal cord compression
  • Serious cardiac condition within the last 6 months, such as uncontrolled arrhythmia, myocardial infarction, unstable angina or heart disease defined by the New York Heart Association (NYHA) Class III or Class IV
  • QT interval corrected for rate (QTc) > 480 msec for on the ECG obtained at Screening using Fridericia method for QTc calculation
  • Known positive for human immunodeficiency virus (HIV), hepatitis B virus surface antigen (HBsAg) or hepatitis C virus (HCV)
  • Active infection requiring IV antibiotic usage within the last week prior to study treatment
  • Any other medical intervention or other condition which, in the opinion of the Principal Investigator, could compromise adherence to study requirements or confound the interpretation of study results
  • Pregnant or breast-feeding

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03332589


Contacts
Contact: Linda J Paradiso, DVM +1 (713) 898-8965 linda.paradiso@spiritaoncology.com

Locations
United States, Arizona
University of Arizona Cancer Center Recruiting
Tucson, Arizona, United States, 85724
Contact: Crystal Placencia, BS    520-694-1231    cplacencia@uacc.arizona.edu   
Principal Investigator: Hani Babiker, MD         
Sponsors and Collaborators
Spirita Oncology, LLC
University of Arizona
Investigators
Principal Investigator: Hani M Babiker, MD University of Arizona

Additional Information:
Responsible Party: Spirita Oncology, LLC
ClinicalTrials.gov Identifier: NCT03332589     History of Changes
Other Study ID Numbers: STX-101-02
First Posted: November 6, 2017    Key Record Dates
Last Update Posted: November 15, 2018
Last Verified: November 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Spirita Oncology, LLC:
Melanoma
CNS metastases
BRAF mutation
MEK mutation
E6201

Additional relevant MeSH terms:
Melanoma
Neoplasm Metastasis
Neoplasms, Second Primary
Neuroendocrine Tumors
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Nerve Tissue
Nevi and Melanomas
Neoplastic Processes
Pathologic Processes