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A Study of Repotrectinib in Pediatric and Young Adult Subjects Harboring ALK, ROS1, OR NTRK1-3 Alterations

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04094610
Recruitment Status : Recruiting
First Posted : September 19, 2019
Last Update Posted : November 12, 2020
Sponsor:
Information provided by (Responsible Party):
Turning Point Therapeutics, Inc.

Brief Summary:

Phase 1 will evaluate the safety and tolerability at different dose levels of repotrectinib in pediatric and young adult subjects with advanced or metastatic malignancies harboring anaplastic lymphoma kinase (ALK), receptor tyrosine kinase encoded by the gene ROS1 (ROS1), or neurotrophic receptor kinase genes encoding TRK kinase family (NTRK1-3) alterations to estimate the Maximum Tolerated Dose (MTD) or Maximum Administered Dose (MAD) and select the Pediatric Recommended Phase 2 Dose (RP2D).

Phase 2 will determine the anti-tumor activity of repotrectinib in pediatric subjects with advanced or metastatic malignancies harboring ALK, ROS1, or NTRK1-3 alterations.


Condition or disease Intervention/treatment Phase
Locally Advanced Solid Tumors Metastatic Solid Tumors Lymphoma Primary CNS Tumors Drug: Oral repotrectinib (TPX-0005) Phase 1 Phase 2

Detailed Description:

Enrollment of subjects into Phase 1 will proceed concurrently by age as follows:

  • Subjects <12 years old will initially be enrolled in the Phase 1 part to determine the pediatric RP2D for this age group; once the pediatric RP2D is determined, subjects age <12 years old may be enrolled into the Phase 2 part of the study.
  • Subjects 12 to 25 years old will be directly enrolled into the Phase 2 part concurrent with Phase 1 enrollment.

Phase 1:

Approximately 12 pediatric subjects with locally advanced or metastatic solid tumors, including a primary central nervous system (CNS) tumor, or anaplastic large cell lymphoma (ALCL), with disease progression or who are non-responsive or intolerant to available therapies and for which no standard or available curative therapy exists.

Phase 2:

Subjects will be enrolled in one of 3 cohorts as follows:

Cohort 1: approximately 10-20 subjects with solid tumors characterized by NTRK fusion, TRK tyrosine kinase inhibitor (TKI)-naïve, and centrally confirmed measurable disease at baseline.

Cohort 2: approximately 23 subjects with solid tumors characterized by NTRK fusion, TRK TKI-pretreated, and centrally confirmed measurable disease at baseline.

Cohort 3: approximately 20 subjects with solid tumors or ALCL characterized by other ALK/ROS1/NTRK alterations or NTRK fusions without centrally confirmed measurable disease not otherwise eligible for Cohort 1 or 2.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 75 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 1/2, Open-Label, Safety, Tolerability, Pharmacokinetics, and Anti-Tumor Activity Study of Repotrectinib in Pediatric and Young Adult Subjects With Advanced or Metastatic Malignancies Harboring ALK, ROS1, NTRK1-3 Alterations
Actual Study Start Date : March 20, 2020
Estimated Primary Completion Date : December 2022
Estimated Study Completion Date : December 2023


Arm Intervention/treatment
Experimental: Repotrectinib (TPX-0005)

Phase 1

Oral repotrectinib (TPX-0005):

Safety and tolerability at different dose levels

Phase 2

Oral repotrectinib (TPX-0005): 3 cohorts

Cohort 1: TKI-naive NTRK fusion Cohort 2: Prior TKI NTRK fusion Cohort 3: ALK/ROS1/NTRK alterations or fusions in tumors and ALCL

Drug: Oral repotrectinib (TPX-0005)
Oral repotrectinib (TPX-0005)
Other Names:
  • Oral repotrectinib (TPX-0005) capsules
  • Oral repotrectinib (TPX-0005) oral suspension
  • repotrectinib




Primary Outcome Measures :
  1. Dose limiting toxicities (DLTs) (Phase 1) [ Time Frame: Within 28 days of the first repotrectinib dose ]
    Define the dose limiting toxicities (DLTs) (Phase 1)

  2. Pediatric Recommended Phase 2 Dose (RP2D) (Phase 1) [ Time Frame: Within 28 days of the last patient dosed in escalation ]
    To determine the pediatric RP2D (Phase 1)

  3. Overall Response Rate (ORR) (Phase 2) [ Time Frame: Two to three years after first dose of repotrectinib ]
    To determine the confirmed ORR of repotrectinib (TPX-0005) as assessed by Blinded Independent Central Review (Phase 2)


Secondary Outcome Measures :
  1. Overall Response Rate (ORR) (Phase 1) [ Time Frame: Approximately three years ]
    To determine the overall response rate (ORR) by Blinded Independent Central Review (BICR) (Phase 1)

  2. Clinical Benefit Rate (CBR) (Phase 1 and Phase 2) [ Time Frame: Approximately three years ]
    To determine the CBR of repotrectinib (TPX-0005) (Phase 1 and Phase 2)

  3. Time to response (TTR) (Phase 1 and Phase 2) [ Time Frame: Approximately three years ]
    To determine the TTR of reprotrectinib (TPX-005) (Phase 1 and Phase 2)

  4. Duration of response (DOR) (Phase 1 and Phase 2) [ Time Frame: Approximately three years ]
    To determine the DOR of repotrectinib (TPX-0005) (Phase 1 and Phase 2)

  5. Intracranial objective response rate (IC-ORR) (Phase 1 and Phase 2) [ Time Frame: Approximately three years ]
    To determine the IC-ORR of repotrectinib (TPX-005) (Phase 1 and Phase 2)

  6. Central Nervous System Progression-Free Survival (CNS-PFS) (Phase 2) [ Time Frame: Approximately three years ]
    CNS-PFS in subjects with measurable brain metastases (Phase 2)

  7. Progression-free survival (PFS) (Phase 2) [ Time Frame: Approximately three years ]
    To determine the PFS (Phase 2)

  8. Overall survival (OS) (Phase 2) [ Time Frame: Approximately three years ]
    To determine the OS (Phase 2)

  9. Maximum concentration of repotrectinib in plasma (Cmax) [ Time Frame: Pre-dose and up to 24 hours post-dose on Day 1 and Day 15 in Cycle 1 (each cycle is 28 days) ]
    To determine the Cmax

  10. Area under the concentration versus time curve of repotrectinib in plasma (AUC) [ Time Frame: Pre-dose and up to 24 hours post-dose on Day 1 and Day 15 in Cycle 1 (each cycle is 28 days) ]
    To determine the AUC



Information from the National Library of Medicine

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, Learn About Clinical Studies.


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Ages Eligible for Study:   up to 25 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Key Inclusion Criteria:

  1. Documented genetic ALK, ROS1, or NTRK1-3 alteration (point mutation, fusion, amplification) as identified by local testing in a Clinical Laboratory Improvement Amendments (CLIA) laboratory in the US or equivalently accredited diagnostic lab outside the United States (US) is required.
  2. Age <12 years.
  3. Prior cytotoxic chemotherapy is allowed.
  4. Prior immunotherapy is allowed.
  5. Resolution of all acute toxic effects (excluding alopecia) of any prior anti-cancer therapy to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version 4.03 Grade less than or equal to 1.
  6. All subjects must have measurable disease by RECIST v1.1 or Response Assessment in Neuro-Oncology Criteria (RANO) criteria at time of enrollment.
  7. Subjects with a primary CNS tumor or CNS metastases must be neurologically stable on a stable or decreasing dose of steroids for at least 14 days prior to enrollment.
  8. Subjects must have a Lansky (< 16 years) or Karnofsky (≥ 16 years) score of at least 50.
  9. Life expectancy greater than or equal to 12 weeks.
  10. Adequate hematologic, renal and hepatic function.

Phase 2 Inclusion Criteria:

  1. Age 12 to <25 years
  2. Cohort Specific Inclusion Criteria:

    • Cohort 1: Subjects with NTRK fusion gene positive (NTRK+) advanced solid tumors (including primary CNS tumors), that are tropomyosin receptor kinase (TRK) TKI naïve;
    • Cohort 2: subjects with NTRK+ advanced solid tumors (including primary CNS tumors), that are TRK TKI pre-treated;
    • Cohort 3: subjects with tumors or ALCL characterized by other ALK/ROS1/NTRK alterations or NTRK fusions without centrally confirmed measurable disease or not otherwise eligible for Cohort 1 or 2.
  3. Subjects in Cohorts 1 and 2 must have prospectively confirmed measurable disease by BICR prior to enrollment.

Key Exclusion Criteria (Phase 1 and Phase 2):

  1. Subjects with neuroblastoma with only bone marrow disease evaluable by bone marrow aspiration only.
  2. Major surgery within 14 days (2 weeks) of start of repotrectinib treatment. Central venous access (Broviac, Mediport, etc.) placement does not meet criteria for major surgery.
  3. Known active infections (bacterial, fungal, viral including HIV positivity).
  4. Gastrointestinal disease (e.g., Crohn's disease, ulcerative colitis, or short gut syndrome) or other malabsorption syndromes that would impact drug absorption.
  5. Any of the following cardiac criteria:

    • Mean resting corrected QT interval (ECG interval measured from the onset of the QRS complex to the end of the T wave) for heart rate (QTc) > 470 msec obtained from three ECGs, using the screening clinic ECG machine-derived QTc value
    • Any clinically important abnormalities in rhythm, conduction, or morphology of resting ECG (e.g., complete left bundle branch block, third degree heart block, second degree heart block, PR interval > 250 msec)
    • Any factors that increase the risk of QTc prolongation or risk of arrhythmic events such as heart failure, congenital long QT syndrome, family history of long QT syndrome, or any concomitant medication known to prolong the QT interval
  6. Peripheral neuropathy of CTCAE ≥grade 2.
  7. Subjects being treated with or anticipating the need for treatment with strong CYP3A4 inhibitors or inducers.

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): NCT04094610


Contacts
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Contact: Zachary Zimmerman, M.D. (858) 276-0005 clinical@tptherapeutics.com

Locations
Show Show 22 study locations
Sponsors and Collaborators
Turning Point Therapeutics, Inc.
Investigators
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Study Director: Zachary Zimmerman, M.D. Turning Point Therapeutics
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Responsible Party: Turning Point Therapeutics, Inc.
ClinicalTrials.gov Identifier: NCT04094610    
Other Study ID Numbers: TPX-0005-07
First Posted: September 19, 2019    Key Record Dates
Last Update Posted: November 12, 2020
Last Verified: November 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: There are no plans to share individual participant data with other researchers.

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Turning Point Therapeutics, Inc.:
ALK
ROS1
NTRK1-3
Primary CNS tumor
anaplastic large cell lymphoma
metastatic solid tumor
advanced solid tumor
sarcoma
infantile fibrosarcoma
glioblastoma
soft tissue schwannoma
solitary fibrous tumor
glioma
inflammatory myofibroblastic tumor
pediatric
Additional relevant MeSH terms:
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Neoplasms
Central Nervous System Neoplasms
Nervous System Neoplasms
Neoplasms by Site
Nervous System Diseases