Investigation of SCO-101 in Combination With FOLFIRI for Patients With Metastatic Colorectal Cancer (mCRC) With Acquired Resistance to FOLFIRI

• ClinicalTrials.gov Identifier: NCT04247256
• Recruitment Status: Recruiting
• First Posted: January 30, 2020
• Last Update Posted: April 3, 2020
• Sponsor: Scandion Oncology A/S
• Collaborator: TFS Trial Form Support International AB
• Information provided by (Responsible Party): Scandion Oncology A/S

Study Description

Brief Summary:

This study evaluates the combination of SCO-101 to FOLFIRI for the treatment of metastatic colorectal cancer patients who have developed resistance to FOLFIRI treatment. The study is divided in two parts, where the first part evaluates the safety and toxicity of increasing doses of SCO-101 in combination with FOLFIRI at the same dose as the patient has previously developed resistance to. The second part of the study evaluates the safety and efficacy of the combination of FOLFIRI and SCO-101 at the dose level established in the first part.

Condition or disease	Intervention/treatment	Phase
Metastatic Colorectal Cancer	Drug: FOLFIRI Protocol; Drug: SCO-101	Phase 1; Phase 2

Detailed Description:

This is a multi-center, open label, dose escalation, Phase 2 study of SCO-101 in combination with FOLFIRI in up to 50 mCRC patients. All patients included have previously had effect from treatment with FOLFIRI, but have now progressed (i.e. treatment failure due to acquired resistance).

FOLFIRI is a key anti-cancer chemotherapeutic combination in the treatment of several solid tumor cancers, e.g. colorectal cancer. Cancer resistance to FOLFIRI exposure is a well known phenomenon and can often be attributed to upregulation of cellular efflux pumps, e.g. ATP-Binding Cassette (ABC)G2 and ABCB1, involved in the efflux of the chemotherapeutic agents from the cancer cells and resulting in treatment failure.

SCO-101 is an inhibitor of ATP-Binding Cassette (ABC) efflux pumps and SRPK1 kinase which is responsible for phosphorylation of splicing factors, a key element involved in tumour growth.

The combination of SCO-101 with FOLFIRI is expected to inhibit the active efflux of chemotherapy molecules from the cancer cell thereby re-sensitizing it to the chemotherapeutic agents.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 35 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment

Intervention Model Description

This is a multi-center, open label, dose escalation, Phase 2 study of SCO-101 in combination with FOLFIRI in up to 50 mCRC patients.

Cohorts of FOLFIRI-resistant mCRC patients will be treated with SCO-101 in combination with FOLFIRI . Patients to be enrolled should previously have had either complete response (CR), partial response (PR), or stable disease (SD) (>16 weeks) on FOLFIRI.

The study is separated in two parts. Part 1 is a dose escalation part with a standard 3+3 design, designed to evaluate the safety and toxicity of the combination of SCO-101 and FOLFIRI, and to identify the maximum tolerated dose (MTD). A maximum of 5 cohorts have been planned. Starting dose of SCO-101 is 150 mg (cohort 1) and maximum dose is 350 mg (cohort 5).

Part 2 is the efficacy part, where patients are treated with the MTD dose identified in the first part and evaluated for efficacy and safety of the combination SCO-101 plus FOLFIRI.

• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: An Open-label Phase II Prospective Clinical Trial to Investigate Safety, Tolerability, Maximum Tolerated Dose and Anti-tumor Effect for SCO-101 in Combination With FOLFIRI as a Safe and Efficient Treatment Modality in Metastatic or Advanced Colorectal Cancer (mCRC) Patients With Acquired FOLFIRI Resistant Cancer Disease.
• Actual Study Start Date: March 20, 2020
• Estimated Primary Completion Date: January 2021
• Estimated Study Completion Date: March 2021

Arms and Interventions

Arm	Intervention/treatment
Experimental: Treatment arm; SCO-101 in combination with FOLFIRI	Drug: FOLFIRI Protocol; FOLFIRI standard treatment on day 5 to 7 (both days included) of a 14 day period. repeated bi-weekly; Drug: SCO-101; Investigational Medicinal Product, oral tablet administered on day 1 to 6 (both days included) of a 14 day period. repeated bi-weekly

Outcome Measures

Primary Outcome Measures :

1. Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability] of combination of SCO-101 and FOLFIRI [ Time Frame: 4 cycles (each cycle is 2 weeks) ]
   Safety and tolerability by assessing the number, frequency, and severity of adverse events (AEs) collected from the time of first treatment until four weeks after end of treatment to evaluate safety of SCO-101 in combination with FOLFIRI determined according to CTCAE version 5.0
2. Maximum Tolerated Dose [ Time Frame: 1 cycle (each cycle is 2 weeks) ]
   Maximum tolerated dose (MTD) by evaluation of dose-limiting toxicities (DLTs) of SCO-101 in combination with FOLFIRI evaluated by CTCAE v. 5.0 (part 1 only)
3. Objective Response Rate [ Time Frame: 4 cycles (each cycle is 2 weeks) ]
   Objective response rate (ORR) defined as CR and PR using the RECIST v. 1.1

Secondary Outcome Measures :

1. Progression Free Survival (PFS) [ Time Frame: Start of treatment to first objective sign of progression, assessed up to 100 months ]
   Progression free survival (PFS) defined as time in months from the date of first study treatment to the date of disease progression or death from any cause, whichever comes first.
2. Duration of Response [ Time Frame: From first response to progression, assessed up to 100 months ]
   Duration of response (from first response to progression)
3. Duration of Response compared to prior Duration of response [ Time Frame: From first response to progression, assessed up to 100 months ]
   Duration of response (DOR) after administration of SCO-101 compared to DOR from patients initial FOLFIRI treatment regimen (without SCO-101).
4. Overall Survival [ Time Frame: Up to 2 years ]
   Overall survival (OS) defined as time in months from the date of first study treatment to the date of death;
5. Clinical Benefit Rate [ Time Frame: from benefit (CR, PR or SD > 16 weeks) to progression, assessed up to 100 months ]
   Clinical benefit rate (CBR) defined as the number of patients obtaining CR, PR, or SD > 16 weeks according to RECIST v.1.1.
6. Pharmacokinetic profile of SCO-101 in combination with FOLFIRI [ Time Frame: First week of administration (study part 1 only) ]
   Pharmacokinetic profile of SCO-101 in blood samples
7. ctDNA [ Time Frame: First 4 cycles of treatment (each cycle is 2 weeks) (study part 2 only) ]
   Change in ctDNA from baseline (prior first dose of SCO-101) until first CT scan
8. Biomarker UGT1A1 [ Time Frame: Baseline (pre-treatment (all study parts)) ]
   Evaluation of Selected UGT1A1 polymorphism in a pre-treatment blood sample
9. Biomarker IndiTreat(TM) [ Time Frame: Baseline (pre-treatment tumor biopsy (study part 2 only)) ]
   Efficacy of IndiTreat® to predict clinical response to SCO-101 treatment in combination with FOLFIRI from a tumor biopsy sample.
10. Biomarkers ABCG2, ABCB1, SRPK1 [ Time Frame: Baseline (Pre-treatment biopsy (study part 2 only)) ]
    Efficacy of molecular biomarkers ABCB1/ABCG2/SRPK1 determined by immunohistochemistry to predict clinical response to SCO-101 treatment

Eligibility Criteria

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

Criteria

Inclusion Criteria:

• 1. Ability to understand and willingness to provide written informed consent before any trial-related activities.

  2. Age 18 years or older.

  3. Histologically verified colorectal adenocarcinoma;

  4. Non resectable mCRC with or without known BRAF, KRAS or repair enzyme mutations.

  5. Documented progressive disease on FOLFIRI with or without antiangiogenetic and EGFR inhibitory biological treatment.

  6. Maximum reduction of 25% in prior dose of FOLFIRI

  7. mCRC with a prior benefit (SD for more than 16 weeks, or CR or PR) to FOLFIRI treatment regimen but now in progression;

  8. No indication for treatment with an oxaliplatin-containing treatment regimen. The patient may have received oxaliplatin treatment after treatment with FOLFIRI.

  9. Measurable disease by CT scan or MRI, according to RECIST 1.1.

  10. Performance status of ECOG ≤ 1.

  11. Recovered to Grade 1 or less from prior surgery or acute toxicities of prior radiotherapy or treatment with cytotoxic or biologic agents.

  12. ≥ 2 weeks must have elapsed since any prior surgery

  13. Adequate conditions as evidenced by the following clinical laboratory values:

  • Absolute neutrophils count (ANC) ≥ 1.5 x 109/L

  • Haemoglobin is at least 6,0 mmol/L

  • Platelets ≥ 100 x 109 /L

  • Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 x ULN*

  • Serum bilirubin ≤ 1.0 ULN
  • Alkaline phosphatase ≤ 2.5 x ULN*
  • Creatinine ≤ 1.5 ULN
  • Blood urea within normal limits
  • Creatinine clearance within normal limits.

  • Adequate blood clothing function as defined by the International Normalized Ratio (INR) < 1.20;

    14. Life expectancy equal to or longer than 3 months.

    15. Sexually active males and females of child-producing potential must use highly effective contraception (intrauterine devices, hormonal contraceptives (contraceptive pills, implants, transdermal patches, hormonal vaginal devices or injections with prolonged release)) for the study duration and at least 6 months after the last dose of study drug

    16. Signed informed consent.

    *In case of known liver metastases with ALT and AST ≤ 5 x ULN and/or alkaline phosphatase ≤ 5 x ULN: Patients who do not conform to the transaminase and/or alkaline phosphatase inclusion criteria, but who by the PI are considered in good PS and otherwise eligible for inclusion, and where the transaminase and/or alkaline phosphatase levels are considered elevated due to other reasons than deteriorated lever capacity, may be considered for inclusion based on conferred agreement between PI and sponsor.

Exclusion Criteria:

• 1. Concurrent chemotherapy, radiotherapy, or other investigational drug except non-disease related conditions (e.g. insulin for diabetes) during study period.

  2. Malabsorption syndrome or previous surgeries with resection of the stomach or small intestine, whereby absorption of SCO-101 may be affected. This includes patients with ileostomy.

  3. Difficulty in swallowing tablets.

  4. Clinical symptoms of CNS metastases requiring steroids.

  5. Any active infection requiring parenteral or oral antibiotic treatment.

  6. Known HIV positivity.

  7. Known active hepatitis B or C.

  8. Clinical significant (i.e. active) cardiovascular disease:

  • -Stroke within ≤ 6 months prior to day 1

  • -Transient ischemic attach (TIA) within ≤ 6 months prior to day 1
  • -Myocardial infarction within ≤ 6 months prior to day 1
  • -Unstable angina
  • -New York Heart Association (NYHA) Grade II or greater congestive heart failure (CHF)

  • -Serious cardiac arrhythmia requiring medication

    9. Mental status is not fit for clinical study or CNS disease including symptomatic epilepsy.

    10. Other medications or conditions that in the Investigator's opinion would contraindicate study participation of safety reasons or interfere with the interpretation of study results. Other severe medical conditions, including serious heart disease, unstable diabetes, uncontrolled hypercalcemia, clinically active infections or previous organ transplants. Participation in another clinical trial with experimental medication within 30 days prior to registration.

    11. Known hypersensitivity to irinotecan, 5FU or capecitabine

    12. Women who are breastfeeding

Contacts and Locations

Contacts

Contact: Peter M Vestlev, MD; +45 22779696; pmv@scandiononcology.com

Locations

Denmark

Aalborg University Hospital; Recruiting

Aalborg, Denmark

Contact: Peter M Vestlev, MD

Sponsors and Collaborators

Scandion Oncology A/S

TFS Trial Form Support International AB

Investigators

• Principal Investigator: Jacob Hagen Vasehus Schou, MD; Herlev and Gentofte Hospital

More Information

• Responsible Party: Scandion Oncology A/S
• ClinicalTrials.gov Identifier: NCT04247256
• Other Study ID Numbers: SCO101-001
• First Posted: January 30, 2020
• Last Update Posted: April 3, 2020
• Last Verified: April 2020

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No
• Product Manufactured in and Exported from the U.S.: No

Keywords provided by Scandion Oncology A/S:

colorectal; cancer; resistant; FOLFIRI; metastatic

Additional relevant MeSH terms:

Colorectal Neoplasms; Intestinal Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Neoplasms; Digestive System Diseases; Gastrointestinal Diseases; Colonic Diseases; Intestinal Diseases; Rectal Diseases