Study of ARQ 092 in Subjects With PIK3CA-related Overgrowth Spectrum and Proteus Syndrome (MOSAIC)

• ClinicalTrials.gov Identifier: NCT03094832
• Recruitment Status: Recruiting
• First Posted: March 29, 2017
• Last Update Posted: November 19, 2019
• Sponsor: ArQule
• Collaborator: Worldwide Clinical Trials
• Information provided by (Responsible Party): ArQule

Study Description

Brief Summary:

This is an open label, Phase 1/2 study of oral ARQ 092 (Miransertib) administered to subjects at least 2 years of age with PIK3CA-related Overgrowth Spectrum (PROS) and Proteus syndrome (PS) (MOSAIC).

Condition or disease	Intervention/treatment	Phase
Proteus Syndrome; PIK3CA-Related Overgrowth Spectrum (PROS)	Drug: ARQ 092	Phase 1; Phase 2

Expanded Access : An investigational treatment associated with this study is available outside the clinical trial.   More info ...

Detailed Description:

This is an open label, Phase 1/2 study of ARQ 092 (Miransertib) administered orally. The study consists of two parts: Part A and Part B. Part A is now closed to enrollment.

The study objectives for Part A are:

• To assess the safety and tolerability of ARQ 092 in patients with PROS and PS
• To assess the clinical activity of ARQ 092
• To evaluate the dosing schedule of ARQ 092
• To determine the pharmacokinetic (PK) profile of ARQ 092.

The study objectives for Part B are:

Primary objective:

• To determine the efficacy of ARQ 092 in subjects with PROS and PS

Secondary objectives:

• To estimate the change from baseline in pain score
• To estimate change from baseline in physical functioning
• To describe the long-term tolerability and safety of ARQ 092
• To determine the duration of response

All enrolled subjects (except for those in cohort 4 of Part B) will receive ARQ 092 at the 15 mg/m2 QD dose level during the first three cycles. The dose may be increased to 25 mg/m2 at cycle 4 provided no clinically significant drug-related toxicity is observed and upon agreement between the Investigator and the Sponsor.

For an individual subject, treatment will continue until disease progression, unacceptable toxicity, or another discontinuation criterion is met. It is expected that most subjects will receive between 3 to 48 cycles of treatment.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 85 participants
• Allocation: Non-Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Phase 1/2 Study of ARQ 092 (Miransertib) in Subjects With PIK3CA-related Overgrowth Spectrum (PROS) and Proteus Syndrome (PS) (MOSAIC)
• Actual Study Start Date: May 30, 2017
• Estimated Primary Completion Date: June 30, 2021
• Estimated Study Completion Date: June 30, 2023

Arms and Interventions

Arm	Intervention/treatment
Experimental: ARQ 092 - Part A; One cohort of subjects at least 2 years of age with either PROS or PS	Drug: ARQ 092; ARQ 092 should be taken either 1 hour before or 2 hours after a meal
Experimental: ARQ 092 - Part B, cohort 1; Subjects with PROS who have a measurable lesion by volumetric MRI .	Drug: ARQ 092; ARQ 092 should be taken either 1 hour before or 2 hours after a meal
Experimental: ARQ 092 - Part B, cohort 2; Subjects with PS who have a measurable lesion by standardized digital photography	Drug: ARQ 092; ARQ 092 should be taken either 1 hour before or 2 hours after a meal
Experimental: ARQ 092 - Part B, cohort 3; Subjects with PROS or PS who do not meet all the eligibility criteria for cohorts 1 or 2	Drug: ARQ 092; ARQ 092 should be taken either 1 hour before or 2 hours after a meal
Experimental: ARQ 092 - Part B, cohort 4; Subjects previously treated with ARQ 092 or currently receiving ARQ 092 under Compassionate Use/Expanded Access.	Drug: ARQ 092; ARQ 092 should be taken either 1 hour before or 2 hours after a meal

Outcome Measures

Primary Outcome Measures :

1. Part A - Incidence of adverse events graded using current National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) guidelines [ Time Frame: At each visit up to 48 months ]
   The incidence of adverse events will be assessed as a measure of the safety and tolerability profile of ARQ 092
2. Part B - Change in lesion size from baseline in the treated population [ Time Frame: At any time point from baseline up through 12 months ]
   For Cohort 1 (PROS), the primary endpoint is response rate, as assessed by blinded central imaging review of volumetric MRI; For Cohort 2 (PS), the primary endpoint is response rate, as assessed by blinded central photography review of CCTN lesional area

Secondary Outcome Measures :

1. Part A - Assess the peak plasma concentration (Cmax) of the pharmacokinetic (PK) profile of ARQ 092 [ Time Frame: Cycle 1 Day 1 through Cycle 8 Day 1 (each cycle is 28 days) ]
2. Part A - Assess the area under the plasma concentration vs. time curve (AUC) of the PK profile of ARQ 092 [ Time Frame: Cycle 1 Day 1 through Cycle 8 Day 1 (each cycle is 28 days) ]
3. Part A - Assess the time to maximum plasma drug concentration (Tmax) of the PK profile of ARQ 092 [ Time Frame: Cycle 1 Day 1 through Cycle 8 Day 1 (each cycle is 28 days) ]
4. Part A - Evaluate changes in fibrinogen and D-dimers from blood [ Time Frame: Baseline, once every cycle for the first year (each cycle is 28 days), and once at study completion, an average of 3 years. ]
   Changes in fibrinogen and D-dimers will determine the pharmacodynamic activity of ARQ 092
5. Part A - Evaluate efficacy measured as evidence of changes to the lesion size or volume [ Time Frame: Baseline, once at end of every 3rd cycle (each cycle is 28 days) during 1st year, once every 6 cycles thereafter through study completion, an average of 3 years, and once at study completion ]
   Disease measurement will occur by imaging examination (e.g., MRI, CT, US), photography, video recording, and/or change in body measurements (e.g., linear or circumference measurements) as performed by a tape measure
6. Part B (cohorts 1, 2, 3) - Change from baseline in pain score [ Time Frame: Screening,Cycle 1 Day 1, Cycle 7, Cycle 13, Cycle 19, Cycle 25, Cycle 37, End of Trial ]
   Change from baseline in pain score will be assessed by Wong-Baker FACES® Pain Rating Scale
7. Part B (cohorts 1, 2, 3) - Change from baseline in physical functioning [ Time Frame: Screening,Cycle 1 Day 1, Cycle 7, Cycle 13, Cycle 19, Cycle 25, Cycle 37, End of Trial ]
   Change from baseline in physical functioning will be assessed by PROMIS® (Pediatric Upper Extremity Short Form 8a, Parent Proxy Upper Extremity Short Form 8a, Pediatric Mobility Short Form 8a, Parent Proxy Mobility Short Form 8a, Physical Function Short Form 8b)
8. Part B (cohorts 1, 2, 3) - duration of response [ Time Frame: The time period from when subject first achieve a response to the next assessment, and all subsequent assessments ]
9. Part B (cohorts 1, 2, 3) - safety and tolerability [ Time Frame: Safety and tolerability will be assessed by frequency, duration and severity of AEs from the first dose of ARQ 092 through 30 days after the last dose of the drug (severity of AEs will be assessed by current CTCAE version) ]

Eligibility Criteria

• Ages Eligible for Study: 2 Years and older (Child, Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria for Part A

1. Signed informed consent and, when applicable, signed assent
2. Male or female patients ≥ 2 years old with BSA of ≥ 0.33 m2
3. Have a clinical diagnosis of PROS or PS with documented somatic PIK3CA or AKT1 mutations
4. Archival or fresh overgrowth tissue sample available to be shipped to Sponsor or designee
5. Have poor prognosis, significant morbidity, and/or progressive disease (e.g., worsening of the disease/increase in number or size of the overgrowth lesions in the last 12 months)
6. Have measurable disease (at least one overgrowth lesion that can be accurately measured in size by imaging and/or linear or circumference measure)

7. Adequate organ function as indicated by the following laboratory values:

   Hematological

   1. Hgb depending on age:

      • 2-5 years male and female: ≥ 10.0 g/dL
      • 6-9 years male and female: ≥ 11.5 g/dL
      • 10-17 years female: ≥ 11.0 g/dL
      • 10-17 years male: ≥ 11.5 g/dL
      • > 17 years male and female: ≥ 10.0 g/dL
   2. Glycated hemoglobin (HbA1c): ≤ 8% (≤ 64 mmol/mol)
   3. Absolute neutrophil count (ANC): ≥ 1.5 x 109/L
   4. Platelet count ≥ 150 x 109/L

   Hepatic

   1. Total bilirubin ≤ 1.5 x upper limit of normal (ULN)/L
   2. AST and ALT ≤ 3 x ULN

   Renal

   a. Serum creatinine depending on age:

   • 2-5 years male and female: maximum 0.50 mg/dL
   • 6-10 years male and female: maximum 0.59 mg/dL
   • 11-15 years male and female: maximum 1.2 mg/dL
   • > 15 years male and female: maximum 1.5 mg/dL

   Metabolic (lipids)

   1. Cholesterol: ≤ 400 mg/dL (≤ 10.34 mmol/L)
   2. Triglyceride: ≤ 500 mg/dL (≤ 5.7 mmol/L)
8. If a female is of child-bearing potential, documentation of a negative pregnancy test is required prior to enrollment. Sexually active patients (male and female) must agree to use double-barrier contraceptive measures, oral contraception, or avoidance of intercourse while on study and for up to 90 days after ending treatment
9. Ability to complete the QoL questionnaires by the patient or his/her caregiver

Exclusion Criteria for Part A:

1. History of Type 1 or 2 uncontrolled diabetes mellitus requiring regular medication (other than metformin or other oral hypoglycemic agents) or fasting glucose ≥ 160 mg/dL (if > 12 years old) and ≥ 180 mg/dL (if ≤ 12 years old) at the screening visit

2. History of significant cardiac disorders:

   • Myocardial infarction (MI) or congestive heart failure defined as Class II-IV per the New York Heart Association (NYHA) classification within 6 months of the first dose of ARQ 092 (MI occurring > 6 months of the first dose of ARQ 092 will be permitted)
   • Grade 2 (per NCI CTCAE version 4.03) or worse conduction defect (e.g., right or left bundle branch block); left ventricular ejection fraction (LVEF) < 50% assessed by echocardiogram/multigated acquisition (MUGA) scan
3. Major surgery, radiotherapy, or immunotherapy within four weeks of the first dose of ARQ 092

4. Any experimental systemic therapy for the purpose of treating PROS or PS (e.g., sirolimus, everolimus, high dose steroids) within two weeks of the first dose of ARQ 092, except for patients who were previously or are currently treated with ARQ 092 under a Compassionate Use/Expanded Access program

   - Patients, who were previously treated with or currently are receiving ARQ 092, will be enrolled and treated according to the Schedule of Assessments/Study Visits defined in this protocol

5. Intolerance of or severe toxicity attributed to AKT inhibitors (e.g., ARQ 092, uprosertib, afuresertib, ipatasertib)

6. Concurrent severe uncontrolled illness not related to PROS or PS

   • Ongoing or active infection
   • Known human immunodeficiency virus (HIV) infection
   • Malabsorption syndrome
   • Psychiatric illness/substance abuse/social situation that would limit compliance with study requirements
7. Pregnant or breastfeeding
8. Inability to comply with study evaluations or to follow drug administration guidelines

Inclusion criteria for Part B:

1. Signed consent form and when applicable, signed assent

2. Cohort 1 (PROS) specific criteria

   • Male or female subjects ≥ 2 years and ≤30 years of age with BSA of ≥ 0.33 m2
   • Have clinical diagnosis of PROS per Diagnostic Criteria for PROS and documented somatic PIK3CA variant
   • Have at least one lesion that can be measured by study- standardized volumetric MRI (eligibility to be confirmed by blinded independent central imaging review

3. Cohort 2 (PS) specific criteria

   • Male or female subjects ≥ 2 years and ≤18 years of age with BSA of ≥ 0.33 m2
   • Have clinical diagnosis of PS per Diagnostic Criteria for PS and documented somatic AKT1 variant
   • Have at least one plantar CCTN and pre-CCTN lesion that can be measured by standardized photography.

4. Cohort 3 specific criteria

   • Male or female subjects ≥2 years old with BSA of ≥ 0.33 m2 and who fail to meet the eligibility criteria for Cohorts 1 or 2

5. Cohort 4 (PROS or PS) specific criteria

   • Subjects previously treated with ARQ 092 or currently receiving ARQ 092 under Compassionate Use/Expanded Access

   Note: Subjects should meet the age criterion by/on the date of the first dose, Cycle 1 Day 1.

   All Cohorts:

6. Archival or fresh overgrowth tissue sample available to be shipped to Sponsor or designee
7. Except for Cohort 4, clinically progressive or worsening disease defined as an increase in number or size of the overgrowth lesion(s) in the last 6 months as assessed by the Investigator.

8. Adequate organ function as indicated by the following laboratory values:

   Hematological

   a. Hemoglobin (Hgb) depending on age: 2-5 years male and female: ≥ 10.0 g/dL 6-9 years male and female: ≥ 11.5 g/dL 10-17 years female: ≥ 11.0 g/dL 10-17 years male: ≥ 11.5 g/dL

   • 18 years male and female: ≥ 10.0 g/dL b. Glycated hemoglobin (HbA1c): ≤ 8% (≤ 64 mmol/mol) c. Absolute neutrophil count (ANC): ≥ 1.5 x 109/L d. Platelet count ≥ 150 x 109/L Hepatic

     1. Total bilirubin ≤ 1.5 x upper limit of normal (ULN)/L
     2. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 3 x ULN Renal

     1. Serum creatinine depending on age:

        2-5 years male and female: maximum 0.80 mg/dL 6-10 years male and female: maximum 1.0 mg/dL 11-15 years male and female: maximum 1.2 mg/dL > 15 years male and female: maximum 1.5 mg/dL

     2. Estimated Glomerular Filtration Rate (eGFR):

   • 60 mL/min/1.73 m2 Metabolic (lipids)

     1. Cholesterol: ≤ 400 mg/dL (≤ 10.34 mmol/L)
     2. Triglyceride: ≤ 500 mg/dL (≤ 5.7 mmol/L)
9. Male or female subjects of child-producing potential must agree to use double-barrier contraceptive measures, oral contraception, or avoidance of intercourse during the study and for 90 days after the last dose of ARQ 092
10. Ability to complete the study questionnaires by the subject or his/her caregiver

Exclusion Criteria for Part B

1. History of Type 1 diabetes mellitus or Type 2 uncontrolled diabetes mellitus requiring regular medication (other than metformin or other oral hypoglycemic agents) or fasting glucose ≥ 160 mg/dL (if > 12 years old) and ≥ 180 mg/dL (if ≤ 12 years old) at the screening visit

2. History of significant cardiac disorders:

   • Myocardial infarction (MI) or congestive heart failure defined as Class II-IV per the New York Heart Association (NYHA) classification within 6 months of the first dose of ARQ 092 (MI occurring > 6 months of the first dose of ARQ 092 will be permitted)
   • Grade 2 (per current version of National Cancer Institute [NCI] Common Terminology Criteria for Adverse Events [CTCAE]) or worse conduction defect (e.g., right or left bundle branch block)
   • Major surgery or locoregional therapy within four weeks of the first dose of ARQ 092
3. Any experimental systemic therapy for the purposes of treating PROS or PS (e.g., sirolimus, everolimus, high dose steroids) within two weeks of the first dose of ARQ 092
4. Intolerance of or severe toxicity attributed to AKT inhibitors (e.g., ARQ 092, uprosertib, afuresertib, ipatasertib)

5. Concurrent severe uncontrolled illness not related to PROS or PS, e.g.,

   • Ongoing or active infection
   • Known human immunodeficiency virus (HIV) infection
   • Malabsorption syndrome
   • Psychiatric illness/substance abuse/social situation that would limit compliance with study requirements
6. Pregnant or breastfeeding
7. Inability to comply with study evaluations or to follow drug administration guidelines

Contacts and Locations

Contacts

Contact: ArQule, Inc.; 781-994-0300; ClinicalTrials@arqule.com

  Show 21 Study Locations

Sponsors and Collaborators

ArQule

Worldwide Clinical Trials

Investigators

• Study Director: Brian Schwartz, MD; ArQule

More Information

• Responsible Party: ArQule
• ClinicalTrials.gov Identifier: NCT03094832 History of Changes
• Other Study ID Numbers: ARQ 092-103; MOSAIC ( Other Identifier: Mirasnsertib in Overgrowth Syndromes in Adults and Children )
• First Posted: March 29, 2017
• Last Update Posted: November 19, 2019
• Last Verified: November 2019

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 ArQule:

ARQ 092; ArQule; AKT; PIK3CA; Overgrowth; Congenital malformations; Miransertib; MOSAIC

Additional relevant MeSH terms:

Proteus Infections; Proteus Syndrome; Syndrome; Disease; Pathologic Processes; Enterobacteriaceae Infections; Gram-Negative Bacterial Infections; Bacterial Infections; Hamartoma Syndrome, Multiple; Hamartoma; Neoplasms; Neoplasms, Multiple Primary; Bone Diseases, Developmental; Bone Diseases; Musculoskeletal Diseases; Limb Deformities, Congenital; Musculoskeletal Abnormalities; Abnormalities, Multiple; Congenital Abnormalities