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APG-2575 in Combination With Novel Therapeutic Regimens in Subjects With Relapsed or Refractory Multiple Myeloma

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ClinicalTrials.gov Identifier: NCT04942067
Recruitment Status : Recruiting
First Posted : June 28, 2021
Last Update Posted : August 20, 2021
Sponsor:
Information provided by (Responsible Party):
Ascentage Pharma Group Inc.

Brief Summary:
This is a Phase Ib/II, open-label, multi-center study evaluating the safety, tolerability, efficacy, and PK/ Pharmacodynamics of APG-2575 in combination with Pd/DRd in patients with relapsed/refractory (RR) multiple myeloma (MM). The study consists of dose escalation and dose expansion phases. The study consists of will start with 2 arms noted below, both arms are independent

Condition or disease Intervention/treatment Phase
Multiple Myeloma Drug: APG2575+ Pd Drug: APG2575 + DRd Phase 1 Phase 2

Detailed Description:

This is a Phase Ib/II, open-label, multi-center study evaluating the safety, tolerability, efficacy, and PK/ Pharmacodynamics of APG-2575 in combination with Pd/DRd in patients with relapsed/refractory (RR) multiple myeloma (MM). The study consists of dose escalation and dose expansion phases. The study consists of will start with 2 arms noted below, both arms are independent.

Arm A: APG-2575 will be administered in combination with Pd to determine the MTD and /RP2D of APG-2575 in subjects with R/R MM.

3+3 design will be utilized in dose escalation phase of APG-2575 in combination with Pd. The starting target dose of APG-2575 is 400 mg (dose level; DL1) and will be escalated in subsequent cohorts to 600 mg (DL2), 800 mg (DL3) accordingly. Dose reduction to 200 mg (DL-1) is acceptable if APG-2575 at dose of 400 mg cannot be tolerated. This rule-based design proceeds with cohorts of three patients. If none of the three patients enrolled in DL1 experiences a DLT, another three patients will be treated at DL2, and so on. However, if one patient experiences a DLT, three more patients will be treated at the same dose level. The dose escalation continues until at least two patients among a cohort of three to six patients experience DLT. MTD is conventionally defined as the highest dose level at which ≤ 33% of patients experience DLT. Higher dose level would be considered after a comprehensive analyses of safety data in the context of 800 mg can be well tolerated, otherwise, 800 mg (DL3) should be considered as MTD (Arm A). RP2D (Arm A) will be determined based on efficacy and safety profile of APG-2575 in combination with Pd.

Patients will receive APG-2575 at target dose once daily for 28 days plus pomalidomide (4 mg ) on Days 1 through 21 and dexamethasone (40 mg for patients ≤ 75 years old or 20 mg for patients > 75 years old) on Days 1, 8, 15, and 22 of a repeated 28-day cycle

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 70 participants
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Intervention Model Description: dose escalation and dose expansion after MTD
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase Ib/II Open-Label Study of APG-2575 in Combination With Novel Therapeutic Regimens in Subjects With Relapsed or Refractory Multiple Myeloma and Immunoglobin Light Chain Amyloidosis
Actual Study Start Date : June 1, 2021
Estimated Primary Completion Date : September 1, 2022
Estimated Study Completion Date : December 1, 2023

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Multiple Myeloma

Arm Intervention/treatment
Experimental: APG2575 +Pd or LD
APG2575+ Pomalidomide 4mg QD x 21 days + dexamethasone
Drug: APG2575+ Pd
APG 2575 + Pomalidomide 4mg QD x 21 days + dexamethasone (40 mg for patients ≤ 75 years old or 20 mg for patients > 75 years old) on Days 1, 8, 15, and 22 of a repeated 28-day cycle
Other Name: APG 2575+ Pomalidomide + Dexamethasone

Experimental: APG2575+LD
APG2575+ Lenalidomide +Dexa Days 1 through 21 of each 28-day cycle,
Drug: APG2575 + DRd
APG2575+ Lenalidomide administered at a dose of 25 mg orally (PO) on Days 1 through 21 of each 28-day cycle, dexamethasone will be administered at a dose of 40 mg (or 20 mg for patients > 75 years old) once weekly, and daratumumab will be administered intravenously at a dose of 16 mg/kg (or 1800 mg administered subcutaneously if commercially available) weekly in cycles 1 and 2 and then every 2 weeks in cycles 3 to 6 and every 4 weeks thereafter.
Other Name: APG2575+ Lenalidomide +Dexamethasone+Daratumumab




Primary Outcome Measures :
  1. Dose limiting toxicity [ Time Frame: 45 days ]
    DLT will be defined based on the rate of drug-related grade 3-5 adverse events experienced within the first 6 weeks (2 cycles) of study treatment. These will be assessed via CTCAE version 5.0



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Ages Eligible for Study:   18 Years to 99 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. ≥ 18 years of age.
  2. MM patients (for Arm A and Arm B): Patients with Relapsed/Refractory MM per 2016 IMWG criteria, previously treated with at least 1 but not more than 4 prior lines of therapy for MM. Refractory MM, meanwhile, is defined as disease that progresses on salvage therapy or progresses within 60 days of the last treatment.

    AL amyloidosis patients (for Arm C ONLY): Patients with AL amyloidosis when meeting:

    i. histochemical diagnosis based on detection by polarizing microscopy of green birefringent material in Congo red-stained tissue specimens, the type must have been confirmed unequivocally. ii. have symptomatic organ involvement as defined by Appendix J. Only purpura and/or carpal tunnel syndrome are not acceptable. iii. have at least one prior line of systemic therapy for AL. Patients who do not achieve at least a PR to frontline therapy in 3 months are eligible. iv. have measurable disease as defined by at least ONE of the following:

    • Serum monoclonal protein ≥1.0 g/dl by protein electrophoresis.
    • >200 mg of monoclonal protein in the urine on 24-hour electrophoresis.
    • Serum differential FLC concentration (dFLC, difference between amyloid forming [involved] and nonamyloid forming [uninvolved] free light chain [FLC]) > 5 mg/dL; OR serum FLC of 7.5 mg/dL provided the κ/λ FLC ratio is abnormal (κ/λ <0.26 for patients with monoclonal λ FLC, κ/λ >1.65 for patients with monoclonal κ FLC).
  3. Eastern Cooperative Oncology Group (ECOG) ≤ 2.
  4. Life expectancy ≥ 6 months.
  5. Adequate hematologic function defined as:

    1. ANC ≥1.0 x 109/L independent of growth factor support within 7 days of the first dose with study drug.
    2. Hemoglobin ≥8 g/dL without transfusion or growth factor support within 7 days of the first dose of study drug.
    3. Platelet count ≥ 50 x 109/L without transfusion support within 7 days of the first doseof study drug (for MM patients); or platelet count ≥ 100 x 109/L or ≥ 50 x 109/L if bone marrow involvement independent of transfusion support in either (for AL amyloidosis patients).
  6. Adequate hepatic and renal function defined as:

    1. AST and ALT < 3 x ULN (upper limit of normal)
    2. Creatinine clearance >30mL/min(for MM patients); or Creatinine ≤3 mg/dL and CrCL

      ≥25 ml/min using the Cockcroft-Gault formula (for AL amyloidosis patients)

    3. Bilirubin< 1.5 x ULN (Except if considered secondary to Gilbert's syndrome and primarily indirect bilirubinemia)
  7. PT/INR ≤2 x ULN and PTT (or aPTT) ≤2 x ULN.
  8. Female subjects who are of non-reproductive potential (i.e., post-menopausal by historyno menses for ≥2 year; OR history of hysterectomy; OR history of bilateral tubal ligation;OR history of bilateral oophorectomy). Female subjects of childbearing potential must havea negative serum pregnancy test upon study entry.
  9. Male and female subjects who agree to use highly effective methods of birth control (e.g.,condoms, implants, injectables, combined oral contraceptives, some intrauterine devices[IUDs], sexual abstinence, or sterilized partner) during the period of therapy and for 90days after the last dose of study drug.
  10. Ability to complete questionnaire(s) by themselves or with assistance (For AL amyloidosis patients only).

Exclusion Criteria:

  1. MM patients with newly diagnosed MM, previously untreated for MM or only had been treated with localized palliative treatment or steroids less than equivalent of dexamethasone 40 mg daily for 4 days). AL amyloidosis patients with AL amyloidosis have not been treated with any systemic therapy, or AL amyloidosis clinically overt multiple myeloma i.e. original CRAB criteria. Extent of marrow plasmacytosis is not prohibitive.
  2. Subject has received antineoplastic therapy within 2 weeks before the date of registration.
  3. Subject has previously received an allogenic stem cell transplant (regardless of timing).
  4. Subjects planning to undergo a stem cell transplant prior to progression of disease on this study, i.e., these subjects should not be enrolled in order to reduce disease burden prior to transplant.
  5. Prior exposure to any BCL-2-directed therapy for MM.
  6. For Arm A only: The subjects show evidence of intolerance to pomalidomide, which is defined as subjects discontinued due to any AEs related to prior pomalidomide treatment;
  7. For Arm B only: The subjects show evidence of intolerance to daratumumab or lenalidomide, which is defined as subjects discontinued due to any AEs related to prior daratumumab or lenalidomide treatment;
  8. Patients with any uncontrolled active systemic infection, including but not limited to :

    active hepatitis B or C virus infection, known human immunodeficiency virus (HIV) positive

  9. Subject has peripheral neuropathy ≥grade 3.
  10. Subject has plasma cell leukemia (>2.0*109/L circulating plasma cells by standard differential) or Waldenström's macroglobulinemia or POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes).
  11. Plasmapheresis <35 days prior to the initiation of study drug. (Note: Subjects with high Mprotein values or hyper-viscosity symptoms during screening may receive plasmapheresis prior to initiating study drug if the previous plasmapheresis was performed >35 days before the plasmapheresis performed during screening (in order to obtain a true baseline M-protein value for efficacy evaluations).
  12. Failure to have fully recovered (i.e., ≤ Grade 1 toxicity) from the reversible effects of prior treatment for MM or AL amyloidosis..
  13. Unable to swallow tablets or malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel, symptomatic inflammatory bowel disease or ulcerative colitis, or partial or complete bowel obstruction.
  14. Currently active, clinically significant cardiovascular disease, such as uncontrolled arrhythmia (including Frederica corrected QT interval (QTc) ≥470 msec ) or Class 3 or 4 congestive heart failure as defined by the New York Heart Association Functional Classification; or a history of myocardial infarction, unstable angina, or acute coronary syndrome within 6 months prior to randomization.
  15. Major surgical procedure within ≤14 days prior to initiating study treatment, or anticipation of the need for major surgery during the course of the study treatment, radiotherapy ≤14 days prior to initiating study treatment, systemic treatment within 14 days before the first dose of APG2575.
  16. Recent infection requiring systemic treatment that was completed≤14 days before the first dose of study drug.
  17. Vaccinated with live, attenuated vaccines within 4 weeks of initiation of APG2575.
  18. Subject has any concurrent or recent malignancy ≤ 1 year prior to registration with the exception of: basal or squamous cell skin cancer, any carcinoma in situ,. NOTE: If there is a history or prior malignancy, they must not be receiving other specific treatment for their cancer.
  19. Requires treatment with a strong cytochrome P450 (CYP) 3A inhibitor.
  20. Known bleeding disorders (e.g., von Willebrand's disease) or hemophilia.
  21. History of stroke or intracranial hemorrhage within 6 months prior to enrollment.
  22. Any other condition or circumstance that would, in the opinion of the investigator, make the patient unsuitable for participation in the study

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): NCT04942067


Contacts
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Contact: Angela Kaiser 301-509-0357 angela.kaiser@ascentagepharma.com

Locations
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United States, Florida
Mayo Clinic Recruiting
Jacksonville, Florida, United States, 32224
United States, New York
Weil Cornell Medical Center Recruiting
New York, New York, United States, 10065
United States, Ohio
Cleveland Clinic Hosptials Not yet recruiting
Cleveland, Ohio, United States, 44103
Sponsors and Collaborators
Ascentage Pharma Group Inc.
Investigators
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Principal Investigator: Wensi Li, M. M, MD Ascentage Pharma
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Responsible Party: Ascentage Pharma Group Inc.
ClinicalTrials.gov Identifier: NCT04942067    
Other Study ID Numbers: APG2575MU101
First Posted: June 28, 2021    Key Record Dates
Last Update Posted: August 20, 2021
Last Verified: August 2021

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Multiple Myeloma
Neoplasms, Plasma Cell
Neoplasms by Histologic Type
Neoplasms
Hemostatic Disorders
Vascular Diseases
Cardiovascular Diseases
Paraproteinemias
Blood Protein Disorders
Hematologic Diseases
Hemorrhagic Disorders
Lymphoproliferative Disorders
Immunoproliferative Disorders
Immune System Diseases
Dexamethasone
Dexamethasone acetate
Lenalidomide
Pomalidomide
Daratumumab
BB 1101
Anti-Inflammatory Agents
Antiemetics
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Gastrointestinal Agents
Glucocorticoids
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Antineoplastic Agents, Hormonal