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A Phase 1, Open-Label, Dose Escalation Study to Evaluate Safety, Pharmacokinetics and Pharmacodynamics of Combined Oral C-Met/ALK Inhibitor (PF-02341066) and Pan-Her Inhibitor (PF-0299804) in Patients With Advanced Non-Small Cell Lung Cancer


Phase 1
18 Years
N/A
Open (Enrolling)
Both
Carcinoma, Non-Small Cell Lung, Adenocarcinoma, Carcinoma, Squamous Cell, Carcinoma, Large Cell

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Trial Information

A Phase 1, Open-Label, Dose Escalation Study to Evaluate Safety, Pharmacokinetics and Pharmacodynamics of Combined Oral C-Met/ALK Inhibitor (PF-02341066) and Pan-Her Inhibitor (PF-0299804) in Patients With Advanced Non-Small Cell Lung Cancer


BACKGROUND:

- Approximately 85% of lung cancer is defined histologically as NSCLC and the majority of
patients present with inoperable locally advanced (Stage IIIB) or metastatic (Stage IV)
disease for which no curative treatment is available.

- Patients with disease progression on or after first-line treatment with platinum-based
doublets may be candidates for second-line treatment.

- Recent evidence strongly implicates EGFR activating somatic mutations as a mechanism of
tumorigenesis and a determinant of sensitivity to EGFR TKIs in NSCLC.

- Despite the dramatic initial response to gefitinib and erlotinib, about 50% of NSCLC
tumors develop resistance due to secondary activating mutations in EGFR itself,
including the EGFR T790M gatekeeper mutation, and more than 20% of acquired
resistance is due to an increase in mesenchymal-epithelial transition factor (c-Met)
signaling.

- There is evidence from a limited number of tumors from patients with acquired
resistance to EGFR-TKIs that both T790M and cMET resistance mechanisms can occur in the
same patient at different metastatic sites and even in different fractions of the same
lesion.

- Tumors with acquired resistance to erlotinib and gefitinib might be vulnerable to a
combination of PF-00299804 a second generation EGFR TKI which is also an inhibitor of
T790M mutation, and PF-02341066 which is an inhibitor of c- Met/Hepatocyte Growth
Factor Receptor (HGFR).

OBJECTIVES:

- To define the recommended Phase 2 dose (RP2D) of combined PF-02341066 plus

PF-00299804 in patients with advanced Non-Small Cell Lung Cancer (NSCLC).

- To assess the overall safety and tolerability, plasma pharmacokinetics (PK) and
clinical activity of combined PF-02341066 plus PF-00299804.

- To analyze potential predictive and pharmacodynamic biomarkers in tumor and blood in
patients with advanced NSCLC who have acquired resistance to erlotinib or gefitinib

ELIGIBILITY:

- Dose Escalation Phase: Adults with histologically documented diagnosis of NSCLC that is
locally advanced or metastatic, after failure of either at least one chemotherapy regimen or
treatment with erlotinib or gefitinib.

Expansion Phase: Adults with histologically documented diagnosis of NSCLC that is locally
advanced or metastatic, with acquired resistance to erlotinib or gefitinib, and must have
one lesion amendable to biopsy.

- All pathology samples will be reviewed at the NCI.

DESIGN:

- Phase 1, multi-center, open-label, non-randomized trial of combined oral PF- 02341066
and oral PF-00299804 in patients with advanced NSCLC. Trial consists of two phases.

- Dose Escalation Phase: Patients will be treated with varying doses of combined PF-
02341066 plus PF-00299804. Tumor biopsy is not required.

- Expansion Phase: Two expansion cohorts will run concurrently following completion of
the Dose Escalation Phase. Both cohorts will enroll patients with locally advanced or
metastatic NSCLC with acquired resistance to erlotinib or gefitinib, which is defined
as progression following an initial response (complete or partial) or stable disease
for at least six months while on erlotinib or gefitinib.

- The dose escalation phase and the dose expansion phase can run concurrently insofar as
the dose expansion phase can enroll before completion of the dose escalation phase
provided that the dose used in the expansion phase has already been tested in the
escalation phase and has been declared safe; i.e., for each specific safe dose the
escalation phase is followed by the expansion phase.

- Tumor biopsy is mandatory for Expansion Phase entrance, however, all patients will be
treated with study drugs irrespective of the biomarker identified which will be
analyzed retrospectively. The mandatory biopsy in the Expansion Phase is necessary in
order to identify acquired mutations that change over time.

- Expansion cohort 1 will continue to evaluate safety, tolerability and PK of the drug
combination PF-02341066 plus PF-00299804.

- Expansion cohort 2 will enroll patients who are either untreated by prior PF- 00299804
or who have progressed on single agent PF-00299804 administered in an ongoing clinical
trial. Patients who are previously untreated with PF-00299804 will be treated
sequentially; i.e., first with single agent PF-00299804 until progression, then with
the combination of PF-02341066 plus PF-00299804. Those who progressed with single agent
PF-00299804 on another clinical trial will be treated with the combination PF-02341066
plus PF-00299804.

Inclusion Criteria


- INCLUSION CRITERIA:

- Subject eligibility should be reviewed and documented by an appropriately qualified
member of the investigator's study team before subjects are included in the study.

- Evidence of a personally signed and dated informed consent document indicating that
the subject (or a legally acceptable representative) has been informed of all
pertinent aspects of the study.

- Subjects must be willing and able to comply with scheduled visits, treatment plan,
laboratory tests, and other study procedures.

- Subjects must meet all of the following inclusion criteria to be eligible for
enrollment into the study:

- Disease Criteria:

- Dose Escalation Phase: Histologically proven diagnosis of NSCLC that is locally
advanced or metastatic, after failure of either at least one prior chemotherapy
regimen or targeted therapy.

- Expansion Phase: Histologically proven diagnosis of NSCLC that is locally advanced or
metastatic and with acquired resistance to erlotinib or gefitinib. Acquired
resistance is defined as progression following either an initial response (complete
or partial), or stable disease for at least six months, while on single agent
erlotinib or single agent gefitinib. In addition to these patients, Cohort 2 will
also enroll patients from ongoing trials, including A7471017 and A7471028, who have
progressed on single agent PF-00299804.

- For the dose escalation phase, any prior treatment (chemotherapy, targeted therapy,
radiation or surgery) must have been completed at least 2 weeks prior to initiation
of study medication, except patients being treated with single agent PF-02341066 will
have the option of continuing single agent PF-02341066 until the combination of PF-
02341066 and PF-00299804 is given. For the expansion phase, patients must not have
had any intervening treatmen (chemotherapy, targeted therapy, radiation or surgery)
between single agent erlotinib or single agent gefitinib treatment, and biopsy and
dosing with study drug, unless agreed by the sponsor. In Expansion Cohort 2, patients
who have received PF-00299804 as part of an ongoing clinical trial will continue with
single agent therapy with PF-00299804 at their current dose after documentation of
progression until the combination is given.

- Any acute toxicity from prior treatment must have been recovered to less than or
equal to Grade 1 (except alopecia).

- At least 1 target lesion used for assessment of antitumor activity must be measurable
by RECIST (version 1.1), or considered evaluable by agreement between the
investigator and the sponsor.

- Target lesions can be chosen from a previous irradiated area if lesions in those
areas have documented progression.

- Female or male, 18 years of age or older.

- ECOG (Zubrod) performance status 0-2.

- Adequate organ function as defined by the following criteria measured within 7 days
prior to enrollment.

- Serum aspartate transaminase (AST) and serum alanine transaminase (ALT) less than or
equal to 2.5 times upper limit of normal (ULN), or AST and ALT less than or equal to
5 times ULN if liver function abnormalities are due to underlying malignancy;

- Total serum bilirubin less than or equal to 1.5 times ULN (except patients with
documented Gilbert's syndrome);

- Absolute neutrophil count (ANC) greater than or equal to1000/microL;

- Platelets greater than or equal to 30,000/microL;

- Hemoglobin greater than or equal to 8.0 g/dl;

- Serum creatinine < 2 times institution ULN.

- Adequate cardiac function, including:

- 12-Lead electrocardiogram (ECG) with normal tracing or non-clinically significant
changes that do not require medical intervention;

- QTc interval less than or equal to 470 msec and without history of Torsades de
Pointes or other symptomatic QTc abnormality;

- LVEF (by MUGA or echocardiogram) of greater than or equal to 50%.

- All female patients of child-bearing potential are required to have a negative
pregnancy test at screening. The test should be repeated whenever one menstrual cycle
is missed during treatment or a potential pregnancy is otherwise suspected.

- Willingness and ability to comply with scheduled visits, treatment plans, laboratory
tests, other study procedures and, for enrollment into the Expansion Phase, must be
willing to undergo a tumor biopsy.

EXCLUSION CRITERIA:

Subjects presenting with any of the following will not be included in the study:

- Participation in other studies or treatment within 2 weeks before the current study
begins and/or during study participation (with the exception of patients who are
receiving single agent PF-00299804 and who enroll into Expansion Cohort 2 from
ongoing trials including A7471017 and A7471028, and with the exception of patients
being treated with single agent PF-02341066 treatment who enroll during the dose
escalation phase and exercise the option of continuing single agent PF-02341066
treatment until the combination of PF-02341066 and PF-00299804 is given) to allow for
recovery and drug wash-out.

- Known interstitial fibrosis or interstitial lung disease.

- Patients with known brain metastases who are neurologically stable (asymptomatic) for
at least 2 weeks and with no ongoing requirement for corticosteroids may enroll on
study before treatment of brain metastases.

- History of carcinomatous meningitis, or leptomeningeal disease.

- Any of the following within 6 months prior to starting study treatment: myocardial
infarction, severe/unstable angina pectoris, coronary/peripheral artery bypass graft,
congestive heart failure, cerebrovascular accident including transient ischemic
attack.

- Any history of clinically significant ventricular arrhythmias (such as ventricular
tachycardia, ventricular fibrillation or Torsades de Pointes). Diagnosed or suspected
congenital long QT syndrome. Ongoing cardiac dysrhythmias of Grade greater than or
equal to 2 (CTCAE version 4.02), uncontrolled atrial fibrillation of any grade, or
QTc interval > 470 msec.

- Hypertension that cannot be controlled by medications (> 150/100 mmHg despite optimal
medical therapy).

- Patient must not have had major surgery or trauma within 28 days prior to enrollment.

- Active uncontrolled infection.

- Pregnant or lactating females.

- Significant gastrointestinal condition that may impair intake, transit, absorption or
ability to tolerate investigational drugs.

- Prior malignancy (other than NSCLC): patients will not be eligible if they have
evidence of active malignancy (other than non-melanoma skin cancer or in situ
cervical cancer, or localized and presumed cured prostate cancer with PSA < ULN)
within the last 3 years.

- Other severe acute or chronic medical or psychiatric condition or laboratory
abnormality that may increase the risk associated with study participation or
investigational product administration or may interfere with the interpretation of
study results and, in the judgment of the investigator, would make the subject
inappropriate for entry into this study.

- Use of drugs or foods that are known potent CYP3A4 inhibitors within 7 days prior to
the first dose of study medication, including but not limited to itraconazole,
ketoconazole, miconazole, clarithromycin, erythromycin, indinavir, nefazodone,
amprenavir, delavirdine, nelfinavir, ritonavir, saquinavir, diltiazem, verapamil and
grapefruit juice.

- Use of drugs that are known potent CYP3A4 inducers within 12 days prior to the first
dose of study medication, including but not limited to carbamazepine, phenobarbital,
phenytoin, rifabutin, rifabutin, rifampin, tipranavir, ritonavir, and St. John's
wort.

- Concurrent use of drugs that are CYP3A4 substrates with narrow therapeutic indices,
including but not limited to pimozide, aripiprazole, triazolam, ergotamine and
halofantrine.

- Concurrent use of drug that are highly dependent on CYP2D6 metabolism including
S-metoprolol, propafenone, timolol, amitriptyline, clomipramine, desipramine,
imipramine, paroxetine, haloperidol, risperidone, thioridazine, codeine, flecainide,
mexilletine, tamoxifen, venlafaxine.

Dextromethorphan, a CYP2D6, substrate is allowed if medically indicated and no suitable
alternative anti-tussive medication is available. However, the dose of dextromethorphan
may need to be modified. In a clinical study in healthy volunteers who were extensive
metabolizers (A7471039) PF-00299804 increased mean total exposure (AUC(last) and C(max))
of dextromethorphan 855% and 874%, respectively, following concomitant administration with
PF-00299804 45 mg compared to exposure of administration of dextromethorphan alone.
Extensive metabolizers comprise approximately 80% of the population, with ultra-,
intermediate-, and poor-metabolizers accounting for the remaining portion of the general
population. Therefore, if no alternative is available dextromethorphan dosing should be
initiated at a lower dose (approx 25%) with close monitoring of patient clinical status.
Dose increases or decreases of dextromethorphan may be considered based upon individual
patient tolerability.

Lidocaine may be used systemically with clinical monitoring (including telemetry).

Opiates such as morphine, oxycodone, dihydrocodeine, hydrocodone, and tramadol can be used
as substitutes to replace codeine. Use of these opiates should be monitored for altered
analgesic effect during treatment as they may be partly metabolized by CYP2D6.

Type of Study:

Interventional

Study Design:

Allocation: Non-Randomized, Endpoint Classification: Safety Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Overall safety profile of combined PF-0234 1066 plus PF-00299804 including adverse events.

Principal Investigator

Arun Rajan, M.D.

Investigator Role:

Principal Investigator

Investigator Affiliation:

National Cancer Institute (NCI)

Authority:

United States: Federal Government

Study ID:

110250

NCT ID:

NCT01441128

Start Date:

September 2011

Completion Date:

November 2016

Related Keywords:

  • Carcinoma, Non-Small Cell Lung
  • Adenocarcinoma
  • Carcinoma, Squamous Cell
  • Carcinoma, Large Cell
  • Lung Neoplasms
  • Epithelial-Mesenchymal Transition Factor (c-Met)
  • Tyrosine Kinase Inhibitor
  • Hepatocyte Growth Factor Receptor
  • Epidermal Growth Factor Receptor
  • Non Small Cell Lung Cancer
  • NSCLC
  • Adenocarcinoma
  • Adenocarcinoma, Mucinous
  • Carcinoma
  • Carcinoma, Non-Small-Cell Lung
  • Carcinoma, Squamous Cell
  • Lung Neoplasms
  • Carcinoma, Large Cell

Name

Location

National Institutes of Health Clinical Center, 9000 Rockville PikeBethesda, Maryland  20892