a study of selpercatinib (loxo-292) in participants with advanced solid tumors, ret fusion-positive solid tumors, and medullary thyroid cancer (libretto-001)

Conditions: Non-Small Cell Lung Cancer; Medullary Thyroid Cancer; Colon Cancer; Any Solid Tumor

Summary: this is an open-label, first-in-human study designed to evaluate the safety, tolerability, pharmacokinetics (pk) and preliminary anti-tumor activity of selpercatinib (also known as loxo-292) administered orally to participants with advanced solid tumors, including rearranged during transfection (ret)-fusion-positive solid tumors, medullary thyroid cancer (mtc) and other tumors with ret activation.

this is an open-label, multi-center phase 1/2 study in participants with advanced solid tumors, including ret fusion-positive solid tumors, mtc, and other tumors with ret activation. the trial will be conducted in 2 parts: phase 1 (dose escalation - completed) and phase 2 (dose expansion). participants with advanced cancer are eligible if they have progressed on or are intolerant to available standard therapies, or no standard or available curative therapy exists, or in the opinion of the investigator, they would be unlikely to tolerate or derive significant clinical benefit from appropriate standard of care therapy, or they declined standard therapy. a dose of 160 milligrams (mg) twice a day (bid) has been selected as the recommended phase 2 dose (rp2d). approximately 875 participants with advanced solid tumors harboring a ret gene alteration in tumor and/or blood will be enrolled to one of seven phase 2 cohorts: * cohort 1: advanced ret fusion positive solid tumor other than nsclc or thyroid cancer for participants who progressed on or intolerant to first line therapy (open) * cohort 2: advanced ret fusion positive solid tumor other than nsclc or thyroid cancer for treatment naïve participants (open) * cohort 3: advanced ret-mutant mtc participants who progressed on or intolerant to first line therapy (closed) * cohort 4: advanced ret-mutant mtc participants who are treatment naïve (closed) * cohort 5: advanced ret-altered solid tumor for participants other than nsclc or thyroid cancer and ret-mutant men2 spectrum tumors (e.g. pheochromocytoma) otherwise ineligible for cohorts 1-4. see details in inclusion/exclusion criteria (open) * cohort 6: participants otherwise eligible for cohorts 1-5 who discontinued another ret inhibitor due to intolerance may be eligible with prior sponsor approval (closed) * cohort 7: ret fusion positive early-stage non-small cell lung cancer (nsclc) participants who are candidates for definitive surgery. participants will receive selpercatinib in a neoadjuvant and adjuvant setting. participants will be followed for disease recurrence for up to 5 years from the date of surgery (closed)

Eligibility criteria:
key inclusion criteria: for phase 1: * participants with a locally advanced or metastatic solid tumor that: * has progressed on or is intolerant to standard therapy, or * for which no standard therapy exists, or in the opinion of the investigator, are not candidates for or would be unlikely to tolerate or derive significant clinical benefit from standard therapy, or * decline standard therapy * prior multikinase inhibitors (mkis) with anti-ret activity are allowed * a ret gene alteration is not required initially. once adequate pk exposure is achieved, evidence of ret gene alteration in tumor and/or blood is required as identified through molecular assays, as performed for clinical evaluation * measurable or non-measurable disease as determined by recist 1.1 or rano as appropriate to tumor type * eastern cooperative oncology group (ecog) score of 0, 1, or 2 or lansky performance score (lps) greater than or equal to (≥) 40 percent (%) (age less than \[\<\] 16 years) with no sudden deterioration 2 weeks prior to the first dose of study treatment * adequate hematologic, hepatic and renal function * life expectancy of at least 3 months for phase 2: as for phase 1 with the following modifications: * for cohort 1: participants must have received prior standard therapy appropriate for their tumor type and stage of disease, or in the opinion of the investigator, would be unlikely to tolerate or derive clinical benefit from appropriate standard of care therapy * cohorts 1 and 2: * enrollment will be restricted to participants with evidence of a ret gene alteration in tumor * at least one measurable lesion as defined by recist 1.1 or rano, as appropriate to tumor type and not previously irradiated * cohorts 3 and 4: enrollment closed * cohort 5: * cohorts 1-4 without measurable disease * mct not meeting the requirements for cohorts 3 or 4 * mtc syndrome spectrum cancers (e.g., mtc, pheochromocytoma), cancers with neuroendocrine features/differentiation, or poorly differentiated thyroid cancers with other ret alteration/activation may be allowed with prior sponsor approval * cfdna positive for a ret gene alteration not known to be present in a tumor sample * cohort 6: participants who otherwise are eligible for cohorts 1, 2 or 5 who discontinued another ret inhibitor may be eligible with prior sponsor approval * cohort 7: participants with a histologically confirmed stage ib-iiia nsclc and a ret fusion; determined to be medically operable and tumor deemed resectable by a thoracic surgical oncologist, without prior systemic treatment for nsclc key exclusion criteria (phase 1 and phase 2): * phase 2 cohorts 1 and 2: an additional known oncogenic driver * cohorts 3 and 4: enrollment closed * cohorts 1, 2 and 5: prior treatment with a selective ret inhibitor notes: participants otherwise eligible for cohorts 1, 2, and 5 who discontinued another selective ret inhibitor may be eligible for phase 2 cohort 6 with prior sponsor approval * investigational agent or anticancer therapy (including chemotherapy, biologic therapy, immunotherapy, anticancer chinese medicine or other anticancer herbal remedy) within 5 half-lives or 2 weeks (whichever is shorter) prior to planned start of loxo-292 (selpercatinib). in addition, no concurrent investigational anti-cancer therapy is permitted note: potential exception for this exclusion criterion will require a valid scientific justification and approval from the sponsor * major surgery (excluding placement of vascular access) within 2 weeks prior to planned start of loxo-292 (selpercatinib) * radiotherapy with a limited field of radiation for palliation within 1 week of planned start of loxo-292 (selpercatinib), with the exception of participants receiving radiation to more than 30% of the bone marrow or with a wide field of radiation, which must be completed at least 4 weeks prior to the first dose of study treatment * any unresolved toxicities from prior therapy greater than common terminology criteria for adverse events (ctcae) grade 1 at the time of starting study treatment with the exception of alopecia and grade 2, prior platinum-therapy related neuropathy * symptomatic primary cns tumor, metastases, leptomeningeal carcinomatosis, or untreated spinal cord compression. participants are eligible if neurological symptoms and cns imaging are stable and steroid dose is stable for 14 days prior to the first dose of loxo-292 (selpercatinib) and no cns surgery or radiation has been performed for 28 days, 14 days if stereotactic radiosurgery (srs) * clinically significant active cardiovascular disease or history of myocardial infarction within 6 months prior to planned start of loxo-292 (selpercatinib) or prolongation of the qt interval corrected (qtcf) greater than (\>) 470 milliseconds (msec) * participants with implanted pacemakers may enter the study without meeting qtc criteria due to nonevaluable measurement if it is possible to monitor for qt changes. * participants with bundle branch block may be considered for study entry if qtc is appropriate by a formula other than fridericia's and if it is possible to monitor for qt changes. * required treatment with certain strong cytochrome p450 3a4 (cyp3a4) inhibitors or inducers and certain prohibited concomitant medications * phase 2 cohort 7 (neoadjuvant treatment): participant must not have received prior systemic therapy for nsclc.

Keywords: loxo-292 kif5b-ret m918t ccdc6-ret ret-ptc1 ncoa4-ret ret-ptc ret-ptc3 ret-ptc4 prkar1a-ret ret-ptc2 golga5-ret ret-ptc5 erc1-ret ktn1-ret ret-ptc8 hook3-ret pcm1-ret trim24-ret ret-ptc6 trim27-ret trim33-ret ret-ptc7 akap13-ret fkbp15-ret specc1l-ret tbl1xr1-ret bcr-ret fgrf1op-ret rfg8-ret ret-ptc9 acbd5-ret myh13-ret cux1-ret kiaa1468-ret frmd4a-ret sqstm1-ret afap1l2-ret ppfibp2-ret eml4-ret pard3-ret g533c c609f c609g c609r c609s c609y c611f c611g c611s c611y c611w c618f c618r c618s c620f c620r c620s c630r c630y d631y c634f c634g c634r c634s c634w c634y k666e e768d l790f v804l v804m a883f s891a r912p clip1-ret y806c ret fusion ret alteration ret mutation ret rearrangement ret translocation neoplasms by site neoplasms non-small cell lung cancer lung neoplasms carcinoma, non-small-cell lung cancer of lung cancer of the lung lung cancer neoplasms, lung neoplasms, pulmonary pulmonary cancer pulmonary neoplasms respiratory tract neoplasms lung diseases respiratory tract diseases carcinoma, bronchogenic bronchial neoplasms medullary thyroid cancer papillary thyroid cancer thyroid diseases thyroid neoplasms cancer of the thyroid cancer of thyroid neoplasms, thyroid thyroid ademona thyroid cancer thyroid carcinoma endocrine system diseases endocrine gland neoplasms head and neck neoplasms thoracic neoplasms cns tumor primary cns tumor cancer of colon cancer of the colon colon cancer colon neoplasms colonic cancer neoplasms, colonic malignant tumor of breast mammary cancer mammary carcinoma, human mammary neoplasm, human neoplasms, breast tumors, breast human mammary carcinoma malignant neoplasm of breast breast carcinoma breast tumors cancer of the breast breast neoplasms breast cancer ret inhibitor mtc nsclc selpercatinib neo-adjuvant treatment in early stage nsclc