Patient case: 70-year-old female with breast cancer; genetic feature: AURKA amplification

Clinical trial: A Phase 1 First-in-Human Study Evaluating AMG 900 in Advanced Solid Tumors

Summary: This first-in-human study of AMG 900 will be conducted in two parts: dose escalation and dose expansion. The dose escalation part of the study is aimed at evaluating the safety, tolerability and PK of oral AMG 900 in subjects with advanced solid tumors. Up to 50 subjects may be enrolled in dose escalation. The dose expansion part of the study will consist of 42 subjects in three taxane-resistant tumor types. The dose of AMG 900 will be dependent upon data from the dose escalation part of the study

Detailed description: that G-CSF must be started at day 5, 1 day after the last day of AMG 900 and be continued until neutrophiles are > 1000 or until day 12, meaning 2 days before the reinduction.

Eligibility: Inclusion Criteria:
  -  Men or women ≥ 18 years old
  -  Part 1 Dose Escalation only: advanced solid tumor refractory to standard treatment for which no standard therapy is available or the subject refuses standard therapy
  -  Part 1 Dose Escalation only: Measurable or evaluable disease per RECIST guidelines
  -  Part 2 Dose Expansion only: Taxane-resistant tumor (defined as refractory to or progression within 6 months of discontinuing paclitaxel or docetaxel) of prespecified histology
  -  Part 2 Dose Expansion only: Measurable disease per RECIST guidelines
  -  Eastern Cooperative Oncology Group (ECOG) Performance Status of ≤ 2
  -  Life expectancy of > 3 months, in the opinion of the investigator
  -  Willing to provide existing and/or future paraffin-embedded tumor samples
  -  Part 1 Dose Escalation: must have tumor tissue that is accessible for biopsy by fine needle aspiration (FNA) and must consent to undergo biopsies of their tumor (subjects in non-accelerated phase only)
  -  Ability to take oral medications
  -  Competent to sign and date an Institutional Review Board approved informed consent form
  -  Absolute neutrophil count (ANC) ≥ 1.5 x 109/L
  -  Platelet count ≥ 100 x 109/L
  -  Hemoglobin > 9 g/dL
  -  Prothrombin time (PT) or partial thromboplastin time (PTT) < 1.5 x upper limit of normal (ULN)
  -  Serum creatinine < 2.0 mg/dL
  -  Calculated creatinine clearance ≥ 50 ml/min
  -  AST < 2.5 x ULN (if liver or bone metastases are present, ≤ 5 x ULN)
  -  ALT < 2.5 x ULN (if liver or bone metastases are present, ≤ 5 x ULN)
  -  Alkaline phosphatase < 2.0 x ULN (if liver or bone metastases are present, ≤ 5 x ULN)
  -  Total bilirubin < 1.5 x ULN
  Exclusion Criteria:
  -  Active parenchymal brain metastases. Subjects who have had brain metastases resected or have received radiation therapy ending at least 4 weeks prior to study day 1 are eligible if they meet all of the following criteria: a) residual neurological symptoms grade < 1; b) no dexamethasone requirement; and c) follow-up MRI shows no new lesions appearing
  -  Prior bone marrow transplant (autologous or allogeneic)
  -  History or presence of hematological malignancies
  -  History of bleeding diathesis
  -  Myocardial infarction within 6 months of study day 1, symptomatic congestive heart failure (New York Heart Association > class II), unstable angina, or unstable cardiac arrhythmia requiring medication
  -  Active peptic ulcer disease
  -  Gastrointestinal (GI) tract disease causing the inability to take oral medication, malabsorption syndrome, requirement for intravenous alimentation, prior surgical procedures affecting absorption, uncontrolled inflammatory GI disease (eg, Crohn's disease, ulcerative colitis)
  -  Active infection requiring intravenous (IV) antibiotics within 2 weeks of study enrollment (day 1)
  -  Known positive test for HIV
  -  Active or chronic hepatitis B or hepatitis C infection, determined by serologic tests
  -  Unresolved toxicities from prior anti-tumor therapy, defined as not having resolved to Common Terminology Criteria for Adverse Events (CTCAE) grade 0 or 1, or to levels dictated in the eligibility criteria with the exception of alopecia
  -  Anti-tumor therapy within 28 days of study day 1; concurrent use of hormone deprivation therapy for hormone-refractory prostate cancer or breast cancer is permitted
  -  Treatment with immune modulators including, but not limited to, corticosteroids, cyclosporine and tacrolimus within two weeks prior to enrollment
  -  Therapeutic or palliative radiation therapy within two weeks of study day 1
  -  Systemic anticoagulation therapy, including warfarin, within 28 days of day 1
  -  Prior treatment with aurora inhibitors
  -  Prior participation in an investigational study (drug or device) within 28 days of study day 1
  -  Major surgery within 28 days of study day 1
  -  Any co-morbid medical disorder that may increase the risk of toxicity, in the opinion of the investigator or sponsor

Relevance to patient case: not relevant