Effects of Fluconazole and Itraconazole CYP3A-Mediated Inhibition on the Pharmacokinetics, Safety, and Tolerability of MLN4924 in Participants With Advanced Solid Tumors
Condition: Advanced Solid Tumors
MeSH terms: Neoplasms
Intervention: MLN4924; Fluconazole; Itraconazole; Docetaxel; Carboplatin; Paclitaxel
Intervention description: MLN4924 intravenous solution.; Fluconazole tablets.; Itraconazole oral solution.; Docetaxel intravenous solution.; Carboplatin intravenous solution.; Paclitaxel intravenous solution.
Intervention MeSH terms: Itraconazole; Fluconazole; Paclitaxel; Docetaxel; Carboplatin; Pevonedistat
Phase: Phase 1
Study type: Interventional
Primary purpose: Treatment
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 51.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Drug Therapy

Summary:

      The primary purpose of this study is to assess the effect of multiple-dose administration of
      fluconazole on the single-dose intravenous (IV) pharmacokinetics (PK) of MLN4924; and to
      assess the effect of multiple-dose administration of itraconazole on the single-dose IV PK of
      MLN4924.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Male or female participants 18 years of age or older.

          2. Must have a histologically or cytologically confirmed metastatic or locally advanced
             and incurable solid tumor that is deemed appropriate for treatment with 1 of the 2
             chemotherapy regimens in Part B of this study, or have progressed despite standard
             therapy, or for whom conventional therapy is not considered effective. The tumor must
             be radiographically or clinically evaluable or measurable.

          3. Recovered (that is, less than or equal to (<=) Grade 1 toxicity) from the effects of
             prior antineoplastic therapy.

          4. Suitable venous access for the study-required blood sampling for MLN4924
             pharmacokinetic (PK) and pharmacodynamic assessments.

          5. Eastern Cooperative Oncology Group performance status (PS) of 0 or 1.

          6. Clinical laboratory values as specified below within 3 days before the first dose of
             study drug:

               1. Hemoglobin greater than or equal to (>=) 9 gram per deciliter (g/dL)

               2. Absolute neutrophil count >=1,500 per cubic millimeter (/mm^3), not supported by
                  growth factor

               3. Platelet count >=100,000/mm^3

               4. Total bilirubin <=upper limit of normal (ULN)

               5. Prothrombin time (PT) and activated partial thromboplastin time (aPTT) <=1.5*ULN

               6. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline
                  phosphatase (ALP) <=2.5*ULN

                  • For participants to be treated with MLN4924 + docetaxel in Part B, AST and ALT
                  must be <=1.5*ULN, and total bilirubin should be within the normal range.

               7. Serum creatinine <=1.2 mg/dL or calculated/measured creatinine clearance >=50
                  mL/minute

          7. Female participants who:

               1. Are postmenopausal for at least 1 year before the screening visit, OR

               2. Are surgically sterile, OR

               3. If they are of childbearing potential, agree to practice 2 effective methods of
                  contraception, at the same time, from the time of signing the informed consent
                  through four months after the last dose of study drug, or

               4. Agree to practice true abstinence, when this is in line with the preferred and
                  usual lifestyle of the participant. (Periodic abstinence [example, calendar,
                  ovulation, symptothermal, postovulation methods] and withdrawal are not
                  acceptable methods of contraception.)

               5. Male participants, even if surgically sterilized (that is, status postvasectomy),
                  who:

               6. Agree to practice effective barrier contraception during the entire study
                  treatment period and through 4 months after the last dose of study drug, or

               7. Agree to practice true abstinence, when this is in line with the preferred and
                  usual lifestyle of the participant. (Periodic abstinence [example, calendar,
                  ovulation, symptothermal, postovulation methods for the female partner] and
                  withdrawal are not acceptable methods of contraception.)

          8. Voluntary written consent must be given before performance of any study-related
             procedure not part of standard medical care, with the understanding that consent may
             be withdrawn by the participant at any time without prejudice to future medical care.

          9. Participants who are willing to refrain from donating blood for at least 90 days after
             their final dose of MLN4924 and (for male participants) willing to refrain from
             donating semen for at least 4 months after their final dose of MLN4924.

        Exclusion Criteria:

          1. Prior treatment with MLN4924; however, prior treatment with docetaxel, paclitaxel, and
             carboplatin is allowed.

          2. Treatment with any systemic antineoplastic therapy or investigational products within
             21 days before the first dose of study treatment.

          3. Radiotherapy within 14 days before the first dose of study treatment.

          4. Prior treatment with radiation therapy involving >= 25 percent (%) of
             hematopoietically active bone marrow.

          5. Known hypersensitivity or history of severe intolerance or toxicity to study-assigned
             chemotherapy. Note: History of severe hypersensitivity reactions to docetaxel
             (polysorbate 80-based formulations) for participants to be treated with MLN4924 +
             docetaxel; history of hypersensitivity to carboplatin for participants to be treated
             with MLN4924 + carboplatin + paclitaxel; or history of severe hypersensitivity to
             paclitaxel (Cremophor-based formulations) for participants to be treated with MLN4924
             + carboplatin + paclitaxel in Part B.

          6. Known hypersensitivity/allergy to fluconazole or itraconazole or their respective
             excipients.

          7. Systemic treatment with moderate and strong cytochrome P450 (CYP) CYP3A inhibitors or
             inducers must be discontinued at least 14 days before the first dose of MLN4924.
             Moderate and strong CYP3A inhibitors and CYP3A inducers are not permitted during the
             study. Participants must have no history of amiodarone use in the 6 months before the
             first dose of MLN4924.

          8. Any life-threatening or serious medical or psychiatric illness unrelated to cancer
             that could, in the investigator's opinion, potentially interfere with the completion
             of treatment according to this protocol.

          9. Major surgery within 14 days before the first dose of study treatment.

         10. Active uncontrolled infection or severe infectious disease, such as pneumonia,
             meningitis, septicemia, or methicillin-resistant Staphylococcus aureus infection.

         11. Clinically significant central nervous system disease defined as untreated,
             progressive, or requiring steroids for control of symptoms.

         12. Known gastrointestinal (GI) disease or GI procedure that could interfere with the oral
             absorption or tolerance of fluconazole or itraconazole including difficulty swallowing
             capsules.

         13. Persistent diarrhea (>= Grade 2) lasting greater than (>) 3 days within 2 weeks before
             the first dose of study treatment.

         14. Known hepatic cirrhosis, hepatitis B surface antigen-positive status, or suspected
             active hepatitis C infection. Note: Participants who have isolated positive hepatitis
             B core antibody (that is, in the setting of negative hepatitis B surface antigen and
             negative hepatitis B surface antibody) must have an undetectable hepatitis B viral
             load.

         15. Known human immunodeficiency virus (HIV) positive status.

         16. Female participants who are lactating and breastfeeding or have a positive serum
             pregnancy test during the Screening period or a positive urine pregnancy test on Day 1
             before first dose of study drug.

         17. Uncontrolled high blood pressure (that is, systolic blood pressure >180 millimeter of
             mercury [mmHg], diastolic blood pressure >95 mmHg).

         18. Left ventricular ejection fraction < 50% as assessed by echocardiogram or radionuclide
             angiography.

         19. Congestive heart failure New York Heart Association Class III or IV, or Class II with
             a recent decompensation requiring hospitalization within 4 weeks before screening.

         20. Cardiomyopathy or history of ischemic heart disease.

             o Participants with ischemic heart disease who have had acute coronary syndrome (ACS),
             myocardial infarction (MI), or revascularization (example, coronary artery bypass
             graft, stent) in the past 6 months are excluded. However, participants with ischemic
             heart disease who have had ACS, MI, or revascularization greater than 6 months before
             screening and who are without cardiac symptoms may enroll.

         21. Arrhythmia (example, history of polymorphic ventricular fibrillation or torsade de
             pointes). However, participants with < Grade 3 atrial fibrillation for a period of at
             least 6 months may enroll. Grade 3 atrial fibrillation is defined as symptomatic and
             incompletely controlled medically, or controlled with device (example, pacemaker) or
             ablation, and is excluded. Participants with paroxysmal atrial fibrillation are
             permitted to enroll.

         22. Prolonged rate corrected QT interval (QTc) >=500 millisecond (msec), calculated
             according to institutional guidelines.

         23. Implantable cardioverter defibrillator.

         24. Participants with a cardiac pacer whose heart rate is set at a fixed rate and
             participants on concomitant medication that may limit increase in heart rate in
             response to hypotension (example, high-dose beta blocker).

         25. Moderate to severe aortic or mitral stenosis or other valvulopathy (ongoing).

         26. Known moderate to severe chronic obstructive pulmonary disease (COPD), interstitial
             lung disease, pulmonary fibrosis, and pulmonary arterial hypotension.