Study of TAK-228 In Patients With Previously Treated Metastatic Renal Cell Carcinoma
Condition: Renal Cell Carcinoma
MeSH terms: Carcinoma; Carcinoma, Renal Cell
Intervention: TAK-228
Intervention description: TAK-228 works to inhibit or interfere with cellular functions involved in cell growth and survival. TAK-228 specifically targets a type of protein that can make chemicals that trigger cell growth, including cancer cell growth
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 39.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Renal Cell Carcinoma

Summary:

      This research study is investigating a drug as a possible treatment for metastatic renal cell
      carcinoma. The intervention involved in this study is TAK-228.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Age ≥ 18 years.

          -  Measurable disease according to RECIST 1.1 within 28 days prior to registration.

          -  Documented pathologic diagnosis of RCC. All subtypes eligible including but not
             limited to clear cell, papillary, chromophobe, collecting duct carcinoma, medullary
             carcinoma, and unclassified categories. Sarcomatoid and rhabdoid differentiation are
             allowed.

          -  Patients with clear cell histology must have demonstrated: 1) Progression on at least
             one prior anti -angiogenic agent unless intolerable; AND 2) progression on at least
             one agent that blocks the PD-1 pathway unless felt by the treating physician to be
             contraindicated (examples include but are not limited to: patients with autoimmune
             disease or patients requiring systemic steroids greater than 10 mg/day prednisone or
             its equivalent) or if they have been discontinued due to toxicity. Prior rapalogues
             are allowed.

          -  Patients with non-clear cell histology must have received at least one prior
             anti-cancer therapy. Prior rapalogues are allowed.

          -  Left ventricular ejection fraction (LVEF) ³ lower limit of normal (LLN) as assessed by
             either multigated acquisition (MUGA) scan or echocardiogram (ECHO).

          -  Eastern Cooperative Oncology Group (ECOG) performance status of 0-2.

          -  Must have adequate organ and bone marrow function.

          -  Hematological

               -  Absolute Neutrophil Count (ANC) ≥ 1500 K/mm^3 (without use of G-CSF 4 weeks prior
                  to enrollment)

               -  Hemoglobin (Hgb) ≥ 9 g/dL (transfusions allowed)

               -  Platelets (Plts) ≥ 100 k/mm^3

          -  Renal

               -  Calculated creatinine clearance (Cockcroft-Gault formula will be used to
                  calculate creatinine clearance) ≥ 30 mL/min

               -  Urinalysis: For patients with 2+ proteinuria on urinalysis, 24 hour urine
                  collection should be obtained, 24 hour urine protein should be <2 grams.

          -  Hepatic

               -  Bilirubin ≤ 1.5 × upper limit of normal (ULN). For subjects with Gilbert's
                  disease ≤ 3.0 mg/dL

               -  Aspartate aminotransferase (AST) ≤ 2.5 × ULN; ≤ 5 x ULN if liver metastases are
                  present

               -  Alanine aminotransferase (ALT) ≤ 2.5 × ULN; ≤ 5 x ULN if liver metastases are
                  present

          -  Metabolic

               -  Glycosylated hemoglobin (HbA1c) < 7.0%,

               -  Fasting serum glucose ≤ 130 mg/dL

               -  Fasting triglycerides ≤ 300 mg/dL

          -  Recovery to baseline or ≤ grade 1 Common Terminology Criteria for Adverse Events
             (CTCAE) version 4.0 from toxicities related to any prior treatment, unless adverse
             events are clinically non-significant and/or stable on supportive therapy.

          -  Capable of understanding and complying with the protocol requirements and has signed
             the informed consent document. 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 subject at any time without
             prejudice to future medical care.

          -  Submission of formalin-fixed, paraffin-embedded (FFPE) archival tumor specimens from
             the previous 18 months, if available. If not available, a fresh tumor biopsy prior to
             treatment initiation is MANDATORY unless determined medically unsafe or not feasible
             by the site investigator.

               -  The archival specimen must contain adequate viable tumor tissue.

               -  Specimens may consist of a tissue block (preferred and should contain the highest
                  grade of tumor) or a recommended minimum of 20 unstained serial sections.
                  Fine-needle aspiration, brushings, cell pellet from pleural effusion, bone marrow
                  aspirate/biopsy are not acceptable.

               -  Distant metastases specimens are preferred but if not available primary
                  nephrectomy specimens are acceptable.

          -  Subjects who experience a disease response per RECIST 1.1 criteria followed by
             subsequent progression will be required to have a post-treatment biopsy if feasible
             and safe.

          -  Sexually active subjects and their partners must agree to use medically accepted
             methods of contraception.

               -  For women:

                    -  Postmenopausal for at least 1 year before the screening visit, OR

                    -  Surgically sterile, OR

                    -  Agree to practice 1 effective method of contraception and 1 additional
                       effective (barrier) method at the same time, from the time of signing the
                       informed consent through 90 days (or longer, as mandated by local labeling
                       [eg. USPI, SmPC, etc.] after the last dose of study drug, OR

                    -  Agree to practice true abstinence, when this is in line with the preferred
                       and usual lifestyle of the subject (Periodic abstinence [e.g, calendar,
                       ovulation, symptothermal, postovulation methods] and withdrawal, spermicides
                       only, and lactational amenorrhea are not acceptable methods of
                       contraception. Female and male condoms should not be used together.)

               -  For men:

                    -  Even if surgically sterilized (ie, status post-vasectomy), they must agree
                       to practice highly effective barrier contraception during the entire study
                       treatment period and through 120 days after the last dose of study drug, OR

                    -  Agree to practice true abstinence, when this is in line with the preferred
                       and usual lifestyle of the subject (Periodic abstinence [e.g, calendar,
                       ovulation, symptothermal, postovulation methods for the female partner] and
                       withdrawal, spermicides only, and lactational amenorrhea are not acceptable
                       methods of contraception. Female and male condoms should not be used
                       together.)

                    -  Agree not to donate sperm during the course of this study or 120 days after
                       receiving their last dose of study drug

        Exclusion Criteria:

          -  Subjects with a history of deep vein thrombosis (DVT) or pulmonary embolism (PE)
             within 6 months of study treatment initiation.

          -  Receipt of any type of small molecular kinase inhibitor (including investigational
             kinase inhibitors) within 2 weeks of enrollment or receipt of any anti-cancer therapy
             (including investigational therapy, monoclonal antibodies, cytokine therapy) within 3
             weeks of enrollment.

          -  Treatment with any investigational products within 3 weeks before the first dose of
             study drug.

          -  Radiation therapy for bone metastases within 2 weeks, other external radiation therapy
             within 4 weeks of enrollment.

          -  Received prior hemibody external radiotherapy.

          -  Known brain metastases or cranial epidural disease unless adequately treated with
             radiotherapy, radiosurgery, or surgery and stable for at least 4 weeks prior to
             enrollment as documented by magnetic resonance imaging (MRI) or computed tomography
             (CT) imaging. Treated brain metastases are defined as having no ongoing requirement
             for steroids and no evidence of progression or hemorrhage after treatment for at least
             4 weeks prior to enrollment as documented by MRI or CT imaging.

          -  Imminent or established spinal cord compression based on clinical and/or imaging. In
             subjects with untreated imminent or established spinal cord compression, treatment
             with standard of care as clinically indicated should be completed at least 4 weeks
             before enrollment.

          -  The subject has a history of any of the following within the last 6 months before
             administration of the first dose of the drug:

               -  Ischemic myocardial event, including angina requiring therapy and artery
                  revascularization procedures

               -  Ischemic cerebrovascular event, including transient ischemic attack and artery
                  revascularization procedures

               -  Requirement for inotropic support (excluding digoxin) or serious (uncontrolled)
                  cardiac arrhythmia (including atrial flutter/fibrillation, ventricular
                  fibrillation or ventricular tachycardia)

               -  Placement of a pacemaker for control of rhythm

               -  New York Heart Association (NYHA) Class III or IV heart failure

               -  Significant active cardiovascular or pulmonary disease including:

                    -  Uncontrolled hypertension defined as sustained BP >160 mm Hg systolic or >
                       95 mm Hg diastolic despite optimal antihypertensive treatment.

                    -  Pulmonary hypertension

                    -  Uncontrolled asthma or O2 saturation < 90% by arterial blood gas analysis or
                       pulse oximetry on room air

                    -  Significant valvular disease; severe regurgitation or stenosis by imaging
                       independent of symptom control with medical intervention, or history of
                       valve replacement

                    -  History of arrhythmia requiring an implantable cardiac defibrillator

                    -  Medically significant (symptomatic) bradycardia

          -  Poorly controlled diabetes mellitus defined as glycosylated hemoglobin (HbA1c) > 7%;
             subjects with a history of transient glucose intolerance due to corticosteroid
             administration may be enrolled in this study if all other inclusion/exclusion criteria
             are met

          -  Active gastrointestinal (GI) disorders including those associated with a high risk of
             perforation or fistula formation. Subjects with enteric stomata (such as ileostomy,
             colostomy) are also excluded:

          -  Tumors invading the GI-tract, active peptic ulcer disease, inflammatory bowel disease,
             diverticulitis, cholecystitis, symptomatic cholangitis or appendicitis, acute
             pancreatitis or acute obstruction of the pancreatic or biliary duct, or gastric outlet
             obstruction.

             --Abdominal fistula, gastrointestinal perforation, bowel obstruction, or
             intraabdominal abscess within 12 weeks before enrollment. NOTE: Complete healing of an
             intra-abdominal abscess must be confirmed before enrollment.

          -  Clinically significant hematemesis or hemoptysis of > 0.5 teaspoon (2.5 ml) of red
             blood, or other history of significant bleeding (such as pulmonary hemorrhage) within
             4 weeks of enrollment.

          -  Other clinically significant disorders such as:

               -  Known active infection requiring systemic treatment, infection with human
                  immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)-related
                  illness, chronic hepatitis B or known or suspected active hepatitis C infection.

               -  Serious non-healing wound or ulcer.

               -  Malabsorption syndrome.

               -  Symptomatic hypothyroidism.

               -  Moderate to severe hepatic impairment (Child-Pugh B or C).

               -  Requirement for hemodialysis or peritoneal dialysis.

               -  History of solid organ transplantation.

          -  Major surgery (such as GI surgery) within 6 weeks of enrollment. However, subjects who
             have had a nephrectomy may be enrolled 4 weeks after surgery, providing there are no
             wound-healing complications. Subjects with clinically relevant ongoing complications
             from prior surgery are not eligible. The following are not considered to be major
             procedures: Thoracentesis, paracentesis, port placement, laparoscopy, thoracoscopy,
             bronchoscopy, endoscopic ultrasonographic procedures, mediastinoscopy, skin biopsies,
             incisional biopsies, imaging-guided biopsy for diagnostic purposes, and routine dental
             procedures.

          -  QTcF (Fridericia formula for the QT interval correction for the heart rate) > 480 msec
             within 4 weeks of enrollment. If the initial QTcF is found to be > 480 msec, two
             additional electrocardiograms (EKGs) separated by at least 3 minutes should be
             performed. If the average of these three consecutive results for QTcF is ≤ 480 msec,
             the subject meets eligibility in this regard. Subjects with history of congenital long
             QT syndrome, or torsades de pointes, are not allowed.

          -  Pregnant or lactating females.

          -  Inability to swallow tablets or capsules.

          -  Previously identified allergy or hypersensitivity to components of the study treatment
             formulations.

          -  Malignancies other than RCC within 5 years of first study treatment with the exception
             of those with negligible risk of metastases or death (carcinoma in situ of the cervix,
             basal or squamous cell skin cancer, localized prostate cancer, ductal carcinoma in
             situ of the breast, non-muscle invasive urothelial carcinoma).

          -  Any serious medical or psychiatric illness that could, in the site investigator's
             opinion, potentially interfere with the completion of treatment according to this
             protocol.

          -  Daily or chronic use of a proton pump inhibitor (PPI) and/or having taken a PPI within
             7 days before receiving the first dose of study drug.