Abstract CT090: PEPN2011: a phase 1/2 study of tegavivint in children, adolescents, and young adults with recurrent or refractory solid tumors, including lymphomas and desmoid tumors: a report from the pediatric early phase clinical trials network
Authors: Whittle Sarah B. , Pressey Joseph G. , Liu Xiaowei , Minard Charles G. , Denic Kristina Z. , Reid Joel M. , Berg Stacey L. , Fox Elizabeth , Weigel Brenda J. 
Published: April 2023

Introduction: Tegavivint is a first in class small molecule inhibitor of Wnt-ß-catenin signaling that functions by disrupting the interaction of ß-catenin and TBL1/TBLR1 resulting in degradation of nuclear ß-catenin. Aberrant Wnt signaling has been identified as a key mechanism of cancer biology, resulting in uncontrolled transcription of pro-oncogenic Wnt target genes. Pre-clinical in vivo studies of tegavivint demonstrated anti-tumor activity in a variety of pediatric solid tumors, including osteosarcoma, Ewing sarcoma, and lymphoma.

Methods: We conducted a phase 1 dose-escalation study of single agent tegavivint in children aged ≥12 months to ≤21 years with relapsed or refractory solid tumors including lymphoma and desmoid tumors. The dose escalation was conducted using a rolling six design starting with the recommended phase 2 dose (RP2D) in adults, 5 mg/kg, administered intravenously over four hours on days 1, 8 and 15 of a 28 day cycle. A single de-escalation to 4 mg/kg and escalations to 6.5 mg/kg and 8 mg/kg if pharmacokinetic (PK) parameters indicated were planned. Once the RP2D is defined a PK cohort and phase 2 cohorts including Ewing sarcoma, desmoid tumor, osteosarcoma, liver tumors, Wilms tumor and a disease agnostic cohort including cancers with Wnt alterations will be evaluated.

Results: A total of 15 patients were enrolled on the phase 1 part of the study. Two patients were not treated due to pre-therapy DEXA scan demonstrating grade 1 osteoporosis; therefore, 13 patients received treatment with tegavivint on 2 dose levels (5 mg/kg and 6.5 mg/kg). The median age of treated patients was 16 years (range 3-21). Patient diagnoses included desmoid tumor (5), Wilms tumor (3), and one each of Ewing sarcoma, osteosarcoma, CIC::DUX4 sarcoma, neuroblastoma, and hepatocellular carcinoma. There were no dose limiting toxicities among 4 DLT-evaluable patients at DL1 and 6 at DL2. The maximum tolerated dose was not determined. Grade three or higher adverse events at least possibly related to treatment included anemia (2) and lymphopenia (2). A single patient had a grade 3 QT prolongation requiring cessation of tegavivint after cycle 3. At 5 mg/kg, the mean AUC was 94,900 hr*ng/mL (range 52,000-136,000), and at 6.5 mg/kg was 91,200 hr*ng/mL (range 28,400-144,000). The pediatric RP2D dose was determined to be 6.5 mg/kg based on the pre-specified objective of achieving pharmacologically relevant plasma concentrations and less than 20% difference in mean AUC between the two tested dose levels.

Conclusions: Tegavivint is well tolerated in children with refractory solid tumors, the pediatric RP2D is 6.5 mg/kg demonstrating pharmacologically relevant plasma concentrations. The study is currently enrolling patients to a pharmacokinetic expansion cohort and will then proceed to phase 2.

Citation Format: Sarah B. Whittle, Joseph G. Pressey, Xiaowei Liu, Charles G. Minard, Kristina Z. Denic, Joel M. Reid, Stacey L. Berg, Elizabeth Fox, Brenda J. Weigel. PEPN2011: a phase 1/2 study of tegavivint in children, adolescents, and young adults with recurrent or refractory solid tumors, including lymphomas and desmoid tumors: a report from the pediatric early phase clinical trials network [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr CT090.