Dose-escalation Study of Oral Administration of S 055746 in Patients With Acute Myeloid Leukaemia or Myelodysplastic Syndrome

Study Overview
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Brief Summary
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The purpose of this study is to determine the safety profile and tolerability of S 055746 in patients with AML, and high or very high risk MDS, in terms of Dose-Limiting Toxicities (DLTs), Maximum Tolerated Dose (MTD) and determine the Recommended Phase 2 Dose (RP2D) through safety profile (DLT, MTD), PK profile, PD profile and preliminary efficacy.

Official Title
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Phase I Dose-escalation Study of the Orally Administered Selective Bcl-2 Inhibitor S 055746 as Monotherapy for the Treatment of Patients With Acute Myeloid Leukaemia (AML) or High or Very High Risk Myelodysplastic Syndrome (MDS)

Conditions
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Acute Myeloid Leukaemia (AML), Myelodysplastic Syndrome (MDS)

Intervention / Treatment
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* Drug: S 055746


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women or men aged >= 18 years Patients with cytologically confirmed and documented de novo, secondary or therapy-related AML excluding acute promyelocytic leukaemia: with relapsed or refractory disease or > or = 65 years not previously treated for AML, who are not candidates for intensive chemotherapy or not candidates for standard chemotherapy Patients with cytologically confirmed and documented MDS or non proliferative Chronic Myelomonocytic Leukaemia (CMML) in relapse or refractory after previous treatment line including at least one hypomethylating agent therapy: with high or very high risk MDS and without established alternative therapy transformed to AML and without established alternative therapy Ability to swallow oral tablet(s) World Health Organization (WHO) performance status 0-2 Circulating white blood cells < or = 30 x 10^9 /L and < or = 13 x10^9 for non proliferative CMML Adequate renal and hepatic functions Negative serum pregnancy test within 7 days prior to the first day of study drug administration Patients must use effective contraception Written informed consent Exclusion Criteria: Foreseeable poor compliance to the study procedures Legally incapacitated person under guardianship or trusteeship Pregnant or breast-feeding women Participation in therapeutic interventional study involving investigational drug intake at the same time or within 2 weeks or at least 5 half-lives or patient already enrolled Previous treatment with a BH3 mimetic Patients who have not recovered to baseline or CTCAE< or = Grade 1 from toxicity due to all prior therapies received for the studied disease Any previous anti-leukaemic treatment for the studied disease within at least 5 half-lives or 2 weeks (hydroxycarbamide permitted) Any radiotherapy within 4 weeks before first intake (except palliative radiotherapy at localized lesions) Major surgery within 3 weeks before first intake of S 055746 Allogenic stem cell transplant within 6 months before the first intake of S 055746 and for patients who still need immunosuppressive treatment Leukaemic leptomeningeal or leukaemic central nervous system involvement Concomitant uncontrolled infection, organ dysfunction or medical disease likely to interfere with evaluation of S 055746 safety or study outcome Human immunodeficiency virus (HIV) infection, hepatitis B or active hepatitis C infection Within 6 months prior to the first intake of S 055746, history of myocardial infarction, acute coronary syndromes (including unstable angina), coronary angioplasty, and/or stenting, ischemic/haemorrhagic stroke, atrial fibrillation, digestive haemorrhagic risk, deep venous/arterial thromboembolic complication or bleeding diathesis Decreased Left Ventricular Ejection Fraction (LVEF) QTcF prolongation Patients who are receiving QT prolonging drug Coagulopathies with increased risk of bleeding complications Other malignancy within 2 years prior to the first intake Strong or moderate CYP3A4 inhibitors or inducers (treatment, food or drink products) within 7 days prior to the first intake Treatment highly metabolised by the CYP3A4 or CYP2D6 and/or with a narrow therapeutic index, multi-enzymes and/or OATP and/or P-gp substrates or herbal products within 7 days prior to the first intake. Patients receiving proton pump inhibitor Patients having received anticoagulant oral drugs, aspirin > 325 mg/day and antiplatelets within 7 days prior to first S 055746 intake

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: S 055746<br> | Drug: S 055746<br>* S 055746, per os administration, from 50 to 2000 mg once a day during a 21-day cycle. Participants will receive 21-day cycles of treatment until a discontinuation criterion is met.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximum Tolerated Dose (MTD) | MTD is the highest drug dosage that is unlikely (<25% posterior probability) to cause DLT in more than 33% of the treated patients in the first cycle of S 055746 treatment. | During cycle 1 (21 days) | 
| Incidence of Adverse Events (AEs) | Characterized by severity and seriousness of AEs, laboratory abnormalities and other safety parameters such as electrocardiogram (ECG) changes | From first dose until 30 days after the last dose intake | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Plasma concentration of S 055746 |  | Pre-dose on Cycle 1 Day 1 (C1D1), C1D2, C1D3, C1D8, C1D9, C2D1 ; 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10-12 hours post-dose on C1D1, C1D8 | 
| The pharmacokinetic (PK) profile of S 055746: Area Under the Curve [AUC] |  | Pre-dose on Cycle 1 Day 1 (C1D1), C1D2, C1D3, C1D8, C1D9, C2D1 ; 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10-12 hours post-dose on C1D1, C1D8 | 
| The PK profile of S 055746: Maximal Concentration [Cmax] |  | Pre-dose on Cycle 1 Day 1 (C1D1), C1D2, C1D3, C1D8, C1D9, C2D1 ; 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10-12 hours post-dose on C1D1, C1D8 | 
| Best Response Rate (BRR) |  | Up to study completion (maximum of 3 years) | 
| Progression Free Survival (PFS) |  | From date of inclusion until the date of progression or date of death, whichever occurs first, assessed up to study completion (maximum of 3 years) | 
| Event Free Survival (EFS) |  | From date of inclusion until the date of progression or date of death or discontinuation of treatment, whichever occurs first, assessed up to study completion (maximum of 3 years) |