Clinical trial NCT02327169: A Study MLN2480 in Combination With MLN0128 or Alisertib, or Paclitaxel, or Cetuximab, or Irinotecan in Adult Participants With Advanced Nonhematologic Malignancies
Official title: A Multiarm, Open-label, Phase 1b Study of MLN2480 (an Oral A-, B-, and CRAF Inhibitor) in Combination With MLN0128 (an Oral mTORC 1/2 Inhibitor), or Alisertib (an Oral Aurora A Kinase Inhibitor), or Paclitaxel, or Cetuximab, or Irinotecan, in Adult Patients With Advanced Nonhematologic Malignancies
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
Conditions: Advanced Nonhematologic Malignancies
Keywords: Drug therapy
Lead sponsor: Takeda
Sponsor class: INDUSTRY
First posted: 2014-12-30
Enrollment: 81
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The primary purpose of this study is to determine the safety profile and the maximum tolerated doses (MTDs)/ potential recommended phase 2 doses (RP2Ds) of the combination treatments of MLN2480 + MLN0128, MLN2480 + alisertib, MLN2480 + paclitaxel, MLN2480 + cetuximab, and MLN2480 + irinotecan in participants with advanced nonhematologic malignancies.

Detailed description: The drug being tested in this study is called MLN2480 (TAK-580). MLN2480 was tested to evaluate side effects and determine the maximum tolerated dose (MTD) and recommended dose for future studies when administered in combination with five other medications. This study was to assess the safety of MLN2480 as well as how it is processed by the body in participants with solid nonhematologic malignancies who have failed standard therapies.

The study was to be conducted in two phases, the dose escalation phase and the dose expansion phase. A total of 71 participants were enrolled in the escalation phase. Participants in this phase were assigned to one of the five treatment groups:

* MLN2480 + MLN0128
* MLN2480 + Alisertib
* MLN2480 + Paclitaxel
* MLN2480 + Cetuximab
* MLN2480 + Irinotecan

Once the MTD for each combination treatment arm was established in the escalation phase, one or more of the combination treatments will be selected for the expansion phase. A total of 10 participants were enrolled in the expansion phase.

This multi-centre trial was be conducted worldwide. The overall time to participate in this study is approximately 14 months. Participants made multiple visits to the clinic including an end of study visit 30 days after last dose of study drug for a follow-up assessment.

Eligibility criteria: Inclusion Criteria:

All Treatment Arms:

1. Male or female participants 18 years or older.
2. Participants who, in the opinion of the treating physician, have failed standard therapies and for whom a phase 1 trial is an appropriate option.
3. Radiographically or clinically evaluable tumor. For expansion phase: Tumors must be measurable and of the protocol specified genetic mutational status, where applicable.
4. Recovered (ie, less than or equal to \[\<=\] Grade 1 toxicity) from adverse effects (except alopecia) of prior therapy.
5. Eastern Cooperative Oncology Group (ECOG) performance status 0-1.
6. Expected survival time of at least 3 months in the opinion of the investigator.
7. Block of banked tumor tissue and/or greater than or equal to (\>=) 10 unstained slides. Participants who satisfy all other eligibility criteria but do not have banked tissue/slides may be asked to consent to baseline biopsy.
8. Suitable vein access for the study-required blood sampling.
9. Thyroid function tests consistent with stable thyroid function. Note: Participants on a stable dose of thyroid replacement therapy for a suggested minimum of 12 weeks before Cycle 1, Day 1 are eligible.
10. Left ventricular ejection fraction (LVEF) of 50 percent (%) or greater, as measured by echocardiogram (ECHO) or multiple-gated acquisition scan (MUGA), within 28 days before the first dose of MLN2480
11. Female participants who are post-menopausal for at least 1 year, surgically sterile, or agree to practice 2 effective methods of contraception through 120 days (4 months) after the last dose of study drug for participants in Arms 1, 2, and 5, and through 6 months for participants in Arms 3 and 4, or agree to practice true abstinence.
12. Male participants who, even if surgically sterilized, agree to practice effective barrier contraception through 120 days (4 months) after the last dose of study drug for participants in Arms 1, 2, and 5, and through 6 months for participants in Arms 3, and 4, or agree to practice true abstinence.
13. Additional inclusion criteria for arm 3 expansion only (MLN2480 + paclitaxel):

    a. Participants with Kirsten rat sarcoma viral oncogene homolog (KRAS) exon 2 or BRAF non-V600 mutation-positive non-small cell lung cancer (NSCLC) who have received a minimum of 1 but not more than 2 prior cytotoxic-approved regimens.
14. Additional inclusion criteria for arms 4 and 5 expansion only (MLN2480 + cetuximab; MLN2480 + irinotecan):

    1. Participants with CRC who have received a minimum of 1 but not more than 2 prior cytotoxic-approved regimens.

Exclusion Criteria:

All treatment arms:

1. Female participants who are pregnant or currently breastfeeding.
2. History of any serious medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with safe protocol completion.
3. History of uncontrolled brain metastasis unless: previously treated with surgery, whole-brain radiation, or stereotactic radiosurgery; stable disease for \>= 60 days without steroid use (or stable steroid dose established for \>= 28 days before the first dose of MLN2480).
4. Ongoing seizure disorder or a requirement for antiepileptics.
5. Recent prior therapies, including: chemotherapy and hormonal therapy \<= 4 weeks or 4 half lives, whichever occurs first, before administration of study drug; immunotherapy/monoclonal antibody use \<= 4 weeks before administration of MLN2480; or radiation therapy \<= 3 weeks before administration of study drug.
6. Chronic therapeutic corticosteroid use with the exception of replacement therapy for adrenal insufficiency or corticosteroid inhalers.
7. Known history of human immunodeficiency virus infection, hepatitis B, or hepatitis C; Prior allogeneic bone marrow or organ transplantation, or active condition of chronic immune suppression is not allowed.
8. Concomitant use, or administration \<= 14 days before first dose of study drug(s), of clinically significant enzyme inducers.
9. Treatment with gemfibrozil (strong Cytochrome P4502C8 \[CYP2C8\] inhibitor) within 14 days before the first dose of MLN2480.
10. History of or current illicit drug use, drug abuse, or alcohol abuse.
11. Major surgery within 14 days before the first dose of study drug.
12. Inability to comply with study requirements.
13. Other unspecified reasons that, in the opinion of the investigator or Millennium, make the participant unsuitable for enrollment.
14. Additional exclusion criteria for arms 3, 5, and 6 expansion only (MLN2480 + paclitaxel; MLN2480 + irinotecan; MLN2480 monotherapy):

    a. Prior treatment with rapidly accelerated fibrosarcoma (RAF), extracellular signal-regulated kinases (MEK), or other inhibitors of the mitogen-activated protein kinase (MAPK) pathway.
15. Additional exclusion criteria for arm 2 only (MLN2480 + alisertib):

    a. History of uncontrolled sleep apnea syndrome and other conditions that could result in excessive daytime sleepiness, such as severe chronic obstructive pulmonary disease.
16. Additional exclusion criteria for arm 3 only (MLN2480 + paclitaxel):

    a. Known hypersensitivity to paclitaxel, or its components or other drugs formulated in Cremophor® EL (polyoxyethylated castor oil).
17. Additional exclusion criteria for arm 5 only (MLN2480 + irinotecan):

    1. Use of strong or moderate Cytochrome P4503A (CYP3A) inhibitors \<= days of the first dose of irinotecan.

Primary outcomes:
measure: Number of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)
timeFrame: From Day 1, Cycle 1 through 30 days after the last dose of study drug (up to 13 months)
measure: Number of Participants With Dose-Limiting Toxicities (DLTs)
timeFrame: From Day 1, Cycle 1 through 30 days after the last dose in Cycle 1 (up to 8 weeks)
measure: Maximum Tolerated Dose (MTD) for MLN2480
timeFrame: Day 1, Cycle 1 up to 28 days
measure: Recommended Phase 2 Dose (RP2D) of MLN2480
timeFrame: Day 1, Cycle 1 up to 28 days
Secondary outcomes:
measure: Cmax : Maximum Observed Plasma Concentration for MLN2480
timeFrame: Cycle 1, Day 10 pre-dose and at multiple timepoints (Up to 48 hours) post-dose
measure: Cmax: Maximum Observed Plasma Concentration for MLN0128
timeFrame: Cycle 1, Day 10 pre-dose and at multiple timepoints (Up to 48 hours) post-dose
measure: Cmax: Maximum Observed Plasma Concentration for Alisertib
timeFrame: Cycle 1, Day 10 pre-dose and at multiple timepoints (Up to 48 hours) post-dose
measure: Tmax: Time to Reach the Maximum Plasma Concentration (Cmax) for MLN2480
timeFrame: Cycle 1, Day 10 pre-dose and at multiple timepoints (Up to 48 hours) post-dose
measure: Tmax: Time to Reach the Maximum Plasma Concentration (Cmax) for MLN0128
timeFrame: Cycle 1, Day 10 pre-dose and at multiple timepoints (Up to 48 hours) post-dose
measure: Tmax: Time to Reach the Maximum Plasma Concentration (Cmax) for Alisertib
timeFrame: Cycle 1, Day 10 pre-dose and at multiple timepoints (Up to 48 hours) post-dose
measure: AUC(0-tau): Area Under the Plasma Concentration-time Curve From Time 0 to Time Tau Over the Dosing Interval for MLN2480
timeFrame: Cycle 1, Day 10 pre-dose and at multiple timepoints (Up to 48 hours) post-dose
measure: AUC(0-tau): Area Under the Plasma Concentration-time Curve From Time 0 to Time Tau Over the Dosing Interval for MLN0128
timeFrame: Cycle 1, Day 10 pre-dose and at multiple timepoints (Up to 48 hours) post-dose
measure: AUC(0-tau): Area Under the Plasma Concentration-time Curve From Time 0 to Time Tau Over the Dosing Interval for Alisertib
timeFrame: Cycle 1, Day 10 pre-dose and at multiple timepoints (Up to 48 hours) post-dose
measure: Cmax: Maximum Observed Plasma Concentration for Paclitaxel
timeFrame: Cycle 1, Day 15 pre-dose and at multiple timepoints (Up to 48 hours) post-dose
measure: AUC(0-last): Area Under the Plasma Concentration-Time Curve From Time 0 to the Time of the Last Quantifiable Concentration for Paclitaxel
timeFrame: Cycle 1, Day 15 pre-dose and at multiple timepoints (Up to 48 hours) post-dose
measure: AUC(0-inf): Area Under the Plasma Concentration-time Curve From Time 0 to Infinity, Calculated Using the Observed Value of the Last Quantifiable Concentration for Paclitaxel
timeFrame: Cycle 1, Day 15 pre-dose and at multiple timepoints (Up to 48 hours) post-dose
measure: Terminal Elimination Half-life (T1/2) for Paclitaxel
timeFrame: Cycle 1, Day 15 pre-dose and at multiple timepoints (Up to 48 hours) post-dose
measure: Objective Response Rate (ORR) Based on Response Evaluation Criteria in Solid Tumors (RECIST)
timeFrame: Baseline then every 2 cycles beginning at Cycle 2, Day 27, until disease progression, death or end of study (Up to 13 months)
measure: Duration of Response
timeFrame: From first documented response until disease progression (Up to 13 months)
measure: Time to Response
timeFrame: From date of enrollment to the date of the first documentation of a confirmed response (Up to 13 months)
measure: Progression Free Survival (PFS)
timeFrame: Baseline then every 2 cycles beginning at Cycle 2, Day 27, until disease progression, death or end of study (Approximately up to 13 months)
Other outcomes:
Locations:
city: Boston
country: United States
facility: Massachusetts General Hospital Cancer Center
state: Massachusetts
city: Boston
country: United States
facility: Beth Israel Deaconess Medical Center
state: Massachusetts
city: Boston
country: United States
facility: Dana Farber Cancer Institute
state: Massachusetts
city: Philadelphia
country: United States
facility: Fox Chase Cancer Center
state: Pennsylvania
city: Houston
country: United States
facility: The University of Texas MD Anderson Cancer Center
state: Texas
city: Bordeaux cedex
country: France
facility: Institut Bergonie
state: Gironde
city: Toulouse cedex 09
country: France
facility: Institut Claudius Regaud-Oncopole
state: Haute Garonne
city: Villejuif cedex
country: France
facility: Institut Gustave Roussy
state: Val De Marne
city: Barcelona
country: Spain
facility: Hospital Universitari Vall d'Hebron
city: Madrid
country: Spain
facility: START Madrid. Fundacion Jimenez Diaz
city: Malaga
country: Spain
facility: Hospital Clinico Universitario Virgen de la Victoria
city: London
country: United Kingdom
facility: Sarah Cannon Research Institure UK
state: Greater London
city: Manchester
country: United Kingdom
facility: The Chrisie
state: Greater Manchester
city: Oxford
country: United Kingdom
facility: Churchill Hospital
state: Oxfordshire
Study officials:
affiliation: Takeda
name: Medical Director Clinical Science
role: STUDY_DIRECTOR
References: