Clinical trial NCT05493800: Evaluate the Safety and Efficacy for Oral Mucositis Prevention of MIT-001 in Auto HSCT
Official title: A Phase IIa, Multi-center, Dose-finding Study to Evaluate Safety and Efficacy for Prevention of Oral Mucositis and PK of MIT-001 in Patients With Lymphoma or Multiple Myeloma Receiving Conditioning Chemotherapy Followed by Auto HSCT
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: PHASE2
Conditions: Oral Mucositis
Lymphoma
Multiple Myeloma
Hematologic Cancer
Keywords: oral mucositis
MIT-001
auto HSCT
HSCT
hematopoietic stem cell transplantation
ferroptosis inhibitor
necrosis inhibitor
Lead sponsor: MitoImmune Therapeutics
Sponsor class: INDUSTRY
First posted: 2022-08-09
Enrollment: 60
Sex: ALL
Minimum age (years): 19
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: SEQUENTIAL
Intervention model description: Part 1 was completed with 16 patients and open label design to to evaluate the pharmacokinetic characteristics, efficacy, and safety of MIT-001 on prevention effect of MIT-001 in combination with conditioning regimen in auto-HSCT. 5mg as low dose and 20mg as high dose of MIT-001 were determined as RP2D through steering comittee and optional group of 30mg was not needed at Part 1 because low level of MIT-001 was enough to show efficacy and safety of MIT-001.

In Part 2, it's to determine the optimal dose (recommended part 2 dose (RP2D)) of MIT-001 in combination with conditioning regimen in auto-HSCT.
Primary purpose: PREVENTION

Brief summary: Evaluate the efficacy and safety for the prevention of oral mucositis and PK of MIT-001 for lymphoma or multiple myeloma patients receiving conditioning chemotherapy for autologous hematopoietic stem cell transplantation(auto-HSCT).

Detailed description: In Part 1, it was to determine Recommended Part 2 Dose(RP2D) the prevention effect of MIT-001 in combination with conditioning regimen in autologous hematopoietic stem cell transplantation(auto-HSCT) and to evaluate the pharmacokinetic characteristics of MIT-001.

In Part 2, it's to determine the optimal dose of MIT-001 in combination with conditioning regimen in auto-HSCT.

This clinical trial consists of a 28-days of screening period, 4 to 9 days of conditioning chemotherapy with MIT-001 treatment, auto-HSCT and a 14-days of follow-up and recovery period.

MIT-001 group consists of 5 mg (group 1), 10 mg (group 2), and 20mg (group 3), and the subject will be assigned to from 5 mg of MIT-001 sequentially.

After completion of MIT-001 administration from all 3 MIT-001 groups, Steering Committee (SC) was convened and reviewed the safety and efficacy to determine one of the followings.

* Determine whether the next dose (Group 4: 30 mg) in Part 1: It was not proceeded.
* Determine the RP2D to enter Part 2 phase: 5mg as low dose, 20mg as high dose for Part 2 The investigators will continuously monitor the safety of MIT-001, and can request the steering committee call at any time, and can be carefully reviewed the data such as safety and efficacy.

In Part 2, the subjects are randomly assigned to either one of MIT-001 treatment groups (high-dose, low-dose among RP2D) and placebo at a ratio of 1: 1: 1. If two or more conditioning regimen are determined, conditioning regimen can be considered the stratification factor. Subject will be randomly assigned to either group in blinded method.

Eligibility criteria: Inclusion Criteria:

1. Men and women aged 19 to 70 years old
2. Patients with lymphoma or multiple myeloma planned for receiving one of the following conditioning chemotherapy followed by autologous hematopoietic stem cell transplantation

   * BuCyE Regimen: Busulfan (iv) 3.2 mg/kg (Day 1, Day 2, Day 3) + Etoposide (iv) 400 mg/m² (Day 3, Day 4) + Cyclophosphamide (iv) 50 mg/kg/Mesna (iv) 50 mg/kg (Day 5, Day 6), and autologous HSCT after 1 day rest after completion of 6 days of conditioning chemotherapy
   * BMT Regimen: Busulfan (iv) 2.4 mg/kg (Day 1, Day 2, Day 3) + Melphalan (iv) 40 mg/m2 (Day 4, Day 5) + Thiotepa (iv) 200 mg/ m2 (Day 6, Day 7), and autologous HSCT after 1 day rest after completion of 7 days of conditioning chemotherapy
   * Melphalan Regimen: Melphalan (iv) 100 mg/m2 (Day 1, Day 2), and autologous HSCT after 1 day rest after completion of 2 days of conditioning chemotherapy
   * BuMel Regimen: Busulfan (iv) 3.2 mg/kg (Day 1, Day 2, Day 3) + Melphalan (iv) 140 mg/m2 (Day 4), and autologous HSCT after 1 day rest after completion of 4 days of conditioning chemotherapy (In part 2, BUCYE, BMT and MELPHALAN regimens are allowed.)
3. Patients who have not received a hematopoietic stem cell transplant before
4. Patients with Body Mass Index (BMI) 35 or less
5. Patients who have prepared at least 2 x 10\^6 CD34+ cell/kg
6. Patients whose hematologic, kidney and liver functions were confirmed to be proper through the following laboratory test results last measured within 8 days prior to the investigational product(IP) administration Laboratory endpoint Required limit for inclusion Absolute neutrophil count (ANC) ≥ 1,000/mm\^3 Hemoglobin (Hb) ≥ 9.0 g/dL Platelet count ≥ 100,000/mm\^3 Total bilirubin (TB) ≤ 2 mg/Dl AST and ALT ≤ 3.0 x ULN(if liver metastasis, ≤ 5 x ULN) Prothrombin time (PT) INR ≤ 1.5 (if taking warfarin, \< 3) Serum creatinine or creatinine clearance (CrCl) \< 2 mg/dL or≥ 60 mL/min
7. Patients with Eastern Cooperative Oncology Group performance status (ECOG-PS) of 0 or 1
8. Patients who voluntarily decided to participate in this study after being informed of the study information, and provided written consent to faithfully comply with the study requirements

Exclusion Criteria:

1. Patients who has the following medical history or concomitant diseases at screening

   * Patients with oral mucositis or oral ulcer at screening
   * Patients who have severe infections or other uncontrolled active infectious diseases at screening that require administration of antibiotics, antibacterial agents, antifungal agents, antivirals, etc. (e.g., Human Immunodeficiency Virus positive, active hepatitis B or active hepatitis C, etc.) However, in case of administration of antiviral drugs in patients with hepatitis B or C infection, whose disease is controlled, the subjects can be enrolled.
   * Patients who have major cardiovascular disease within 6 months before screening, which includes, but not limited to Severe heart disease (heart failure (NYHA class 3 and 4), acute coronary artery disease (unstable angina, acute myocardial infarction), clinically significant ventricular tachycardia, atrial fibrillation, atrial flutter, or other clinically significant arrhythmia and peripheral vascular diseases confirmed by the investigator Hypertrophic obstructive cardiomyopathy, clinically significant heart valve disease or aortic disease
   * Patients who are considered inappropriate to participate in the study because they have uncontrolled disease and have a comorbid disease that requires treatment by the investigator's judgement (e.g., blood coagulation disorder, bleeding disorder or bleeding diatheses, pulmonary function decline, decline in renal function, hypotension, hypertension, hepatitis, liver cirrhosis, etc)
   * Patients who have major mental illness (e.g., depression, bipolar disorder, etc.) or a history of drug/alcohol abuse
2. If the following therapy has been administered or received, or when the need for administration is expected

   * The following therapies within 12 weeks before the baseline that may have a significant effect on the results of the study Palifermin Oral low-level laser therapy Oral cryotherapy Glutamine (parenteral, IV supplement of protein amino acids containing glutamic acid, not glutamine supplements, are permitted)
   * Vaccination of yellow fever vaccine or other live attenuated vaccine within 4 weeks before the baseline
   * Anti-cancer or radiation therapy\* within 3 weeks before the baseline (However, the use of Anti-cancer drugs for hematopoietic stem cell collection is permitted and subjects who have been irradiated with head and neck within the last 2 years are excluded.) (\*Radio(chemo)therapy, chemotherapy, targeted therapy (small molecule drugs, monoclonal antibodies), cancer immunotherapy (biological drugs), or hormone therapy, etc.)
   * The following drugs that may affect the metabolism of IP from within 7 days before the baseline to the end of treatment (EOT) period Strong CYP3A4 inhibitors: boceprevir, citrus x paradisi, clarithromycin, cobicistat, conivaptan, delavirdine, diltiazem, idelalisib, indinavir, itraconazole, ketoconazole, mibefradil, miconazole, nefazodone, nelfinavir, posaconazole, lopinavir/ritonavir, saquinavir, telaprevir, telithromycin, tipranavir, troleandomycin, voriconazole Strong CYP3A4 inducers: avasimibe, carbamazepine, enzalutamide, fosphenytoin, hypericum perforatum, lumacaftor, methylphenobarbital, mitotane, phenobarbital, phenobarbital quinine, primidone, rifabutin, rifampicin, rifapentine OATP inhibitors: cyclosporin A, cyclosporine, estradiol-17β-glucuronide, estrone-3-sulfate, rifampicin, rifamycin SV, lopinavir/ritonavir
3. Pregnant and lactating women or women or childbearing potential and men who have a pregnancy plan up to 30 days after the end of the IP administration or who do not intend to use appropriate contraception: ① Hormonal contraceptives, ② Implantation of an intrauterine device or intrauterine system, ③ Double blocking method with spermicide (both male condom and closed cap (contraceptive diaphragm or neck cap) are used), ④ Infertility procedures (e.g., vasectomy, bilateral tubal ligation, etc.)
4. Patients who participated in other clinical trials within 30 days from the start of IP administration and received other study drug (or medical devices)
5. Patient who are judged to be difficult to participate in the study according to the opinions of investigators

Primary outcomes:
measure: The incidence of Severe Oral Mucositis(SOM).
timeFrame: up to 14 days after the end of therapy( or discharge if hospitalization extension is necessary)
Secondary outcomes:
measure: The incidence of oral mucositis by WHO OM grading scale
timeFrame: up to 14 days after the end of therapy( or discharge if hospitalization extension is necessary)
measure: The incidence of oral mucositis based on the maximum severity by WHO OM grading scale
timeFrame: up to 14 days after the end of therapy( or discharge if hospitalization extension is necessary)
measure: The average grade of oral mucositis by WHO OM grading scale
timeFrame: Each 1, 5, 7, 14, 21 and 28 day after the end of therapy
measure: The duration of oral mucositis by WHO OM grading scale
timeFrame: up to 14 days after the end of therapy( or discharge if hospitalization extension is necessary)
measure: The incidence of oral mucositis by NCI-CTCAE v5.0 criteria
timeFrame: up to 14 days after the end of therapy( or discharge if hospitalization extension is necessary)
measure: The average grade of oral mucositis by NCI-CTCAE v5.0 criteria
timeFrame: Each 1, 5, 7, 14, 21 and 28 day after the end of therapy
measure: The mean area under curve(AUC) of score for each question in oral mucositis daily questionnaire(OMDQ)
timeFrame: up to 14 days after the end of therapy( or discharge if hospitalization extension is necessary)
measure: The proportion of using opioid analgesics
timeFrame: From the baseline to 14 days after the end of therapy( or discharge if hospitalization extension is necessary)
measure: Total cumulative dose of opioid analgesics
timeFrame: From the baseline to 14 days after the end of therapy( or discharge if hospitalization extension is necessary)
Other outcomes:
measure: Adverse Events(AEs)
timeFrame: From baseline to 28 day after discharge
measure: Auto hematopoietic stem cell engraftment
timeFrame: From auto-HSCT to 28 day
Locations:
city: Seoul
country: Korea, Republic of
facility: Seoul ST. Mary's Hospital
city: Seoul
country: Korea, Republic of
facility: Yeouido ST. Mary's Hospital
Study officials:
affiliation: Seoul St. Mary's Hospital
name: Seok-Goo Cho, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References: