Clinical trial NCT04919642: Study to Evaluate the Efficacy and Safety of TT-00420 (Tinengotinib) in Cholangiocarcinoma
Official title: A Phase II, Open Label, Multicenter Study to Evaluate the Efficacy and Safety of TT-00420 (Tinengotinib) Tablet in Adult Patients With Advanced Cholangiocarcinoma
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Cholangiocarcinoma
FGFR2 Fusion
FGFR2 Gene Mutation
FGFR1 Alteration
FGFR3 Alteration
Lead sponsor: TransThera Sciences (Nanjing), Inc.
Sponsor class: INDUSTRY
First posted: 2021-06-09
Enrollment: 55
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: This study is an open-label, multicenter study to evaluate the efficacy and safety of TT-00420 tablet in adult patients with advanced cholangiocarcinoma.

Detailed description: This is a Phase II, open-label study to evaluate the efficacy and safety of TT00420 in patients with advanced/metastatic and surgically unresectable cholangiocarcinoma (CCA) with 1) FGFR 2 fusions who failed prior FGFR inhibitor treatment, 2) FGFR2 fusions who responded on prior FGFR inhibitor treatment, 3) with other FGFR alterations, or 4) whose tumors do not contain a detectable FGFR alteration.

Eligibility criteria: Inclusion Criteria:

1. ≥ 18 years of age, at the time of signing informed consent
2. Histologically or cytologically documented advanced/metastatic or surgically unresectable cholangiocarcinoma who have received at least one line of prior systemic chemotherapy. Patients will be assigned to 1 of 4 cohorts:

   * Cohort A1: FGFR2 fusions who have failed at least one previous treatment with an FGFR inhibitor
   * Cohort A2: FGFR2 fusions who have previously responded on at least one previous treatment with an FGFR inhibitor
   * Cohort B: other FGFR alterations, including FGFR2 mutations and FGFR1/3 alterations, including fusions
   * Cohort C: negative for FGFR alterations (FGFR wild-type)
3. At least one measurable lesion as defined by RECIST V1.1 criteria for solid tumors5
4. Documentation of FGFR gene alteration status
5. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
6. Adequate organ function confirmed at screening and within 10 days of initiating treatment, as evidenced by:

   * Absolute neutrophil count (ANC) ≥ 1.5 x 10\^9/L
   * Hemoglobin (Hgb) ≥ 8 g/dl
   * Platelets (plt) ≥ 75 x 10\^9/L
   * aspartate aminotransferase/serum glutamate oxaloacetate transaminase (AST/SGOT) and alanine aminotransferase/serum glutamate pyruvate transaminase (ALT/SGPT) ≤ 2.5 x Upper Limit of Normal (ULN) or ≤ 5.0 x ULN if liver metastases are present
   * Total bilirubin ≤ 1.5 x ULN
   * Calculated creatine clearance ≥ 50 mL/min (Cockcroft Gault formula
7. Negative pregnancy test within 72 hours before starting study treatment in all premenopausal women and women \< 12 months after the onset of menopause
8. Must agree to take sufficient contraceptive methods to avoid pregnancy (including male and female participants) during the study and until at least 6 months after ceasing study treatment
9. Able to sign informed consent and comply with the protocol

Exclusion Criteria:

1. Women who are pregnant or lactating
2. Women of child-bearing potential (WOCBP) who do not use adequate birth control
3. Patients with untreated brain or central nervous system (CNS) metastases or brain/CNS metastases that have progressed (e.g. evidence of new or enlarging brain metastasis or new neurological symptoms attributable to brain/CNS metastases) Note: Patients with treated brain metastases that are off corticosteroids and have been clinically stable for 28 days are eligible for enrollment.
4. Patients with a known concurrent malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin, carcinoma in situ of the cervix or other noninvasive or indolent malignancy that has previously undergone potentially curative therapy.
5. Patients with the following mood disorders as judged by the Investigator or a psychiatrist:

   * Medically documented history of or active major depressive episode, bipolar disorder (I or II), obsessive-compulsive disorder, schizophrenia; a history of suicidal attempt or ideation, or homicidal ideation (immediate risk of doing harm to others)
   * ≥ CTCAE grade 3 anxiety
6. Impaired cardiac function or significant diseases, including but not limited to any of the following:

   * left ventricular ejection fraction (LVEF) \< 45% as determined by multigated acquisition (MUGA) scan or echocardiogram (ECHO)
   * Congenital long QT syndrome
   * QTcF ≥ 480 msec on screening ECG
   * Unstable angina pectoris ≤ 3 months prior to starting study drug
   * Acute myocardial infarction ≤ 3 months prior to starting study drug
7. Patients with uncontrolled hypertension (defined as blood pressure of ≥ 150 mmHg systolic and/or ≥ 90 mmHg diastolic at Screening)
8. Patients with:

   * unresolved diarrhea ≥ CTCAE grade 2, or
   * impairment of gastrointestinal (GI) function, or
   * GI disease that may significantly alter the absorption of TT-00420.
9. Other concurrent severe and/or uncontrolled concomitant medical conditions (e.g. uncontrolled hypertriglyceridemia \[triglycerides \> 500 mg/dL\], or active or uncontrolled infection) that could cause unacceptable safety risks or compromise compliance with the protocol
10. Patients who have received chemotherapy, targeted therapy, or immunotherapy ≤ 5 half-lives or 3 weeks, whichever is shorter, (6 weeks for nitrosourea or mitomycin-C) prior to starting study drug
11. Patients who have received wide field radiotherapy ≤ 4 weeks or limited field radiation for palliation ≤ 2 weeks prior to starting study drug or who have not recovered from adverse events of prior therapy
12. Patients who have undergone major surgery ≤ 4 weeks prior to starting study drug or who have not recovered from adverse events of prior therapy
13. Patients who are currently receiving treatment with therapeutic doses of warfarin sodium (Coumadin®) or any other coumarin-derivative anticoagulants
14. Patients who are currently receiving treatment with strong CYP3A inhibitors or inducers, or sensitive substrates of CYP3A4 ≤ 2 weeks prior to starting study drug.
15. Patients who are using a proton pump inhibitor within 4 days prior to the start of study therapy or a histamine-2 blocker within 2 days prior to the start of study therapy.
16. Known diagnosis of human immunodeficiency virus (HIV) infection (HIV testing is not mandatory; patients with well controlled HIV might be enrolled per investigator's discretion and Sponsor approval)
17. Evidence of active infection with Hepatitis B or Hepatitis C that is not adequately controlled. For patients with known prior history of Hepatitis B or Hepatitis C, enrollment may be allowed per investigator's discretion and Sponsor approval.
18. Inability to swallow or tolerate oral medication
19. Has a history or current evidence of any condition, therapy, or laboratory abnormality that, in the opinion of the investigator, might confound the results of the trial, interfere with the patient's safe participation and compliance in the trial.

Primary outcomes:
measure: Objective Response Rate (ORR) in patients with FGFR2 fusions who have failed at least one previous treatment with an FGFR inhibitor (Cohort A1)
timeFrame: Through study completion, an average of 9 months.
measure: ORR in patients with FGFR2 fusions who have responded (CR or PR) on at least one previous treatment with an FGFR inhibitor and discontinued due to progressive disease (Cohort A2)
timeFrame: Through study completion, an average of 9 months.
measure: ORR in patients with FGFR alterations other than FGFR2 fusions (Cohort B)
timeFrame: Through study completion, an average of 9 months.
measure: ORR in patients without FGFR alterations (wild-type FGFR mutation status) (Cohort C)
timeFrame: Through study completion, an average of 9 months.
Secondary outcomes:
measure: ORR in all patients with FGFR alterations (Cohorts A and B)
timeFrame: Through study completion, an average of 9 months.
measure: Progression Free Survival (PFS) (All Cohorts)
timeFrame: From first study drug administration until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 24 months
measure: Disease Control Rate (DCR) (All Cohorts)
timeFrame: Through study completion, an average of 9 months.
measure: Overall Survival (OS) (All Cohorts)
timeFrame: From first study drug administration until the date of death from any cause, assessed up to 24 months
measure: Number of Participants With Abnormal Laboratory Values and/or Adverse Events That Are Related to Treatment (All Cohorts)
timeFrame: Up to 30 days from study discontinuation
measure: Concentration of TT-00420 at Protocol-Specified Timepoints (All Cohorts)
timeFrame: From Cycle 1 to Cycle 4, an average of 4 months (each cycle is 28 days)
Other outcomes:
measure: Genetic Alteration Status
timeFrame: Through study completion, an average of 9 months
Locations:
city: Anchorage
country: United States
facility: Providence Cancer Center
state: Alaska
city: Duarte
country: United States
facility: City of Hope
state: California
city: Santa Monica
country: United States
facility: University of California, Los Angeles, School of Medicine
state: California
city: Denver
country: United States
facility: USO Oncology Network- Rocky Mountain Cancer Centers
state: Colorado
city: Miami Beach
country: United States
facility: Mount Sinai Medical Center
state: Florida
city: Chicago
country: United States
facility: University of Chicago Medical Center - Duchossis Center for Advanced Medicine
state: Illinois
city: Baltimore
country: United States
facility: University of Maryland - Marlene and Stewart Greenebaum Cancer Center
state: Maryland
city: Ann Arbor
country: United States
facility: University of Michigan Comprehensive Cancer Center
state: Michigan
city: Detroit
country: United States
facility: Henry Ford Health Center
state: Michigan
city: Rochester
country: United States
facility: Mayo Clinic
state: Minnesota
city: Las Vegas
country: United States
facility: Comprehensive Cancer Center of Nevada
state: Nevada
city: Florham Park
country: United States
facility: Summit Medical Group - Florham Park Campus
state: New Jersey
city: Buffalo
country: United States
facility: Roswell Park Comprehensive Cancer Center
state: New York
city: New York
country: United States
facility: Ruttenberg Treatment Center - Mount Sinai
state: New York
city: New York
country: United States
facility: USOR Oncology Network- New York Oncology
state: New York
city: Stony Brook
country: United States
facility: Stony Brook University - Long Island Cancer Center
state: New York
city: Cincinnati
country: United States
facility: University of Cincinnati Cancer Institute
state: Ohio
city: Cleveland
country: United States
facility: University Hospitals Seidman Cancer Center
state: Ohio
city: Portland
country: United States
facility: USO Oncology Network-Northwest Cancer Specialists, P.C.
state: Oregon
city: Charleston
country: United States
facility: Medical College of South Carolina
state: South Carolina
city: Knoxville
country: United States
facility: The University of Tennessee Medical Center
state: Tennessee
city: Nashville
country: United States
facility: Sarah Cannon Research Institute at Tennessee Oncology
state: Tennessee
city: Dallas
country: United States
facility: Methodist Dallas Medical Center
state: Texas
city: Dallas
country: United States
facility: Parkland Health & Hospital System
state: Texas
city: Dallas
country: United States
facility: University of Texas Southwestern Harold C. Simmons Comprehensive Cancer Center
state: Texas
city: Houston
country: United States
facility: Houston Methodist Hospital - Outpatient Center
state: Texas
city: Houston
country: United States
facility: UT MD Anderson Cancer Center
state: Texas
city: Tyler
country: United States
facility: USO Oncology Network-Texas Oncology
state: Texas
city: Norfolk
country: United States
facility: USO Oncology Network-Virginia Oncology Associates - Brock Cancer Center - Norfolk
state: Virginia
city: Roanoke
country: United States
facility: USO Oncology Network-Oncology and Hematology Associates of Southwest Virginia, Inc.
state: Virginia
city: Madison
country: United States
facility: University of Wisconsin School of Medicine and Public Health
state: Wisconsin
city: Milwaukee
country: United States
facility: Medical College of Wisconsin
state: Wisconsin
Study officials:
affiliation: M.D. Anderson Cancer Center
name: Milind Javle, MD
role: PRINCIPAL_INVESTIGATOR
References: