Metastatic NUT CarcinomaPhase 1/2NCT04116359
Testing of the Addition of a New Anti-cancer Drug, Molibresib, to Chemotherapy Treatment (Etoposide and Cisplatin) for Patients With NUT Carcinoma
A Phase 1/2 study testing Cisplatin, Etoposide and Etoposide Phosphate in people with Metastatic NUT Carcinoma and Unresectable NUT Carcinoma, run by National Cancer Institute (NCI).
Trial summary
This phase I/II trial studies the side effects and best dose of molibresib when given together with chemotherapy (etoposide and cisplatin) and how well they work for the treatment of NUT cancer that has spread to other places in the body (metastatic) or cannot be removed by surgery (unresectable). Read more about this study
- Who is it for?
- Ages 12 years and older
- Conditions the study is for
- Metastatic NUT Carcinoma, Unresectable NUT Carcinoma
- What is being tested?
- Cisplatin, Etoposide and Etoposide Phosphate
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 0 participants
- Where
- No sites listed yet
- Study dates
- 18 Sep 2020to 18 Sep 2020
- Phase
- Phase 1/2
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 12 years and older
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Who may be able to join
- PHASE 1, PHASE 2, AND NON-THORACIC, NON-BRD4 EXPLORATORY COHORT
- Patients must have histologically or cytologically confirmed NUT carcinoma (NC) based on at least one of the following criteria:
- Ectopic expression of NUT protein (> 50% tumor nuclei) as determined by immunohistochemistry (IHC) testing performed in a Clinical Laboratory Improvement Act (CLIA) certified laboratory
- Detection of the NUT gene translocation as determined by fluorescence in situ hybridization (FISH) performed at the Brigham and Women's Hospital (BWH) Center for Advanced Molecular Diagnostics (CAMD)
- Participants must have disease that is metastatic, unresectable, or for which a surgical approach would not likely confer a survival benefit or would be otherwise contraindicated in the opinion of the treating investigator. Participants who have already undergone surgical resection are eligible
- Eastern Cooperative Oncology Group (ECOG) performance status of =< 2 (Karnofsky >= 60%) for patients >= 16 years of age, Lansky >= 50% if < 16 years of age
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- Participants must have measurable disease per RECIST version 1.1 criteria. Participants enrolling to the phase 1 or non-BRD4 exploratory cohort without measurable disease per the RECIST definition may be allowed to enroll with permission from the overall principal investigator if their disease is otherwise evaluable (e.g. bone metastases, malignant pleural effusions, malignant ascites
- Ability to swallow and retain oral medications
- Absolute neutrophil count >= 1.5 x 10^9/L
- Platelets >= 100 x 10^9/L
- Hemoglobin >= 9.0 g/dL
- Albumin >= 2.5 g/dL
- Total bilirubin =< 1.5 x institutional upper limit of normal (ULN) for age
- Aspartate aminotransferase (AST)(serum glutamic-oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT)(serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x institutional ULN for age OR
- Calculated creatinine clearance >= 60 mL/min (via the using CKD-epi equation)
- Prothrombin time (PT)/international normalized ratio (INR) =< 1.5 x ULN
- Partial thromboplastin time (PTT) =< 1.5 x ULN
- Left ventricular ejection fraction >= lower limit of normal (LLN)
- Troponin T =< ULN
- Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 3 months are eligible for this trial as long as their anti-retroviral therapy does not have the potential for drug-drug interactions as judged by the treating investigator
- For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated
- Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load. Hepatitis C (hepC antibody) testing is required. Hepatitis C RNA is optional; however, a confirmatory negative hepatitis C RNA test must be obtained to be able to enroll participants with positive hepatitis C antibody due to prior resolved disease
- Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for treatment in the phase 1 portion, but not in the phase 2 or non-BRD4 exploratory cohort
- The effects of GSK525762C on the developing human fetus are unknown. For this reason and because the chemotherapeutic agents used in this trial are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (barrier method of birth control; abstinence) from the time of the screening, for the duration of study participation, and for 7 months after the completion of GSK525762C administration. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and 4 months after completion of GSK525762C administration.
- For female subjects of child-bearing potential receiving GSK525762C, all hormonal means of birth control such as oral, injectable, dermal, subdermal or topical contraceptives are NOT acceptable forms of birth control given that their efficacy has not been evaluated when given in combination with the investigational drugs. "Adequate contraception" is defined as the following:
- Contraceptive Methods with a Failure Rate of =< 1%. Defined as:
- Intrauterine device (IUD) or intrauterine system (IUS) that meets the < 1% failure rate as stated in the product label
- Note: Hormonal IUDs may only be used if the following criteria are met:
- Male condoms are required AND
- Subjects are informed of the potential for reduced systemic hormone levels from the IUD when taking GSK525762C
- Male partner sterilization (vasectomy with documentation of azoospermia) prior to the female subject's entry into the study, and this male is the sole partner for that subject. For this definition, "documented" refers to the outcome of the investigator's/designee's medical examination of the subject or review of the subject's medical history for study eligibility, as obtained via a verbal interview with the subject or from the subject's medical records.
- Male subjects with female partners of child-bearing potential must use one of the following contraceptive methods:
- Vasectomy with documentation of azoospermia OR
- Condom use PLUS partner use of a highly effective contraceptive (=< 1% rate of failure per year) such as intrauterine device or system, or hormonal birth control such as contraceptive subdermal implant, combined estrogen and progestogen oral contraceptive, injectable progestogen, contraceptive vaginal ring, or percutaneous contraceptive patches
- Male subjects should not donate sperm while on study and for 16 weeks after the last dose of study medication. Male subjects whose partners are or become pregnant must continue to use condoms for 16 weeks after the last dose of study medication
- Ability to understand and the willingness to sign a written informed consent document (or parent or legally authorized representative, if minor)
- Women of childbearing potential must have a negative pregnancy test within 7 days of starting treatment
- Participants who have not had cytotoxic chemotherapy, oral tyrosine kinase inhibitor (TKI) or small molecule therapy, or immunotherapy within 2 weeks prior to the first dose of study medication or 5 half-lives, whichever is shorter. There is no required washout for previous EP therapy. There is no required washout for previous GSK525762C therapy for patients enrolling to the dose escalation or phase 2 portion of the study
- Participants who have received prior radiation therapy can be enrolled at least 1 week after completing radiation
- Participants who have had major surgery can be enrolled at least 3 weeks after the surgery
- Any therapy-related toxicities must have resolved to =< grade 1 or baseline as per the judgement of the treating investigator (with the exception of alopecia, peripheral neuropathy, or rash that will be permitted at =< grade 2). Other grade 2 toxicities attributed to prior treatment may be permitted with agreement from the overall principal investigator if they are toxicities not commonly attributed to GSK525762C. Toxicities attributed to current EP therapy are excluded from this requirement for participants enrolling to the dose escalation or phase 2 portion of the study, as long as the participant meets all other eligibility criteria
- NON-THORACIC,NON-BRD4 EXPLORATORY COHORT
- Participants must lack BRD4-NUT rearrangement as identified via FISH testing performed at the BWH CAMD
Who cannot join
- PHASE 1, PHASE 2, AND NON-THORACIC,NON-BRD4 EXPLORATORY COHORT.
- Participants with known untreated central nervous system (CNS) metastases. Patients with a history of CNS metastases are eligible, provided they meet the following criteria:
- Disease outside the CNS is present
- Recovery from acute toxicity associated with the treatment to =< Common Terminology Criteria for Adverse Events (CTCAE) grade 1 or baseline (with the exception of alopecia), with no requirement for escalating doses of corticosteroids over the past 7 days
- Subjects currently taking enzyme-inducing anticonvulsants (EIAC) must be transitioned to non-enzyme inducing anticonvulsants at least 14 days or 5 half-lives prior to the first dose of study medication
- No presence of symptomatic or untreated leptomeningeal metastases or spinal cord compression
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- History of allergic reactions attributed to compounds of similar chemical or biologic composition to the study agent(s) (e.g., benzodiazepines for GSK525762C) the participant will be receiving once enrolled
- Uncontrolled intercurrent illness including, but not limited to: ongoing or active infection requiring systemic treatment, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
- Any gastrointestinal (GI) disorder that may affect absorption of oral medications in the opinion of the treating investigator, such as malabsorption syndrome or major bowel or stomach resection
- Fridericia's correction formula (QTcF) > 450 msec on screening electrocardiogram (ECG)
- Patients who are receiving any other investigational agents
- GSK525762C is primarily metabolized by CYP3A4; therefore, concomitant administration with strong inhibitors or inducers of CYP3A4 should be avoided unless medically necessary. Because the lists of these agents are constantly changing, it is important to regularly consult a frequently-updated medical reference. As part of the enrollment/informed consent procedures, the patient will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the patient is considering a new over-the-counter medicine or herbal product
- Pregnant women are excluded from this study because GSK525762C is a BET inhibitor with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with GSK525762C, breastfeeding should be discontinued if the mother is treated with GSK525762C. These potential risks may also apply to other agents used in this study
- Patients receiving therapeutic-dose anticoagulation (e.g., warfarin, low-molecular weight heparin [LMWH], or novel oral anticoagulants) are not eligible. Prophylactic anticoagulation, with low doses (per standard practice) of agents such as low molecular weight heparin (LMWH), direct thrombin inhibitors, or factor Xa inhibitors are permitted
- Patients who are known to require concurrent use of nonsteroidal antiinflammatory drugs (NSAIDS), except for cases where NSAIDS provide benefit over other analgesics or high dose aspirin (patients are allowed up to 100 mg aspirin PO daily)
- Patients with a history of known bleeding disorders or history of clinically significant hemorrhage (e.g. GI, neurologic) within the past 6 months
- Cardiac abnormalities as evidenced by any of the following:
- Clinically significant conduction abnormalities or arrhythmias. NOTE: Any clinically significant ECG assessments should be reviewed by the site cardiologist prior to study entry
- Presence of cardiac pacemaker or defibrillator with a paced ventricular rhythm limiting ECG analysis
- History or evidence of current >= class II congestive heart failure as defined by New York Heart Association (NYHA)
- History of acute coronary syndromes (including unstable angina and myocardial infarction), coronary angioplasty, or stenting within the past 3 months. Subjects with a history of stent placement requiring ongoing antithrombotic therapy (e.g., clopidogrel, prasugrel) will not be permitted to enroll
- Clinically significant cardiomegaly, ventricular hypertrophy, or cardiomyopathy
- PHASE 1 OR PHASE 2
- For enrollment to the dose escalation or phase 2 portion of the study: patients who are currently receiving EP or GSK525762C, or received EP or GSK525762C in the past, must be candidates to receive the study agents at the protocol-defined dose level and schedule as judged by the treating investigator. Patients who previously required dose reductions of their EP or GSK525762C due to unacceptable toxicities attributed to the agent(s) are not eligible
- Patients must be candidates to receive EP per institutional standards of practice and/or the Food and Drug Administration (FDA) package inserts as judged by the treating investigator
- NON-THORACIC, NON-BRD4 EXPLORATORY COHORT
- For enrollment to the non-BRD4 exploratory cohort: patients who previously received treatment with a BETi, including but not limited to previous GSK525762C therapy. Exceptions may be allowed for patients who have not received treatment with GSK525762C but who have received a different BETi with approval from the overall principal investigator
- For enrollment to the non-BRD4 exploratory cohort: patients with disease that originated in the thoracic cavity. In the case of patients with metastatic disease at diagnosis where disease origin is uncertain, the patient may be allowed to enroll with approval from the overall principal investigator
About this study
Official title: A Phase 1/2 Study of the Bromodomain Inhibitor Molibresib in Combination With Etoposide/Platinum in Patients With NUT Carcinoma
This phase I/II trial studies the side effects and best dose of molibresib when given together with chemotherapy (etoposide and cisplatin) and how well they work for the treatment of NUT cancer that has spread to other places in the body (metastatic) or cannot be removed by surgery (unresectable). Molibresib may stop the growth of tumor cells by blocking some of the proteins needed for cell growth. Drugs used in chemotherapy, such as etoposide and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Adding molibresib to chemotherapy (etoposide and cisplatin), may work better in treating patients with NUT cancer compared to the usual approach.
Read the detailed description
PRIMARY OBJECTIVES:
- Determine the maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D) of the combination of molibresib besylate (molibresib [GSK525762C]) with etoposide phosphate (etoposide) and cisplatin (EP) in patients with NUT carcinoma (NC). (Phase I) II. Evaluate the overall objective response rate (ORR) of the triplet combination in participants utilizing Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 criteria. (Phase II)
SECONDARY OBJECTIVES:
- Evaluate the preliminary progression-free survival (PFS) rate, ORR, duration of response (DoR), and overall survival (OS) rate of the triplet combination in participants utilizing RECIST version 1.1 criteria. (Phase I) II. Determine the pharmacokinetic (PK) profile of the triplet combination. (Phase I) III. Determine the PFS, DoR, and OS rates of the triplet in participants with NC using RECIST version 1.1 criteria. (Phase II) IV. Confirm the safety and tolerability of the regimen in this patient population. (Phase II) V. Evaluate the preliminary PFS rate, ORR, DoR, and the OS rate of GSK525762C monotherapy in a small exploratory cohort of patients with non-thoracic origin, non-BRD4-NUT NC. (Phase II) VI. To observe and record anti-tumor activity. (Phase 1, phase 2, and non-thoracic, non-BRD4 exploratory cohort) VII. Explore potential biomarker indicators of response and resistance in tumor tissue samples. (Phase 1, phase 2, and non-thoracic, non-BRD4 exploratory cohort)
VIII. To perform molecular profiling assays on malignant and normal tissues, including, but not limited to, whole exome sequencing (WES) and messenger ribonucleic acid (RNA) sequencing (RNAseq), in order to:
VIIIa. Identify potential predictive and prognostic biomarkers beyond any genomic alteration by which treatment may be assigned. (Phase 1, phase 2, and non-thoracic, non-BRD4 exploratory cohort) VIIIb. Identify resistance mechanisms using genomic deoxyribonucleic acid (DNA)- and RNA-based assessment platforms. (Phase 1, phase 2, and non-thoracic, non-BRD4 exploratory cohort) IX. To contribute genetic analysis data from de-identified biospecimens to Genomic Data Commons (GDC), a well annotated cancer molecular and clinical data repository, for current and future research. (Phase 1, phase 2, and non-thoracic, non-BRD4 exploratory cohort) X. To bank formalin-fixed, paraffin-embedded (FFPE) tissue, blood (for cell-free DNA analysis), and nucleic acids obtained from patients at the Experimental Therapeutics Clinical Trials Network (ETCTN) Biorepository at Nationwide Children's Hospital. (Phase 1, phase 2, and non-thoracic, non-BRD4 exploratory cohort)
OUTLINE: This is a phase I, dose-escalation study of molibresib besylate followed by a phase II study. Patients are assigned to 1 of 2 cohorts.
PHASE I AND II COHORT: Patients receive molibresib besylate orally (PO) once daily (QD) on days 1-14 (may switch to days 1-21 after completion of etoposide and cisplatin cycles). Patients also receive etoposide phosphate intravenously (IV) over 60 minutes on days 1-3 and cisplatin IV over 60 minutes on day 1 of cycles 1-4. Treatments repeat every 21 days in the absence of disease progression or unacceptable toxicity. After completion of cycle 4, patients may receive etoposide phosphate and cisplatin for up to 8 cycles total in the absence of disease progression or unacceptable toxicity at the investigator's discretion.
Non-BRD4 EXPLORATORY COHORT: Patients receive molibresib besylate PO QD on days 1-21. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients who experience disease progression may receive molibresib besylate, etoposide phosphate and cisplatin as in Phase I and II Cohort at the discretion of the principal investigator.
After completion of study treatment, patients are followed up for 30 days and then every 4 weeks for up to 2 years.
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
CisplatinDrug
Also called Abiplatin, Blastolem, Briplatin, CDDP
Given IV
EtoposideDrug
Also called Demethyl Epipodophyllotoxin Ethylidine Glucoside, EPEG, Lastet, Toposar
Given IV
Etoposide PhosphateDrug
Also called Etopophos
Given IV
MolibresibDrug
Also called GSK-525762A, GSK525762, I-BET 762
Given PO
Molibresib BesylateDrug
Also called GSK525762C
Given PO
| Study group | Role | What they receive |
|---|---|---|
| Non-BRD4 exploratory cohort (molibresib, cisplatin, etoposide) | Experimental | Patients receive molibresib besylate PO QD on days 1-21. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients who experience disease progression may receive molibresib besylate, etoposide phosphate and cisplatin as in Phase I and II Cohort at the discretion of the principal investigator. Receives: Drug: Cisplatin; Drug: Etoposide; Drug: Etoposide Phosphate; Drug: Molibresib; Drug: Molibresib Besylate |
| Phase I and II cohort (molibresib, etoposide, cisplatin) | Experimental | Patients receive molibresib besylate PO QD on days 1-14 (may switch to days 1-21 after completion of etoposide and cisplatin cycles). Patients also receive etoposide phosphate IV over 60 minutes on days 1-3 and cisplatin IV over 60 minutes on day 1 of cycles 1-4. Treatments repeat every 21 days in the absence of disease progression or unacceptable toxicity. After completion of cycle 4, patients may receive etoposide phosphate and cisplatin for up to 8 cycles total in the absence of disease progression or unacceptable toxicity at the investigator's discretion. Receives: Drug: Cisplatin; Drug: Etoposide; Drug: Etoposide Phosphate; Drug: Molibresib; Drug: Molibresib Besylate |
What is being measured
The primary outcome is the main question the study is designed to answer.
Incidence of adverse events (Phase I)
Assessed using Common Terminology Criteria for Adverse Events (CTCAE) version (V.) 5.0 criteria.
Measured: Up to 21 days
Maximum tolerated dose (MTD) (Phase I)
The MTD will be the highest dose level at which 0/3 or 1/6 subjects experience a dose limiting toxicity (DLT). Data will be summarized using descriptive statistics for continuous variables and frequencies, percentages for discrete variables, and presented by dose group, as appropriate.
Measured: Up to 21 days
Overall response rate (ORR) (Phase II)
Radiological response will be assessed by RECIST 1.1 criteria and will be graded as CR, PR, SD and PD. Point estimates and exact binomial 90% confidence intervals will be provided.
Measured: Up to 2 years
Secondary outcomes (5)
Overall response rate (ORR) (Phase I, Phase II, and Non-BRD4 Exploratory Cohort)
Radiological response will be assessed by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria and will be graded as complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Point estimates and exact binomial 90% confidence intervals will be provided.
Measured: Up to 2 years
Duration of response (DoR) rates (Phase I, Phase II, and Non-BRD4 Exploratory Cohort)
The method of Kaplan and Meier will be used to estimate duration of response in those that achieve PR or CR.
Measured: From the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented, assessed up to 2 years
Progression free survival (Phase I, Phase II, and Non-BRD4 Exploratory Cohort)
Measured: From study enrollment until the identification of disease progression or death, assessed up to 2 years
Overall survival (OS) rates (Phase I, Phase II, and Non-BRD4 Exploratory Cohort)
The method of Kaplan and Meier will be used to estimate overall survival in all patients.
Measured: Up to 2 years
Pharmacodynamic parameters (Phase I, Phase II, and Non-Thoracic, Non-BRD4 Exploratory Cohort)
Will be compared to those in pre-treatment biopsies using paired statistics such as the Wilcoxon signed-rank test.
Measured: Up to 2 years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted4 Oct 2019
- Study start18 Sep 2020
- Primary completion18 Sep 2020
- Study completion18 Sep 2020
Why it stopped: Other - Protocol moved to Disapproved
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Metastatic NUT CarcinomaStudies of the same condition, open and under way.
- More trials run by National Cancer Institute (NCI)The sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 1/2
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 0 participants (actual)
Sponsor and investigators
- Lead sponsor
- National Cancer Institute (NCI)
- Sponsor type
- US National Institutes of Health
- Responsible party
- Sponsor
- Investigators
- Geoffrey I Shapiro, Principal investigator, Dana-Farber - Harvard Cancer Center LAO
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04116359
- Sponsor's protocol ID
- NCI-2019-06676
- Other IDs
- NCI-2019-06676, 10295, 10295, UM1CA186709
- Status last verified
- Sep 2020
- First submitted
- 3 Oct 2019
- Last updated
- 28 Sep 2020
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- Yes: NCI is committed to sharing data in accordance with NIH policy. For more details on how clinical trial data is shared, access the link to the NIH data sharing policy page.
Study at a glance
From the registry record, last updated by the sponsor on 28 Sep 2020. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Phase 1/2 Study of the Bromodomain Inhibitor Molibresib in Combination With Etoposide/Platinum in Patients With NUT Carcinoma
- ClinicalTrials.gov ID
- NCT04116359
- Acronym / sponsor ID
- NCI-2019-06676
- Phase
- Phase 1/2
- Study type
- Interventional
- Recruitment status
- WithdrawnReason stopped: Other - Protocol moved to Disapproved
- Enrolment
- 0 participants (actual)
- Lead sponsor
- National Cancer Institute (NCI)US National Institutes of Health
- Study start
- 18 Sep 2020 (actual)
- Primary completion
- 18 Sep 2020 (actual)
- Study completion
- 18 Sep 2020 (actual)
- First posted
- 4 Oct 2019 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This phase I/II trial studies the side effects and best dose of molibresib when given together with chemotherapy (etoposide and cisplatin) and how well they work for the treatment of NUT cancer that has spread to other places in the body (metastatic) or cannot be removed by surgery (unresectable). Molibresib may stop the growth of tumor cells by blocking some of the proteins needed for cell growth. Drugs used in chemotherapy, such as etoposide and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Adding molibresib to chemotherapy (etoposide and cisplatin), may work better in treating patients with NUT cancer compared to the usual approach.
Detailed description
PRIMARY OBJECTIVES:
- Determine the maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D) of the combination of molibresib besylate (molibresib [GSK525762C]) with etoposide phosphate (etoposide) and cisplatin (EP) in patients with NUT carcinoma (NC). (Phase I) II. Evaluate the overall objective response rate (ORR) of the triplet combination in participants utilizing Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 criteria. (Phase II)
SECONDARY OBJECTIVES:
- Evaluate the preliminary progression-free survival (PFS) rate, ORR, duration of response (DoR), and overall survival (OS) rate of the triplet combination in participants utilizing RECIST version 1.1 criteria. (Phase I) II. Determine the pharmacokinetic (PK) profile of the triplet combination. (Phase I) III. Determine the PFS, DoR, and OS rates of the triplet in participants with NC using RECIST version 1.1 criteria. (Phase II) IV. Confirm the safety and tolerability of the regimen in this patient population. (Phase II) V. Evaluate the preliminary PFS rate, ORR, DoR, and the OS rate of GSK525762C monotherapy in a small exploratory cohort of patients with non-thoracic origin, non-BRD4-NUT NC. (Phase II) VI. To observe and record anti-tumor activity. (Phase 1, phase 2, and non-thoracic, non-BRD4 exploratory cohort) VII. Explore potential biomarker indicators of response and resistance in tumor tissue samples. (Phase 1, phase 2, and non-thoracic, non-BRD4 exploratory cohort)
VIII. To perform molecular profiling assays on malignant and normal tissues, including, but not limited to, whole exome sequencing (WES) and messenger ribonucleic acid (RNA) sequencing (RNAseq), in order to:
VIIIa. Identify potential predictive and prognostic biomarkers beyond any genomic alteration by which treatment may be assigned. (Phase 1, phase 2, and non-thoracic, non-BRD4 exploratory cohort) VIIIb. Identify resistance mechanisms using genomic deoxyribonucleic acid (DNA)- and RNA-based assessment platforms. (Phase 1, phase 2, and non-thoracic, non-BRD4 exploratory cohort) IX. To contribute genetic analysis data from de-identified biospecimens to Genomic Data Commons (GDC), a well annotated cancer molecular and clinical data repository, for current and future research. (Phase 1, phase 2, and non-thoracic, non-BRD4 exploratory cohort) X. To bank formalin-fixed, paraffin-embedded (FFPE) tissue, blood (for cell-free DNA analysis), and nucleic acids obtained from patients at the Experimental Therapeutics Clinical Trials Network (ETCTN) Biorepository at Nationwide Children's Hospital. (Phase 1, phase 2, and non-thoracic, non-BRD4 exploratory cohort)
OUTLINE: This is a phase I, dose-escalation study of molibresib besylate followed by a phase II study. Patients are assigned to 1 of 2 cohorts.
PHASE I AND II COHORT: Patients receive molibresib besylate orally (PO) once daily (QD) on days 1-14 (may switch to days 1-21 after completion of etoposide and cisplatin cycles). Patients also receive etoposide phosphate intravenously (IV) over 60 minutes on days 1-3 and cisplatin IV over 60 minutes on day 1 of cycles 1-4. Treatments repeat every 21 days in the absence of disease progression or unacceptable toxicity. After completion of cycle 4, patients may receive etoposide phosphate and cisplatin for up to 8 cycles total in the absence of disease progression or unacceptable toxicity at the investigator's discretion.
Non-BRD4 EXPLORATORY COHORT: Patients receive molibresib besylate PO QD on days 1-21. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients who experience disease progression may receive molibresib besylate, etoposide phosphate and cisplatin as in Phase I and II Cohort at the discretion of the principal investigator.
After completion of study treatment, patients are followed up for 30 days and then every 4 weeks for up to 2 years.
Study design
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Non-BRD4 exploratory cohort (molibresib, cisplatin, etoposide) | Experimental | Drug: Cisplatin, Drug: Etoposide, Drug: Etoposide Phosphate, Drug: Molibresib, Drug: Molibresib BesylatePatients receive molibresib besylate PO QD on days 1-21. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients who experience disease progression may receive molibresib besylate, etoposide phosphate and cisplatin as in Phase I and II Cohort at the discretion of the principal investigator. |
| Phase I and II cohort (molibresib, etoposide, cisplatin) | Experimental | Drug: Cisplatin, Drug: Etoposide, Drug: Etoposide Phosphate, Drug: Molibresib, Drug: Molibresib BesylatePatients receive molibresib besylate PO QD on days 1-14 (may switch to days 1-21 after completion of etoposide and cisplatin cycles). Patients also receive etoposide phosphate IV over 60 minutes on days 1-3 and cisplatin IV over 60 minutes on day 1 of cycles 1-4. Treatments repeat every 21 days in the absence of disease progression or unacceptable toxicity. After completion of cycle 4, patients may receive etoposide phosphate and cisplatin for up to 8 cycles total in the absence of disease progression or unacceptable toxicity at the investigator's discretion. |
Who may qualify
- Ages
- 12 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (43 listed)
- PHASE 1, PHASE 2, AND NON-THORACIC, NON-BRD4 EXPLORATORY COHORT
- Patients must have histologically or cytologically confirmed NUT carcinoma (NC) based on at least one of the following criteria:
- Participants must have disease that is metastatic, unresectable, or for which a surgical approach would not likely confer a survival benefit or would be otherwise contraindicated in the opinion of the treating investigator. Participants who have already undergone surgical resection are eligible
- Eastern Cooperative Oncology Group (ECOG) performance status of =< 2 (Karnofsky >= 60%) for patients >= 16 years of age, Lansky >= 50% if < 16 years of age
- Participants must have measurable disease per RECIST version 1.1 criteria. Participants enrolling to the phase 1 or non-BRD4 exploratory cohort without measurable disease per the RECIST definition may be allowed to enroll with permission from the overall principal investigator if their disease is otherwise evaluable (e.g. bone metastases, malignant pleural effusions, malignant ascites
Key exclusion criteria (28 listed)
- PHASE 1, PHASE 2, AND NON-THORACIC,NON-BRD4 EXPLORATORY COHORT.
- Participants with known untreated central nervous system (CNS) metastases. Patients with a history of CNS metastases are eligible, provided they meet the following criteria:
- History of allergic reactions attributed to compounds of similar chemical or biologic composition to the study agent(s) (e.g., benzodiazepines for GSK525762C) the participant will be receiving once enrolled
- Uncontrolled intercurrent illness including, but not limited to: ongoing or active infection requiring systemic treatment, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
- Any gastrointestinal (GI) disorder that may affect absorption of oral medications in the opinion of the treating investigator, such as malabsorption syndrome or major bowel or stomach resection
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| CisplatinAlso: Abiplatin, Blastolem, Briplatin, CDDPGiven IV | Drug | Non-BRD4 exploratory cohort (molibresib, cisplatin, etoposide), Phase I and II cohort (molibresib, etoposide, cisplatin) |
| EtoposideAlso: Demethyl Epipodophyllotoxin Ethylidine Glucoside, EPEG, Lastet, ToposarGiven IV | Drug | Non-BRD4 exploratory cohort (molibresib, cisplatin, etoposide), Phase I and II cohort (molibresib, etoposide, cisplatin) |
| Etoposide PhosphateAlso: EtopophosGiven IV | Drug | Non-BRD4 exploratory cohort (molibresib, cisplatin, etoposide), Phase I and II cohort (molibresib, etoposide, cisplatin) |
| MolibresibAlso: GSK-525762A, GSK525762, I-BET 762Given PO | Drug | Non-BRD4 exploratory cohort (molibresib, cisplatin, etoposide), Phase I and II cohort (molibresib, etoposide, cisplatin) |
| Molibresib BesylateAlso: GSK525762CGiven PO | Drug | Non-BRD4 exploratory cohort (molibresib, cisplatin, etoposide), Phase I and II cohort (molibresib, etoposide, cisplatin) |
Primary outcome
Incidence of adverse events (Phase I)
Time frame: Up to 21 days
Assessed using Common Terminology Criteria for Adverse Events (CTCAE) version (V.) 5.0 criteria.
Maximum tolerated dose (MTD) (Phase I)
Time frame: Up to 21 days
The MTD will be the highest dose level at which 0/3 or 1/6 subjects experience a dose limiting toxicity (DLT). Data will be summarized using descriptive statistics for continuous variables and frequencies, percentages for discrete variables, and presented by dose group, as appropriate.
Overall response rate (ORR) (Phase II)
Time frame: Up to 2 years
Radiological response will be assessed by RECIST 1.1 criteria and will be graded as CR, PR, SD and PD. Point estimates and exact binomial 90% confidence intervals will be provided.
5 secondary outcomes
Overall response rate (ORR) (Phase I, Phase II, and Non-BRD4 Exploratory Cohort)
Time frame: Up to 2 years
Duration of response (DoR) rates (Phase I, Phase II, and Non-BRD4 Exploratory Cohort)
Time frame: From the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented, assessed up to 2 years
Progression free survival (Phase I, Phase II, and Non-BRD4 Exploratory Cohort)
Time frame: From study enrollment until the identification of disease progression or death, assessed up to 2 years
Overall survival (OS) rates (Phase I, Phase II, and Non-BRD4 Exploratory Cohort)
Time frame: Up to 2 years
Pharmacodynamic parameters (Phase I, Phase II, and Non-Thoracic, Non-BRD4 Exploratory Cohort)
Time frame: Up to 2 years
Results and safety
The study was withdrawn before enrolling participants, so there are no results.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 28 Sep 2020.
- Individual participant dataSharing planned: Yes. NCI is committed to sharing data in accordance with NIH policy. For more details on how clinical trial data is shared, access the link to the NIH data sharing policy page.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Geoffrey I Shapiro principal investigator
Dana-Farber - Harvard Cancer Center LAO
Questions about this trial
What is this clinical trial studying?
A Phase 1/2 study testing Cisplatin, Etoposide and Etoposide Phosphate in people with Metastatic NUT Carcinoma and Unresectable NUT Carcinoma, run by National Cancer Institute (NCI).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 43 inclusion and 28 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: withdrawn, as of the sponsor's last update on 28 Sep 2020. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this combined phase mean?
Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study was withdrawn before enrolling participants, so there are no results.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Incidence of adverse events (Phase I) (time frame: Up to 21 days). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Sep 2020.