Study of PI3 Kinase/mTOR Inhibitor BEZ235 Twice Daily for Advanced Solid Tumors

This study has been completed.
Sponsor:
Collaborator:
Novartis
Information provided by (Responsible Party):
SCRI Development Innovations, LLC
ClinicalTrials.gov Identifier:
NCT01343498
First received: April 22, 2011
Last updated: March 26, 2014
Last verified: March 2014
  Purpose

This is a dose escalation trial to evaluate twice daily dosing of the sachet formulation of BEZ235. This trial will find the maximum tolerated dose (MTD) of the sachet formulation given twice daily, as well as evaluate pharmacokinetics (PK) and pharmacodynamics (PD) of the twice daily dosing. Patients will initially be given once daily dosing to determine the PK and PD of the single daily dose. On Day 9, they will begin twice daily dosing, with half of the single daily dose divided twice daily, and PK and PD of the twice daily dose will be determined.


Condition Intervention Phase
Malignant Solid Tumour
Drug: BEZ235
Phase 1

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase I PK/PD Study of the PI3 Kinase/mTOR Inhibitor BEZ235 Given Twice Daily for the Treatment of Patients With Advanced Solid Tumors

Resource links provided by NLM:


Further study details as provided by SCRI Development Innovations, LLC:

Primary Outcome Measures:
  • Maximum tolerated dose of BEZ235 given twice daily [ Time Frame: 18 months ] [ Designated as safety issue: Yes ]
    To determine the maximum tolerated dose (MTD) of BEZ235 given twice daily in patients with advanced solid tumors


Secondary Outcome Measures:
  • To describe the toxicities of this regimen [ Time Frame: 18 months ] [ Designated as safety issue: Yes ]

    The safety endpoints to be summarized are:

    • Incidence of dose-limiting toxicities (DLTs)
    • Incidence of adverse events (AEs)
    • Incidence of grade 1, grade 2, grade 3 and grade 4 AEs
    • Incidence of serious adverse events (SAEs)

  • Clinical Efficacy [ Time Frame: 18 months ] [ Designated as safety issue: No ]
    To describe the clinical efficacy of this regimen in patients with advanced solid tumors. The tumor response will be measured by the number of patients with complete responses, partial responses, stable disease and progressive disease.

  • PK profile of BEZ235 [ Time Frame: 18 months ] [ Designated as safety issue: Yes ]

    To characterize the PK profile of BEZ235 given as a twice daily dose. The PK parameters (including AUC (0-∞), AUC (0-t), Cmax, tmax, λz, and t½) of BEZ235 following oral administration will be assessed by analysis of BEZ235 plasma concentrations using a non-compartmental approach.

    During treatment PK blood samples will be taken at the following timepoints:

    • Cycle 1, Day 1: pre-dose, 1, 2, 4, 8, 10, 12 and 24 hours post-dose
    • Cycle 1, Day 8: pre-dose, 1, 2, 4, 8, 10, 12 and 24 hours post-dose
    • Cycle 1, Day 28: pre-dose, and at 1, 2, 4, 8, 10, 12 and 24 hours post-dose


Enrollment: 33
Study Start Date: April 2011
Study Completion Date: January 2014
Primary Completion Date: January 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: BEZ235 Drug: BEZ235
BEZ235 will be given on a dose-escalation design, beginning at 200 mg BID (SDS sachet) in 3 patients and progressing to 400 mg, 600 mg, and 800 mg respectively based on tolerability.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Histologically or cytologically confirmed diagnosis of solid tumor malignancy that is metastatic or unresectable and not responsive to standard therapies or for which there is no effective therapy.
  2. Eastern Cooperative Group (ECOG) Performance Status score of 0 or 1.
  3. Patient has recovered (to grade ≤ 1) from all clinically significant toxicities related to prior antineoplastic therapies with the exception of alopecia and bone marrow and organ functions (described separately).
  4. Adequate organ system function, defined as follows:

    • Absolute neutrophil count (ANC) ≥ 1.5 x 109/L

    • Platelets ≥ 100 x 109/L

    • Hemoglobin ≥ 9 g/dL
    • INR ≤ 2
    • Fasting plasma glucose ≤ 140 mg/dL
    • Total bilirubin ≤ 1.5 times the upper limit of normal (ULN)
    • Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 3.0 x the upper limit of normal (ULN) if no liver involvement or ≤ 5 x the upper limit of normal with liver involvement.
    • Creatinine ≤ 1.5 x ULN, OR calculated creatinine clearance ≥ 50 mL/min as calculated by the Cockcroft-Gault method, OR 24-hour measured urine creatinine clearance ≥ 50 mL/min.
  5. Ability to swallow and retain oral medication.
  6. Life expectancy of ≥ 3 months.
  7. Male patients willing to use adequate contraceptive measures.
  8. Female patients who are not of child-bearing potential, and female patients of child-bearing potential who agree to use adequate contraceptive measures and who have a negative serum or urine pregnancy test within 72 hours prior to initial trial treatment.
  9. Patients must have measurable or evaluable disease.
  10. Patients must be ≥18 years of age.
  11. Patients entering this study must be willing to provide tissue from a previous tumor biopsy (if available) for correlative testing. If tissue is not available, a patient will still be eligible for enrollment into the study.
  12. Ability to understand the nature of this trial and give written informed consent.

Exclusion Criteria:

  1. Patients currently receiving cancer therapy (i.e., chemotherapy, radiation therapy, immunotherapy, biologic therapy, hormonal therapy [with the exception of LHRH agonists for prostate cancer], surgery and/or tumor embolization).
  2. Use of an investigational drug within 21 days or 5 half-lives (whichever is shorter) prior to the first dose of BEZ235. For investigational drugs for which 5 half-lives is less than 21 days, a minimum of 10 days between termination of the investigational drug and administration of BEZ235 is required. In addition, any drug-related toxicity should have recovered to grade 1 or less.
  3. Any major surgery, radiotherapy, or immunotherapy within the last 28 days (limited palliative radiation is allowed ≥ 2 weeks). Chemotherapy regimens with delayed toxicity within the last 4 weeks (or within the last 6 weeks for prior nitrosourea or mitomycin C). Chemotherapy regimens given continuously or on a weekly basis with limited potential for delayed toxicity within the last 2 weeks.
  4. Patient has received wide field radiotherapy (including therapeutic radioisotopes such as strontium 89) ≤ 28 days or limited field radiation for palliation ≤ 14 days prior to starting study drug or has not recovered from side effects of such therapy.
  5. Leptomeningeal metastases or spinal cord compression due to disease.
  6. Patients with previously untreated brain metastases. Patients who have received radiation or surgery for brain metastases are eligible if there is no evidence of central nervous system (CNS) disease progression, and at least 2 weeks have elapsed since treatment. Patients are not permitted to receive enzyme inducing anti-epileptic drugs (EIAEDs) during the study and should not be receiving chronic corticosteroid therapy for CNS metastases.
  7. Patients with acute or chronic pancreatitis.
  8. Patients with diabetes mellitus requiring insulin treatment or a history of gestational diabetes mellitus.
  9. Presence of active gastrointestinal (GI) disease or other condition that will interfere significantly with the absorption, distribution, metabolism, or excretion of BEZ235 (e.g. ulcerative diseases, uncontrolled nausea, vomiting, diarrhea ≥ grade 2, and malabsorption syndrome).
  10. Patient has active cardiac disease including any of the following:

    • Left Ventricular Ejection Fraction (LVEF) < 50% as determined by Multiple Gated acquisition (MUGA) scan or echocardiogram (ECHO)

    • QTcF > 480 msec on screening ECG

    • Unstable angina pectoris
    • Ventricular arrhythmias except for benign premature ventricular contractions
    • Supraventricular and nodal arrhythmias requiring a pacemaker or not controlled with medication
    • Conduction abnormality requiring a pacemaker
    • Valvular disease with documented compromise in cardiac function
    • Symptomatic pericarditis
  11. Patient has a history of cardiac dysfunction including any of the following:

    • Myocardial infarction within the last 6 months, documented by persistent elevated cardiac enzymes or persistent regional wall abnormalities on assessment of LVEF function
    • History of documented congestive heart failure (New York Heart Association functional classification III-IV).
    • Documented cardiomyopathy
  12. Family history of congenital long or short QT, or known history of QT/QTc prolongation or Torsades de Pointes (TdP). Patients who are currently receiving treatment with medication that has the potential to prolong the QT interval or inducing Torsades de Pointes and the treatment cannot either be discontinued or switched to a different medication prior to starting study drug.
  13. Inadequately controlled hypertension (i.e., SBP > 180 mmHg or DBP>100mmHg).
  14. Patient is receiving chronic treatment with systemic steroids or another immuno-suppressive agent at the start of study treatment.

    Note: Topical applications (e.g. rash), inhaled sprays (e.g. obstructive airways diseases), eye drops, or local injections (e.g. intra-articular) are allowed.

  15. Patient is consuming Seville oranges, grapefruit, grapefruit hybrids, pummelos or exotic citrus fruits (as well as their juices) during the last 7 days prior to start of treatment. Regular orange juice is permitted.
  16. Patients who are receiving a strong CYP3A4 inhibitor or inducer.
  17. Patients who are currently receiving treatment with therapeutic doses of warfarin sodium. Patients receiving low molecular weight heparin are allowed.
  18. A serious active infection at the time of treatment, or another serious underlying medical condition that would impair the ability of the patient to receive protocol treatment.
  19. Known diagnosis of human immunodeficiency virus (HIV), Hepatitis B or Hepatitis C.
  20. Psychological, familial, sociological, or geographical conditions that do not permit compliance with the protocol.
  21. Concurrent condition that in the investigator's opinion would jeopardize compliance with the protocol.
  22. Inability or unwillingness to comply with study and/or follow-up procedures outlined in the protocol.
  23. Women of child-bearing potential who are pregnant or breastfeeding or adults of reproductive potential not employing an effective method of birth control.

    • Women are considered post-menopausal and not of child bearing potential if they have had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g. age appropriate, history of vasomotor symptoms) or six months of spontaneous amenorrhea with serum FSH levels > 40 mIU/mL and estradiol < 20 pg/mL] or have had surgical bilateral oophorectomy (with or without hysterectomy) at least six weeks ago. In the case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment is she considered not of child bearing potential.
    • Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, must use highly effective contraception during the study and for 5 T1/2 (8 days) after stopping treatment. The highly effective contraception is defined as either:

1. True abstinence: When this is in line with the preferred and usual lifestyle of the subject. Periodic abstinence (e.g. calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception.

2. Sterilization: have had surgical bilateral oophorectomy (with or without hysterectomy) or tubal ligation at least six weeks ago. In case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment.

3. Male partner sterilization: (with the appropriate post-vasectomy documentation of the absence of sperm in the ejaculate). For female subjects on the study, the vasectomised male partner should be the sole partner for that patient.

4. Use of a combination of any two of the following (a+b):

  1. Placement of an intrauterine device (IUD) or intrauterine system (IUS).
  2. Barrier methods of contraception: Condom or Occlusive cap (diaphragm or cervical/vault caps) with spermicidal foam/gel/film/cream/vaginal suppository.

Oral contraception, injected or implanted hormonal methods are not allowed as BEZ235 potentially decreases the effectiveness of hormonal contraceptives.

  • Women of child-bearing potential must have a negative serum or urine pregnancy test ≤ 72 hours prior to initiating treatment.
  • Fertile males, defined as all males physiologically capable of conceiving offspring must use condom during treatment, for 5 T1/2 (8 days) after stopping treatment and for additional 12 weeks (3 months in total after study drug discontinuation) and should not father a child in this period.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01343498

Locations
United States, Oklahoma
Oklahoma University
Oklahoma City, Oklahoma, United States, 71304
United States, Tennessee
Tennessee Oncology
Nashville, Tennessee, United States, 37203
Sponsors and Collaborators
SCRI Development Innovations, LLC
Novartis
Investigators
Study Chair: Johanna C Bendell, M.D. SCRI Development Innovations, LLC
  More Information

No publications provided

Responsible Party: SCRI Development Innovations, LLC
ClinicalTrials.gov Identifier: NCT01343498     History of Changes
Other Study ID Numbers: SCRI REFMAL 233
Study First Received: April 22, 2011
Last Updated: March 26, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by SCRI Development Innovations, LLC:
Solid Tumor Malignancy
Advanced Solid Tumors
BEZ235
mTOR Inhibitor

Additional relevant MeSH terms:
Neoplasms
Sirolimus
Everolimus
Anti-Bacterial Agents
Anti-Infective Agents
Therapeutic Uses
Pharmacologic Actions
Antibiotics, Antineoplastic
Antineoplastic Agents
Antifungal Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs

ClinicalTrials.gov processed this record on September 30, 2014