A Phase 1 Study of CC-486 as a Single Agent and in Combination With Carboplatin or ABI-007 in Subjects With Relapsed or Refractory Solid Tumors

The purpose of the study is to evaluate the safety and to define the Maximal Tolerated Dose (MTD) or the Maximal Administered Dose (MAD) of oral azacitidine as a single agent and in combination with carboplatin (CBDCA) or paclitaxel protein bound particles (ABI-007,ABX) in subjects with relapsed or refractory solid tumors.

Study Overview

• Status: Completed
• Conditions: Carcinoma, Non-Small-Cell Lung; Urinary Bladder Neoplasms; Tumor Virus Infections; Ovarian Neoplasms; Fallopian Tube Neoplasms; Peritoneal Neoplasms; Carcinoma, Transitional Cell; Carcinoma, Pancreatic Ductal
• Intervention / Treatment: Drug: CC-486; Drug: Carboplatin; Drug: ABI-007

• Study Type: Interventional
• Enrollment (Actual): 169
• Phase: Phase 1

Contacts and Locations

Study Locations

• France
  • Dijon, France, 21079
    • Centre Georges Francois Leclerc
  • Paris, France, 75005
    • Institut Curie
• Netherlands
  • Amsterdam, Netherlands, 1066 CX
    • The Netherlands Cancer Instiute Antoni Van Leeuwenhoekziekenhuis
  • Rotterdam, Netherlands, 3015 CN
    • Erasmus Medical Center
• Spain
  • Madrid, Spain, 28041
    • Hospital Universitario 12 de octubre
  • Madrid, Spain, 28007
    • Hospital General Universitario Gregorio Maranon
• United States
  • Arizona
    • Scottsdale, Arizona, United States, 85258
      • Scottsdale Healthcare Research Institute
  • California
    • San Francisco, California, United States, 94115
      • University of California, San Francisco
  • Indiana
    • Indianapolis, Indiana, United States, 46202
      • Indiana University Cancer Center
  • Michigan
    • Detroit, Michigan, United States, 48201-2014
      • Karmanos Cancer Institute
  • South Carolina
    • Greenville, South Carolina, United States, 29605
      • Greenville Hospital
  • Tennessee
    • Nashville, Tennessee, United States, 37205
      • Sarah Cannon Research Institute
  • Texas
    • San Antonio, Texas, United States, 78229
      • South Texas Accelerated Research Therapeutics

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Men and women, 18 years or older at the time of signing the Informed Consent Document (ICD).
2. Understand and voluntarily sign an ICD prior to any study-related assessments or procedures are conducted.
3. Able to adhere to the study visit schedule and other protocol requirements.
4. With histological or cytological confirmation of advanced unresectable solid tumors, including those who have progressed on (or not been able to tolerate) standard anticancer therapy, or for whom no other effective therapy exists, or for who declines standard therapy.
5. Consent to screening tumor biopsy (for accessible tumors when appropriate [optional in Part 1, mandatory in Part 2]).
6. Eastern Cooperative Oncology Group (ECOG) Performance Status of ≤ 2.

7. The following laboratory values:

   • Absolute neutrophil count (ANC) ≥ 1.5 X 10^9/L
   • Hemoglobin (Hgb) ≥90 g/L
   • Platelets (plt) ≥ 100 x 10^9/L
   • Potassium within normal range, or correctable with supplements;
   • AST and ALT ≤2.5 x Upper Limit Normal (ULN) or ≤5.0 x ULN if liver tumor is present;
   • Serum total bilirubin ≤ 1.5 x ULN
   • Serum creatinine ≤ 1.5 x ULN, or 24-hr clearance ≥ 60ml/min; and
   • Negative serum pregnancy test within 7 days before starting study treatment in females of childbearing potential (FCBP)

8. Females of child-bearing potential {defined as a sexually mature women who

   • has not undergone a hysterectomy (the surgical removal of the uterus) or bilateral oophorectomy (the surgical removal of both ovaries) or,

   • has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time during the preceding 24 consecutive months} must

     • agree to the use of a physician- approved contraceptive method (oral, injectable, or implantable hormonal contraceptive ; tubal ligation; intra-uterine device; barrier contraceptive with spermicide; or vasectomized partner) while on oral azacitidine and for 3 months following the last dose of study medication; and
     • have a negative serum pregnancy test during screening
9. Male subjects with female partner of childbearing potential must agree to the use of a physician-approved contraceptive method throughout the course of the study to avoid fathering a child during the course of the study and for 6 months following the last dose of oral azacitidine.

The criteria below are in addition to or supersede the Part 1 inclusion criteria above:

1. With histological or cytological confirmation of relapsed or refractory advanced unresectable solid tumors as listed below for each Arm, including those who have progressed on or were unable to tolerate standard anti-cancer therapy.

   • Arm A: CC-486 plus CBDCA:
   • Relapsed or refractory urothelial carcinoma of the bladder, renal pelvis, ureter, or urethra (mixed histologies are permitted provided a component of urothelial carcinoma is present)
   • Epithelial ovarian, fallopian tube, or primary peritoneal carcinoma
   • Arm B: CC-486 plus ABI-007:
   • NSCLC
   • Pancreatic carcinoma
   • Arm C: CC-486 single agent:
   • Virally-associated tumors - tumor types known to be driven by Epstein-Barr Virus (EBV), Human Papilloma Virus (HPV), and Merkel cell carcinoma of the skin (MC Polomavirus)
   • Nasopharyngeal carcinoma (a minimum of 5 subjects)
   • Cervical carcinoma
   • Anal carcinoma
   • Merkel cell carcinoma (MCC)
   • Note: Hepatitis B virus (HBV) and Hepatitis C virus (HCV)-associated tumors (hepatocellular cancers) are not eligible.
   • Note: Head and neck squamous cell cancers (HNSCC) must have HPV-positive status documented to be eligible
2. Subjects with documented liver metastases must have serum albumin ≥ 3 g/dL;
3. Sites of disease (primary or metastatic) that are, in the opinion of the investigator, accessible for biopsy without undue risk to the subject
4. Consent to tumor biopsy at screening (prior to the first dose of CC-486) and at Cycle 1 Day 15.
5. Measurable disease according to RECIST v1.1.

Exclusion Criteria:

1. Any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from participating in the study.
2. Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study.
3. Any condition that confounds the ability to interpret data from the study.
4. Symptomatic central nervous system metastases. Subjects with brain metastases that have been previously treated and are stable for 6 weeks are allowed.
5. Known acute or chronic pancreatitis.
6. Any peripheral neuropathy ≥ NCI CTCAE grade 2.
7. Persistent diarrhea or malabsorption ≥ NCI CTCAE grade 2, despite medical management.
8. Impaired ability to swallow oral medication.
9. Unstable angina, significant cardiac arrythmia, or New York Heart Association (NYHA) class 3 or 4 congestive heart failure.
10. Prior systemic cancer-directed treatments or investigational modalities ≤ 5 half lives or 4 weeks, whichever is shorter, prior to starting study drug or who have not recovered from side effects of such therapy. (except alopecia).
11. Major surgery ≤ 2 weeks prior to starting a study drug or who have not recovered from side effects of such therapy.
12. Pregnant or breast feeding.
13. Known Human Immunodeficiency Virus (HIV) infection.
14. Known chronic hepatitis B or C virus (HBV/HCV) infection, unless this is a comorbidity in subjects with HCV.
15. Liver metastases with serum albumin < 3 g/dL.
16. Other prior cancers within previous 5 years except adequately treated in situ carcinoma cervix, or basal, or squamous carcinoma of the skin.
17. Subjects with > 4 prior systemic chemotherapy regimens will require approval by the Celgene Medical Monitor prior to enrollment. A regimen is defined as >/= 2 cycles of systemic anti-cancer therapy containing 1 or more agents in the following classes: topoisomerase 1 or 2 inhibitors, platinum salts, alkylating agents, tubulin inhibitors, anti-metabolites or vinca alkaloids.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Arm A: CC-486 plus Carboplatin; CC-486 will be administered orally at doses between 100-300 mg daily for either 14 or 21 days depending on tolerability. Carboplatin will be given by intravenous (IV) infusion once every 21 Days at a dosage of AUC x 4.	Drug: CC-486; CC-486 will be administered orally at doses between 100-300 mg daily for either 14 or 21 days depending on tolerability; Other Names: Oral Azacitidine; Drug: Carboplatin; Carboplatin will be given by intravenous (IV) infusion once every 21 Days at a dosage of AUC x 4.; Other Names: Paraplatin
Experimental: Arm B: CC-486 plus ABI-007; CC-486 will be administered orally at doses between 100-300 mg daily for either 14 or 21 days depending on tolerability ABI-007 will be administered by intravenous (IV) infusion on two of every three weeks at a dosage of 100 mg/m^2	Drug: CC-486; CC-486 will be administered orally at doses between 100-300 mg daily for either 14 or 21 days depending on tolerability; Other Names: Oral Azacitidine; Drug: ABI-007; ABI-007 will be administered by intravenous (IV) infusion on two of every three weeks at a dosage of 100 mg/m^2; Other Names: Abraxane; nab-paclitaxel
Experimental: Arm C: CC-486; CC-486 will be administered orally at doses between 100-300 mg daily for either 14 or 21 days depending on tolerability	Drug: CC-486; CC-486 will be administered orally at doses between 100-300 mg daily for either 14 or 21 days depending on tolerability; Other Names: Oral Azacitidine

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of participants with adverse events	An adverse event (AE) is any noxious, unintended, or untoward medical occurrence that may appear or worsen in a subject during the course of a study. It may be a new intercurrent illness, a worsening concomitant illness, an injury, or any concomitant impairment of the subject's health, including laboratory test values, regardless of etiology. Any worsening (i.e., any clinically significant adverse change in the frequency or intensity.	Up to 3 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cmax	Maximum observed concentration in plasma (Cmax)	Up to 30 days
AUC	Area under the concentration-time curve (AUC)	Up to 30 days
Tmax	Time to maximum concentration (tmax);	Up to 30 days
T1/2	Terminal half-life (t1/2)	Up to 30 days
CL/F	Apparent total body clearance (CL/F)	Up to 30 days
Vz/F	Apparent volume of distribution (Vz/F).	Up to 30 days
DNA Methylation	Change from baseline (Cycle 1 Day 1 pre-dose) in DNA methylation (global and gene-specific assays) in whole blood and tumor tissue (as available in Part 1)	Up to 30 days
DNMT1 protein levels	Reduction from baseline (Cycle 1 Day 1 predose) in DNMT1 protein levels in tumor tissue (as available in Part 1)	Up to 30 days
Tumor Response Rate	Response and progression were evaluated using the RECIST 1.1 criteria. Treatment response includes both complete response and partial response.; Complete response-disappearance of all lesions; Partial response-30% decrease in the sum of diameters of target lesions from baseline	Up to 3 years
Progression Free Survival	Progression-free survival is defined as the time from first dose of study drug to the start of disease progression or patient death, whichever occurs first.	Up to 3 years
Duration of Response	Duration of response is defined as progression-free survival in responders, i.e. as the time between the start of a complete response (CR) or partial response (PR) and the start of progressive disease (PD) or patient death from any cause, whichever occurred first	Up to 3 years

Collaborators and Investigators

• Sponsor: Celgene
• Investigators: Study Director: Gordan Bray, M.D., Ph.D, Celgene

Publications and helpful links

General Publications

• LoRusso P, et al. A Phase Ib study of CC-486 (Oral Azacitidine) as a priming agent for carboplatin or NAB-paclitaxel in subjects with relapsed and refractory solid tumors . Presented at 25th AACR-NCI-EORTC Symposium on Molecular Targets and Cancer Therapeutics, October 19-23, 2013, Boston, MA. Abstract No. A120.

Study record dates

Study Major Dates

• Study Start (Actual): November 29, 2011
• Primary Completion (Actual): November 17, 2015
• Study Completion (Actual): November 17, 2015

Study Registration Dates

• First Submitted: November 21, 2011
• First Submitted That Met QC Criteria: November 22, 2011
• First Posted (Estimate): November 23, 2011

Study Record Updates

• Last Update Posted (Actual): November 12, 2019
• Last Update Submitted That Met QC Criteria: November 7, 2019
• Last Verified: November 1, 2019

More Information

Terms related to this study

• Keywords: Relapsed or Refractory Solid Tumors
• Additional Relevant MeSH Terms: Digestive System Diseases; Virus Diseases; Infections; Respiratory Tract Diseases; Neoplasms by Histologic Type; Lung Diseases; Urologic Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Urologic Diseases; Adenocarcinoma; Neoplasms, Glandular and Epithelial; Peritoneal Diseases; Urinary Bladder Diseases; Genital Neoplasms, Female; Endocrine System Diseases; Ovarian Diseases; Adnexal Diseases; Gonadal Disorders; Digestive System Neoplasms; Endocrine Gland Neoplasms; Respiratory Tract Neoplasms; Thoracic Neoplasms; Carcinoma, Bronchogenic; Bronchial Neoplasms; Lung Neoplasms; Fallopian Tube Diseases; Abdominal Neoplasms; Pancreatic Diseases; Neoplasms, Ductal, Lobular, and Medullary; Pancreatic Neoplasms; Carcinoma, Ductal; Neoplasms; Carcinoma, Non-Small-Cell Lung; Carcinoma; Ovarian Neoplasms; Fallopian Tube Neoplasms; Peritoneal Neoplasms; Urinary Bladder Neoplasms; Carcinoma, Transitional Cell; Carcinoma, Pancreatic Ductal; Tumor Virus Infections; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antimetabolites, Antineoplastic; Antimetabolites; Antineoplastic Agents; Tubulin Modulators; Antimitotic Agents; Mitosis Modulators; Antineoplastic Agents, Phytogenic; Carboplatin; Paclitaxel; Azacitidine; Albumin-Bound Paclitaxel; Cc-486
• Other Study ID Numbers: AZA-ST-001