Gemcitabine Hydrochloride and Smac Mimetic TL32711 in Treating Patients With Advanced Solid Tumors

August 11, 2022 updated by: Roswell Park Cancer Institute

A Phase I Study of TL32711 In Combination With Gemcitabine in Patients With Advanced Solid Tumors

The purpose of this study is to determine the dose of smac mimetic TL32711 that is safe and tolerated when given with gemcitabine hydrochloride to patients with advanced cancer

Study Overview

Detailed Description

PRIMARY OBJECTIVES:

I. To determine the maximum tolerated dose (MTD) and recommended Phase II dose of TL32711 (smac mimetic TL32711) in combination with gemcitabine (gemcitabine hydrochloride) in patients with advanced solid tumors.

SECONDARY OBJECTIVES:

I. To determine the toxicity and safety profile of TL32711 in combination with gemcitabine in patients with advanced solid tumors.

II. To determine the pharmacokinetic profile of TL32711 and gemcitabine when administered in combination.

III. To determine the preliminary efficacy of the study combination in patients with advanced solid tumors.

IV. To determine the relationship between predictive biomarkers and clinical activity using archival tumor tissue samples for biomarker analysis.

OUTLINE: This is a dose-escalation study of smac mimetic TL32711.

Patients receive gemcitabine hydrochloride intravenously (IV) over 30 minutes and smac mimetic TL32711 IV over 30 minutes once weekly for 2 weeks. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up for at least 4 weeks.

Study Type

Interventional

Enrollment (Actual)

21

Phase

  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • New York
      • Buffalo, New York, United States, 14263
        • Roswell Park Cancer Institute
    • Pennsylvania
      • Philadelphia, Pennsylvania, United States, 19107
        • Thomas Jefferson University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

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:

  • Histologically or cytologically confirmed solid tumors that are advanced or metastatic that gemcitabine-based treatment is considered standard therapy
  • Patient must consent to the use of their archival tumor tissue for protocol use if available
  • Patient with at least one measurable site of disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 that has not been previously irradiated
  • Eastern Cooperative Oncology Group (ECOG) Performance Status =< 1
  • Life expectancy >= 3 months
  • Absolute neutrophil count (ANC) >= 1,500 cells/mm^3 (system international [SI] units 1.5 x 10^6/L)
  • Platelets >= 100,000 cells/m^3 (SI units 100 x 10^6/L)
  • Hemoglobin >= 9.0 g/dL (SI units 90 g/L) (in the absence of transfusion within 24 hours prior to dosing)
  • Aspartate aminotransferase (AST)/serum glutamic oxaloacetic transaminase (SGPT) and alanine aminotransferase (ALT)/serum glutamate pyruvate transaminase (SGPT) =< 3 x Upper Limit of Normal (ULN); In patients with known hepatic involvement, AST and ALT < 5 x ULN are allowed
  • Total bilirubin =< 1.5 x ULN; in patients with known hepatic involvement, total bilirubin =< 1.5 x ULN is allowed
  • Serum creatinine =< 1.5 x ULN, or 24-hr urine creatinine clearance calculation >= 60 mL/min
  • Willing and able to comply with scheduled visits, treatment plan and laboratory tests
  • Ability to understand and willingness to sign a written informed consent; a signed informed consent must be obtained prior to any study specific procedures
  • Women of childbearing potential must have a negative serum pregnancy test at screening and negative (serum or urine) pregnancy test within 48 hours prior to the first dose of the first cycle of study treatment
  • Women of childbearing potential must agree to use 2 methods of adequate contraception (i.e., hormonal and barrier method) prior to enrollment, during the study, and for a period of 30 days following the last dose of study drug(s); males who are sexually active must agree to use a condom during the study for a period of 30 days following the last dose of study drug(s), and if their partner is of childbearing potential, she must agree to use a secondary method of contraception (i.e., hormonal, intrauterine device, barrier) during the study and for a period of 30 days following the last dose of study drug(s)

Exclusion Criteria:

  • Patients who have receive recent anti-cancer therapy defined by:
  • Chemotherapy, immunotherapy, hormonal therapy and monoclonal antibodies (but excluding nitrosourea, mitomycin-C, targeted therapy and radiation) =< 4 weeks prior to starting study drug, or who have not recovered from side effects of such therapy
  • Last administration of nitrosourea or mitomycin-C =< 6 weeks prior to starting study drug, or who have not recovered from the side effects of such therapy; or
  • Targeted therapy (e.g. sunitinib, sorafenib, pazopanib) =< 2 weeks prior to starting study drug, or who have not recovered from the side effects of such therapy; or
  • Radiotherapy =< 4 weeks prior to starting study drug, or =< 2 weeks prior to starting study drug in the case of localized radiotherapy (e.g. for analgesic purpose or for lytic lesions at risk of fracture), or who have not recovered from radiotherapy toxicities
  • Patients who have undergone major surgery (e.g. intra-thoracic, intra-abdominal or intra-pelvic), open biopsy or significant traumatic injury =< 4 weeks prior to starting study treatment, or patients who have had minor procedures, percutaneous biopsies or placement of vascular access device =< 1 week prior to starting study drug, or who have not recovered from side effects of such procedure or injury
  • Uncontrolled concurrent illness, including but not limited to ongoing or active serious infection requiring systemic antimicrobials (within 2 weeks prior to first dose of TL32711), arterial hypertension (> 160/100 mm/Hg on antihypertensive medications), uncontrolled endocrine diseases, altered mental status or psychiatric illness/social situations that would limit compliance with protocol requirements and/or obscure study results
  • Known or suspected diagnosis of human immunodeficiency virus (HIV) or chronic active Hepatitis B or C; viral testing is not required
  • Inability to start prophylactic anti-viral medication
  • Clinically significant pulmonary illness resulting in Grade >= 2 hypoxia (National Cancer Institute Common Terminology Criteria for Adverse Events [NCI CTCAE, v4]) or any requirement for supplemental oxygen, or pulse oximetry less than 90% saturation on room air
  • Symptomatic or uncontrolled brain metastases requiring current treatment (less than 4 weeks from last cranial radiation or 4 weeks from last steroids)
  • Impaired cardiac function or clinically significant cardiac disease including the following:

    • Clinically significant arrhythmias (except chronic well controlled atrial fibrillation)
    • New York Heart Association (NYHA) grade II, III, or IV congestive heart failure
    • Angina pectoris =< 6 months prior to dosing with TL32711
    • Myocardial infarction within the last 12 months prior to dosing with TL32711
  • QT interval corrected for heart rate (QTc) > 480 msec (including patients on medication); patients with a ventricular pacemaker for whom QT interval is not measurable may be eligible for enrollment after consultation with the Sponsor and the documentation of approval
  • Ongoing auto-immune disease or with history of an auto-immune disease within the past 5 years; a patient with a history of auto-immune disease that is currently in remission must not be receiving medication designed to control the disease and must not have experienced an exacerbation of the disease requiring treatment with immunomodulatory agents in the last 5 years; auto-immune disease includes but are not limited to systemic lupus erythematosis, scleroderma, rheumatoid arthritis, psoriasis, psoriatic arthritis, ulcerative colitis and regional enteritis (Crohn's disease)
  • Systemic or chronic topical corticosteroids or immunosuppressive therapy within 4 weeks prior to study entry or anticipated need of systemic corticosteroids or immunosuppressive therapy during study participation
  • Patients with a healing or open wound
  • Skin lesions of Grade >= 2 severity (NCI CTCAE v4), except alopecia
  • Lack of recovery or prior adverse events to Grade =< 1 severity (NCI CTCAE v4) (except alopecia) due to medications administered prior to the first dose of TL32711
  • Patients with prior history of Bell's Palsy
  • Any other condition or finding that in the opinion of the investigator may render the patient at excessive risk for treatment complications or may not be able to provide evaluable outcome information
  • Pregnant or breast-feeding women
  • Known allergy to any of the formulation components of TL32711 including citric acid monohydrate, sodium citrate dehydrate, and sodium chloride

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: TREATMENT
  • Allocation: NA
  • Interventional Model: SINGLE_GROUP
  • Masking: NONE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
EXPERIMENTAL: Treatment (enzyme inhibitor therapy)
Patients receive gemcitabine hydrochloride IV over 30 minutes and smac mimetic TL32711 IV over 30 minutes once weekly for 2 weeks. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.
Correlative studies
Correlative studies
Other Names:
  • pharmacological studies
Given IV
Other Names:
  • Gemzar
  • gemcitabine
  • dFdC
  • difluorodeoxycytidine hydrochloride
Optional correlative studies
Other Names:
  • biopsies
Given IV
Other Names:
  • TL32711

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
MTD of smac mimetic TL32711
Time Frame: During the first course (21 days)
Defined as the highest dose level at which less than 2 of 6 patients experience study treatment-related dose-limiting toxicity. Summarized with frequencies and descriptive measures, and tabulated according to body system, severity and relation to treatment.
During the first course (21 days)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Progression-free survival
Time Frame: Up to 2 years
Up to 2 years
Overall toxicity profile characterized by type, frequency, severity (according to the NCI CTCAE version 4.0), timing, seriousness, and relationship to study treatment
Time Frame: Up to 4 weeks post-treatment
Summarized with frequencies and descriptive measures, and tabulated according to body system, severity and relation to treatment.
Up to 4 weeks post-treatment
Response rates according to the RECIST v1.1 (solid tumor/dose-finding cohort)
Time Frame: Up to 4 weeks post-treatment
Data presented in tabular format and summarized descriptively.
Up to 4 weeks post-treatment
Plasma pharmacokinetic parameters of smac mimetic TL32711, gemcitabine hydrochloride and its metabolites
Time Frame: Days 1 and 8 of course 1 and then day 1 of course 2 (day 22)
Comparison of pharmacokinetic parameters among the dose levels and drug-drug interaction performed using non-parametric statistical methods for K-independent samples.
Days 1 and 8 of course 1 and then day 1 of course 2 (day 22)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

April 1, 2012

Primary Completion (ACTUAL)

September 1, 2013

Study Registration Dates

First Submitted

March 13, 2012

First Submitted That Met QC Criteria

April 9, 2012

First Posted (ESTIMATE)

April 10, 2012

Study Record Updates

Last Update Posted (ACTUAL)

August 15, 2022

Last Update Submitted That Met QC Criteria

August 11, 2022

Last Verified

August 1, 2022

More Information

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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