Pilot Study of X-82 in Patients With Wet AMD

A Phase 1 Open-label, Dose Escalation Clinical Trial to Evaluate the Safety and Preliminary Biologic Activity/Efficacy of the VEGFR/PDGFR Inhibitor X-82 Administered Per Os in Subjects With Neovascular Age-related Macular Degeneration (AMD)

The objective of this study is to evaluate the safety and preliminary biologic activity/efficacy of X-82 in patients with wet Age-related Macular Degeneration (AMD). Preliminary efficacy will be assessed by change from baseline in visual acuity, fluorescein leakage, retinal thickness and fibrosis, if detectable, based on fundus examination, fundus photography, fluorescein angiography and optical coherence tomography (OCT).

Study Overview

• Status: Completed
• Conditions: Exudative Macular Degeneration
• Intervention / Treatment: Drug: X-82 oral; Drug: ranibizumab (Lucentis)

• Study Type: Interventional
• Enrollment (Actual): 35
• Phase: Phase 2; Phase 1

Contacts and Locations

Study Locations

• United States
  • California
    • Beverly Hills, California, United States, 90211
      • Retina Vitreous Associates Medical Group
  • Connecticut
    • New London, Connecticut, United States, 06320
      • New England Retina Associates
  • Maryland
    • Baltimore, Maryland, United States, 21237
      • Elman Retina Group
  • Texas
    • Abilene, Texas, United States, 79606
      • Retina Research Institute of Texas
    • Houston, Texas, United States, 77030
      • Retina Consultants of Houston

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 50 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Active choroidal neovascularization (CNV) associated with AMD, as evidenced on fluorescein angiography (FA) and OCT.
2. No previous treatment with anti-VEGF therapy or prior anti-VEGF therapy with evidence of response to treatment and the need for additional treatment.
3. Early Treatment Diabetic Retinopathy Study (ETDRS) BCVA 20/32 to 20/320 in the study eye(s).
4. Adequate bone marrow function.
5. PT within the institutional upper limit of normal.
6. Adequate hepatic function.
7. Adequate renal function; serum creatinine.
8. Ability to swallow oral medication.
9. Age ≥ 50 years.
10. Willing and able to provide written informed consent, comply with the investigational study protocol and return for all study visits.

Exclusion Criteria:

1. Previous treatment with photodynamic therapy (PDT) within 4 months of screening in the study eye.
2. CNV due to causes other than AMD.
3. Geographic atrophy involving the foveal center in the study eye.
4. Any retinal vascular disease or retinal degeneration other than AMD in the study eye.
5. In the opinion of the investigator, any significant disease in the study eye that could compromise best-corrected visual acuity.
6. Cataract surgery in the study eye within three months of screening.
7. Trabeculectomy or aqueous shunt or valve in the study eye.
8. Intraocular surgery in the study eye within three months of screening; Nd:YAG capsulotomy or laser iridotomy within 30 days of screening.
9. Inadequate pupillary dilation or significant media opacities in the study eye.
10. Use of any investigational agent or participation in any other clinical trial of an investigational agent or investigational therapy within thirty (30) days of baseline with the exception of subjects who are participating in the AREDS2 study.
11. Females of child bearing potential that are pregnant or not using medically acceptable contraception; males unwilling to take adequate contraceptive measures. Females that are breastfeeding are also excluded.
12. Serious allergy to or prior significant adverse reaction to fluorescein.
13. Undiagnosed acute illness first observed during screening or between screening and baseline, or severe concurrent medical conditions that, in the investigators judgment, represent a safety concern.
14. Severe cardiac disease, symptomatic congestive heart failure, unstable angina, acute coronary syndrome, myocardial infarction or coronary artery revascularization, or arterial thrombosis within 12 months of start of study drug, inadequately controlled hypertension, or ventricular tachyarrhythmias requiring ongoing treatment.
15. QTc ≥450 msec or subjects with a history of risk factors for Torsades de Pointes or other clinically significant ECG abnormalities as determined by the investigator.
16. Stroke or transient ischemic attack within 12 months of trial entry.
17. Clinically significant impaired renal or hepatic function.
18. Any major surgical procedure within one month of trial entry.
19. Presence of active gastrointestinal (GI) disease or other condition that will interfere significantly with the absorption, distribution, metabolism, or excretion of X-82.
20. Receiving treatment with anti-coagulants other than 325 mg of aspirin per day.
21. Serious active infection, other serious medical condition or any other condition that would impair the ability of the subject to administer the investigational drug or to adhere to the study protocol requirements.
22. Presence of any condition which, in the judgment of the investigator, would prevent the subject from completing the study.
23. No herbal medications with the exception of bilberry are allowed within 7 days of start of study drug.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NON_RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

6

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: 50 mg X-82 oral alternate days; 50 mg X-82 oral on alternate days with intravitreous ranibizumab (Lucentis) using predefined retreatment criteria for 24 weeks or until unacceptable toxicity develops	Drug: X-82 oral; X-82 oral for 24 weeks or until unacceptable toxicity develops; Drug: ranibizumab (Lucentis); Rescue treatment with intravitreal ranibizumab (Lucentis) as needed
EXPERIMENTAL: 50 mg X-82 oral QD; 50 mg X-82 oral QD with intravitreous ranibizumab (Lucentis) therapy using predefined retreatment criteria.for 24 weeks or until unacceptable toxicity develops	Drug: X-82 oral; X-82 oral for 24 weeks or until unacceptable toxicity develops; Drug: ranibizumab (Lucentis); Rescue treatment with intravitreal ranibizumab (Lucentis) as needed
EXPERIMENTAL: 100 mg X-82 oral alternate days; 100 mg X-82 oral on alternate days with intravitreous ranibizumab (Lucentis) using predefined retreatment criteria.for 24 weeks or until unacceptable toxicty develops	Drug: X-82 oral; X-82 oral for 24 weeks or until unacceptable toxicity develops; Drug: ranibizumab (Lucentis); Rescue treatment with intravitreal ranibizumab (Lucentis) as needed
EXPERIMENTAL: 100 mg X-82 oral QD; 100 mg X-82 oral QD with intravitreous ranibizumab (Lucentis) using predefined retreatment criteria for 24 weeks or until unacceptable toxicity occurs	Drug: X-82 oral; X-82 oral for 24 weeks or until unacceptable toxicity develops; Drug: ranibizumab (Lucentis); Rescue treatment with intravitreal ranibizumab (Lucentis) as needed
EXPERIMENTAL: 200 mg X-82 oral QD; 200 mg X-82 oral QD with intravitreous ranibizumab (Lucentis) therapy using predefined retreatment criteria for 24 weeks or until unacceptable toxicity occurs	Drug: X-82 oral; X-82 oral for 24 weeks or until unacceptable toxicity develops; Drug: ranibizumab (Lucentis); Rescue treatment with intravitreal ranibizumab (Lucentis) as needed
EXPERIMENTAL: 300 mg X-82 oral QD; 300 mg X-82 oral QD with intravitreous ranibizumab (Lucentis) therapy using predefined retreatment criteria for 24 weeks or until unacceptable toxicity occurs.	Drug: X-82 oral; X-82 oral for 24 weeks or until unacceptable toxicity develops; Drug: ranibizumab (Lucentis); Rescue treatment with intravitreal ranibizumab (Lucentis) as needed

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline Visual Acuity at 6 Months	The best corrected visual acuity by the Early Treatment Diabetic Retinopathy Study (ETDRS) method was determined at baseline and at various times during the study. The ETDRS method records the number of letters of decreasing size on a chart that a subject can read from a defiend distance. During the study the ETDRS visual acuity was used to monitor the need for rescue therapy. The primary endpoint of the study was the change from baseline visual ETDRS visual acuity at 6 months. It was calculated by subtracting the baseline visual acuity from the visual acuity at 6 months for each individual subject. A positive change from baseline indicates improvement in visual acuity.	6 months

Collaborators and Investigators

• Sponsor: Tyrogenex

Publications and helpful links

General Publications

• Jackson TL, Boyer D, Brown DM, Chaudhry N, Elman M, Liang C, O'Shaughnessy D, Parsons EC, Patel S, Slakter JS, Rosenfeld PJ. Oral Tyrosine Kinase Inhibitor for Neovascular Age-Related Macular Degeneration: A Phase 1 Dose-Escalation Study. JAMA Ophthalmol. 2017 Jul 1;135(7):761-767. doi: 10.1001/jamaophthalmol.2017.1571.

Study record dates

Study Major Dates

• Study Start: October 1, 2012
• Primary Completion (ACTUAL): February 1, 2015
• Study Completion (ACTUAL): February 1, 2015

Study Registration Dates

• First Submitted: August 23, 2012
• First Submitted That Met QC Criteria: August 28, 2012
• First Posted (ESTIMATE): August 29, 2012

Study Record Updates

• Last Update Posted (ACTUAL): August 7, 2018
• Last Update Submitted That Met QC Criteria: July 31, 2018
• Last Verified: July 1, 2018

More Information

Terms related to this study

• Keywords: VEGF; AMD; PDGF
• Additional Relevant MeSH Terms: Eye Diseases; Retinal Degeneration; Retinal Diseases; Macular Degeneration; Wet Macular Degeneration; Physiological Effects of Drugs; Antineoplastic Agents; Angiogenesis Inhibitors; Angiogenesis Modulating Agents; Growth Substances; Growth Inhibitors; Ranibizumab
• Other Study ID Numbers: X82-OPH-102

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO