Open-label Trial of SUBA™-Itraconazole (SUBA-Cap) in Subjects With Basal Cell Carcinoma Nevus Syndrome (BCCNS)

Phase IIb Open-label Trial of SUBA™-Itraconazole in Subjects With Basal Cell Carcinoma Nevus Syndrome (BCCNS)

The study will assess the safety and efficacy of SUBA-Cap in subjects with Basal Cell Carcinoma Nevus Syndrome.

Study Overview

• Status: Completed
• Conditions: Basal Cell Carcinoma in Basal Cell Nevus Syndrome
• Intervention / Treatment: Drug: SUBA-Itraconazole

Detailed Description

Single arm, phase IIb, multi-center, open-label study evaluating the use of oral SUBA-Cap in subjects with Basal Cell Carcinoma Nevus Syndrome and non-metastatic Basal Cell Carcinoma.

Following informed consent, subjects will undergo a skin biopsy for Gli1 analysis and an assessment of extent of disease using both tumor measurements (using modified Response Evaluation Criteria in Solid Tumors criteria) and color photographs of the skin.

Subjects will receive daily oral SUBA-Cap, at a starting dose of 150 mg twice daily (BID). Reassessments of disease will be conducted at weeks 4, 8, 16, and then every 8 weeks thereafter. Subjects with evidence of response (partial or complete) will be re-evaluated at least 4 weeks later for confirmation. Subjects may continue to receive SUBA-Cap until disease progression (defined as the appearance of one or more new lesions or ulceration of a target lesion) that requires a change in therapy (surgical intervention or use of other systemic therapy) or the appearance of unacceptable side effects. Pharmacokinetic assessments (serial trough levels) will be performed at defined intervals and, when possible, prior to and following any dose adjustment. Skin biopsies will be taken for Gli1 expression at defined intervals.

• Study Type: Interventional
• Enrollment (Actual): 38
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • California
    • Oceanside, California, United States, 92056
      • Dermatology Specialists, Inc
  • Florida
    • Ormond Beach, Florida, United States, 32174
      • Ameriderm Research
  • Michigan
    • Warren, Michigan, United States, 48034
      • Grekin Skin Institute
  • New York
    • East Setauket, New York, United States, 11733
      • Stony Brook University
  • Pennsylvania
    • Hershey, Pennsylvania, United States, 17033
      • Penn State Hershey Medical Center

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:

• ECOG performance status of 0 or 1
• Diagnosis of Basal Cell Carcinoma Nevus Syndrome (BCCNS)
• Histologic confirmation of BCC from at least one lesion
• History of surgical removal of at least ten (10) prior BCCs
• Measurable disease as defined, namely at least ten (10) measurable lesions such that the sum of the longest diameters of the measurable lesions is at least 40 mm.
• Has failed, refused, or is not eligible for standard of care therapy for BCC
• Willingness to abstain from the use of non-study treatments for BCC, including but not limited to topical medications, PDT, and/or irradiation therapy.
• At least four weeks from prior major surgery
• Women who are pre-menopausal or not surgically sterile must be willing to use an acceptable contraceptive method for the duration of the study and for 30 days following the last dose of study drug
• Sexually active men must be willing to use an acceptable contraceptive method for the duration of time on study and for 30 days following the last dose of study drug

• Clinical laboratory values within the following ranges:

  1. Negative serum pregnancy test
  2. Adequate hematologic function (ANC ≥1.5 x 10^9/L; platelet count ≥75x10^9/L; hemoglobin ≥9g/dL (in the absence of red blood cell transfusions in the prior 14 days)
  3. Prothrombin time (PT-INR) or activated partial thromboplastin time (APTT) <1.5 times the upper limit of normal range, unless currently receiving anticoagulants
  4. Serum creatinine ≤ 1.5 x ULN or calculated creatinine clearance ≥60 mL/min
  5. Total bilirubin ≤ 1.5x the upper limit of normal unless considered due to Gilbert syndrome in which case, ≤ 3x the upper limit of normal
  6. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels ≤ the upper limit of normal
• Willingness to undergo biopsies (BCC lesions and normal skin)
• Willingness to provide prior and study-related BCC biopsies for central review
• Willingness to participate in collection of pharmacokinetic samples
• Willingness to not donate blood, semen, or eggs for the duration of the study and for 3 months following discontinuation of SUBA-Cap
• Willingness to delay removal of otherwise surgically eligible BCC's

Exclusion Criteria:

• Presence of metastatic BCC
• Subjects who would be disserved significantly by a delay in conventional therapy, such as surgical intervention of their BCC
• Prior use of a hedgehog inhibitor (e.g., sonidegib, vismodegib) or Itraconazole within the past 6 months
• History of progressive disease on a hedgehog inhibitor (e.g., sonidegib, vismodegib) or other Hh pathway inhibitors for the treatment of BCC
• Pregnant and/or nursing women
• Use of any medications metabolized by the cytochrome P450 3A4 isoenzyme system (CYP3A4) known to lead to potentially serious and/or life threatening adverse events when used in conjunction with itraconazole
• Any illness that is likely to reduce absorption of oral medications
• Corrected QT (Fridericia) interval of >450 msec for females and >430 msec for males
• Use of any medications known to result in a prolongation of the QT interval
• History of congestive heart failure or other cardiac abnormality that would contraindicate the use of itraconazole
• Any condition or situation which in the Investigator's opinion may put the subject at significant risk, could confound the study results, or could interfere significantly with the subject's participation in the study
• Any indication of compromised liver function that would otherwise contraindicate use of itraconazole
• Any concurrent malignancy, except for squamous cell carcinoma of the skin and cervical carcinoma in situ, that is likely to require treatment within the next two years or would interfere with study requirements
• Psychiatric illness and/or social situations (e.g., excessive alcohol use or use of illicit drugs) that would interfere with study compliance
• Known HIV infection, active hepatitis B or active hepatitis C infection (testing not required unless indicated by history)
• Known allergy to itraconazole or any of its excipients

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: SUBA-Itraconazole; Subjects will receive an oral dose of 300 mg SUBA-itraconazole daily.	Drug: SUBA-Itraconazole; Subjects will receive an oral dose of 300 mg SUBA-Itraconazole daily.; Other Names: SUBA-Cap

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Response rate of BCC lesions	Up to 26 weeks

Secondary Outcome Measures

Outcome Measure	Time Frame
Safety and tolerance; measured by number of subjects with adverse events	Participants will be followed for the duration of study participation, an expected average of 26 weeks
Number of new BCCs eligible for surgical resection	Up to 26 weeks
Duration of response in those subjects that have responded	Up to 26 weeks
Time to next therapy (systemic therapy or surgical intervention)	Up to 26 weeks
Change in the number of jaw cysts	Up to 26 weeks
Changes in the number of palmar/plantar pits	Up to 26 weeks
Gli1 expression in normal skin	Up to 26 weeks
Levels of itraconazole and hydroxy-itraconazole in the skin	Up to 26 weeks
Levels of itraconazole and hydroxy-itraconazole in the blood	For Cycle 1 and Cycle 2, Up to week 8

Collaborators and Investigators

• Sponsor: HedgePath Pharmaceuticals, Inc.
• Investigators: Principal Investigator: James Solomon, MD, PhD, Ameriderm Clinical Research

Study record dates

Study Major Dates

• Study Start (Actual): August 7, 2015
• Primary Completion (Actual): March 1, 2019
• Study Completion (Actual): March 1, 2019

Study Registration Dates

• First Submitted: January 21, 2015
• First Submitted That Met QC Criteria: January 29, 2015
• First Posted (Estimate): February 3, 2015

Study Record Updates

• Last Update Posted (Actual): August 5, 2020
• Last Update Submitted That Met QC Criteria: August 3, 2020
• Last Verified: August 1, 2020

More Information

Terms related to this study

• Keywords: BCC; basal cell carcinoma; locally advanced basal cell carcinoma; itraconazole; Basal Cell Carcinoma Nevus Syndrome; BCCNS
• Additional Relevant MeSH Terms: Pathologic Processes; Neoplasms by Histologic Type; Neoplasms; Neoplasms, Glandular and Epithelial; Disease; Cysts; Congenital Abnormalities; Genetic Diseases, Inborn; Musculoskeletal Diseases; Stomatognathic Diseases; Bone Diseases; Neoplastic Syndromes, Hereditary; Nevi and Melanomas; Jaw Diseases; Abnormalities, Multiple; Bone Diseases, Developmental; Odontogenic Cysts; Jaw Cysts; Bone Cysts; Neoplasms, Basal Cell; Syndrome; Carcinoma; Nevus; Basal Cell Nevus Syndrome; Carcinoma, Basal Cell; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Enzyme Inhibitors; Hormones, Hormone Substitutes, and Hormone Antagonists; Cytochrome P-450 CYP3A Inhibitors; Cytochrome P-450 Enzyme Inhibitors; Hormone Antagonists; Antifungal Agents; Steroid Synthesis Inhibitors; 14-alpha Demethylase Inhibitors; Itraconazole
• Other Study ID Numbers: HP2001; SCORING (Other Identifier: HedgePath)