Special Combination of BBI608 and Pembrolizumab

A Phase Ib/II Study of BBI608 in Combination With Pembrolizumab in Patients With Metastatic Colorectal Cancer

the efficacy and safety of BBI608 in combination with pembrolizumab

Study Overview

• Status: Terminated
• Conditions: Metastatic Colorectal Cancer
• Intervention / Treatment: Drug: Napabucasin; Drug: Pembrolizumab

Detailed Description

This is a multicenter, open-label Phase Ib/II study to exploratively evaluate the efficacy and safety of BBI608 in combination with pembrolizumab in patients with metastatic colorectal cancer (CRC) not responded to or intolerant of standard chemotherapy.The same analysis will be performed for the additional cohort to the Phase II part, consisting of patients with metastatic CMS 1 or 4, MMS, CRC not responsive to or intolerant of standard chemotherapy.

• Study Type: Interventional
• Enrollment (Actual): 55
• Phase: Phase 2; Phase 1

Contacts and Locations

Study Locations

• Japan
  • Chiba
    • Kashiwa, Chiba, Japan, 277-8577
      • National Cancer Center Hospital East

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

For the additional cohort to the Phase II part, screening tests will be performed to identify CMS 1 or 4 and MSS before obtaining informed consent.

Patients, who meet all of the following inclusion criteria and none of the exclusion criteria, are eligible for enrollment in the study.

Inclusion Criteria

1. Patients who personally provided written consent to be the subjects of the study
2. Age of 20 years or older on the day of informed consent

3. [Phase Ib] Histologically confirmed gastrointestinal cancer

   [Phase II] Histologically confirmed colon or rectal cancer that is adenocarcinoma , and identification of at least the KRAS codon 12 and 13 mutation status determined by RAS gene testing. Confirmation of the microsatellite instability (MSI) status.

   [Additional cohort to the Phase II part] Histologically confirmed colon or rectal cancer that is adenocarcinoma, and identification of RAS mutation status. Identification of CMS 1 or 4 and MSS by screening tests.

4. [Phase Ib] Gastrointestinal cancer not responded to or intolerant of standard chemotherapy

   [Phase II]A history of treatment with one or more regimens of the following standard chemotherapies for metastatic CRC, and being not responded to or tolerated the chemotherapies

   [Additional cohort to the Phase II part] In accordance with Cohort B in the Phase II part.

5. Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0 or 1
6. Patients with evaluable lesions (Cohort A in Phase II and Phase Ib) or measurable lesions (Cohort B in Phase II and the additional cohort to the Phase II part) specified in the RECIST version 1.1
7. Patients with adequate organ function based on the following laboratory values measured within 7 days before enrollment
8. Women of childbearing potential who are negative in a pregnancy test within 7 days before enrollment. Both male and female patients who consent to practice appropriate contraception during the study and for 4 months after the discontinuation of the protocol treatment
9. Patients with an expected survival of at least 3 months

Exclusion criteria

1. Patients who received chemotherapy, molecular-targeted agents and/or palliative radiotherapy within 2 weeks before the start of the protocol treatment or have not recovered from toxicity caused by previous treatment
2. Patients who underwent general anesthesia, surgery requiring hospitalization and extensive radiotherapy within 4 weeks before the start of the protocol treatment or minor surgery such as implantation of a central venous access device within two weeks before the start of the protocol treatment
3. Patients with active central nervous system metastases or carcinomatous meningitis.
4. Pregnant or lactating women
5. Patients who are unable or not willing to take BBI608 capsules every day
6. Patients with gastrointestinal disease markedly interfering with the absorption of oral formulations as judged by the investigator
7. Patients with active autoimmune disease requiring systemic treatment within 2 years before the start of the protocol treatment.
8. Patients with a history or signs of interstitial lung disease or active non-infectious pneumonitis
9. Patients who underwent organ or bone marrow transplantation
10. Patients who received a live vaccine within 30 days before the start of the protocol treatment
11. Patients who participated in another clinical study within 4 weeks before the start of the protocol treatment and used or using an investigational drug or device
12. Patients who previously received immunotherapy with drugs targeting PD-1, PD-L1 and/or PD-L2 or BBI608 therapy, or took part in a clinical study of pembrolizumab or BBI608
13. Patients with uncontrollable complications
14. Patients with a history of other malignancies within 3 years before the start of the protocol treatment.
15. Patients with clinically significant Electrocardiogram (ECG) abnormalities
16. Patients with a history of Human Immunodeficiency Virus (HIV)
17. Patients with active hepatitis B or C

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: BBI608 + Pembrolizumab; BBI608 and Pembrolizumab

Drug: Napabucasin; 1 cycle is 21days. BBI608: Oral administration at a dose of 240mg or 480 mg twice daily (BID), every day. [Additional cohort to the Phase II part] Oral administration at a dose of 240mg mg BID, every day The therapy will be repeated until meeting the discontinuation criteria.; Drug: Pembrolizumab; 1 cycle is 21days. Pembrolizumab: Administration at a dose of 200 mg/body on Day 1 of each cycle [Additional cohort to the Phase II part] Administration at a dose of 200 mg/body on Day 1 of each cycle. The therapy will be repeated until meeting the discontinuation criteria.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
irORR	Immune-related objective response rate determined by their Response Evaluation Criteria In Solid Tumors (RESIST): for the Phase II part	2 years
ORR	Objective response rate determined by RECIST version 1.1: for additional cohort to the Phase II part	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
irPFS	Immune-related progression free survival rate at week 12 determined by the irRECIST	12 weeks
ORR	Objective response rate determined by RECIST version 1.1: for the Phase II part	2 years
irORR	Immune-related objective response rate determined by their Response Evaluation Criteria In Solid Tumors (RESIST): for additional cohort to the Phase II part	1 year
Progression free survival rate at week 12 determined by the RECIST version 1.1	PFS	12 weeks
PFS	Progression free survival	3 years
OS	Overall survival	4 years
DCR	Disease Control rate	2 years
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]	Incidence of adverse events	4 years
Pharmacokinetic	Area under the blood concentration-time curve (AUC)	2 months
Pharmacokinetic	CmaxPeak Plasma Concentration (Cmax)	2 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
efficacy according to immune status - Immune status will be analyzed using biopsy and blood samples by flow cytometry, RNA seq, whole exome sequencing, and immunohistochemistry etc.	Efficacy evaluations according to immune status	3 years
safety according to immune status	Safety evaluations according to immune status	3 years

Collaborators and Investigators

• Sponsor: Takayuki Yoshino
• Collaborators: Sumitomo Pharma Co., Ltd.
• Investigators: Study Chair: Takayuki Yoshino, Dr, National Cancer Center Hospital East

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2016
• Primary Completion (Actual): February 3, 2020
• Study Completion (Actual): August 23, 2021

Study Registration Dates

• First Submitted: July 14, 2016
• First Submitted That Met QC Criteria: July 27, 2016
• First Posted (Estimate): August 1, 2016

Study Record Updates

• Last Update Posted (Actual): September 5, 2021
• Last Update Submitted That Met QC Criteria: August 30, 2021
• Last Verified: August 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Digestive System Diseases; Neoplasms; Neoplasms by Site; Gastrointestinal Neoplasms; Digestive System Neoplasms; Gastrointestinal Diseases; Colonic Diseases; Intestinal Diseases; Intestinal Neoplasms; Rectal Diseases; Colorectal Neoplasms; Antineoplastic Agents; Antineoplastic Agents, Immunological; Pembrolizumab
• Other Study ID Numbers: EPOC1503

Plan for Individual participant data (IPD)

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