A Study of DKN-01 as a Monotherapy or in Combination With Paclitaxel in Patients With Recurrent Epithelial Endometrial or Epithelial Ovarian Cancer or Carcinosarcoma (P204)

A Phase 2 Study Evaluating the Efficacy and Safety of DKN-01 as a Monotherapy or in Combination With Paclitaxel in Patients With Recurrent Epithelial Endometrial, Epithelial Ovarian Cancer, or Carcinosarcoma

A Phase 2 Study Evaluating the Efficacy and Safety of DKN-01 as a Monotherapy or in Combination with Paclitaxel in Patients With Recurrent Epithelial Endometrial Cancer, Epithelial Ovarian Cancer, or Carcinosarcoma

Study Overview

• Status: Completed
• Conditions: Ovarian Cancer; Carcinosarcoma; Endometrial Cancer; Uterine Cancer
• Intervention / Treatment: Drug: 300mg DKN-01; Drug: Paclitaxel; Drug: 600mg DKN-01

Detailed Description

This study employs a "basket" design to concurrently investigate DKN-01 as monotherapy and in combination with paclitaxel in patients with recurrent epithelial endometrial cancer (EEC), epithelial ovarian cancer (EOC), or carcinosarcoma (malignant mixed Mullerian tumor [MMMT]. Thus, 6 distinct patient groups are being independently investigated:

1. 300mg DKN-01 monotherapy in recurrent EEC (Group 1)
2. 300mg DKN-01+paclitaxel in recurrent EEC (Group 2)
3. 300mg DKN-01 monotherapy in recurrent EOC (Group 3)
4. 300mg DKN-01+paclitaxel in recurrent EOC (Group 4)
5. 600mg DKN-01 monotherapy in recurrent carcinosarcoma (MMMT) (Group 5)
6. 600mg DKN-01+paclitaxel in recurrent carcinosarcoma (MMMT) (Group 6)

• Study Type: Interventional
• Enrollment (Actual): 111
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Alabama
    • Birmingham, Alabama, United States, 35294
      • University of Alabama
  • Arizona
    • Scottsdale, Arizona, United States, 85258
      • HonorHealth
  • Florida
    • West Palm Beach, Florida, United States, 33401
      • Florida Cancer Specialists & Research Institute
  • Illinois
    • Chicago, Illinois, United States, 60637
      • University of Chicago
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
      • Massachusetts General Hospital
    • Boston, Massachusetts, United States, 02215
      • Dana Farber Cancer Institute
  • Missouri
    • Kansas City, Missouri, United States, 64132
      • HCA Midwest Health System Clinical Research
  • Ohio
    • Cleveland, Ohio, United States, 44195
      • Cleveland Clinic
    • Hilliard, Ohio, United States, 43026
      • Ohio State University Wexner Medical Center
  • Oklahoma
    • Oklahoma City, Oklahoma, United States, 73104
      • Stephenson Cancer Center - University of Oklahoma Health Sciences Center
  • Tennessee
    • Germantown, Tennessee, United States, 38138
      • The University of Tennessee West Cancer Center
    • Nashville, Tennessee, United States, 37232
      • Vanderbilt University Medical Center
    • Nashville, Tennessee, United States, 37203
      • Tennessee Oncology, PLLC
  • Texas
    • Dallas, Texas, United States, 75390
      • University of Texas Southwestern Medical Center
  • Virginia
    • Charlottesville, Virginia, United States, 22903
      • University of Virginia Cancer Center
  • Wisconsin
    • Madison, Wisconsin, United States, 53715
      • University of Wisconsin
    • Milwaukee, Wisconsin, United States, 53226
      • Froedtert and Medical College of Wisconsin

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Diagnosis:

   1. Epithelial Endometrial Cancer: histologically confirmed diagnosis (by either primary surgical specimen or biopsy for recurrence) of recurrent previously treated EEC.
   2. Epithelial Ovarian Cancer: histologically confirmed diagnosis (by either primary surgical specimen or biopsy for recurrence) of recurrent platinum-resistant/refractory EOC, primary peritoneal, or fallopian tube cancer (i.e., disease recurrence within 6 months of completion of or progression during platinum-based chemotherapy).
   3. Carcinosarcoma/Malignant Mixed Mullerian Tumors: histologically confirmed diagnosis (by either primary surgical specimen or biopsy for recurrence) of recurrent uterine or ovarian carcinosarcoma (MMMT). Patients must have had only 1 prior chemotherapeutic regimen for management of carcinosarcoma that may have been included chemotherapy (including in adjuvant setting), chemotherapy and radiotherapy, and/or consolidation/maintenance therapy.

2. Refractory or intolerant to at least one prior standard therapy(ies) for metastatic or locally advanced disease (see Inclusion Criterion #1c for Groups 5-6).

   1. If prior therapy consisted of palliative chemoradiation therapy, it will be considered one line of therapy.
   2. Prior treatment with paclitaxel as part of definitive therapy regimen is acceptable, provided the patient is not intolerant of paclitaxel.
   3. Patients who are not eligible to receive paclitaxel will be allowed to receive single agent DKN-01.
3. Tumor tissue for mandatory pre-treatment and on-treatment biopsies.
4. One or more tumors measurable on radiographic imaging as defined by RECIST 1.1.
5. Ambulatory and ≥18 years of age.

6. ECOG performance status (PS) of 0 or 1

   a. ECOG PS of 2 may be eligible upon the review and approval of the Medical Monitor.

7. Estimated life expectancy of at least 3 months, in the judgment of the Investigator.
8. Disease-free of active second/secondary or prior malignancies for ≥2 years with the exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma in-situ of the cervix or breast.
9. Acceptable liver, renal, hematologic and coagulation function
10. Females of child bearing potential and male partners of female patients must agree to use adequate contraception during the study and for 6 months after their last dose of study drug.
11. Reliable and willing to make themselves available for the duration of the study and are willing to follow study-specific procedures.
12. Provided written informed consent prior to any study-specific procedures.

Exclusion Criteria:

1. Patients with the following pure histologies of endometrial or ovarian cancer are not eligible for enrollment: germ cell, sex cord stroma, or sarcoma.
2. New York Heart Association Class III or IV cardiac disease, myocardial infarction within the past 6 months, or unstable arrhythmia.
3. Fridericia-corrected QT interval (QTcF) > 470 msec (female) or history of congenital long QT syndrome.
4. Active, uncontrolled bacterial, viral, or fungal infections, within 7 days of study entry requiring systemic therapy.
5. Known to be human immunodeficiency virus (HIV) positive, have hepatitis B surface antigen (HBSAg), or hepatitis C antibodies (HCAb), unless hepatitis C virus ribonucleic acid (HCV RNA) undetected/negative.
6. History of major organ transplant (i.e., heart, lungs, liver, or kidney).
7. History of autologous/allogenic bone marrow transplant.
8. Serious nonmalignant disease
9. Pregnant or nursing.
10. History of osteonecrosis of the hip or have evidence of structural bone abnormalities in the proximal femur on MRI scan that are symptomatic and clinically significant.
11. Symptomatic central nervous system (CNS) malignancy or metastasis.
12. Known osteoblastic bony metastasis
13. Treatment with surgery or chemotherapy within 21 days prior to study entry (42 days for nitrosoureas or mitomycin C)
14. Any hormonal therapy directed at the malignant tumor must be discontinued at least one week prior to study entry.
15. Clinically significant peripheral neuropathy at the time of study entry. Patients with pre-existing peripheral neuropathy will be allowed to receive single agent DKN-01
16. History of hypersensitivity reactions to paclitaxel or other drugs formulated in Cremophor® EL (polyoxyethylated castor oil). Patients who exhibit these hypersensitivities will be eligible to receive single agent DKN-01
17. Prior radiation therapy within 14 days prior to study entry
18. Currently receiving any other investigational agent or received an investigational agent within last 30 days of study entry.
19. Previously treated with an anti-DKK1 therapy
20. Significant allergy to a pharmaceutical therapy that, in the opinion of the Investigator, poses an increased risk to the patient
21. Active substance abuse

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

6

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: DKN-01 monotherapy in recurrent EEC; 300mg DKN-01 monotherapy in recurrent EEC	Drug: 300mg DKN-01; Administered by IV infusion
Experimental: DKN-01+paclitaxel in recurrent EEC; 300mg DKN-01+paclitaxel in recurrent EEC	Drug: 300mg DKN-01; Administered by IV infusion; Drug: Paclitaxel; Administered by IV infusion; Other Names: Taxol
Experimental: DKN-01 monotherapy in recurrent EOC; 300mg DKN-01 monotherapy in recurrent EOC	Drug: 300mg DKN-01; Administered by IV infusion
Experimental: DKN-01+paclitaxel in recurrent EOC; 300mg DKN-01+paclitaxel in recurrent EOC	Drug: 300mg DKN-01; Administered by IV infusion; Drug: Paclitaxel; Administered by IV infusion; Other Names: Taxol
Experimental: DKN-01 monotherapy in carcinosarcoma; 600mg DKN-01 monotherapy in carcinosarcoma	Drug: 600mg DKN-01; Administered by IV infusion
Experimental: DKN-01 +paclitaxel in carcinosarcoma; 600mg DKN-01 +paclitaxel in carcinosarcoma	Drug: Paclitaxel; Administered by IV infusion; Other Names: Taxol; Drug: 600mg DKN-01; Administered by IV infusion

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Subjects With Objective Response Rate (ORR) in EEC or EOC Patients	Best overall response of Complete Response (CR; disappearance of all target lesions, any pathological lymph nodes whether target or non-target must have reduction in short axis to <10mm) or Partial Response (PR; at least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum of diameters) as assessed by the Investigator per Response Evaluation Criteria in Solid Tumors Criteria (RECIST v1.1)	Baseline to study completion (approximately 6 months)
Number of Subjects With Objective Response Rate (ORR) in Carcinosarcoma (MMMT) Patients	Best overall response of Complete Response (CR; disappearance of all target lesions, any pathological lymph nodes whether target or non-target must have reduction in short axis to <10mm) or Partial Response (PR; at least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum of diameters) as assessed by the Investigator per Response Evaluation Criteria in Solid Tumors Criteria (RECIST v1.1)	Baseline to study completion (approximately 6 months)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Subjects With Objective Disease Control Rate (ODCR) in Patients With Recurrent EEC or EOC or Carcinosarcoma (MMMT).	Objective Disease Control Rate (ODCR) was defined as the percentage of subjects with a Best Overall Response of Complete Response (CR; disappearance of all target lesions, any pathological lymph nodes whether target or non-target must have reduction in short axis to <10mm), Partial Response (PR; at least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum of diameters), or Stable Disease (neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify as Progressive Disease) as assessed by the Investigator per Response Evaluation Criteria in Solid Tumors Criteria (RECIST v1.1)	Baseline to study completion (approximately 6 months)
Overall Survival (OS) in Patients With Recurrent EEC or EOC or Carcinosarcoma (MMMT).	Overall Survival (OS) is defined as the time from first dose of study drug until date of death due to any cause.	Baseline to study completion (maximum 17.6 months)
Progression-free Survival (PFS) in Patients With Recurrent EEC or EOC or Carcinosarcoma (MMMT).	Progression-free survival (PFS) is defined as time from first dose of study drug to first documentation of PD (per RECIST 1.1) or death due to any cause.	Baseline to study completion (maximum 7.1 months)
Duration of Response (DoR) in Patients With Recurrent EEC or EOC or Carcinosarcoma (MMMT).	Duration of Response (DoR) includes only patients that have responded with an objective disease response (PR or CR) and is defined as the time from the first tumor assessment that supports the patient's objective disease response to the time of PD or death due to any cause.	Baseline to study completion (approximately 11 months)
Duration of Complete Response (DoCR) in Patients With Recurrent EEC or EOC or Carcinosarcoma (MMMT).	Number of participants analyzed only includes patients with a CR and is otherwise defined and analyzed similar to DoR.	Baseline to study completion (approximately 11 months)
Duration of Clinical Benefit (DoCB) in Patients With Recurrent EEC or EOC or Carcinosarcoma (MMMT).	Duration of Clinical Benefit (DoCB) includes patients with a Best Overall Response of CR, PR, or SD and is defined as the time from the first tumor assessment of CR, PR or SD to the time of PD or death due to any cause.	Baseline to study completion (approximately 13.1 months)

Other Outcome Measures

Outcome Measure	Time Frame
Area Under the Curve (AUC)	Baseline to study completion (approximately 6 months)
Number of Subjects With Response to Therapy in Patients With and Without Activating β-catenin Mutations and/or Wnt Signaling Genetic Alterations in Patients With Recurrent EEC or EOC or Carcinosarcoma (MMMT)	Baseline to study completion (approximately 6 months)
Dickkopf-1 (DKK1) Concentration in Serum and Plasma Relative to Safety and Efficacy Outcomes in Patients With Recurrent EEC or EOC or Carcinosarcoma (MMMT).	Baseline to study completion (approximately 6 months)
Number of Subjects With Adverse Drug Reactions and Toxicities as Evaluated by NCI CTCAE v5.0 of DKN-01 600 mg +/- Paclitaxel in Patients With Recurrent Carcinosarcoma (MMMT) in Carcinosarcoma (MMMT) Patients	Baseline to study completion (approximately 6 months)
Number of Participants With Treatment-related Adverse Events as Assessed by CTCAE v4.0	Baseline to study completion (approximately 6 months)
Maximum Plasma Concentration (Cmax)	Baseline to study completion (approximately 6 months)
Time Taken to Reach the Maximum Plasma Concentration (Tmax)	Baseline to study completion (approximately 6 months)
Number of Subjects With Adverse Drug Reactions and Toxicities as Evaluated by NCI CTCAE v4.03 as DKN-01 as Monotherapy or in Combination With Paclitaxel in Patients With Recurrent EEC or EOC or Carcinosarcoma (MMMT)	Baseline to study completion (approximately 6 months)
Number of Subjects With Adverse Drug Reactions and Toxicities to Study Treatment Regimen in Patients With Recurrent EEC or EOC or Carcinosarcoma (MMMT) as Evaluated by NCI CTCAE v5.0	Baseline to study completion (approximately 6 months)
Concentration of DKN-01 Antibodies in Human Serum in Patients With Recurrent EEC or EOC or Carcinosarcoma (MMMT)	Baseline to study completion (approximately 6 months)

Collaborators and Investigators

• Sponsor: Leap Therapeutics, Inc.
• Investigators: Study Director: Cynthia Sirard, MD, Leap Therapeutics; Principal Investigator: Rebecca Arend, MD, University of Alabama at Birmingham

Study record dates

Study Major Dates

• Study Start (Actual): March 5, 2018
• Primary Completion (Actual): September 9, 2020
• Study Completion (Actual): January 27, 2021

Study Registration Dates

• First Submitted: January 2, 2018
• First Submitted That Met QC Criteria: January 8, 2018
• First Posted (Actual): January 10, 2018

Study Record Updates

• Last Update Posted (Actual): July 12, 2023
• Last Update Submitted That Met QC Criteria: June 27, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Keywords: ovarian; endometrial; Wnt pathway; uterine; DKK1; epithelial histology; carcinosarcoma
• Additional Relevant MeSH Terms: Neoplasms, Connective and Soft Tissue; Neoplasms by Histologic Type; Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Carcinoma; Neoplasms, Glandular and Epithelial; Genital Neoplasms, Female; Uterine Diseases; Endocrine System Diseases; Ovarian Diseases; Adnexal Diseases; Gonadal Disorders; Endocrine Gland Neoplasms; Neoplasms, Complex and Mixed; Sarcoma; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Genital Diseases; Genital Diseases, Female; Ovarian Neoplasms; Endometrial Neoplasms; Carcinosarcoma; Mixed Tumor, Mullerian; Carcinoma, Ovarian Epithelial; Uterine Neoplasms; Molecular Mechanisms of Pharmacological Action; Antineoplastic Agents; Tubulin Modulators; Antimitotic Agents; Mitosis Modulators; Antineoplastic Agents, Phytogenic; Paclitaxel
• Other Study ID Numbers: DEK-DKK1-P204

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No