MPH966 for Prevention of Graft-versus-host Disease After Allogeneic Hematopoietic Stem Cell Transplantation

A Phase 1/2 Study of MPH966, an Oral Neutrophil Elastase Inhibitor, for Prevention of Graft-versus-host Disease After Allogeneic Hematopoietic Stem Cell Transplantation

The purpose of this study is evaluate the safety and tolerability of MPH966, a neutrophil elastase inhibitor, and its ability to prevent graft-versus-host disease after hematopoietic stem cell transplant.

Study Overview

• Status: Withdrawn
• Conditions: Hematologic Malignancy
• Intervention / Treatment: Drug: MPH966; Drug: Placebo

Detailed Description

Phase 1 is a 3+3 dose escalation study to determine the safety and recommended phase 2 dose (RP2D) of MPH966 in patients undergoing allogeneic hematopoietic stem cell transplantation (HCT). We will evaluate up to 4 doses: 60 mg po bid, 120 mg po bid, 180 mg po bid, and 240 mg po bid. Safety, tolerability, and efficacy will be assessed in real time and pharmacokinetics and pharmacodynamics after each dose cohort before escalating to the next cohort.

Phase 2 is a randomized, double-blind, placebo-controlled study to determine the clinical efficacy of MPH966 vs. placebo in preventing acute graft-versus-host disease (GVHD) after HCT, using the RP2D as determined by the phase 1 trial.

• Study Type: Interventional
• Phase: Phase 2; Phase 1

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Durham, North Carolina, United States, 27705
      • Duke University Adult Bone Marrow Transplant Clinic

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Provision of written informed consent prior to any study specific procedures
2. Plan to undergo allogeneic HCT for any cancer or non-cancer illness with a planned cell dose of ≥2 x 106 CD34/kg using peripheral blood stem cells.
3. Plan to receive a myeloablative conditioning regimen (see 4.3.1).
4. Plan to receive GVHD prophylaxis with tacrolimus and methotrexate.
5. Having a donor who is a 10 of 10 HLA match;
6. Karnofsky Performance Scale KPS ≥60
7. Willing to abstain from sexual activity or use two methods of birth control while on study drug and for 5 half-lives (4 days) after last dose.

Exclusion Criteria:

1. If female, pregnant or nursing.
2. Life expectancy <6 months
3. Other malignancy or neoplastic disease (i.e. aside from the malignancy for which they are undergoing HCT) within the past 5 years with the exception of treated basal/squamous cell skin carcinoma or treated cervical cancer in situ
4. Clinically significant active infection within 1 week of starting study drug

5. Any of the following organ system function criteria:

   1. Cardiac: Ejection fraction ≤40% or myocardial infarction within 6 months of transplant or QTc >450 msec for males and >470 msec for females or other EKG abnormality which in the opinion of the investigator may put the subject at risk or interfere with study assessments
   2. Renal: Creatinine clearance (CLcr) ≤ 60 mL/min as estimated by the Cockcroft-Gault equation
   3. Pulmonary: FEV1, FVC, or corrected DLCO ≤40% predicted (forced expiratory volume in 1 second; forced vital capacity; and diffusing capacity of the lung for carbon monoxide, respectively)
   4. Hepatic: Total bilirubin >1.5 x (in the absence of known inherited hyperbilirubinemia, e.g. Gilbert's) and/or aspartate transaminase (AST)/alanine transaminase (ALT) >3 x upper limit of institutional normal for age (grade 2 or higher) and/or INR >1.5 (unless on anticoagulant), or history or evidence of cirrhosis (e.g. esophageal varices, ascites, or hepatic encephalopathy) or other chronic liver disease (e.g. Wilson's disease, autoimmune liver disease, primary biliary cirrhosis, etc.). Abnormalities in platelet number or albumin will not be considered exclusion criteria given that these are often due to the hematologic malignancy for which the patient is undergoing HCT rather than actual liver dysfunction
   5. Uncontrolled infection, including detection of hepatitis B virus (HBV) or hepatitis C virus (HCV) by serology or nucleic acid testing or HIV by polymerase chain reaction (PCR)

   i. Treated HBV/HCV/HIV with documented clearance is ok f. Other significant organ dysfunction (cardiac, pulmonary, renal, metabolic or central nervous system) that is uncontrolled and may interfere with study completion

6. Any significant medial history of alcohol abuse within 3 months of starting study drug and/or unwillingness to abstain for the duration of the study and follow up periods
7. Prior (within 30 days) or concomitant use of another neutrophil elastase inhibitor (e.g. alpha-1 antitrypsin)
8. Plan for in vivo or ex vivo T cell depletion.

9. Participated in another clinical study involving an investigational drug or device within 30 days or 5 half-lives prior to planned start of MPH966/placebo, or scheduled to participate in another clinical study involving an investigational drug or device within Day 100 of transplant

   1. If the patient develops GVHD within the first 100 days, they are allowed to enroll on trials of investigational drugs to treat GVHD provided they come off of this study.
   2. Enrollment in biorepository or supportive care trials that do not involve investigational drugs or devices is allowed
10. Any clinically relevant abnormal findings in physical examination, vital signs, hematology, clinical chemistry, or urinalysis at visit, which in the opinion of the Investigator, may put the subject at risk because of his/her participation in the study, or may influence the results of the study, or the subject's ability to participate in the study
11. Low or intermediate risk acute leukemia in first complete remission, chronic myeloid leukemia in first chronic phase, and any benign (non-malignant) disorders (phase 1 dose-escalation portion only)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: DOUBLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: MPH966; Participants receive MPH966 at RP2D tablet orally twice daily from the start of conditioning chemotherapy through 45 days post transplant.	Drug: MPH966; RP2D tablet; Other Names: alvelestat
PLACEBO_COMPARATOR: Placebo; Participants receive MPH placebo tablet matching MPH966 orally twice daily from the start of conditioning chemotherapy through 45 days post transplant.	Drug: Placebo; MPH966 placebo table

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Incidence of grade 2-4 acute Graft vs Host Disease (GVHD) requiring systemic therapy	day 100

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of grade 2-4 acute GVHD		day 100
Incidence of grade 3-4 acute GVHD		day 100
Incidence of grade 2-4 acute GVHD		month 6
Incidence of grade 3-4 acute GVHD		month 6
Kaplan-Meier analysis of time-to-event: percentage of participants who develop grade 2-4 acute GVHD by visit		day 0 and 100 days, 6 months
Kaplan-Meier analysis of time-to-event: percentage of participants who develop grade 3-4 acute GVHD by visit		Day 0 and day 100, month 6
Incidence of chronic GVHD		month 6
Incidence of chronic GVHD		month 12
Kaplan-Meier analysis of time-to-event: percentage of participants who develop chronic GVHD	Time to event distributions estimated by the Kaplan-Meier method	Day 0 and month 6, 12
Incidence of GVHD-free survival	GVHD-free survival is defined as freedom from GVHD requiring systemic steroids	month 6
Incidence of GVHD-free survival	GVHD-free survival is defined as freedom from GVHD requiring systemic steroids	month 12
Incidence of relapse-free survival	Relapse-free survival is defined as freedom from relapse	month 6
Incidence of relapse-free survival	Relapse-free survival is defined as freedom from relapse	month 12
Incidence of bacterial infections		Day 100
Incidence of fungal infections		Day 100
Incidence of viral infections		Day 100
Incidence of overall infections		Day 100
Incidence of bacterial infections		6 months
Incidence of fungal infections		month 6
Incidence of viral infections		month 6
Incidence of overall infections		month 6
Incidence of bacterial infections		month 12
Incidence of fungal infections		month 12
Incidence of viral infections		month 12
Incidence of overall infections		month 12
Kaplan-Meier analysis of time-to-event: percentage of participants who develop bacterial infections		Day 0 and day 100, month 6,12
Kaplan-Meier analysis of time-to-event: percentage of participants who develop fungal infections		Day 0 and day 100, month 6,12
Kaplan-Meier analysis of time-to-event: percentage of participants who develop viral infections		Day 0 and day 100, month 6,12
Kaplan-Meier analysis of time-to-event: percentage of participants who develop overall infections		Day 0 and day 100, month 6,12
Incidence of relapse		month 6
Incidence of relapse		month 12
Kaplan-Meier analysis of time-to-event: percentage of participants who relapse		Day 0 and month 6,12
Incidence of non-relapse mortality	Non-relapse mortality is defined as death while in remission from the primary disease	month 6
Incidence of non-relapse mortality	Non-relapse mortality is defined as death while in remission from the primary disease	month 12
Kaplan-Meier analysis of time-to-event: percentage of participants who experience non-relapse mortality	Non-relapse mortality is defined as death while in remission from the primary disease	Day 0 and month 6,12
Incidence of hospital re-admission		Day 100
Incidence of hospital re-admission		month 6
Incidence of hospital re-admission		month 12
Kaplan-Meier analysis of time-to-event: percentage of participants who are re-admitted to the hospital		Day 0 and day 100, month 6,12
Length of hospital re-admission		Day 100
Length of hospital re-admission		month 6
Length of hospital re-admission		month 12
Incidence of intensive care unit (ICU) admission		Day 100
Incidence of intensive care unit (ICU) admission		month 6
Incidence of intensive care unit (ICU) admission		month 12
Kaplan-Meier analysis of time-to-event: percentage of participants who are admitted to ICU		Day 0 and month 6,12
Length of intensive care unit (ICU) admission		Day 100
Length of intensive care unit (ICU) admission		month 6
Length of intensive care unit (ICU) admission		month 12
Length of stay in days between transplant and discharge to home	To determine the length of stay between transplant (Day 0) and discharge to home for those alive to be discharged home	Day 0 until discharge from hospital, up to 100 days
Quality of life as measured by the FACT-BMT assessment		day 30
Quality of life as measured by the FACT-BMT assessment		day 100
Quality of life as measured by the EQ 5D-5L assessment		Day 30
Quality of life as measured by the EQ 5D-5L assessment		Day 100
Quality of life as measured by the Lorig Self-Efficacy assessment		Day 30
Quality of life as measured by the Lorig Self-Efficacy assessment		Day 100
Quality of life as measured by the PG-SGA (patient-generated subjective global assessment)		day 30
Quality of life as measured by the PG-SGA (patient-generated subjective global assessment)		day 100
Quality of life as measured by the PROMIS-Depression assessment		day 30
Quality of life as measured by the PROMIS-Depression assessment		day 100
Quality of life as measured by the PROMIS-Anxiety assessment		Day 30
Quality of life as measured by the PROMIS-Anxiety assessment		Day 100
Quality of life as measured by the PROMIS-Social Isolation assessment		Day 30
Quality of life as measured by the PROMIS-Social Isolation assessment		Day 100
Quality of life as measured by the PROMIS-Emotional Support assessment		day 30
Quality of life as measured by the PROMIS-Emotional Support assessment		Day 100
Quality of life as measured by the PROMIS-Cognitive Function assessment		Day 30
Quality of life as measured by the PROMIS-Cognitive Function assessment		Day 100
Quality of life as measured by the PROMIS-Physical Function assessment		Day 30
Quality of life as measured by the PROMIS-Physical Function assessment		Day 100
Rate of grade 2 or higher adverse events, causally related during treatment period		Day 75
Rate of grade 2 or higher adverse events, causally related during follow up period		Year 1
Rate of grade 2 or higher adverse events, non related during treatment period		Day 75
Rate of grade 2 or higher adverse events, non related during follow up period		Year 1

Collaborators and Investigators

• Sponsor: Nelson Chao
• Collaborators: National Center for Advancing Translational Sciences (NCATS); Mereo BioPharma
• Investigators: Principal Investigator: Anthony Sung, MD, Duke University Health System (DUHS)

Study record dates

Study Major Dates

• Study Start (ANTICIPATED): September 1, 2021
• Primary Completion (ANTICIPATED): December 1, 2022
• Study Completion (ANTICIPATED): December 1, 2023

Study Registration Dates

• First Submitted: June 12, 2019
• First Submitted That Met QC Criteria: June 12, 2019
• First Posted (ACTUAL): June 14, 2019

Study Record Updates

• Last Update Posted (ACTUAL): March 20, 2020
• Last Update Submitted That Met QC Criteria: March 18, 2020
• Last Verified: March 1, 2020

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Immune System Diseases; Neoplasms; Neoplasms by Site; Hematologic Diseases; Hematologic Neoplasms; Graft vs Host Disease
• Other Study ID Numbers: Pro00102362

Plan for Individual participant data (IPD)

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

Drug and device information, study documents

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