A Study to Assess the Efficacy and Safety of DCC-2618 and Sunitinib in Patients With Advanced Gastrointestinal Stromal Tumors After Treatment With Imatinib

A Multicenter Phase 2, Single-Arm Open-Label Study of DCC-2618 to Assess Efficacy, Safety, and Pharmacokinetics In Patients With Advanced Gastrointestinal Stromal Tumors Who Have Progressed On Prior Anticancer Therapies

the primary objective of this study is to assess the efficacy (progression-free survival,PFS) of DCC-2618 (ripretinib, ZL-2307) and sunitinib in patients with advanced gastrointestinal stromal tumors after treatment with imatinib. This study will enroll approximately 98 subjects in around 18 sites in China mainland, and all subjects will be receiving DCC-2618 or Sunitinib in equal chance as treatment.

Study Overview

• Status: Completed
• Conditions: Gastrointestinal Stromal Tumor(GIST)
• Intervention / Treatment: Drug: Ripretinib; Drug: Sunitinib

• Study Type: Interventional
• Enrollment (Actual): 108
• Phase: Phase 2

Contacts and Locations

Study Locations

• China
  • Beijing
    • Beijing, Beijing, China
      • Beijing Cancer Hospital
    • Beijing, Beijing, China
      • Chinese PLA General Hospital
    • Beijing, Beijing, China
      • The General Hospital of Peking University
  • Chognqing
    • Chongqing, Chognqing, China
      • The First Affiliated Hospital of Chongqing Medical Universty
  • Fujian
    • Fuzhou, Fujian, China
      • Fujian Medical University Union Hospital
  • Guangdong
    • Guangzhou, Guangdong, China
      • The First Affiliated Hospital of Sun Yat-Sen University
    • Guangzhou, Guangdong, China
      • The Cancer Hospital of Sun Yat-sen University
    • Guangzhou, Guangdong, China
      • The Sixth Affiliated Hospital of Sun Yat-sen University
  • Hebei
    • Shijiazhuang, Hebei, China
      • The 4th Hospital of Hebei Medical University
  • Heilongjiang
    • Ha'erbin, Heilongjiang, China
      • The Affiliated Hospital of Haerbin MedicalUniversity
  • Hubei
    • Wuhan, Hubei, China
      • Union Hospital of HUST
  • Shandong
    • Qingdao, Shandong, China
      • The Affiliated Hospital of Qingdao University
  • Shanghai
    • Shanghai, Shanghai, China
      • Renji Hospital, Shanghai Jiaotong University School of Medicine
    • Shanghai, Shanghai, China
      • Fudan University Cancer Hospital
    • Shanghai, Shanghai, China
      • Fudan University, Zhongshan Hospital
  • Sichuan
    • Chengdu, Sichuan, China
      • West China Hospital of Sichuan University
  • Xinjiang
    • Ürümqi, Xinjiang, China
      • The Affiliated Hospital of Xinjiang Medical University
  • Zhejiang
    • Hangzhou, Zhejiang, China
      • Zhejiang Cancer Hospital

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:

• Male or female patients ≥18 years of age.
• Histological diagnosis of advanced GIST and capability of providing tumor tissue sample (the interval between tumor tissue collection and signing of informed consent form should be less than 3 years). Otherwise, biopsy is required.
• Provide molecular test report with KIT/PDGFRA mutation status prior to randomization.
• Patients must have progressed on imatinib or have documented intolerance to imatinib. Subjects must have discontinued imatinib treatment 10 days prior to the first dose of the study drug. All prior imatinib treatments will be considered as first-line (such as imatinib adjuvant therapy and imatinib dose increase).
• ECOG PS of 0-2.
• Female patients of childbearing potential must have a negative serum beta-human chorionic gonadotropin (β-hCG) pregnancy test at screening.
• Patients of reproductive potential must agree to follow the contraception requirements.
• At least 1 measurable lesion according to the "RECIST v1.1-GIST-specific Criteria" (non-nodal lesions must be ≥1.0 cm in the long axis or ≥ double the slide thickness in the long axis) ; obtaining radiographic image results within 28 days prior to the first dose of study drug.

• Good organ function and bone marrow reserve function, including:

  • Neutrophil count ≥ 1,000/µL
  • Hemoglobin ≥ 8 g/dL
  • Platelet count ≥ 75,000/µL
  • Total bilirubin ≤ 1.5 × the upper limit of normal (ULN)
  • AST and ALT ≤ 3×ULN, and AST and ALT≤ 5×ULN in the presence of hepatic metastases
  • Creatinine clearance ≥ 50 mL/min (based on Cockcroft-Gault estimation Formulas for calculation)
  • Prothrombin time (PT), international normalized ratio (INR) or partial thromboplastin time ≤ 1.5 × ULN. Patients on a stable, maintenance regimen of anticoagulant therapy for at least 30 days prior to study drug administration may have PT/INR measurements >1.5 × ULN if, in the opinion of the investigator, the patient is suitable for the study. An adequate rationale must be provided to the sponsor prior to randomization.
• Resolution of all toxicities from prior therapy to ≤Grade 1 (or baseline) within 1 week prior to the first dose of study drug (excluding alopecia and ≤ Grade 3 clinically asymptomatic lipase, amylase, and creatine phosphokinase laboratory abnormalities).
• Patient is capable of understanding and complying with the protocol. Subjects should sign the written informed consent before any study-related procedures were performed.

Exclusion Criteria:

• Treatment with any other line of therapy in addition to imatinib for advanced GIST. Imatinib-containing combination therapy in the first-line treatment should not be enrolled.
• Patients with a prior or concurrent malignancy whose natural history or treatment have the potential to interfere with the safety or efficacy assessment of this clinical trial are not eligible.
• Patient has known active central nervous system metastases.
• New York Heart Association class II - IV heart disease, myocardial infarct, active ischemia or any other uncontrolled cardiac condition within the first 6 months of the first dose of study drug such as angina pectoris, clinically significant cardiac arrhythmia requiring therapy, uncontrolled hypertension or congestive heart failure.
• Left ventricular ejection fraction (LVEF) < 50%.
• Arterial thrombotic or embolic events such as cerebrovascular accident (including ischemic attacks) or hemoptysis within 6 months before the first dose of study drug.
• Venous thrombotic events (e.g. deep vein thrombosis) or pulmonary arterial events (e.g. pulmonary embolism) within 1 month before the first dose of study drug. Patients on stable anticoagulation therapy for at least one month are eligible.
• 12-lead electrocardiogram (ECG) demonstrating QT interval corrected by Fridericia's formula > 450 ms in males or > 470 ms in females at screening or history of long QT interval syndrome.
• Use of strong or moderate inhibitors and/or inducers of cytochrome P450 (CYP) 3A4 within 14 days or 5 x the half-life (whichever is longer) prior to the first dose of study drug, including certain herbal medications (eg, St. John's Wort) and consumption of grapefruit or grapefruit juice within 14 days prior to the first dose of study drug.
• Use of known substrates or inhibitors of breast cancer resistance protein (BCRP) transporters within 14 days or 5 x the half-life (whichever is longer) prior to the first dose of study drug.
• Major surgeries (e.g. abdominal laparotomy) within 4 weeks of the first dose of study drug; all major surgical wounds must be healed and free of infection or dehiscence before the first dose of study drug.
• Any other clinically significant comorbidities, such as uncontrolled pulmonary disease, active infection, or any other condition, which in the judgment of the investigator, could compromise compliance with the protocol, interfere with interpretation of the study results, or predispose the patient to safety risks.
• Known human immunodeficiency virus or hepatitis C infection only if the patient is taking medications that are excluded per protocol, hepatitis B virus (HBV) DNA > 2000 IU/ml or > 104 copies/ml.
• Female patients who are pregnant or lactating or who plan to become pregnant during the study treatment period.
• Known hypersensitivity to any component of the study drug. Patients with Stevenson Johnson syndrome in previous TKI treatment need to be excluded.

• Gastrointestinal abnormalities including but not limited to:

  • inability to take oral medication
  • malabsorption syndrome
  • Requiring intravenous nutrition
• Any active hemorrhages, excluding hemorrhoids or gum bleeding.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Ripretinib; 50mg/tablet,150 mg QD continuous administration, 6 weeks (42 days) for a cycle.	Drug: Ripretinib; Oral kinase inhibitor; Other Names: DCC-2618
Active Comparator: Sunitinib; 12.5mg/capsule, 50 mg QD, in 6 weeks (42 days) with 4 weeks continuous dosing followed by 2 weeks break.	Drug: Sunitinib; second-line therapy in GIST patients who have progressed after imatinib treatment or are intolerant to imatinib

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
PFS assessed by independent central review	To assess the efficacy (progression-free survival [PFS], by independent radiologic review)of DCC-2618 (ripretinib, ZL-2307) and sunitinib in patients	7 months after enrollment is completed in study

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
objective response rate（ORR）	To assess objective response rate (ORR) by independent radiologic review using RECIST v1.1-GIST-specific criteria	7 months after enrollment is completed in study
DCR	To assess disease control rate (DCR) by independent radiologic review	7 months after enrollment is completed in study
PFS assessed by investigator	To assess PFS based on Investigator assessment	7 months after enrollment is completed in study
overall survival (OS)	To assess overall survival (OS)	7 months after enrollment is completed in study
To compare the safety profile of DCC-2618 (ripretinib, ZL-2307) to the safety profile of sunitinib by using AE/SAE/AESI collection during study.	Incidence of treatment emergent adverse event (TEAE), adverse event of special interest (AESI) and serious adverse event (SAE); severity of adverse event will be assessed (based on NCI CTCAE 5.0);; Incidence of adverse events resulting in dose adjustment of the study drug or termination of the study	7 months after enrollment is completed in study

Collaborators and Investigators

• Sponsor: Zai Lab (Shanghai) Co., Ltd.

Study record dates

Study Major Dates

• Study Start (Actual): November 25, 2020
• Primary Completion (Actual): July 20, 2022
• Study Completion (Actual): July 20, 2022

Study Registration Dates

• First Submitted: November 11, 2020
• First Submitted That Met QC Criteria: November 16, 2020
• First Posted (Actual): November 18, 2020

Study Record Updates

• Last Update Posted (Actual): March 20, 2023
• Last Update Submitted That Met QC Criteria: March 17, 2023
• Last Verified: March 1, 2023

More Information

Terms related to this study

• Keywords: Gastrointestinal Stromal Tumors,GIST,DCC-2618,Ripretinib
• Additional Relevant MeSH Terms: Digestive System Diseases; Neoplasms, Connective and Soft Tissue; Neoplasms by Histologic Type; Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms; Gastrointestinal Diseases; Neoplasms, Connective Tissue; Gastrointestinal Stromal Tumors; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antineoplastic Agents; Angiogenesis Inhibitors; Angiogenesis Modulating Agents; Growth Substances; Growth Inhibitors; Protein Kinase Inhibitors; Sunitinib
• Other Study ID Numbers: ZL-2307-003

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