- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05166616
Minnelide and Osimertinib for the Treatment of Advanced EGFR Mutated Non-Small Cell Lung Cancer
A Phase 1b Open-Label, Dose-Escalation, Safety, and Pharmacodynamic Study of Minnelide™ Capsules Given in Combination With Osimertinib in Patients With EGFR Mutated NSCLC
Study Overview
Status
Conditions
- Stage IVA Lung Cancer AJCC v8
- Stage IVB Lung Cancer AJCC v8
- Stage III Lung Cancer AJCC v8
- Stage IV Lung Cancer AJCC v8
- Stage IIIA Lung Cancer AJCC v8
- Stage IIIB Lung Cancer AJCC v8
- Stage IIIC Lung Cancer AJCC v8
- Unresectable Lung Non-Small Cell Carcinoma
- Advanced Lung Non-Small Cell Carcinoma
- Locally Advanced Lung Non-Small Cell Carcinoma
Intervention / Treatment
Detailed Description
PRIMARY OBJECTIVES:
I. To determine the maximum tolerated dose (MTD) and the dose limiting toxicities (DLT) of triptolide analog (minnelide) capsules when given in combination with osimertinib.
II. To establish the dose of minnelide capsules recommended for future phase II studies when given in combination with full dose osimertinib (recommended phase II dose [RP2D]).
SECONDARY OBJECTIVES:
I. To observe patients for any evidence of antitumor activity of minnelide capsules by objective radiographic assessment when in combination with osimertinib.
II. To determine pharmacodynamic effects of minnelide capsules on heat shock protein (HSP)72 levels when given in combination with osimertinib.
EXPLORATORY OBJECTIVES:
I. Measure HSP levels, pre/post and during therapy as predictive biomarker. II. Determine levels of minnelide in the blood, and its effect. III. Determine the cell free deoxyribonucleic acid (DNA) in blood as biomarker. IV. Evaluate the microbiome pre-, during-, and post-therapy as potentiator of therapeutic response.
V. Determine the exosomes as biomarker.
OUTLINE: This is a dose-escalation study of minnelide.
Patients receive minnelide orally (PO) once daily (QD) on days 1-21 and osimertinib PO QD on days 1-28. Cycles repeat every 28 days for 6 months in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 30 days and then every 3 months for 2 years.
Study Type
Enrollment (Estimated)
Phase
- Phase 1
Contacts and Locations
Study Locations
-
-
California
-
Duarte, California, United States, 91010
- Recruiting
- City of Hope Medical Center
-
Contact:
- Erminia Massarelli
- Phone Number: 626-218-3712
- Email: emassarelli@coh.org
-
Principal Investigator:
- Erminia Massarelli
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Documented informed consent of the participant and/or legally authorized representative
- Assent, when appropriate, will be obtained per institutional guidelines
Agreement to two research biopsies
- If tumor is unbiopsiable or not safely biopsied, exceptions may be granted with study principal investigator (PI) approval
- Age: >= 18 years
- Karnofsky performance >= 70%
- Histologically confirmed advanced non-small cell lung cancer (NSCLC). Patients with locally advanced NSCLC must not be candidates for surgical resection, radiation, or chemoradiation with curative intent
- The tumor harbors 1 of the 2 common epidermal growth factor receptor (EGFR) mutations known to be associated with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI) sensitivity (Ex19del or L858R), either alone or in combination with other epidermal growth factor receptor (EGFR) mutations, which may include T790M
- Measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1
- Tumor progression after receiving standard/approved osimertinib
- Fully recovered from the acute toxic effects (except alopecia) to =< grade 1 to prior anti-cancer therapy. Grade 2 neuropathy is allowed
Absolute neutrophil count (ANC) >= 1,500/mm^3 (within 14 days prior to day 1 of protocol therapy)
- NOTE: Growth factor is not permitted within 14 days of ANC assessment
Platelets >= 100,000/mm^3 (within 14 days prior to day 1 of protocol therapy)
- NOTE: Platelet transfusions are not permitted within 14 days of platelet assessment
- Hemoglobin >= 9 g/dL (within 14 days prior to day 1 of protocol therapy)
- Total bilirubin =< 1.5 X ULN (unless has Gilbert's disease). Total bilirubin < 3 x ULN in the presence of documented Gilbert's disease (within 14 days prior to day 1 of protocol therapy)
- Aspartate aminotransferase (AST) =< 2.5 x upper limit of normal (ULN) (if liver metastases are present, then =< 5 x ULN is allowed) (within 14 days prior to day 1 of protocol therapy)
- Alanine aminotransferase (ALT) =< 2.5 x ULN if liver metastases are present, then =< 5 x ULN is allowed) (within 14 days prior to day 1 of protocol therapy)
- Alkaline phosphatase =< 2.5 x ULN if liver metastases are present, then =< 5 x ULN is allowed) (within 14 days prior to day 1 of protocol therapy)
Serum creatinine within normal limits, OR creatinine clearance of >= 60 mL/min per 24 hour urine test for patients with creatinine levels above ULN (within 14 days prior to day 1 of protocol therapy)
- Creatinine clearance (CrCl, by Cockcroft-Gault) is utilized for all patients to allow for evaluation of the effect of CrCl on the minnelide/triptolide exposures
If not receiving anticoagulants: International normalized ratio (INR) OR prothrombin time (PT) =< 1.5 x ULN (within 14 days prior to day 1 of protocol therapy)
- If on anticoagulant therapy: PT must be within therapeutic range of intended use of anticoagulants
If not receiving anticoagulants: Activated partial thromboplastin time (aPTT) =< 1.5 x ULN (within 14 days prior to day 1 of protocol therapy)
- If on anticoagulant therapy: aPTT must be within therapeutic range of intended use of anticoagulants
- Albumin >= 3.0 /dL (within 14 days prior to day 1 of protocol therapy)
- Urinalysis - no clinically significant abnormalities (within 14 days prior to day 1 of protocol therapy)
QT corrected (QTc) =< 470 ms (using the Bazett's formula)
- Note: To be performed within 28 days prior to Day 1 of protocol therapy.
Women of childbearing potential (WOCBP): negative urine or serum pregnancy test (within 14 days prior to day 1 of protocol therapy)
- If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required
Agreement by females and males of childbearing potential to use an effective method of birth control or abstain from heterosexual activity for the course of the study through at least 6 weeks after the last dose of protocol therapy. Contraception must be continued following discontinuation of the study drugs for at least five half-lives of both study drugs
- Childbearing potential defined as not being surgically sterilized (men and women) or have not been free from menses for > 1 year (women only)
Female patients of childbearing potential must:
- Agree to practice 1 highly effective method of non-hormonal contraception and one additional effective (barrier) method at the same time, from the time of signing the informed consent through 180 days after the last dose of study drug, or
- Agree to practice true abstinence, when is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence [e.g. calendar, ovulation, symptothermal, postovulation methods], withdrawal, spermicides only, and lactational amenorrhea are not acceptable methods of contraception. Female and male condoms should not be used together.)
- Agree not to donate eggs (ova) during the course of this study or 180 days after receiving their last dose of study drug. Agree not to breast-feed for the duration of treatment through 6 months post treatment.
Male patients of childbearing potential must:
- Agree to practice effective barrier contraception during the entire study treatment period and through 180 days after the last dose of study drug, or
- Agree to practice true abstinence, when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence [e.g. calendar, ovulation, symptothermal, postovulation methods for the female partner] and withdrawal are not acceptable methods of contraception. Female and male condoms should not be used together.)
- Agree not to donate sperm during the course of this study or within 180 days after receiving their last dose of study drug.
- Patients must be able to swallow and retain oral medications
- Previously tolerant of osimertinib at 80 mg QD
Exclusion Criteria:
- Treatment with radiation therapy, surgery, chemotherapy, or investigational therapy within 21 days prior to day 1 of protocol therapy (6 weeks for nitrosoureas or Mitomycin C). Exceptions to this exclusion are brain radiation and osimertinib
- Biological therapy, immunotherapy within 21 days prior to day 1 of protocol therapy
- Strong CYP3A4 inducers/ inhibitors within 14 days prior to day 1 of protocol therapy
- Patients receiving class 1A or class III antiarrhythmic agents within 14 days prior to Day 1 of protocol therapy
- Herbal and alternative (eg. turmeric, cannabidiol, ginseng) medications within 7 days prior to Day 1 of protocol therapy
- Clarithromycin, loperamide, ondansetron within 7 days prior to day 1 of protocol therapy
- History of allergic reactions attributed to compounds of similar chemical or biologic composition to study agent
- Active diarrhea
- Clinically significant uncontrolled illness
- Known history of immunodeficiency virus (HIV) or hepatitis B or hepatitis C infection
- Prior malignancy other than carcinoma in situ of the cervix, or nonmelanoma skin cancer, unless that prior malignancy was diagnosed and definitively treated 5 or more years prior to study entry with no subsequent evidence of recurrence. Patients with a history of low grade (Gleason score =< 6 = Gleason Group 1) localized prostate cancer will be eligible even if diagnosed less than 5 years prior to study entry
- Females only: Pregnant or breastfeeding
- Any malabsorption condition
- Any other condition that would, in the Investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns with clinical study procedures.
- New York Heart Association Class III or IV, cardiac disease, myocardial infarction within the past 6 months, unstable arrhythmia, or evidence of ischemia on electrocardiogram (ECG)
- Clinical evidence of central nervous system (CNS) metastases or leptomeningeal carcinomatosis, except for individuals who have previously-treated CNS metastases, are asymptomatic, and have had no requirement for steroid medication for 1 week prior to the first dose of study drug and have completed radiation 2 weeks prior to the first dose of study drug
- Active, uncontrolled bacterial, viral, or fungal infections, requiring systemic therapy
- Diagnosis of congenital long QT syndrome
- Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Treatment (minnelide, osimertinib)
Patients receive minnelide PO QD on days 1-21 and osimertinib PO QD on days 1-28.
Cycles repeat every 28 days for 6 months in the absence of disease progression or unacceptable toxicity.
|
Given PO
Other Names:
Correlative studies
Other Names:
Given PO
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Maximum tolerated dose (MTD) of osimertinib and minnelide
Time Frame: Up to 28 days
|
Up to 28 days
|
Recommended phase II dose (RP2D) of minnelide and osimertinib
Time Frame: Up to 28 days
|
Up to 28 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pharmacodynamic effects of minnelide on heat shock protein (HSP)72 expression
Time Frame: Up to 2 years
|
To analyze the pharmacodynamic effects of Minnelide on HSP72 protein levels in serum collected at specific timepoints before and after treatment.
|
Up to 2 years
|
Objective response rate
Time Frame: Up to 2 years
|
Assessed per Response Evaluation Criteria in Solid Tumors (RECIST) version (v) 1.1.
|
Up to 2 years
|
Duration of overall response
Time Frame: Up to 2 years
|
Up to 2 years
|
|
Evidence of anti-tumor activity of minnelide when in combination with osimertinib
Time Frame: Up to 2 years
|
Assessed by objective radiographic assessment.
|
Up to 2 years
|
Incidence of adverse events
Time Frame: Up to 2 years
|
Assessed per Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
|
Up to 2 years
|
Progression-free survival (PFS)
Time Frame: Up to 2 years
|
Assessed per RECIST v 1.1.
Median PFS will be determined using the Kaplan-Meier method.
|
Up to 2 years
|
Overall survival
Time Frame: From the date of study enrollment to the date of death from any cause, assessed up to 2 years
|
Assessed per RECIST v 1.1.
|
From the date of study enrollment to the date of death from any cause, assessed up to 2 years
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
HSP levels pre and post therapy
Time Frame: Baseline and up to 2 years
|
Baseline and up to 2 years
|
|
Levels of minnelide in the blood
Time Frame: Up to 2 years
|
Up to 2 years
|
|
Cell free deoxyribonucleic acid (DNA) in blood
Time Frame: Up to 2 years
|
Up to 2 years
|
|
Evaluation of the microbiome
Time Frame: Up to 2 years
|
To evaluate the microbiome through amplicon sequencing of DNA extracted from fecal material collected by patients at baseline, restaging (2 cycles/8 weeks), and post-therapy (after disease progression/treatment discontinuation).
|
Up to 2 years
|
Determination of the exosomes
Time Frame: Up to 2 years
|
To determine potential biomarkers through whole exome sequencing of tumor specimen. In brief, whole exome sequencing using a structured exome design will be performed on paired tumor/normal samples. This assay enables identification of mutations within exons as well as detection of structural variants including copy number variants and translocation breakpoints. |
Up to 2 years
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Erminia Massarelli, City of Hope Medical Center
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Respiratory Tract Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Lung Diseases
- Neoplasms by Site
- Neoplasms, Glandular and Epithelial
- Respiratory Tract Neoplasms
- Thoracic Neoplasms
- Carcinoma, Bronchogenic
- Bronchial Neoplasms
- Lung Neoplasms
- Carcinoma, Non-Small-Cell Lung
- Carcinoma
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Antineoplastic Agents, Alkylating
- Alkylating Agents
- Protein Kinase Inhibitors
- Contraceptive Agents
- Reproductive Control Agents
- Contraceptive Agents, Male
- Antispermatogenic Agents
- Osimertinib
- Triptolide
Other Study ID Numbers
- 20609 (Other Identifier: City of Hope Medical Center)
- P30CA033572 (U.S. NIH Grant/Contract)
- NCI-2021-12558 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Stage IVA Lung Cancer AJCC v8
-
M.D. Anderson Cancer CenterNational Cancer Institute (NCI)Active, not recruitingStage IVA Lung Cancer AJCC v8 | Stage IVB Lung Cancer AJCC v8 | Stage III Lung Cancer AJCC v8 | Stage IV Lung Cancer AJCC v8 | Stage II Lung Cancer AJCC v8 | Stage IIA Lung Cancer AJCC v8 | Stage IIB Lung Cancer AJCC v8 | Stage IIIA Lung Cancer AJCC v8 | Stage IIIB Lung Cancer AJCC v8 | Stage I Lung Cancer... and other conditionsUnited States
-
M.D. Anderson Cancer CenterNational Cancer Institute (NCI)RecruitingStage IVA Lung Cancer AJCC v8 | Stage IVB Lung Cancer AJCC v8 | Lung Non-Small Cell Carcinoma | Stage III Lung Cancer AJCC v8 | Stage IV Lung Cancer AJCC v8 | Stage II Lung Cancer AJCC v8 | Stage IIA Lung Cancer AJCC v8 | Stage IIB Lung Cancer AJCC v8 | Stage IIIA Lung Cancer AJCC v8 | Stage IIIB Lung... and other conditionsUnited States
-
City of Hope Medical CenterNational Cancer Institute (NCI)CompletedStage IVA Lung Cancer AJCC v8 | Stage IVB Lung Cancer AJCC v8 | Stage III Lung Cancer AJCC v8 | Metastatic Lung Carcinoma | Stage IV Lung Cancer AJCC v8 | Head and Neck Carcinoma | Lung Carcinoma | Stage II Lung Cancer AJCC v8 | Stage IIA Lung Cancer AJCC v8 | Stage IIB Lung Cancer AJCC v8 | Stage IIIA Lung... and other conditionsUnited States
-
City of Hope Medical CenterNational Cancer Institute (NCI)CompletedStage IVA Lung Cancer AJCC v8 | Stage IVB Lung Cancer AJCC v8 | Stage III Lung Cancer AJCC v8 | Stage IV Lung Cancer AJCC v8 | Stage II Lung Cancer AJCC v8 | Stage IIA Lung Cancer AJCC v8 | Stage IIB Lung Cancer AJCC v8 | Stage IIIA Lung Cancer AJCC v8 | Stage IIIB Lung Cancer AJCC v8 | Malignant Female... and other conditionsUnited States
-
University of Southern CaliforniaNational Cancer Institute (NCI); Genentech, Inc.RecruitingStage IVA Lung Cancer AJCC v8 | Stage IVB Lung Cancer AJCC v8 | Lung Non-Small Cell Carcinoma | Stage III Lung Cancer AJCC v8 | Stage IV Lung Cancer AJCC v8 | Stage II Lung Cancer AJCC v8 | Stage IIA Lung Cancer AJCC v8 | Stage IIB Lung Cancer AJCC v8 | Stage IIIA Lung Cancer AJCC v8 | Stage IIIB Lung... and other conditionsUnited States
-
OHSU Knight Cancer InstituteOregon Health and Science University; NovoCure Ltd.TerminatedStage IVA Lung Cancer AJCC v8 | Stage IVB Lung Cancer AJCC v8 | Stage III Lung Cancer AJCC v8 | Stage IV Lung Cancer AJCC v8 | Stage II Lung Cancer AJCC v8 | Stage IIA Lung Cancer AJCC v8 | Stage IIB Lung Cancer AJCC v8 | Stage IIIA Lung Cancer AJCC v8 | Stage IIIB Lung Cancer AJCC v8 | Extensive Stage... and other conditionsUnited States
-
National Cancer Institute (NCI)Active, not recruitingAnatomic Stage III Breast Cancer AJCC v8 | Anatomic Stage IIIA Breast Cancer AJCC v8 | Anatomic Stage IIIB Breast Cancer AJCC v8 | Anatomic Stage IIIC Breast Cancer AJCC v8 | Prognostic Stage III Breast Cancer AJCC v8 | Prognostic Stage IIIA Breast Cancer AJCC v8 | Prognostic Stage IIIB Breast... and other conditionsUnited States, Puerto Rico
-
Academic and Community Cancer Research UnitedNational Cancer Institute (NCI)Active, not recruitingMetastatic Colon Adenocarcinoma | Metastatic Colorectal Carcinoma | Metastatic Rectal Adenocarcinoma | Stage III Colon Cancer AJCC v8 | Stage III Rectal Cancer AJCC v8 | Stage IIIA Colon Cancer AJCC v8 | Stage IIIA Rectal Cancer AJCC v8 | Stage IIIB Colon Cancer AJCC v8 | Stage IIIB Rectal Cancer AJCC... and other conditionsUnited States
-
Roswell Park Cancer InstituteRecruitingStage IVA Lung Cancer AJCC v8 | Stage IVB Lung Cancer AJCC v8 | Lung Non-Small Cell Carcinoma | Stage III Lung Cancer AJCC v8 | Stage IV Lung Cancer AJCC v8 | Stage IIIA Lung Cancer AJCC v8 | Stage IIIB Lung Cancer AJCC v8 | Stage IIIC Lung Cancer AJCC v8 | Positive Surgical Margin | Resected MassUnited States
-
Ohio State University Comprehensive Cancer CenterCompletedStage III Uterine Corpus Cancer AJCC v8 | Stage IVA Uterine Corpus Cancer AJCC v8 | Malignant Female Reproductive System Neoplasm | Stage I Cervical Cancer AJCC v8 | Stage IA Cervical Cancer AJCC v8 | Stage IA1 Cervical Cancer AJCC v8 | Stage IA2 Cervical Cancer AJCC v8 | Stage IB Cervical Cancer... and other conditionsUnited States
Clinical Trials on Osimertinib
-
Li ZhangHubei Cancer HospitalNot yet recruitingStage IV Non-small Cell Lung CancerChina
-
Qingdao Central HospitalRecruiting
-
AstraZenecaActive, not recruitingNon Small Cell Lung Cancer (Stage III)United States, Spain, Taiwan, Thailand, Vietnam, Turkey, Korea, Republic of, Brazil, Hungary, India, Japan, Mexico, Peru, Russian Federation, China, Malaysia, Argentina
-
Wuhan Union Hospital, ChinaNot yet recruitingNon Small Cell Lung Cancer
-
AstraZenecaTerminated
-
Istituto Oncologico Veneto IRCCSActive, not recruitingEGF-R Positive Non-Small Cell Lung CancerItaly
-
Shanghai JMT-Bio Inc.CSPC ZhongQi Pharmaceutical Technology Co., Ltd.Not yet recruitingLocally Advanced or Metastatic Non-Small Cell Lung Cancer | EGFR Exon20 Insertion Mutations
-
Qingdao Central HospitalRecruiting
-
Suzhou Genhouse Bio Co., Ltd.RecruitingNon-Small Cell Lung Cancer With EGFR MutationChina
-
AstraZenecaCompletedT790M Positive NSCLC PatientsChina