- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06229340
Leflunomide or Combination of MEK Inhibitor and Hydroxychloroquine for Refractory Patients With RAS Mutations (NТО-RAS)
New Therapeutic Approaches for Tumors With RAS Gene Mutations
There is a huge variety of nucleotide substitutions that activate RAS. The search for new "universal" drugs for the RAS pathway that either interfere with RAS upregulation upstream in the signaling pathway or offset the consequences of RAS activation is important for improving therapeutic outcomes for patients with refractory malignancies.
The use of leflunomide or the combination of MEK inhibitor + hydroxychloroquine ± bevacizumab is promising for patients with mutations in RAS cascade genes who have failed all existing treatment standards.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Mutations in the RAS gene are a common cause for the development of many tumors.
It is of practical interest to study the potential efficacy of several drugs registered for the treatment of other diseases, which may also be able to affect various parts of the RAS pathway.
Leflunomide, with its active metabolite , inhibits the enzyme dihydroorotate dehydrogenase (DHODH). DHODH plays an essential role in the biosynthesis of pyrimidine, which is particularly important for the growth of RAS mutant cells.
Tumors with KRAS, NRAS, and HRAS mutations are characterized by increased MEK kinase activity. The combination of MEK inhibitor + hydroxychloroquine ± bevacizumab is able to affect MEK kinase activity by direct inhibition as well as regulation of autophagy, which is controlled in this case by the antimalarial drug hydroxychloroquine.
The use of bevacizumab is appropriate because there is evidence of its efficacy in the treatment of patients with colorectal cancer, including colorectal cancer with mutations in the KRAS gene.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Evgeny Imyanitov
- Phone Number: +79013023707
- Email: evgeny@imyanitov.spb.ru
Study Contact Backup
- Name: Liliya Baboshkina
- Phone Number: +79869932745
- Email: lilya_baboshkina@mail.ru
Study Locations
-
-
-
Saint Petersburg, Russian Federation
- Recruiting
- Department of Tumor Growth Biology, N.N. Petrov Institute of Oncology, Saint Petersburg, Russian Federation
-
Contact:
- Liliya Baboshkina
- Phone Number: +79869932745
- Email: lilya_baboshkina@mail.ru
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patient is able to provide informed consent and sign approved consent forms to participate in the study.
- Patient age is at least 18 years old.
- Performance status Eastern Cooperative Oncology Group (ECOG) 0-2.
- Histologically confirmed metastatic metastatic disease stage 4.
- Must have documented RAS (KRAS, HRAS, NRAS) mutation identified within the last 5 years by a local test on tumor tissue.
- More than 2 lines of standard drug antitumor therapy in the anamnesis.
- Must have disease progression as defined by RECIST version 1.1 criteria
Appropriate hematologic and liver function:
- Absolute neutrophil count (ANC) ≥ 1.5 x 109/L (1500/μL)
- Lymphocyte count ≥ 0.5 x 109/L (500/μL)
- Platelet count ≥ 100 x 109/L (100,000/μL) without transfusion
- Hemoglobin ≥ 90 g/L without transfusion.
- Creatinine clearance ≥ 40 mL/min
- Serum albumin ≥ 25 g/L (2.5 g/dL)
- Serum bilirubin ≤ 1.5 x HGH, with the following exception:
- Patients with known Gilbert's disease or liver metastases: serum bilirubin level ≤ 3 x IUH
- AST, ALT, and alkaline phosphate ≤ 2.5 x HGN;
10. For women of childbearing potential: consent to abstinence (abstain from heterosexual intercourse) or use at least two forms of effective contraception with an ineffectiveness rate < 1% per year during treatment.
11. Patients with asymptomatic new or advanced brain metastases (active brain metastases) are eligible to participate if the treating physician determines that localized treatment is not required.
Exclusion Criteria:
- Age over 85 years.
- Рresence of acute or active chronic infections.
- Impaired renal and hepatic function; - left ventricular ejection fraction (LVEF) < 45%
- Known history of acute or chronic hepatitis B or C due to known potential hepatotoxicity of leflunomide.
- History of allergic reactions associated with compounds similar in chemical or biological composition to leflunomide or teriflunomide or other drugs in the combination.
- Uncontrolled intercurrent disease, including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina, cardiac arrhythmias, or mental illness/social situations that limit study compliance.
- Patients should not be pregnant or breastfeeding due to the potential for teratogenic effects and side effects of planned chemotherapeutic regimens.
- History of retinal disease (retinal tear, exudate, hemorrhage) or retinal vein occlusion, central serous retinopathy or retinal pigment epithelium detachment, or current risk factors for ROS (e.g., uncontrolled glaucoma or ocular hypertension, history of hyperviscosity or hypercoagulability syndromes).
Exit criteria:
- Refusal to continue participation in the study.
- Intolerable toxicity.
- Progression according to RECIST 1.1 and IRECIST criteria or clinically significant (in the opinion of the physician) progression requiring a change in anticancer treatment.
- Non-compliance with IND procedures.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: Non-Randomized
- Interventional Model: Crossover Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Group 1
Leflunomide
|
100 mg daily for 3 days at the loading dose, then 20 mg daily at the standard dose.
|
Experimental: Group 2
Combination of MEK Inhibitor and Hydroxychloroquine ( Plaquenil)
|
Use of one of the possible MEK-inhibitor options: Trametinib 2 mg once daily orally; Cobimetinib 60 mg on days 1-21, break 7 days, cycle 28 days orally; Binimetinib 45 mg 2 times a day daily orally. + Hydroxychloroquine 600 mg 2 times a day daily orally. ± Bevacizumab 7.5 mg/m² every 3 weeks intravenously. |
No Intervention: historical control group
standard therapy
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Objective response rate
Time Frame: at the end of 2 cycles of treatment (each cycle is 28 days)
|
Objective response rate was assigned for a subject if the subject displayed either complete response (CR) or partial response (PR) per RECIST version 1.1
|
at the end of 2 cycles of treatment (each cycle is 28 days)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Assessment of patients' quality of life
Time Frame: at the end of 2 cycles of treatment (each cycle is 28 days)
|
European Organization for the Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) is a 30-question tool used to assess the overall quality of life (QoL) in cancer participants.
It consisted of 15 domains: 1 global health status (GHS) scale, 5 functional scales (Physical, role, cognitive, emotional, social), and 9 symptom scales/items (Fatigue, nausea and vomiting, pain, dyspnoea, sleep disturbance, appetite loss, constipation, diarrhea, financial impact.
The EORTC QLQ-C30 GHS/QoL score ranges from 0 to 100; High score indicates better GHS/QoL.
Score 0 represents: very poor physical condition and QoL.
Score 100 represents: excellent overall physical condition and QoL.
|
at the end of 2 cycles of treatment (each cycle is 28 days)
|
Progression-free survival (PFS)
Time Frame: at the end of 2 cycles of treatment (each cycle is 28 days)
|
Progression-free survival was defined as the time from start treatment to subsequent confirmed progression per RECIST version 1.1, or death (whichever occurred first), measured in weeks and months.
For PFS assessment clinical progression (i.e., treatment discontinuation due to progression of disease) was also considered as an event.
|
at the end of 2 cycles of treatment (each cycle is 28 days)
|
Overall survival
Time Frame: up to 3 years
|
Overall survival was defined as the time from start treatment to subsequent death, measured in weeks and months.
|
up to 3 years
|
Collaborators and Investigators
Investigators
- Study Director: Evgeny Imyanitov, N.N. Petrov NMRC of Oncology
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 (Estimated)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Digestive System Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Neoplasms by Site
- Endocrine System Diseases
- Gastrointestinal Neoplasms
- Digestive System Neoplasms
- Gastrointestinal Diseases
- Endocrine Gland Neoplasms
- Neuroectodermal Tumors
- Neoplasms, Germ Cell and Embryonal
- Neoplasms, Nerve Tissue
- Colonic Diseases
- Intestinal Diseases
- Intestinal Neoplasms
- Rectal Diseases
- Pancreatic Diseases
- Neuroendocrine Tumors
- Nevi and Melanomas
- Colorectal Neoplasms
- Pancreatic Neoplasms
- Melanoma
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Enzyme Inhibitors
- Antirheumatic Agents
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Antineoplastic Agents, Immunological
- Angiogenesis Inhibitors
- Angiogenesis Modulating Agents
- Growth Substances
- Growth Inhibitors
- Antiprotozoal Agents
- Antiparasitic Agents
- Antimalarials
- Bevacizumab
- Leflunomide
- Hydroxychloroquine
Other Study ID Numbers
- LS01
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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.
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