Lurbinectedin + Doxorubicin In Leiomyosarcoma

Advanced Soft-tissue Sarcoma Clinical Trial

Official title:

A Phase 1b/2 Trial of Lurbinectedin Plus Doxorubicin in Leiomyosarcoma

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05099666
• Other study ID #: 21-437
• Status: Recruiting
• Phase: Phase 1/Phase 2
• Start date: February 4, 2022
• Est. completion date: July 2025

Study information

• Verified date: March 2024
• Source: Massachusetts General Hospital
• Contact: Gregory Cote, M.D. Ph.D
• Phone: (617)-724-4000
• Email: GCOTE[@]mgh.harvard.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This research study involves the study drug lurbinectedin in combination with doxorubicin.

This research has two parts. The first part is being done to determine the tolerability of lurbinectedin with doxorubicin in people with soft tissue sarcoma. The second part is a randomized study to determine which is more effective at treating leiomyosarcoma, lurbinectedin with doxorubicin or lurbinectedin alone.

Description:

This is an open label phase 1b/2 study exploring the safety and efficacy of lurbinectedin with doxorubicin.

• The phase 1b trial will follow a standard 3+3 design. Upon determination of the maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D) of lurbinectedin plus doxorubicin, the randomized phase 2 trial in participants with advanced leiomyosarcoma (LMS) will commence. Participants will be randomized 1:1 for enrollment to one of two treatment arms:

• Arm 1: Lurbinectedin with Doxorubicin

• Arm 2: Doxorubicin Monotherapy

This is a Phase Ib/II clinical trial. A Phase Ib clinical trial tests the safety of an investigational drug combination and also tries to define the appropriate dose of the investigational drugs to use for further studies. "Investigational" means that the drugs are being studied.

The U.S. Food and Drug Administration (FDA) has not approved lurbinectedin for this specific disease but it has been approved for the treatment of small cell lung cancer.

The U.S. FDA has approved doxorubicin as a treatment option for soft-tissue sarcoma.

Lurbinectedin is a synthetically derived chemical that binds to DNA. The binding to DNA likely induces cell death. Doxorubicin is a cytotoxic chemotherapy drug that kills cancer cells by several mechanisms including binding to DNA.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 62
• Est. completion date: July 2025
• Est. primary completion date: July 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• For Enrollment to Phase 1b: Participants must have histologically confirmed advanced or metastatic soft-tissue sarcoma and no curative multimodality treatment options available.

• For Enrollment to Phase 2: Participants must have histologically confirmed advanced or metastatic leiomyosarcoma (LMS) and no curative multimodality treatment options available.

• Participants must have measurable disease per RECIST 1.1 criteria

• Age = 18 years. Because no dosing or adverse event data are currently available on the use of lurbinectedin in combination with doxorubicin in participants <18 years of age, children are excluded from this study, but will be eligible for future pediatric trials.

• ECOG performance status = 2 (Karnofsky = 60%,).

• Participants must have adequate organ and marrow function as defined below:

• Absolute Neutrophil Count = 1,500/mcL

• Hemoglobin (Hgb) = 8 g/dl (transfusion support permitted)

• Platelet Count = 100,000/mcL

• Total Bilirubin = 1.5 × institutional upper limit of normal (ULN)

• AST (SGOT) / ALT(SGPT) = 2.5 × institutional ULN, OR = 5 × institutional ULN if elevation is a result of metastases

• Creatinine = 1.5 × institutional ULN, OR Creatinine Clearance = 60 mL/min/1.73 m2 for participants with creatinine levels above 1.5 × institutional normal (calculated via the Cockcroft-Gault equation)

• Creatine Phosphokinase (CPK)< 2.5 × institutional ULN on two different determinations performed one week (± 1 day) apart

• For participants with known chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated.

• Participants with a known history of hepatitis C virus (HCV) infection must have been treated and cured. For participants with known HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load.

• Left ventricular ejection fraction (LVEF) = 50% on screening echocardiogram (ECHO) or multigated acquisition (MUGA) scan.

• The effects of lurbinectedin or doxorubicin on the developing human fetus are unknown. For this reason and because anti-cancer agents are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men and women treated or enrolled on this protocol must agree to use adequate contraception prior to the study, for the duration of study participation, and 6 months after completion of study agent administration.

• Ability to understand and the willingness to sign a written informed consent document.

• Participants must have archival tissue available for analysis in the form of a formalin-fixed paraffin embedded (FFPE) block or unstained slides. Participants without archival tissue available may be enrolled with approval of the Sponsor-Investigator. Note: confirmation of availability of archival tissue is the only requirement for eligibility, archival tissue does not need to be received by the study team or site prior to enrollment.

• Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen as assessed by the treating investigator may be included with the approval of the Sponsor-Investigator.

Exclusion Criteria:

• Participants who have received prior anthracycline or trabectedin (Yondelis, ET-743), including prior exposure to doxorubicin or liposomal doxorubicin.

• Participants who have received more than 2 prior lines of cytotoxic chemotherapy for the phase 1b study and no more than 1 prior line of cytotoxic chemotherapy for the phase 2 study. There is no limit on the number of prior lines of non-cytotoxic chemotherapy (e.g., pazopanib, immunotherapy).

• Prior exposure to lurbinectedin (PM01183).

• Participants who have received prior radiation treatment of > 45 Gy to the pelvis.

• Participants who have received or undergone prior chemotherapy within 14 days of cycle 1 day 1, therapeutic radiation therapy within 21 days of cycle 1 day 1 or major surgery within 21 days of cycle 1 day 1.

• Participants who have received prior palliative radiation therapy within 7 days of cycle 1 day 1.

• Participants who have received prior antibody-based therapy (e.g., nivolumab) within 4 weeks or 3 half-lives (whichever is shorter) of cycle 1 day 1.

• Participants who have received prior oral small molecule or tyrosine kinase inhibitor (TKI) therapy within 2 weeks or 3 half-lives (whichever is shorter) of cycle 1 day 1.

• Participants who have not recovered to = Grade 1 or baseline from adverse events attributed to any prior anti-cancer therapy, with the exceptions of alopecia, controlled endocrine toxicity (e.g., hypothyroidism), and cutaneous toxicity which will be permitted at Grade 2.

• Participants who are receiving any other investigational agents.

• Participants with known CNS disease involvement, with the exception of patients with brain metastases that have been previously treated and have remained stable on MRI = 28 days prior to cycle 1 day 1 without use of steroids or anti-epileptic medications.

• History of allergic reactions attributed to compounds of similar chemical or biologic composition to lurbinectedin or doxorubicin.

• Participants receiving any medications or substances that are strong or moderate inhibitors or inducers of CYP3A, CYP2D6, or P-gp are ineligible. Because the lists of these agents are constantly changing, it is important to regularly consult a frequently updated medical reference. As part of the enrollment/informed consent procedures, the participant must be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the participant is considering a new over-the-counter medicine or herbal product.

• Uncontrolled intercurrent illness including, but not limited to: ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, chronic indwelling drains, or psychiatric illness/social situations that would limit compliance with study requirements.

• History of interstitial pneumonitis or pulmonary fibrosis.

• Known cardiomyopathy.

• Pregnant women are excluded from this study because lurbinectedin and doxorubicin are anti-cancer agents with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with lurbinectedin or doxorubicin, breastfeeding must be discontinued if the mother is treated with lurbinectedin or doxorubicin. A negative pregnancy test is required for women of childbearing potential prior to the first dose of study medication.

• Immunocompromised patients, including patients who are known to be seropositive for human immunodeficiency virus (HIV) due to the increased risk of lethal infections when treated with marrow-suppressive therapy. HIV testing is not required as part of screening.

Related Conditions & MeSH terms

• Advanced Leiomyosarcoma
• Advanced Soft-tissue Sarcoma
• Leiomyosarcoma
• Leiomyosarcoma Metastatic
• Metastatic Soft-tissue Sarcoma
• Sarcoma

Intervention

Drug:
• Lurbinectedin
Dosage per protocol, escalation per protocol, IV over 60 minutes (± 5 minute infusion window), schedule per protocol
• Doxorubicin
Dosage per protocol, IV per institutional standards of practice and the FDA package insert, schedule per protocol

Locations

Country	Name	City	State
United States	Dana Farber Cancer Institute	Boston	Massachusetts
United States	Massachusetts General Hospital	Boston	Massachusetts
United States	Mayo Jacksonville	Jacksonville	Florida
United States	Memorial Sloan Kettering	New York	New York
United States	Mayo Arizona	Phoenix	Arizona
United States	Mayo Rochester	Rochester	Minnesota

Sponsors (2)

Lead Sponsor	Collaborator
Massachusetts General Hospital	Jazz Pharmaceuticals

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The maximum tolerated dose (MTD) of lurbinectedin with doxorubicin in participants with advanced soft-tissue sarcoma	The MTD will be defined as the dose where less than 1 in 3 patients experience a DLT. At least 6 patients must be treated at this dose level. DLTs will be defined as toxicities experienced by participants enrolled to the phase 1b portion of the trial that are considered at least possibly related to the treatment regimen, occur during the first cycle of treatment.	21 Days
Primary	PFS rate of lurbinectedin with doxorubicin compared to doxorubicin alone in participants with advanced LMS	Progression-Free Survival (PFS) is defined as the time from randomization (or registration) to the earlier of progression or death due to any cause. Participants alive without disease progression are censored at date of last disease evaluation.	Up to 5 years
Secondary	Disease Control Rate Phase 1b	Response and progression will be evaluated in this study using the new international criteria proposed by the Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1) Changes in the largest diameter (unidimensional measurement) of the tumor lesions and the shortest diameter in the case of malignant lymph nodes are used in the RECIST criteria	6 Months
Secondary	Disease Control Rate Phase 1b	Response and progression will be evaluated in this study using the new international criteria proposed by the Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1) Changes in the largest diameter (unidimensional measurement) of the tumor lesions and the shortest diameter in the case of malignant lymph nodes are used in the RECIST criteria	12 Months
Secondary	Progression Free Survival Phase 1b	PFS is defined as the time from as the time from randomization (or registration) to the earlier of progression or death due to any cause, whichever occurs first	Up to 5 years
Secondary	Overall Survival Phase 1b	OS is defined as the time from randomization (or registration) to death due to any cause, or censored at date last known alive.	Up to 5 years
Secondary	Objective Response Phase 1b	assessed by RECIST version 1.1 criteria	Up to 5 years
Secondary	Disease Control Rate Phase 2	Response and progression will be evaluated in this study using the new international criteria proposed by the Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1) Changes in the largest diameter (unidimensional measurement) of the tumor lesions and the shortest diameter in the case of malignant lymph nodes are used in the RECIST criteria	6 Months
Secondary	Disease Control Rate Phase 2	Response and progression will be evaluated in this study using the new international criteria proposed by the Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1) Changes in the largest diameter (unidimensional measurement) of the tumor lesions and the shortest diameter in the case of malignant lymph nodes are used in the RECIST criteria	12 Months
Secondary	Overall Survival Rate Phase 2	OS is defined as the time from randomization (or registration) to death due to any cause, or censored at date last known alive.	Up to 5 years
Secondary	Objective Response Rate Phase 2	assessed by RECIST version 1.1 criteria	Up to 5 years
Secondary	Number of Participants Treatment Related Adverse Events	NCI Common Terminology Criteria for Adverse Events (CTCAE) version 5.0	Up to 5 years