Belumosudil for the Pre-emptive Treatment of Patients With Chronic Graft Versus Host Disease

Chronic Graft Versus Host Disease Clinical Trial

Official title:

Randomized Phase II Study of Belumosudil vs. Placebo for Preemptive Treatment of Chronic Graft Versus Host Disease

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05996627
• Other study ID #: RG1123523
• Secondary ID: NCI-2023-05293RG
• Status: Recruiting
• Phase: Phase 2
• Start date: December 6, 2023
• Est. completion date: December 31, 2027

Study information

• Verified date: May 2024
• Source: Fred Hutchinson Cancer Center
• Contact: Chloe Te
• Phone: 206-667-4196
• Email: cte[@]fredhutch.org
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This phase II trial compares the effect of belumosudil to a placebo in treating patients with chronic graft versus host disease. Chronic graft versus host disease remains a major complication of stem cell transplantation and can involve multiple organ systems. Belumosudil is a ROCK2 selective inhibitor that works to reduce the immune system response causing the chronic graft versus host disease. Giving belumosudil may better treat patients with chronic graft versus host disease and prevent the need for starting additional immune suppressive medications.

Description:

OUTLINE: Patients are randomized to 1 of 2 arms. ARM I: Patients receive belumosudil orally (PO) daily (QD) or twice daily (BID) if taken with strong CYP3A inducers or proton pump inhibitors for days 1 through 28 of each cycle. Cycles repeat every 28 days for a total of 11 cycles, followed by one cycle of tapering prior to discontinuation, in the absence of disease progression or unacceptable toxicity. ARM II: Patients receive a placebo PO QD or BID if taken with strong CYP3A inducers or proton pump inhibitors for days 1 through 28 of each cycle. Cycles repeat every 28 days for a total of 11 cycles, followed by one cycle of tapering prior to discontinuation, in the absence of disease progression or unacceptable toxicity. Patients undergo blood sample collection on study. Patients follow up after completion of study medication at 30 days, and at 60 days if 12 cycles are completed.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 82
• Est. completion date: December 31, 2027
• Est. primary completion date: May 31, 2027
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• At least one diagnostic or distinctive cGVHD manifestation(s), with a clinical diagnosis of cGVHD,but patients do not need to meet National Institute of Health (NIH) criteria for cGVHD
• If eye involvement only, cGVHD must be confirmed on exam by an ophthalmologist or optometrist
• No new immune suppressive therapy added within preceding 2 weeks prior to study enrollment for any indication
• Continuation of agents previously given as either GVHD prophylaxis or acute/late acute GVHD therapy are permitted. Modification of dose of these agents for targeting of therapeutic drug levels is permitted, as are decreases in existing prednisone dose based on routine clinical tapering practices. Increases in prednisone are not allowed in the 2 weeks prior to enrollment
• Age 18 and older
• Karnofsky performance score >= 70
• Able to take oral medications
• Signed informed consent
• Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 3 x upper limit of normal (ULN)
• Total bilirubin =< 1.5 x ULN
• Glomerular filtration rate (GFR) >= 30 mL/min/1.73 m^2
• Female subjects of childbearing potential have a negative serum or urine pregnancy test at screening. Females of childbearing potential are defined as sexually mature females without prior hysterectomy or who have had any evidence of menses in the past 12 months. However, females who have been amenorrheic for 12 or more months are still considered to be of childbearing potential if the amenorrhea is possibly due to prior chemotherapy, anti-estrogens, or ovarian suppression
• Sexually active females of childbearing potential enrolled in the study must agree to use two forms of accepted methods of contraception during the course of the study and

for 3 months after their last dose of study drug. Effective birth control includes:

• Intrauterine device (IUD) plus one barrier method
• Stable doses of hormonal contraception for at least 3 months (eg, oral, injectable, implant, transdermal) plus one barrier method
• 2 barrier methods. Effective barrier methods are male or female condoms, diaphragms, and spermicides (creams or gel that contain a chemical to kill sperm); or
• A vasectomized partner
• For male subjects who are sexually active and who are partners of females of childbearing potential: Agreement to use two forms of contraception as per above and to not donate sperm during the treatment period and for at least 3 months after the last dose of study drug
• No evidence of active malignancy

Exclusion Criteria:

• Any systemic immune suppressive treatment for cGVHD (topical or local therapies are allowed)
• Plan to start systemic immune suppressive therapy for cGVHD or increase steroid dose within 14 days after planned start of study medication
• 0.25 mg/kg/day or higher prednisone dose at time of screening
• History of non-compliance that in the investigator's opinion would interfere with study participation
• Uncontrolled psychiatric illness
• Female subject who is pregnant or breast feeding
• Previous therapy with belumosudil
• Known allergy/sensitivity to belumosudil or any other ROCK2 inhibitor
• Treatment with another investigational agent within 28 days (or 5 half-lives, whichever is greater) of enrollment

Related Conditions & MeSH terms

• Bronchiolitis Obliterans Syndrome
• Chronic Graft Versus Host Disease
• Graft vs Host Disease

Intervention

Drug:
• Belumosudil
Given PO

Procedure:
• Biospecimen Collection
Undergo blood sample collection

Other:
• Electronic Health Record Review
Ancillary study

Drug:
• Placebo Administration
Given PO

Locations

Country	Name	City	State
United States	Dana Farber Cancer Institute	Boston	Massachusetts
United States	Mass General Cancer Center	Boston	Massachusetts
United States	Memorial Sloan Kettering Cancer Center	New York	New York
United States	Fred Hutch/University of Washington Cancer Consortium	Seattle	Washington
United States	Moffitt Cancer Center	Tampa	Florida

Sponsors (2)

Lead Sponsor	Collaborator
Fred Hutchinson Cancer Center	Sanofi

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Time to start of subsequent systemic immune suppressive treatment for chronic graft versus host disease (cGVHD)	Systemic therapies include any systemic agent given for a cGVHD indication, including extracorporeal photopheresis. Will use Gray's test. Point estimates of new systemic immunosuppressive use will be obtained using cumulative incidence estimates.	From first dose of study medication to starting a new systemic immunosuppressive agent for cGVHD therapy, up to 12 months
Secondary	Event-free survival	Point estimates will be obtained using the method of Kaplan and Meier and the log-rank test will be used to assess the difference between treatment groups.	From randomization to death, malignancy relapse or addition of a new systemic immune suppressive therapy, up to 12 months or end of study
Secondary	Overall survival	Point estimates will be obtained using the method of Kaplan and Meier and the log-rank test will be used to assess the difference between treatment groups.	Up to 12 months or end of study
Secondary	Rate of relapse	Point estimates will be obtained using the method of Kaplan and Meier and the log-rank test will be used to assess the difference between treatment groups.	Up to 12 months or end of study