Study of Ulixertinib for Patients With Advanced Malignancies Harboring MEK or Atypical BRAF Alterations

Advanced Solid Tumor Clinical Trial

Official title:

A Two-Part, Phase II, Multi-center Study of the ERK Inhibitor Ulixertinib (BVD-523) for Patients With Advanced Malignancies Harboring MEK or Atypical BRAF Alterations

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT04488003
• Other study ID #: BVD-523-ABC
• Status: Terminated
• Phase: Phase 2
• Start date: January 7, 2021
• Est. completion date: May 23, 2023

Study information

• Verified date: May 2024
• Source: BioMed Valley Discoveries, Inc
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This BVD-523-ABC study builds on the safety and clinical activity experience of previous studies that have evaluated ulixertinib as a novel targeted cancer treatment in cohorts of patients with specific genetic alterations and tumor histologies that result in aberrant MAPK pathway signaling. Early clinical data have demonstrated anti-tumor activity with ulixertinib treatment and have identified specific groups of patients for whom additional development is warranted.

Description:

This multi-center, phase II study will be conducted in two parts and assess the clinical benefit, safety, pharmacokinetics, and pharmacodynamics of ulixertinib (BVD-523) in patients with advanced malignancies.

Part A (tumor histology agnostic) will be open label and enroll patients to one of six groups based on their tumor alteration. Targeted enrollment per group was 38 patients with a total targeted enrollment of 228 patients. Actual enrollment was total of 104 patients with 77 patients allocated to treatment.

• Group 1: Patients with tumors, other than colorectal cancer (CRC), having a BRAF alteration that results in an amino acid change at positions G469, L485, or L597.

• Group 2: Patients with tumors, other than CRC, having a defined Class 2 BRAF alteration (see Appendix 2 of protocol).

• Group 3: Patients with tumors, other than CRC, having an atypical BRAF alteration (non V600) that is not specified in Group 1 or Group 2.

• Group 4: Patients with CRC having any atypical BRAF alteration.

• Group 5: Patients with tumors, other than CRC, harboring alterations in MEK1/2.

• Group 6: Patients with CRC harboring alterations in MEK1/2.

Part B (tumor histology specific) will randomly enroll patients with one of up to three specified tumor histologies to receive either ulixertinib or the physician's choice of treatment in a 2:1 ratio. Tumors must harbor a specified MEK or atypical BRAF alteration. If a patient progresses on physician's choice of treatment, crossover to the ulixertinib arm is permitted.The specific histologies to be included in this part will be selected based on available data and discussion with the clinical investigators, the medical monitor, and the sponsor. Total enrollment was targeted to approximately 80-100 patients per histology with up to three histologies included; however, the study was terminated prior to any patients enrolling in Part B.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 104
• Est. completion date: May 23, 2023
• Est. primary completion date: February 15, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Patients with a locally advanced or metastatic malignancy, that has progressed following systemic therapy for their disease, if available, or for which the patient is not a candidate or refuses.

• Tumors harboring a MEK or atypical BRAF alteration.

• Provide signed and dated informed consent prior to initiation of any study-related procedures that are not considered standard of care (SoC).

• Male or female patients aged =18 years.

• Patients must have measurable disease by RECIST version 1.1.

• Eastern Cooperative Oncology Group (ECOG) performance status of 0 - 2.

• Adequate renal function [creatinine =1.5 times ULN (upper limit of normal)] or a glomerular filtration rate (GFR) of =50 mL/min (using Cockcroft-Gault).

• Adequate hepatic function [total bilirubin =1.5 times ULN; AST (aspartate transaminase) and ALT (alanine transaminase) =3 times ULN or =5 times ULN if the elevation is due to liver involvement by tumor].

• Adequate bone marrow function (hemoglobin =9.0 g/dL; platelets =100 x 109 cells/L; absolute neutrophil count =1.5 x 109 cells/L).

• Adequate cardiac function: Left ventricular ejection fraction (LVEF) of >50% as assessed by multi-gated acquisition (MUGA) or ultrasound/echocardiography (ECHO); and a corrected QT interval (QTc) <480ms by the Fridericia method (QTcF).

• Contraception - women: Negative pregnancy test for females of child-bearing potential; must be surgically sterile, postmenopausal (no menstrual cycle for at least 12 consecutive months), or compliant with a medically approved contraceptive regimen during and for 3 months after the last administration of study drug. Abstinence is not considered an adequate contraceptive regimen.

• Contraception - men: Must be surgically sterile, or compliant with a medically approved contraceptive regimen during and for 3 months after the last administration of study drug.

• Willing and able to participate in the trial and comply with all trial requirements.

• 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 agent may be included after consultation with the medical monitor.

Exclusion Criteria:

• Gastrointestinal (GI) condition that could impair absorption of study medication (specific cases e.g., remote history of GI surgery, may be enrolled after discussion with the medical monitor) or inability to ingest study medication.

• Uncontrolled or severe intercurrent medical condition.

• Known uncontrolled brain metastases. Stable brain metastases either treated or being treated with a stable dose of steroids/anticonvulsants, with no dose change in the previous 4 weeks, can be allowed.

• Having received any cancer-directed therapy (chemotherapy, hormonal therapy, biologic or immunotherapy, etc.) within 28 days or 5 half-lives (whichever is shorter) prior to the first dose of study drug. Patients previously treated with radiotherapy must have recovered from the acute toxicities associated with such treatment.

• Major surgery within 4 weeks prior to first dose.

• Any use of an investigational drug within 28 days or 5 half-lives (whichever is shorter) prior to the first dose of study drug. A minimum of 10 days between termination of the prior investigational drug and administration of study drug is required. In addition, any drug-related toxicity except alopecia should have recovered to Grade 1 or less.

• Prior therapy with any ERK inhibitor (e.g. LY3214996, LTT462).

• Groups 1-4: Prior therapy with any BRAF and/or MEK inhibitor (e.g. encorafenib, dabrafenib, vemurafenib, binimetinib, trametinib, cobimetinib) is excluded. Prior BRAF and/or MEK inhibitor therapy is permitted for Groups 5 and 6.

• For Part B, agents targeting BRAF or MEK kinases and experimental agents are not permitted as physician's choice

• Pregnant or breast-feeding women.

• Any evidence of serious active infections. Patients are allowed to enroll if they have been fever-free for at least 48 hours and are on an active treatment that is not prohibited in Appendix 1 of the protocol.

• Any important medical illness or abnormal laboratory finding that would increase the risk of participating in this study (based on the investigator's judgment).

• A history or current evidence/risk of retinal vein occlusion (RVO) or central serous retinopathy (CSR).

• Concurrent therapy with any other investigational agent.

• Concurrent therapy with drugs known to be strong inhibitors or inducers of CYP1A2, CYP2D6, and CYP3A4.

Related Conditions & MeSH terms

• Advanced Solid Tumor
• BRAF Gene Alteration
• BRAF Gene Mutation
• MAP2K1 Gene Alteration
• MAP2K1 Gene Mutation
• MAP2K2 Gene Alteration
• MAP2K2 Gene Mutation
• MEK Alteration
• MEK Mutation
• Neoplasms

Intervention

Drug:
• Ulixertinib
Oral, 600 mg, twice daily, for 28-days in each treatment cycle
• Physician's Choice
Physician's choice will be restricted to two approved (not off-label) treatments for each tumor histology (agents targeting BRAF or MEK kinases and experimental agents are not permitted as physician choice)).

Locations

Country	Name	City	State
United States	Massachusetts General Hospital	Boston	Massachusetts
United States	Montefiore Medical Center	Bronx	New York
United States	Duke University Medical Center / Duke Cancer Institute	Durham	North Carolina
United States	Virginia Cancer Specialists, PC	Fairfax	Virginia
United States	University of Florida	Gainesville	Florida
United States	MD Anderson Cancer Center	Houston	Texas
United States	Mayo Clinic	Jacksonville	Florida
United States	Kettering Cancer Center	Kettering	Ohio
United States	University of Wisconsin Clinical Science Center	Madison	Wisconsin
United States	Marshfield Medical Center	Marshfield	Wisconsin
United States	Tennessee Oncology, PLLC - Sarah Cannon (SCRI)	Nashville	Tennessee
United States	Columbia University Irving Medical Center	New York	New York
United States	Christiana Care Health Services / Helen F. Graham Cancer Center	Newark	Delaware
United States	Hoag Memorial Hospital Presbyterian	Newport Beach	California
United States	Mayo Clinic	Phoenix	Arizona
United States	UPMC Hillman Cancer Center	Pittsburgh	Pennsylvania
United States	Mayo Clinic	Rochester	Minnesota
United States	Washington University School of Medicine - Siteman Cancer Center	Saint Louis	Missouri
United States	Metro-Minnesota Community Oncology Research Consortium (MMCORC)	Saint Louis Park	Minnesota
United States	University of Washington/Seattle Cancer Care Alliance	Seattle	Washington
United States	Avera Cancer Institute	Sioux Falls	South Dakota
United States	Johns Hopkins Sibley Memorial Hospital	Washington	District of Columbia

Sponsors (1)

Lead Sponsor	Collaborator
BioMed Valley Discoveries, Inc

Country where clinical trial is conducted

United States, 

References & Publications (2)

Germann UA, Furey BF, Markland W, Hoover RR, Aronov AM, Roix JJ, Hale M, Boucher DM, Sorrell DA, Martinez-Botella G, Fitzgibbon M, Shapiro P, Wick MJ, Samadani R, Meshaw K, Groover A, DeCrescenzo G, Namchuk M, Emery CM, Saha S, Welsch DJ. Targeting the MAPK Signaling Pathway in Cancer: Promising Preclinical Activity with the Novel Selective ERK1/2 Inhibitor BVD-523 (Ulixertinib). Mol Cancer Ther. 2017 Nov;16(11):2351-2363. doi: 10.1158/1535-7163.MCT-17-0456. Epub 2017 Sep 22. — View Citation

Sullivan RJ, Infante JR, Janku F, Wong DJL, Sosman JA, Keedy V, Patel MR, Shapiro GI, Mier JW, Tolcher AW, Wang-Gillam A, Sznol M, Flaherty K, Buchbinder E, Carvajal RD, Varghese AM, Lacouture ME, Ribas A, Patel SP, DeCrescenzo GA, Emery CM, Groover AL, Saha S, Varterasian M, Welsch DJ, Hyman DM, Li BT. First-in-Class ERK1/2 Inhibitor Ulixertinib (BVD-523) in Patients with MAPK Mutant Advanced Solid Tumors: Results of a Phase I Dose-Escalation and Expansion Study. Cancer Discov. 2018 Feb;8(2):184-195. doi: 10.1158/2159-8290.CD-17-1119. Epub 2017 Dec 15. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Part A: Overall Response Rate (ORR) According to RECIST 1.1	ORR will be defined as the percentage of patients achieving a Best Overall Response (BOR) of confirmed Complete Response (CR) and/or Partial Response (PR). Patients will be evaluated at baseline & at periodic follow-up visits through the time their participation in the study is complete.The best responses will occur at different time points for each patient.	Up to 25 months
Secondary	Part A: Progression Free Survival (PFS) According to RECIST 1.1	PFS will be defined as time from first day of study drug to disease progression or death. Patients with no event will be censored at the last available tumor assessment. This analysis will be based on investigator assessment.	18 months
Secondary	Part A: Overall Survival (OS) According to RECIST 1.1	OS will be defined as time from first day of study drug to death. Patients with no event will be censored at the last date the patient is known to be alive.	18 months
Secondary	Part A: Pharmacokinetic Concentration of BVD-523 at Steady State	Single time point taken prior to taking study drug (trough) at steady state. Steady state is defined as patients who have received at least 5 days, or 10 consecutive doses, of study drug.	Single time point drawn at Visit 4/approximately day 15 (or whenever the patient reaches steady state).

External Links

•   BioMed Valley Discoveries