Combination Therapy of RMC-4630 and LY3214996 in Metastatic KRAS Mutant Cancers

Colorectal Cancer Clinical Trial

— SHERPA  

Official title:

Phase I/Ib Study With the Combination of RMC-4630 (SHP2 Inhibitor) and LY3214996 (ERK Inhibitor) in Metastatic KRAS Mutant CRC, PDAC and NSCLC

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04916236
• Other study ID #: M20SHP
• Status: Recruiting
• Phase: Phase 1
• Start date: March 31, 2022
• Est. completion date: July 2024

Study information

• Verified date: June 2022
• Source: The Netherlands Cancer Institute
• Contact: Emile Voest, MD, PhD
• Phone: +31-(0)20 512 9111
• Email: e.voest[@]nki.nl
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a Phase I/Ib study in which the safety of the combination therapy of RMC-4630 and LY3214996 in the treatment of KRAS mutant cancers will be studied.

Description:

This is a phase I / Ib study in which the safety of the combination therapy of RMC-4630 and LY3214996 in the treatment of KRAS mutant cancers colorectal cancer (CRC), non-small cell lung cancer (NSCLC) and pancreatic ductal adenocarcinoma will be studied. The phase I dose-escalation study is designed to identify the recommended phase 2 dose (RP2D) of the combination regimen of RMC-4630 (SHP2-inhibitor) plus LY3214996 (ERK-inhibitor) in patients with KRASm CRC, NSCLC or PDAC. The phase Ib expansion cohort is designed to further characterize the safety of the selected dose from the first stage of the study and to explore the clinical activity of RMC-4630 in combination with LY3214996 in patients with metastatic KRASm PDAC.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 55
• Est. completion date: July 2024
• Est. primary completion date: January 31, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Part A: Histological or cytological proof of advanced KRASm NSCLC, CRC or PDAC; PART B: Histological or cytological proof of advanced KRASm PDAC.

2. Age => 18 years;

3. Able and willing to give written informed consent;

4. WHO performance status of 0 or 1

5. Able and willing to undergo blood sampling for PK and PD analysis;

6. Able and willing to undergo tumor biopsies prior to start (or have undergone a biopsy within 2 months of inclusion), while on study treatment and upon progression of disease;

7. Life expectancy => 3 months and no deterioration or hospitalizations within 2 weeks leading to C1D1, allowing adequate follow up of toxicity evaluation and antitumor activity;

8. Evaluable disease according to RECIST 1.1 criteria; (PART A and PART B);

9. Women of childbearing potential must have a negative serum pregnancy test within 14 days prior to registration and agree to use effective contraceptive methods, as defined in section 5.9.3, through-out the treatment period, and for 4 months after the study treatment

10. Adequate organ system function.

Exclusion Criteria:

1. Part A: No excluded genotypes

Part B: Excluded genotypes (including co occurring mutations):

• NRAS (except G12A/C)
• RASQ61
• KRASG13
• BRAF Class 1, 2, or unclassified
• PIK3CA
• STK11
• KEAP1

2. Any treatment with investigational drugs within 30 days prior to receiving the first dose of investigational treatment;

3. Patients currently using concomitant medication that are strong inhibitors or inducers of CYP3A4;

4. History of another malignancy Exception PART A: Patients who have been disease-free for at least 3 years, or patients with a history of completely resected non-melanoma skin cancer and/or patients with indolent completely resected second malignancies are eligible. Exception PART B: Adequately treated carcinoma in situ of the cervix and adequately treated basal cell carcinoma of the skin.

5. Symptomatic or untreated leptomeningeal disease

6. Symptomatic brain metastasis. Patients previously treated or untreated for these conditions that are asymptomatic in the absence of corticosteroid and anticonvulsant therapy (for at least 4 weeks) are allowed to enroll. Radiotherapy for brain metastasis must have been completed at least 6 weeks prior to start of study treatment. Brain metastasis must be stable with verification by imaging (e.g. brain MRI or CT completed at screening demonstrating no current evidence of progressive brain metastases). Patients are not permitted to receive antiepileptic drugs or corticosteroids.

7. Patients who have had previous treatment with any targeted drug combination known to interfere RAS/MEK/MAPK pathway components.

8. Toxicities related to prior treatments > grade 1 (excluding alopecia)

9. History of interstitial lung disease or pneumonitis

10. Woman who are breast feeding;

11. Patients who have undergone any major surgery within the last 4 weeks prior to starting study drug or who would not have fully recovered from previous surgery.

12. Radio- or chemotherapy within the last 4 weeks prior to receiving the first dose of investigational treatment; except a palliative dose of radiation of 8 Gy, which is allowed up to one week before study start and should not be applied to the target lesion.

13. Uncontrolled infectious disease or known Human Immunodeficiency Virus HIV-1 or HIV-2 type patients;

14. Patients with a known history of or uncontrolled hepatitis B (HBV) or C (HCV);

15. Patients with known alcoholism, drug addiction and/or psychiatric of physiological condition which in the opinion of the investigator would impair study compliance;

16. Patients with cardiac comorbidities (myocardial infarct within 6 months of study start, NYHA class = III, congestive heart failure or instable angina pectoris), uncontrolled hypertension (systolic blood pressure > 160 mm Hg and/or diastolic pressure > 90 mm Hg), prolonged QT interval(> 440 ms for men, > 460 ms for women) or patients who have had a stroke within 6 months prior to start study.

17. Other severe, acute, or chronic medical or psychiatric condition, laboratory abnormality active infections that may increase the risk associated with study participation or study drug administration or that may interfere with the interpretation of study results and, in the judgment of the investigator, would make the patient inappropriate for the study.

18. Patients with pulmonary embolisms or deep venous thrombosis (DVT) within 3 months prior to start

19. Known hypersensitivity to one of the study drugs or excipients.

20. Baseline diarrhea and/or any condition that would impair absorption of oral agents

21. Patient with a history or findings of central or branch retinal artery or venous occlusion with significant vision loss or other retinal diseases that cause current visual impairment or would likely cause visual impairment over the time period of the study, as assessed by an ophthalmologist.

Related Conditions & MeSH terms

• Colorectal Cancer
• KRAS Mutation-Related Tumors
• Non-small Cell Lung Cancer
• Pancreatic Cancer

Intervention

Drug:
• RMC-4630
SHP2-inhibitor Powder in capsule Administered on day 1 and day 2 of every week
• LY3214996
ERK inhibitor Powder in capsule Administered every day

Locations

Country	Name	City	State
Netherlands	Netherlands Cancer Institute - Antoni van Leeuwenhoek	Amsterdam	Noord-Holland

Sponsors (2)

Lead Sponsor	Collaborator
The Netherlands Cancer Institute	Lustgarten Foundation

Country where clinical trial is conducted

Netherlands, 

References & Publications (1)

Mainardi S, Mulero-Sánchez A, Prahallad A, Germano G, Bosma A, Krimpenfort P, Lieftink C, Steinberg JD, de Wit N, Gonçalves-Ribeiro S, Nadal E, Bardelli A, Villanueva A, Bernards R. SHP2 is required for growth of KRAS-mutant non-small-cell lung cancer in — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Phase I - Maximum tolerated dose (MTD)	Maximum Tolerated Dose (MTD) of the combination of RMC-4630 and LY3214996. Dose escalation will follow 3+3 design. The CTCAE criteria will be used to determine if adverse events and lab abnormalities will be accounted as dose limiting toxicity (DLT)	Through study completion, an average of 2 year
Primary	Phase Ib - Clinical activity of the RMC-4630 and LY3214996 combination in patients with KRASm PDAC	Response and progression evaluated using internationally accepted response criteria and definitions proposed by the RECIST criteria	Tumor assessed every 8 weeks through study completion, with an expected average of 4 treatment cycles (each cycle is 28 days)
Secondary	Observed plasma concentrations of RMC-4630 and LY3214996	Blood samples are obtained and plasma concentrations of RMC-4630 and LY3214996 are measured using a validated LC-MS/MS method.	Prior to initial dose on day 1, day 8, day 15, day 22 and 0.5, 1, 2, 4, 8, 24 hours post dose on day 1 and day 15.
Secondary	Area under de plasma - time concentration curve of RMC-4630 and LY3214996	Blood samples are obtained and plasma concentrations of RMC-4630 and LY3214996 are measured using a validated LC-MS/MS method.	Prior to initial dose on day 1, day 15, and 0.5, 1, 2, 4, 8, 24 hours post dose.
Secondary	Elimination half-life of RMC-4630 and LY3214996 (T1/2)	Blood samples are obtained and plasma concentrations of RMC-4630 and LY3214996 are measured using a validated LC-MS/MS method.	Prior to initial dose on day 1, day 15, and 0.5, 1, 2, 4, 8, 24 hours post dose.
Secondary	Total body clearance of RMC-4630 and LY3214996	Blood samples are obtained and plasma concentrations of RMC-4630 and LY3214996 are measured using a validated LC-MS/MS method.	Prior to initial dose on day 1, day 15, and 0.5, 1, 2, 4, 8, 24 hours post dose.
Secondary	Volume of distribution of RMC-4630 and LY3214996	Blood samples are obtained and plasma concentrations of RMC-4630 and LY3214996 are measured using a validated LC-MS/MS method.	Prior to initial dose on day 1, day 15, and 0.5, 1, 2, 4, 8, 24 hours post dose.
Secondary	Baseline molecular status of potential predictive markers of tumor response	Baseline molecular status of potential predictive markers of tumor response wil be studied in tumor biopsies taken before treatment, during treatment and (optional) after treatment using the Ampliseq SOCV1panel	Before start of treatment, during treatment and (optional) after treatment discontinuation with RMC-4630 and LY3214996 with an expected average of 4 treatment cycles (each cycle is 28 days)
Secondary	Pharmacodynamic biomarkers of RMC-4630 and LY3214996	To evaluate pharmacodynamic (PD) biomarkers of the RMC-4630- LY3214996 combination, the expression levels of relevant down-stream proteins are measured in tumor biopsies, using the Ampliseq SOCV1panel. Markers to be assessed include molecular status (mutation/amplification/expression) of markers related to the RAF/MEK/ERK and PI3K/AKT pathway (e.g. BRAF, HRAS, NRAS, KRAS, PIK3CA, PTEN, pS6-RP, c-MET, EGFR, HER-3, pERK, pAKT, pEGFR, and pRSK).	Before start of treatment, during treatment and (optional) after treatment discontinuation with RMC-4630 and LY3214996 with an expected average of 4 treatment cycles (each cycle is 28 days)
Secondary	Potential mechanism of resistance	Potential mechanisms of are studied in tumor biopsies taken before treatment, during treatment and (optional) after treatment using the Ampliseq SOCV1panel	Before start of treatment, during treatment and (optional) after treatment discontinuation with RMC-4630 and LY3214996 with an expected average of 4 treatment cycles (each cycle is 28 days)