MPH966 for Prevention of Graft-versus-host Disease After Allogeneic Hematopoietic Stem Cell Transplantation

Hematologic Malignancy Clinical Trial

Official title:

A Phase 1/2 Study of MPH966, an Oral Neutrophil Elastase Inhibitor, for Prevention of Graft-versus-host Disease After Allogeneic Hematopoietic Stem Cell Transplantation

Clinical Trial Details — Status: Withdrawn

Administrative data

• NCT number: NCT03986086
• Other study ID #: Pro00102362
• Status: Withdrawn
• Phase: Phase 1/Phase 2
• Start date: September 2021
• Est. completion date: December 2023

Study information

• Verified date: March 2020
• Source: Duke University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is evaluate the safety and tolerability of MPH966, a neutrophil elastase inhibitor, and its ability to prevent graft-versus-host disease after hematopoietic stem cell transplant.

Description:

Phase 1 is a 3+3 dose escalation study to determine the safety and recommended phase 2 dose (RP2D) of MPH966 in patients undergoing allogeneic hematopoietic stem cell transplantation (HCT). We will evaluate up to 4 doses: 60 mg po bid, 120 mg po bid, 180 mg po bid, and 240 mg po bid. Safety, tolerability, and efficacy will be assessed in real time and pharmacokinetics and pharmacodynamics after each dose cohort before escalating to the next cohort.

Phase 2 is a randomized, double-blind, placebo-controlled study to determine the clinical efficacy of MPH966 vs. placebo in preventing acute graft-versus-host disease (GVHD) after HCT, using the RP2D as determined by the phase 1 trial.

Recruitment information / eligibility

• Status: Withdrawn
• Enrollment: 0
• Est. completion date: December 2023
• Est. primary completion date: December 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

1. Provision of written informed consent prior to any study specific procedures

2. Plan to undergo allogeneic HCT for any cancer or non-cancer illness with a planned cell dose of =2 x 106 CD34/kg using peripheral blood stem cells.

3. Plan to receive a myeloablative conditioning regimen (see 4.3.1).

4. Plan to receive GVHD prophylaxis with tacrolimus and methotrexate.

5. Having a donor who is a 10 of 10 HLA match;

6. Karnofsky Performance Scale KPS =60

7. Willing to abstain from sexual activity or use two methods of birth control while on study drug and for 5 half-lives (4 days) after last dose.

Exclusion Criteria:

1. If female, pregnant or nursing.

2. Life expectancy <6 months

3. Other malignancy or neoplastic disease (i.e. aside from the malignancy for which they are undergoing HCT) within the past 5 years with the exception of treated basal/squamous cell skin carcinoma or treated cervical cancer in situ

4. Clinically significant active infection within 1 week of starting study drug

5. Any of the following organ system function criteria:

1. Cardiac: Ejection fraction =40% or myocardial infarction within 6 months of transplant or QTc >450 msec for males and >470 msec for females or other EKG abnormality which in the opinion of the investigator may put the subject at risk or interfere with study assessments

2. Renal: Creatinine clearance (CLcr) = 60 mL/min as estimated by the Cockcroft-Gault equation

3. Pulmonary: FEV1, FVC, or corrected DLCO =40% predicted (forced expiratory volume in 1 second; forced vital capacity; and diffusing capacity of the lung for carbon monoxide, respectively)

4. Hepatic: Total bilirubin >1.5 x (in the absence of known inherited hyperbilirubinemia, e.g. Gilbert's) and/or aspartate transaminase (AST)/alanine transaminase (ALT) >3 x upper limit of institutional normal for age (grade 2 or higher) and/or INR >1.5 (unless on anticoagulant), or history or evidence of cirrhosis (e.g. esophageal varices, ascites, or hepatic encephalopathy) or other chronic liver disease (e.g. Wilson's disease, autoimmune liver disease, primary biliary cirrhosis, etc.). Abnormalities in platelet number or albumin will not be considered exclusion criteria given that these are often due to the hematologic malignancy for which the patient is undergoing HCT rather than actual liver dysfunction

5. Uncontrolled infection, including detection of hepatitis B virus (HBV) or hepatitis C virus (HCV) by serology or nucleic acid testing or HIV by polymerase chain reaction (PCR)

i. Treated HBV/HCV/HIV with documented clearance is ok f. Other significant organ dysfunction (cardiac, pulmonary, renal, metabolic or central nervous system) that is uncontrolled and may interfere with study completion

6. Any significant medial history of alcohol abuse within 3 months of starting study drug and/or unwillingness to abstain for the duration of the study and follow up periods

7. Prior (within 30 days) or concomitant use of another neutrophil elastase inhibitor (e.g. alpha-1 antitrypsin)

8. Plan for in vivo or ex vivo T cell depletion.

9. Participated in another clinical study involving an investigational drug or device within 30 days or 5 half-lives prior to planned start of MPH966/placebo, or scheduled to participate in another clinical study involving an investigational drug or device within Day 100 of transplant

1. If the patient develops GVHD within the first 100 days, they are allowed to enroll on trials of investigational drugs to treat GVHD provided they come off of this study.

2. Enrollment in biorepository or supportive care trials that do not involve investigational drugs or devices is allowed

10. Any clinically relevant abnormal findings in physical examination, vital signs, hematology, clinical chemistry, or urinalysis at visit, which in the opinion of the Investigator, may put the subject at risk because of his/her participation in the study, or may influence the results of the study, or the subject's ability to participate in the study

11. Low or intermediate risk acute leukemia in first complete remission, chronic myeloid leukemia in first chronic phase, and any benign (non-malignant) disorders (phase 1 dose-escalation portion only)

Related Conditions & MeSH terms

• Graft vs Host Disease
• Hematologic Malignancy

Intervention

Drug:
• MPH966
RP2D tablet
• Placebo
MPH966 placebo table

Locations

Country	Name	City	State
United States	Duke University Adult Bone Marrow Transplant Clinic	Durham	North Carolina

Sponsors (3)

Lead Sponsor	Collaborator
Nelson Chao	Mereo BioPharma, National Center for Advancing Translational Science (NCATS)

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Incidence of grade 2-4 acute Graft vs Host Disease (GVHD) requiring systemic therapy		day 100
Secondary	Incidence of grade 2-4 acute GVHD		day 100
Secondary	Incidence of grade 3-4 acute GVHD		day 100
Secondary	Incidence of grade 2-4 acute GVHD		month 6
Secondary	Incidence of grade 3-4 acute GVHD		month 6
Secondary	Kaplan-Meier analysis of time-to-event: percentage of participants who develop grade 2-4 acute GVHD by visit		day 0 and 100 days, 6 months
Secondary	Kaplan-Meier analysis of time-to-event: percentage of participants who develop grade 3-4 acute GVHD by visit		Day 0 and day 100, month 6
Secondary	Incidence of chronic GVHD		month 6
Secondary	Incidence of chronic GVHD		month 12
Secondary	Kaplan-Meier analysis of time-to-event: percentage of participants who develop chronic GVHD	Time to event distributions estimated by the Kaplan-Meier method	Day 0 and month 6, 12
Secondary	Incidence of GVHD-free survival	GVHD-free survival is defined as freedom from GVHD requiring systemic steroids	month 6
Secondary	Incidence of GVHD-free survival	GVHD-free survival is defined as freedom from GVHD requiring systemic steroids	month 12
Secondary	Incidence of relapse-free survival	Relapse-free survival is defined as freedom from relapse	month 6
Secondary	Incidence of relapse-free survival	Relapse-free survival is defined as freedom from relapse	month 12
Secondary	Incidence of bacterial infections		Day 100
Secondary	Incidence of fungal infections		Day 100
Secondary	Incidence of viral infections		Day 100
Secondary	Incidence of overall infections		Day 100
Secondary	Incidence of bacterial infections		6 months
Secondary	Incidence of fungal infections		month 6
Secondary	Incidence of viral infections		month 6
Secondary	Incidence of overall infections		month 6
Secondary	Incidence of bacterial infections		month 12
Secondary	Incidence of fungal infections		month 12
Secondary	Incidence of viral infections		month 12
Secondary	Incidence of overall infections		month 12
Secondary	Kaplan-Meier analysis of time-to-event: percentage of participants who develop bacterial infections		Day 0 and day 100, month 6,12
Secondary	Kaplan-Meier analysis of time-to-event: percentage of participants who develop fungal infections		Day 0 and day 100, month 6,12
Secondary	Kaplan-Meier analysis of time-to-event: percentage of participants who develop viral infections		Day 0 and day 100, month 6,12
Secondary	Kaplan-Meier analysis of time-to-event: percentage of participants who develop overall infections		Day 0 and day 100, month 6,12
Secondary	Incidence of relapse		month 6
Secondary	Incidence of relapse		month 12
Secondary	Kaplan-Meier analysis of time-to-event: percentage of participants who relapse		Day 0 and month 6,12
Secondary	Incidence of non-relapse mortality	Non-relapse mortality is defined as death while in remission from the primary disease	month 6
Secondary	Incidence of non-relapse mortality	Non-relapse mortality is defined as death while in remission from the primary disease	month 12
Secondary	Kaplan-Meier analysis of time-to-event: percentage of participants who experience non-relapse mortality	Non-relapse mortality is defined as death while in remission from the primary disease	Day 0 and month 6,12
Secondary	Incidence of hospital re-admission		Day 100
Secondary	Incidence of hospital re-admission		month 6
Secondary	Incidence of hospital re-admission		month 12
Secondary	Kaplan-Meier analysis of time-to-event: percentage of participants who are re-admitted to the hospital		Day 0 and day 100, month 6,12
Secondary	Length of hospital re-admission		Day 100
Secondary	Length of hospital re-admission		month 6
Secondary	Length of hospital re-admission		month 12
Secondary	Incidence of intensive care unit (ICU) admission		Day 100
Secondary	Incidence of intensive care unit (ICU) admission		month 6
Secondary	Incidence of intensive care unit (ICU) admission		month 12
Secondary	Kaplan-Meier analysis of time-to-event: percentage of participants who are admitted to ICU		Day 0 and month 6,12
Secondary	Length of intensive care unit (ICU) admission		Day 100
Secondary	Length of intensive care unit (ICU) admission		month 6
Secondary	Length of intensive care unit (ICU) admission		month 12
Secondary	Length of stay in days between transplant and discharge to home	To determine the length of stay between transplant (Day 0) and discharge to home for those alive to be discharged home	Day 0 until discharge from hospital, up to 100 days
Secondary	Quality of life as measured by the FACT-BMT assessment		day 30
Secondary	Quality of life as measured by the FACT-BMT assessment		day 100
Secondary	Quality of life as measured by the EQ 5D-5L assessment		Day 30
Secondary	Quality of life as measured by the EQ 5D-5L assessment		Day 100
Secondary	Quality of life as measured by the Lorig Self-Efficacy assessment		Day 30
Secondary	Quality of life as measured by the Lorig Self-Efficacy assessment		Day 100
Secondary	Quality of life as measured by the PG-SGA (patient-generated subjective global assessment)		day 30
Secondary	Quality of life as measured by the PG-SGA (patient-generated subjective global assessment)		day 100
Secondary	Quality of life as measured by the PROMIS-Depression assessment		day 30
Secondary	Quality of life as measured by the PROMIS-Depression assessment		day 100
Secondary	Quality of life as measured by the PROMIS-Anxiety assessment		Day 30
Secondary	Quality of life as measured by the PROMIS-Anxiety assessment		Day 100
Secondary	Quality of life as measured by the PROMIS-Social Isolation assessment		Day 30
Secondary	Quality of life as measured by the PROMIS-Social Isolation assessment		Day 100
Secondary	Quality of life as measured by the PROMIS-Emotional Support assessment		day 30
Secondary	Quality of life as measured by the PROMIS-Emotional Support assessment		Day 100
Secondary	Quality of life as measured by the PROMIS-Cognitive Function assessment		Day 30
Secondary	Quality of life as measured by the PROMIS-Cognitive Function assessment		Day 100
Secondary	Quality of life as measured by the PROMIS-Physical Function assessment		Day 30
Secondary	Quality of life as measured by the PROMIS-Physical Function assessment		Day 100
Secondary	Rate of grade 2 or higher adverse events, causally related during treatment period		Day 75
Secondary	Rate of grade 2 or higher adverse events, causally related during follow up period		Year 1
Secondary	Rate of grade 2 or higher adverse events, non related during treatment period		Day 75
Secondary	Rate of grade 2 or higher adverse events, non related during follow up period		Year 1