| Eligibility |
Inclusion Criteria:
1. Be able to provide written informed consent approved by institutional review board
(IRB) or independent ethics committee (IEC).
2. Age =18 years.
3. At the escalation stage, patients should fulfill the following criteria at Screening:
1) Participants with locally advanced or metastatic solid tumors including TNBC,
ER+HER2-BC, ovarian cancer, small cell lung cancer, castrate-resistant prostate cancer
(CRPC), or PDAC with KRAS mutant; Or any other locally advanced or metastatic solid tumor
with evidence of deregulated RB-pathway based on available molecular test results and after
sponsor review to confirm eligibility as determined with prior molecular assays performed
in a CLIA-certified or equivalent laboratory. (Note: ? 0% - 1% of tumor cells expressing ER
or PR as negative while = 1% of tumor cells expressing ER or PR as positive on IHC
staining, recommended by ASCO/CAP guideline Update 2020; negative HER2 is defined as IHC 0
or 1+, or IHC 2+ but confirmed by the negative ISH, recommended by ASCO/CAP Guideline 2018;
? Genes of KRAS and other biomarkers will be detected by the Polymerase Chain Reaction
(PCR) or Next-Generation Sequencing (NGS)); 2) Patients who have progressed on established
standard medical anti-cancer therapies for a given tumor type or have been intolerant to
such therapy, or in the opinion of the investigator have been considered ineligible for a
particular form of standard therapy on medical grounds.
4. At the expansion stage, patients should fulfill the following criteria at Screening :
1)Cohort : TNBC patients progressed on = 2 previous lines of therapy and/or other solid
tumors will receive TY-2699a. ? Previous therapy can be of any nature (chemotherapy,
immunotherapy, antiangiogenics, experimental therapy, etc.); ? Histologically-confirmed
breast carcinoma not expressing ER, PR, and HER2 (negative ER and PR is defined as < 1%
tumor cells expressing ER and PR on IHC staining, recommended by ASCO/CAP Guideline Update
2020; negative HER2 is defined as IHC staining 0 or 1+ , or IHC 2+ but confirmed by the
negative ISH, recommended by ASCO/CAP Guideline 2018; negative HER2 is defined as IHC 0 or
1+, or IHC 2+ but confirmed by the negative ISH, recommended by ASCO/CAP Guideline 2018); ?
With or without BRCA mutation.
5. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, and life
expectancy > 3 months.
6. Capability to swallow intact capsule (without chewing, crushing or opening). 7. At least
1 measurable target lesion according to Response Evaluation Criteria in Solid Tumor Version
1.1 (RECIST v1.1, Appendices 15.2 RECIST v1.1 ) determined by the investigator.
8. All acute toxic effects (excluding alopecia and neuropathy associated with prior
platinum-based drug therapy) of any prior therapy recovered to grade =1 based on NCI CTCAE
v5.0.
9. Baseline laboratory results fulfilling the following requirements: Absolute neutrophils
count (ANC) =1500/mm3 (1.5×109/L) * Platelets =100,000/mm3 (100×109/L) * Hemoglobin > 90
g/L* Estimated creatinine clearance =55 mL/min+ Total serum bilirubin <1.5 × ULN <3.0 × ULN
if known Gilbert's disease Liver transaminases (AST/ALT) <2.5 × ULN; <5 × ULN if liver
metastases are present ULN: upper limit normal.
- No blood transfusion, blood products, or hematopoietic factors such as G-CSF,
erythropoietin or albumin within 14 days prior to first dose.
- Cockcroft-Gault Equation. 10. For female patients of childbearing potential, the
serum or urine pregnancy test within 7 days prior to the start of TY-2699a
treatment should be negative.
11. Male and female patients of childbearing potential must agree to use at least
two method of highly effective contraception from signing ICF, throughout the
study and continued for 90 days after the last dose of TY-2699a treatment at the
escalation stage or for the labeled duration of contraception of the combined
approved drug fulvestrant (e.g., FASLODEX requires one-year contraception after
the last dose) or PD-L1 antibody (will decide a brand approved in US before
starting expansion stage) after the last dose at the expansion stage.
12. Willing and able to comply with all aspects of the protocol.
Exclusion Criteria:
1. Concurrent participation in another interventional clinical trial, unless the patient
at long-term follow-up period.
2. Patients with the following treatment:
1. Received undergone major surgery (except minor surgery such as appendicitis,
tumor biopsy, etc.) within 4 weeks prior to the first dose.
2. Received bone marrow (equal to area of pelvis) or extensive radiation therapy
within 28 days prior to the first dose; received local radiation therapy (e.g.,
thoracic spine and rib radiation therapy) within 7 days prior to the first dose
of the study drug.
3. Received CYP3A and CYP2C8 strong inducers/strong inhibitors or p-gp glycoprotein
inhibitors within 14 days prior to the first dose (see Appendices 15.3 Examples
of CYP450-related Drugs/food).
4. History of proton pump inhibitors (PPIs) within 4 days prior to the first dose of
TY-2699a; OR history of histamine H2 blockers within 2 days prior to the first
dose of TY-2699a. Patients who are receiving and require continuation of drug
therapy during the study with drugs known to prolong the QTc interval or that may
cause torsades de pointes.
5. Prior exposure to transcriptional kinase family CDK inhibitors, such as the CDK7
and CDK9 inhibitors SY-5609,CT-7001,Alvocidib,Dinaciclib,Seliciclib and SY-1365.
Exception: Previous exposure to cell cycle CDK inhibitors such as inhibitors of
CDK4 and CDK6 (ie, palbociclib) is allowed.
3. History of other previous cancer (except for squamous cell or basal-cell carcinoma of
the skin, or any in situ carcinoma that has been completely resected), requiring
therapy within the previous 5 years
4. Patients with unstable brain metastases: Patients with CNS complications requiring
urgent neurosurgical treatment (e.g., surgery, etc.) (except when surgery is completed
>7 days and side effects from complications are = grade 1); patients requiring
glucocorticoids, mannitol or diuretics at equivalent doses greater than 4 mg of
dexamethasone to control symptoms of brain metastases within 14 days prior to the
first study dose; patients who have undergone whole brain radiation therapy or gamma
knife within 14 days prior to the first study dose; patients with symptoms of spinal
cord compression from the tumor. Note: conversely, patients with stable CNS metastasis
and those who are beyond the treatment washout period of 14 days per protocol are
eligible to the study.
5. Epilepsy needing treatment; having a history of psychotropic substance abuse that
cannot abstain; have mental disorders (successful abstain must pass at least 2 weeks
without observing withdrawal reaction).
6. Patients receiving long-term systemic immunosuppressant therapy (=10 mg/ day of
prednisone or other equivalent dose of corticosteroid inhalation or topical
administration can be included).
7. Any of the following cardiac criteria:
1. Mean resting corrected QT interval (electrocardiogram interval measured from the
onset of the QRS complex to the end of the T wave) for heart rate QTc > 470 msec
obtained from 3 electrocardiograms, using the screening clinic electrocardiogram
machine derived QTc value.
2. Any clinically important abnormalities in rhythm, conduction, or morphology of
resting electrocardiogram (e.g., complete left bundle branch block, third-degree
heart block, second-degree heart block, PR interval >250 msec). Any factors that
increase the risk of QTc prolongation or risk of arrhythmic events such as heart
failure, hypokalemia, congenital long QT syndrome, family history of long QT
syndrome, or any concomitant medication known to prolong the QT interval during
Screening.
3. Left ventricular ejection fraction (LVEF) <50%;
4. Clinically significant cardiovascular disease (either active at Screening or
within 6 months prior to enrollment): myocardial infarction, unstable angina,
coronary/peripheral artery bypass graft, symptomatic congestive heart failure
(New York Heart Association Classification Class =II), cerebrovascular accident
or transient ischemic attack, stroke, symptomatic bradycardia, or requirement for
anti-arrhythmic medication.
5. Unstable patients that may affect their safety or compliance of study, any
serious or uncontrolled systemic disease including uncontrolled high blood
pressure (systolic blood pressure >160mmHg, or diastolic pressure >100mmHg),
uncontrolled diabetes (fasting plasma glucose >10 mmol/L), active bleeding,
severe eye disease, severe psychosis, nerve, vascular, or respiratory disease.
8. Known active infections, including human immunodeficiency virus (HIV), hepatitis B
virus (HBV), and hepatitis C virus (HCV) infection, except for asymptomatic chronic
HBV or HCV carriers. Active HBV, HCV, or HIV infections are defined as
1. Hepatitis B surface antigen (HBsAg) positive and HBV-DNA = 2000 cps/mL or 500
IU/mL; HBsAg-negative, anti-HBc-positive patients are at high risk of HBV
reactivation who require suppressive antiviral therapy prior to initiation of
cancer therapy
2. Anti-HCV antibody positive and HCV-RNA > upper normal limit defined by sites
3. Anti-HIV antibody positive with uncontrolled opportunistic infections; anti-HIV
antibody positive with CD4+ count < 350 cells/uL that requires HIV therapy prior
to the cancer treatment; other conditions allowing concurrent ART but the therapy
not tolerated and that the toxicities confused with investigational drug
toxicities. Note: Examples of drug-drug interactions that affect absorption,
distribution, metabolism, and excretion of the TY-2699a are shown in Appendices
15.3 Examples of CYP450-related Drugs/food.
9. Diagnosed interstitial lung disease with or without symptoms, as well as conditions
that may cause pulmonary toxicity or related pneumonia after using TY-2699a, or
pulmonary symptoms deemed by the investigator to have high risk of developing
interstitial lung disease. Note: Patients with history of prior radiation pneumonitis
will not be excluded.
10. Active gastrointestinal disease with significant symptoms (e.g., gastric ulcer,
Crohn's disease, ulcerative colitis, short gut syndrome) or other malabsorption
syndromes that will impact in ingesting, transporting, or absorbing the drug.
11. Known/suspected allergy to the composition of TY-2699a or the analogues.
12. Pregnant and breastfeeding women.
13. The Prinicpal Investigator considers that the patient is not suitable to participate
in this study.
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