A Phase 1/2, Open-Label, Safety, Tolerability, Pharmacokinetics, and Anti-Tumor Activity Study of Repotrectinib in Pediatric and Young Adult Subjects With Advanced or Metastatic Malignancies Harboring ALK, ROS1, NTRK1-3 Alterations
Summary
Phase 1 will evaluate the safety and tolerability at different dose levels of repotrectinib in pediatric and young adult subjects with advanced or metastatic malignancies harboring anaplastic lymphoma kinase (ALK), receptor tyrosine kinase encoded by the gene ROS1 (ROS1), or neurotrophic receptor kinase genes encoding TRK kinase family (NTRK1-3) alterations to estimate the Maximum Tolerated Dose (MTD) or Maximum Administered Dose (MAD) and select the Pediatric Recommended Phase 2 Dose (RP2D). Phase 2 will determine the anti-tumor activity of repotrectinib in pediatric and young adult subjects with advanced or metastatic malignancies harboring ROS1 or NTRK1-3 alterations.
Detailed description
Enrollment of subjects into Phase 1 will proceed concurrently by age as follows: * Subjects \<12 years old will initially be enrolled in the Phase 1 part to determine the pediatric RP2D for this age group; once the pediatric RP2D is determined, subjects age \<12 years old may be enrolled into the Phase 2 part of the study. * Subjects 12 to 25 years old will be directly enrolled into the Phase 2 part concurrent with Phase 1 enrollment. Phase 1: Approximately 12 pediatric subjects with locally advanced or metastatic solid tumors, including a primary central nervous system (CNS) tumor, or anaplastic large cell lymphoma (ALCL), with disease progression or who are non-responsive or intolerant to available therapies and for which no standard or available curative therapy exists. Phase 2: Subjects will be enrolled in one of 3 cohorts as follows: Cohort 1: approximately 10-20 subjects with solid tumors characterized by NTRK fusion, TRK tyrosine kinase inhibitor (TKI)-naïve, and centrally confirmed measurable disease at baseline. Cohort 2: approximately 23 subjects with solid tumors characterized by NTRK fusion, TRK TKI-pretreated, and centrally confirmed measurable disease at baseline. Cohort 3: approximately 20 subjects with solid tumors or ALCL characterized by other ALK/ROS1/NTRK alterations or NTRK fusions without centrally confirmed measurable disease not otherwise eligible for Cohort 1 or 2. As of the current protocol amendment, only patients with ROS1 alterations will be enrolled to this cohort.
Arms & interventions
- DrugOral repotrectinib (TPX-0005)
Oral repotrectinib (TPX-0005)
Outcome measures
Primary
Dose limiting toxicities (DLTs) (Phase 1)
Define the dose limiting toxicities (DLTs) (Phase 1)
Time frame: Within 28 days of the first repotrectinib dose
Pediatric Recommended Phase 2 Dose (RP2D) (Phase 1)
To determine the pediatric RP2D (Phase 1)
Time frame: Within 28 days of the last patient dosed in escalation
Overall Response Rate (ORR) (Phase 2)
To determine the confirmed ORR of repotrectinib (TPX-0005) as assessed by Blinded Independent Central Review (Phase 2)
Time frame: Two to three years after first dose of repotrectinib
Secondary
Overall Response Rate (ORR) (Phase 1)
Time frame: Approximately three years
Clinical Benefit Rate (CBR) (Phase 1 and Phase 2)
Time frame: Approximately three years
Time to response (TTR) (Phase 1 and Phase 2)
Time frame: Approximately three years
Duration of response (DOR) (Phase 1 and Phase 2)
Time frame: Approximately three years
Intracranial objective response rate (IC-ORR) (Phase 1 and Phase 2)
Time frame: Approximately three years
Central Nervous System Progression-Free Survival (CNS-PFS) (Phase 2)
Time frame: Approximately three years
Progression-free survival (PFS) (Phase 2)
Time frame: Approximately three years
Overall survival (OS) (Phase 2)
Time frame: Approximately three years
Maximum concentration of repotrectinib in plasma (Cmax)
Time frame: Pre-dose and up to 24 hours post-dose on Day 1 and Day 15 in Cycle 1 (each cycle is 28 days)
Area under the concentration versus time curve of repotrectinib in plasma (AUC)
Time frame: Pre-dose and up to 24 hours post-dose on Day 1 and Day 15 in Cycle 1 (each cycle is 28 days)
Eligibility criteria
Study locations (20)
Children's Hospital Los Angeles
Los Angeles, California, 90027-6062
University of California at Los Angeles
Los Angeles, California, 90095
Children's Hospital Colorado - Anschutz Medical Campus
Aurora, Colorado, 80045
Local Institution - 2105
Orlando, Florida, 32806
Local Institution - 2120
Orlando, Florida, 32827
Children's Healthcare of Atlanta - Egleston Hospital
Atlanta, Georgia, 30329
Maine Medical Center
Scarborough, Maine, 04074
Dana Farber Cancer Institute.
Boston, Massachusetts, 02215
Washington University School of Medicine in St. Louis
St Louis, Missouri, 63110
Local Institution - 2110
New Brunswick, New Jersey, 08901
Local Institution - 2102
New York, New York, 10065
Levine Children's Hospital- Pediatric Neuro-Oncology
Charlotte, North Carolina, 28203
Local Institution - 2112
Cleveland, Ohio, 44195
Local Institution - 2114
Hershey, Pennsylvania, 17033
Children's Hospital of Philadelphia-Center for Childhood Cancer Research
Philadelphia, Pennsylvania, 19104
St. Jude Children's Research Hospital
Memphis, Tennessee, 38015
The University of Texas Southwestern Medical Center - Harold C Simmons Comprehensive Cancer Center
Dallas, Texas, 75390
Baylor College of Medicine
Houston, Texas, 77030
Local Institution - 2104
Houston, Texas, 77030
Children's Hospital of Richmond at VCU
Richmond, Virginia, 23219
References
- Wachter F, Al-Ibraheemi A, Trissal MC, Hollowell M, DuBois SG, Collins NB, Church AJ, Janeway KA. Molecular Characterization of Inflammatory Tumors Facilitates Initiation of Effective Therapy. Pediatrics. 2021 Dec 1;148(6):e2021050990. doi: 10.1542/peds.2021-050990.(PubMed)