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RecruitingInterventionalPhase 1

PIKture-01: First-in-Human Study of the PI3KαH1047R Mutant-Selective Inhibitor OKI-219 as Monotherapy in Participants With Advanced Solid Tumors and as Part of Combination Therapy in Participants With Advanced Breast Cancer

NCT ID: NCT06239467Sponsor: OnKure, Inc.Last updated: 2025-09-09

Summary

OKI-219-101 is a Phase 1a/1b, open-label, multicenter, dose-escalation study designed to evaluate the safety, tolerability, pharmacokinetics (PK), pharmacodynamics (PDx), and efficacy of OKI-219 as monotherapy and in combination with other anti-cancer drugs. Phase 1a (Part A) will investigate escalating doses of OKI-219 monotherapy, and Phase 1b will investigate OKI-219 (at a tolerated dose determined in Part A) in combination with fulvestrant (Part B), trastuzumab and tucatinib (Part C), atirmociclib (Part D), and ribociclib and fulvestrant (Part E). Participants will continue to receive study treatment until disease progression, intolerable toxicity, or other study treatment withdrawal criteria are met.

Arms & interventions

  • DrugOKI-219

    Oral twice daily

  • DrugFulvestrant

    Intramuscular injection

  • DrugTrastuzumab

    Intravenous (IV)

  • DrugTucatinib

    Oral twice daily

  • DrugAtirmociclib

    Oral twice daily

  • DrugRibociclib

    Oral once daily continuous for 21-days followed by 7 days off

Outcome measures

Primary

  • Identify maximum tolerated dose (MTD) of OKI-219 in monotherapy

    Frequency of participants experiencing dose-limiting toxicities during the first 28-day cycle

    Time frame: Cycle 1 (First 28 days on treatment)

  • Assess safety of OKI-219 as monotherapy or in combination with other anti-cancer therapies: incidence of SAEs

    Number and type of SAEs experienced by participants during treatment and follow-up

    Time frame: Through 30 days after last dose, an average of 1 year

  • Assess safety of OKI-219 as monotherapy or in combination with other anti-cancer therapies: incidence of Grade 2 or greater treatment emergent adverse events

    Number of treatment-emergent adverse events (TEAEs) equal or greater than Grade 2 experienced during treatment and follow-up

    Time frame: Through 30 days after last dose, an average of 1 year

  • Assess rate of dose modifications during treatment with OKI-219 as monotherapy or in combination with other anti-cancer therapies

    rate of dose modifications

    Time frame: Through last study dose, an average of 1 year

Secondary

  • Assess the plasma PK of OKI-219 following single and multiple doses as monotherapy or in combination with other anti-cancer therapies: maximum plasma concentration (Cmax)

    Time frame: Through cycle 6 of treatment (up to 28 weeks)

  • Assess the plasma PK of OKI-219 following single and multiple doses as monotherapy or in combination with other anti-cancer therapies: time of maximum plasma concentration (Tmax)

    Time frame: Through cycle 6 of treatment (up to 28 weeks)

  • Assess the plasma PK of OKI-219 following single and multiple doses as monotherapy or in combination with other anti-cancer therapies: area under the plasma concentration-time curve (AUC)

    Time frame: Through cycle 6 of treatment (up to 28 weeks)

  • Assess the plasma PK of OKI-219 following single and multiple doses as monotherapy or in combination with other anti-cancer therapies: terminal elimination half-life time (t1/2)

    Time frame: Through cycle 6 of treatment (up to 28 weeks)

  • To estimate the preliminary antitumor activity of OKI-219 as monotherapy and in combination with other anti-cancer therapies: objective response rate (ORR)

    Time frame: Up to approximately 36 months

  • To estimate the preliminary antitumor activity of OKI-219 as monotherapy and in combination with other anti-cancer therapies: clinical benefit rate (CBR)

    Time frame: Up to approximately 36 months

  • Dose optimization only: to estimate the preliminary antitumor activity of OKI-219 as monotherapy and in combination with other anti-cancer therapies: progression free survival (PFS)

    Time frame: Up to approximately 36 months

  • To assess the dose-response impact of OKI-219 as monotherapy and in combination with other anti-cancer therapies on PI3KαH1047R ctDNA levels

    Time frame: Through last study dose, an average of 1 year

  • To determine the impact of OKI-219 dosing as monotherapy and in combination with other anti-cancer therapies on blood glucose and insulin

    Time frame: Through last study dose, an average of 1 year

  • To assess the PDx activity of OKI-219 as monotherapy and in combination with other anti-cancer therapies

    Time frame: Through last study dose, an average of 1 year

Eligibility criteria

Sex: AllAge: 18 Years and olderHealthy volunteers: No
Key Inclusion Criteria: * Participants with advanced solid tumors with documented evidence of a PI3KαH1047R mutation in tumor tissue and/or blood (ie, ctDNA). * Eastern Cooperative Oncology Group (ECOG) Performance status score of to 1. * Life expectancy \> 12 weeks for Part A and \> 6 months for Parts B, C, D, and E in the opinion of the Investigator. * Adequate organ and bone marrow function * Have adequate archival tumor tissue sample available or be approved by the Sponsor for enrollment if no tumor sample is available. * At least 1 measurable lesion based on RECIST version 1.1. Additional Cohort-specific key inclusion criteria: Part A * Participants with HR+/HER2- locally advanced, unresectable or metastatic breast cancer, must have received at least 1 prior line of hormonal therapy and at least 1 prior line of CDK4/6-inhibitor in the advanced or metastatic setting. * Participants with HER2+ locally advanced, unresectable or metastatic breast cancer, must have received prior taxane, trastuzumab, pertuzumab, and tucatinib. Prior trastuzumab deruxtecan is allowed but not required. * Participants with HER2-low breast cancer must have received prior trastuzumab deruxtecan. * Participants with colorectal cancer must have KRAS wild-type disease. Part B * Participants with locally advanced, unresectable or metastatic HR+/HER2- breast cancer must have received at least 1 prior line of hormonal therapy in the advanced or metastatic setting and at least 1 prior CDK4/6-inhibitor. * Participants with HER2-low breast cancer should have received prior trastuzumab deruxtecan Part C ● Participants with HR±/HER2+ locally advanced, unresectable or metastatic breast cancer must have received prior taxane, trastuzumab, and pertuzumab unless unavailable in the region or contraindicated. Prior trastuzumab deruxtecan is allowed but not required. Part D ● Participants must have HR+/HER2- locally advanced, unresectable or metastatic breast cancer Part E ● Participants must have HR+/HER2- locally advanced, unresectable or metastatic breast cancer. Key Exclusion Criteria: * Treatment with any investigational product or other anticancer therapy within 28 days or 5 half-lives, whichever is shorter, of the start of treatment * Participants with a known KRAS mutation. * Participants with a known deleterious mutation in phosphatase and tensin homolog (PTEN) or negative for PTEN protein expression by IHC. * Major surgery or wide-field radiation within 28 days or limited field palliative radiation within 7 days prior to the first dose of study drug. * Known active central nervous system metastasis, including leptomeningeal disease. * Uncontrolled Type 1 or Type 2 diabetes as defined by HbA1C ≥ 8%. * Concomitant active malignancy or previous malignancy within 2 years of the time of enrollment. * Impaired cardiovascular function or clinically significant cardiovascular disease, * History of symptomatic drug-induced pneumonitis. * Participants with active HIV, Hepatitis B, and Hepatitis C viral infections Additional Cohort-specific key exclusion criteria: Part C: * Grade 2 or higher diarrhea at study entry. * History of chronic liver disease. Part E: ● History of interstitial lung disease.

Study locations (13)

California Cancer Associates for Research and Excellence

Encinitas, California, 92024

Recruiting
Dante Pasiliao · Contact

University of California San Diego UCSD

La Jolla, California, 92093

Recruiting
Jasmine Fernandez · Contact

UCLA Jonsson Comprehensive Cancer Center

Los Angeles, California, 90024

Recruiting
Doris Quintanilla · Contact

Hoag - Huntington Beach

Newport Beach, California, 92663

Recruiting
Abigail Lazo · Contact

Regents of the University of Colorado

Aurora, Colorado, 80045

Recruiting
Leah Adams · Contact

Sarah Cannon Research Institute at HealthONE

Denver, Colorado, 80218

Recruiting
Jessica Ellis · Contact

Massachusetts General Hospital

Boston, Massachusetts, 02114

Recruiting
Jennifer Petersen · Contact

Karmanos Cancer Insitute

Detroit, Michigan, 48201

Withdrawn

Comprehensive Cancer Centers of Nevada

Las Vegas, Nevada, 89169

Recruiting
Elizabeth Hutchings · Contact

Stony Brook University

Stony Brook, New York, 11794

Recruiting
Pushpa Talanki · Contact

SCRI Oncology Partners - Nashville

Nashville, Tennessee, 37203

Recruiting
Gretchen Johnston · Contact

NEXT Oncology Virginia

Fairfax, Virginia, 22031

Recruiting
Blake Patterson · Contact

Fred Hutchinson Cancer Center

Seattle, Washington, 98109

Recruiting
Kaysey Hermens · Contact