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A Study of Repotrectinib (TPX-0005) in Patients With Advanced Solid Tumors Harboring ALK, ROS1, or NTRK1-3 Rearrangements

Study Status Open To Accrual
National Clinical Trial Identifier NCT03093116
Phase I/II
  • Full Title

    A Phase I/II, Open-Label, Multi-Center, First-in-Human Study of the Safety, Tolerability, Pharmacokinetics, and Anti-Tumor Activity of TPX-0005 in Patients with Advanced Solid Tumors Harboring ALK, ROS1, or NTRK1-3 Rearrangements (TRIDENT-1)

  • Purpose
    Phase 1 dose escalation will determine the first cycle dose-limiting toxicities (DLTs), the
    maximum tolerated dose (MTD), the biologically effective dose and recommended Phase 2 dose
    (RP2D) of repotrectinib given to adult subjects with advanced solid malignancies harboring an
    ALK, ROS1, NTRK1, NTRK2, or NTRK3 gene rearrangement.

    Midazolam DDI substudy will examine effect of of repotrectinib on CYP3A induction.

    Phase 2 will determine the confirmed Overall Response Rate (ORR) as assessed by Blinded
    Independent Central Review (BICR) of repotrectinib in each subject population expansion
    cohort of advanced solid tumors that harbor a ROS1, NTRK1, NTRK2, or NTRK3 gene
    rearrangement. The secondary objective will include the duration of response (DOR), time to
    response (TTR), progression-free survival (PFS), overall survival (OS) and clinical benefit
    rate (CBR) of repotrectinib in each expansion cohort of advanced solid tumors that harbor a
    ROS1, NTRK1, NTRK2, or NTRK3 gene rearrangement.
  • Objective
    In Phase 2, study subjects will be enrolled into 6 distinct expansion (EXP) cohorts:

    - EXP-1: ROS1 TKI-na??ve ROS1+ NSCLC. Up to one prior line of chemotherapy OR immunotherapy
    is allowed

    - EXP-2: 1 Prior ROS1 TKI AND 1 Platinum-based Chemotherapy ROS1+ NSCLC. Disease
    progression, or intolerant to one prior line of a ROS1 TKI. Must have received one prior
    line of platinum based chemotherapy OR one prior line of platinum based chemotherapy in
    combination with immunotherapy before or after a ROS1 TKI

    - EXP-3: 2 Prior ROS1 TKIs AND NO Chemotherapy ROS1+ NSCLC. Disease progression, or
    intolerant to 2 prior lines of a ROS1 TKI treatment. No prior lines of chemotherapy or
    immunotherapy are allowed.

    - EXP-4: 1 Prior ROS1 TKI and NO Chemotherapy or Immunotherapy. Disease progression or
    intolerant to one prior line of a ROS1 TKI. No prior lines of chemotherapy or
    immunotherapy are allowed.

    - EXP-5: TRK TKI-na??ve NTRK+ solid tumors. Any number of prior lines of chemo or
    immunotherapy is allowed.

    - EXP-6: TRK TKI-pretreated NTRK+ solid tumors. Disease progression, or intolerant to 1 or
    2 prior TRK TKIs. Any number of prior lines of chemo- or immunotherapy are allowed.
  • Eligibility
    PHASE 1

    Key Inclusion Criteria:

    1. Histologically or cytologically confirmed diagnosis of locally advanced, or metastatic
    solid tumor (including primary CNS tumors) (Stage IV, American Joint Committee on
    Cancer v.7) that harbors an ALK, ROS1, NTRK1, NTRK2, or NTRK3 gene rearrangement by
    protocol specified tests.

    2. ECOG PS 0-1.

    3. Age ???18 (or age ??? 20 of age as required by local regulation).

    4. Capability to swallow capsules intact (without chewing, crushing, or opening).

    5. At least 1 measurable target lesion according to RECIST version 1.1. CNS-only
    measurable disease as defined by RECIST version 1.1 is allowed.

    6. Prior cytotoxic chemotherapy is allowed.

    7. Prior immunotherapy is allowed.

    8. Resolution of all acute toxic effects (excluding alopecia) of any prior anti-cancer
    therapy to National Cancer Institute Common Terminology Criteria for Adverse Events
    (NCI CTCAE) Version 4.03 Grade less than or equal to 1.

    9. Patients with asymptomatic CNS metastases (treated or untreated) and/or asymptomatic
    leptomeningeal carcinomatosis are eligible to enroll if they satisfy the protocol
    specified criteria.

    10. Baseline laboratory values fulfilling the following requirements:Absolute neutrophils
    count (ANC) ???1500/mm3 (1.5 ?? 109/L); Platelets (PLTs) ???100,000/mm3 (100 ?? 109/L);
    Hemoglobin ??? 9.0 g/dL transfusions are allowed; Serum creatinine or creatinine
    clearance Within normal limits or > 40 mL/min; Total serum bilirubin < 1.5 ?? ULN;
    Liver transaminases (ASTs/ALTs) < 2.5 ?? ULN; < 5 ?? ULN if liver metastases are present
    Alkaline phosphatase (ALP); < 2.5 ?? ULN; < 5 ?? ULN if liver and/or bone metastasis are
    present; Serum calcium, magnesium, and potassium Normal or CTCAE grade ??? 1 with or
    without supplementation

    11. Life expectancy ??? 3 months.

    PHASE 2 Key Inclusion Criteria

    1. Histologically or cytologically confirmed diagnosis of locally advanced, or metastatic
    solid tumor (including primary CNS tumors) that harbors a ROS1, or NTRK1-3 gene
    fusion.

    2. Subject must have a documented ROS1 or NTRK1-3 gene fusion determined by tissue-based
    local testing using either:

    1. a next-generation sequencing (NGS) or quantitative polymerase chain reaction
    (qPCR) test will be accepted to determine molecular eligibility.

    ??? Adequate tumor tissue needs to be sent to the Sponsor designated central
    diagnostic laboratory for retrospective confirmation by a central diagnostic
    laboratory test selected by the Sponsor.

    OR

    2. a fluorescence in situ hybridization (FISH) test AND prospective confirmation of
    fusion status by a central diagnostic laboratory test selected by the Sponsor
    PRIOR to enrollment will be accepted to determine molecular eligibility.

    - Adequate tumor tissue must be sent to the Sponsor designated central
    diagnostic laboratory for prospective confirmation by a central diagnostic
    laboratory test selected by the Sponsor PRIOR to enrollment.

    3. Eastern Cooperative Oncology Group (ECOG) Performance Status 0-1.

    4. Age ???12 (or age ??? 20 as required by local regulation).

    5. Willing and able to provide written institutional review board (IRB)/institutional
    ethics committee-approved Informed Consent or an Assent signed by a parent or legal
    guardian for subjects age 12 to 17.

    6. At least 1 measurable target lesion according to RECIST (v1.1) prospectively confirmed
    by Blinded Independent Central Radiology Review (BICR), selected by Sponsor, PRIOR to
    enrollment. Subjects with CNS-only measurable disease ???10 mm as defined by RECIST
    (v1.1) are eligible.

    7. Subjects with advanced solid tumors harboring ROS1, NTRK1, NTRK2, or NTRK3
    rearrangement will be assigned into 6 distinct expansion (EXP) cohorts provided all
    inclusion and exclusion criteria are met.

    i. EXP-1: ROS1 TKI-na??ve ROS1+ NSCLC ii. EXP-2: 1 Prior ROS1 TKI and 1 Platinum based
    chemo ROS1+ NSCLC iii. EXP-3: 2 Prior ROS1 TKIs ROS1+ NSCLC (No Chemo or IO) iv.
    EXP-4: 1 Prior ROS1 TKI ROS1+ NSCLC (No Chemo or IO) v. EXP-5: TRK TKI-na??ve NTRK+
    solid tumors vi. EXP-6: TRK TKI-pretreated NTRK+ solid tumors

    8. Subjects with asymptomatic CNS metastases (treated or untreated) and/or asymptomatic
    leptomeningeal carcinomatosis are eligible to enroll if they satisfy the protocol
    specified criteria.

    9. Baseline laboratory values fulfilling the following requirements:Absolute neutrophils
    count (ANC) ???1500/mm3 (1.5 ?? 109/L); Platelets (PLTs) ???100,000/mm3 (100 ?? 109/L);
    Hemoglobin ??? 9.0 g/dL transfusions are allowed; Serum creatinine or creatinine
    clearance > 40 mL/min; Total serum bilirubin < 1.5 ?? ULN; Liver transaminases
    (ASTs/ALTs) < 2.5 ?? ULN; < 5 ?? ULN if liver metastases are present Alkaline
    phosphatase (ALP); < 2.5 ?? ULN; < 5 ?? ULN if liver and/or bone metastasis are present;
    Serum calcium, magnesium, and potassium Normal or CTCAE grade ??? 1 with or without
    supplementation

    10. Life expectancy ??? 3 months.

    Key Exclusion Criteria PHASE 1 and PHASE 2

    1. Concurrent participation in another therapeutic clinical trial.

    2. Symptomatic brain metastases or leptomeningeal involvement.

    3. History of 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 2 years.

    4. Major surgery within 4 weeks of start of repotrectinib treatment. Radiation therapy
    (except palliative to relieve bone pain) within 2 weeks of study entry. Palliative
    radiation (???10 fractions) must have been completed at least 48 hours prior to study
    entry

    5. Clinically significant cardiovascular disease (either active 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,
    symptomatic bradycardia, requirement for anti-arrhythmic medication. Ongoing cardiac
    dysrhythmias of NCI CTCAE grade ???2

    6. Any of the following cardiac criteria:

    Mean resting corrected QT interval (ECG interval measured from the onset of the QRS
    complex to the end of the T wave) for heart rate (QTcF) > 470 msec obtained from 3
    ECGs, using the screening clinic ECG machine-derived QTc value Any clinically
    important abnormalities in rhythm, conduction or morphology of resting ECG (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.

    7. Known active infections (bacterial, fungal, viral including HIV positivity).

    8. Gastrointestinal disease (e.g., Crohn's disease, ulcerative colitis, or short gut
    syndrome) or other malabsorption syndromes that would impact drug absorption.

    9. Peripheral neuropathy of CTCAE ???grade 2.

    10. History of extensive, disseminated, bilateral, or presence of CTCAE grade 3 or 4
    interstitial fibrosis or interstitial lung disease including a history of pneumonitis,
    hypersensitivity pneumonitis, interstitial pneumonia, interstitial lung disease,
    obliterative bronchiolitis, and pulmonary fibrosis. Subjects with history of prior
    radiation pneumonitis are not excluded.
  • Resources & Links
  • Interested in this Trial?
    If you are interested in participating in this study, call The JamesLine at 800-293-5066 to make an appointment with the principal investigator listed or ask your doctor if you are eligible for this study.

Trial Information

Protocol Number:OSU-19176
Gender:All
Disease Groups:Sarcoma, Thoracic