HRAS Mutant Tumor, Other Squamous Cell Carcinoma (SCC) With HRAS Mutant Tumor, Squamous Cell Carcinoma Head and Neck Cancer (HNSCC), Thyroid Cancer
Conditions
Brief summary
Phase II study to investigate the antitumor activity in terms of objective response rate (ORR) of tipifarnib in subjects with advanced tumors that carry HRAS mutations and for whom there is no standard curative therapy available.
Detailed description
This Phase II study will investigate the antitumor activity in terms of ORR of tipifarnib in subjects with locally advanced, unresectable or metastatic, relapsed and/or refractory tumors that carry HRAS mutations and for whom there is no curative therapy available. Subjects with information available on tumor HRAS status previously generated are eligible. All subjects must consent to provide at least 10 tumor slides from a prior diagnostic biopsy for a retrospective testing of HRAS gene status at a central facility. Subjects will be enrolled into three nonrandomized cohorts: * Cohort 1: Malignant thyroid tumors with HRAS mutations. * Cohort 2: Squamous Cell Carcinoma Head and Neck Cancer with HRAS mutations. * Cohort 3: Squamous Cell Carcinoma (SCC) with HRAS mutations other than HNSCC.
Interventions
FTase inhibitor
Sponsors
Study design
Eligibility
Inclusion criteria
* histologically or cytologically confirmed diagnosis of thyroid cancer (cohort 1) or Squamous Cell Carcinoma head and neck cancer (cohort 2) or Squamous Cell Carcinoma other than HNSCC (cohort 3) for which there is no curative therapy available. * tumor that carries a missense HRAS mutation ith a variant allele frequency (VAF) \> 20%. * Subject consents to provide at least 10 unstained tumor slides for retrospective testing of HRAS gene tumor status * Subject has measurable disease according to RECIST v1.1 and has relapsed or is refractory to prior therapy. * At least 2 weeks since the last systemic therapy or radiotherapy regimen prior to enrolment * ECOG PS 0 or 1 * Acceptable liver function * Acceptable renal function * Acceptable hematologic status • Serum albumin ≥ 3.5 g/dL. Subjects with tumors potentially highly sensitive to tipifarnib (HRAS mutant VAF ≥ 35%) may be enrolled despite a serum albumin \< 3.5 g/dL.
Exclusion criteria
* Prior treatment with an FTase inhibitor * History of relevant coronary heart disease or myocardial infarction within last 3 years, NYHA Grade III or greater congestive heart failure, cerebro-vascular attack within the prior year, or serious cardiac arrhythmia requiring medication except atrial fibrillation. * Known uncontrolled brain, leptomeningeal or epidural metastases (unless treated and well controlled for at least 4 weeks prior to Cycle 1 Day 1). Controlled brain metastases that require continuous high dose corticosteroid use within 4 weeks of Day 1. * Non-tolerable \> Grade 2 neuropathy or evidence of unstable neurological symptoms within 4 weeks first dose * Major surgery, other than diagnostic surgery, within 4 weeks prior to first dose, without complete recovery. * Active, uncontrolled bacterial, viral, or fungal infections, requiring systemic therapy. Known infection with HIV, or an active infection with hepatitis B or hepatitis C
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Antitumor Activity by Objective Response Rate (ORR) | Up to approximately 3 years | The ORR of tipifarnib was response assessments according to RECIST 1.1. The estimate of the ORR was calculated based on the maximum likelihood estimator (i.e., crude percentage of subjects whose best overall response was complete response \[CR\] or partial response \[PR\]). The estimate of the ORR was accompanied by 2-sided 95% confidence interval (CI). The 95% CI was estimated using the Wilson score test-based method. CR: Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. Disappearance of all non-target lesions and normalization of tumor marker level. All lymph nodes must be non-pathological in size (\< 10 mm short axis). PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. Persistence of one or more non-target lesion(s) and/or maintenance of tumor marker level above the normal limits. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Subjects That Experienced One or More Treatment-emergent Adverse Events (TEAEs) | Up to approximately 3 years | An adverse event (AE) was any untoward medical occurrence in a subject or clinical investigation subject administered a pharmaceutical product, which did not necessarily have a causal relationship with this treatment. TEAEs were defined as AEs that started on or after the first dose of study drug and within 30 days of the last administration of study drug or immediately before the initiation of any other anticancer therapy. The Investigator was required to grade the severity/ intensity of each AE according to NCI-CTCAE version 4.03. If a severity/intensity of Grade 4 (life-threatening) or 5 (death) was applied to an AE, then the Investigator also reported the event as a serious AE. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Progression-free Survival (PFS) | Up to approximately 3 years | PFS was defined as the time from first dose (Cycle 1 Day 1) to either first observation of progressive disease (PD) or occurrence of death due to any cause within 126 days (approximately 2 time-intervals for tumour assessments) of either first administration of tipifarnib or the last tumour assessment. Observation of PD could have been by either documented radiographic progression (i.e., scan results) or documentation of symptomatic or clinical progression agreed upon and documented by investigators. In subjects without a progression date or with a death date more than 126 days after the first administration of study drugs or the last tumour assessment, the PFS time should have been censored on the date of last tumour assessment or date of first administration of study tipifarnib. |
| Duration of Response (DOR) | Up to approximately 3 years | DOR was the number of months from start date of PR or CR (whichever response was achieved first) to the first date that PD was documented (in subjects with an objective response). PD was determined by the Investigator using RECIST 1.1. The DOR was right-censored at the date for subjects who achieved CR or PR and met one of the following conditions: 1) when non-protocol anticancer treatment started before documentation of PD, 2) when death prior to documented PD or documented PD after more than 1 missed disease assessment visit, or 3) when alive and did not have documentation of PD before a data analysis cut-off date (therefore, analysis cut-off date was used as the censoring date). Median and 95% CI were calculated via Kaplan-Meier analysis. |
| Overall Survival (OS) | Up to approximately 4 years | An analysis of OS was conducted to estimate median OS time and corresponding 95% CI. OS was defined as the time from first dose (Cycle 1 Day 1) to the occurrence of death due to any cause. In subjects without a death date, the OS was censored on 1) the last date of survival status if alive, 2) a data analysis cut-off date for subjects with no survival status documentation, or 3) the date a subject withdrew consent or was lost to follow-up if there was no additional information. Median and 95% CI were calculated via Kaplan-Meier analysis. |
| Antitumor Activity - Best Overall Response (BOR) | Up to approximately 3 years | BOR according to RECIST 1.1. Stable disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study. Persistence of one or more non-target lesion(s) and/or maintenance of tumor marker level above the normal limits. |
Countries
Belgium, France, Germany, Greece, Italy, Netherlands, South Korea, Spain, United Kingdom, United States
Participant flow
Recruitment details
Subjects with thyroid cancer with Harvey Rat sarcoma virus (HRAS) mutations were enrolled in Cohort 1; subjects with any solid tumour with HRAS mutation were enrolled in Stage 1 of Cohort 2; subjects with head and neck squamous cell carcinoma (HNSCC) with HRAS mutations were enrolled in Stage 2 of Cohort 2; subjects with any squamous cell carcinoma (SCC) (excluding HNSCC) with HRAS mutation were enrolled in Cohort 3.
Pre-assignment details
Only consented subjects who met all the eligibility criteria were enrolled in the study. All screening evaluations were to be completed within 4 weeks (28 days) of Cycle 1 Day 1.
Participants by arm
| Arm | Count |
|---|---|
| Cohort 1 Subjects with thyroid cancer with HRAS mutations.
Subjects received tipifarnib as monotherapy orally BID on Days 1-7 and 15-21 of each 28-day treatment cycle.
In the absence of unacceptable tipifarnib-related emergent toxicity or disease progression, subjects could receive treatment with tipifarnib for up to 12 months at the discretion of the Investigator. Treatment beyond 12 months may have continued upon agreement of the Investigator and the Sponsor. | 13 |
| Cohort 2/Stage 1 Subjects with any solid tumour with HRAS mutation.
Subjects received tipifarnib as monotherapy orally BID on Days 1-7 and 15-21 of each 28-day treatment cycle.
In the absence of unacceptable tipifarnib-related emergent toxicity or disease progression, subjects could receive treatment with tipifarnib for up to 12 months at the discretion of the Investigator. Treatment beyond 12 months may have continued upon agreement of the Investigator and the Sponsor. | 10 |
| Cohort 2/Stage 2 Subjects with HNSCC with HRAS mutations.
Subjects received tipifarnib as monotherapy orally BID on Days 1-7 and 15-21 of each 28-day treatment cycle.
In the absence of unacceptable tipifarnib-related emergent toxicity or disease progression, subjects could receive treatment with tipifarnib for up to 12 months at the discretion of the Investigator. Treatment beyond 12 months may have continued upon agreement of the Investigator and the Sponsor. | 30 |
| Cohort 3 Subjects with any SCC (excluding HNSCC) with HRAS mutation.
Subjects received tipifarnib as monotherapy orally BID on Days 1-7 and 15-21 of each 28-day treatment cycle.
In the absence of unacceptable tipifarnib-related emergent toxicity or disease progression, subjects could receive treatment with tipifarnib for up to 12 months at the discretion of the Investigator. Treatment beyond 12 months may have continued upon agreement of the Investigator and the Sponsor. | 10 |
| Total | 63 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Adverse Event | 4 | 1 | 3 | 5 |
| Overall Study | Disease Progression | 8 | 8 | 15 | 4 |
| Overall Study | Miscellaneous | 1 | 0 | 0 | 1 |
| Overall Study | Physician Decision | 0 | 0 | 2 | 0 |
| Overall Study | Termination by Symptomatic Deterioration | 0 | 0 | 6 | 0 |
| Overall Study | Withdrawal by Subject | 0 | 1 | 4 | 0 |
Baseline characteristics
| Characteristic | Cohort 2/Stage 2 | Cohort 3 | Cohort 2/Stage 1 | Total | Cohort 1 |
|---|---|---|---|---|---|
| Age, Continuous | 61.0 years STANDARD_DEVIATION 14.4 | 67.0 years STANDARD_DEVIATION 11.7 | 59.1 years STANDARD_DEVIATION 16.9 | 65.32 years STANDARD_DEVIATION 11.6 | 61.7 years STANDARD_DEVIATION 7.4 |
| Eastern Cooperative Oncology Group (ECOG) performance score Performance score 0 | 3 Participants | 1 Participants | 3 Participants | 14 Participants | 7 Participants |
| Eastern Cooperative Oncology Group (ECOG) performance score Performance score 1 | 27 Participants | 9 Participants | 7 Participants | 49 Participants | 6 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 2 Participants | 0 Participants | 0 Participants | 3 Participants | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 28 Participants | 10 Participants | 10 Participants | 60 Participants | 12 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Asian | 4 Participants | 0 Participants | 1 Participants | 7 Participants | 2 Participants |
| Race/Ethnicity, Customized Black or African American | 1 Participants | 0 Participants | 1 Participants | 4 Participants | 2 Participants |
| Race/Ethnicity, Customized Other | 1 Participants | 0 Participants | 1 Participants | 4 Participants | 2 Participants |
| Race/Ethnicity, Customized White | 24 Participants | 10 Participants | 7 Participants | 48 Participants | 7 Participants |
| Sex: Female, Male Female | 8 Participants | 5 Participants | 2 Participants | 19 Participants | 4 Participants |
| Sex: Female, Male Male | 22 Participants | 5 Participants | 8 Participants | 44 Participants | 9 Participants |
| Stage of cancer Stage I | 0 Participants | 1 Participants | 0 Participants | 1 Participants | 0 Participants |
| Stage of cancer Stage II | 2 Participants | 0 Participants | 0 Participants | 2 Participants | 0 Participants |
| Stage of cancer Stage III | 2 Participants | 0 Participants | 1 Participants | 4 Participants | 1 Participants |
| Stage of cancer Stage IV | 26 Participants | 9 Participants | 9 Participants | 56 Participants | 12 Participants |
| Type of tumour Head and neck | 30 Participants | 0 Participants | 0 Participants | 30 Participants | 0 Participants |
| Type of tumour Other | 0 Participants | 6 Participants | 3 Participants | 9 Participants | 0 Participants |
| Type of tumour Salivary | 0 Participants | 0 Participants | 7 Participants | 7 Participants | 0 Participants |
| Type of tumour Skin | 0 Participants | 4 Participants | 0 Participants | 4 Participants | 0 Participants |
| Type of tumour Thyroid | 0 Participants | 0 Participants | 0 Participants | 13 Participants | 13 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 6 / 13 | 9 / 10 | 24 / 30 | 9 / 10 |
| other Total, other adverse events | 13 / 13 | 10 / 10 | 29 / 30 | 9 / 10 |
| serious Total, serious adverse events | 6 / 13 | 5 / 10 | 20 / 30 | 9 / 10 |
Outcome results
Antitumor Activity by Objective Response Rate (ORR)
The ORR of tipifarnib was response assessments according to RECIST 1.1. The estimate of the ORR was calculated based on the maximum likelihood estimator (i.e., crude percentage of subjects whose best overall response was complete response \[CR\] or partial response \[PR\]). The estimate of the ORR was accompanied by 2-sided 95% confidence interval (CI). The 95% CI was estimated using the Wilson score test-based method. CR: Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. Disappearance of all non-target lesions and normalization of tumor marker level. All lymph nodes must be non-pathological in size (\< 10 mm short axis). PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. Persistence of one or more non-target lesion(s) and/or maintenance of tumor marker level above the normal limits.
Time frame: Up to approximately 3 years
Population: The Full Analysis Set (FAS) Population excluding subjects for the following reasons: no baseline data; failure to receive at least 1 dose of tipifarnib; no post-baseline endpoint data subsequent to at least 1 dose of study drug.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cohort 1 | Antitumor Activity by Objective Response Rate (ORR) | 0.0 percentage of participants |
| Cohort 2/Stage 1 | Antitumor Activity by Objective Response Rate (ORR) | 0.0 percentage of participants |
| Cohort 2/Stage 2 | Antitumor Activity by Objective Response Rate (ORR) | 43.5 percentage of participants |
| Cohort 3 | Antitumor Activity by Objective Response Rate (ORR) | 28.6 percentage of participants |
Number of Subjects That Experienced One or More Treatment-emergent Adverse Events (TEAEs)
An adverse event (AE) was any untoward medical occurrence in a subject or clinical investigation subject administered a pharmaceutical product, which did not necessarily have a causal relationship with this treatment. TEAEs were defined as AEs that started on or after the first dose of study drug and within 30 days of the last administration of study drug or immediately before the initiation of any other anticancer therapy. The Investigator was required to grade the severity/ intensity of each AE according to NCI-CTCAE version 4.03. If a severity/intensity of Grade 4 (life-threatening) or 5 (death) was applied to an AE, then the Investigator also reported the event as a serious AE.
Time frame: Up to approximately 3 years
Population: The ASaT Population consists of all enrolled subjects who received at least 1 dose of tipifarnib.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Cohort 1 | Number of Subjects That Experienced One or More Treatment-emergent Adverse Events (TEAEs) | Serious TEAEs | 6 Participants |
| Cohort 1 | Number of Subjects That Experienced One or More Treatment-emergent Adverse Events (TEAEs) | TEAEs | 13 Participants |
| Cohort 2/Stage 1 | Number of Subjects That Experienced One or More Treatment-emergent Adverse Events (TEAEs) | Serious TEAEs | 5 Participants |
| Cohort 2/Stage 1 | Number of Subjects That Experienced One or More Treatment-emergent Adverse Events (TEAEs) | TEAEs | 10 Participants |
| Cohort 2/Stage 2 | Number of Subjects That Experienced One or More Treatment-emergent Adverse Events (TEAEs) | Serious TEAEs | 20 Participants |
| Cohort 2/Stage 2 | Number of Subjects That Experienced One or More Treatment-emergent Adverse Events (TEAEs) | TEAEs | 30 Participants |
| Cohort 3 | Number of Subjects That Experienced One or More Treatment-emergent Adverse Events (TEAEs) | TEAEs | 10 Participants |
| Cohort 3 | Number of Subjects That Experienced One or More Treatment-emergent Adverse Events (TEAEs) | Serious TEAEs | 9 Participants |
Antitumor Activity - Best Overall Response (BOR)
BOR according to RECIST 1.1. Stable disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study. Persistence of one or more non-target lesion(s) and/or maintenance of tumor marker level above the normal limits.
Time frame: Up to approximately 3 years
Population: The FAS Population excluding subjects for the following reasons: no baseline data; failure to receive at least 1 dose of tipifarnib; no post-baseline endpoint data subsequent to at least 1 dose of study drug.
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Cohort 1 | Antitumor Activity - Best Overall Response (BOR) | PD | 2 Participants |
| Cohort 1 | Antitumor Activity - Best Overall Response (BOR) | PR | 0 Participants |
| Cohort 1 | Antitumor Activity - Best Overall Response (BOR) | Not evaluable | 0 Participants |
| Cohort 1 | Antitumor Activity - Best Overall Response (BOR) | SD | 9 Participants |
| Cohort 1 | Antitumor Activity - Best Overall Response (BOR) | CR | 0 Participants |
| Cohort 2/Stage 1 | Antitumor Activity - Best Overall Response (BOR) | SD | 6 Participants |
| Cohort 2/Stage 1 | Antitumor Activity - Best Overall Response (BOR) | PD | 2 Participants |
| Cohort 2/Stage 1 | Antitumor Activity - Best Overall Response (BOR) | Not evaluable | 0 Participants |
| Cohort 2/Stage 1 | Antitumor Activity - Best Overall Response (BOR) | PR | 0 Participants |
| Cohort 2/Stage 1 | Antitumor Activity - Best Overall Response (BOR) | CR | 0 Participants |
| Cohort 2/Stage 2 | Antitumor Activity - Best Overall Response (BOR) | SD | 11 Participants |
| Cohort 2/Stage 2 | Antitumor Activity - Best Overall Response (BOR) | CR | 0 Participants |
| Cohort 2/Stage 2 | Antitumor Activity - Best Overall Response (BOR) | PR | 10 Participants |
| Cohort 2/Stage 2 | Antitumor Activity - Best Overall Response (BOR) | PD | 2 Participants |
| Cohort 2/Stage 2 | Antitumor Activity - Best Overall Response (BOR) | Not evaluable | 0 Participants |
| Cohort 3 | Antitumor Activity - Best Overall Response (BOR) | PD | 1 Participants |
| Cohort 3 | Antitumor Activity - Best Overall Response (BOR) | PR | 2 Participants |
| Cohort 3 | Antitumor Activity - Best Overall Response (BOR) | CR | 0 Participants |
| Cohort 3 | Antitumor Activity - Best Overall Response (BOR) | SD | 4 Participants |
| Cohort 3 | Antitumor Activity - Best Overall Response (BOR) | Not evaluable | 0 Participants |
Duration of Response (DOR)
DOR was the number of months from start date of PR or CR (whichever response was achieved first) to the first date that PD was documented (in subjects with an objective response). PD was determined by the Investigator using RECIST 1.1. The DOR was right-censored at the date for subjects who achieved CR or PR and met one of the following conditions: 1) when non-protocol anticancer treatment started before documentation of PD, 2) when death prior to documented PD or documented PD after more than 1 missed disease assessment visit, or 3) when alive and did not have documentation of PD before a data analysis cut-off date (therefore, analysis cut-off date was used as the censoring date). Median and 95% CI were calculated via Kaplan-Meier analysis.
Time frame: Up to approximately 3 years
Population: The Per Protocol (PP) Population was a subset of the FAS population that excluded subjects due to major deviations from the protocol that may have substantially affected the results of the primary analysis. Only participants participants with response data were included.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cohort 2/Stage 2 | Duration of Response (DOR) | 6.2 months |
| Cohort 3 | Duration of Response (DOR) | NA months |
Overall Survival (OS)
An analysis of OS was conducted to estimate median OS time and corresponding 95% CI. OS was defined as the time from first dose (Cycle 1 Day 1) to the occurrence of death due to any cause. In subjects without a death date, the OS was censored on 1) the last date of survival status if alive, 2) a data analysis cut-off date for subjects with no survival status documentation, or 3) the date a subject withdrew consent or was lost to follow-up if there was no additional information. Median and 95% CI were calculated via Kaplan-Meier analysis.
Time frame: Up to approximately 4 years
Population: The FAS Population excluding subjects for the following reasons: no baseline data; failure to receive at least 1 dose of tipifarnib; no post-baseline endpoint data subsequent to at least 1 dose of study drug.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cohort 1 | Overall Survival (OS) | 36.7 months |
| Cohort 2/Stage 1 | Overall Survival (OS) | 13.8 months |
| Cohort 2/Stage 2 | Overall Survival (OS) | 10.8 months |
| Cohort 3 | Overall Survival (OS) | 10.4 months |
Progression-free Survival (PFS)
PFS was defined as the time from first dose (Cycle 1 Day 1) to either first observation of progressive disease (PD) or occurrence of death due to any cause within 126 days (approximately 2 time-intervals for tumour assessments) of either first administration of tipifarnib or the last tumour assessment. Observation of PD could have been by either documented radiographic progression (i.e., scan results) or documentation of symptomatic or clinical progression agreed upon and documented by investigators. In subjects without a progression date or with a death date more than 126 days after the first administration of study drugs or the last tumour assessment, the PFS time should have been censored on the date of last tumour assessment or date of first administration of study tipifarnib.
Time frame: Up to approximately 3 years
Population: The FAS Population excluding subjects for the following reasons: no baseline data; failure to receive at least 1 dose of tipifarnib; no post-baseline endpoint data subsequent to at least 1 dose of study drug.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cohort 1 | Progression-free Survival (PFS) | 4.6 months |
| Cohort 2/Stage 1 | Progression-free Survival (PFS) | 6.4 months |
| Cohort 2/Stage 2 | Progression-free Survival (PFS) | 5.5 months |
| Cohort 3 | Progression-free Survival (PFS) | 8.0 months |