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A Phase I Clinical Study With Investigational Compound LTT462 in Adult Patients With Specific Advanced Cancers.

A Phase I Dose Finding Study of Oral LTT462 in Adult Patients With Advanced Solid Tumors Harboring MAPK Pathway Alterations.

Status
Terminated
Phases
Phase 1
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02711345
Enrollment
65
Registered
2016-03-17
Start date
2016-04-15
Completion date
2018-11-21
Last updated
2019-09-19

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Ovarian Neoplasms, Non-Small-Cell Lung Carcinoma, Melanoma, Other Solid Tumors

Keywords

LTT462, ERK, MAPK, solid tumor

Brief summary

A phase I study of LTT462 in patients with advanced solid tumors that harbor MAPK pathway alterations.

Interventions

DRUGLTT462

ERK Inhibitor

Sponsors

Novartis Pharmaceuticals
Lead SponsorINDUSTRY

Study design

Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
12 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Patient (male or female) ≥12 years of age * ECOG (Eastern Cooperative Oncology Group) performance status ≤1 * Must have progressed following standard therapy, or for whom, in the opinion of the Investigator, no effective standard therapy exists, is tolerated or appropriate. * Patients must be willing and able to undergo study required biopsies. * Presence of at least one measurable lesion according to RECIST v1.1. * Documented MAPK pathway alteration

Exclusion criteria

* Prior treatment with ERK inhibitors. * History or current evidence of retinal vein occlusion (RVO) or current risk factors for RVO. * Any medical condition that would, in the investigator's judgment, prevent the patient's participation in the clinical study due to safety concerns or compliance with clinical study procedures. * Patients receiving proton pump inhibitors (PPI) which cannot be discontinued 3 days prior to the start study treatment and for the duration of the study. * Patients with malignant disease other than that being treated in the study. * Clinically significant cardiac disease. Other protocol-defined

Design outcomes

Primary

MeasureTime frameDescription
Percentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)Up to 2.8 yearsAn adverse events is defined as the appearance of (or worsening of any pre-existing) undesirable signs, symptoms, or medical conditions that occur after participant's signed informed consent has been obtained. A SAE is described as any adverse event that leads to death, is life threatening, causes or prolongs hospitalization, results in a congenital anomaly, or any other important medical event not described above.
Percentage of Participants With Dose Limiting Toxicities (DLTs)Up to 2.8 yearsPercentage of participants with dose limiting toxicity were reported.
Percentage of Participants With at Least One Dose ReductionUp to 2.8 yearsPercentage of participants with at least one dose reduction were reported.
Percentage of Participants With at Least One Dose InterruptionsUp to 2.8 yearsPercentage of participants with at least dose interruptions were reported.
Dose Intensity Received by ParticipantsUp to 2.8 yearsDose intensity of LTT462 received by treatment group was reported.

Secondary

MeasureTime frameDescription
Overall Survival (OS) - Only for Dose Expansion PhaseEvery 2 cycles after starting LTT462 treatment until end of treatment (Up to 2.8 years)Median time for overall survival, only for dose expansion phase was reported.
The Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462day 1, day 15Cmax is the maximum (peak) observed plasma, blood, serum, or other body fluid drug concentration after single dose administration expressed in mass x volume-1.
The Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462day 1, day 15Tmax is the time to reach maximum (peak) plasma, blood, serum, or other body fluid drug concentration after single dose administration.
Area Under the Curve From Time Zero to the Last Measurable Concentration Sampling Time (AUClast) of LTT462Cycle 1 Days 1, 2, 3, 8, 15 and 16; Cycle 2 day 1 and 15; Cycle 3 Day 1; Cycle 5 Day 1AUClast is the area under the curve from time zero to the last measurable concentration sampling time calculated by mass \* time \*volume\^-1
The Area Under the Curve Calculated to the End of a Dosing Interval (Tau) at Steady-state (AUCtau) of LTT462Cycle 1 Days 1, 2, 3, 8, 15 and 16; Cycle 2 day 1 and 15; Cycle 3 Day 1; Cycle 5 Day 1AUCtau is the area under the curve calculated to the end of a dosing interval (tau) at steady-state calculated by formula amount \*time \* volume\^-1
Accumulation Ratio (Racc) of LTT462Cycle 1 Days 1, 2, 3, 8, 15 and 16; Cycle 2 day 1 and 15; Cycle 3 Day 1; Cycle 5 Day 1Racc is the accumulation ratio calculated by AUCtau ratio Day 15 versus Day 1.
Changes From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodCycle 1 Days 1, 2, 3, 15 and 16Assessment of Pharmacodynamic (PD) effects of LTT462 in tumor, pre- and post- treatment tumor biopsies were examined for expression of DUSP6. For assessment of PD effects in blood, levels of DUSP6 were measured in blood samples.
Elimination Half-life (T1/2) of LTT462Cycle 1 Days 1, 2, 3, 8, 15 and 16; Cycle 2 day 1 and 15; Cycle 3 Day 1; Cycle 5 Day 1T1/2 is the Elimination half-life.
Percentage of Participants With Overall Response Rate (ORR)Every 2 cycles after starting LTT462 treatment until end of treatment (Up to 2.8 years)Percentage of participants with overall response rate were reported.
Percentage of Participants With Disease Control Rate (DCR)Every 2 cycles after starting LTT462 treatment until end of treatment (Up to 2.8 years)Percentage of participants with disease control rate were reported.
Duration of Response (DOR)Every 2 cycles after starting LTT462 treatment until end of treatment (Up to 2.8 years)DOR is defined as the time between the date of the first documented response (complete response \[CR\] or partial response \[PR\]) and the date of progression.
Progression Free Survival (PFS)Every 2 cycles after starting LTT462 treatment until end of treatment (Up to 2.8 years)Median time for progression free survival was reported.

Countries

Germany, Japan, Singapore, Spain, Switzerland, United States

Participant flow

Participants by arm

ArmCount
LTT462 45 mg QD
Participants received 45 mg LTT462 once QD as oral capsules.
2
LTT462 100 mg QD
Participants received 100 mg LTT462 QD as oral capsules.
3
LTT462 150 mg QD
Participants received 150 mg LTT462 QD as oral capsules.
6
LTT462 200 mg QD
Participants received 200 mg LTT462 QD as oral capsules.
4
LTT462 300 mg QD
Participants received 300 mg LTT462 QD as oral capsules.
8
LTT462 400 mg QD
Participants received 400 mg LTT462 QD as oral capsules.
6
LTT462 450 mg QD
Participants received 450 mg LTT462 QD as oral capsules.
12
LTT462 600 mg QD
Participants received 600 mg LTT462 QD as oral capsules.
6
LTT462 150 mg BID
Participants received 150 mg LTT462 BID as oral capsules.
6
LTT462 200 mg BID
Participants received 200 mg LTT462 BID as oral capsules.
12
Total65

Withdrawals & dropouts

PeriodReasonFG000FG001FG002FG003FG004FG005FG006FG007FG008FG009
Overall StudyAdverse Event0001121002
Overall StudyDeath1000000100
Overall StudyPhysician Decision0010000010
Overall StudyProgressive disease1353728456
Overall StudySubject/guardian decision0000023104

Baseline characteristics

CharacteristicLTT462 45 mg QDLTT462 100 mg QDLTT462 150 mg QDLTT462 200 mg QDLTT462 300 mg QDLTT462 400 mg QDLTT462 450 mg QDLTT462 600 mg QDLTT462 150 mg BIDLTT462 200 mg BIDTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants0 Participants1 Participants0 Participants0 Participants0 Participants0 Participants0 Participants1 Participants
Age, Categorical
>=65 years
1 Participants1 Participants1 Participants1 Participants2 Participants1 Participants5 Participants1 Participants1 Participants6 Participants20 Participants
Age, Categorical
Between 18 and 65 years
1 Participants2 Participants5 Participants3 Participants5 Participants5 Participants7 Participants5 Participants5 Participants6 Participants44 Participants
Race/Ethnicity, Customized
Asian
1 Participants1 Participants1 Participants1 Participants1 Participants3 Participants4 Participants0 Participants0 Participants2 Participants14 Participants
Race/Ethnicity, Customized
Black
0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants1 Participants0 Participants2 Participants3 Participants
Race/Ethnicity, Customized
Caucasian
1 Participants2 Participants5 Participants2 Participants6 Participants2 Participants7 Participants4 Participants5 Participants8 Participants42 Participants
Race/Ethnicity, Customized
Unknown
00 Participants0 Participants0 Participants1 Participants1 Participants1 Participants1 Participants1 Participants1 Participants0 Participants6 Participants
Sex: Female, Male
Female
1 Participants3 Participants4 Participants2 Participants6 Participants4 Participants5 Participants4 Participants4 Participants7 Participants40 Participants
Sex: Female, Male
Male
1 Participants0 Participants2 Participants2 Participants2 Participants2 Participants7 Participants2 Participants2 Participants5 Participants25 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
EG004
affected / at risk
EG005
affected / at risk
EG006
affected / at risk
EG007
affected / at risk
EG008
affected / at risk
EG009
affected / at risk
EG010
affected / at risk
EG011
affected / at risk
deaths
Total, all-cause mortality
1 / 20 / 30 / 60 / 42 / 81 / 61 / 121 / 66 / 471 / 60 / 121 / 18
other
Total, other adverse events
2 / 23 / 36 / 64 / 48 / 86 / 612 / 125 / 646 / 476 / 612 / 1218 / 18
serious
Total, serious adverse events
1 / 20 / 33 / 61 / 45 / 81 / 68 / 124 / 623 / 473 / 65 / 128 / 18

Outcome results

Primary

Dose Intensity Received by Participants

Dose intensity of LTT462 received by treatment group was reported.

Time frame: Up to 2.8 years

Population: The safety set included all participants who had received at least one dose of LTT462.

ArmMeasureValue (MEAN)Dispersion
LTT462 45 mg QDDose Intensity Received by Participants65.3 milligram per day (mg/day)Standard Deviation 28.74
LTT462 100 mg QDDose Intensity Received by Participants98.1 milligram per day (mg/day)Standard Deviation 3.21
LTT462 150 mg QDDose Intensity Received by Participants133.9 milligram per day (mg/day)Standard Deviation 21.84
LTT462 200 mg QDDose Intensity Received by Participants200.0 milligram per day (mg/day)Standard Deviation 0
LTT462 300 mg QDDose Intensity Received by Participants272.7 milligram per day (mg/day)Standard Deviation 30.9
LTT462 400 mg QDDose Intensity Received by Participants326.7 milligram per day (mg/day)Standard Deviation 81.54
LTT462 450 mg QDDose Intensity Received by Participants409.2 milligram per day (mg/day)Standard Deviation 64.88
LTT462 600 mg QDDose Intensity Received by Participants468.2 milligram per day (mg/day)Standard Deviation 171.48
LTT462 150 mg BIDDose Intensity Received by Participants131.6 milligram per day (mg/day)Standard Deviation 22.08
LTT462 200 mg BIDDose Intensity Received by Participants178.0 milligram per day (mg/day)Standard Deviation 35.32
Primary

Percentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)

An adverse events is defined as the appearance of (or worsening of any pre-existing) undesirable signs, symptoms, or medical conditions that occur after participant's signed informed consent has been obtained. A SAE is described as any adverse event that leads to death, is life threatening, causes or prolongs hospitalization, results in a congenital anomaly, or any other important medical event not described above.

Time frame: Up to 2.8 years

Population: The safety set included all participants who had received at least one dose of LTT462.

ArmMeasureGroupValue (NUMBER)
LTT462 45 mg QDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)AEs2 Percentage of participants
LTT462 45 mg QDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)SAEs1 Percentage of participants
LTT462 100 mg QDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)AEs3 Percentage of participants
LTT462 100 mg QDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)SAEs0 Percentage of participants
LTT462 150 mg QDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)AEs6 Percentage of participants
LTT462 150 mg QDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)SAEs3 Percentage of participants
LTT462 200 mg QDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)AEs4 Percentage of participants
LTT462 200 mg QDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)SAEs1 Percentage of participants
LTT462 300 mg QDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)SAEs5 Percentage of participants
LTT462 300 mg QDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)AEs8 Percentage of participants
LTT462 400 mg QDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)SAEs1 Percentage of participants
LTT462 400 mg QDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)AEs6 Percentage of participants
LTT462 450 mg QDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)SAEs8 Percentage of participants
LTT462 450 mg QDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)AEs12 Percentage of participants
LTT462 600 mg QDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)AEs5 Percentage of participants
LTT462 600 mg QDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)SAEs4 Percentage of participants
LTT462 150 mg BIDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)AEs6 Percentage of participants
LTT462 150 mg BIDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)SAEs3 Percentage of participants
LTT462 200 mg BIDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)AEs12 Percentage of participants
LTT462 200 mg BIDPercentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)SAEs5 Percentage of participants
Primary

Percentage of Participants With at Least One Dose Interruptions

Percentage of participants with at least dose interruptions were reported.

Time frame: Up to 2.8 years

Population: The safety set included all participants who had received at least one dose of LTT462.

ArmMeasureValue (NUMBER)
LTT462 45 mg QDPercentage of Participants With at Least One Dose Interruptions100 Percentage of participants
LTT462 100 mg QDPercentage of Participants With at Least One Dose Interruptions100 Percentage of participants
LTT462 150 mg QDPercentage of Participants With at Least One Dose Interruptions100 Percentage of participants
LTT462 200 mg QDPercentage of Participants With at Least One Dose Interruptions100 Percentage of participants
LTT462 300 mg QDPercentage of Participants With at Least One Dose Interruptions100 Percentage of participants
LTT462 400 mg QDPercentage of Participants With at Least One Dose Interruptions100 Percentage of participants
LTT462 450 mg QDPercentage of Participants With at Least One Dose Interruptions100 Percentage of participants
LTT462 600 mg QDPercentage of Participants With at Least One Dose Interruptions100 Percentage of participants
LTT462 150 mg BIDPercentage of Participants With at Least One Dose Interruptions100 Percentage of participants
LTT462 200 mg BIDPercentage of Participants With at Least One Dose Interruptions100 Percentage of participants
Primary

Percentage of Participants With at Least One Dose Reduction

Percentage of participants with at least one dose reduction were reported.

Time frame: Up to 2.8 years

Population: The safety set included all participants who had received at least one dose of LTT462.

ArmMeasureValue (NUMBER)
LTT462 45 mg QDPercentage of Participants With at Least One Dose Reduction0 Percentage of participants
LTT462 100 mg QDPercentage of Participants With at Least One Dose Reduction0 Percentage of participants
LTT462 150 mg QDPercentage of Participants With at Least One Dose Reduction16.7 Percentage of participants
LTT462 200 mg QDPercentage of Participants With at Least One Dose Reduction0 Percentage of participants
LTT462 300 mg QDPercentage of Participants With at Least One Dose Reduction0 Percentage of participants
LTT462 400 mg QDPercentage of Participants With at Least One Dose Reduction0 Percentage of participants
LTT462 450 mg QDPercentage of Participants With at Least One Dose Reduction16.7 Percentage of participants
LTT462 600 mg QDPercentage of Participants With at Least One Dose Reduction33.3 Percentage of participants
LTT462 150 mg BIDPercentage of Participants With at Least One Dose Reduction16.7 Percentage of participants
LTT462 200 mg BIDPercentage of Participants With at Least One Dose Reduction33.3 Percentage of participants
Primary

Percentage of Participants With Dose Limiting Toxicities (DLTs)

Percentage of participants with dose limiting toxicity were reported.

Time frame: Up to 2.8 years

Population: The dose determining set included all participants from the safety set enrolled in the escalation part of the study who, during the first 28 days of dosing, had received at least 75 percent of the planned daily doses of LTT462 and had had sufficient safety evaluations, or had experienced a DLT.

ArmMeasureValue (NUMBER)
LTT462 45 mg QDPercentage of Participants With Dose Limiting Toxicities (DLTs)0 Percentage of participants
LTT462 100 mg QDPercentage of Participants With Dose Limiting Toxicities (DLTs)0 Percentage of participants
LTT462 150 mg QDPercentage of Participants With Dose Limiting Toxicities (DLTs)16.7 Percentage of participants
LTT462 200 mg QDPercentage of Participants With Dose Limiting Toxicities (DLTs)25.0 Percentage of participants
LTT462 300 mg QDPercentage of Participants With Dose Limiting Toxicities (DLTs)0 Percentage of participants
LTT462 400 mg QDPercentage of Participants With Dose Limiting Toxicities (DLTs)0 Percentage of participants
LTT462 450 mg QDPercentage of Participants With Dose Limiting Toxicities (DLTs)28.6 Percentage of participants
LTT462 600 mg QDPercentage of Participants With Dose Limiting Toxicities (DLTs)100 Percentage of participants
LTT462 150 mg BIDPercentage of Participants With Dose Limiting Toxicities (DLTs)0 Percentage of participants
LTT462 200 mg BIDPercentage of Participants With Dose Limiting Toxicities (DLTs)44.4 Percentage of participants
Secondary

Accumulation Ratio (Racc) of LTT462

Racc is the accumulation ratio calculated by AUCtau ratio Day 15 versus Day 1.

Time frame: Cycle 1 Days 1, 2, 3, 8, 15 and 16; Cycle 2 day 1 and 15; Cycle 3 Day 1; Cycle 5 Day 1

Population: PAS included of all participants who have at least 1 PK blood sample providing measurable LTT462 and received at least 1 dose of study drug, didn't vomit within 4 hours postdose, had at least 1 primary PK parameter. Here 'N' number of participants analyzed signifies number of participants who were evaluable for this outcome measure.

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
LTT462 45 mg QDAccumulation Ratio (Racc) of LTT4623.01 Ratio
LTT462 100 mg QDAccumulation Ratio (Racc) of LTT4623.35 Ratio
LTT462 150 mg QDAccumulation Ratio (Racc) of LTT4625.09 RatioGeometric Coefficient of Variation 72.7
LTT462 200 mg QDAccumulation Ratio (Racc) of LTT4622.74 RatioGeometric Coefficient of Variation 46.9
LTT462 300 mg QDAccumulation Ratio (Racc) of LTT4621.49 RatioGeometric Coefficient of Variation 25.1
LTT462 400 mg QDAccumulation Ratio (Racc) of LTT4621.73 RatioGeometric Coefficient of Variation 62.4
LTT462 450 mg QDAccumulation Ratio (Racc) of LTT4621.44 RatioGeometric Coefficient of Variation 73.4
LTT462 150 mg BIDAccumulation Ratio (Racc) of LTT4623.19 RatioGeometric Coefficient of Variation 50.2
LTT462 200 mg BIDAccumulation Ratio (Racc) of LTT4626.89 RatioGeometric Coefficient of Variation 84.3
Secondary

Area Under the Curve From Time Zero to the Last Measurable Concentration Sampling Time (AUClast) of LTT462

AUClast is the area under the curve from time zero to the last measurable concentration sampling time calculated by mass \* time \*volume\^-1

Time frame: Cycle 1 Days 1, 2, 3, 8, 15 and 16; Cycle 2 day 1 and 15; Cycle 3 Day 1; Cycle 5 Day 1

Population: PAS included of all participants who have at least 1 PK blood sample providing measurable LTT462 and received at least 1 dose of study drug, didn't vomit within 4 hours postdose, had at least 1 primary PK parameter. Here 'N' number of participants analyzed signifies number of participants who were evaluable for this outcome measure.

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
LTT462 45 mg QDArea Under the Curve From Time Zero to the Last Measurable Concentration Sampling Time (AUClast) of LTT462851 hour*nanogram per milliliter (h*ng/mL)Geometric Coefficient of Variation 106
LTT462 100 mg QDArea Under the Curve From Time Zero to the Last Measurable Concentration Sampling Time (AUClast) of LTT4622260 hour*nanogram per milliliter (h*ng/mL)Geometric Coefficient of Variation 30
LTT462 150 mg QDArea Under the Curve From Time Zero to the Last Measurable Concentration Sampling Time (AUClast) of LTT4623880 hour*nanogram per milliliter (h*ng/mL)Geometric Coefficient of Variation 133.6
LTT462 200 mg QDArea Under the Curve From Time Zero to the Last Measurable Concentration Sampling Time (AUClast) of LTT46210400 hour*nanogram per milliliter (h*ng/mL)Geometric Coefficient of Variation 95.4
LTT462 300 mg QDArea Under the Curve From Time Zero to the Last Measurable Concentration Sampling Time (AUClast) of LTT46212800 hour*nanogram per milliliter (h*ng/mL)Geometric Coefficient of Variation 157.4
LTT462 400 mg QDArea Under the Curve From Time Zero to the Last Measurable Concentration Sampling Time (AUClast) of LTT46223300 hour*nanogram per milliliter (h*ng/mL)Geometric Coefficient of Variation 55.5
LTT462 450 mg QDArea Under the Curve From Time Zero to the Last Measurable Concentration Sampling Time (AUClast) of LTT46223800 hour*nanogram per milliliter (h*ng/mL)Geometric Coefficient of Variation 115.3
LTT462 600 mg QDArea Under the Curve From Time Zero to the Last Measurable Concentration Sampling Time (AUClast) of LTT46211800 hour*nanogram per milliliter (h*ng/mL)Geometric Coefficient of Variation 64.2
LTT462 150 mg BIDArea Under the Curve From Time Zero to the Last Measurable Concentration Sampling Time (AUClast) of LTT4629240 hour*nanogram per milliliter (h*ng/mL)Geometric Coefficient of Variation 78.3
LTT462 200 mg BIDArea Under the Curve From Time Zero to the Last Measurable Concentration Sampling Time (AUClast) of LTT4627630 hour*nanogram per milliliter (h*ng/mL)Geometric Coefficient of Variation 98.8
Secondary

Changes From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in Blood

Assessment of Pharmacodynamic (PD) effects of LTT462 in tumor, pre- and post- treatment tumor biopsies were examined for expression of DUSP6. For assessment of PD effects in blood, levels of DUSP6 were measured in blood samples.

Time frame: Cycle 1 Days 1, 2, 3, 15 and 16

Population: The full analysis set included all participants who had received at least one dose of LTT462.

ArmMeasureGroupValue (MEAN)Dispersion
LTT462 45 mg QDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodTumor Sample-0.2 Ratio
LTT462 45 mg QDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodBlood Sample-50.8 RatioStandard Deviation 6.14
LTT462 100 mg QDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodTumor Sample0.8 RatioStandard Deviation 1.11
LTT462 100 mg QDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodBlood Sample-66.1 RatioStandard Deviation 40.22
LTT462 150 mg QDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodTumor Sample-1.1 RatioStandard Deviation 29.46
LTT462 150 mg QDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodBlood Sample-35.2 RatioStandard Deviation 27.33
LTT462 200 mg QDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodTumor Sample-28.8 Ratio
LTT462 200 mg QDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodBlood Sample-34.7 RatioStandard Deviation 22.02
LTT462 300 mg QDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodBlood Sample-42.5 RatioStandard Deviation 16.56
LTT462 300 mg QDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodTumor Sample-31.0 RatioStandard Deviation 31.06
LTT462 400 mg QDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodBlood Sample-43.0 RatioStandard Deviation 13.67
LTT462 400 mg QDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodTumor Sample-56.5 Ratio
LTT462 450 mg QDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodBlood Sample-40.1 RatioStandard Deviation 9.92
LTT462 450 mg QDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodTumor Sample-22.2 RatioStandard Deviation 28.67
LTT462 600 mg QDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodTumor Sample-79.9 Ratio
LTT462 600 mg QDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodBlood Sample-40.4 RatioStandard Deviation 21.04
LTT462 150 mg BIDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodTumor Sample-61.8 RatioStandard Deviation 4.16
LTT462 150 mg BIDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodBlood Sample-39.2 RatioStandard Deviation 12.98
LTT462 200 mg BIDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodTumor Sample-14.4 RatioStandard Deviation 22.27
LTT462 200 mg BIDChanges From Baseline in Relative Quantity (RQ) of Dual Specificity Phosphatase 6 (DUSP6) in Tumor Tissue and in BloodBlood Sample-32.9 RatioStandard Deviation 18.71
Secondary

Duration of Response (DOR)

DOR is defined as the time between the date of the first documented response (complete response \[CR\] or partial response \[PR\]) and the date of progression.

Time frame: Every 2 cycles after starting LTT462 treatment until end of treatment (Up to 2.8 years)

Population: As there were no participant achieving response (CR or PR) during escalation phase of the study (only stable disease was achieved). Therefore the evaluation of duration of response could not be performed.

Secondary

Elimination Half-life (T1/2) of LTT462

T1/2 is the Elimination half-life.

Time frame: Cycle 1 Days 1, 2, 3, 8, 15 and 16; Cycle 2 day 1 and 15; Cycle 3 Day 1; Cycle 5 Day 1

Population: PAS included of all participants who have at least 1 PK blood sample providing measurable LTT462 and received at least 1 dose of study drug, didn't vomit within 4 hours postdose, had at least 1 primary PK parameter. Here 'N' number of participants analyzed signifies number of participants who were evaluable for this outcome measure.

ArmMeasureValue (MEDIAN)
LTT462 45 mg QDElimination Half-life (T1/2) of LTT46227.9 hour
LTT462 100 mg QDElimination Half-life (T1/2) of LTT46239.2 hour
LTT462 150 mg QDElimination Half-life (T1/2) of LTT46220.8 hour
LTT462 200 mg QDElimination Half-life (T1/2) of LTT46216.8 hour
LTT462 300 mg QDElimination Half-life (T1/2) of LTT46215.2 hour
LTT462 400 mg QDElimination Half-life (T1/2) of LTT46214.0 hour
LTT462 450 mg QDElimination Half-life (T1/2) of LTT46217.6 hour
LTT462 600 mg QDElimination Half-life (T1/2) of LTT46213.2 hour
LTT462 150 mg BIDElimination Half-life (T1/2) of LTT46216.2 hour
LTT462 200 mg BIDElimination Half-life (T1/2) of LTT46217.1 hour
Secondary

Overall Survival (OS) - Only for Dose Expansion Phase

Median time for overall survival, only for dose expansion phase was reported.

Time frame: Every 2 cycles after starting LTT462 treatment until end of treatment (Up to 2.8 years)

Population: Overall survival was not evaluated because the study ended before enrolling into the dose-expansion part.

Secondary

Percentage of Participants With Disease Control Rate (DCR)

Percentage of participants with disease control rate were reported.

Time frame: Every 2 cycles after starting LTT462 treatment until end of treatment (Up to 2.8 years)

Population: The full analysis set included all participants who had received at least one dose of LTT462.

ArmMeasureValue (NUMBER)
LTT462 45 mg QDPercentage of Participants With Disease Control Rate (DCR)50.0 Percentage of participants
LTT462 100 mg QDPercentage of Participants With Disease Control Rate (DCR)0 Percentage of participants
LTT462 150 mg QDPercentage of Participants With Disease Control Rate (DCR)0 Percentage of participants
LTT462 200 mg QDPercentage of Participants With Disease Control Rate (DCR)0 Percentage of participants
LTT462 300 mg QDPercentage of Participants With Disease Control Rate (DCR)37.5 Percentage of participants
LTT462 400 mg QDPercentage of Participants With Disease Control Rate (DCR)16.7 Percentage of participants
LTT462 450 mg QDPercentage of Participants With Disease Control Rate (DCR)8.3 Percentage of participants
LTT462 600 mg QDPercentage of Participants With Disease Control Rate (DCR)16.7 Percentage of participants
LTT462 150 mg BIDPercentage of Participants With Disease Control Rate (DCR)16.7 Percentage of participants
LTT462 200 mg BIDPercentage of Participants With Disease Control Rate (DCR)0 Percentage of participants
Secondary

Percentage of Participants With Overall Response Rate (ORR)

Percentage of participants with overall response rate were reported.

Time frame: Every 2 cycles after starting LTT462 treatment until end of treatment (Up to 2.8 years)

Population: The full analysis set included all participants who had received at least one dose of LTT462.

ArmMeasureValue (NUMBER)
LTT462 45 mg QDPercentage of Participants With Overall Response Rate (ORR)0 Percentage of participants
LTT462 100 mg QDPercentage of Participants With Overall Response Rate (ORR)0 Percentage of participants
LTT462 150 mg QDPercentage of Participants With Overall Response Rate (ORR)0 Percentage of participants
LTT462 200 mg QDPercentage of Participants With Overall Response Rate (ORR)0 Percentage of participants
LTT462 300 mg QDPercentage of Participants With Overall Response Rate (ORR)0 Percentage of participants
LTT462 400 mg QDPercentage of Participants With Overall Response Rate (ORR)0 Percentage of participants
LTT462 450 mg QDPercentage of Participants With Overall Response Rate (ORR)0 Percentage of participants
LTT462 600 mg QDPercentage of Participants With Overall Response Rate (ORR)0 Percentage of participants
LTT462 150 mg BIDPercentage of Participants With Overall Response Rate (ORR)0 Percentage of participants
LTT462 200 mg BIDPercentage of Participants With Overall Response Rate (ORR)0 Percentage of participants
Secondary

Progression Free Survival (PFS)

Median time for progression free survival was reported.

Time frame: Every 2 cycles after starting LTT462 treatment until end of treatment (Up to 2.8 years)

Population: The full analysis set included all participants who had received at least one dose of LTT462.

ArmMeasureValue (MEDIAN)
LTT462 45 mg QDProgression Free Survival (PFS)5.3 months
LTT462 100 mg QDProgression Free Survival (PFS)1.6 months
LTT462 150 mg QDProgression Free Survival (PFS)1.7 months
LTT462 200 mg QDProgression Free Survival (PFS)1.9 months
LTT462 300 mg QDProgression Free Survival (PFS)1.8 months
LTT462 400 mg QDProgression Free Survival (PFS)2.1 months
LTT462 450 mg QDProgression Free Survival (PFS)0.9 months
LTT462 600 mg QDProgression Free Survival (PFS)1.4 months
LTT462 150 mg BIDProgression Free Survival (PFS)1.5 months
LTT462 200 mg BIDProgression Free Survival (PFS)1.6 months
Secondary

The Area Under the Curve Calculated to the End of a Dosing Interval (Tau) at Steady-state (AUCtau) of LTT462

AUCtau is the area under the curve calculated to the end of a dosing interval (tau) at steady-state calculated by formula amount \*time \* volume\^-1

Time frame: Cycle 1 Days 1, 2, 3, 8, 15 and 16; Cycle 2 day 1 and 15; Cycle 3 Day 1; Cycle 5 Day 1

Population: PAS included of all participants who have at least 1 PK blood sample providing measurable LTT462 and received at least 1 dose of study drug, didn't vomit within 4 hours postdose, had at least 1 primary PK parameter. Here 'N' number of participants analyzed signifies number of participants who were evaluable for this outcome measure.

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
LTT462 45 mg QDThe Area Under the Curve Calculated to the End of a Dosing Interval (Tau) at Steady-state (AUCtau) of LTT4623010 h*ng/mL
LTT462 100 mg QDThe Area Under the Curve Calculated to the End of a Dosing Interval (Tau) at Steady-state (AUCtau) of LTT4626370 h*ng/mL
LTT462 150 mg QDThe Area Under the Curve Calculated to the End of a Dosing Interval (Tau) at Steady-state (AUCtau) of LTT4628660 h*ng/mLGeometric Coefficient of Variation 50
LTT462 200 mg QDThe Area Under the Curve Calculated to the End of a Dosing Interval (Tau) at Steady-state (AUCtau) of LTT46214600 h*ng/mLGeometric Coefficient of Variation 96.5
LTT462 300 mg QDThe Area Under the Curve Calculated to the End of a Dosing Interval (Tau) at Steady-state (AUCtau) of LTT46213100 h*ng/mLGeometric Coefficient of Variation 81.6
LTT462 400 mg QDThe Area Under the Curve Calculated to the End of a Dosing Interval (Tau) at Steady-state (AUCtau) of LTT46225400 h*ng/mLGeometric Coefficient of Variation 74.3
LTT462 450 mg QDThe Area Under the Curve Calculated to the End of a Dosing Interval (Tau) at Steady-state (AUCtau) of LTT46235400 h*ng/mLGeometric Coefficient of Variation 94.8
LTT462 600 mg QDThe Area Under the Curve Calculated to the End of a Dosing Interval (Tau) at Steady-state (AUCtau) of LTT4626760 h*ng/mL
LTT462 150 mg BIDThe Area Under the Curve Calculated to the End of a Dosing Interval (Tau) at Steady-state (AUCtau) of LTT46211100 h*ng/mLGeometric Coefficient of Variation 59.5
LTT462 200 mg BIDThe Area Under the Curve Calculated to the End of a Dosing Interval (Tau) at Steady-state (AUCtau) of LTT46218600 h*ng/mLGeometric Coefficient of Variation 85.2
Secondary

The Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462

Cmax is the maximum (peak) observed plasma, blood, serum, or other body fluid drug concentration after single dose administration expressed in mass x volume-1.

Time frame: day 1, day 15

Population: Pharmacokinetic (PK) analysis set (PAS) included of all participants who have at least 1 PK blood sample providing measurable LTT462 and received at least 1 dose of study drug, didn't vomit within 4 hours postdose, had at least 1 primary PK parameter. Here 'n' number analyzed signifies number of participants who were evaluable at each time point.

ArmMeasureGroupValue (GEOMETRIC_MEAN)Dispersion
LTT462 45 mg QDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 161.3 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 55.9
LTT462 45 mg QDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 15139 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 29.9
LTT462 100 mg QDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 1134 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 38.8
LTT462 100 mg QDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 15938 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 82.5
LTT462 150 mg QDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 1218 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 230.9
LTT462 150 mg QDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 15707 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 69
LTT462 200 mg QDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 1494 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 126.8
LTT462 200 mg QDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 15972 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 92.4
LTT462 300 mg QDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 151330 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 131.9
LTT462 300 mg QDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 1717 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 127.4
LTT462 400 mg QDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 152370 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 83.3
LTT462 400 mg QDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 11580 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 60.8
LTT462 450 mg QDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 153470 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 49.7
LTT462 450 mg QDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 11420 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 83.5
LTT462 600 mg QDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 11280 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 47.7
LTT462 600 mg QDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 151030 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 248.8
LTT462 150 mg BIDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 1598 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 83
LTT462 150 mg BIDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 151390 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 58.5
LTT462 200 mg BIDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 1575 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 73.8
LTT462 200 mg BIDThe Maximum (Peak) Observed Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Cmax) After Single Dose Administration of LTT462Day 151510 nanogram per milliliter (ng/mL)Geometric Coefficient of Variation 108
Secondary

The Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462

Tmax is the time to reach maximum (peak) plasma, blood, serum, or other body fluid drug concentration after single dose administration.

Time frame: day 1, day 15

Population: PAS included of all participants who have at least 1 PK blood sample providing measurable LTT462 and received at least 1 dose of study drug, didn't vomit within 4 hours postdose, had at least 1 primary PK parameter. Here 'n' number analyzed signifies number of participants who were evaluable at each time point.

ArmMeasureGroupValue (MEDIAN)
LTT462 45 mg QDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 12.45 hour
LTT462 45 mg QDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 155.93 hour
LTT462 100 mg QDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 11.98 hour
LTT462 100 mg QDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 154.02 hour
LTT462 150 mg QDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 13.49 hour
LTT462 150 mg QDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 154.05 hour
LTT462 200 mg QDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 15.48 hour
LTT462 200 mg QDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 153.00 hour
LTT462 300 mg QDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 152.59 hour
LTT462 300 mg QDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 13.08 hour
LTT462 400 mg QDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 152.55 hour
LTT462 400 mg QDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 13.04 hour
LTT462 450 mg QDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 152.98 hour
LTT462 450 mg QDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 13.98 hour
LTT462 600 mg QDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 13.95 hour
LTT462 600 mg QDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 155.25 hour
LTT462 150 mg BIDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 12.25 hour
LTT462 150 mg BIDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 152.17 hour
LTT462 200 mg BIDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 13.03 hour
LTT462 200 mg BIDThe Time to Reach Maximum (Peak) Plasma, Blood, Serum, or Other Body Fluid Drug Concentration (Tmax) After Single Dose Administration of LTT462Day 152.18 hour

Source: ClinicalTrials.gov · Data processed: Feb 18, 2026