Combined Hepatocellular and Cholangiocarcinoma, Intrahepatic Cholangiocarcinoma
Conditions
Keywords
iCCA, intrahepatic cholangiocarcinoma, FGFR2 gene fusion or FGFR2 gene mutation or amplification, biliary cancer, bile duct cancer, FGFR2 gene rearrangement, liver cancer, targeted therapy, combined hepatocellular and cholangiocarcinoma, cHCC-CCA, derazantinib
Brief summary
This Phase II, open-label, single-arm study evaluated the anti-cancer activity of derazantinib in subjects with inoperable or advanced intrahepatic cholangiocarcinoma (iCCA) who received at least one prior regimen of systemic therapy. Patients received an oral once-daily total dose of 300 mg derazantinib capsules.
Detailed description
This was a multi-center, open-label, single arm study which evaluated the anti-cancer activity of derazantinib in adult patients with inoperable or advanced iCCA in the following study population: Patients with inoperable or advanced iCCA and with fibroblast growth factor receptor 2 (FGFR2) fusions (Substudy 1) or FGFR2 mutations/amplifications (Substudy 2), treated with at least one prior regimen of systemic therapy. Derazantinib was supplied as 100 mg capsules. A dose of 300 mg once-daily (three capsules of 100 mg each) of derazantinib was administered orally to patients, 1 hour before, or 2 hours after, a meal.
Interventions
DRUGderazantinib
Derazantinib was administered orally at 300 mg once daily
Sponsors
Basilea Pharmaceutica
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Key Inclusion Criteria: 1. Signed written informed consent granted prior to initiation of any study-specific procedures 2. 18 years of age or older 3. Histologically or cytologically confirmed locally advanced, inoperable, or metastatic iCCA or mixed histology tumors 4. Substudy 1: FGFR2 fusion status based on the following assessments: a) If central laboratory was designated by Sponsor: Positive FISH test; and/or b) If non-central laboratory: i) Positive FISH or NGS test: patients were potentially enrolled and started dosing, but central confirmation was required\* ii) Negative FISH or NGS test: tissue was submitted to the central laboratory designated by the Sponsor, and patients were only enrolled in case the central test was positive \*By used standard protocols and approved by local IRB/EC, by CLIA or other similar agency. Substudy 2: FGFR2 mutation/amplification status based on local NGS testing performed or commissioned by the respective study site. 5. Received at least one regimen of prior systemic therapy and then experienced documented radiographic progression 6. Measurable disease by RECIST version 1.1 criteria 7. ECOG performance status ≤ 1 8. Adequate organ functions as indicated by the following laboratory values (based on screening visit values from the central laboratory). * Hematological * Hemoglobin (Hgb) ≥ 9.0 g/dL * Absolute neutrophil count (ANC) ≥ 1.5 x 10\^9/L * Platelet count ≥ 75 x 109/L * International normalized ratio (INR) 0.8 to upper limit of normal (ULN) or ≤ 3 for subjects who received anticoagulant therapy such as Coumadin or heparin * Hepatic * Total bilirubin ≤ 2 x ULN * AST and ALT ≤ 3 ULN (≤ 5 x ULN for subjects with liver metastases) * Albumin ≥ 2.8 g/dL * Renal * Serum creatinine ≤ 1.5 x ULN * Creatinine clearance of ≥ 30 mL/min as estimated by the Cockcroft-Gault equation 9. Female and male patients of child-producing potential must had agreed to avoid becoming pregnant or impregnating a partner, respectively, used double-barrier contraceptive measures, oral contraception, or had to avoid of intercourse, during the study, and until at least 120 for 90 days after the last dose of derazantinib. Male or female patients of child-producing potential must had agreed to comply with one of the following until at least 120 days after the last dose of derazantinib: 1. Abstinence from heterosexual activity 2. Using (or having their partner use) an acceptable method of contraception during heterosexual activity. Key
Exclusion criteria
1. Receipt of treatment before the first dose of study drug (Cycle 1 Day 1) within an interval shorter than the following, as applicable: * One chemotherapy or biological (e.g., antibody) cycle interval * Five half-lives of any small-molecule investigational or licensed medicinal product * Two weeks, for any investigational medicinal product with an unknown half-life * Four weeks of curative radiotherapy * Seven days of palliative radiotherapy * 28 days of radiotherapy 2. Major surgery, locoregional therapy, or radiation therapy within four weeks of the first dose of derazantinib 3. Previous treatment with any FGFR inhibitor (e.g., Balversa® \[erdafitinib\], Pemazyre® \[pemigatinib\], infigratinib, rogaratinib, futibatinib, lenvatinib, ponatinib, dovitinib, nintedanib, AZD4547, LY2784455). 4. Patients who were unable or unwilling to swallow the complete daily dose of derazantinib capsules 5. Clinically unstable central nervous system (CNS) metastases (to be eligible, subjects must had stable disease ≥ 3 months, confirmed by magnetic resonance imaging (MRI) or computed tomography (CT) scan, and/or had CNS metastases well controlled by low-dose steroids, anti-epileptics, or other symptom-relieving medications) 6. Evidence of clinically significant corneal or retinal disorder which was likely to increase the risk of eye toxicity, including but not limited to bullous/band keratopathy, keratoconjunctivitis (unless keratoconjunctivitis sicca), corneal abrasion, inflammation/ulceration, confirmed by ophthalmologic examination. 7. Uncontrolled or active hepatobiliary disorders, untreated or ongoing complications after laparoscopic procedures or stent placement, including but not limited to active cholangitis, biloma or abscess (to be eligible, the subjects had to be treated and disorders/complications should had been resolved within 2 weeks prior to the first dose of derazantinib) 8. History of significant cardiac disorders: * Myocardial infarction (MI) or congestive heart failure defined as Class II to IV per the New York Heart Association (NYHA) classification within 6 months of the first dose of derazantinib (MI that occurred \> 6 months prior to the first dose of derazantinib was permitted) * QTcF \>450 msec (males or females) 9. Serum electrolyte abnormalities defined as follows: * Hyperphosphataemia: Serum phosphate \> institutional ULN * Hyperkalemia: \> 6.0 mmol/L * Hypokalemia: \< 3.0 mmol/L * Hypercalcemia: corrected serum calcium \< 1.75 mmol/L (\< 7.0 mg/dL) * Hypocalcemia: corrected serum calcium \> 3.1 mmol/L (\> 12.5 mg/dL) * Hypomagnesemia: \< 0.4 mmol/L (\< 0.9 mg/dL) 10. Significant gastrointestinal disorder(s) that could had, in the opinion of the Investigator, interfered with the absorption, metabolism, or excretion of derazantinib (e.g., Crohn's disease, ulcerative colitis, extensive gastric resection) 11. History of additional malignancy that was progressing or required active treatment. Exceptions included basal cell carcinoma of the skin, squamous cell carcinoma of the skin that had undergone potentially curative therapy, and in situ cervical cancer. 12. Uncontrolled illness not related to cancer, including but not limited to: * Psychiatric illness/substance abuse/social situation that would limit compliance with study requirements * Known uncontrolled human immunodeficiency virus (HIV) infection * Severe bacterial, fungal, viral and/or parasitic infections on therapeutic oral or IV medication at the time of first dose of study drug administration 13. Blood or albumin transfusion within 5 days of the blood draw which has been used to confirm eligibility 14. Pregnant or breast feeding 15. Known hypsersensitivity to derazantinib, or to any of the study drug excipients (starch, lactose, crospovidone, magnesium stearate)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Substudy 1: Objective Response Rate (ORR) | From first dose and up to 54 months | ORR was defined as the proportion of patients who achieved a confirmed clinical response (CR) or partial response (PR) by blinded independent central review using the internationally recognized criteria for the radiological assessment in tumor response of solid tumors (RECIST) Version 1.1 |
| Substudy 2: Progression Free Survival at 3 Months (PFS 3) | From first dose and up to 3 months | PFS3 was defined as the proportion of patients who have progression-free survival at 3 months from the first date of receiving study drug as assessed by survival status and blinded independent central review as per RECIST 1.1. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of Response (DoR) | From first dose and up to 54 months | DoR was calculated from the first date of documented tumor response to disease progression by blinded independent central review per RECIST version 1.1 DoR was derived only for patients who have the best overall response of CR or PR |
| PFS | From first dose and up to 54 months | PFS was calculated from the first date of receiving study drug until radiographic disease progression by blinded independent central review or death. |
| Number of Patients With Grade 3-5 Treatment-emergent Adverse Events (TEAEs) | TEAEs were defined as all events occurring after drug treatment began and up to 30 days after last study drug administration | Number of patients experiencing TEAE of Grade 3 to 5 according to Common Terminology Criteria for Adverse Events (CTCAE) |
| Substudy 2: Objective Response Rate | From first dose and up to 54 months | ORR was defined as the proportion of patients who achieved a confirmed clinical response (CR) or partial response (PR) by blinded independent central review using the internationally recognized criteria for the radiological assessment in tumor response of solid tumors (RECIST) Version 1.1 |
| Overall Survival (OS) | From first dose and up to 54 months | OS was calculated from the first date of receiving study drug until death |
Countries
Belgium, Canada, France, Germany, Ireland, Italy, South Korea, Spain, Switzerland, United Kingdom, United States
Participant flow
Recruitment details
A total of 729 patients underwent molecular screening, and 148 were enrolled and assigned treatment. One patient was subsequently not confirmed to have fibroblast growth factor receptor 2 (FGFR2) fusion, and was therefore excluded from the Safety/ITT population, meaning that for all Safety/ITT population analyses 147 patients were included (Substudy 1 = 103, Substudy 2 = 44).
Participants by arm
| Arm | Count |
|---|---|
| Substudy 1 Substudy 1 comprised of patients with inoperable or advanced iCCA with FGFR2 fusions
Derazantinib was administered orally at 300 mg once daily | 103 |
| Substudy 2 Substudy 2 comprised of patients with inoperable or advanced iCCA with FGFR2 mutations or amplifications
Derazantinib was administered orally at 300 mg once daily | 44 |
| Total | 147 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 5 | 3 |
| Overall Study | Clinical progression | 17 | 7 |
| Overall Study | Death | 3 | 2 |
| Overall Study | Lost to Follow-up | 1 | 0 |
| Overall Study | Other | 3 | 7 |
| Overall Study | Physician Decision | 2 | 3 |
| Overall Study | Radiographic disease progression | 72 | 19 |
| Overall Study | Withdrawal by Subject | 1 | 3 |
Baseline characteristics
| Characteristic | Substudy 2 | Total | Substudy 1 |
|---|---|---|---|
| Age, Continuous | 61.3 years STANDARD_DEVIATION 11.75 | 58.0 years STANDARD_DEVIATION 12.28 | 56.5 years STANDARD_DEVIATION 12.28 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 4 Participants | 7 Participants | 3 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 8 Participants | 8 Participants |
| Race (NIH/OMB) More than one race | 1 Participants | 5 Participants | 4 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 2 Participants | 4 Participants | 2 Participants |
| Race (NIH/OMB) White | 37 Participants | 123 Participants | 86 Participants |
| Sex: Female, Male Female | 25 Participants | 92 Participants | 67 Participants |
| Sex: Female, Male Male | 19 Participants | 55 Participants | 36 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 74 / 103 | 25 / 44 |
| other Total, other adverse events | 103 / 103 | 43 / 44 |
| serious Total, serious adverse events | 37 / 103 | 16 / 44 |
Outcome results
Primary
Substudy 1: Objective Response Rate (ORR)
ORR was defined as the proportion of patients who achieved a confirmed clinical response (CR) or partial response (PR) by blinded independent central review using the internationally recognized criteria for the radiological assessment in tumor response of solid tumors (RECIST) Version 1.1
Time frame: From first dose and up to 54 months
Population: Intent-to-treat (ITT) Population: included all patients who received any amount of study drug
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Substudy 1 | Substudy 1: Objective Response Rate (ORR) | 22.3 Percentage of participants |
Primary
Substudy 2: Progression Free Survival at 3 Months (PFS 3)
PFS3 was defined as the proportion of patients who have progression-free survival at 3 months from the first date of receiving study drug as assessed by survival status and blinded independent central review as per RECIST 1.1.
Time frame: From first dose and up to 3 months
Population: Modified intent-to-treat (mITT) Population: included all patients in the Safety/ITT population, who had at least one post-baseline disease assessment (at least one post-baseline imaging assessment in accordance with RECIST 1.1, or documented clinical progression \[every effort was made to objectively assess radiographic progression\]), or reported death during the treatment period.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Substudy 1 | Substudy 2: Progression Free Survival at 3 Months (PFS 3) | 62.8 Percentage of participants |
Secondary
Duration of Response (DoR)
DoR was calculated from the first date of documented tumor response to disease progression by blinded independent central review per RECIST version 1.1 DoR was derived only for patients who have the best overall response of CR or PR
Time frame: From first dose and up to 54 months
Population: ITT Population: included all patients who received any amount of study drug
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Substudy 1 | Duration of Response (DoR) | 6.5 Months |
| Substudy 2 | Duration of Response (DoR) | NA Months |
Secondary
Number of Patients With Grade 3-5 Treatment-emergent Adverse Events (TEAEs)
Number of patients experiencing TEAE of Grade 3 to 5 according to Common Terminology Criteria for Adverse Events (CTCAE)
Time frame: TEAEs were defined as all events occurring after drug treatment began and up to 30 days after last study drug administration
Population: Safety / ITT population included all patients who received any amount of study drug
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Substudy 1 | Number of Patients With Grade 3-5 Treatment-emergent Adverse Events (TEAEs) | Number of patients with only unrelated TEAEs of Grade 3-5 | 31 Participants |
| Substudy 1 | Number of Patients With Grade 3-5 Treatment-emergent Adverse Events (TEAEs) | Number of patients with related TEAEs of Grade 3-5 | 35 Participants |
| Substudy 1 | Number of Patients With Grade 3-5 Treatment-emergent Adverse Events (TEAEs) | Number of patients without TEAEs of Grade 3-5 | 37 Participants |
| Substudy 2 | Number of Patients With Grade 3-5 Treatment-emergent Adverse Events (TEAEs) | Number of patients with only unrelated TEAEs of Grade 3-5 | 16 Participants |
| Substudy 2 | Number of Patients With Grade 3-5 Treatment-emergent Adverse Events (TEAEs) | Number of patients with related TEAEs of Grade 3-5 | 10 Participants |
| Substudy 2 | Number of Patients With Grade 3-5 Treatment-emergent Adverse Events (TEAEs) | Number of patients without TEAEs of Grade 3-5 | 18 Participants |
Secondary
Overall Survival (OS)
OS was calculated from the first date of receiving study drug until death
Time frame: From first dose and up to 54 months
Population: ITT population: included all patients who received any amount of study drug
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Substudy 1 | Overall Survival (OS) | 17.2 Months |
| Substudy 2 | Overall Survival (OS) | 11.9 Months |
Secondary
PFS
PFS was calculated from the first date of receiving study drug until radiographic disease progression by blinded independent central review or death.
Time frame: From first dose and up to 54 months
Population: mITT Population: included all patients in the Safety/ITT population, who had at least one post-baseline disease assessment (at least one post-baseline imaging assessment in accordance with RECIST 1.1, or documented clinical progression \[every effort was made to objectively assess radiographic progression\]), or reported death during the treatment period.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Substudy 1 | PFS | 8.1 Months |
| Substudy 2 | PFS | 8.3 Months |
Secondary
Substudy 2: Objective Response Rate
ORR was defined as the proportion of patients who achieved a confirmed clinical response (CR) or partial response (PR) by blinded independent central review using the internationally recognized criteria for the radiological assessment in tumor response of solid tumors (RECIST) Version 1.1
Time frame: From first dose and up to 54 months
Population: mITT Population: included all patients in the Safety/ITT population, who had at least one post-baseline disease assessment (at least one post-baseline imaging assessment in accordance with RECIST 1.1, or documented clinical progression \[every effort was made to objectively assess radiographic progression\]), or reported death during the treatment period.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Substudy 1 | Substudy 2: Objective Response Rate | 9.3 Percentage of participants |