Gastrointestinal Stromal Tumors
Conditions
Brief summary
This is a 2-arm, randomized, placebo-controlled, double-blind, international, multicenter study comparing the efficacy of ripretinib (DCC-2618) to placebo in patients who have received treatment with prior anticancer therapies. Prior anticancer therapies must include imatinib, sunitinib, and regorafenib (3 prior therapies). Approximately 120 patients were randomized in a 2:1 ratio to ripretinib 150 mg QD or placebo
Interventions
DRUGDCC-2618
Oral KIT/PDGFRA kinase inhibitor
DRUGPlacebo Oral Tablet
Placebo
Sponsors
Deciphera Pharmaceuticals, LLC
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Histologic diagnosis of GIST 2. Patients must have progressed on imatinib, sunitinib, and regorafenib or have documented intolerance to any of these treatments. 3. ECOG PS of 0 to 2 at screening. 4. Able to provide an archival tumor tissue sample if no anticancer therapy was administered since the sample was collected; otherwise, a fresh tumor tissue sample is required prior to the first dose of study drug. 5. Female patients of childbearing potential must have a negative serum beta-human chorionic gonadotrophin (β-hCG) pregnancy test at screening and negative urine pregnancy test at Cycle 1 Day 1 prior to the first dose of study drug. 6. Patients of reproductive potential must agree to follow the contraception requirements. 7. The patient is capable of understanding and complying with the protocol and has signed the informed consent document. A signed informed consent form must be obtained before any study-specific procedures are performed. 8. At least 1 measurable lesion according to modified RECIST Version 1.1 (non-nodal lesions must be ≥1.0 cm in the long axis or ≥double the slide thickness in the long axis) within 21 days prior to the first dose of study drug. 9. Adequate organ function and bone marrow reserve as indicated by the following laboratory assessments performed at screening. * Absolute neutrophil count ≥1000/uL * Hemoglobin ≥8 g/dL * Platelet count ≥75,000/uL * Total bilirubin ≤1.5 x the upper limit of normal (ULN) * Aspartate transaminase or alanine transaminase ≤3 x ULN (≤5x ULN in the presence of hepatic metastases) * Serum creatinine ≤1.5 x ULN or creatinine clearance ≥50 mL/min based on either urine collection or Cockcroft Gault estimation. * Prothrombin time (PT) or international normalized ratio (INR) or partial thromboplastin time ≤1.5 x ULN. Patients on a stable, maintenance regimen of anticoagulant therapy for at least 30 days prior to study drug administration may have PT/INR measurements \>1.5 x ULN if, in the opinion of the Investigator, the patient is suitable for the study. An adequate rationale must be provided to the Sponsor prior to randomization. 10. Resolution of all toxicities from prior therapy to ≤Grade 1 (or baseline) within 1 week prior to the first dose of study drug (excluding alopecia and ≤Grade 3 clinically asymptomatic lipase, amylase, and creatine phosphokinase laboratory abnormalities).
Exclusion criteria
1. Treatment with anticancer therapy, including investigational therapy, or investigational procedures within 14 days or 5 x the half-life (whichever is longer) prior to the first dose of study drug. For prior biological therapies, eg, monoclonal antibodies with a half-life longer than 3 days, the interval must be at least 28 days prior to the first dose of study drug. 2. Prior treatment with DCC-2618 3. Prior or concurrent malignancy whose natural history or treatment have the potential to interfere with the safety or efficacy assessment of DCC-2618. Patients receiving adjuvant cancer treatment are not eligible if those medications are potentially active against GIST or excluded per protocol. 4. Patient has known active central nervous system metastases. 5. New York Heart Association class II - IV heart disease, active ischemia or any other uncontrolled cardiac condition such as angina pectoris, clinically significant cardiac arrhythmia requiring therapy, uncontrolled hypertension or congestive heart failure. 6. Arterial thrombotic or embolic events such as cerebrovascular accident (including ischemic attacks) or hemoptysis within 6 months before the first dose of study drug. 7. Venous thrombotic events (eg, deep vein thrombosis) or pulmonary arterial events (eg, pulmonary embolism) within 3 months before the first dose of study drug. Patients with venous thrombotic events ≥3 months before the first dose of study drug on stable anticoagulation therapy are eligible. 8. 12-lead electrocardiogram (ECG) demonstrating QT interval corrected by Fridericia's formula \>450 ms in males or \>470 ms in females at screening or history of long QT interval corrected syndrome. 9. Left ventricular ejection fraction (LVEF) \<50% at screening. 10. Use of proton-pump inhibitors within 4 days prior to the first dose of study drug. Other medications that increase gastric pH, ie, histamine H2 receptor antagonists and antacids may be taken provided they are not administered within 2 hours before or after administration of study drug. 11. Use of strong or moderate inhibitors and inducers of cytochrome P450 (CYP) 3A4, including certain herbal medications (eg, St. John's Wort) and consumption of grapefruit or grapefruit juice within 14 days or 5 x the half-life (whichever is longer) prior to the first dose of study drug. 12. Use of known substrates or inhibitors of breast cancer resistance protein (BCRP) transporters within 14 days or 5 x the half-life (whichever is longer) prior to the first dose of study drug. 13. Major surgeries (eg, abdominal laparotomy) within 4 weeks of the first dose of study drug. Following major surgeries, \>4 weeks prior to the first dose of study drug, all surgical wounds must be healed and free of infection or dehiscence. 14. Any other clinically significant comorbidities, such as uncontrolled pulmonary disease, active infection, or any other condition, which in the judgment of the Investigator, could compromise compliance with the protocol, interfere with interpretation of the study results, or predispose the patient to safety risks. 15. Known human immunodeficiency virus or hepatitis C infection only if the patient is taking medications that are excluded per protocol, active hepatitis B, or active hepatitis C infection. 16. If female, the patient is pregnant or lactating. 17. Known allergy or hypersensitivity to any component of the investigational drug product. Patients with a history of Stevens-Johnson syndrome on a prior TKI are excluded. 18. Gastrointestinal abnormalities including but not limited to: * inability to take oral medication * malabsorption syndromes * requirement for intravenous alimentation 19. Any active bleeding excluding hemorrhoidal or gum bleeding.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival (PFS) | From date of randomization to the earliest date of disease progression or death from any cause [through database cutoff 31-May-2019 (up to approximately 15 months)]. | PFS was defined as the time interval between the date of randomization and the earliest documented evidence of the first disease progression based on the independent radiologic review or death due to any cause on initially assigned study treatment, whichever comes earlier, assessed at 26, 39, and 52 weeks. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Tumor Progression (TTP) Based on Independent Radiologic Review | From date of randomization to the earliest date of disease progression [through database cutoff 31-May-2019 (up to approximately 15 months)]. | TTP is defined as the interval between the date of randomization and the earliest documented evidence of disease progression based on the independent radiologic review. |
| Overall Survival (OS) | From the date of randomization to the date of death from any cause [through database cutoff 31-May-2019 (up to approximately 15 months)]. | Overall Survival (OS) was defined as the interval between the date of randomization until the date of death or the date of last follow-up. |
| Objective Response Rate (ORR) | From date of randomization to the earliest date of disease progression or death from any cause [through database cutoff 31-May-2019 (up to approximately 15 months)]. | The percentage of patients with a confirmed complete response or PR (CR: Disappearance of all target lesions and non-target lesions (if present at baseline); all lymph nodes must be non-pathological in size) or partial response (PR: \>=30% decrease in the Sum of Diameters of target lesions and non-target lesions non-PD or NE or none at baseline; or target lesions CR and non-target lesions non-CR/Non-PD or NE) based on the independent radiologic review and during the initially assigned study treatment. To be assigned a status of a CR or PR, changes in tumor measurements must be confirmed by repeat CT or MRI assessments that must be performed at least 4 weeks after the criteria for response are first met. |
| Quality of Life & Disease-Related Symptoms - Physical Functioning | From the date of randomization (Baseline) to Cycle 2 Day 1 (Month 2) | Changes from baseline in European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer 30-Item - Physical Functioning. For the ripretinib arm, the minimum and maximum for the outcome were -33 to 53; the placebo arm had a range of -47 to 20. The higher value represents a higher quality of life in disease-related symptoms. |
| Quality of Life & Disease-Related Symptoms - EuroQol Visual Analogue Scale | From the date of randomization (Baseline) to Cycle 2 Day 1 (Month 2) | Change from baseline in EuroQol Visual Analogue Scale. For the ripretinib arm the minimum and maximum for the outcome were -43 to 91; the placebo arm had a range of -68 to 23. The higher value represents a higher quality of life in disease-related symptoms. |
| Quality of Life & Disease-Related Symptoms - European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer 30-Item - Role Functioning | From the date of randomization (Baseline) to Cycle 2 Day 1 (Month 2) | Changes from baseline in European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer 30-item - Role Functioning. For the ripretinib arm the minimum and maximum for the outcome were -67 to 67; the placebo arm had a range of -83 to 67. The higher value represents a higher quality of life in disease-related symptoms. |
Countries
Australia, Belgium, Canada, Finland, France, Germany, Italy, Netherlands, Poland, Singapore, Spain, United Kingdom, United States
Participant flow
Recruitment details
The first patient enrolled on 27 Feb 2018, with the last patient in (LPI) on 16 Nov 2018. The study is ongoing; Data cutoff date of 31 May 2019. Of the 129 patients enrolled in the double-blind period (ITT population), 85 patients were randomized to the ripretinib arm and 44 patients were randomized to the placebo arm.
Participants by arm
| Arm | Count |
|---|---|
| Ripretinib Ripretinib (150 mg) once daily in 28-day cycles until disease progression by Independent Radiologic Review (IRR) in patients with advanced gastrointestinal stromal tumors (GIST) who have received treatment with prior therapies (therapies must include treatment with imatinib, sunitinib, and regorafenib). Ripretinib vs. Placebo 2:1 ratio | 85 |
| Placebo Placebo once daily in 28-day cycles until disease progression by Independent Radiologic Review (IRR) in patients with advanced gastrointestinal stromal tumors (GIST) who have received treatment with prior therapies (therapies must include treatment with imatinib, sunitinib, and regorafenib). Ripretinib vs. Placebo 2:1 ratio | 44 |
| Total | 129 |
Baseline characteristics
| Characteristic | Placebo | Ripretinib | Total |
|---|---|---|---|
| Age, Customized Age Category (years) 18 - 64 Years | 22 Participants | 57 Participants | 79 Participants |
| Age, Customized Age Category (years) 65 - 74 Years | 12 Participants | 20 Participants | 32 Participants |
| Age, Customized Age Category (years) 75 Years or Older | 10 Participants | 8 Participants | 18 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 1 Participants | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 38 Participants | 76 Participants | 114 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 6 Participants | 8 Participants | 14 Participants |
| Number of Prior Systemic Anticancer Treatments 3 | 27 Participants | 54 Participants | 81 Participants |
| Number of Prior Systemic Anticancer Treatments ≥ 4 | 17 Participants | 31 Participants | 48 Participants |
| Race/Ethnicity, Customized Race Asian | 5 Participants | 4 Participants | 9 Participants |
| Race/Ethnicity, Customized Race Black or African American | 2 Participants | 8 Participants | 10 Participants |
| Race/Ethnicity, Customized Race Not Reported | 4 Participants | 8 Participants | 12 Participants |
| Race/Ethnicity, Customized Race Other | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Race White | 33 Participants | 64 Participants | 97 Participants |
| Region Non-US | 24 Participants | 45 Participants | 69 Participants |
| Region US | 20 Participants | 40 Participants | 60 Participants |
| Sex: Female, Male Female | 18 Participants | 38 Participants | 56 Participants |
| Sex: Female, Male Male | 26 Participants | 47 Participants | 73 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 26 / 85 | 26 / 43 |
| other Total, other adverse events | 84 / 85 | 42 / 43 |
| serious Total, serious adverse events | 26 / 85 | 19 / 43 |
Outcome results
Primary
Progression-Free Survival (PFS)
PFS was defined as the time interval between the date of randomization and the earliest documented evidence of the first disease progression based on the independent radiologic review or death due to any cause on initially assigned study treatment, whichever comes earlier, assessed at 26, 39, and 52 weeks.
Time frame: From date of randomization to the earliest date of disease progression or death from any cause [through database cutoff 31-May-2019 (up to approximately 15 months)].
Population: ITT Population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Ripretinib | Progression-Free Survival (PFS) | 27.6 Weeks |
| Placebo | Progression-Free Survival (PFS) | 4.1 Weeks |
p-value: <0.000195% CI: [0.09, 0.25]Log Rank
Secondary
Objective Response Rate (ORR)
The percentage of patients with a confirmed complete response or PR (CR: Disappearance of all target lesions and non-target lesions (if present at baseline); all lymph nodes must be non-pathological in size) or partial response (PR: \>=30% decrease in the Sum of Diameters of target lesions and non-target lesions non-PD or NE or none at baseline; or target lesions CR and non-target lesions non-CR/Non-PD or NE) based on the independent radiologic review and during the initially assigned study treatment. To be assigned a status of a CR or PR, changes in tumor measurements must be confirmed by repeat CT or MRI assessments that must be performed at least 4 weeks after the criteria for response are first met.
Time frame: From date of randomization to the earliest date of disease progression or death from any cause [through database cutoff 31-May-2019 (up to approximately 15 months)].
Population: ITT Population
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Ripretinib | Objective Response Rate (ORR) | 9.4 Percentage of Participants |
| Placebo | Objective Response Rate (ORR) | 0 Percentage of Participants |
p-value: 0.0504Fisher Exact
Secondary
Overall Survival (OS)
Overall Survival (OS) was defined as the interval between the date of randomization until the date of death or the date of last follow-up.
Time frame: From the date of randomization to the date of death from any cause [through database cutoff 31-May-2019 (up to approximately 15 months)].
Population: ITT Population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Ripretinib | Overall Survival (OS) | 65.6 weeks |
| Placebo | Overall Survival (OS) | 28.6 weeks |
p-value: 0.000495% CI: [0.21, 0.62]Log Rank
Secondary
Quality of Life & Disease-Related Symptoms - European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer 30-Item - Role Functioning
Changes from baseline in European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer 30-item - Role Functioning. For the ripretinib arm the minimum and maximum for the outcome were -67 to 67; the placebo arm had a range of -83 to 67. The higher value represents a higher quality of life in disease-related symptoms.
Time frame: From the date of randomization (Baseline) to Cycle 2 Day 1 (Month 2)
Population: ITT Population
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Ripretinib | Quality of Life & Disease-Related Symptoms - European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer 30-Item - Role Functioning | 3.5 units on a scale | Standard Deviation 27.31 |
| Placebo | Quality of Life & Disease-Related Symptoms - European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer 30-Item - Role Functioning | -17.1 units on a scale | Standard Deviation 30.28 |
p-value: 0.001ANCOVA
Secondary
Quality of Life & Disease-Related Symptoms - EuroQol Visual Analogue Scale
Change from baseline in EuroQol Visual Analogue Scale. For the ripretinib arm the minimum and maximum for the outcome were -43 to 91; the placebo arm had a range of -68 to 23. The higher value represents a higher quality of life in disease-related symptoms.
Time frame: From the date of randomization (Baseline) to Cycle 2 Day 1 (Month 2)
Population: ITT Population
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Ripretinib | Quality of Life & Disease-Related Symptoms - EuroQol Visual Analogue Scale | 3.7 Units on a Scale | Standard Deviation 20.36 |
| Placebo | Quality of Life & Disease-Related Symptoms - EuroQol Visual Analogue Scale | -8.9 Units on a Scale | Standard Deviation 19.31 |
p-value: 0.004t-test, 2 sided
Secondary
Quality of Life & Disease-Related Symptoms - Physical Functioning
Changes from baseline in European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer 30-Item - Physical Functioning. For the ripretinib arm, the minimum and maximum for the outcome were -33 to 53; the placebo arm had a range of -47 to 20. The higher value represents a higher quality of life in disease-related symptoms.
Time frame: From the date of randomization (Baseline) to Cycle 2 Day 1 (Month 2)
Population: ITT Population
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Ripretinib | Quality of Life & Disease-Related Symptoms - Physical Functioning | 1.6 units on a scale | Standard Deviation 16.03 |
| Placebo | Quality of Life & Disease-Related Symptoms - Physical Functioning | -8.9 units on a scale | Standard Deviation 19.28 |
p-value: 0.004ANCOVA
Secondary
Time to Tumor Progression (TTP) Based on Independent Radiologic Review
TTP is defined as the interval between the date of randomization and the earliest documented evidence of disease progression based on the independent radiologic review.
Time frame: From date of randomization to the earliest date of disease progression [through database cutoff 31-May-2019 (up to approximately 15 months)].
Population: ITT Population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Ripretinib | Time to Tumor Progression (TTP) Based on Independent Radiologic Review | 28 Weeks |
| Placebo | Time to Tumor Progression (TTP) Based on Independent Radiologic Review | 4.1 Weeks |