Metastatic Colorectal Cancer
Conditions
Keywords
Metastatic Colorectal Cancer, PI3K Inhibitor, PIK3CA mutated, MEN1611, Cetuximab, anti-EGFR, mCRC
Brief summary
Open-label, dose-confirmation and cohort expansion, multicenter, Phase Ib/II study to assess the anti-tumor activity and safety of MEN1611 in combination with cetuximab for the treatment of participants with phosphatidylinositol 3-kinase, catalytic, alpha polypeptide gene (PIK3CA)-mutated metastatic colorectal cancer.
Detailed description
This Phase Ib/II study investigated the anti-tumor activity and safety of daily oral doses MEN1611 in combination with cetuximab in female and male participants affected by PIK3CA-mutated, neuroblastoma-Kristen-rat sarcoma virus (N-K-RAS) wild-type, and BRAF wild-type metastatic colorectal cancer. MEN1611 is a potent, selective class I phosphoinositide 3-kinase (PI3K) inhibitor. The maximum tolerated dose of MEN1611 given as single agent was assessed in a Phase I trial in participants with advanced solid tumors. This Phase Ib/II started with a dose confirmation part (Step 1) to identify the recommended phase 2 dose of MEN1611 given in combination with cetuximab. The study continued with a cohort expansion (Step 2) to explore the anti-tumor activity of the selected MEN1611 dose level combined with cetuximab with further assessment of safety and tolerability.
Interventions
MEN1611 oral dose administered twice daily for a continuous 28-day cycle.
Cetuximab solution for infusion administered weekly via intravenous infusion.
Sponsors
Study design
Intervention model description
Step 1: Confirmation of Dose for Cohort Expansion / Step 2: Cohort Expansion
Eligibility
Inclusion criteria
Main Inclusion Criteria: * Histological documentation of adenocarcinoma of the colon or rectum. * Progression or recurrence following prior irinotecan, oxaliplatin, 5-fluorouracil (5-FU) and anti-epidermal growth factor receptor (EGFR) containing regimens for metastatic disease. * Best response according to Response Evaluation Criteria in Solid Tumours (RECIST) criteria to the last anti-EGFR containing regimen of partial response or stable disease for at least 4 months. * Measurable disease according to RECIST criteria. * N-K-RAS (exons 2, 3 and 4) and BRAF wild-type and PIK3CA mutated. * Eastern Cooperative Oncology Group performance status of 0 or 1. Main
Exclusion criteria
* Previous treatment with PI3K inhibitor. * Brain metastases, unless treated \>4 weeks before screening visit and only if clinically stable and not receiving corticosteroids. * National Cancer Institute Common Terminology Criteria for Adverse Events v5.0 Grade ≥2 diarrhea. * History of significant, uncontrolled or active cardiovascular disease. * Known active or uncontrolled pulmonary dysfunction. * Uncontrolled diabetes mellitus (glycated hemoglobin \>7%) and fasting plasma glucose \>126 milligrams/deciliter. * Known history of human immunodeficiency virus infection or active infection with hepatitis C virus or hepatitis B virus. * Concurrent chronic immunosuppressive treatment either with steroids or other immunosuppressive agents.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Phase 1b: Recommended Phase 2 Dose (RP2D) of MEN1611 in Combination With Cetuximab | Day 1 through Day 28 of Cycle 1 (28 days/cycle) | RP2D was defined as the highest dose level in milligrams (mg) at which no more than 1 participant during the dose confirmation phase (Phase 1b) experienced a dose-limiting toxicity (DLT) during the DLT assessment window (28 days), or the maximum dose judged to be tolerable by the data safety committee. |
| Best Overall Response Rate (ORR) of MEN1611 in Combination With Cetuximab | Up to 37 Months | The best ORR was defined as percentage of participants who had a best overall response to therapy of complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD) and was defined according to Response Evaluation Criteria in Solid Tumors version 1.1 assessment locally performed using computed tomography scans or magnetic resonance imaging of the chest and abdomen (including pelvis and adrenal glands). |
| Phase 1b: Number of Participants With DLTs for MEN1611 | Day 1 through Day 28 of Cycle 1 (28 days/cycle) | A DLT was defined as any of the following adverse drug reactions (ADRs) related to the combination regimens or to MEN1611 alone and unrelated to the participants' underlying disease or concomitant medication occurring during Cycle 1 over the DLT assessment window of 28 days: any Grade 3 (lasting \>7 days) or Grade 4 increase in aspartate aminotransferase, alanine aminotransferase, or alkaline phosphatase; any Grade ≥3 cardiac disorder or new segmental wall-motion abnormalities; any Grade ≥3 non-hematologic toxicity with the following exceptions: nausea, vomiting, diarrhea, skin rash, hyperglycemia. An ADR was defined as any adverse event suspected by the investigator and/or the sponsor to be related to MEN1611, cetuximab, or both given in combination. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression-free Survival (PFS) of MEN1611 in Combination With Cetuximab | Up to 37 months | PFS was defined as the number of days between the first study treatment administration to the date of first documented disease progression as per local assessment, relapse or death from any cause. Responding participants and participants who were lost to follow-up were censored at their last tumor assessment date. |
| Plasma Concentration of MEN1611 in Combination With Cetuximab | Day 22 (1.5 hours postdose) of Cycle 1 (28 days/cycle) | Blood samples were taken for the analyses of MEN1611 in plasma at designated time points. Results are reported as nanograms/millilitre (ng/mL). |
| Overall Survival (OS) of MEN1611 in Combination With Cetuximab | Up to 37 months | OS was defined as the number of days between the first study treatment administration and death from any cause. Participants still alive that had withdrawn from the study were censored using the latest among end of study and follow-up dates. Drop-out participants were considered censored and the last available date in which the participant was known to be alive was considered. |
| Disease Control Rate (DCR) of MEN1611 in Combination With Cetuximab | Up to 37 Months | DCR was defined as percentage of participants whose disease shrank or remained stable over a certain time period and was calculated based on the sum of the CR, PR, and SD rates according to local assessment. |
| Duration of Response (DOR) of MEN1611 in Combination With Cetuximab | Up to 37 months | DOR was defined as the time from confirmation of a PR, CR or SD as locally assessed, until the disease had been shown to progress following treatment. Participants with a previous response who did not show a relapse or died without recording a relapse were censored at their last available relapse-free tumor assessment date. Participants with only one tumor assessment after baseline showing a PD were not included in the calculation. |
Countries
France, Germany, Italy, Netherlands, Poland, Spain, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Phase 1b (Dose Confirmation) Participants received MEN1611 twice daily and cetuximab weekly, every 28-day cycle. | 7 |
| Phase 2 (Cohort Expansion) Participants received MEN1611 twice daily and cetuximab weekly, every 28-day cycle. | 22 |
| Total | 29 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 7 | 11 |
| Overall Study | Investigator Decision | 0 | 7 |
| Overall Study | Lost to Follow-up | 0 | 1 |
| Overall Study | Withdrawal by Subject | 0 | 3 |
Baseline characteristics
| Characteristic | Phase 1b (Dose Confirmation) | Phase 2 (Cohort Expansion) | Total |
|---|---|---|---|
| Age, Continuous | 53.9 years STANDARD_DEVIATION 12.16 | 58.9 years STANDARD_DEVIATION 12.38 | 57.7 years STANDARD_DEVIATION 12.31 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 7 Participants | 15 Participants | 22 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 7 Participants | 7 Participants |
| Sex: Female, Male Female | 1 Participants | 11 Participants | 12 Participants |
| Sex: Female, Male Male | 6 Participants | 11 Participants | 17 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 7 / 7 | 11 / 22 |
| other Total, other adverse events | 7 / 7 | 22 / 22 |
| serious Total, serious adverse events | 5 / 7 | 11 / 22 |
Outcome results
Best Overall Response Rate (ORR) of MEN1611 in Combination With Cetuximab
The best ORR was defined as percentage of participants who had a best overall response to therapy of complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD) and was defined according to Response Evaluation Criteria in Solid Tumors version 1.1 assessment locally performed using computed tomography scans or magnetic resonance imaging of the chest and abdomen (including pelvis and adrenal glands).
Time frame: Up to 37 Months
Population: Efficacy Population: all participants who received at least 2 complete treatment cycles and had at least 1 disease assessment.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Phase 1b (Dose Confirmation) | Best Overall Response Rate (ORR) of MEN1611 in Combination With Cetuximab | Complete Response | 0.0 percentage of participants |
| Phase 1b (Dose Confirmation) | Best Overall Response Rate (ORR) of MEN1611 in Combination With Cetuximab | Partial Response | 40.0 percentage of participants |
| Phase 1b (Dose Confirmation) | Best Overall Response Rate (ORR) of MEN1611 in Combination With Cetuximab | Progressive Disease | 20.0 percentage of participants |
| Phase 1b (Dose Confirmation) | Best Overall Response Rate (ORR) of MEN1611 in Combination With Cetuximab | Stable Disease | 40.0 percentage of participants |
| Phase 2 (Cohort Expansion) | Best Overall Response Rate (ORR) of MEN1611 in Combination With Cetuximab | Progressive Disease | 28.6 percentage of participants |
| Phase 2 (Cohort Expansion) | Best Overall Response Rate (ORR) of MEN1611 in Combination With Cetuximab | Complete Response | 7.1 percentage of participants |
| Phase 2 (Cohort Expansion) | Best Overall Response Rate (ORR) of MEN1611 in Combination With Cetuximab | Partial Response | 7.1 percentage of participants |
| Phase 2 (Cohort Expansion) | Best Overall Response Rate (ORR) of MEN1611 in Combination With Cetuximab | Stable Disease | 57.1 percentage of participants |
Phase 1b: Number of Participants With DLTs for MEN1611
A DLT was defined as any of the following adverse drug reactions (ADRs) related to the combination regimens or to MEN1611 alone and unrelated to the participants' underlying disease or concomitant medication occurring during Cycle 1 over the DLT assessment window of 28 days: any Grade 3 (lasting \>7 days) or Grade 4 increase in aspartate aminotransferase, alanine aminotransferase, or alkaline phosphatase; any Grade ≥3 cardiac disorder or new segmental wall-motion abnormalities; any Grade ≥3 non-hematologic toxicity with the following exceptions: nausea, vomiting, diarrhea, skin rash, hyperglycemia. An ADR was defined as any adverse event suspected by the investigator and/or the sponsor to be related to MEN1611, cetuximab, or both given in combination.
Time frame: Day 1 through Day 28 of Cycle 1 (28 days/cycle)
Population: Dose-limiting Toxicity (DLT) Population: all participants who received at least 80% of MEN1611 and 75% of cetuximab during Cycle 1 with a safety follow-up of 28 days after the first administration of the study treatment. Any participant who experienced DLT was also considered evaluable, regardless of the dose received. As pre-specified, data were collected and reported for the 'Phase 1b (Dose Confirmation)' cohort only.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Phase 1b (Dose Confirmation) | Phase 1b: Number of Participants With DLTs for MEN1611 | 0 Participants |
Phase 1b: Recommended Phase 2 Dose (RP2D) of MEN1611 in Combination With Cetuximab
RP2D was defined as the highest dose level in milligrams (mg) at which no more than 1 participant during the dose confirmation phase (Phase 1b) experienced a dose-limiting toxicity (DLT) during the DLT assessment window (28 days), or the maximum dose judged to be tolerable by the data safety committee.
Time frame: Day 1 through Day 28 of Cycle 1 (28 days/cycle)
Population: Safety Population: all participants who received at least 1 dose of MEN1611. As pre-specified, RP2D data were collected and are reported for 'Phase 1b (Dose Confirmation)' cohort only.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Phase 1b (Dose Confirmation) | Phase 1b: Recommended Phase 2 Dose (RP2D) of MEN1611 in Combination With Cetuximab | 48 mg |
Disease Control Rate (DCR) of MEN1611 in Combination With Cetuximab
DCR was defined as percentage of participants whose disease shrank or remained stable over a certain time period and was calculated based on the sum of the CR, PR, and SD rates according to local assessment.
Time frame: Up to 37 Months
Population: Efficacy Population: all participants who received at least 2 complete treatment cycles and had at least 1 disease assessment.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Phase 1b (Dose Confirmation) | Disease Control Rate (DCR) of MEN1611 in Combination With Cetuximab | 80 percentage of participants |
| Phase 2 (Cohort Expansion) | Disease Control Rate (DCR) of MEN1611 in Combination With Cetuximab | 71.4 percentage of participants |
Duration of Response (DOR) of MEN1611 in Combination With Cetuximab
DOR was defined as the time from confirmation of a PR, CR or SD as locally assessed, until the disease had been shown to progress following treatment. Participants with a previous response who did not show a relapse or died without recording a relapse were censored at their last available relapse-free tumor assessment date. Participants with only one tumor assessment after baseline showing a PD were not included in the calculation.
Time frame: Up to 37 months
Population: Efficacy Population: all participants who received at least 2 complete treatment cycles and had at least 1 disease assessment. Here, 'Overall Number of Participants Analyzed' signifies those participants who were evaluable for this outcome measure.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Phase 1b (Dose Confirmation) | Duration of Response (DOR) of MEN1611 in Combination With Cetuximab | 85 days |
| Phase 2 (Cohort Expansion) | Duration of Response (DOR) of MEN1611 in Combination With Cetuximab | 169 days |
Overall Survival (OS) of MEN1611 in Combination With Cetuximab
OS was defined as the number of days between the first study treatment administration and death from any cause. Participants still alive that had withdrawn from the study were censored using the latest among end of study and follow-up dates. Drop-out participants were considered censored and the last available date in which the participant was known to be alive was considered.
Time frame: Up to 37 months
Population: Efficacy Population: all participants who received at least 2 complete treatment cycles and had at least 1 disease assessment.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Phase 1b (Dose Confirmation) | Overall Survival (OS) of MEN1611 in Combination With Cetuximab | 471 days |
| Phase 2 (Cohort Expansion) | Overall Survival (OS) of MEN1611 in Combination With Cetuximab | 308 days |
Plasma Concentration of MEN1611 in Combination With Cetuximab
Blood samples were taken for the analyses of MEN1611 in plasma at designated time points. Results are reported as nanograms/millilitre (ng/mL).
Time frame: Day 22 (1.5 hours postdose) of Cycle 1 (28 days/cycle)
Population: Pharmacokinetics (PK) Set: all participants who received MEN1611 and for whom a PK sample was obtained and analyzed. Here, 'Overall Number of Participants Analyzed' signifies those participants who were evaluable for this outcome measure.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Phase 1b (Dose Confirmation) | Plasma Concentration of MEN1611 in Combination With Cetuximab | 173.37 ng/mL | Standard Deviation 125.513 |
| Phase 2 (Cohort Expansion) | Plasma Concentration of MEN1611 in Combination With Cetuximab | 241.2 ng/mL | — |
Progression-free Survival (PFS) of MEN1611 in Combination With Cetuximab
PFS was defined as the number of days between the first study treatment administration to the date of first documented disease progression as per local assessment, relapse or death from any cause. Responding participants and participants who were lost to follow-up were censored at their last tumor assessment date.
Time frame: Up to 37 months
Population: Efficacy Population: all participants who received at least 2 complete treatment cycles and had at least 1 disease assessment.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Phase 1b (Dose Confirmation) | Progression-free Survival (PFS) of MEN1611 in Combination With Cetuximab | 121 days |
| Phase 2 (Cohort Expansion) | Progression-free Survival (PFS) of MEN1611 in Combination With Cetuximab | 162 days |