Metastatic Uveal Melanoma
Conditions
Brief summary
This phase II trial studies the effect of combining defactinib and VS-6766 in treating patients with uveal melanoma that has spread to other places in the body (metastatic). The way cells communicate with one another (different cell signaling pathways) are overactive in uveal melanoma tumor cells. Giving defactinib together with VS-6766 may block pathways that are important for the growth of uveal melanoma cells, and may result in shrinkage or stabilization of the cancer and prolonged time to disease progression and survival.
Detailed description
PRIMARY OBJECTIVE: I. To investigate the potential efficacy of the combination of defactinib hydrochloride (defactinib \[VS-6063\]) and Raf/MEK serine/threonine kinase inhibitor RO5126766 (VS-6766) in patients with metastatic uveal melanoma. SECONDARY OBJECTIVES: I. To assess the effectiveness of defactinib in combination with VS-6766 in patients with metastatic uveal melanoma (MUM). II. To assess the safety and toxicity profile of the combination of defactinib and VS6766. EXPLORATORY OBJECTIVES: I. To study the pharmacodynamic profile of defactinib in combination with VS-6766 in pre-treatment, on-treatment, and post-treatment tumor biopsies. II. To investigate mechanisms of resistance to the combination of defactinib and VS-6766. III. To investigate the potential efficacy of circulating cell free deoxyribonucleic acid (DNA) for prediction/monitoring. OUTLINE: Patients receive defactinib orally (PO) twice daily (BID) and VS-6766 PO twice a week (BIW) (Monday and Thursday or Tuesday and Friday) for 3 weeks in every cycle. Cycles repeat every 28 days for up to 2 years in the absence of disease progression or unacceptable toxicity. Patients undergo tumor biopsy at baseline, after cycle 1 or 2, and post-treatment. After completion of study treatment, patients are followed every 3 months until death or up to 2 years after the last patient is enrolled.
Interventions
Given PO
DRUGRaf/MEK Inhibitor VS-6766
Given PO
PROCEDUREBiopsy
Undergo tumor biopsy
Sponsors
Verastem, Inc.
Thomas Jefferson University
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
* Histologically confirmed metastatic uveal melanoma * Predicted life expectancy of at least 12 weeks * Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 * Measurable disease according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 based on spiral computed tomography (CT) or magnetic resonance imaging (MRI) scan, all radiology studies must be performed within 28 days prior to registration. Corrected QT interval (QTc) \< 470 ms (as calculated by the Fridericia correction formula, averaged over 3 electrocardiograms \[ECGs\]) * Hemoglobin (Hb) \>= 9.0 g/dL (performed within two weeks \[day -14 to day 1\] before the patient goes on the trial) * Absolute neutrophil count (ANC) \>= 1.5 x 10\^9/L (performed within two weeks \[day -14 to day 1\] before the patient goes on the trial) * Platelet count \>= 100 x 10\^9/L (performed within two weeks \[day -14 to day 1\] before the patient goes on the trial) * Serum bilirubin =\< 1.5 x upper limit of normal (ULN) (performed within two weeks \[day -14 to day 1\] before the patient goes on the trial) * Albumin \>= 3.0 mg/dL (performed within two weeks \[day -14 to day 1\] before the patient goes on the trial) * Creatine phosphokinase (CPK) =\< 2.5 x ULN (performed within two weeks \[day -14 to day 1\] before the patient goes on the trial) * Alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) =\< 2.5 x ULN unless raised due to tumor in which case up to 5 x ULN is permissible (performed within two weeks \[day -14 to day 1\] before the patient goes on the trial) * Calculated creatinine clearance \>= 45 mL/min by the Cockcroft-Gault formula (performed within two weeks \[day -14 to day 1\] before the patient goes on the trial) * International normalized ratio (INR) =\< 1.5 in absence of anticoagulation or therapeutic levels in presence of anticoagulation (performed within two weeks \[day -14 to day 1\] before the patient goes on the trial) * Partial thromboplastin time (PTT) =\< 1.5 x ULN in absence of anticoagulation or therapeutic levels in presence of anticoagulation (performed within two weeks \[day -14 to day 1\] before the patient goes on the trial) * Patients with adequate cardiac function (left ventricular ejection fraction \>= 50%) by echocardiography or multigated acquisition scan (MUGA) scan * No active retinopathy or retinal vein occlusion confirmed by full ophthalmological exam in the eye unaffected by uveal melanoma * Adequate recovery from toxicities related to prior treatments to at least grade 1 by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Exceptions include alopecia and peripheral neuropathy grade =\< 2. Subjects with other toxicities that are stable on supportive therapy may be allowed to participate with prior approval by the sponsor * Men and women aged 18 years or over * Females with reproductive potential and their male partners agree to use highly effective method of contraceptive (per Clinical Trial Facilitation Group \[CFTG\] recommendations during the trial and for 3 months following the last dose of study drug) * Written (signed and dated) informed consent and be capable of cooperating with treatment and follow-up * Absence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule
Exclusion criteria
1. Radiotherapy (except for palliative reasons), endocrine therapy, biological therapy, immunotherapy or chemotherapy during the previous four weeks (six weeks for nitrosoureas, Mitomycin-C) before treatment. 2. Ongoing toxic manifestations of previous treatments. Exceptions to this are alopecia or certain Grade 1 toxicities, which in the opinion of the Investigator and the DDU should not exclude the patient. 3. Known untreated or active central nervous system (CNS) metastases (progressing or requiring corticosteroids for symptomatic control). Patients with a history of treated CNS metastases are eligible, provided they meet all of the following criteria: * Evaluable or measurable disease outside the CNS is present. * Radiographic demonstration of improvement upon the completion of CNS- directed therapy and no evidence of interim progression between the completion of CNS- directed therapy and the baseline disease assessment for at least 28 days. 4. Gilbert syndrome diagnosed with elevated indirect (unconjugated) bilirubin ( \>1.2 mg/dl) at least two occasions with normal direct bilirubin in the absence of hemolysis or structural liver damage. 5. Ability to become pregnant (or already pregnant or lactating). However, those female patients who have a negative serum or urine pregnancy test before enrollment and agree to use two medically approved forms of contraception (oral, injected or implanted hormonal contraception and condom, have an intra-uterine device and condom, diaphragm with spermicidal gel and condom) from time of consent, during the trial and for six months afterwards are considered eligible. 6. Male patients with partners of child-bearing potential (unless they agree to take measures not to father children by using one form of medically approved contraception \[condom plus spermicide\] during the trial and for six months afterwards). Men with pregnant or lactating partners should be advised to use barrier method contraception (for example, condom plus spermicidal gel) to prevent exposure to the fetus or neonate. 7. Major surgery within 4 weeks prior to entry to the study (excluding placement of vascular access), or minor surgery within 2 weeks of entry into the study and from which the patient has not yet recovered. 8. Treatment with warfarin. Patients on warfarin for DVT/PE can be converted to low-molecular-weight heparin (LMWH). 9. Acute or chronic pancreatitis. 10. At high medical risk because of non-malignant systemic disease including active uncontrolled infection. 11. Known to be serologically positive for hepatitis B, hepatitis C or human immunodeficiency virus (HIV). 12. Patients with the inability to swallow oral medications or impaired gastrointestinal absorption due to gastrectomy or active inflammatory bowel disease. 13. History of abdominal fistula, gastro-intestinal perforation, or diverticulitis. 14. Patients with history of symptomatic cholelithiasis or cholecystitis within six months before enrollment. 15. Concurrent ocular disorders in the eye unaffected by uveal melanoma: 1. Patients with history of retinal vein occlusion (RVO), predisposing factors for RVO, including uncontrolled hypertension, uncontrolled diabetes 2. Patients with history of retinal pathology or evidence of visible retinal pathology that is considered a risk factor for RVO, intraocular pressure \> 21 mm Hg as measured by tonometry, or other significant ocular pathology, such as anatomical abnormalities that increase the risk for RVO. 3. Patients with a history of corneal erosion (instability of corneal epithelium), corneal degeneration, active or recurrent keratitis, and other forms of serious ocular surface inflammatory conditions. 16. Concurrent congestive heart failure, prior history of class III/ IV cardiac disease (New York Heart Association \[NYHA\]), myocardial infarction within the last 6 months, unstable arrhythmias, unstable angina or severe obstructive pulmonary disease. 17. Patients exposed to strong CYP3A4 and strong CYP2C9 inhibitors within 7 days prior to the first dose. Because the lists of these agents are constantly changing, it is important to regularly consult a frequently-updated list such as http://medicine.iupui.edu/clinpharm/ddis/table.aspx; medical reference texts such as the Physicians' Desk Reference may also provide this information. 18. Is a participant or plans to participate in another interventional clinical trial, whilst taking part in this Phase II study of VS-6766 in combination with VS- 6063\. Participation in an observational trial would be acceptable. 19. Patients with a history of hypersensitivity to any of the inactive ingredients (hydroxypropylmethylcellulose, mannitol, magnesium stearate) of the investigational product. 20. Prior corticosteroids as anti-cancer therapy within a minimum of 14 days of first receipt of study drugs. 21. Any other condition which in the Investigator's opinion would not make the patient a good candidate for the clinical trial.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Best Overall Response | From baseline through last follow-up visit (up to 24 months per participant) | Defined as complete response (CR) + partial response (PR) + stable disease (SD) and determined by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 |
| Disease Control Rate | From baseline through last follow-up visit (up to 24 months per participant) | Defined as CR+PR+SD and determined by RECIST criteria version 1.1. All estimates of rates will be presented with corresponding 95% exact confidence intervals. For disease control rates, the method of Atkinson and Brown will be used to allow for the two-stage design. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression-free Survival (PFS) | From first dose of study drug until disease progression or death (whichever occurs first). Up to 24 months per participant. | A Kaplan Meier graph and median PFS will be presented overall and by cohort. |
| Overall Survival (OS) | From first dose of study drug until disease progression or death (whichever occurs first). Up to 14 months. | A Kaplan Meier graph will be presented overall and by cohort. |
| Incidence of Adverse Events | From baseline through last follow-up visit (up to 14 months) | Will determine causality of each adverse event to defactinib and VS-6766 and grading severity according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. Estimates of toxicity rates will be presented with corresponding 95% exact confidence intervals. Safety variables will be summarized by descriptive statistics. Laboratory variables will be described using the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. Adverse events (AEs) will be reported for each dose level and presented as tables of frequency of AEs by body system and by worse severity grade observed. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Detection of Biomarkers of Resistance | Up to 28 days after the last dose of treatment | Tumor samples will be analyzed. The specific type and number of biomarkers from the tumor samples will be decided during the course of the study and documented in the study records. |
| Circulating Free Deoxyribonucleic Acid (DNA) | Up to 28 days after the last dose of treatment | Will correlate circulating free DNA with cancer remission and predicting cancer relapse. |
| Changes in Tumor Metabolic Activity | Baseline up to 28 days after the last dose of treatment | Tumor samples will be analyzed for changes in tumor metabolic activity. |
| Changes in Signaling to the FAK Pathways | Baseline up to 28 days after the last dose of treatment | Tumor samples will be analyzed for changes in signaling to the FAK pathways |
| Changes in Signaling to the PI3K TOR Pathways | Baseline up to 28 days after the last dose of treatment | Tumor samples will be analyzed for changes in signaling to the PI3K TOR pathways |
| Changes in Signaling to the YAP Pathways | Baseline up to 28 days after the last dose of treatment | Tumor samples will be analyzed for changes in signaling to the YAP pathways |
| Changes in Signaling to the ERK Pathways | Baseline up to 28 days after the last dose of treatment | Tumor samples will be analyzed for changes in signaling to the ERK pathways. Subjects grouped (Progressive Disease v Stable Disease) for sake of results reporting. |
| Changes in Cell Proliferation (Ki67) | Baseline up to 2 years after the last patient is enrolled | Tumor samples will be analyzed for changes in cell proliferation |
| Changes in Apoptosis Induction (Caspase Activation) | Baseline up to 28 days after the last dose of treatment | Tumor samples will be analyzed for changes in apoptosis induction |
| Changes in Tumor Microenvironment | Baseline up to 28 days after the last dose of treatment | Tumor samples will be analyzed for changes in tumor microenvironment |
Countries
United States
Participant flow
Pre-assignment details
One subject did not initiate treatment due to rapid disease progression.
Participants by arm
| Arm | Count |
|---|---|
| Treatment (Defactinib, VS-6766) Patients receive defactinib PO BID and VS-6766 PO BIW (Monday and Thursday or Tuesday and Friday) for 3 weeks in every cycle. Cycles repeat every 28 days for up to 2 years in the absence of disease progression or unacceptable toxicity.
Defactinib Hydrochloride: Given PO
Raf/MEK Inhibitor VS-6766: Given PO
Biopsy: Undergo tumor biopsy | 13 |
| Total | 13 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | one subject did not initiate treatment due to rapid disease progression | 1 |
Baseline characteristics
| Characteristic | Treatment (Defactinib, VS-6766) |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 2 Participants |
| Age, Categorical Between 18 and 65 years | 11 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 13 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 13 Participants |
| Sex: Female, Male Female | 6 Participants |
| Sex: Female, Male Male | 7 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 11 / 12 |
| other Total, other adverse events | 12 / 12 |
| serious Total, serious adverse events | 5 / 12 |
Outcome results
Primary
Best Overall Response
Defined as complete response (CR) + partial response (PR) + stable disease (SD) and determined by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1
Time frame: From baseline through last follow-up visit (up to 24 months per participant)
Population: No subjects met this criteria. The trial was closed before the anticipated accrual of 18 patients, but of the 12 patients that were treated the best overall response rate was 0% as no patient achieved CR or PR. All subjects died or relapsed disease/progression and did not complete.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Treatment (Defactinib, VS-6766) | Best Overall Response | 0 Participants |
Primary
Disease Control Rate
Defined as CR+PR+SD and determined by RECIST criteria version 1.1. All estimates of rates will be presented with corresponding 95% exact confidence intervals. For disease control rates, the method of Atkinson and Brown will be used to allow for the two-stage design.
Time frame: From baseline through last follow-up visit (up to 24 months per participant)
Population: The trial was closed before the anticipated accrual of 18 patients, but of the 12 patients that were treated the disease control rate was 50% (6 patients with SD).
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Treatment (Defactinib, VS-6766) | Disease Control Rate | 6 Participants |
Secondary
Incidence of Adverse Events
Will determine causality of each adverse event to defactinib and VS-6766 and grading severity according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. Estimates of toxicity rates will be presented with corresponding 95% exact confidence intervals. Safety variables will be summarized by descriptive statistics. Laboratory variables will be described using the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. Adverse events (AEs) will be reported for each dose level and presented as tables of frequency of AEs by body system and by worse severity grade observed.
Time frame: From baseline through last follow-up visit (up to 14 months)
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Treatment (Defactinib, VS-6766) | Incidence of Adverse Events | 43 Number of AEs |
Secondary
Overall Survival (OS)
A Kaplan Meier graph will be presented overall and by cohort.
Time frame: From first dose of study drug until disease progression or death (whichever occurs first). Up to 14 months.
Population: Trial closed prematurely based on limited clinical activity as reflected by the low rate of short-lasting disease control without any partial responses, slow enrollment, and the heavily pretreated study population reflecting the changing treatment landscape.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Treatment (Defactinib, VS-6766) | Overall Survival (OS) | 2 Participants |
Secondary
Progression-free Survival (PFS)
A Kaplan Meier graph and median PFS will be presented overall and by cohort.
Time frame: From first dose of study drug until disease progression or death (whichever occurs first). Up to 24 months per participant.
Population: 12 patients received at least one dose of study drug and were included in progression-free survival (PFS) and follow-up analysis population.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Treatment (Defactinib, VS-6766) | Progression-free Survival (PFS) | Follow up period | 20 Months |
| Treatment (Defactinib, VS-6766) | Progression-free Survival (PFS) | Progression-Free Survival | 3.04 Months |
Other Pre-specified
Changes in Apoptosis Induction (Caspase Activation)
Tumor samples will be analyzed for changes in apoptosis induction
Time frame: Baseline up to 28 days after the last dose of treatment
Population: Analysis not performed. Trial closed prematurely based on limited clinical activity as reflected by the low rate of short-lasting disease control without any partial responses, slow enrollment, and the heavily pretreated study population reflecting the changing treatment landscape.
Other Pre-specified
Changes in Cell Proliferation (Ki67)
Tumor samples will be analyzed for changes in cell proliferation
Time frame: Baseline up to 2 years after the last patient is enrolled
Population: Analysis not performed. Trial closed prematurely based on limited clinical activity as reflected by the low rate of short-lasting disease control without any partial responses, slow enrollment, and the heavily pretreated study population reflecting the changing treatment landscape.
Other Pre-specified
Changes in Signaling to the ERK Pathways
Tumor samples will be analyzed for changes in signaling to the ERK pathways. Subjects grouped (Progressive Disease v Stable Disease) for sake of results reporting.
Time frame: Baseline up to 28 days after the last dose of treatment
Population: 4 total patients with pre- and post- biopsy samples were available. Pre- vs post- biopsy samples was assessed for changes in active ERK (pERK)
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Treatment (Defactinib, VS-6766) | Changes in Signaling to the ERK Pathways | Reduction in active ERK (pERK) | 0 Participants |
| Treatment (Defactinib, VS-6766) | Changes in Signaling to the ERK Pathways | No change in active ERK (pERK) | 2 Participants |
| Treatment (Defactinib, VS-6766) - Subjects With Stable Disease | Changes in Signaling to the ERK Pathways | Reduction in active ERK (pERK) | 2 Participants |
| Treatment (Defactinib, VS-6766) - Subjects With Stable Disease | Changes in Signaling to the ERK Pathways | No change in active ERK (pERK) | 0 Participants |
Other Pre-specified
Changes in Signaling to the FAK Pathways
Tumor samples will be analyzed for changes in signaling to the FAK pathways
Time frame: Baseline up to 28 days after the last dose of treatment
Population: Analysis not performed. Trial closed prematurely based on limited clinical activity as reflected by the low rate of short-lasting disease control without any partial responses, slow enrollment, and the heavily pretreated study population reflecting the changing treatment landscape.
Other Pre-specified
Changes in Signaling to the PI3K TOR Pathways
Tumor samples will be analyzed for changes in signaling to the PI3K TOR pathways
Time frame: Baseline up to 28 days after the last dose of treatment
Population: Analysis not performed. Trial closed prematurely based on limited clinical activity as reflected by the low rate of short-lasting disease control without any partial responses, slow enrollment, and the heavily pretreated study population reflecting the changing treatment landscape.
Other Pre-specified
Changes in Signaling to the YAP Pathways
Tumor samples will be analyzed for changes in signaling to the YAP pathways
Time frame: Baseline up to 28 days after the last dose of treatment
Population: Analysis not performed. Trial closed prematurely based on limited clinical activity as reflected by the low rate of short-lasting disease control without any partial responses, slow enrollment, and the heavily pretreated study population reflecting the changing treatment landscape.
Other Pre-specified
Changes in Tumor Metabolic Activity
Tumor samples will be analyzed for changes in tumor metabolic activity.
Time frame: Baseline up to 28 days after the last dose of treatment
Population: Analysis not performed. Trial closed prematurely based on limited clinical activity as reflected by the low rate of short-lasting disease control without any partial responses, slow enrollment, and the heavily pretreated study population reflecting the changing treatment landscape.
Other Pre-specified
Changes in Tumor Microenvironment
Tumor samples will be analyzed for changes in tumor microenvironment
Time frame: Baseline up to 28 days after the last dose of treatment
Population: Analysis not performed. Trial closed prematurely based on limited clinical activity as reflected by the low rate of short-lasting disease control without any partial responses, slow enrollment, and the heavily pretreated study population reflecting the changing treatment landscape.
Other Pre-specified
Circulating Free Deoxyribonucleic Acid (DNA)
Will correlate circulating free DNA with cancer remission and predicting cancer relapse.
Time frame: Up to 28 days after the last dose of treatment
Population: Analysis not performed. Trial closed prematurely based on limited clinical activity as reflected by the low rate of short-lasting disease control without any partial responses, slow enrollment, and the heavily pretreated study population reflecting the changing treatment landscape.
Other Pre-specified
Detection of Biomarkers of Resistance
Tumor samples will be analyzed. The specific type and number of biomarkers from the tumor samples will be decided during the course of the study and documented in the study records.
Time frame: Up to 28 days after the last dose of treatment
Population: Analysis not performed. Trial closed prematurely based on limited clinical activity as reflected by the low rate of short-lasting disease control without any partial responses, slow enrollment, and the heavily pretreated study population reflecting the changing treatment landscape.