A Phase 1/2 Study of the Safety, Tolerability, Pharmacokinetics and Preliminary Anti-Tumor Activity of the Oral ALK/EGFR Inhibitor AP26113
Inclusion Criteria
Patients must meet all the criteria for the cohort for which their entry is proposed.
PART 1: Dose Escalation Phase:
1. Histologically confirmed advanced malignancies. All histologies except leukemia
2. Refractory to available therapies or for whom no standard or available curative
treatments exist
3. Tumor tissue available for analysis.
PART 2: Expansion cohorts (4 additional cohorts):
1. Expansion cohort 1: Non-small cell lung cancer (NSCLC) patients whose tumors exhibit
anaplastic lymphoma kinase (ALK) rearrangements and who have not been treated with
previous ALK inhibitors.
- Histologically confirmed NSCLC
- Tumor tissue available for analysis
- ALK rearrangement by fluorescence in situ hybridization (FISH)
- No prior ALK inhibitor therapy.
2. Expansion cohort 2: NSCLC patients whose tumors exhibit ALK rearrangements and who
are resistant to crizotinib:
- Histologically confirmed NSCLC
- Tumor tissue available for analysis
- ALK rearrangement by FISH
- Resistant to crizotinib.
3. Expansion cohort 3: NSCLC patients whose tumors exhibit epidermal growth factor
receptor (EGFR) activating mutations and who are resistant to at least one (1) prior
EGFR inhibitor:
- Histologically confirmed NSCLC
- Tumor tissue available for analysis;
- Activating mutation in EGFR including point mutation or activating deletion;
- Resistant to at least one (1) prior EGFR inhibitor.
4. Expansion cohort 4: Patients with any cancers with abnormalities in ALK or other
targets against which AP26113 is active. Examples include, but are not limited to,
anaplastic large cell lymphoma (ALCL), diffuse large-cell lymphoma (DLCL),
inflammatory myofibroblastic tumors (IMT), and other cancers with ALK abnormalities,
or tumors with ROS fusions:
- Histologically confirmed lymphomas and other cancers except for leukemias
- Tumor tissue available for analysis.
General Eligibility Criteria:
All patients (irrespective of whether they are enrolled in PART 1 or PART 2) must meet
all the following eligibility criteria for study entry.
- All patients must have tumor tissue available for analysis. If sufficient tissue is
not available, patients must undergo a biopsy to obtain adequate samples.
- In the expansion cohorts, for which failure of prior therapy is specified (expansion
cohorts 2 and 3), tumor tissue must be obtained following failure to prior therapy.
- Must have measurable disease by Response Evaluation Criteria in Solid Tumors
(RECIST).
- Male or female patients ≥ 18 years old.
- Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1.
- Minimum life expectancy of 3 months or more.
- Adequate renal and hepatic function.
- Adequate bone marrow function.
- Normal QT interval on screening electrocardiogram (ECG) evaluation.
- For females of childbearing potential, a negative pregnancy test must be documented
prior to enrollment.
- Female and male patients who are of childbearing potential must agree to use an
effective form of contraception with their sexual partners throughout study
participation.
- Signed and dated informed consent indicating that the patient has been informed of
all pertinent aspects of the study.
- Willingness and ability to comply with scheduled visits and study procedures.
Main Exclusion Criteria:
- Received an investigational agent within 14 days prior to initiating AP26113.
- Received systemic anticancer therapy or radiation therapy within 14 days prior to
initiating AP26113. (Except for FDA-approved TKIs targeted against EGFR or ALK, which
are allowed up to 72 hours prior to initiating AP26113 if the patient is free of
treatment-related toxicity)
- Received any prior agents targeted against ALK, with the exception of crizotinib.
- Major surgery within 28 days prior to initiating AP26113.
- Central nervous system metastases that are symptomatic or require steroid or
anticonvulsant use (unless discussed with and otherwise agreed to by the sponsor).
- Significant uncontrolled or active cardiovascular disease.
- Uncontrolled hypertension (diastolic blood pressure [BP] > 100 mm Hg; systolic > 150
mm Hg).
- Prolonged QT interval, or being treated with medications known to cause Torsades de
Pointes.
- History or presence of pulmonary interstitial disease.
- Ongoing or active infection. The requirement for intravenous (IV) antibiotics is
considered active infection.
- Known history of human immunodeficiency virus (HIV). Testing is not required in the
absence of history.
- Pregnant or breastfeeding.
- Malabsorption syndrome or other gastrointestinal illness that could affect oral
absorption of AP26113.
- Any condition or illness that, in the opinion of the Investigator, would compromise
patient safety or interfere with the evaluation of the safety of the drug.