This is a single arm, open-label, Phase Ib/II study to evaluate the safety, pharmacokinetics, pharmacodynamics, and efficacy of the oral AKT inhibitor, GSK2110183, when administered to subjects with proteasome inhibitor refractory multiple myeloma (MM). During Part 1 of the study, GSK2110183 will be administered to subjects in sequential Pharmacokinetic (PK) Cohorts on a continuous daily dosing schedule in 21-day cycles until one of the Treatment Discontinuation Criteria is met. The PK Cohorts will characterize the PK of GSK2110183 in plasma and urine as well as determine the Recommended Phase 2 Dose (RP2D) of GSK2110183. The RP2D will be that dose that provides adequate PK exposure and biologic activity without exceeding the maximum tolerated dose (MTD) in MM subjects as defined in the current study. In Part 2 of the study, the RP2D will be further evaluated using a flexible 2-stage design with a stopping rule to allow for early termination based on lack of efficacy at the end of Stage 1. The first stage will accrue 20 subjects who will receive GSK2110183 at the RP2D. If a clinical response is observed in at least 1 subject in Stage 1, the study will proceed to Stage 2 and 20 additional subjects will be enrolled. GSK2110183 will be administered in Part 2 (Stage 1 and Stage 2) on a continuous daily dosing schedule in 21 day cycles until International Myeloma Working Group criteria for progression are met, at which point the subject will proceed to GSK 2110183 + bortezomib salvage therapy provided they meet the additional eligibility criteria for this phase of the study. GSK2110183 and bortezomib will be continued until one of the Treatment Discontinuation Criteria is met. Exploratory PK/PD analyses may be performed to examine the potential relationships between GSK2110183 pharmacokinetics and pharmacodynamic biomarkers.
This is a single arm, open-label, Phase Ib/II study to evaluate the safety, pharmacokinetics, pharmacodynamics, and efficacy of the oral AKT inhibitor GSK2110183 when administered to subjects with proteasome inhibitor refractory MM. During Part 1 of the study, dose escalation will follow a 3 + 3 dose escalation procedure starting with an initial dosing regimen of 125 mg GSK2110183 with escalate to next dose level with an increase of GSK2110183 less than or equal to 50% if DLTs are below a certain level described in the protocol. Subjects will receive a single dose of GSK2110183 on Day -3 of Cycle 0, followed by PK sampling over the next 72 hours. Cycle 1 may commence at any time (but within 7 days) after collection of the 72 hour Cycle 0 PK sample. GSK2110183 will be administered to subjects in sequential PK Cohorts on a continuous daily dosing schedule in 21 day cycles until one of the Treatment Discontinuation Criteria is met. Sparse PK sampling will also be collected during the first 8 cycles. Urine PK samples will be collected prior to the first dose of GSK2110183 and as a 24-hour urine collection at steady-state. The PK Cohorts will characterize the pharmacokinetics of GSK2110183 in plasma and urine, as well as determine the RP2D of GSK2110183. The RP2D will be that dose that provides adequate PK exposure and biologic activity without exceeding the MTD in MM subjects as defined in the current study. GSK2110183 + bortezomib salvage therapy will not be given to subjects who progress on GSK2110183 monotherapy in the PK Cohorts. Following the completion of PK sampling in the PK Cohorts and the determination of a RP2D of GSK2110183, Part 2 of the study will then commence at the RP2D. Part 2 of the study will further evaluate the R2PD using a flexible 2-stage design with a stopping rule to allow for early termination based on lack of efficacy at the end of Stage 1. GSK2110183 will be administered on a continuous daily dosing schedule in 21-day cycles until one of the Treatment Discontinuation Criteria is met. Twenty subjects will be enrolled in Stage 1, if no subject responds, the study will be stopped; otherwise, the study will continue to enroll an additional 20 subjects in Stage 2. At the end of Stage 2, if 4 or fewer of 40 subjects respond, the study will not be deemed as a success for the monotherapy. Those subjects meeting the criteria for progression during Part 2 \[as defined by the 2011 Report of the International Myeloma Workshop Consensus Panel 1\], who also meet the additional eligibility criteria for salvage therapy may proceed to GSK2110183 + bortezomib salvage therapy. GSK2110183 + bortezomib salvage therapy will be continued until one of the Treatment Discontinuation Criteria is met. Exploratory PK/PD analyses may be performed in Part 1 and Part 2 to examine the potential relationships between GSK2110183 pharmacokinetics and pharmacodynamic biomarkers (e.g., pAKT, pPRAS40 in the bone marrow), markers for disease activity in serum (e.g., beta-2 microglobulin, C-reactive protein), or blood-based cytokines and angiogenesis factors (e.g., IL-6, VEGF). A secondary objective of this study is to determine whether the addition of bortezomib to GSK2110183 has clinical activity in patients refractory to proteasome inhibitor therapy who progress on single-agent GSK2110183 therapy.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
On Cycle 0, Day -3, three subjects will be enrolled to receive a single oral dose of 125mg GSK2110183. After the 72 hour PK sampling is completed, the subjects will continue the 125mg GSK2110183 dose daily for 21 day cycles. If none of the 3 subjects experience one of the DLTs listed in the protocol during Cycle 1, the dose will be escalated to 150mg GSK2110183 for the subject enrolled to Cohort 2. Alternately, if 1 subject reports a DLT, then 3 more subjects will be enrolled at the same dose. If 2 of 6 subjects report a DLT, then the MTD has been exceeded. Subjects will remain on study until they meet one of the Treatment Discontinuation Criteria.
For Cohort 2, on Cycle 0, Day -3, three subjects will be enrolled to receive a single oral dose of 150mg GSK2110183. After the 72 hour PK sampling is completed, the subjects will continue the 150mg GSK2110183 dose daily for 21 day cycles. If none of the 3 subjects experience one of the DLTs listed in the protocol during Cycle 1, the MTD will be determined unless the PK and Pharmacodynamic data indicates another dose level should be evaluated. Alternately, if 1 subject reports a DLT, then 3 more subjects will be enrolled at the same dose. If 2 of 6 subjects report a DLT, then the MTD has been exceeded. Subjects will remain on study until they meet one of the Treatment Discontinuation Criteria.
Following the completion of PK sampling and the determination of a Recommended Phase 2 Dose (RP2D) of GSK2110183 in Cohorts 1 and 2, subjects will be enrolled into Part 2, Stage 1 of the study. Twenty subjects will be enrolled in Stage 1. If no subject responds, the study will be stopped; otherwise, the study will continue enrollment of Stage 2.
Twenty subjects will be enrolled in Part 2, Stage 2. If 4 or fewer of the 40 subjects (Stages 1 and 2) respond, the study will not be deemed as a success for GSK2110183 monotherapy. However, those subjects meeting the criteria for progression (as defined by IMWC Panel 1) who also meet the additional eligibility criteria for salvage therapy may proceed to GSK2110183 + bortezomib salvage therapy. GSK2110183 + bortezomib salvage therapy will be continued until one of the Treatment Discontinuation Criteria is met
GSK Investigational Site
Melbourne, Victoria, Australia
Evaluate the safety and tolerability of GSK2110183 in subjects with proteasome inhibitor refractory MM.
Subjects with proteasome inhibitor refractory MM enrolled into Parts 1 and 2 will be evaluate for safety and tolerability of GSK2110183 by the assessment of adverse events and changes from baseline in safety assessments including laboratory parameters, vital signs, and electrocardiogram (ECG) parameters.
Time frame: Subjects will continue on the study from the date of randomization until the date of the first documented progression or when the subjects meet one of the Treatment Discontinuation Criteria and may be assessed on average up to 48 months.
Determine a Recommended Phase II Dose (RP2D).
RP2D is defined as a dose that provides adequate pharmacokinetics exposure and biologic activity without exceeding the Maximum Tolerated Dose (MTD) in Multiple Myeloma (MM) subjects as defined in the current study. RP2D will be defined in Part 1 of the study. The specific number of subjects to be enrolled is dependent on the number of Dose Limiting Toxicities (DLTs) reported; however, enrollment of approximately 18 subjects is estimated. The RP2D chosedn in Part 1 will be the dosing regimen used in Part 2.
Time frame: Subjects will continue on the study from the date of randomization until the date of the first documented progression or when the subjects meet one of the Treatment Discontinuation Criteria and may be assessed on average up to 48 months.
Assess the clinical activity of GSK2110183 in subjects with proteasome inhibitor refractory MM.
Subjects enrolled into Parts 1 and 2 will be assessed for overall response rate of GSK2110183 in subjects with proteasome inhibitor refractory Multiple Myeloma using the 2011 recommendations in the Report of the International Myeloma Workshop Consensus.
Time frame: Subjects will continue on the study from the date of randomization until the date of the first documented progression or when the subjects meet one of the Treatment Discontinuation Criteria and may be assessed on average up to 48 months.
Evaluate progression-free survival (PFS), overall survival (OS), time to response, and duration of response.
Subjects enrolled into Parts 1 and 2 will be assessed for PFS, OS, time to response, and duration of response using the 2011 Report of the International Myeloma Workshop Consensus Panel 1. PFS is measured from the date of first dose until the date of disease progression or death due to any cause. OS is defined as the time from the date of first dose until the date of death due to any cause. Duration of response will be defined as the time from the first documented evidence of partial, very good partial, complete, or stringent complete tumor response until date of disease progression or death
Time frame: Subjects will continue on the study from the date of randomization until the date of the first documented progression or when the subjects meet one of the Treatment Discontinuation Criteria and may be assessed on average up to 48 months.
Characterize the pharmacokinetics (PK) profile of GSK2110183 in subjects with proteasome inhibitor refractory MM.
To characterize GSK2110183 pharmacokinetic parameters; area of concentration under the curve (AUC), Pre-dose (trough) concentration at the end of the dosing interval (Cτ), maximum observed concentration (Cmax), time of occurrence of Cmax (tmax) will be evaluated in the plasma and urine samples. The main PK sampling will take place in Part 1 of the study and Part 2 will have only sparse PK sampling.
Time frame: Part 1: plasma PK on C0 (D-3), C1 (D15) pre-dose, 0.5, 1, 2, 3, 4, 5, 8, 10-12, 14-22, 24, 48, and 72. In C2-8 (D1) pre-dose and post-dose. Urine PK on: C0 (D-3) pre-dose and C1 (D15) 24h post. Part 2: plasma PKs on C2-8 (D1) pre-dose and 1-2 hours post
Evaluate the clinical benefit of GSK2110183+bortezomib as salvage therapy for those subjects who progressed on GSK2110183 monotherapy.
In Part 2 of the study, subjects whom bortezomib is added to GSK2110183 due to disease progression on GSK2110183 monotherapy overall response rate (ORR = stringent complete response + complete response + very good partial response + partial response rates), PFS, duration of response, and time-to-next-therapy will be evaluated.
Time frame: Subjects will continue on the study from the date of randomization until the date of the first documented progression or when the subjects meet one of the Treatment Discontinuation Criteria and may be assessed on average up to 48 months.
Explore the association of biologic/clinical endpoints with DNA or protein profiles from malignant cells as data permit.
Subjects enrolled into Parts 1 and 2 will have samples collected for analysis of the markers of AKT pathway activation (e.g., pAKT, pPRAS40) in bone marrow biopsy and/or aspirate samples, potential predictive markers of response (e.g., cytogenetics, FISH, Ki67, mutations in NRAS and KRAS) in bone marrow biopsy and/or aspirate samples, and soluble cytokine levels (e.g., VEGF, IL-6, IGF1) in plasma.
Time frame: Assessed up to 48 months.
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