The purpose of this study is to evaluate the efficacy and safety of ponatinib in participants with metastatic and/or unresectable gastrointestinal stromal tumor (GIST) following failure of prior tyrosine kinase inhibitor (TKI) therapy.
This is a non-randomized, open label, multi-center phase 2 study to evaluate the efficacy and safety of ponatinib in participants with metastatic and/or unresectable GIST after failure of prior TKI therapy. Participants whose tumors have an activating mutation in exon 11 of cellular KIT (KIT) will be enrolled into Cohort A. Participants whose tumors have other activating mutations will be enrolled into in Cohort B. The primary objective is to assess clinical benefit in participants with KIT exon 11-mutant GIST (Cohort A) defined as clinical benefit rate (CBR), which is the composite of complete response (CR), partial response (PR) and stable disease (SD) lasting greater than or equal to (\>=) 16 weeks per modified response evaluation criteria in solid tumors (RECIST 1.1) as a measure of disease control. The secondary objective is to assess clinical benefit in participants with GIST that lacks an activating KIT exon 11 mutation (Cohort B) and in the total participant population. The efficacy assessments are tumor response using RECIST Version 1.1, modified for GIST and assessment of progression-free survival (PFS) and overall survival (OS). The safety assessments include routine physical and laboratory evaluations, electrocardiograms (ECGs), echocardiograms (ECHOs), and adverse event (AE) monitoring. Other assessments include optional 18F fluorodeoxyglucose positron emission tomography (FDG-PET); optional pre- and post-treatment tumor biopsy for pharmacodynamic studies; and pharmacokinetics (PK). It is estimated that accrual will be complete within 1 year; the total estimated duration of the study is 3 years.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
45
Ponatinib 45 mg, tablets, orally, once-daily.
Massachusetts General Hospital, Site #047
Boston, Massachusetts, United States
Dana-Farber Cancer Institute, Site #008
Boston, Massachusetts, United States
Oregon Health & Sciences University, Site #048
Portland, Oregon, United States
Fox Chase Cancer Center, Site #012
Philadelphia, Pennsylvania, United States
Clinical Benefit Rate (CBR) in Cohort A
To assess clinical benefit rate in participants with KIT exon 11-mutant GIST.It is defined as the composite of complete response(CR),partial response(PR),and stable disease(SD) lasting \>=16 weeks per modified Response Evaluation Criteria In Solid Tumors(RECIST) 1.1 as a measure of disease control.CR is complete disappearance of all target lesions and non-target disease, with the exception of nodal disease.All nodes, both target and non-target, must decrease to normal (short axis \<10millimeter \[mm\]).No new lesions.PR is \>=30% decrease under baseline of the sum of diameters of all target lesions.The short axis was used in the sum for target nodes, while the longest diameter was used in the sum for all other target lesions.No unequivocal progression of non-target disease.No new lesions.SD is not qualifying for CR,PR,Progressive Disease(PD).PD is \>=20% increase from the smallest prior sum of the longest diameter(SLD)and with \>=5mm absolute increase, or appearance of a new lesion.
Time frame: 16 weeks after first dose
Clinical Benefit Rate (CBR) in Cohort B
To assess clinical benefit rate in participants with GIST that lacks KIT exon 11 mutations (Cohort B) and in the total participant population. CR was defined as complete disappearance of all target lesions and non-target disease, with the exception of nodal disease. All nodes, both target and non-target, must decrease to normal (short axis \<10 millimeter \[mm\]). No new lesions. PR was defined as \>=30% decrease under baseline of the sum of diameters of all target lesions. The short axis was used in the sum for target nodes, while the longest diameter was used in the sum for all other target lesions. No unequivocal progression of non-target disease. No new lesions. SD was defined as not qualifying for CR, PR, PD.
Time frame: 16 weeks after first dose
Progression-free Survival (PFS)
PFS is defined as the duration of time from start of study drug administration to time of objective disease progression or death due to any cause, whichever may come first. To assess PFS in each cohort and in the total participant population.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: From date of enrollment until the end of the study or disease progression or death due to any cause, whichever came first, assessed up to 3 years
Percentage of Participants With Objective Response Rate (ORR)
ORR is defined as the composite of CR and PR per Response Evaluation Criteria in RECIST 1.1, assessed for each cohort and in the total participant population. CR was defined as complete disappearance of all target lesions and non-target disease, with the exception of nodal disease. All nodes, both target and non-target, must decrease to normal (short axis \<10 mm). No new lesions. PR was defined as \>=30% decrease under baseline of the sum of diameters of all target lesions.
Time frame: From date of enrollment until discontinuation or the end of the study, whichever came first, assessed up to 3 years
Overall Survival (OS)
OS is defined as the time interval between the first dose of study drug to death due to any cause. Overall survival was analyzed using the Kaplan-Meier method.
Time frame: From first dose of drug until the end of the study or death, whichever came first, assessed up to 3 years
Number of Participants With Physical Examination
Time frame: From date of enrollment until the End-of-Treatment, assessed up to 3 years
Number of Participants With Treatment-emergent Adverse Events (TEAEs) Related to Vital Sign Measurements
Time frame: From date of enrollment until the End-of-Treatment, assessed up to 3 years
Number of Participants With Worst Shift From Baseline Values to Post-baseline Values in Laboratory Parameters
Time frame: From date of enrollment until the End-of-Treatment, assessed up to 3 years
Number of Participants With TEAEs Related to Electrocardiogram (ECG) Findings
Time frame: From date of enrollment until the End-of-Treatment, assessed up to 3 years
Number of Participants With TEAEs Related to Echocardiography Parameter
Time frame: From date of enrollment until the End-of-Treatment, assessed up to 3 years
Number of Participants Reporting One or More TEAEs and Serious Adverse Event (SAE)
Time frame: From date of enrollment until the End-of-Treatment, assessed up to 3 years
Cmax, SS: Maximum Observed Plasma Concentration at Steady State for Ponatinib
Time frame: Pre-dose and at multiple timepoints (up to 1 month) post-dose