This research study is evaluating the experimental drug palbociclib in combination with another experimental drug PD-0325901 as a possible treatment for cancers with KRAS mutations, particularly for those which started in the lung.
This will be an open label Phase I dose escalation study evaluating the combination of the CDK4/6 inhibitor palbociclib (PD-0332991) and the MEK inhibitor PD-0325901. To determine the maximally tolerated dose (MTD) and recommended phase 2 dose (RP2D), a 3+3 dose escalation protocol will be undertaken. Once the RP2D has been determined, the study will then evaluate, in a randomized phase II study design, the combination of palbociclib and PD-0325901 compared to PD-0325901 alone and palbociclib alone in KRAS mutant NSCLC. * Phase 1: The investigators are looking for the highest dose of the study drug that can be administered safely without severe or unmanageable side effects in participants that have cancer, not everyone who participates in this research study will receive the same dose of the study drug. The dose the participant receives will depend on the number of participants who have been enrolled in the study before and how well the dose has been tolerated. * Study Drug(s): The participant will be given a study drug-dosing calendar for each treatment cycle. Each treatment cycle lasts 4 weeks during which time you will be taking the study drug for 3 weeks at a time. The participant will take Palbociclib by mouth once a day, every day for 3 weeks. The participant will take PD-0325901 by mouth twice a day, every day for 3 weeks. * Clinical Exams: During all cycles the participant will have a physical exam and will be asked questions about general health and specific questions about any problems that they might be having and any medications they may be taking. * Scans (or Imaging tests): The investigators will assess the participant's tumor by either a CT scan or MRI * Blood Tests: These are special tests to check the amount of drug and the amount of tumor DNA in the participant's blood at specific points in time. Secondary Outcomes: * Evaluate PK parameters for the combination of palbociclib and PD-0325901 * Confirm target engagement of palbociclib and PD-0325901 in patients undergoing pre- and on-treatment biopsies in an expansion cohort at the MTD * Evaluate preliminary clinical efficacy of the combination of palbociclib and PD-0325901 in patients with tumors harboring KRAS mutations.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
60
Palbociclib will be administered orally once daily, 3 weeks out of every 4 in each cycle. The initial dose for phase 1 of the study will be 75 mg daily. Dosing will be adjusted until Maximum Tolerated Dose (MTD) and the Recommended Phase 2 Dose (RP2D) are established. No pre-medications for palbociclib are required. It should be administered without food with patients fasting for 1 hour prior and 2 hours post drug administration.
PD-0325901 will be administered orally twice daily, 3 weeks out of every 4 in each cycle. The initial dose for phase 1 of the study will be 2 mg twice daily. Dosing will be adjusted until Maximum Tolerated Dose (MTD) and the Recommended Phase 2 Dose (RP2D) are established. PD-0325901 will be administered using a flat-dosing plan. No premedications are required. As the effect of food on PD-0325901 is uncertain, patients will be permitted to dose either fasting or after food.
Dana Farber Cancer Institute
Boston, Massachusetts, United States
Safety and tolerability
Toxicities will be graded using version 4.0 of the NCI Common Terminology Criteria for Adverse Events (CTCAE).
Time frame: 2 Years
Maximum Tolerated Dose and Recommended Phase 2 Dose
A standard 3+3 design will be implemented to discover the maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D) of the combination of study drugs. A dose will be declared the MTD if zero or 1 patient out of 6 experience a dose limiting toxicity (DLT) at the highest dose level below the maximally administered dose. This is generally the RP2D.
Time frame: 2 years
Maximum plasma concentration (Cmax) of palbociclib
Cmax (ng/ml) of palbociclib will be assessed utilizing serial blood draws on cycle 1 day 1 and on cycle 1 day 15 (steady state).
Time frame: 1 month
Time to maximum concentration (tmax) of palbociclib
tmax (h) of palbociclib will be assessed utilizing serial blood draws on cycle 1 day 1 and on cycle 1 day 15 (steady state).
Time frame: 1 month
AUC-12 of palbociclib
The AUC-12 (ng.h/ml) of palbociclib will be assessed utilizing serial blood draws on cycle 1 day 1 and on cycle 1 day 15 (steady state).
Time frame: 1 month
Clearance (CL/F) of palbociclib
Clearance (L/h) of palbociclib will be assessed utilizing serial blood draws on cycle 1 day 1 and on cycle 1 day 15 (steady state).
Time frame: 1 month
Maximum plasma concentration (Cmax) of PD-0325901
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Cmax (ng/ml) of PD-0325901 will be assessed utilizing serial blood draws on cycle 1 day 1 and on cycle 1 day 15 (steady state).
Time frame: 1 month
Time to maximum concentration (tmax) of PD-0325901
tmax of PD-0325901 will be assessed utilizing serial blood draws on cycle 1 day 1 and on cycle 1 day 15 (steady state).
Time frame: 1 month
AUC-12 of PD-0325901
AUC-12 (ng.h/ml) of PD-0325901 will be assessed utilizing serial blood draws on cycle 1 day 1 and on cycle 1 day 15 (steady state).
Time frame: 1 month
Clearance (CL/F ) of PD-0325901
Clearance (L/h) of PD-0325901 will be assessed utilizing serial blood draws on cycle 1 day 1 and on cycle 1 day 15 (steady state).
Time frame: 1 month
Target engagement of palbociclib by immunohistochemistry (IHC) of phospho-Rb in tumor
IHC for phospho-Rb will be performed in pre- and on-treatment tumor biopsies to assess palbociclib target engagement.
Time frame: 2 Years
Target engagement of palbociclib by immunohistochemistry (IHC) of phospho-Rb in skin
IHC for phospho-Rb will be performed in pre- and on-treatment skin biopsies to assess palbociclib target engagement.
Time frame: 2 Years
Target engagement of PD-0325901 by immunohistochemistry (IHC) of phospho-ERK in tumor
IHC for phospho-ERK will be performed in pre- and on-treatment tumor biopsies to assess PD-0325901 target engagement.
Time frame: 2 Years
Cell cycle arrest by palbociclib using serum thymidine kinase 1 (TK1) assays
Serial serum collections (pre- and on-treatment) will be assayed for TK1 activity to assess cell cycle arrest mediated by palbociclib.
Time frame: 2 Years
Quantitative non-invasive genotyping for KRAS in cfDNA
Serial cfDNA samples will be collected and assessed for KRAS plasma allellic burden as a measure of anti-tumor activity of the combination of palbociclib and PD-0325901.
Time frame: 2 Years
Overall Response Rate
The preliminary clinical efficacy of palbociclib and PD-0325901 in advanced KRAS-mutant solid tumors will be assessed using CT and MRI scans per RECIST version 1.1.
Time frame: 2 Years