This phase Ib/II trial studies the side effects and best dose of trametinib and navitoclax and how well they work in treating patients with solid tumors that have spread to other places in the body (advanced or metastatic). Trametinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Navitoclax inhibits members of the BCL2 family of proteins that are believed to play key roles in promoting the survival of cancer cells. It may stop the growth of cancer cells by blocking Bcl-2, Bcl-XL, and Bcl-w, proteins needed for cancer cell survival. Giving trametinib and navitoclax may help stop the growth of tumor cells.
PRIMARY OBJECTIVES: I. To determine the dose-limiting toxicities of trametinib in combination with navitoclax, and the maximal doses at which both drugs can be safely administered together. (Phase Ib) II. To determine the response rate of the combination of trametinib and navitoclax in subjects with KRAS or NRAS mutation-positive advanced or metastatic solid tumors in disease-specific expansion cohorts. (Phase II) III. To confirm the safety and tolerability of trametinib and navitoclax in combination at the recommended phase 2 dose (RP2D) determined in the Phase 1b portion. (Phase II) SECONDARY OBJECTIVES: I. To determine the pharmacokinetics of both drugs administered together. (Phase Ib) II. To assess for evidence of response to therapy. (Phase Ib) III. To evaluate the pharmacodynamic response to therapy in tumor biopsies. (Phase Ib) IV. To evaluate the pharmacodynamic response to therapy in tumor biopsies (first 15 patients enrolled overall). (Phase II) OUTLINE: This is a phase Ib, dose-escalation study followed by a phase II study. Patients receive trametinib orally (PO) once daily (QD) and navitoclax PO QD on days 1-28 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. If unacceptable toxicity is observed, patients may receive trametinib PO QD on days 1-14. Patients also undergo computed tomography (CT), positron emission tomography (PET)/CT, or magnetic resonance imaging (MRI) every 8 weeks following cycle 1 day 1, biopsy on day 15 or 22 of cycle 1, and collection of blood samples on day 1 of cycles 2, 4, 8, and 12. After completion of study treatment, patients are followed up for 30 days.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
96
Undergo biopsy
Undergo collection of blood samples
Undergo conventional CT or PET/CT
Undergo MRI
Given PO
Undergo PET/CT
Given PO
Massachusetts General Hospital Cancer Center
Boston, Massachusetts, United States
Dana-Farber Cancer Institute
Boston, Massachusetts, United States
(Phase 1b) Maximal Tolerated Dose of Trametinib and Navitoclax
Dose escalation uses a 3+3 enrollment design per dose level. The occurrence of 1 dose limiting toxicity (DLT) will prompt expansion of a given dose level to 6 participants. The occurrence of 2 DLTs in a given dose level will indicate that the maximal tolerated dose (MTD) has been exceeded, and expansion of the prior dose level to 6 participants will occur, if not already performed. The recommended phase 2 dose (RP2D) will be the highest dose level at which no more than 1 out of 6 participants experiences a DLT. Dose escalation will proceed until the MTD/RP2D have been determined.
Time frame: Within the first 42 days of treatment
(Phase 1b) Dose-Limiting Toxicities of Trametinib and Navitoclox
Dose-limiting toxicity (DLT) are adverse events (AEs) that are serious enough to prevent an increase in dose level of that treatment. Grading based on Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. CTCAE version 5.0 will be utilized beginning April 1, 2018.
Time frame: Within the first 42 days of treatment
(Phase 2) Response Rate
Response rate is defined as the number of participants who achieve complete response (CR) or partial response (PR), according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria version 1.1: * CR = Disappearance of target lesion(s). Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 mm * PR = At least a 30% decrease in the sum of the longest diameter(s) of target lesion(s) Participants are considered evaluable for response if they had measurable disease present at baseline, received at least one cycle of therapy, and had their disease re-evaluated at least once after initiating therapy.
Time frame: Up to 6 months
(Phase 2) Progression-free Survival
Progression-free survival (PFS) is defined as the duration of time from start of treatment to time of progressive disease (PD) or death, whichever occurs first. PD is defined according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria version 1.1 as at least a 20% increase in the (sum of the) longest diameter(s) of target lesion(s), and an absolute increase of at least 5 mm. The appearance of one or more new lesions is also considered progression.
Time frame: Up to 31 months
(Phase 2) Treatment Emergent Adverse Events
Treatment emergent adverse events (TEAEs) are undesirable events not present prior to study treatment, or an already present event that worsens either in intensity or frequency while on treatment. TEAEs are assessed as grade 3 or higher according to Common Terminology Criteria for Adverse Events (CTCAE) criteria version 4.0. CTCAE criteria version 5.0 will be utilized beginning April 1, 2018. TEAEs are also assessed as possibly, probably, or definitely related to study treatment.
Time frame: up to 29 months on treatment
(Phase 1b) Pharmacokinetic Parameter Cmax for Trametinib and Navitoclax When Administered in Combination
Pharmacokinetic blood draw samples collected for the following parameter and reported as mean values per day: maximum observed plasma drug concentration (Cmax). Schedule A: * C1 D7 = pre-nav (0h) then 2h, 4h, 6h, 8h * C1 D8 = pre-tram (-1h = 23h post-nav) * C1 D21 = pre-tram (-1h); pre-nav (0h); then 2h, 4h, 6h, 8h post-nav * C1 D22 = pre-tram (-1h = 23h post-nav) * D1 of Cycle 2,4,8,12 (single trough) = pre-tram (-1h) Schedule B: * C1 D7, D14 = pre-tram (-1h); pre-nav (0h); then 2h, 4h, 6h, 8h post-nav * C1 D8, D15 = pre-tram (-1h = 23h post-nav) * D1 of Cycle 2,4,8,12 (single trough) = pre-tram (-1h) Schedule C: * C1 D7, D14 = pre-navitoclax (0h) then 2h, 4h, 6h, 8h * C1 D8, D15 = pre-trametinib (-1h = 23h post-navitoclax) * D1 of Cycle 2,4,8,12 (single trough) = pre-nav (0h)
Time frame: Cycle 1 day 7 and day 21
(Phase 1b) Pharmacokinetic Parameter AUC for Trametinib and Navitoclax When Administered in Combination
Pharmacokinetic blood draw samples collected for the following parameter and reported as mean values per day: area under the concentration time curve from zero (pre-dose) to 24 hours (AUC 0-24). Schedule A: * C1 D7 = pre-nav (0h) then 2h, 4h, 6h, 8h * C1 D8 = pre-tram (-1h = 23h post-nav) * C1 D21 = pre-tram (-1h); pre-nav (0h); then 2h, 4h, 6h, 8h post-nav * C1 D22 = pre-tram (-1h = 23h post-nav) * D1 of Cycle 2,4,8,12 (single trough) = pre-tram (-1h) Schedule B: * C1 D7, D14 = pre-tram (-1h); pre-nav (0h); then 2h, 4h, 6h, 8h post-nav * C1 D8, D15 = pre-tram (-1h = 23h post-nav) * D1 of Cycle 2,4,8,12 (single trough) = pre-tram (-1h) Schedule C: * C1 D7, D14 = pre-navitoclax (0h) then 2h, 4h, 6h, 8h * C1 D8, D15 = pre-trametinib (-1h = 23h post-navitoclax) * D1 of Cycle 2,4,8,12 (single trough) = pre-nav (0h)
Time frame: Cycle 1 day 7 and day 21
(Phase 1b) Pharmacokinetic Parameter C0 for Trametinib and Navitoclax When Administered in Combination
Pharmacokinetic blood draw samples collected for the following parameter and reported as mean values per day: trough plasma drug concentration (C0). Schedule A: * C1 D7 = pre-nav (0h) then 2h, 4h, 6h, 8h * C1 D8 = pre-tram (-1h = 23h post-nav) * C1 D21 = pre-tram (-1h); pre-nav (0h); then 2h, 4h, 6h, 8h post-nav * C1 D22 = pre-tram (-1h = 23h post-nav) * D1 of Cycle 2,4,8,12 (single trough) = pre-tram (-1h) Schedule B: * C1 D7, D14 = pre-tram (-1h); pre-nav (0h); then 2h, 4h, 6h, 8h post-nav * C1 D8, D15 = pre-tram (-1h = 23h post-nav) * D1 of Cycle 2,4,8,12 (single trough) = pre-tram (-1h) Schedule C: * C1 D7, D14 = pre-navitoclax (0h) then 2h, 4h, 6h, 8h * C1 D8, D15 = pre-trametinib (-1h = 23h post-navitoclax) * D1 of Cycle 2,4,8,12 (single trough) = pre-nav (0h)
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Time frame: Cycle 1 day 7 and day 21
(Phase 1b) Response Rate
Response rate is defined as the number of participants who achieve complete response (CR) or partial response (PR), according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria version 1.1: * CR = Disappearance of target lesion(s). Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 mm * PR = At least a 30% decrease in the sum of the longest diameter(s) of target lesion(s) Participants are considered evaluable for response if they had measurable disease present at baseline, received at least one cycle of therapy, and had their disease re-evaluated at least once after initiating therapy.
Time frame: Up to 4 months
(Phase 2) Pharmacokinetic Parameters for Trametinib and Navitoclax When Administered in Combination at Recommended Phase 2 Dose
Pharmacokinetic (PK) blood draw samples collected for the following parameters: * Maximum observed plasma drug concentration (Cmax) * Area under the concentration time curve from zero (pre-dose) to 24 hours (AUC 0-24) * Pre-dose (trough) drug concentration at the end of the dosing interval (C0) * Half-life (t1/2) Recommended phase 2 dose (RP2D) schedule: \- Day 1 of cycles 2, 4, 8, 12 = pre-trametinib (-1h)
Time frame: Day 1 of cycles 2, 4, 8, and 12
(Phase 1b and 2) Percent Change in Levels of Proteins/Messenger Ribonucleic Acids Implicated in Mitogen-activated Protein Kinase Signaling
Paired pre-treatment and on treatment tumor biopsies will be obtained to assess the pharmacodynamic response to therapy (e.g., change in levels of proteins/mRNAs implicated in MAPK signaling). Results will be reported as a mean percent (%) change in MAPK transcripts day 15 vs day 0. Pre-treatment tumor tissue for analysis will be obtained either from archival tissue remaining from a participant's prior surgery, diagnostic biopsy, or other procedure performed during routine clinical care. Alternatively, study-related pre-treatment biopsies will be obtained between days -21 and -1 of treatment if necessary. On-treatment biopsies will be obtained after \~2 weeks of Cycle 1 combination dosing: * Phase 1b Schedule A = Day 22 +/- 7 days * Phase 1b Schedule B or C = Day 15 +/- 7 days * Phase 2 RP2D = Day 15 +/- 7 days
Time frame: up to 50 days