This is an open label, multi-center, randomized phase I/II study of MLN0128 versus standard sorafenib. Eligible subjects in the phase I trial will receive MLN0128 in escalating doses. Eligible subjects in the phase II trial will be 1:1 randomized to either the MLN0128 arm or the sorafenib arm.
OUTLINE: This is a multi-center trial. The phase 1 dose escalation trial will evaluate MLN0128 in a standard 3+3 successive cohort design to identify the highest planned dose level. Phase II trial subjects will be 1:1 randomized to receive either MLN0128 (investigational arm) or sorafenib (control arm). PHASE I DOSE ESCALATION INVESTIGATIONAL TREATMENT: Cohort 1 (dose level +1) will consist of 3-6 evaluable patients who will receive MLN0128 15mg on day 1 of the 28-day cycle. Cohort 2 (dose level +2) will consist of 3-6 evaluable patients who will receive MLN0128 20mg on day 1 of the 28-day cycle. Cohort 3 (dose level +3) will consist of 3-6 evaluable patients who will receive MLN0128 30mg on day 1 of the 28-day cycle. Subjects will be evaluated for dose limiting toxicity (DLT) in the first 28 days of treatment (1 cycle). However, decisions to move to next dose escalation cohort will not be made until all subjects complete 2 cycles of therapy at a given dose. There will be no further dose escalation beyond dose level +3. PHASE II INVESTIGATIONAL TREATMENT: Randomization will take place following completion of the screening evaluations and eligibility assessments. Stratification factors will be employed during randomization to minimize between-arm assignment imbalance. * 1 Child-Pugh score 5-6 * 2 Child-Pugh score 7 Within the strata, subjects will be randomly assigned with equal probability to either the investigational arm (Arm A: MLN0128) or the control arm (Arm B: sorafenib). Arm A: MLN0128 will be administered orally at the recommended phase II dose (RP2D) once weekly. Arm B: Sorafenib will be administered at 400mg PO BID daily, with dose adjustment per standard of care. A new treatment cycle (1 cycle = 28 days) will only be initiated when all of the following conditions are met: * Absolute neutrophil count (ANC) ≥ 1.5 x 10\*9/L * Platelets ≥ 50 x 10\*9/L * Non-hematologic treatment related toxicities have improved to grade 1 or resolved per Common Terminology Criteria for Adverse Events v4.0 (CTCAE) Treatment may continue until progression, unacceptable toxicity, or withdrawal from study. Estimated Life Expectancy: ≥ 3 months Subjects must have adequate organ function, as specified below, within 7 days before study registration: Bone marrow reserve consistent with: * Absolute neutrophil count (ANC) ≥ 1.5 x 10\*9/L * Platelet count ≥ 50 x 10\*9/L * Hemoglobin ≥ 9 g/dL Hepatic: * Total bilirubin ≤ 2 x upper limit of normal (ULN) * Transaminases (aspartate aminotransferase (AST), serum glutamic oxaloacetic transaminase (SGOT) and alanine aminotransferase (ALT), serum glutamic pyruvic transaminase (SGPT) ≤ 5 x ULN Renal: * Creatinine clearance ≥50 mL/min based either on Cockcroft-Gault estimate or based on urine collection (12 or 24 hour) Metabolic: * Fasting serum glucose (≤ 130 mg/dL) and fasting triglycerides ≤ 300 mg/dL. * Glycosylated hemoglobin (HbA1c) \<7.0%
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
11
Phase I Dose Escalation Study Cohort 1 MLN0128 15mg QW; Cohort 2 MLN0128 20mg QW; Cohort 3 MLN0128 30mg QW
Phase II Arm A: MLN0128 administered orally at the recommended phase II dose (RP2D) once weekly.
Phase II Arm B: Sorafenib administered at 400mg PO BID daily
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
University of Illinois Cancer Center
Chicago, Illinois, United States
Indiana University Melvin and Bren Simon Cancer Center
Indianapolis, Indiana, United States
University of Noth Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
Phase I: Maximum Tolerated Dose (MTD) of MLN0128
The primary objective for phase I of this study is to determine the maximum tolerated dose (MTD) of MLN0128. Maximum Tolerated Dose is defined as the dose level at which fewer than 33% of subjects experience a dose limiting toxicity (DLT).
Time frame: From start of treatment Day 1 (D1) until completion of two cycles of treatment (maximum 56 days)
Phase II: Time to Progression (TTP)
The primary endpoint of Phase II of the study is to evaluate the time to progression, which is defined as the time from randomization until tumor progression as defined by RECIST v1.1.
Time frame: From date of randomization until the date of first documented progression or date of death from any cause, whichever occurs first, assessed up to 7 months (estimated).
Phase I: Characterize Adverse Effects (AE)
Toxicity assessed using Common Terminology Criteria for Adverse Events v4.0 (CTCAE) criteria
Time frame: From date of first dose until 30 days after the last treatment, assessed for estimated 7 cycles (est. 196 days)
Phase I: Overall Survival (OS) Rate
Overall Survival of subjects receiving MLN0128 is defined by the time from randomization to date of death from any cause.Here median overall survival in months has been reported for subjects per dose level with 95% confidence interval.
Time frame: From date of registration until death from any cause, up to a maximum of 27 months
Phase II: Overall Survival (OS) Rate
Overall Survival of subjects randomized to both MLN0128 and sorafenib arms is defined by the time from randomization to date of death from any cause.
Time frame: From date of registration until death from any cause, up to a maximum of 24 months
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Penn State Cancer Institute
Hershey, Pennsylvania, United States
University of Wisconsin
Madison, Wisconsin, United States
Phase I: Time to Progression (TTP)
Time to progression (TTP) of subjects receiving MLN0128 assessed using RECIST v1.1 criteria is defined as the time from randomization until tumor progression as defined by RECIST v1.1. Here median Time to Progression in months has been reported for subjects per dose level with 95% confidence interval.
Time frame: From date of randomization until the date of first documented progression or date of death from any cause, whichever occurs first, assessed up to 6 months (estimated).
Phase I: Progression-free Survival (PFS)
Progression free survival (PFS) of subjects receiving MLN0128 assessed using RECIST v1.1 criteria is defined by time from randomization to tumor progression or death from any cause. Here median Progression-free survival in months has been reported for subjects per dose level with 95% confidence interval.
Time frame: From date of randomization to tumor progression or death from any cause, up to a maximum of 6 months
Phase II: Progression Free Survival (PFS)
Progression Free Survival of subjects randomized to both MLN0128 and sorafenib arms assessed using RECIST v1.1 criteria, is defined as time from randomization to tumor progression or death from any cause.
Time frame: From date of randomization to tumor progression or death from any cause, up to a maximum of 24 months
Phase I: Objective Response Rate (ORR)
Objective Response Rate (ORR) of subjects receiving MLN0128 defined as complete response (CR)+partial response (PR), as defined by RECIST v1.1.
Time frame: Objective Response Rate is assessed at 16 weeks and 24 weeks from start of treatment cycle until Progressive disease is documented.
Phase I: Disease Control Rate (DCR)
Disease Control Rate (DCR) of subjects receiving MLN0128 as a sum of stable disease (SD for 8 weeks or longer), partial response (PR), and complete response (CR), as defined by RECIST v1.1.
Time frame: Disease Control Rate is assessed at 16 weeks and 24 weeks from start of treatment cycle until Progressive disease is documented.
Phase II: Characterize Adverse Effects (AE)
Toxicity for subjects randomized to both MLN0128 and sorafenib arms, assessed using CTCAE v4 criteria
Time frame: From date of first dose until 30 days after the last treatment, assessed for estimated 7 cycles (est. 196 days)
Phase II: Radiographic Response Rate (RRR)
Radiographic Response Rate for subjects randomized to both MLN0128 and sorafenib arms, determined utilizing objective response rate (ORR) and disease control rate (DCR) at 16 and 24 weeks.
Time frame: Radiographic Response Rate is assessed at 16 weeks and 24 weeks from start of treatment cycle until Progressive disease is documented.