This is a phase 1b/2a, open label, multi-centre, safety and efficacy study of glasdegib in patients with sclerotic cGVHD refractory to second-line treatment. The design for the current study is a standard 3+3 dose-finding scheme. A dose escalation/de-escalation design will be applied in successive patient cohorts until identification of MTD. Glasdegib will be self-administered orally once daily in the morning as monotherapy in continuous 28-day treatment cycles for a maximum of 24 cycles. Those patients enrolled in the trial that obtain objective clinical benefit under treatment with glasdegib (defined as the achievement of at least a partial response at one or more target organs), will be allowed to proceed to a slow dose withdrawal phase over a period of 6 months after the end of Cycle 24.
Three patients will be initially treated at the corresponding dose level of glasdegib at each dose escalation stage. Dose escalation will be started in a first cohort of 3 patients at a starting dose of 50 mg (Dose Level 1) and will then proceed as follows: * If no dose-limiting toxicity is observed among the first 3 patients in a cohort, then 3 additional patients will be treated at the next higher dose level. * If a dose-limiting toxicity is observed in 1 of the initial 3 treated patients, 3 additional patients, resulting in a total of 6 patients, will be enrolled and treated at the same dose level. * If no further dose-limiting toxicity is observed (1/6 patients), dose escalation will continue to the next dose level in a new cohort of 3 patients. * If ≥ 2/3 or 2/6 patients experience a dose-limiting toxicity, then MTD has been exceeded and the next lower dose of glasdegib will be expanded until a total number of 6 patients treated at that dose level is reached. If 0 or 1 patient out of 6 experiences a dose-limiting toxicity, this dose level will be declared MTD. If ≥ 2/6 patients experience a dose-limiting toxicity, the next lower dose level will be expanded. * Prior safety data evaluation and approval by an independent data monitoring committee will be required before escalation at each dose level. In case that MTD is exceeded within the first cohort, then a -1 Dose Level (25 mg OD) will be tested. If MTD is exceeded at 25 mg OD, the trial will be stopped and no additional testing of glasdegib at lower doses will be allowed. Dose escalation will continue following the above-specified rules until MTD is declared. Once MTD is defined, dose expansion at MTD in cohorts of 3 patients will proceed until the pre-established sample size (20 patients) is reached. In the event that the highest pre-defined dose (200 mg OD) is tested in two successive cohorts of 3 patients and MTD is not attained, dose expansion at 200 mg OD will precede until a sample size of 20 patients is reached. The administered dose level may be subject to further adjustment (dose reduction only) in the dose expansion phase based on emerging safety, pharmacokinetic or pharmacodynamic data. Additional dose levels may be explored, if appropriate, based on emerging safety, pharmacokinetic, or pharmacodynamic data, prior safety data evaluation and approval by an external monitoring committee. Patients who are not evaluable for dose-limiting toxicity (e.g., those not receiving at least 80% of the planned dose of glasdegib in the dose-limiting toxicity monitoring period (first 2 cycles) for reasons other than study treatment-related toxicities) must be replaced. If the pre-specified sample size is completed before MTD is defined or before the highest pre-defined dose (200 mg OD) is tested in at least 6 patients, additional patients may be recruited into the study (for a total sample size of up to 24 patients) until MTD is defined or two cohorts of 3 patients complete treatment at 200 mg OD. Glasdegib may be dose reduced or discontinued during any cycle based on the patient's individual tolerability. During the dose-escalation phase, once a patient has a dose reduction for a study drug-related toxicity; the dose will not be re-escalated. Dose re-escalation up to the MTD will be allowed at the investigator's discretion during the dose expansion phase.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
21
A dose escalation/de-escalation design will be applied in successive patient cohorts until identification of MTD (dose range: 25-200 mg OD).
Hospital Clinic de Barcelona
Barcelona, Spain
Hospital General Universitario Morales Meseguer
Murcia, Spain
Hospital Universitario Son Espases
Palma de Mallorca, Spain
Hospital Universitario de Salamanca
Salamanca, Spain
Hospital Universitario Marqués de Valdecilla
Santander, Spain
Hospital Universitario Virgen del Rocío
Seville, Spain
Maximum tolerated dose.
To determine the maximum tolerated dose (MTD) or maximum administered dose (MAD) and/or the recommended Phase 2 dose (RP2D) of glasdegib in subjects with sclerotic cGVHD.
Time frame: Up to 48 weeks.
Adverse events.
Type, incidence, severity (graded by the National Cancer Institute \[NCI\] Common. Terminology Criteria for Adverse Events \[CTCAE\], Version 4.0), timing, intensity, and relatedness of adverse events.
Time frame: Adverse events will be assessed from the date the informed consent document is signed until 28 days after the last administered dose of glasdegib.
Overall response rate (ORR).
ORR as assessed by the NIH cGVHD Response Criteria.
Time frame: Response to treatment will be evaluated on Day 1 of Cycles 1, 2, 4, 7, 10, 13, 16, 19, 22, 25, 28 (each cycle is 28 days) and end treatment.
Immunosuppression requirements.
Dose reduction and/or withdrawal of concomitantly administered immunosuppressive drugs.
Time frame: Modifications to the immunosuppressive regimen will be assessed from date of study entry to study withdrawal or end of treatment (up to 48 weeks).
Duration of clinical response.
Duration of clinical response as assessed by the NIH cGVHD Response Criteria.
Time frame: Response to treatment will be evaluated on Day 1 of Cycles 1, 2, 4, 7, 10, 13, 16, 19, 22, 25, 28 (each cycle is 28 days) and day 28 of Cycle 24,
Survival outcomes: overall survival.
Overall survival (OS).
Time frame: Survival status of participants will be followed from inclusion to end of trial (once every recruited patient has completed 12 cycles of treatment or withdrawn from the study).
Survival outcomes: progression-free survival.
Progression-free survival (PFS).
Time frame: Progression-free survival status of participants will be followed from inclusion to end of trial (once every recruited patient has completed 12 cycles of treatment or withdrawn from the study).
Pharmacokinetics: elimination half-life.
Elimination half-life of glasdegib.
Time frame: Day 1 of Cycles 1, 2 and 4 (each cycle is 28 days).
Pharmacokinetics: AUC.
Area under the plasma concentration versus time curve (AUC) for each dose group.
Time frame: Day 1 of Cycles 1, 2 and 4 (each cycle is 28 days).
Pharmacokinetics: Cmax.
Maximum plasma concentration (Cmax) for each dose group.
Time frame: Day 1 of Cycles 1, 2 and 4 (each cycle is 28 days).
Pharmacodynamics: Gli1 expression.
To explore the relationship of glasdegib plasma levels and Gli1 expression in peripheral blood mononuclear cells.
Time frame: Day 1 of Cycle 1 and Cycle 2, 4 , 13 and 25 (or End of Treatment if the patient does not subsequently proceed to the dose reduction phase) .
Pharmacodynamics: Gli2 expression
To explore the relationship of glasdegib plasma levels and Gli2 expression in peripheral blood mononuclear cells.
Time frame: Day 1 of Cycle 1 and Cycle 2, 4 , 13 and 25 (or End of Treatment if the patient does not subsequently proceed to the dose reduction phase) .
Pharmacodynamics: Shh expression.
To explore the relationship of glasdegib plasma levels and Shh expression in peripheral blood mononuclear cells.
Time frame: Day 1 of Cycle 1 and Cycle 2, 4 , 13 and 25 (or End of Treatment if the patient does not subsequently proceed to the dose reduction phase) .
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