Safety and Efficacy of Tipifarnib in Head and Neck Cancer With HRAS Mutations and Impact of HRAS on Response to Therapy

Phase 2CompletedNCT03719690

Kura Oncology, Inc.296 enrolled

Overview

An international, multicenter, open-label, 2 cohort, non-comparative, pivotal study evaluating the efficacy of tipifarnib in HRAS mutant HNSCC (AIM-HN). The first cohort will assess the objective response rate (ORR) of tipifarnib in subjects with HNSCC with HRAS mutations. The second study cohort, SEQ-HN, is an observational sub-study including HNSCC patients in whom HRAS mutations were not identified (wild type HRAS HNSCC) and who consent to provide first line outcome data and additional follow up.

KO-TIP-007 is an international, multicenter, open-label, 2 cohort, non-comparative, pivotal study evaluating the efficacy of tipifarnib in HRAS mutant HNSCC (AIM-HN) and the impact of HRAS mutations on response to first line systemic therapies for HNSCC (SEQ-HN). KO-TIP-007 has 2 study cohorts. The first study cohort, named AIM-HN, includes HNSCC subjects with HRAS mutations. AIM-HN subjects will receive treatment with tipifarnib and the outcome of this cohort will be evaluated for ORR by an independent review facility. The second study cohort, SEQ-HN, is an observational sub-study including HNSCC patients in whom HRAS mutations were not identified (wild type HRAS HNSCC) and who consent to provide first line outcome data and additional follow up. HNSCC patients in whom HRAS mutations are identified and who meet eligibility criteria will be offered participation in AIM-HN. HNSCC patients in whom HRAS mutations are not identified may participate in SEQ-HN only. These patients will be followed and the comparison of outcomes of HRAS mutant and HRAS wild type HNSCC will address the exploratory objective to determine the effect of HRAS mutation on the ORR of first line systemic therapy in patients with recurrent/metastatic HNSCC. Outcome data from subsequent lines of therapy will be collected.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: AIM-HN 1. At least 18 years of age. 2. Histologically confirmed head and neck cancer (oral cavity, pharynx, larynx, sinonasal, nasopharyngeal, or unknown primary) of squamous histology not amenable to local therapy with curative intent (surgery or radiation therapy with or without chemotherapy). 3. Documented treatment failure from most recent prior therapy (e.g. tumor progression, clinical deterioration, or recurrence), and from at least one prior platinum-containing regimen, in any treatment setting. 4. Known tumor missense HRAS mutation. 5. Measurable disease by RECIST v1.1. 6. ECOG performance status of 0-1. 7. Acceptable liver, renal and hematological function 8. Other protocol defined inclusion criteria may apply. Exclusion Criteria: 1. Histologically confirmed salivary gland, thyroid, (primary) cutaneous squamous or nonsquamous histologies (e.g. mucosal melanoma). 2. Received treatment for unstable angina within prior year, myocardial infarction within the prior year, cerebro-vascular attack within the prior year, history of New York Heart Association grade III or greater congestive heart failure, or current serious cardiac arrhythmia requiring medication except atrial fibrillation. 3. Non-tolerable Grade 2 or ≥ Grade 3 neuropathy or evidence of unstable neurological symptoms within 4 weeks of Cycle 1 Day 1. 4. Active, uncontrolled bacterial, viral or fungal infections requiring systemic therapy. Known history of infection with human immunodeficiency virus or an active infection with hepatitis B or hepatitis C. 5. Received treatment for non-cancer related liver disease within prior year. 6. Other protocol defined exclusion criteria may apply Inclusion Criteria: SEQ-HN 1. At least 18 years of age. 2. Histologically confirmed head and neck cancer (oral cavity, pharynx, larynx, sinonasal, nasopharyngeal, or unknown primary) of squamous histology. 3. Will or has received at least one systemic anti-cancer therapy for recurrent or metastatic HNSCC. 4. HRAS wildtype (i.e., have no identified tumor missense HRAS mutation). 5. Other protocol defined inclusion criteria may apply Exclusion Criteria: SEQ-HN 1\. Histologically confirmed salivary gland, thyroid, (primary) cutaneous squamous or nonsquamous histologies (e.g. mucosal melanoma). 5\. Other protocol defined exclusion criteria may apply

Locations (102)

University of Southern California Norris Comprehensive Cancer Center

Los Angeles, California, United States

UCLA - Jonsson Comprehensive Cancer Center

Los Angeles, California, United States

UCSF - Helen Diller Family Comprehensive Cancer Center

San Francisco, California, United States

The Oncology Institute of Hope and Innovation - Anaheim

Whittier, California, United States

Miami Cancer Institute

Miami, Florida, United States

Outcomes

Primary Outcomes

Objective Response Rate (ORR) in High Variable Allele Frequency (VAF) Population, as Assessed by Independent Review Facility (IRF)

ORR was defined as the percentage of participants who experienced a best overall response (BOR) of complete response (CR; disappearance of all target lesions) or partial response (PR; at least a 30% decrease in the sum of diameters of target lesions) and was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 by IRF. 95% confidence interval (CI) was calculated by the exact binomial (Clopper-Pearson) method.

Time frame: Up to approximately 28 months

Secondary Outcomes

ORR in All VAF Population, as Assessed by IRF

ORR was defined as the percentage of participants who experienced a BOR of CR or PR and was assessed using RECIST v1.1 by IRF. 95% CI was calculated by the exact binomial (Clopper-Pearson) method.

Time frame: Up to approximately 28 months

Duration of Response (DoR) in High VAF Population, as Assessed by IRF

DoR was defined as the time from the date of first response (CR or PR \[whichever occurred first\]) to the date of progression of disease or death of any cause, whichever occurred first, in participants with a confirmed CR or PR and was assessed using RECIST v1.1 by IRF. Median was calculated using the Kaplan-Meier method. 95% CI was based on Brookmeyer and Crowley method with log-log transformation.

Time frame: Up to approximately 28 months

DoR in All VAF Population, as Assessed by IRF

Time frame: Up to approximately 28 months

Progression Free Survival (PFS) in High VAF Population, as Assessed by IRF

PFS was defined as months from the first dose of the study drug to the first documented progressive disease (PD, appearance of one or more new lesions or at least a 20% increase in the sum of the diameters of target lesions) or death, whichever came first and was assessed using RECIST v1.1 by IRF. Median was calculated using the Kaplan-Meier method. 95% CI was based on Brookmeyer and Crowley method with log-log transformation.

Time frame: Up to approximately 28 months

PFS in All VAF Population, as Assessed by IRF

PFS was defined as months from the first dose of the study drug to the first documented PD or death, whichever came first and was assessed using RECIST v1.1 by IRF. Median was calculated using the Kaplan-Meier method. 95% CI was based on Brookmeyer and Crowley method with log-log transformation.

Time frame: Up to 28 approximately months

PFS Rate in High VAF Population, as Assessed by IRF

PFS rate was defined as the percentage of participants who had not experienced documented PD or death, whichever came first and was assessed using RECIST v1.1 by IRF at 6 and 9 month timepoints. Percentage of participants was calculated using the Kaplan-Meier method. 95% CI was calculated using normal approximation to the log transformed cumulative hazard rate

Time frame: 6 months and 9 months

PFS Rate in All VAF Population, as Assessed by IRF

Time frame: 6 months and 9 months

Overall Survival (OS) in High VAF Population

OS was defined as months from first dose date until death from any cause. Median was calculated using the Kaplan-Meier method. 95% CI was based on Brookmeyer and Crowley method with log-log transformation.

Time frame: Up to approximately 28 months

OS in All VAF Population

Time frame: Up to approximately 28 months

OS Rate at 12 Months in High VAF Population

OS rate was defined as the percentage of participants who had not experienced or death and was assessed at 12 months. Percentage of participants was calculated using the Kaplan-Meier method. 95% CI was calculated using normal approximation to the log transformed cumulative hazard rate.

Time frame: 12 months

OS Rate at 12 Months in All VAF Population

Time frame: 12 months

Time to Response (TTR) in High VAF Population, as Assessed by IRF

TTR was defined as months from treatment start to first CR or PR (whichever was first recorded) in participants with confirmed CR or PR and was assessed using RECIST v1.1 by IRF. TTR was summarized descriptively by summary statistics.

Time frame: Up to approximately 28 months

TTR in All VAF Population, as Assessed by IRF

Time frame: Up to approximately 28 months

Number of Participants Who Experienced Treatment-Emergent Adverse Events (TEAEs)

TEAEs were defined as adverse events (AEs) that started on or after the first dose of the study drug and within 30 days of the last administration of the study drug. Common Terminology Criteria for Adverse Events (CTCAE) v5.0 was used for toxicity grading (Grade 3: severe or disabling; Grade 4: life-threatening; Grade 5: death related to AE). Clinically significant changes in laboratory tests, vital signs, and electrocardiogram results were reported as AEs.

Time frame: Up to approximately 28 months

Change From Baseline in the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module 35 (EORTC QLQ-H&N35) Subscales

Change from Baseline score in pain, swallowing, speech problems, and senses problems subscales of EORTC QLQ-H\&N35 are summarized individually. Raw scores for each subscale were linear transformations and standardized to range (0 - 100), with higher scores representing worse levels of symptoms. Change from Baseline was calculated as End of Treatment Observed - Baseline with a negative change representing a reduction in symptoms.

Time frame: Baseline and End of Treatment Visit (up to approximately 28 months)

Change From Baseline in the EuroQol-Visual Analog Scale (EQ-VAS) Score

The EQ-VAS forms part of the EQ-5D-5L and collects the self-rating health status from 0 (the worst imaginable health) to 100 (the best imaginable health). Change from Baseline was calculated as End of Treatment Observed - Baseline with a negative change representing an increase in symptoms.

Time frame: Baseline and End of Treatment Visit (up to approximately 28 months)

Safety and Efficacy of Tipifarnib in Head and Neck Cancer With HRAS Mutations and Impact of HRAS on Response to Therapy

Overview

Conditions

Interventions

Eligibility

Locations (102)

Outcomes

Primary Outcomes

Secondary Outcomes