This study aims to assess the safety and tolerability of PHI-101 in patients with platinum-resistance/refractory ovarian, fallopian tubal, and primary peritoneal cancer. This study also evaluates the pharmacokinetics of PHI-101 and efficacy of PHI-101 during treating platinum-resistance/refractory ovarian, fallopian tubal, and primary peritoneal cancer. PHI-101 is a CHK2 inhibitor that is a checkpoint kinase binding specifically to CHK2, rather than CHK1, and it inhibits the DDR system by inhibiting the ATM-CHK2 pathway, which is activated in response to DSBs. When a high-grade serous ovarian (HGSO) cancer cell line and various ovarian cancer cell lines (CAOV3, OVCAR3, SK-OV-03, and SW626) were treated with PHI-101 in a non-clinical study, the therapeutic effect of PHI-101 against ovarian cancer was demonstrated by a decrease in viability of ovarian cancer cells. In addition, a stronger growth inhibition effect was observed compared to that of treatment with olaparib or rucaparib alone, and a much stronger inhibition effect was observed when concomitantly used with paclitaxel, cisplatin, and topotecan. Based on the aforementioned results of the non-clinical studies, the potential of PHI-101 as a new treatment or concomitant cytotoxic chemotherapeutics for patients with ovarian cancer who are resistant to existing antineoplastic drugs was confirmed.
In this study, a maximum of 6 dose levels (cohorts) were planned for daily oral administration of PHI-101. Subjects who meet the inclusion/exclusion criteria of this study will be enrolled in each cohort and assessed for safety and tolerability after administering PHI-101 to determine the MTD. Subjects will be enrolled sequentially starting from the low-dose cohort, and DLT will be assessed for the first 28 days (Cycle 1) after the first dose of PHI-101. Before DLT is assessed in a specific cohort, enrolling a subsequent subject in the next higher dose cohort will not be allowed. According to the accelerated 3+3 design, the accelerated dose escalation scheme, which assesses DLT in 1 subject in each cohort ('single subject cohort'), is applied until toxicity (ADRs) related to PHI-101 ≥ \[CTCAE version 5.0\] grade 2 occurs. If ADRs ≥ grade 2 do not occur in 1 subject, DLT can be assessed in one level higher cohort according to the SRC's recommendation. If an ADR ≥ grade 2 occurs in a specific cohort, the accelerated 3+3 design will be immediately switched to the standard 3+3 scheme, and 2 additional subjects will be enrolled in that cohort (1 subject + 2 additional subjects) to assess DLT during 1 cycle. After switching to the standard 3+3 scheme, 3 to 6 subjects will be enrolled in each cohort. If no DLT is observed in the first 3 subjects, DLT can be assessed in one level higher cohort according to the SRC's recommendation. If DLT is observed in 1 out of 3 subjects (DLT: 1/3 subject), that cohort will be expanded to 6 subjects by enrolling 3 additional subjects. If 2 out of 3 to 6 subjects experience DLT (DLT: 2/3 to 6 subjects), this means that the MTD is exceeded. Thus, additional enrollment will be ended for that cohort. The one level lower cohort will expand to 6 subjects (If 6 subjects were already enrolled in that cohort, additional enrollment is unnecessary). A subject not evaluable for DLT (withdrawal for reasons other than AEs or ADRs, or less than 20 out of 28 doses of PHI-101 were administered during Cycle 1) may be replaced by another subject according to the judgment of the investigator (decision/recommendation of the SRC, if necessary). If a subject in the single subject cohort is not evaluable for DLT, a substitute will be enrolled in the same cohort (1 subject + 1 additional subject) to assess DLT. If it is determined not to replace the subject not evaluable for DLT, the subject will be considered to have experienced DLT when the dose escalation is decided. If DLT is observed in \> 1 out of 6 subjects in a specific cohort (χ) and DLT is observed in ≤ 1 out of 6 subjects in the cohort (χ-1) that is one level lower than the specific cohort, the one level lower cohort (χ-1) will be considered as the MTD. The dose of PHI-101 will be escalated until an MTD is determined. If the MTD is not determined at the MPD, dose escalation will be ended at that dose (Addition of cohorts may be reviewed by and discussed with the SRC, if necessary, but reporting to the MFDS and the IRB and protocol amendment should occur first.) According to the schedule of activities (SOA), observation, questioning, examination, and tests to assess the safety and tolerability of PHI-101, PK sampling to assess PK, and tumor response assessment to explore efficacy will be performed. After the EOT of PHI-101, the EOT visit will take place. Survival of subjects and initiation of new antineoplastic therapy will be periodically checked until the EOS. The follow-up will be performed for 1 year after the EOS to obtain such information.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
36
Escalated doses of PHI-101 will be administered to each cohort.
Seoul National University Hospital
Seoul, South Korea
RECRUITINGProportion of patients with dose-limiting toxicity (DLT)
The frequency and percentage of DLT that occurs during 1 cycle (28 days) after administration of the IP will be presented by the cohort.
Time frame: Subjects will be treated and observed for DLT through the end of the first cycle (Days 1-28)
Maximum tolerated dose
The dose of PHI-101 will be escalated until an MTD is determined, and if the MTD is not determined at the MPD, dose escalation will be ended at that dose
Time frame: Through the first cycle (Day1-28)
Dose interruption (temporary discontinuation) percent (%)
Dose interruption percent (temporary discontinuation) of the IP due to adverse events (AEs) in each cohort will be presented using frequency and percentage, and 95% exact confidence intervals (CIs).
Time frame: Through the first cycle (Day1-28)
Dose reduction percent (%)
Dose reduction percent (%) of the IP due to adverse events (AEs) in each cohort will be presented using frequency and percentage, and 95% exact confidence intervals (CIs).
Time frame: Through the first cycle (Day1-28)
Dose termination (permanent discontinuation) percent (%)
Dose termination percent (%) of the IP due to adverse events (AEs) in each cohort will be presented using frequency and percentage, and 95% exact confidence intervals (CIs).
Time frame: Through the first cycle (Day1-28)
Cmax
Maximum plasma concentration after administration
Time frame: Cycle1Day1, Cycle1Day8, Cycle1Day15, Cycle2Day1, Cycle3Day1, Cycle6day1, and then, every 12 weeks until end of the study, up until 24 months (each cycle is 28 days)
AUCt
Area under the plasma concentration-time curve to the last measurable blood sampling time point, calculated by the trapezoidal method. AUC of the interval with increasing plasma concentration is calculated by a linear trapezoidal method, and AUC of the interval with decreasing plasma concentration is calculated by the log-linear trapezoidal summation. Concentrations below lower limit of quantification (LLOQ) will be excluded from calculation.
Time frame: Cycle1Day1, Cycle1Day8, Cycle1Day15, Cycle2Day1, Cycle3Day1, Cycle6day1, and then, every 12 weeks until end of the study, up until 24 months (each cycle is 28 days)
AUCτ
Area under the plasma concentration-time curve from time of administration to τ (AUCτ) (τ: dosing interval)
Time frame: Cycle1Day1, Cycle1Day8, Cycle1Day15, Cycle2Day1, Cycle3Day1, Cycle6day1, and then, every 12 weeks until end of the study, up until 24 months (each cycle is 28 days)
AUCinf
Area under the plasma concentration-time curve extrapolated from the time of a single dose to infinity. AUCinf = AUClast + Clast /λz
Time frame: Cycle1Day1, Cycle1Day8, Cycle1Day15, Cycle2Day1, Cycle3Day1, Cycle6day1, and then, every 12 weeks until end of the study, up until 24 months (each cycle is 28 days)
Tmax
Time to maximum plasma concentration after administration
Time frame: Cycle1Day1, Cycle1Day8, Cycle1Day15, Cycle2Day1, Cycle3Day1, Cycle6day1, and then, every 12 weeks until end of the study, up until 24 months (each cycle is 28 days)
Tmax,ss
Time to maximum plasma concentration at steady state
Time frame: Cycle1Day1, Cycle1Day8, Cycle1Day15, Cycle2Day1, Cycle3Day1, Cycle6day1, and then, every 12 weeks until end of the study, up until 24 months (each cycle is 28 days)
t1/2
Half-life obtained by calculating ln(2)/λz, where λz is the elimination rate constant obtained from the linear regression analysis of log-linear plot at the terminal phase of the plasma concentration-time curve
Time frame: Cycle1Day1, Cycle1Day8, Cycle1Day15, Cycle2Day1, Cycle3Day1, Cycle6day1, and then, every 12 weeks until end of the study, up until 24 months (each cycle is 28 days)
PTF
Fluctuation (%) between the maximum and minimum plasma concentrations at steady state
Time frame: Cycle1Day1, Cycle1Day8, Cycle1Day15, Cycle2Day1, Cycle3Day1, Cycle6day1, and then, every 12 weeks until end of the study, up until 24 months (each cycle is 28 days)
AR
Ratio of systemic exposure of the drug at steady state to systemic exposure of the drug after a single dose
Time frame: Cycle1Day1, Cycle1Day8, Cycle1Day15, Cycle2Day1, Cycle3Day1, Cycle6day1, and then, every 12 weeks until end of the study, up until 24 months (each cycle is 28 days)
CL/F
Apparent clearance CL/F = Dose/AUCinf
Time frame: Cycle1Day1, Cycle1Day8, Cycle1Day15, Cycle2Day1, Cycle3Day1, Cycle6day1, and then, every 12 weeks until end of the study, up until 24 months (each cycle is 28 days)
CLss/F
Apparent clearance at steady state
Time frame: Cycle1Day1, Cycle1Day8, Cycle1Day15, Cycle2Day1, Cycle3Day1, Cycle6day1, and then, every 12 weeks until end of the study, up until 24 months (each cycle is 28 days)
Vdz/F
Volume of distribution in the terminal phase
Time frame: Cycle1Day1, Cycle1Day8, Cycle1Day15, Cycle2Day1, Cycle3Day1, Cycle6day1, and then, every 12 weeks until end of the study, up until 24 months (each cycle is 28 days)
Objective response rate (ORR)
ORR = complete response (CR) + partial response (PR) : For subjects who have best overall response (BOR) of complete response (CR) or partial response (PR), frequency and percentage, and 95% exact CIs will be presented by cohort evaluated according to the RECIST criteria by CT imaging.
Time frame: Until the end of the study or death, which may be up to 24 months
Disease control rate (DCR)
DCR=CR+PR+SD For subjects with BOR of CR, PR, or stable disease (SD), frequency and percentage, and 95% exact CIs will be presented by cohort and evaluated according to the RECIST criteria by CT imaging.
Time frame: Until the end of the study or death, which may be up to 24 months
Duration of response (DOR)
The time interval from response to progression or death
Time frame: Until the end of the study or death, which may be up to 24 months
Progression-free survival (PFS)
The time interval from enrollment to progression or death
Time frame: Until the end of the study or death, which may be up to 24 months
Overall survival (OS)
The time interval from enrollment to death
Time frame: Until the end of the study or death, which may be up to 24 months
Time to progression (TTP)
the time interval from enrollment date to disease recurrence or progression except death
Time frame: Until the end of the study or death, which may be up to 24 months
presence of genetic variation
homologous recombination deficiency \[HRD\] related genetic variation such as BRCA mutation
Time frame: at the time of enrollment
Number of of adverse events
The investigator should review the measurement, examination, and assessment results of vital signs, physical examination, laboratory tests, ECG, etc. performed for the safety assessment, and assess and record the clinical significance of abnormal results. Any clinically significant abnormal findings (medical condition or abnormal values) should be collected as AEs.
Time frame: Up to 24 months from the start of the intervention
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