This is a first-in-human study of CM93, an oral investigational drug, in adults with Epidermal Growth Factor Receptor-modified glioblastoma. The study is designed in three parts consisting of a dose-escalation phase, a dose-expansion phase and a window-of-opportunity surgical trial. The trial objectives are to evaluate the safety, pharmacokinetics, pharmacodynamics and clinical effects of CM93 in this patient population.
CM93 is a third-generation, covalent/irreversible, brain penetrant small molecule Epidermal Growth Factor Receptor (EGFR) tyrosine kinase inhibitor. It is not a substrate of p-glycoprotein or breast cancer resistance protein (bcrp) and is a mild inhibitor of bcrp. It is a potent inhibitor of EGFR mutations but also has activity against wild type EGFR. This first-in-human phase I trial will evaluate the safety, tolerability, and pharmacokinetics (PK) of CM93 and determine the recommended Phase 2 dose (RP2D) for further evaluation using a 3+3 design (Part 1). Once the RP2D has been determined 12 additional patients will be treated in a dose expansion cohort to confirm the safety and tolerability of the selected dose (Part 2). Subsequent to the phase I trial a window-of-opportunity surgical trial will initiate. Tumor from both contrast enhancing and non-contrast enhancing areas of patients who received CM93 before surgery will be resected and evaluated to determine if therapeutic concentrations of the drug are achieved. Pharmacodynamic studies will be conducted in tumor tissue from patients who received CM93 before surgery and the patients who did not receive drug before surgery to determine if there is adequate inhibition of EGFR. After recovery from surgery all 30 patients will receive CM93 until progression, development of unacceptable toxicity, or withdrawal of consent and preliminary evidence of activity will be obtained.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
72
oral capsule of CM93 administered once daily
Dose-limiting toxicities
Record and compare safety and tolerability, adverse events, changes in laboratory parameters and electrocardiogram measure of patients to baseline measurements. DLTs (dose-limiting toxicities) are defined as a clinically significant adverse event (AE) or laboratory abnormality unrelated to disease progression that meet certain criteria.
Time frame: 28 days
Maximum tolerated dose
The MTD (maximum tolerated dose) is defined as the highest dose level at which ≤1 of 6 subjects experience a DLT during Cycle 1 (the first 28 days of intervention).
Time frame: 28 days
Recommended phase 2 dose
Determined by the DSMC (Data Safety Monitoring Committee) after review of safety data, the RP2D (recommended phase 2 dose) will be the MTD unless: * Significant clinical anti-tumor effect (complete response, partial response, or stable disease for ≥2 months) is seen below the MTD, in which case a clinically active dose level may be selected as an RP2D; or * Toxicities observed beyond Cycle 1 require reducing the RP2D(s) below the MTD level; or * MTD is not achieved, in which case the highest dose level administered may become an RP2D.
Time frame: 28 days
Concentration of CM93 in non-enhancing areas of tumor
In part 3 of the study, tissue samples from non-enhancing areas of the tumor will be analyzed for CM93 and concentration will be reported for the CM93-treated group.
Time frame: 7 days
Half-life of CM93
Calculate half-life from the plasma bioanalysis of CM93 and its active metabolite at different time points and doses.
Time frame: 22 days
Maximum plasma concentration (Cmax)
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Calculate Cmax from the plasma bio analysis of CM93 and its active metabolite.
Time frame: 22 days
Time to Maximum plasma concentration (Tmax)
Calculate Tmax from the plasma bio analysis of CM93 and its active metabolite.
Time frame: 22 days
Area under the curve (AUC)
Calculate AUC from the plasma bio analysis of CM93 and its active metabolite.
Time frame: 22 days
EGFR level in tumor specimens
In part 3 of the study, average pEGFR (phosphorylated epidermal growth factor receptor) levels in the tumor specimens of CM93-treated surgical patients will be compared to the levels in tumor specimens from untreated patients and difference between the two groups noted.
Time frame: 7 days