This phase I/Ib trial tests the side effects, best dose, tolerability, and effectiveness of RMC-5552 in treating patients with glioblastoma that has come back (recurrent). RMC-5552 is a type of medicine called an mechanistic target of rapamycin (mTOR) inhibitor. These types of drugs prevent the formation of a specific group of proteins called mTOR. This protein controls cancer cell growth, and the study doctors believe stopping mTOR from forming may help to kill tumor cells.
PRIMARY OBJECTIVES: I. To determine the maximum tolerated dose (MTD) and/or the recommended phase II dose (RP2D) of mTORC1 kinase inhibitor RMC-5552 (RMC- 5552). (Cohort A). II. To characterize the safety and tolerability of RMC-5552 monotherapy. (Cohort A). III. To characterize the pharmacokinetics (PK) of RMC-5552 after a single dose of RMC-5552 prior to surgical resection. (Cohort B). IV. To evaluate the preliminary antitumor effect of RMC-5552. (Cohort C). SECONDARY OBJECTIVES: I. To measure the pharmacokinetics (PK) of RMC-5552. (Cohort A). II. To evaluate the preliminary antitumor effect of RMC-5552. (Cohort A). III. To assess pharmacodynamic (PD) markers of drug activity, including biochemical markers of mTORC1 pathway inhibition in tumor tissue. (Cohort B). IV. To characterize the safety and tolerability of RMC-5552 monotherapy. (Cohort B). V. To evaluate the preliminary antitumor effect of RMC-5552 in recurrent glioblastoma multiforme (GBM). (Cohort B). VI. To characterize the safety and tolerability of RMC-5552 monotherapy. (Cohort C). VII. To measure the PK of RMC-5552. (Cohort C). OUTLINE: This is a phase I, dose-escalation study (Cohort A) followed by a phase Ib study (Cohorts B and C). Participants are assigned to 1 of 3 cohorts. COHORT A: Non-surgical patients receive RMC-5552 intravenously (IV) on study. Patients undergo a pulmonary function test and chest x-ray during screening. Patients also undergo a brain magnetic resonance imaging (MRI) throughout the trial. Patents undergo blood sample collection on study. \*\*\* Participants will be enrolled concurrently in Cohorts B and C \*\*\* COHORT B: Surgical patients receive a single dose of RP2D RMC-5552 IV prior to standard of care surgery and then on study. Patients undergo a pulmonary function test and chest x-ray during screening. Patients also undergo a brain MRI throughout the trial. Patents undergo blood sample collection on study. COHORT C: Non-surgical patients receive RP2D of RMC-5552 IV on study. Patients undergo a pulmonary function test and chest x-ray during screening. Patients also undergo a brain MRI throughout the trial. Patents undergo blood sample collection on study. Participants will be followed after their last treatment with RMC-5552 until the participant voluntarily withdraws consent, or until death; whichever comes first.
Given IV
University of California, San Francisco
San Francisco, California, United States
RECRUITINGMaximum Tolerated Dose (MTD) (Cohort A)
MTD is defined as the maximal dose at which fewer than one-third of participants experience a dose-limiting toxicity (DLT).
Time frame: Up to 1 cycle (1 cycle is equal to 21 days)
Recommended phase II dose (RP2D) (Cohort A)
RP2D is defined as the selected dose that will be given to participants in Cohorts B and then C. The RP2D will be either the MTD or one dose level lower based on an analysis of the safety data collected in Cohort A, and discussions between the sponsor-investigator and representatives of RevMed.
Time frame: Up to 1 cycle (1 cycle is equal to 21 days)
Number of Dose-Limiting Toxicities (DLTs) (Cohort A)
The frequency of adverse events classified by National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version (v)5.0 determined to be DLTs will be reported by dose level.
Time frame: Up to 1 cycle (1 cycle is equal to 21 days)
Frequency of Grade 3 or Higher Adverse Events (Cohort A)
Adverse events and clinically significant laboratory abnormalities (meeting Grade 3, 4, or 5 criteria according to CTCAE) for participants in Cohort A will be summarized by maximum intensity and relationship to study drug.
Time frame: Up to 1 year after enrollment
Median concentration of RMC-5552 in plasma (Cohort B)
Median drug levels of RMC-5552 concentration in plasma of participants in Cohort B will be measured on the day of surgery.
Time frame: At end of infusion & at time of surgery, 1 day
Median concentration of RMC-5552 in tumor (Cohort B)
Median drug levels of RMC-5552 in tumor tissue of participants in Cohort B will be measured at time of tumor issue removal/surgical resection. The statistical analysis will be descriptive and will be limited to summary statistics for RMC-5552 concentration in tumor (non-enhancing, enhancing, and border).
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Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
48
Time frame: At time of surgery, 1 day
Objective Response Rate (ORR) (Cohort C)
ORR for participants in Cohort C is defined as the proportion of treated participants with a documented complete response (CR) or partial response (PR) per Response Assessment in Neuro-Oncology (RANO) criteria.
Time frame: Up to 3 years
Median Duration of Response (DOR) (Cohort C)
DOR is defined as the time of first documented response to trial therapy (PR or better) until the participants in Cohort C demonstrate disease progression per RANO criteria, initiates subsequent anti-cancer therapy, or completes study participation (whichever occurs first). If disease progression is not observed prior to initiating subsequent anti-cancer therapy or completing study participation, the DOR will be censored as the last available disease assessment.
Time frame: Up to 5 years
Median Progression-free survival (PFS) (Cohort C)
PFS for participants in Cohort C is defined as the time that elapses between cycle 1, day 1 (C1D1) and until the participant experiences disease progression (per RANO criteria), initiates subsequent anti-cancer therapy, completes study participation, or experiences death from any cause (whichever is sooner). If disease progression or death from any cause is not observed prior to initiating subsequent anti-cancer therapy or completing study participation, the PFS will be censored as the last available disease assessment.
Time frame: Up to 5 years
Median Overall survival (OS) (Cohort C)
OS is defined as the time from C1D1 until the participant completes study follow-up participation, experiences death from any cause or is documented as lost to follow up per institutional standard (whichever is sooner). If death from any cause is not observed prior to completing study participation, the OS will be censored as the time of the last available documentation of survival status.
Time frame: Up to 5 years
Area under the plasma concentration time curve (AUC) (Cohort A & C)
Pharmacokinetic (PK) parameters for participants in Cohorts A \& C will be estimated based on non-compartmental analysis methods. These estimates will be summarized descriptively by dose cohort. All PK parameters will be computed using actual elapsed time calculated relative to start of infusion.
Time frame: Pre-dose and end of infusion on Cycle 1 Day 1 and Cycle 1 Day 15 (1 cycle is equal to 21 days)
Median Maximum concentration (Cmax) (Cohort A & C)
PK parameters for participants in Cohorts A \& C will be estimated based on non-compartmental analysis methods. These estimates will be summarized descriptively by dose cohort. All PK parameters will be computed using actual elapsed time calculated relative to start of infusion.
Time frame: Pre-dose and end of infusion on Cycle 1 Day 1 and Cycle 1 Day 15 (1 cycle is equal to 21 days)
Median time to maximum concentration (Tmax) (Cohort A & C)
PK parameters for participants in Cohorts A \& C will be estimated based on non-compartmental analysis methods. These estimates will be summarized descriptively by dose cohort. All PK parameters will be computed using actual elapsed time calculated relative to start of infusion.
Time frame: Pre-dose and end of infusion on Cycle 1 Day 1 and Cycle 1 Day 15 (1 cycle is equal to 21 days)
Objective Response Rate (ORR) (Cohort A)
ORR for participants in Cohort A is defined as the proportion of treated participants with a documented complete response (CR) or partial response (PR) per Response Assessment in Neuro-Oncology (RANO) criteria.
Time frame: Up to 3 years
Median Duration of Response (DOR) (Cohort A)
DOR is defined as the time of first documented response to trial therapy (PR or better) until the participants in Cohort A demonstrate disease progression per RANO criteria, initiates subsequent anti-cancer therapy, or completes study participation (whichever occurs first). If disease progression is not observed prior to initiating subsequent anti-cancer therapy or completing study participation, the DOR will be censored as the last available disease assessment.
Time frame: Up to 5 years
Median PFS (Cohorts A & B)
PFS for participants in Cohorts A \& B is defined as the time that elapses between cycle 1, day 1 (C1D1) and until the participant experiences disease progression (per RANO criteria), initiates subsequent anti-cancer therapy, completes study participation, or experiences death from any cause (whichever is sooner). If disease progression or death from any cause is not observed prior to initiating subsequent anti-cancer therapy or completing study participation, the PFS will be censored as the last available disease assessment.
Time frame: Up to 5 years
Median Overall Survival (Cohorts A & B)
OS for participants in Cohorts A \& B is defined as the time from C1D1 until the participant completes study follow-up participation, experiences death from any cause or is documented as lost to follow up per institutional standard (whichever is sooner). If death from any cause is not observed prior to completing study participation, the OS will be censored as the time of the last available documentation of survival status.
Time frame: Up to 5 years
Proportion of participants with detectable levels of phosphorylated S6 ribosomal protein (pS6RP) in Tumor Tissue (Cohort B)
To assess pharmacodynamic (PD) markers of drug activity, including biochemical markers of mTORC1 pathway inhibition in fresh tumor tissue and in archival tissue, levels of pS6RP will be measured.
Time frame: At time of surgery, 1 day
Proportion of participants with detectable levels of Phosphorylation of Eukaryotic translation initiation factor 4E binding protein 1 (p4EBP1) in Tumor Tissue (Cohort B)
To assess pharmacodynamic (PD) markers of drug activity, including biochemical markers of mTORC1 pathway inhibition in fresh tumor tissue and in archival tissue, levels of p4EBP1 will be measured.
Time frame: At time of surgery, 1 day
Proportion of participants with detectable levels of phosphorylated AKT (pAKT) in Tumor Tissue (Cohort B)
To assess pharmacodynamic (PD) markers of drug activity, including biochemical markers of mTORC1 pathway inhibition in fresh tumor tissue and in archival tissue, levels of pAKT will be measured.
Time frame: At time of surgery, 1 day
Proportion of participants with detectable levels of total Protein kinase B (AKT) in Tumor Tissue (Cohort B)
To assess pharmacodynamic (PD) markers of drug activity, including biochemical markers of mTORC1 pathway inhibition in fresh tumor tissue and in archival tissue, levels of total AKT will be measured.
Time frame: At time of surgery, 1 day
Proportion of participants with detectable levels of Cleaved Caspase 3 in Tumor Tissue (Cohort B)
To assess pharmacodynamic (PD) markers of drug activity, including biochemical markers of mTORC1 pathway inhibition in fresh tumor tissue and in archival tissue, levels of Cleaved Caspase 3 will be measured.
Time frame: At time of surgery, 1 day
Proportion of participants with detectable levels of Phosphorylation of PRAS40 (p-PRAS40) in Tumor Tissue (Cohort B)
To assess pharmacodynamic (PD) markers of drug activity, including biochemical markers of mTORC1 pathway inhibition in fresh tumor tissue and in archival tissue, levels of p-PRAS40 will be measured.
Time frame: At time of surgery, 1 day
Proportion of participants with detectable levels of total proline-rich AKT substrate of 40 kDa, encoded by the gene AKT1S1 (PRAS40) in Tumor Tissue (Cohort B)
To assess pharmacodynamic (PD) markers of drug activity, including biochemical markers of mTORC1 pathway inhibition in fresh tumor tissue and in archival tissue, levels of total PRAS40 will be measured.
Time frame: At time of surgery, 1 day
Proportion of participants with detectable levels of total Mindbomb Homolog-1 (MIB-1) in Tumor Tissue (Cohort B)
To assess pharmacodynamic (PD) markers of drug activity, including biochemical markers of mTORC1 pathway inhibition in fresh tumor tissue and in archival tissue, levels of MIB-1 will be measured.
Time frame: At time of surgery, 1 day
Frequency of Grade 3 or Higher Adverse Events (Cohorts B & C)
Adverse events and clinically significant laboratory abnormalities (meeting Grade 3, 4, or 5 criteria according to CTCAE) for participants in Cohorts B \& C summarized by maximum intensity and relationship to study drug. Descriptive statistics will be utilized to display the data on toxicity seen.
Time frame: Up to 1 year after enrollment