The goal of this clinical trial is to evaluate elenestinib (BLU-263) in participants with Advanced Systemic Mastocytosis (AdvSM), SM with an associated hematologic neoplasm (SM-AHN), and other hematologic malignancies. The main questions it aims to answer are: * Determine Recommended Dose of elenestinib (BLU-263) monotherapy for participants with AdvSM * Safety and tolerability of elenestinib (BLU-263) monotherapy * Efficacy of elenestinib (BLU-263) monotherapy in participants with AdvSM * Determine Recommended Dose of elenestinib (BLU-263) in combination with azacitidine in participants with AdvSM * Safety and tolerability of elenestinib (BLU-263) in combination with azacitidine * Efficacy of elenestinib (BLU-263) in combination with azacitidine in participants with AdvSM The estimated study duration for each participant will be approximately 4 years: 2 years of treatment followed by 2 years of follow-up. Participants may be required to attend monthly visits for the first six months, followed by quarterly visits for the remainder of the study.
Systemic mastocytosis includes five major subtypes: Indolent SM (ISM), SM with an associated hematologic neoplasm (SM-AHN), aggressive SM (ASM), and MC leukemia (MCL). In 2016, the smoldering subtype of SM, a former provisional ISM subvariant, was designated as a distinct variant of SM by the World Health Organization (WHO). Aggressive SM, SM-AHN, and MCL together are referred to as Advanced SM (AdvSM).
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
9
BLU-263 Oral Tablets
Azacitidine powder for suspension for intravenous infusion / subcutaneous injection
Stanford Cancer Institute
Palo Alto, California, United States
Dana-Farber Cancer Institute
Boston, Massachusetts, United States
University of Michigan
Ann Arbor, Michigan, United States
Huntsman Cancer Institute
Salt Lake City, Utah, United States
Antwerp University Hospital
Edegem, Belgium
University Hospital Ghent
Ghent, Belgium
CHU Caen - Institut d'Hematologie de Basse Normandie
Caen, France
University Medical Centre Mannheim
Mannheim, Germany
Maastricht University Medical Center
Maastricht, Netherlands
Oslo University Hospital
Oslo, Norway
...and 1 more locations
Dose Escalation: Number of Dose-limiting Toxicities (DLTs) (monotherapy only)
Monotherapy: The Recommended Dose (RD) will be primarily determined by the number of DLTs in the first 28 days of treatment with elenestinib (BLU-263) monotherapy.
Time frame: 28 Days
Dose Escalation: Number of DLTs (combination therapy only)
Combination therapy: The RD will be primarily determined by the number of DLTs (during 28 days starting from Day 15 of C1 or Day 15 of C2) with elenestinib (BLU-263) in combination with azacitidine.
Time frame: 28 Days
Dose Escalation and Expansion: Pure Pathological Response (PPR) Rate for SM in Selective KIT Inhibitor-naïve Participants (monotherapy only)
PPR Rate is defined as complete remission (resolution of palpable splenomegaly/hepatomegaly) (CR) + complete remission with partial recovery of peripheral blood counts (CRh) + partial remission (≥35% reduction in spleen volume) (PR)
Time frame: Up to approximately 4 years
Dose Escalation and Expansion: Number of Participants with Adverse Events (AEs)
Time frame: Up to approximately 4 years
Dose Escalation and Expansion: Number of Participants with Serious Adverse Events (SAEs)
Time frame: Up to approximately 4 years
Dose Escalation and Expansion: Overall Response Rate (ORR) for AdvSM using modified International Working Group-Myeloproliferative Neoplasms Research and Treatment and European Competence Network on Mastocytosis (IWG-MRT-ECNM) (monotherapy only)
ORR is defined as CR + CRh + PR + Clinical Improvement (CI)
Time frame: Up to approximately 4 years
Dose Escalation and Expansion: ORR for SM Using Modified IWG-MRT-ECNM (combination therapy only)
Time frame: Up to approximately 4 years
Dose Escalation and Dose Expansion: Maximum Plasma Concentration (Cmax) of BLU-263
Time frame: Up to approximately 4 years
Dose Escalation and Dose Expansion: Cmax of Azacitidine (combination therapy only)
Time frame: Up to approximately 4 years
Dose Escalation and Dose Expansion: Time to Maximum Concentration (Tmax) of BLU-263
Time frame: Up to approximately 4 years
Dose Escalation and Dose Expansion: Tmax of Azacitidine (combination therapy only)
Time frame: Up to approximately 4 years
Dose Escalation and Dose Expansion: Area Under the Curve From Time Zero to 24 Hours (AUC(0-24)) of BLU-263
Time frame: Up to approximately 4 years
Dose Escalation and Dose Expansion: AUC(0-24) of Azacitidine (combination therapy only)
Time frame: Up to approximately 4 years
Dose Escalation and Dose Expansion: Apparent Volume of Distribution (Vz/F) of BLU-263
Time frame: Up to approximately 4 years
Dose Escalation and Dose Expansion: Vz/F of Azacitidine (combination therapy only)
Time frame: Up to approximately 4 years
Dose Escalation and Dose Expansion: Terminal Elimination Half-life (t1/2) of BLU-263
Time frame: Up to approximately 4 years
Dose Escalation and Dose Expansion: t1/2 of Azacitidine (combination therapy only)
Time frame: Up to approximately 4 years
Dose Escalation and Dose Expansion: Apparent Oral Clearance (CL/F) of BLU-263
Time frame: Up to approximately 4 years
Dose Escalation and Dose Expansion: CL/F of Azacitidine (combination therapy only)
Time frame: Up to approximately 4 years
Dose Escalation and Dose Expansion: Accumulation Ratio of BLU-263
Time frame: Up to approximately 4 years
Dose Escalation and Dose Expansion: Accumulation Ratio of Azacitidine (combination therapy only)
Time frame: Up to approximately 4 years
Dose Escalation and Expansion: Overall Survival (OS) (monotherapy only)
Time frame: Up to approximately 4 years
Dose Escalation and Expansion: Time to Response (TtR) (monotherapy only)
Time frame: Up to approximately 4 years
Dose Escalation and Expansion: Duration of Response (DOR) (monotherapy only)
Time frame: Up to approximately 4 years
Dose Escalation and Expansion: Progression-Free Survival (PFS) (monotherapy only)
Time frame: Up to approximately 4 years
Dose Escalation and Expansion: Proportion of Participants Pursuing Stem Cell Transplant (monotherapy only)
Time frame: Up to approximately 4 years
Dose Escalation and Expansion: PPR Rate for SM (combination therapy only)
Time frame: Up to approximately 4 years
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