This phase I trial tests the safety, side effects, and best dose of combination therapy with pelcitoclax (APG-1252) and cobimetinib in treating patients with ovarian and endometrial cancers that have come back after a period of improvement (recurrent). APG-1252 is a drug that inhibits activity of proteins that prevent cell death, leading to increased cell death and reduced cell growth. Cobimetinib is used in patients whose cancer has a mutated (changed) form of a gene called BRAF. It is in a class of medications called kinase inhibitors. It works by blocking the action of an abnormal protein that signals cancer cells to multiply. This helps slow or stop the spread of cancer cells. Giving APG-1252 in combination with cobimetinib may shrink or stabilize tumor in patients with recurrent ovarian and endometrial cancers.
PRIMARY OBJECTIVE: I. To establish the recommended phase 2 dosing (RP2D) for combination pelcitoclax (APG-1252) and cobimetinib in advanced/recurrent endometrial and ovarian cancers. SECONDARY OBJECTIVES: I. To observe and record anti-tumor activity. II. To assess the side effects associated with combination APG-1252 and cobimetinib in advanced/recurrent endometrial and ovarian cancers, as measured by treatment-emergent and treatment-related adverse events by Common Terminology Criteria for Adverse Events (CTCAE) criteria. III. To assess the activity of combination APG-1252 and cobimetinib in advanced/recurrent endometrial and ovarian cancers, via measures of clinical activity, including response rate (RR), progression-free survival (PFS), clinical benefit rate (CBR), and duration of response (DoR). TRANSLATIONAL OBJECTIVES: I. To evaluate the pharmacodynamic effects of combination APG-1252 and cobimetinib on BCL-xL activity, including BCL-xL:BAX and BCL-xL-BAK heterodimers, as measured by the National Clinical Laboratory Network (NCLN) apoptosis multiplex immunoassay. II. To evaluate markers of response and resistance to APG-1252 and cobimetinib via whole exome sequencing and ribonucleic acid (RNA) sequencing obtained in pre-treatment/archival and on-treatment samples. III. To explore the effect of combination APG-1252 and cobimetinib on RAS pathway signaling, as measured by the NCLN ERK/MEK multiple immunoassay, and the association between RAS pathway activation with activity of combination APG-1252 and cobimetinib. IV. To explore markers of response and resistance to APG-1252 and cobimetinib through evaluation of BIM and MCL1 expression and RAS pathway signaling by reverse phase protein array (RPPA) and by BIM and pERK expression by immunohistochemistry. V. To determine pharmacokinetic (PK) parameters of APG-1252 and cobimetinib in combination. VI. To investigate RAS allelic burden and resistance mutations in patients receiving combination APG-1252 and cobimetinib. OUTLINE: This is a dose-escalation study of APG-1252 and cobimetinib followed by a dose-expansion study. Patients receive APG-1252 intravenously (IV) once a week (Q7D). Patients also receive cobimetinib orally (PO) once a day (QD) on days 1-21 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients also undergo biopsy and collection of blood on study and undergo computed tomography (CT) and/or magnetic resonance (MRI) throughout the trial. Patients undergo echocardiography (ECHO) or multigated acquisition scan (MUGA) during screening and on study. Patients are followed for up to 30 days after removal from study therapy.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
42
Undergo biopsy
Undergo collection of blood
Given PO
Undergo CT
Undergo ECHO
Undergo MRI
Undergo MUGA
Given IV
Emory University Hospital/Winship Cancer Institute
Atlanta, Georgia, United States
RECRUITINGJohns Hopkins University/Sidney Kimmel Cancer Center
Baltimore, Maryland, United States
RECRUITINGNational Cancer Institute Developmental Therapeutics Clinic
Bethesda, Maryland, United States
ACTIVE_NOT_RECRUITINGNational Institutes of Health Clinical Center
Bethesda, Maryland, United States
ACTIVE_NOT_RECRUITINGDana-Farber Cancer Institute
Boston, Massachusetts, United States
RECRUITINGRutgers Cancer Institute of New Jersey
New Brunswick, New Jersey, United States
RECRUITINGMaximum tolerable dose
Will be identified using a Bayesian optimal interval design.
Time frame: Up to 28 days after the beginning of the treatment cycle
Recommended phase 2 dose
The dose level chosen based on safety, tolerability, efficacy, pharmacokinetics (PK), and pharmacodynamic (PD) data collected during the dose escalation portion of the study,
Time frame: At completion of the dose escalation phase
Incidence of dose-limiting toxicities (DLTs)
The toxicity of the combination will be assessed using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 criteria. Participants enrolled to the dose escalation will be observed during the first cycle of therapy for adverse events consistent with a DLT definition.
Time frame: During the first cycle of therapy (28 days)
Radiological response
Will be assessed by Response Evaluation Criteria in Solid Tumors version 1.1 criteria and will be graded as complete response (CR), partial response (PR), stable disease (SD) and progressive disease.
Time frame: Up to 3 years
Incidence of adverse events
Will be graded according to National Cancer Institute CTCAE, version 5.0. Toxicities will be summarized by maximum grade and by treatment dose level. Incidence rate of each toxicity will be reported with 95% exact confidence intervals.
Time frame: Up to 30 days after removal from study or until death, whichever occurs first
Response rate (RR)
Proportion of participants with CR + PR will be summarized by frequencies and percentages, by dose level.
Time frame: Up to 30 days after removal from study or until death, whichever occurs first
Progression-free survival
Will be summarized using Kaplan-Meier curves by dose-level (for dose levels with sufficient sample size to permit estimation).
Time frame: From study enrollment until the identification of disease progression or death, assessed up to 30 days after removal from study
Clinical benefit rate
Proportion of participants whose response is CR + PR + SD \> 24 weeks will be summarized by frequencies and percentages, by dose level.
Time frame: Up to 30 days after removal form study or death, whichever occurs first
Duration of response (DoR)
Median DoR will be reported with ranges.
Time frame: From the time measurement criteria are met for CR or PR until the first date that recurrent or progressive disease is objectively documents, assessed up to 30 days after removal from study or until death, whichever occurs first
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