The goal of this phase 1/2 multicenter, open-label, single-arm dose escalation and expansion study is to assess the safety, tolerability, pharmacokinetic and pharmacodynamic profile of CTX-712 in patients with relapsed/refractory (R/R) acute myeloid leukemia (AML) and higher risk myelodysplastic syndromes (HR-MDS), or MDS/MPN (including CMML). The phase 1 part of the study consists of sequential standard 3 + 3 dose escalation, where patients will receive ascending doses of CTX-712 to determine the recommended phase 2 dose (RP2D) for further clinical development. This is followed by initial expansion cohorts in AML and/or HR-MDS where patients will be treated with CTX-712 at the RP2D to gain further confidence in the selected dose level. Additional expansion cohorts may be initiated if considered necessary. After RP2D is determined, Drug-Drug-Interaction cohorts will be started. The phase 2 part of the study will commence after the RP2D has been identified and confirmed and will evaluate therapeutic activity in R/R AML or R/R HR-MDS, in addition to confirmation of the safety profile.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
225
CTX-712 will be provided as a 20 mg tablet for oral administration. Patients will take CTX-712 once or twice weekly, depending on their dose level assignment, during each 28-day cycle.
Mayo Clinic Arizona
Phoenix, Arizona, United States
RECRUITINGMayo Clinic Florida
Jacksonville, Florida, United States
RECRUITINGNorthwestern University
Chicago, Illinois, United States
RECRUITINGMayo Clinic Comprehensive Cancer Center
Rochester, Minnesota, United States
RECRUITINGThe University of Rochester
Rochester, New York, United States
RECRUITINGThe University of Texas MD Anderson Cancer Center
Houston, Texas, United States
RECRUITINGUniversity of Virginia
Charlottesville, Virginia, United States
RECRUITINGFred Hutchinson Cancer Center
Seattle, Washington, United States
RECRUITINGPhase 1: Frequency of treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs) related to CTX-712.
Time frame: Adverse events are collected from time of informed consent through 28 days after last dose of CTX-712.
Phase 1: The maximum tolerated dose MTD.
MTD is the dose producing \<33% of dose-limiting toxicities.
Time frame: Dose-limiting toxicities are collected during the first treatment cycle (28 days).
Phase 2: Complete remission rate, defined as the proportion of patients who achieve complete remission.
Time frame: Measured from date of first dose to 28 days after last dose of CTX-712.
Phase 1 and 2: Objective response rate, defined as the proportion of patients achieving a response.
For AML: CR, CRi, PR, MLFS. For MDS: CR, PR, mCR, HI.
Time frame: Measured from date of first dose to 28 days after last dose of CTX-712.
Phase 1 and 2: Duration of response.
Time frame: Measure from documentation of tumor response to disease progression or death from any cause, whichever occurs first, assessed up to 24 months.
Phase 1 and 2: Progression-free survival.
Time frame: Measured from the date of initiating study treatment to the date of disease progression or death from any cause, whichever occurs first, assessed up to 24 months.
Phase 1 and 2: Overall survival.
Time frame: Measured from the date of initiating study treatment to the date of death from any cause, assessed up to 36 months.
Phase 1 and 2: Proportion of patients who transition to hematopoietic stem cell transplantation (HSCT).
Time frame: Measured from the date of the last administration of CTX-712 until HSCT, or one year from the date of the start of administration of CTX-712.
Phase 1: Maximum observed plasma concentration (Cmax) of CTX-712. Plasma samples for PK analyses will be collected at predetermined time points and analyzed.
Time frame: Pharmacokinetic evaluation performed in treatment Cycle 1 (cycle duration is 28 days).
Phase 1: Concentration before dose at steady state (Ctrough) of CTX-712. Plasma samples for PK analyses will be collected at predetermined time points and analyzed.
Time frame: Pharmacokinetic evaluation performed in treatment Cycles 1, 2 and 4 (cycle duration is 28 days).
Phase 1: Area under the plasma concentration time curve (AUC) of CTX-712. Plasma samples for PK analyses will be collected at predetermined time points and analyzed.
Time frame: Pharmacokinetic evaluation performed in treatment Cycle 1 (cycle duration is 28 days).
Phase 1: Volume of distribution (Vd) of CTX-712. Plasma samples for PK analyses will be collected at predetermined time points and analyzed.
Time frame: Pharmacokinetic evaluation performed in treatment Cycle 1 (cycle duration is 28 days).
Phase 1: Elimination half-life of plasma concentration of CTX-712 at terminal phase (T1/2). Plasma samples for PK analyses will be collected at predetermined time points and analyzed.
Time frame: Pharmacokinetic evaluation performed in treatment Cycle 1 (cycle duration is 28 days).
Phase 1: Clearance (CL) of CTX-712. Plasma samples for PK analyses will be collected at predetermined time points and analyzed.
Time frame: Pharmacokinetic evaluation performed in treatment Cycle 1 (cycle duration is 28 days).
Phase 1: Measurement of the change in RNA splicing by CTX-712 in peripheral blood samples as pharmacodynamic markers. Peripheral blood samples for PD analyses will be collected at predetermined time points and analyzed.
Time frame: Pharmacodynamic evaluation performed in treatment Cycle 1 (cycle duration is 28 days).
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