This is a first-in-human, dose-escalation and dose-expansion Phase I study to evaluate the safety, tolerability, pharmacokinetics (PK) and efficacy of STI-8591 in subjects with advanced AML who have signed an informed consent form (ICF) and have been screened for enrollment in this study. * Dose escalation phase: rapid titration and conventional 3+3 test design were used to evaluate the safety, dose-limiting toxicity (DLT), maximum tolerated dose (MTD) and PK characteristics of STI-8591. * Dose Expansion Phase: Evaluate the safety, preliminary efficacy and determine the recommended phase II dose (RP2D) of STI-8591 for the treatment of subjects with advanced AML under the conditions of reaching the expanded dose.
Dose escalation phase:Based on the preclinical trial data and with reference to the modified Fibonacci method, the dose escalation ratios are 100%, 100%, 50% and 6.7%, and the initial 5 dose groups for STI-8591 dose escalation are 40, 80, 160, 240 and 280 mg/day, respectively. Screened subjects will be entered into the 5 dose groups in order of succession from lowest to highest dose.This test dose increment will be performed using the rapid titration method and the traditional 3+3 test design. Dose expansion phase:During dose escalation, for dose groups (except for ≥2 DLT dose groups) when the following dose signals suggesting initial efficacy are present. 1\) CR, CRh or CRi in ≥1 subject in either dose group.2) Median decrease in FLT3 phosphorylation was ≥90% in ≥3 subjects in either dose group.The SRC will decide whether to initiate an extension study for that dose group and its subsequent dose groups at the same time as the dose escalation to the next dose group. Subjects in the dose escalation phase will be administered BID every 28 days in 1 cycle, with ≥8h between doses, fasting for at least 2 hours before and at least 1 hour after dosing with approximately 240mL of water (subject to adjustment based on data results from the dose escalation phase) . If initiation was determined, the dose group identified for initiation and its subsequent dose group extension studies were further enrolled in 14 to 17 cases \[a total of 20 cases in each dose group, with FLT3 mutation-positive (FLT3 internal tandem repeat (ITD) and/or FLT3 tyrosine kinase structural domain (TKD) mutation-positive subjects enrolled in at least 10 cases\] to further define the final RP2D.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
84
Four dosing cohorts will be evaluated in the dose escalation phase: 20mg, 40mg, 60mg and 80mg. Expansion is planned in two dose groups of 40mg and 60mg.
the First Affiliated Hospital, College of Medicine, Zhejiang University
Hangzhou, Zhejiang, China
RECRUITINGNumber of participants with treatment-related adverse events as assessed by CTCAE v5.0.
Assessing the incidence of adverse events (AEs) using the Common Terminology Criteria for Adverse Events (CTCAE Version 5)
Time frame: Up to 3 years.
Assessment of the AUC of STI-8591 and its major metabolites (if any).
Assessment of the pharmacokinetic profile of STI-8591 and its major metabolites (if any) in advanced AML:AUC(area under the concentration-time curve)
Time frame: At the end of Cycle 1 and the first day of Cycle 2 (each cycle is 30 days) .
Assessment of the Tmax of STI-8591 and its major metabolites (if any).
Assessment of the pharmacokinetic profile of STI-8591 and its major metabolites (if any) in advanced AML:Tmax (time to peak)
Time frame: At the end of Cycle 1 and the first day of Cycle 2 (each cycle is 30 days) .
Assessment of the Cmax of STI-8591 and its major metabolites (if any).
Assessment of the pharmacokinetic profile of STI-8591 and its major metabolites (if any) in advanced AML:Cmax(peak concentration)
Time frame: At the end of Cycle 1 and the first day of Cycle 2 (each cycle is 30 days) .
Percentage change in FLT3 plasma inhibitory activity (PIA) relative to baseline
Assessment of the percentage of biomarker changes relative to baseline for STI-8591 in advanced AML
Time frame: At the end of Cycle 1 and the first day of Cycle 2 (each cycle is 30 days) .
Assessing the CRc of STI-8591 in advanced AML.
Assessing the initial effectiveness of STI-8591 in advanced AML:CRc, defined as CR, CRh and CRi as judged according to ELN2022 criteria.
Time frame: Through study completion, an average of 2 years.
Assessing the CR rate of STI-8591 in advanced AML.
Assessing the initial effectiveness of STI-8591 in advanced AML:CR rate, defined as the CR rate judged according to ELN 2022 criteria.
Time frame: Through study completion, an average of 2 years.
Assessing the objective remission rate ORR (CRc + PR + morphologic leukemia-free status [MLFS]) of STI-8591 in advanced AML.
Assessing the initial effectiveness of STI-8591 in advanced AML:ORR, defined as CR, CRh, CRi, MLFS and PR as judged by ELN2022 criteria.
Time frame: Through study completion, an average of 2 years.
Assessing the duration of remission (DOR) of STI-8591 in advanced AML.
Assessing the initial effectiveness of STI-8591 in advanced AML:DoR, defined as the time between the subject's first achievement of ORR and the first detection of recurrent disease, treatment failure, or death from any cause, whichever occurs first.
Time frame: Through study completion, an average of 2 years.
Assessing the event-free survival (EFS) of STI-8591 in advanced AML.
Assessing the initial effectiveness of STI-8591 in advanced AML:EFS, defined as the time from the start of the subject's enrollment to the occurrence of any event (treatment failure/relapse after CR, CRh or CRi/permanent termination of treatment for any reason/death from any cause), whichever occurs first.
Time frame: Through study completion, an average of 2 years.
Assessing the progression-free survival (PFS) of STI-8591 in advanced AML.
Assessing the initial effectiveness of STI-8591 in advanced AML:PFS, defined as the time between the subject's first study treatment and the onset of treatment failure or death from any cause, whichever occurs first.
Time frame: Through study completion, an average of 2 years.
Assessing the leukemia-free survival (LFS) of STI-8591 in advanced AML.
Assessing the initial effectiveness of STI-8591 in advanced AML:LFS, defined as the time between the first attainment of CRc and the first detection of recurrent disease or death from any cause, whichever occurs first.
Time frame: Through study completion, an average of 2 years.
Assessing the overall survival (OS) of STI-8591 in advanced AML.
Assessing the initial effectiveness of STI-8591 in advanced AML:OS, defined as the time between the subject's first study treatment and death from any cause.
Time frame: Through study completion, an average of 2 years.
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