This phase I trial tests the safety, side effects, and best dose of FL118 in treating patients with pancreatic ductal adenocarcinoma that may have spread from where it first started to nearby tissue, lymph nodes, or distant parts of the body (advanced). FL118 is a small anti-tumor molecule that inhibits the expression of multiple cancer-associated anti-apoptotic proteins. An anti-apoptotic protein is a protein that interferes with or inhibits cell death. In adults, apoptosis is used to rid the body of cells that have been damaged beyond repair. Apoptosis also plays a role in preventing cancer. If apoptosis is for some reason prevented, it can lead to uncontrolled cell production that can subsequently develop into a tumor. FL118 has been shown to inhibit or block the proteins that prevent damaged/mutated (genetically changed) cells from dying, and, by doing so, prevent the growth of cancerous cells and tumor development.
PRIMARY OBJECTIVES: I. To establish the safety, schedule, and dosing of DDX5 degrader FL118 (FL118) in patients with advanced pancreatic ductal adenocarcinoma (PDAC). II. To determine the pharmacokinetics (PK) of FL118 in patients with advanced PDAC. SECONDARY OBJECTIVES: I. To determine the pharmacodynamics (PD) of FL118 in patients with advanced PDAC. II. To determine the preliminary antineoplastic efficacy of FL118 in patients with advanced PDAC. EXPLORATORY OBJECTIVES: I. To evaluate biomarkers predictive of response or resistance. II. Evaluate changes in the tumor microenvironment. III. To determine the significance of somatic and germline DNA damage repair mutations as predictive biomarkers of antineoplastic activity. OUTLINE: This is a dose-escalation study of FL118 followed by a dose-expansion study. Patients receive FL118 orally (PO) on days 1, 8, and 15 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients also undergo collection of blood samples and computed tomography (CT) or magnetic resonance imaging (MRI) throughout the trial. Patients may optionally undergo biopsy at screening and on study. After completion of study treatment, patients are followed up at 30 days and then every 3 months for up to 12 months.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Undergo biopsy
Undergo collection of blood samples
Undergo CT
Given PO
Undergo MRI
Roswell Park Cancer Institute
Buffalo, New York, United States
Incidence of adverse events
Toxicity and adverse events will be assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0.
Time frame: Up to 30 days
Maximum tolerated dose (MTD)
The MTD will be determined from the observed dose limiting toxicities per cohort using an accelerated dose-escalation design.
Time frame: 4 weeks from administation
Recommended phase 2 dose
The recommended phase 2 dose will be determined based on the MTD (or highest dose administered if the MTD is not reached), the pharmacokinetic/pharmacodynamic modeling, and overall clinical safety and efficacy data.
Time frame: 4 weeks from administration
Half life
PK parameters of half-life area
Time frame: On days 1, 2, 15, and 16 of cycle 1 in dose-escalation phase
Maximum plasma concentration
PK parameters of maximum plasma concentration
Time frame: On days 1, 2, 15, and 16 of cycle 1 in dose-escalation phase
Area under the curve
PK parameter area under the curve
Time frame: On days 1, 2, 15, and 16 of cycle 1 in dose-escalation phase
CL/F
apparent clearance of the analyte in the plasma
Time frame: On days 1, 2, 15, and 16 of cycle 1 in dose-escalation phase
Pharmacodynamics parameters
Will be collected at baseline and day 23
Time frame: At baseline and cycle 2 day 23
Overall response rate
Will be assessed use a two-stage, single-arm Simon minimax design.
Time frame: Up to 12 months
Disease control rate
The disease control (complete response + partial response + stable disease) will be summarized using frequencies and relative frequencies. The disease control rate will be estimated with a 95% credible region obtained by Jeffrey's prior method.
Time frame: Up to 12 months
Progression-free survival
Will be summarized using standard Kaplan-Meier methods, where estimates of median survival will be obtained with 95% confidence intervals.
Time frame: From treatment until disease progression, death from disease, or last follow up, assessed up to 12 months
Overall survival
Will be summarized using standard Kaplan-Meier methods, where estimates of median survival will be obtained with 95% confidence intervals.
Time frame: From treatment until death due to any cause or last follow up, assessed up to 12 months
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