This phase I/II trial tests the side effects and best dose of abemaciclib when added to gemcitabine and compares the effectiveness of that treatment to the usual treatment of gemcitabine with docetaxel for the treatment of patients with soft tissue sarcoma that may have spread from where it first started to nearby tissue, lymph nodes, or distant parts of the body (advanced) or that has spread from where it first started (primary site) to other places in the body (metastatic) (phase 1) or patients with leiomyosarcoma or dedifferentiated liposarcoma (phase 2). Abemaciclib is in a class of medications called kinase inhibitors. It works by blocking the action of an abnormal protein that signals tumor cells to multiply. This helps slow or stop the spread of tumor cells. Gemcitabine is a chemotherapy drug that blocks the cells from making deoxyribonucleic acid and may kill tumor cells. Docetaxel is in a class of medications called taxanes. It stops cancer cells from growing and dividing and may kill them. Giving abemaciclib with gemcitabine may be safe and effective when compared to treatment with gemcitabine and docetaxel for patients with advanced or metastatic soft tissue sarcoma or leiomyosarcoma or dedifferentiated liposarcoma.
PRIMARY OBJECTIVES: I. The primary objective of the phase 1 part of this trial is to define the schedule of sequential abemaciclib and gemcitabine and recommended phase 2 dose (RP2D) of retinoblastoma positive (Rb\[+ve\]) sarcomas. II. The primary objective of the phase 2 part of the trial is to define the progression-free survival (PFS) of sequential abemaciclib followed by gemcitabine at RP2D compared to the standard of care gemcitabine and docetaxel in advanced Rb(+ve) leiomyosarcomas and dedifferentiated liposarcomas. SECONDARY OBJECTIVES: I. To observe and record anti-tumor activity in phase 1. II. To determine cell cycle arrest and recovery with abemaciclib 200mg twice per day (BID) 5 to 7 days by blood thymidine kinase activity (Tka). III. To assess the toxicity profile of the sequential abemaciclib followed by gemcitabine treatment using Common Terminology Criteria for Adverse Events (CTCAE) version 5 in phase 1 \& phase 2. IV. To determine the preliminary objective response rate (ORR) by Response Criteria in Solid Tumors (RECIST)1.1 in phase 1. V. To compare overall survival (OS) of sequential abemaciclib followed by gemcitabine at RP2D to the standard of care gemcitabine and docetaxel in phase 2. VI. To compare the objective response rate (ORR) at time of best response by RECIST1.1 of sequential abemaciclib followed by gemcitabine at RP2D to the standard of care gemcitabine and docetaxel in phase 2. VII. To compare PFS and ORR after cross-over in each treatment arm. VIII. To identify mechanisms of resistance to sequential treatment through correlative studies of the cell cycle genes. EXPLORATORY OBJECTIVE: I. To determine cell cycle arrest and recovery with abemaciclib 200mg BID 5 to 7 days by fluorothymidine F-18 (18F-FLT) positron emission tomography (PET) and its association with blood Tka. OUTLINE: Patients in phase 1 part A are assigned to cohort 1 or 2. Patients in phase 2 are randomized to arm A or arm B and may cross over to the alternate arm after disease progression. PHASE 1 PART A: COHORT I: Patients receive abemaciclib orally (PO) twice per day (BID) on days 1-5 and 15-19 of each cycle and gemcitabine intravenously (IV) over 90 minutes on days 8 and 22 of each cycle. Cycles repeat every 28 days for up to 2 years of total treatment in the absence of disease progression or unacceptable toxicity. Patients may change to Phase 1 Part B treatment once the recommended schedule is determined. Patients also receive 18F-FLT IV and undergo PET/computed tomography (CT) during screening and on study. Additionally, patients undergo blood sample collection during screening and on study. COHORT II: Patients receive abemaciclib PO BID on days 1-7 and gemcitabine IV over 90 minutes on day 10 of each cycle. Cycles repeat every 21 days for up to 2 years of total treatment in the absence of disease progression or unacceptable toxicity. Patients may change to Phase 1 Part B treatment once the recommended schedule is determined. Patients also receive 18F-FLT IV and undergo PET/CT during screening and on study. Additionally, patients undergo blood sample collection during screening and on study. PHASE 1 PART B: Patients receive the selected treatment schedule, Cohort 1 or Cohort 2, as above. Cycles repeat every 21 or 28 days for up to 2 years of total treatment in the absence of disease progression or unacceptable toxicity. PHASE 2: ARM A: Patients receive abemaciclib PO BID and gemcitabine IV on the schedule determined in phase 1 of the trial. Cycles repeat every 21 or 28 days for up to 2 years of total treatment in the absence of disease progression or unacceptable toxicity. At the time of disease progression, patients may cross over to arm B. Patients undergo blood sample collection throughout the study. Patients also undergo tumor biopsy during screening and optionally on study. ARM B: Patients receive gemcitabine IV over 90 minutes on days 1 and 8 of each cycle and docetaxel IV over 60 minutes on day 8 of each cycle. Cycles repeat every 21 days for up to 2 years of total treatment in the absence of disease progression or unacceptable toxicity. At the time of disease progression, patients may cross over to arm A. Patients undergo blood sample collection throughout the study. Patients also undergo tumor biopsy during screening and optionally on study. After completion of study treatment, patients are followed up every 3 months for up to 2 years.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
74
Given PO
Undergo tumor biopsy
Undergo blood sample collection
Undergo PET/CT
Given IV
Given IV
Given IV
Undergo PET/CT
M D Anderson Cancer Center
Houston, Texas, United States
RECRUITINGTime course of blood thymidine kinase activity (TKa) (Phase 1 Part A)
Will be graphically evaluated: the change of blood TKa over time to facilitate a selection of regimen that has maximum decrease in blood TKa after end of abemaciclib (cell cycle arrest) and has maximum increase in blood TKa at time of gemcitabine injection. Descriptive statistics (mean, standard deviation) and graphical methods will be applied to examine the distribution of the data, error checking, and outlier identification. Since blood TKa and fluorothymidine F-18 (18F-FLT) positron emission tomography (PET) will be measured at baseline and multiple post treatment time points, if appropriate, linear mixed effect models for repeated measures analysis will be employed to assess its change over time. Appropriate transformation of the marker values will be used to satisfy the normality assumption of linear mixed effect model.
Time frame: Baseline up to 2 years
Maximum tolerated dose (Phase I Part B)
Time frame: Up to 28 days
Progression free survival (PFS) (phase II)
Will be estimated using the Kaplan-Meier method.
Time frame: From randomization to either disease progression as defined by Response Evaluation Criteria in Solid Tumors (RECIST) or death from any cause, up to 2 years
Anti-tumor activity (phase I)
Time frame: Up to 2 years
Cell cycle arrest (phase I)
Measured by blood TKa.
Time frame: At 5 to 7 days
Cell cycle recovery (phase I)
Measured by blood TKa.
Time frame: At 5 to 7 days
Incidence of adverse events (phase I)
Using Common Terminology Criteria for Adverse Events (CTCAE) version 5.
Time frame: Up to 2 years
Objective response rate (ORR) (phase I)
By Response Criteria in Solid Tumors 1.1 with a 95% exact CI will be provided.
Time frame: Up to 2 years
Overall survival (phase II)
Respective point estimates will be provided along with 95% confidence interval (CI) by treatment arms and then by histologic groups within treatment arm. The hazard ratio along with 95% CI using Cox proportional hazard models will be estimated. Will be estimated using the Kaplan-Meier method.
Time frame: From randomization to death, up to 2 years
ORR at time of best response (phase II)
A 95% exact CI will be provided.
Time frame: Up to 2 years
Incidence of adverse events (phase II)
Assessed by CTCAE v5.
Time frame: Up to 2 years
Cell cycle arrest (phase II)
Measured by blood TKa.
Time frame: At day 5-7
Cell cycle recovery (phase II)
Measured by blood TKa.
Time frame: At day 5-7
Mechanisms of resistance to sequential treatment (phase II)
Time frame: Up to 2 years
PFS after crossover
Will be estimated using the Kaplan-Meier method.
Time frame: From randomization to either disease progression as defined by RECIST or death from any cause, up to 2 years
ORR after crossover
A 95% exact CI will be provided.
Time frame: Up to 2 years
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