This is a Phase 1, open-label, multicenter, dose-escalation and dose-expansion study designed to evaluate the safety, tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) of CT-01, administered either as monotherapy or in combination with everolimus. The study population includes subjects with intermediate or advanced hepatocellular carcinoma (HCC) who have progressed on, or are intolerant to, at least one prior line of systemic treatment. All available standard-of-care therapies should have been received, if deemed appropriate by the investigator (unless contraindicated or considered inappropriate by the treating physician). Eligible subjects are classified as Barcelona Clinic Liver Cancer (BCLC) stage B or C and must not be amenable to curative treatment approaches. Only subjects with preserved liver function (Child-Pugh Class A, score 5-6) at screening are eligible. Approximately 141 participants will be enrolled across 20 sites in Europe (France, Spain, and Germany).
This is an open-label, multicenter study evaluating the safety, tolerability, pharmacokinetics (PK), pharmacodynamics (PD), and preliminary clinical activity of CT-01 in subjects with advanced hepatocellular carcinoma (HCC). The study consists of two sequential parts. Part 1 investigates CT-01 as monotherapy and includes a dose-escalation phase (Part 1A) followed by a dose-expansion phase (Part 1B). A Bayesian Optimal Interval (BOIN) design will be used, with up to seven predefined dose levels. Additional subjects may be enrolled to backfill dose levels of interest. Treatment will be administered in 28-day cycles, with dose-limiting toxicities (DLTs) assessed during Cycle 1. Dose decisions will be made by an Independent Data Monitoring Committee (IDMC), with input from a Safety Monitoring Committee (SMC). Part 2 evaluates CT-01 in combination with everolimus and includes a dose-escalation phase (Part 2A) and a dose-expansion phase (Part 2B). Up to four dose levels are planned in Part 2A, with starting doses informed by Part 1 results. As in Part 1, DLTs will be assessed during Cycle 1 and reviewed by the IDMC and SMC.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
141
Investigational small-molecule degrader targeting transcription factors in HCC. Used as monotherapy or with everolimus in dose-escalation/expansion settings. Specific to protocol CT-01-CD-1.
Approved mTOR inhibitor used in combination with CT-01 for HCC in this study. Evaluated for safety, tolerability, and PK/PD in CT-01-CD-1 protocol.
Number of participants with treatment-emergent adverse events (TEAEs) during CT-01 monotherapy
Safety and tolerability of CT-01 will be evaluated by monitoring the incidence of TEAEs, SAEs, AESIs, and TEAEs leading to study discontinuation or death. Unit of Measure: Number, nature, sverity and relation plausibility of AE
Time frame: Up to 12 months
Maximum tolerated dose (MTDm) of CT-01 monotherapy
The MTDm will be determined based on the incidence and type of dose-limiting toxicities (DLTs) during Cycle 1 of CT-01 monotherapy. Unit of Measure: mg/day
Time frame: Up to 12 months
Number of participants with treatment-emergent adverse events (TEAEs) during CT-01 and everolimus combination therapy
Safety and tolerability will be assessed through monitoring of TEAEs, SAEs, AESIs, and TEAEs leading to study discontinuation or death during combination therapy. Unit of Measure: Number, nature, sverity and relation plausibility of A
Time frame: Up to 12 months
Maximum tolerated dose (MTDc) of CT-01 in combination with everolimus
The MTDc will be determined based on the incidence of DLTs during Cycle 1 of the combination therapy. Unit of Measure: mg/day
Time frame: Up to 12 months
Objective response rate (ORR) per RECIST v1.1 and mRECIST for CT-01 monotherapy
Proportion of participants achieving complete or partial response as per RECIST v1.1 and mRECIST. Unit of Measure: Percentage of participants
Time frame: Up to 12 months
Objective response rate (ORR) per RECIST v1.1 and mRECIST for CT-01 and everolimus
Proportion of participants achieving complete or partial response during combination therapy. Unit of Measure: Percentage of participants
Time frame: Up to 12 months
Maximum plasma concentration (Cmax)
Cmax will be determined for CT-01 using non-compartmental analysis. Unit of Measure: ng/mL
Time frame: Up to 12 months
Area under the concentration-time curve (AUC)
AUC will be calculated for active metabolite of CT-01 using non-compartmental methods (AUC₀-t and AUC₀-inf). Unit of Measure: ng·h/mL
Time frame: Up to 12 months
Time to maximum concentration (Tmax)
Tmax will be recorded as the time to reach Cmax for CT-01. Unit of Measure: Hours
Time frame: Up to 12 months
Change from baseline in MELD-Na score during combination therapy
Change in MELD-Na score (range: typically 6 to 40; higher scores indicate worse liver function) from baseline during CT-01 and everolimus treatment. Unit of Measure: score
Time frame: Up to 12 months
Change from baseline in Child-Pugh score during combination therapy
Change in Child-Pugh score (range: 5-15; higher scores indicate worse liver function) from baseline during CT-01 and everolimus treatment. Unit of Measure: score
Time frame: Up to 12 months
Change from baseline in Albumin-Bilirubin (ALBI) score during combination therapy
Change from baseline in ALBI score will be evaluated during CT-01 and everolimus combination therapy. The ALBI score is calculated using serum bilirubin and albumin. Changes from baseline will be summarized by time point. Higher scores indicate worse liver function. Unit of Measure: score
Time frame: Up to 12 months
Change from baseline in lipid profile during combination therapy
Change in serum lipid parameters (total cholesterol, LDL, HDL, triglycerides) from baseline during CT-01 and everolimus treatment. Unit of measure: mmol/L
Time frame: Up to 12 months
Change from baseline in serum glucose levels during combination therapy
Change in blood glucose concentration from baseline during CT-01 and everolimus treatment. Unit of Measure: mmol/L
Time frame: Up to 12 months
Change from baseline in serum alpha-fetoprotein (AFP) levels during combination therapy
Change in serum AFP concentration from baseline during treatment with CT-01 in combination with everolimus. AFP is a tumor marker used in hepatocellular carcinoma. Unit of Measure: ng/mL
Time frame: Up to 12 months
Terminal half-life (T1/2)
T1/2 will be estimated for active metabolite of CT-01 from the log-linear terminal phase of the concentration-time curve. Unit of Measure: Hours
Time frame: Up to 12 months
Title: Maximum plasma concentration (Cmax)
Cmax will be determined for CT-01 in combination with everolimus using non-compartmental analysis. Unit of Measure: ng/mL
Time frame: Up to 12 months
Change from baseline in serum glucose levels during monotherapy
Change in blood glucose concentration from baseline during CT-01 monotherapy. Unit of Measure: mmol/L
Time frame: Up to 12 months
Area under the concentration-time curve (AUC)
AUC for active metabolite of CT-01 in combination with everolimus will be calculated using non-compartmental methods. ng·h/mL
Time frame: Up to 12 months
Time to maximum concentration (Tmax)
Tmax will be recorded for CT-01 when administered with everolimus. Unit of Measure: Hours
Time frame: Up to 12 months
Terminal half-life (T1/2)
T1/2 will be estimated for active metabolite of CT-01 in combination therapy using non-compartmental analysis. Unit of Measure: Hours
Time frame: Up to 12 months
Change from baseline in lipid profile during monotherapy
Change in serum lipid parameters (total cholesterol, LDL, HDL, triglycerides) from baseline during CT-01 monotherapy. Unit of Measure: mmol/L
Time frame: Up to 12 months
Change from baseline in Albumin-Bilirubin (ALBI) score during monotherapy
Change from baseline in ALBI score will be evaluated during CT-01 monotherapy. The ALBI score is calculated using serum bilirubin and albumin. Changes from baseline will be summarized by time point. Higher scores indicate worse liver function. Unit of Measure: score
Time frame: Up to 12 months
Change from baseline in Child-Pugh score during monotherapy
Change in Child-Pugh score (range: 5-15; higher scores indicate worse liver function) from baseline during CT-01 monotherapy. Unit of Measure: score
Time frame: Up to 12 months
Change from baseline in MELD-Na score during monotherapy
Change in MELD-Na score (range: typically 6 to 40; higher scores indicate worse liver function) from baseline during CT-01 monotherapy. Unit of Measure: score
Time frame: Up to 12 months
Change from baseline in serum alpha-fetoprotein (AFP) levels during monotherapy
Change in serum AFP concentration from baseline during CT-01 monotherapy. AFP is a tumor marker used in hepatocellular carcinoma. Unit of Measure: ng/mL
Time frame: Up to 12 months
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