This is a Phase I(Ib), open-label, single-arm clinical study designed to evaluate the safety, tolerability, pharmacokinetics (PK), and preliminary efficacy of R01 administered orally as monotherapy twice daily (BID) in patients with advanced solid tumors, including squamous cell lung cancer, gastric cancer , and esophageal cancer. Patients with advanced squamous cell lung cancer, gastric cancer , and esophageal cancer will be enrolled. All subjects will receive oral R01 monotherapy and will undergo physical examinations, laboratory tests, radiographic tumor response assessments, biological sample collection, and safety follow-ups as specified in the protocol. The study comprises two consecutive sub-stages: a dose-bridging escalation stage (i.e., a dose escalation stage designed to bridge from the highest dose evaluated in Phase Ia) and a dose expansion stage. The dose escalation follows a classic '3+3' design at three dose levels (240, 320, and 400 mg BID). The 400 mg dose may be initiated after the Safety Review Committee (SRC) review based on safety and PK data. The primary objectives of this stage are to characterize dose-limiting toxicities (DLTs), determine the maximum tolerated dose (MTD), and establish the recommended Phase II dose (RP2D). The dose expansion stage will be conducted at the RP2D in selected indication cohorts, with a planned enrollment of at least 6 subjects per cohort (including subjects with the corresponding indications enrolled at the same dose level during the dose escalation stage), to further evaluate the safety, tolerability, PK characteristics, and preliminary antitumor efficacy at this dose level. With respect to study endpoints: during the dose escalation stage, the primary endpoints are the incidence of DLTs, the MTD, and/or the determination of the expansion dose (RP2D); secondary endpoints include PK parameters of R01 and its metabolites, objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). During the dose expansion stage, the primary endpoints are ORR and the incidence and severity of treatment-related adverse events (TRAEs); secondary endpoints include duration of response (DOR), time to response (TTR), DCR, PFS, OS, and steady-state PK parameters.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
18
The study consists of two parts: (1) Dose Escalation Phase: Three prespecified escalating dose levels will be evaluated: 240 mg BID, 320 mg BID, and 400 mg BID. (2) Dose Expansion Phase: Subjects will receive the expansion dose determined in the dose escalation phase. All subjects will receive R01 orally, twice daily, with each treatment cycle consisting of 21 days. Treatment will continue until the discontinuation criteria specified in the study protocol are met.
Aerospace Central Hospital, Beijing, China, 100049
Beijing, Beijing Municipality, China
Number of Participants with Dose-Limiting Toxicities (DLTs)
Dose-limiting toxicity (DLT) is defined as a toxicity occurring during the observation window at any dose level, judged by the investigator to be related to R01, and meeting any of the following criteria: Hematologic toxicities: Grade 4 hematologic toxicity; Grade 4 neutropenia persisting for \>7 days despite G-CSF treatment; Grade 4 anemia not recovering to ≤Grade 2 within 14 days despite transfusion support; Grade 4 thrombocytopenia regardless of bleeding; Febrile neutropenia ; Grade 3 thrombocytopenia with clinically significant bleeding. Non-hematologic toxicities: Grade ≥3 non-hematologic toxicity; QTcF \>500 ms or increase of \>60 ms from baseline confirmed by repeat ECG; Grade ≥3 hypoxemia or Grade ≥3 dyspnea; Actual dosing in Cycle 1 \<75% of planned dose or dosing delay \>14 days due to study drug-related toxicity. DLTs will be assessed according to CTCAE v6.0 during the DLT observation window.
Time frame: Cycle 1 (21 days)
Determination of Maximum Tolerated Dose (MTD) and/or Expansion Dose
The maximum tolerated dose (MTD) is defined as the highest dose level at which ≤1 of 6 participants experiences a dose-limiting toxicity (DLT) during the DLT observation window. DLTs will be assessed according to CTCAE v6.0. The MTD will be determined using a standard 3+3 dose escalation design. The expansion dose will be selected based on the MTD, pharmacokinetic exposure, safety, tolerability, and preliminary efficacy observed during the dose escalation phase, and will not exceed the MTD.
Time frame: From the beginning of first patient in (FPl) to the end of dose escalation phase up to approximately 9 months
Objective Response Rate (ORR)
Objective response rate (ORR) is defined as the proportion of participants who achieve a confirmed best overall response of complete response (CR) or partial response (PR), as assessed by the investigator according to RECIST version 1.1. CR is defined as the disappearance of all target lesions and any pathological lymph nodes (short axis \<10 mm). PR is defined as at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum of diameters. All responses must be confirmed by a repeat assessment performed no less than 4 weeks after the initial response is first documented. ORR will be reported for each dose cohort and for the overall study population. The 95% confidence interval (CI) for ORR will be calculated using the Clopper-Pearson exact method.
Time frame: From the beginning of first patient in (FPl) to the end of dose expansion phase up to approximately 4 months
Incidence and Severity of Treatment-Emergent Adverse Events (TEAEs) and Treatment-Related Adverse Events (TRAEs)
Treatment-emergent adverse events (TEAEs) are defined as adverse events that start or worsen in severity after the first dose of study drug (R01) through 30 days after the last dose of study drug, or until initiation of another antineoplastic therapy, whichever occurs first. Treatment-related adverse events (TRAEs) are defined as TEAEs for which the investigator assesses a causal relationship to the study drug as possibly, probably, or definitely related. The incidence and severity of TEAEs and TRAEs will be summarized by dose cohort and for the overall safety population. Severity will be graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 6.0.
Time frame: From first dose to 30 days after last dose
Pharmacokinetic (PK) parameters of R01 and its metabolites
Single-dose PK parameters of R01 and its metabolites include maximum plasma concentration (Cmax), time to maximum concentration (Tmax), area under the plasma concentration-time curve from time zero to the last measurable concentration (AUC₀-ₜ), area under the plasma concentration-time curve from time zero to infinity (AUC₀-∞), and terminal elimination half-life (t½). Steady-state PK parameters include area under the plasma concentration-time curve over one dosing interval (AUCτ), maximum plasma concentration at steady state (Cmax,ss), trough plasma concentration at steady state (Ctrough,ss), and accumulation ratio (Rac).
Time frame: Cycle 0 (single-dose PK, 3 days); Cycle 1 (steady-state PK, 21 days)
Objective response rate (ORR)
Objective response rate (ORR) is defined as the proportion of participants who achieve a confirmed best overall response of complete response (CR) or partial response (PR), as assessed by the investigator according to RECIST version 1.1. CR is defined as the disappearance of all target lesions and any pathological lymph nodes (short axis \<10 mm). PR is defined as at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum of diameters. All responses must be confirmed by a repeat assessment performed no less than 4 weeks after the initial response is first documented. ORR will be reported for each dose cohort and for the overall study population. The 95% confidence interval (CI) for ORR will be calculated using the Clopper-Pearson exact method.
Time frame: From the beginning of first patient in (FPl) to the end of dose escalation phase up to approximately 9 months
Disease control rate (DCR)
DCR is defined as the proportion of participants who achieve a best overall response of complete response (CR), partial response (PR), or stable disease (SD), as assessed by the investigator according to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Stable disease (SD) is defined as neither sufficient shrinkage to qualify for PRI nor sufficient increase to qualify for progressive disease (PD), maintained for at least \[X\] weeks.
Time frame: From the beginning of first patient in (FPI) to the end of study up to approximately 13 months
Progression-free survival (PFS)
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PFS is defined as the time from the date of first dose to the date of first documented disease progression (PD) per the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, or death due to any cause, whichever occurs first. Participants who have not progressed or died at the time of analysis will be censored at the date of their last evaluable tumor assessment.
Time frame: From the beginning of first patient in (FPI) to the end of study up to approximately 13 months
Overall survival (OS)
OS is defined as the time from the date of first dose to the date of death due to any cause.
Time frame: From the beginning of first patient in (FPI) to the end of study up to approximately 13 months
Duration of response (DOR)
DOR is defined, for participants who achieve a best overall response of complete response (CR) or partial response (PR), as the time from the date of first documented response (CR or PR) to the date of first documented disease progression (PD) per the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, or death due to any cause, whichever occurs first. Responders who have not progressed or died at the time of analysis will be censored at the date of their last evaluable tumor assessment.
Time frame: From the beginning of first patient in (FPI) to the end of dose expansion phase up to approximately 4 months
Time to response (TTR)
TTR is defined, for participants who achieve a best overall response of complete response (CR) or partial response (PR), as the time from the date of first dose to the date of first documented response (CR or PR), as assessed by the investigator according to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1.
Time frame: From the beginning of first patient in (FPI) to the end of dose expansion phase up to approximately 4 months