This phase 1b/2a study evaluates the investigational oral drug catequentinib hydrochloride (AL3818), given alone or with AL58805, temozolomide, or lomustine (CCNU), in adults with advanced or metastatic solid tumors. The phase 1b part will identify doses that can be given safely based on side effects during the first treatment cycle. The phase 2a part will estimate whether the treatments shrink non-brain tumors or keep glioblastoma from worsening for at least 6 months. The study is open label, which means participants and study investigators will know which treatment is given. Tumor response will be assessed with RECIST version 1.1. The study will also evaluate how the investigational drugs move through the body, the duration of tumor response, progression-free survival, overall survival, and treatment safety.
AL-GB-900 is an international, multicenter, open-label, nonrandomized phase 1b/2a study of oral AL3818, a fibroblast growth factor receptor and vascular endothelial growth factor receptor tyrosine kinase inhibitor. AL3818 is evaluated as monotherapy and in combination with oral AL58805, a PI3K/mTOR inhibitor, or with the alkylating agents temozolomide or lomustine. Phase 1b uses protocol-defined 3+3 dose-exploration cohorts to select a monotherapy recommended phase 2 dose (RP2D) and regimen-specific recommended combination doses (RCDs) based on dose-limiting toxicities (DLTs) during the first cycle. Cohort A1 evaluates AL3818 monotherapy in adults with recurrent or metastatic non-small cell lung cancer, small cell lung cancer, soft tissue sarcoma, thyroid cancer, endometrial cancer, low-grade serous ovarian cancer, or breast cancer. Cohort A2 evaluates AL3818 plus AL58805 in endometrial cancer, low-grade serous ovarian cancer, or soft tissue sarcoma. Cohort B1 evaluates an AL3818 monotherapy run-in in glioblastoma, and eligible participants may transition to Cohort B2 for separate dose evaluations of AL3818 plus temozolomide or AL3818 plus lomustine. Phase 2a evaluates preliminary efficacy and further safety at the selected doses. Cohort C evaluates AL3818 monotherapy in separate endometrial cancer molecular groups (TP53-mutated adenocarcinoma, TP53-associated carcinosarcoma, and TP53-wild-type disease) and in low-grade serous ovarian cancer. Cohort D evaluates AL3818 plus AL58805 in separate endometrial cancer, low-grade serous ovarian cancer, and soft tissue sarcoma groups. Cohort E evaluates AL3818 plus temozolomide and AL3818 plus lomustine in separate glioblastoma groups. For non-glioblastoma phase 2a groups, the primary activity measure is objective response rate according to RECIST version 1.1. For glioblastoma, the primary activity measure is the proportion of participants alive and progression-free at 6 months according to RECIST version 1.1. Imaging is generally performed at baseline and approximately every 8 weeks. Complete or partial responses are confirmed by repeat imaging 4 to 8 weeks later. Study treatment may continue for up to 12 months or until disease progression, unacceptable toxicity, withdrawal, intercurrent illness, or sponsor termination. Temozolomide or lomustine is administered for no more than 6 cycles; participants may continue AL3818 afterward if otherwise eligible. Participants who remain without progression and continue to benefit may continue protocol-specified compassionate-care treatment beyond 12 months at the investigator's discretion. The sponsor must reconcile the enrollment arithmetic, the glioblastoma statistical decision rule, and several dose specifications before the record is released.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
138
AL58805 is a novel chemical-structure antitumor drug with independent intellectual property rights. It functions as a novel dual-target PI3K/mTOR kinase inhibitor, exhibiting effects such as inhibiting tumor cell growth and proliferation, suppressing tumor nutrient metabolism, and exerting anti-angiogenic activity. By simultaneously inhibiting both PI3K and mTOR, it completely blocks the entire PI3K/AKT/mTOR signaling pathway at relatively low safe doses, thereby enhancing antitumor efficacy.
AL3818 is a novel small molecule dual receptor tyrosine kinase inhibitor, which shows highly selective inhibition of fibroblast growth factor receptor (FGFr) and vascular endothelial growth factor receptor (VEGFR). Preclinical studies of this agent in mouse models, including various cancer xenografts, have demonstrated that treatment of tumor-bearing mice with AL3818 induces tumor reductions.
Temozolomide is an alkylating agent, which metabolizes to generate active substance methyl triazene imidazole formamide (MTIC), which interferes with the replication and repair of tumor cell DNA and induces apoptosis of cancer cells.
CCNU is an alkylating agent that works by damaging cancer cell DNA, ultimately leading to cell death. It is lipid-soluble, allowing it to cross the blood-brain barrier, which is crucial for treating brain tumors.
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Recommended combination dose (RCD)
Determine the recommended combination dose (RCD) of AL3818 in combination with other anti-tumor agents based on evaluation of dose-limiting toxicity (DLT) events during Phase 1b.
Time frame: 36 months
Objective Tumor Response Rate (ORR)
Evaluate the proportion of participants who achieve Complete Response (CR) or Partial Response (PR) as the best overall tumor response according to RECIST version 1.1; tumor response in participants with GBM is assessed according to RANO 2.0.
Time frame: 36 months
Pharmacokinetic endpoint: Time to Maximum Plasma Concentration (Tmax)
Time from study drug administration to the observed maximum plasma concentration (Tmax) of AL3818 and, where applicable, AL58805, determined from protocol-specified pharmacokinetic sampling.
Time frame: 36 months
Pharmacokinetic endpoint: Peak Plasma Concentration (Cmax)
Evaluate the maximum observed plasma concentration (Cmax) of AL3818 and, where applicable, AL58805 based on plasma concentration-time data collected at protocol-specified pharmacokinetic sampling time points.
Time frame: 36 months
Pharmacokinetic endpoint: Area Under the Curve (AUC)
Evaluate the area under the plasma concentration-time curve (AUC) of AL3818 and, where applicable, AL58805 based on plasma concentration-time data collected at protocol-specified pharmacokinetic sampling time points.
Time frame: 36 months
Duration of Response (DOR)
Evaluate the time from the date of first documented objective response, defined as Complete Response (CR) or Partial Response (PR), to the date of documented disease progression or death from any cause, whichever occurs first, according to RECIST version 1.1 or RANO 2.0 for GBM.
Time frame: 36 months
Progression-Free Survival (PFS)
Evaluate the time from Cycle 1 Day 1 (C1D1) to the first documented disease progression or death from any cause, whichever occurs first.
Time frame: 36 months
Overall Survival (OS)
Evaluate the time from Cycle 1 Day 1 (C1D1) to death from any cause.
Time frame: 36 months
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