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Hypothesis: encouraging results of phase II study FAVE in the treatment of hormonal resistant prostate cancer lead us to continue clinical development of efavirenz. Furthermore, all available pre-clinical and clinical data lead us to conduct a Phase 1 study with efavirenz. Objective of this Phase I is to test doses above 600 mg / day in patients with cancer in order to determine the maximum tolerated dose to improve therapeutic effect.
This study is a single center Phase I trial, conduct with dose escalation scheme of efavirenz by continual reassessment method likehood approach (CRML) on solid tumours (except pancreatic cancer) and non-Hodgkin lymphoma (NHL).
Main objective is to determine the safety profile, and particularly the maximum tolerated dose of efavirenz for the treatment of patients with solid tumors (except pancreatic cancer) or NHL in therapeutic failure.
Secondary objectives are:
Primary Endpoint
Safety will be evaluated according to the toxicity scale NCI-CTCAE v4.0. Dose limiting toxicities will be collected during the first 28 days (+ / - 7 days) after first dose of Efavirenz and will be defined as follows:
This is a Phase I dose escalation strategy according to the method described by CRML O'Quigley and Shen [O'Quigley et al. Biometrics 1996] and commonly used in phase I trials in oncology.
Six levels of doses are initially defined: 600 mg, 1200 mg, 1800 mg, 2200 mg, 2600 mg, 3000 mg.
The maximum potential dose-limiting toxicities allowed is 25%.
Dose limiting toxicities will be defined as follows:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Efavirenz: 600 mg | Experimental | Cohort 1 : Participants received 600 mg of Efavirenz (oral / once a day), until progression or toxicity. |
|
| Efavirenz: 1200 mg | Experimental | Cohort 2 : Participants received 1200 mg of Efavirenz (oral / once a day), until progression or toxicity. |
|
| Efavirenz: 1800 mg | Experimental | Cohort 3 : Participants received 1800 mg of Efavirenz (oral / once a day), until progression or toxicity. |
|
| Efavirenz: 2200 mg | Experimental | Cohort 4 : Participants received 2200 mg of Efavirenz (oral / once a day), until progression or toxicity. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Efavirenz 600mg | Drug | Efavirenz 600 mg (oral daily intake) |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Maximum Tolerated Dose (MTD) of Efavirenz | MTD was determined by testing increasing doses up to 3000 mg (oral daily intake). The dose escalation scheme is the continual reassessment method likehood approach (CRML) described by O'Quigley and Shen [O'Quigley et al. Biometrics 1996]. MTD reflects the highest dose of drug that did not cause a Dose-Limiting Toxicity (DLT) in > 25% of participants. A DLT was any drug-related toxicity with grade ≥ 3 according to NCI-CTCAE v4.0 (except alopecia, nausea and vomiting, regardless of grade), any drug-related toxicity, regardless of grade, who led a treatment delay> 14 days, a score ≥ 19 for the Hospital Anxiety And Depression Scale (HAD) during treatment. | Up to 28 days for each dosing cohort |
| Number of Participants Who Experienced Dose-Limiting Toxicities (DLTs) | A DLT was any drug-related toxicity with grade ≥ 3 according to NCI-CTCAE v4.0 (except alopecia, nausea and vomiting, regardless of grade), any drug-related toxicity, regardless of grade, who led a treatment delay> 14 days, a score ≥ 19 for the Hospital Anxiety And Depression Scale (HAD) during treatment. | Up to 28 days for each dosing cohort |
| Measure | Description | Time Frame |
|---|---|---|
| 12-week Objective Response Rate | Objective response is defined as complete or partial response (CR, PR) using the Response Evaluation Criteria in Solid Tumors (RECIST v1.1). Objective reponse rate is calculated as the number of patients with objective reponse divided by the number of alive patients. | up to 3 months after first adminitration of Efavirenz |
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Inclusion Criteria :
Exclusion Criteria :
Patient with pancreatic cancer.
Presence of active or symptomatic cerebral localization (known).
History of another cancer except:
Current major depressive state (screening by HAD scale total score ≥ 13).
Patients with history of depressive disorders, suicide attempts, addiction or other psychiatric disorders.
Concomitant use of terfenadine, astemizole, cisapride, midazolam, triazolam, pimozide, bepridil, alkaloids of ergot, voriconazole, mixing St. John's Wort.
Patients treated with anti-vitamin K. Treatment with low molecular weight heparin are allowed.
Known efavirenz hypersensitivity or to any of its excipients.
Severe renal impairment.
Severe hepatic impairment.
Yellow fever vaccine (yellow fever).
Pregnant or lactating.
Presence of toxicity> 1 according to the criteria CTCAE V4.0, due to prior cancer therapy.
Recurrent diarrhea which can interfere with drug absorption capacity.
Patient included in another biomedical research on a drug within 30 days of inclusion.
Patient who previously participated in this study.
Patient, who for reasons psychological, psychiatric, social, family or geographical could not be treated or monitored regularly by the criteria of the study, patients deprived of liberty or under tutorship.
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| Name | Affiliation | Role |
|---|---|---|
| Guilhem Roubaud, MD | Institut Bergonié | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Institut Bergonié | Bordeaux | 33076 | France |
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| ID | Title | Description |
|---|---|---|
| FG000 | Efavirenz - 600 mg | Participants received 600 mg of Efavirenz (oral / once a day), until progression or toxicity. |
| FG001 | Efavirenz - 1200 mg | Participants received 1200 mg of Efavirenz (oral / once a day), until progression or toxicity. |
| FG002 | Efavirenz - 1800 mg | Participants received 1800 mg of Efavirenz (oral / once a day), until progression or toxicity. |
| FG003 | Efavirenz - 2200 mg | Participants received 2200 mg of Efavirenz (oral / once a day), until progression or toxicity. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Efavirenz: 600 mg | Cohort 1 : Participants received 600 mg of Efavirenz (oral / once a day), until progression or toxicity. Efavirenz 600mg: Efavirenz 600 mg (oral daily intake) |
| BG001 | Efavirenz: 1200 mg |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Maximum Tolerated Dose (MTD) of Efavirenz | MTD was determined by testing increasing doses up to 3000 mg (oral daily intake). The dose escalation scheme is the continual reassessment method likehood approach (CRML) described by O'Quigley and Shen [O'Quigley et al. Biometrics 1996]. MTD reflects the highest dose of drug that did not cause a Dose-Limiting Toxicity (DLT) in > 25% of participants. A DLT was any drug-related toxicity with grade ≥ 3 according to NCI-CTCAE v4.0 (except alopecia, nausea and vomiting, regardless of grade), any drug-related toxicity, regardless of grade, who led a treatment delay> 14 days, a score ≥ 19 for the Hospital Anxiety And Depression Scale (HAD) during treatment. | Posted | Number | mg | Up to 28 days for each dosing cohort |
|
Adverse event data were collected until death or date of the end of study (6 months after the inclusion of the last patient)
Adverse Events were monitored/assessed without regard to the specific Adverse Event Term.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Efavirenz: 600 mg | Cohort 1 : Participants received 600 mg of Efavirenz (oral / once a day), until progression or toxicity. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Other | Blood and lymphatic system disorders | Systematic Assessment |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Not collected | Blood and lymphatic system disorders | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr Guilhem Roubaud | Institut Bergonié | 33 5 56 33 33 33 | g.roubaud@bordeaux.unicancer.fr |
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| ID | Term |
|---|---|
| D008228 | Lymphoma, Non-Hodgkin |
| ID | Term |
|---|---|
| D008223 | Lymphoma |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D008232 | Lymphoproliferative Disorders |
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| ID | Term |
|---|---|
| C098320 | efavirenz |
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| Efavirenz 1200 mg |
| Drug |
Efavirenz 1200mg (oral daily intake) |
|
| Efavirenz 1800 mg | Drug | Efavirenz 1800mg (oral daily intake) |
|
| Efavirenz 2200 mg | Drug | Efavirenz 2200mg (oral daily intake) |
|
| 12-week Non-progression Rate | Non progression is defined as complete or partial response (CR, PR) or stable disease (SD), using the Response Evaluation Criteria in Solid Tumors (RECIST v1.1). Non-progression rate is calculated as the number of alive and progression free patients divided by the number of patients. | Evaluated up to 3 months after first administration of Efavirenz |
Cohort 2 : Participants received 1200 mg of Efavirenz (oral / once a day), until progression or toxicity.
Efavirenz 600mg: Efavirenz 1200 mg (oral daily intake)
| BG002 | Efavirenz: 1800 mg | Cohort 3 : Participants received 1800 mg of Efavirenz (oral / once a day), until progression or toxicity. Efavirenz 600mg: Efavirenz 1800 mg (oral daily intake) |
| BG003 | Efavirenz: 2200 mg | Cohort 4 : Participants received 2200 mg of Efavirenz (oral / once a day), until progression or toxicity. Efavirenz 600mg: Efavirenz 2200 mg (oral daily intake) |
| BG004 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
|
|
| Primary | Number of Participants Who Experienced Dose-Limiting Toxicities (DLTs) | A DLT was any drug-related toxicity with grade ≥ 3 according to NCI-CTCAE v4.0 (except alopecia, nausea and vomiting, regardless of grade), any drug-related toxicity, regardless of grade, who led a treatment delay> 14 days, a score ≥ 19 for the Hospital Anxiety And Depression Scale (HAD) during treatment. | Posted | Count of Participants | Participants | Up to 28 days for each dosing cohort |
|
|
|
| Secondary | 12-week Objective Response Rate | Objective response is defined as complete or partial response (CR, PR) using the Response Evaluation Criteria in Solid Tumors (RECIST v1.1). Objective reponse rate is calculated as the number of patients with objective reponse divided by the number of alive patients. | Posted | Count of Participants | Participants | up to 3 months after first adminitration of Efavirenz |
|
|
|
| Secondary | 12-week Non-progression Rate | Non progression is defined as complete or partial response (CR, PR) or stable disease (SD), using the Response Evaluation Criteria in Solid Tumors (RECIST v1.1). Non-progression rate is calculated as the number of alive and progression free patients divided by the number of patients. | Posted | Count of Participants | Participants | Evaluated up to 3 months after first administration of Efavirenz |
|
|
|
| 5 |
| 5 |
| 3 |
| 5 |
| 5 |
| 5 |
| EG001 | Efavirenz: 1200 mg | Cohort 2 : Participants received 1200 mg of Efavirenz (oral / once a day), until progression or toxicity. | 11 | 11 | 4 | 11 | 11 | 11 |
| EG002 | Efavirenz: 1800 mg | Cohort 3 : Participants received 1800 mg of Efavirenz (oral / once a day), until progression or toxicity. | 4 | 4 | 4 | 4 | 4 | 4 |
| EG003 | Efavirenz: 2200 mg | Cohort 4 : Participants received 2200 mg of Efavirenz (oral / once a day), until progression or toxicity. | 5 | 5 | 3 | 5 | 5 | 5 |
| Other | Gastrointestinal disorders | Systematic Assessment |
|
| Other | General disorders | Systematic Assessment |
|
| other | Hepatobiliary disorders | Systematic Assessment |
|
| Other | Metabolism and nutrition disorders | Systematic Assessment |
|
| Other | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | Systematic Assessment |
|
| Other | Nervous system disorders | Systematic Assessment |
|
| Other | Psychiatric disorders | Systematic Assessment |
|
| other | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Not collected | Eye disorders | Systematic Assessment |
|
| Not collected | Gastrointestinal disorders | Systematic Assessment |
|
| Not collected | General disorders | Systematic Assessment |
|
| Not collected | Hepatobiliary disorders | Systematic Assessment |
|
| Not collected | Infections and infestations | Systematic Assessment |
|
| Not collected | Injury, poisoning and procedural complications | Systematic Assessment |
|
| Not collected | Investigations | Systematic Assessment |
|
| Not collected | Metabolism and nutrition disorders | Systematic Assessment |
|
| Not collected | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Not collected | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | Systematic Assessment |
|
| Not collected | Nervous system disorders | Systematic Assessment |
|
| Not collected | Psychiatric disorders | Systematic Assessment |
|
| Not collected | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Not collected | Skin and subcutaneous tissue disorders | Systematic Assessment |
|
| Not collected | Vascular disorders | Systematic Assessment |
|
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| D008206 |
| Lymphatic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D007160 | Immunoproliferative Disorders |
| D007154 | Immune System Diseases |