Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
This is a Phase Ib, open-label, dose-escalation study to determine the Maximal tolerated dose (MTD) and the recommended Phase 2 dose (RP2D) for the combination of afuresertib and paclitaxel in subjects with recurrent HER2-negative gastric cancer, and further assess safety and preliminary efficacy of combination at the RP2D. Afuresertib had showed synergistic activity when combined with paclitaxel in vitro and in vivo models of gastric cancer. Dose escalation will continue until the MTD is established. The dose schedule is once daily (QD) dosing for afuresertib and intravenous (IV) infusion for paclitaxel Dose escalation in Part 1 will follow the 3 + 3 cohort design. A sequential approach will be conducted to explore the optimal paclitaxel regimen (weekly or 3weekly schedule) when combined with afuresertib. The dose escalation will be started from Cohort A (afuresertib combined with weekly paclitaxel regimen at 80 milligram (mg)/meter (m)^2 day1, 8,15, every 4 weeks (q4w). The starting dose in Cohort A will be 125 mg afuresertib QD. Once its MTD is identified, and then the study will move to dosing Cohort B (afuresertib combined with 3 weekly paclitaxel regimen at 175 mg/m^2 day1, every 3 week (q3w). The starting daily dose of Cohort B will be 25 mg less than the MTD dose from Cohort A for afuresertib. If it is tolerated, then the dose escalation schedule will be followed in Cohort B until the MTD in this Cohort is reached. If the starting dose is not tolerated, then dose de-escalation will be explored until the MTD in this Cohort is reached. Once two dimensions of the MTD are achieved, then the optimal regimen for paclitaxel and MTD for afuresertib combined with paclitaxel based on the toxicity profile will be identified. The combination regimen at the RP2D selected following Part I will be further investigated in its efficacy and safety in the Part II Expansion Cohort. Once a combination dose regimen for Part 2 has been determined, at least 20 and up to 40 subjects will be enrolled at the dose regimen selected following Part I. Overall response rate (ORR) will be evaluated using a Green-Dahlberg design. The design consists with one interim analysis. If less than 3 responses are observed in the initial 20 subjects, enrollment will be terminated due to futility; otherwise, the study will continue to meet the planned sample size of 40 subjects.
Not provided
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Part 1: Dose-escalation (weekly paclitaxel) | Experimental | The dose escalation will be started from Cohort A (afuresertib combined with weekly paclitaxel regimen at 80 mg/m^2 d1, 8,15, q4w). The starting dose in Cohort A will be 125 mg afuresertib QD to indentify MTD |
|
| Part 1: Dose-escalation (3 weeks Paclitaxel) | Experimental | Once its MTD is identified, and then the study will move to dosing Cohort B (afuresertib combined with 3 weekly paclitaxel regimen at 175 mg/m^2 d1, q3w. Cohort B (afuresertib combined with 3 weekly paclitaxel regimen at 175 mg/m^2 d1, q3w). The starting daily dose of Cohort B will be 25 mg less than the MTD dose from Cohort A for afuresertib. If it is tolerated, then the dose escalation schedule will be followed in Cohort B until the MTD in this Cohort is reached. If the starting dose is not tolerated, then dose de-escalation will be explored until the MTD in this Cohort is reached. Once two dimensions of the MTD are achieved, then the optimal regimen for paclitaxel and MTD for afuresertib combined with paclitaxel based on the toxicity profile will be identified |
|
| Part 2: Experimental Cohort | Experimental | The optimal regimen for paclitaxel and MTD for afuresertib combined with paclitaxel based on the toxicity profile will be administered |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Afuresertib | Drug | The unit dose strength is 50mg/75mg tablet. Afuresertib will be taken orally once daily continuously during trail. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Number of subjects with any serious adverse event (SAE), non-serious adverse event (AE) in Phase I Dose Escalation phase | An AE is defined as any untoward medical occurrence in a subject or clinical investigation subject, temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. An SAE is defined as any untoward medical occurrence that, at any dose, results in death, is life threatening, requires hospitalization or prolongation of existing hospitalization, results in disability/incapacity, or is a congenital anomaly/birth defect | Day 1 to Day 21 after the last dose of study treatment (assessed up to 1 years) |
| Assessment of changes in clinical laboratory tests in Phase I Dose Escalation phase | Clinical laboratory tests included hematology, clinical chemistry, urinalysis | Day 1 to Day 21 after the last dose of study treatment. (assessed up to 1 years) |
| Assessment of 12-lead electrocardiogram (ECG) findings in Phase I Dose Escalation phase | Heart rate, pulse rate (PR), QRS, QT, and Electrocardiogram QT interval corrected for heart rate using Fridericia's formula (QTcF intervals) will be recorded by measuring triplicate 12-lead ECGs, obtained in semi-recumbent or supine position after 5 minutes rest | Screening and Day 22 |
| Assessment of Echocardiograms (ECHOs) in Phase I Dose Escalation phase | The cardiac ejection fraction and cardiac valve morphology will be assessed by ECHOs. The evaluation of the echocardiographer should include an evaluation for left ventricular ejection fraction (LVEF) | Every 9 weeks (for 3 weekly paclitaxel regimen) and every 8 weeks (for weekly paclitaxel regimen) until day 21 after last dose of study treatment (assessed up to 1 years) |
| Assessment of blood pressure (vital signs) in Phase I Dose Escalation |
| Measure | Description | Time Frame |
|---|---|---|
| Composite of pharmacokinetics parameters of afuresertib and paclitaxel combination regimen in dose escalation cohort | Afuresertib pharmacokinetic parameters following single and repeat dose administration, including Area under the concentration-time curve (AUC), Maximum observed concentration (Cmax) and paclitaxel Pre-dose (trough) concentration at the end of the dosing interval (Ctrough), Cmax after repeat dose administration, time of occurrence of Cmax (tmax), and terminal phase half-life (t1/2) |
Not provided
Inclusion Criteria:
Exclusion Criteria:
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Affiliation | Role |
|---|---|---|
| Novartis Pharmaceuticals | Novartis Pharmaceuticals | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Novartis Investigative Site | Seoul | 110-774 | South Korea | |||
| Novartis Investigative Site |
Not provided
| ID | Term |
|---|---|
| D009369 | Neoplasms |
Not provided
Not provided
Not provided
| ID | Term |
|---|---|
| C000593263 | afuresertib |
| D017239 | Paclitaxel |
| ID | Term |
|---|---|
| D043823 | Taxoids |
| D043822 | Cyclodecanes |
| D003516 | Cycloparaffins |
| D006840 | Hydrocarbons, Alicyclic |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Paclitaxel | Drug | Paclitaxel sourced locally will be administered IV |
|
Vital signs will include measurement of systolic and diastolic blood pressure. Vital signs should be measured after resting for at least 5minutes in a semi-supine position |
| Screening to Day 21 after the last dose of study treatment (assessed up to 1 years) |
| Assessment of preliminary clinical efficacy in Phase II dose expansion | Tumor response will be measured by Response Evaluation Criteria In Solid Tumors (RECIST 1.1), the ORR will be based on confirmed responses by investigator-based assessment for gastric cancer | Every 6 weeks for 3 weekly paclitaxel regimen or every 8 weeks for weekly paclitaxel regimen (assessed up to 1 years) |
| Assessment of respiration rate (vital signs) in Phase I Dose Escalation | Vital signs will include measurement of respiration rate. Vital signs should be measured after resting for at least 5minutes in a semi-supine position. | Screening to Day 21 after the last dose of study treatment (assessed up to 1 years)] |
| Assessment of PR (vital signs) in Phase I Dose Escalation | Vital signs will include measurement of PR. Vital signs should be measured after resting for at least 5minutes in a semi-supine position. | Screening to Day 21 after the last dose of study treatment (assessed up to 1 years)] |
| Day 1 (pre-dose, 1 to 3 hour [h]), Day 22 (pre-dose, 1 to 3 h and 6-8 h) for 3 weekly dose Paclitaxel regimen |
| Evaluation of the progression free survival (PFS) in expansion cohort | PFS is defined as the interval between first dose and the earliest date of disease progression or death due to any cause by investigator assessment | Day 1and the earliest date of disease progression or death due to any cause; up to 6 months |
| Number of subjects with any SAE, AE in expansion cohort | An AE is defined as any untoward medical occurrence in a subject or clinical investigation subject, temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. An SAE is defined as any untoward medical occurrence that, at any dose, results in death, is life threatening, requires hospitalization or prolongation of existing hospitalization, results in disability/incapacity, or is a congenital anomaly/birth defect | Day 1 to Day 21 after the last dose of study treatment (assessed up to 1 years). |
| Assessment of changes in clinical laboratory tests in expansion cohort | Clinical laboratory tests included hematology, clinical chemistry, urinalysis | Day 1 to Day 21 after the last dose of study treatment (assessed up to 1 years) |
| Assessment of 12-lead ECG findings in expansion cohort | Heart rate, PR, QRS, QT, and Electrocardiogram QT interval corrected for heart rate using QTcF intervals will be recorded by measuring triplicate 12-lead ECGs, obtained in semi-recumbent or supine position after 5 minutes rest | Screening and Day 22 |
| Assessment of ECHOs in expansion cohort | The cardiac ejection fraction and cardiac valve morphology will be assessed by ECHOs The evaluation of the echocardiographer should include an evaluation LVEF | Every 9 weeks (for 3 weekly paclitaxel regimen) or every 8 weeks (for weekly paclitaxel regimen) to day 21 after last dose of study treatment (assessed up to 1 years) |
| Assessment of composite pharmacokinetics of afuresertib and paclitaxel in expansion cohort | Afuresertib concentration following single and repeat dose administration and Paclitaxel Ctrough and Cmax after repeat dose administration | Day 1 (pre-dose, 1 to 3 hour [h]), Day 22 (pre-dose, 1 to 3 h and 6-8 h) for 3 weekly dose Paclitaxel regimen Day 1 (pre-dose, 1 to 3 h), Day 15 (pre-dose, 1 to 3 h and 6-8 h) for weekly dose Paclitaxel regimen |
| Seoul |
| 120/752 |
| South Korea |
| Novartis Investigative Site | Seoul | 135-710 | South Korea |
| Novartis Investigative Site | Taipei | 100 | Taiwan |
| Novartis Investigative Site | Taipei | 112 | Taiwan |
| D006844 |
| Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |
| D004224 | Diterpenes |
| D013729 | Terpenes |