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This is a multicenter, open-label, non-randomized Phase 1 study in participants with advanced solid tumors, excluding hepatocellular carcinoma (HCC), that have progressed after treatment with approved therapies, or for which there are no standard therapies available. The study will also include participants with radioiodine-refractory differentiated thyroid cancer (RR-DTC). Its primary intent is to determine the effect of lenvatinib on CYP3A4 activity as well as to assess the safety and activity of lenvatinib in these participants. The study will be conducted in the following 3 phases: Pretreatment Phase, Treatment Phase, and Extension Phase.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Lenvatinib + midazolam | Experimental | Participants with histologically confirmed unresectable or refractory solid tumors. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Lenvatinib | Drug | Lenvatinib 24 mg (as one 4 mg and two 10 mg capsules) will be administered orally once daily with 240 mL (8 fluid oz) of water each morning, starting on Cycle 1 Day 1, in 28-day cycles. |
| Measure | Description | Time Frame |
|---|---|---|
| AUC(0-24): Area Under the Concentration-time Curve From Time Zero to 24 Hours Postdose for Midazolam and 1'-Hydroxymidazolam | Cycle 1 Day-3: 0-24 hours; Cycle 1 Day 1: 0-24 hours; Cycle 1 Day 14: 0-24 hours (Duration of each cycle=28 days) | |
| Cmax: Maximum Observed Plasma Concentration for Midazolam and 1'-Hydroxymidazolam | Cycle 1 Day-3: 0-24 hours; Cycle 1 Day 1: 0-24 hours; Cycle 1 Day 14: 0-24 hours (Duration of each cycle=28 days) |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) | First dose of study drug (Baseline) up to 28 days after last dose of study drug or until resolution, whichever came first (up to approximately 2.5 years) |
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Inclusion Criteria:
Age greater than or equal to 18 years at the time of informed consent.
Histologically or cytologically confirmed advanced solid tumors (excluding HCC) that have progressed following standard therapy, or for which no standard therapy exists (including surgery or radiation therapy) or participants with RR-DTC.
Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1.
Life expectancy greater than or equal to 3 months.
Adequately controlled blood pressure (BP) with or without antihypertensive medications, defined as BP less than or equal to 150/90 mmHg at screening and no change in antihypertensive medications within 1 week prior to the Cycle 1 Day 1.
Adequate renal function defined as calculated creatinine clearance greater than or equal to 30 mL/min per the Cockcroft and Gault formula.
Adequate bone marrow function:
Adequate blood coagulation function as evidenced by an International Normalized Ratio (INR) less than or equal to 1.5.
Adequate liver function:
Participants with Hepatitis B or C are eligible on the condition that they have adequate liver function as defined by Inclusion Criterion 9.
All prior therapy related toxicities must have resolved to Grade less than 2 severity per Common Terminology Criteria for Adverse Events (CTCAE version 4.03), except alopecia and infertility.
Left ventricular ejection fraction (LVEF) greater than 50% on echocardiography or multiple gated acquisition (MUGA) scan.
Females must not be lactating or pregnant at screening or baseline (as documented by a negative beta-human chorionic gonadotropin [B-hCG] test with a minimum sensitivity of 25 IU/L or equivalent units of B-hCG). A separate baseline assessment is required if a negative screening pregnancy test was obtained more than 72 hours before the first dose of study drug.
Participant must voluntarily agree to provide written informed consent.
Participant must be willing and able to comply with all aspects of the protocol.
Exclusion Criteria:
Females who are breastfeeding or pregnant at Screening or Baseline (as documented by a positive beta-human chorionic gonadotropin [ß-hCG] (or human chorionic gonadotropin [hCG]) test with a minimum sensitivity of 25 international units per liter (IU/L) or equivalent units of ß-hCG [or hCG]). A separate baseline assessment is required if a negative screening pregnancy test was obtained more than 72 hours before the first dose of study drug.
OR Females of childbearing potential who do not agree to use a highly effective method of contraception for the entire study period and for 28 days after study drug discontinuation i.e. i) total abstinence (if it is their preferred and usual lifestyle) ii) an intrauterine device (IUD) or hormone releasing system (IUS) iii) a contraceptive implant iv. an oral contraceptive (with additional barrier method) OR who do not have a vasectomized partner with confirmed azoospermia. For sites outside of the European Union (EU), it is permissible that if a highly effective method of contraception is not appropriate or acceptable to the participant, then the participant must agree to use a medically acceptable method of contraception, i.e. double barrier methods of contraception such as condom plus diaphragm or cervical/vault cap with spermicide. All females will be considered to be of childbearing potential unless they are postmenopausal [amenorrheic for at least 12 consecutive months, in the appropriate age group, and without other known or suspected cause] or have been sterilized surgically [i.e., bilateral tubal ligation, total hysterectomy, or bilateral oophorectomy, all with surgery at least 1 month before dosing]
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Facility # 1 | Detroit | Michigan | United States | |||
| Facility # 1 |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32067158 | Derived | Shumaker R, Ren M, Aluri J, Dutcus CE, Rance C, He C. An Open-Label Phase 1 Study to Determine the Effect of Lenvatinib on the Pharmacokinetics of Midazolam, a CYP3A4 Substrate, in Patients with Advanced Solid Tumors. Eur J Drug Metab Pharmacokinet. 2020 Jun;45(3):373-383. doi: 10.1007/s13318-020-00607-7. |
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A total of 51 participants were screened and enrolled, of which 21 were screen failures and 30 participants received the study treatment.
Participants took part in the study at 4 investigative sites in the United States from 18 Apr 2016 to 16 Aug 2018.
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| ID | Title | Description |
|---|---|---|
| FG000 | Midazolam + Lenvatinib | Participants received midazolam 4 milligram (mg) (2 milliliter [mL]) syrup, orally, once daily (QD), after an overnight fast on Day -3, Day 1 and Day 14 of Cycle 1 and lenvatinib 24 mg capsules, orally, QD, on each morning, continuously for 28 days of Cycle 1, starting on Day 1 of Cycle 1. Participants continued to fast for 2 hours postdose of midazolam. Duration of each cycle equal to (=) 28 days. |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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| Midazolam | Drug | Midazolam syrup 4 mg will be administered orally after an overnight fast on Cycle 1 Day -3 and concurrently with lenvatinib on Day 1 and Day 14 of Cycle 1. Participants will have to remain fasting for 2 hours after each dose of midazolam. |
|
| The Bronx |
| New York |
| United States |
| Facility # 1 | Philadelphia | Pennsylvania | United States |
| Facility # 1 | San Antonio | Texas | United States |
| COMPLETED |
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| NOT COMPLETED |
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Safety analysis set included participants who received at least 1 dose of midazolam or lenvatinib and had at least 1 postdose safety assessment.
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| ID | Title | Description |
|---|---|---|
| BG000 | Midazolam + Lenvatinib | Participants received midazolam 4 mg (2 mL) syrup, orally, QD, after an overnight fast on Day -3, Day 1 and Day 14 of Cycle 1 and lenvatinib 24 mg capsules, orally, QD, on each morning, continuously for 28 days of Cycle 1, starting on Day 1 of Cycle 1. Participants continued to fast for 2 hours postdose of midazolam. Duration of each cycle = 28 days. |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean | Standard Deviation | years |
| |||||||||||||||||
| Sex: Female, Male | Count of Participants | Participants |
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| Ethnicity (NIH/OMB) | Count of Participants | Participants |
| ||||||||||||||||||
| Race (NIH/OMB) | Count of Participants | Participants |
|
| 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 | AUC(0-24): Area Under the Concentration-time Curve From Time Zero to 24 Hours Postdose for Midazolam and 1'-Hydroxymidazolam | Pharmacokinetic (PK) analysis set included participants who had sufficient PK data to derive at least 1 PK parameter. Here number analyzed "n" are the participants who were evaluable for this outcome measure for given categories. | Posted | Mean | Standard Deviation | hour*nanograms per milliliter (h*ng/mL) | Cycle 1 Day-3: 0-24 hours; Cycle 1 Day 1: 0-24 hours; Cycle 1 Day 14: 0-24 hours (Duration of each cycle=28 days) |
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| Primary | Cmax: Maximum Observed Plasma Concentration for Midazolam and 1'-Hydroxymidazolam | PK analysis set included participants who had sufficient PK data to derive at least 1 PK parameter. Here number analyzed "n" are the participants who were evaluable for this outcome measure for given categories. | Posted | Mean | Standard Deviation | nanogram per milliliter (ng/mL) | Cycle 1 Day-3: 0-24 hours; Cycle 1 Day 1: 0-24 hours; Cycle 1 Day 14: 0-24 hours (Duration of each cycle=28 days) |
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| Secondary | Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) | Safety analysis set included participants who received at least 1 dose of midazolam or lenvatinib and had at least 1 postdose safety assessment. | Posted | Number | participants | First dose of study drug (Baseline) up to 28 days after last dose of study drug or until resolution, whichever came first (up to approximately 2.5 years) |
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First dose of study drug (Baseline) up to 28 days after last dose of study drug or until resolution, whichever came first (up to approximately 2.5 years)
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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 | Midazolam + Lenvatinib | Participants received midazolam 4 mg (2 mL) syrup, orally, QD, after an overnight fast on Day -3, Day 1 and Day 14 of Cycle 1 and lenvatinib 24 mg capsules, orally, QD, on each morning, continuously for 28 days of Cycle 1, starting on Day 1 of Cycle 1. Participants continued to fast for 2 hours postdose of midazolam. Duration of each cycle = 28 days. | 1 | 30 | 10 | 30 | 28 | 30 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Bradycardia | Cardiac disorders | MedDRA 20.0 | Systematic Assessment |
| |
| Stress cardiomyopathy | Cardiac disorders | MedDRA 20.0 | Systematic Assessment |
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| Abdominal pain | Gastrointestinal disorders | MedDRA 20.0 | Systematic Assessment |
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| Abdominal pain upper | Gastrointestinal disorders | MedDRA 20.0 | Systematic Assessment |
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| Intestinal obstruction | Gastrointestinal disorders | MedDRA 20.0 | Systematic Assessment |
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| Rectal haemorrhage | Gastrointestinal disorders | MedDRA 20.0 | Systematic Assessment |
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| Asthenia | General disorders | MedDRA 20.0 | Systematic Assessment |
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| Pyrexia | General disorders | MedDRA 20.0 | Systematic Assessment |
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| Cerebral haemorrhage | Nervous system disorders | MedDRA 20.0 | Systematic Assessment |
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| Breast discharge | Reproductive system and breast disorders | MedDRA 20.0 | Systematic Assessment |
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| Dyspnoea | Respiratory, thoracic and mediastinal disorders | MedDRA 20.0 | Systematic Assessment |
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| Hypertension | Vascular disorders | MedDRA 20.0 | Systematic Assessment |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Thrombocytopenia | Blood and lymphatic system disorders | MedDRA 20.0 | Systematic Assessment |
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| Hypothyroidism | Endocrine disorders | MedDRA 20.0 | Systematic Assessment |
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| Abdominal pain | Gastrointestinal disorders | MedDRA 20.0 | Systematic Assessment |
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| Constipation | Gastrointestinal disorders | MedDRA 20.0 | Systematic Assessment |
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| Diarrhoea | Gastrointestinal disorders | MedDRA 20.0 | Systematic Assessment |
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| Dyspepsia | Gastrointestinal disorders | MedDRA 20.0 | Systematic Assessment |
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| Nausea | Gastrointestinal disorders | MedDRA 20.0 | Systematic Assessment |
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| Stomatitis | Gastrointestinal disorders | MedDRA 20.0 | Systematic Assessment |
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| Vomiting | Gastrointestinal disorders | MedDRA 20.0 | Systematic Assessment |
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| Asthenia | General disorders | MedDRA 20.0 | Systematic Assessment |
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| Chills | General disorders | MedDRA 20.0 | Systematic Assessment |
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| Fatigue | General disorders | MedDRA 20.0 | Systematic Assessment |
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| Oedema peripheral | General disorders | MedDRA 20.0 | Systematic Assessment |
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| Urinary tract infection | Infections and infestations | MedDRA 20.0 | Systematic Assessment |
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| Blood creatinine increased | Investigations | MedDRA 20.0 | Systematic Assessment |
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| Weight decreased | Investigations | MedDRA 20.0 | Systematic Assessment |
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| Decreased appetite | Metabolism and nutrition disorders | MedDRA 20.0 | Systematic Assessment |
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| Hyperglycaemia | Metabolism and nutrition disorders | MedDRA 20.0 | Systematic Assessment |
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| Hypertriglyceridaemia | Metabolism and nutrition disorders | MedDRA 20.0 | Systematic Assessment |
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| Arthralgia | Musculoskeletal and connective tissue disorders | MedDRA 20.0 | Systematic Assessment |
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| Back pain | Musculoskeletal and connective tissue disorders | MedDRA 20.0 | Systematic Assessment |
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| Muscular weakness | Musculoskeletal and connective tissue disorders | MedDRA 20.0 | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Eisai Medical Information | Eisai Inc. | 1-888-274-2378 | esi_oncmedinfo@eisai.com |
| ID | Term |
|---|---|
| D009369 | Neoplasms |
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| ID | Term |
|---|---|
| C531958 | lenvatinib |
| D008874 | Midazolam |
| ID | Term |
|---|---|
| D001569 | Benzodiazepines |
| D001552 | Benzazepines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
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| Unknown or Not Reported |
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| Native Hawaiian or Other Pacific Islander |
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| Black or African American |
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| White |
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| More than one race |
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| Unknown or Not Reported |
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| 1'-hydroxymidazolam |
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| Geometric Mean Ratio |
| 1.148 |
| 2-Sided |
| 90 |
| 0.938 |
| 1.404 |
| Other |
| AUC(0-24) of 1'-hydroxy midazolam: Cycle 1 Day 1, Lenvatinib (single-dose) + Midazolam vs. Cycle 1 Day -3, Midazolam | Geometric Mean Ratio | 1.120 | 2-Sided | 90 | 0.940 | 1.335 | Other |
| AUC(0-24) of 1'-hydroxy midazolam: Cycle 1 Day 14, Lenvatinib (steady-state) + Midazolam vs.Cycle 1 Day -3, Midazolam | Geometric Mean Ratio | 1.199 | 2-Sided | 90 | 1.057 | 1.360 | Other |
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