Strategic Alliance: Phase 1b Trial of the Combination of the ATR Inhibitor BAY1895344 and PI3K Inhibitor Copanlisib in Molecularly Selected Patients With Advanced Solid Tumors (COPABAY)
Strategic Alliance: Phase 1b Trial of the Combination of the ATR Inhibitor BAY1895344 and PI3K Inhibitor Copanlisib in Molecularly Selected Patients With Advanced Solid Tumors (COPABAY)
This phase Ib trial finds out the best dose, possible benefits and/or side effects of BAY1895344 and copanlisib in treating molecularly selected patients with solid tumors that have spread to other places in the body (advanced). BAY1895344 and copanlisib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving BAY1895344 and copanlisib together may help control the progression of the disease in patients with advanced solid tumors.
PRIMARY OBJECTIVE:
I. To evaluate the safety and determine the maximum tolerated dose (MTD) and/or the recommended phase 2 dose (RP2D) of the combination of copanlisib and elimusertib (BAY1895344) in patients with molecularly-selected advanced solid tumors.
SECONDARY OBJECTIVES:
I. To assess clinical benefit of copanlisib in combination with BAY1895344 in patients with molecularly-selected advanced solid tumors.
II. To assess the pharmacokinetic and pharmacodynamic profile of the combination of copanlisib and BAY1895344.
III. To assess predictive biomarkers of response and resistance to the combination of copanlisib and BAY1895344, as well as pharmacodynamic (PD) biomarkers.
OUTLINE: This is a dose-escalation study. Patients are assigned to 1 of 2 arms.
ARM I (SEQUENTIAL): Patients receive elimusertib orally (PO) twice daily (BID) on days 1-3 and 15-17, and copanlisib intravenously (IV) over 1 hour on days 4 and 18. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients who experience disease progression may continue to receive elimusertib PO BID and copanlisib IV at the discretion of the treating physician.
ARM II (CONCOMITANT): Patients receive elimusertib PO BID on days 1-3 and 15-17, and copanlisib IV over 1 hour on days 1 and 15. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients who experience disease progression may continue to receive elimusertib PO BID and copanlisib IV at the discretion of the treating physician.
After completion of study treatment, patients are followed up at 30 days, then every 12 weeks for up to 2 years.
Inclusion Criteria:
DOSE ESCALATION: Patients must have a pathogenic or likely pathogenic germline or somatic defect as determined by local assessment and classification in at least one of the following:
DOSE EXPANSION: Patients must have a pathogenic or likely pathogenic germline or somatic defect as determined by local assessment and classification
Patients must have histological diagnosis of locally advanced (primary or recurrent) or metastatic solid tumors (except primary central nervous system [CNS] tumors), that are not amenable form treatment with curative intent or who have refused or are intolerant of standard therapy
Availability of a fresh or recent tumor tissue sample from a diagnostic biopsy/surgery or a metastatic tumor biopsy; the sample must have been obtained with 12 months prior to study enrollment. When only bone disease is present, an archival tumor tissue sample obtained within 5 years prior to study enrollment may be accepted for non-prostate cancer patients and a fresh bone biopsy may be accepted for prostate cancer patients only
Patients must be >=18 years of age
Patients must have measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1; or patients may have bone only metastatic disease evaluable by Prostate Cancer Working Group 3 (PCWG3) for subjects with metastatic castration-resistant prostate cancer (mCRPC), or according to the tumor evaluation criteria best suited and accepted for the tumor type being evaluated
Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1
Absolute neutrophil count (ANC) >= 1,500/mcL.
Platelets >= 150,000 / mcL
Hemoglobin >= 10 g/dL without dependence on erythropoietin support or blood product support
Participants must not have received a transfusion (platelets or red blood cells) within 28 days of the first dose of study intervention. Participants must not have received administration of granulocyte colony-stimulating factor, erythropoietin, or thrombopoietic treatments within 14 days of the first dose of study intervention. Hemoglobin (Hb) value must be met without erythropoietin dependency
Serum creatinine =< 1.5 x upper limit of normal (ULN) OR measured or calculated creatinine clearance (glomerular filtration rate [GFR] can also be used in place of creatinine or CrCl) >= 60 mL/min for subject with creatinine levels > 1.5 x institutional ULN
Creatinine clearance can be estimated according to the Cockcroft-Gault formula
Serum total bilirubin =< 1.5 x ULN OR direct bilirubin =< ULN for subjects with total bilirubin levels > 1.5 x ULN
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2.5 x ULN OR =< 5 x ULN for subjects with liver metastases
International normalized ratio (INR) or prothrombin time (PT) =< 1.5 x ULN unless subject is receiving anticoagulant therapy as long as PT or partial thromboplastin time (PTT) is within therapeutic range of intended use of anticoagulants
Activated partial thromboplastin time (aPTT) =< 1.5 x ULN unless subject is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants
Patients must be >= 2 weeks beyond treatment with any chemotherapy or other investigational therapy to include hormonal, biological, or targeted agents; or at least 5 half-lives from hormonal, biological, or targeted agents, whichever is shorter at the time of treatment initiation
Women of childbearing potential MUST have a negative serum or urine HCG test unless prior tubal ligation (>= 1 year before screening), total hysterectomy or menopause (defined as 12 consecutive months of amenorrhea). Patients should not become pregnant or breastfeed while on this study. Sexually active patients must agree to use dual contraception for the duration of study participation and for 120 days after
Ability to understand and willingness to sign informed consent form prior to initiation of the study and any study procedures
Willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures
Any medical condition or diagnosis that would likely impair absorption of an orally administered drug (e.g. gastrectomy, ileal bypass, chronic diarrhea, gastroparesis)
Inability to comply with the study and follow-up procedures
Exclusion Criteria:
Inability or unwillingness to swallow pills
Active infection requiring intravenous (IV) antibiotics or other uncontrolled intercurrent illness requiring hospitalization. Minor infections, e.g. periodontal infection or urinary tract infection (UTI), which may be treated with short term oral antibiotics are allowed
History of cerebrovascular accident (CVA), myocardial infarction or unstable angina within the previous 6 months before starting therapy
Has a known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin, squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer
Has a known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial
Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Subjects with previously treated brain metastases may participate provided they are stable (without evidence of progression by imaging (as determined by magnetic resonance imaging [MRI] or computed tomography [CT]) for at least four weeks prior to the first dose of trial treatment and any neurologic symptoms have returned to baseline) and have no evidence of new or enlarging brain metastases. Subjects with previously treated brain metastases may participate provided they are stable (without evidence of progression by imaging for at least four weeks prior to the first dose of trial treatment and any neurologic symptoms have returned to baseline), have no evidence of new or enlarging brain metastases, and are not using steroids > 10mg or equivalent of prednisone for at least 7 days prior to trial treatment. This exception does not include carcinomatous meningitis which is excluded regardless of clinical stability
Patients with uncontrolled Type I or II diabetes mellitus (DM); uncontrolled DM is defined as hemoglobin A1c (HbA1c) > 8.5% and a fasting blood glucose of > 120 mg/dL within 14 days prior to trial entry
Patients with congestive heart failure > New York Heart Association (NYHA) Class 2, unstable angina, or uncontrolled hypertension despite optimal management
Patients with history or concurrent condition of interstitial lung disease or any severity and/or severely impaired lung function
Patients with prior anti-cancer therapy within 2 weeks prior to study enrollment or prior radiation therapy within 2 weeks prior to study enrollment. Prior palliative radiotherapy to metastatic lesion(s) is permitted, provided it has been completed at least 2 days prior to study enrollment and no clinically significant toxicities are expected (e.g. mucositis, esophagitis)
Patients who have undergone major surgery and have not recovered prior to study enrollment
Patients who have a known prior severe hypersensitivity to investigational products or any component in their formulations
Patients with persisting toxicity related to prior therapy (National Cancer Institute [NCI] Common Terminology Criteria for Adverse Events [CTCAE] v5.0 grade > 1). However, alopecia and sensory neuropathy grade =< 2, or other grade =< 2 adverse events not constituting a safety risk, based on the investigator's judgement, are acceptable
All participants must be screened for hepatitis B virus (HBV) and hepatitis C virus (HCV) up to 28 days prior to start of study intervention, using the routine hepatitis virus laboratorial panel.
Patients who have received external beam radiation therapy (EBRT) to > 50% of the total body reserve of active bone marrow mass involvement. This may be difficult to quantify and will be left to physician discretion
Positive cytomegalovirus (CMV) polymerase chain reaction (PCR) test at baseline
Pregnant female patients; breastfeeding female patients; fertile male patients; and female patients of childbearing potential who are unwilling or unable to use 2 methods of contraception for the duration of the study and for at least 120 days after the last dose of study drugs for female patients or 120 days after the last dose of study drugs for male patients, whichever is later for the individual patient. Highly effective methods of contraception are those that alone or in combination, result in a failure rate of less than 1% per year when used consistently and correctly. These methods include: