Clinical trial • Phase II • Oncology

decitabine, cedazuridine for Melanoma | Non-small cell lung cancer

Phase II trial of decitabine, cedazuridine for Melanoma | Non-small cell lung cancer.

Overview

Trial Therapeutic Area
Oncology
Trial Disease
Melanoma | Non-small cell lung cancer
Trial Stage
Phase II
Drug Modality
Small molecule|Monoclonal antibody

Key dates

Initial CTIS Submission Date
16-10-2024
First CTIS Authorization Date
18-11-2024

Trial design

Randomised, two randomized arms: (1) nivolumab combined with ipilimumab and oral decitabine/cedazuridine (astx727); (2) nivolumab combined with ipilimumab. doses and schedule not specified in the available documents.-controlled Phase II trial across 1 site in Italy.

Randomised
Yes
Comparator
Two randomized arms: (1) nivolumab combined with ipilimumab and oral decitabine/cedazuridine (ASTX727); (2) nivolumab combined with ipilimumab. Doses and schedule not specified in the available documents.
Target Sample Size
148

Eligibility

Recruits 148 The protocol indicates vulnerable population considerations: 'Willing and able to give written informed consent.' Population restricted to adults (Men and women of and over 18 years old). Exclusions explicitly list prisoners or subjects who are involuntarily incarcerated and subjects who are compulsorily detained for treatment. Consent is provided by the participant (written informed consent). No provisions for assent or parental consent for minors are provided (minors are not eligible)..

Pregnancy Exclusion
Sex and Reproductive Status a) Women who are pregnant or breastfeeding; b) WOCBP who are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period and for up to 6 months after the study; c) Women with a positive pregnancy test on enrollment or prior to investigational product administration; d) Sexually active fertile men not using effective birth control if their partners are WOCBP.
Vulnerable Population
The protocol indicates vulnerable population considerations: 'Willing and able to give written informed consent.' Population restricted to adults (Men and women of and over 18 years old). Exclusions explicitly list prisoners or subjects who are involuntarily incarcerated and subjects who are compulsorily detained for treatment. Consent is provided by the participant (written informed consent). No provisions for assent or parental consent for minors are provided (minors are not eligible).

Inclusion criteria

  • {"criterion_text":"- Willing and able to give written informed consent.\n- Women of child-bearing potential must not be pregnant or breastfeeding, must have a negative pregnancy test at Screening and all men must be practicing two medically acceptable methods of birth control. Men should not father a child while receiving treatment with oral decitabine/cedazuridine (ASTX727) and/or ipilimumab plus nivolumab, and for 7 months following completion of treatment. Men with female partners of childbearing potential should use effective contraception during this time. Age and Sex - Men and women of and over 18 years old. Women of childbearing potential (WOCBP) must use appropriate method(s) of contraception. WOCBP should use an adequate method to avoid pregnancy for 6 months (ie, 30 days [duration of ovulatory cycle] plus the time required for the investigational drugs to undergo approximately five half-lives) after the last dose of investigational drug. WOCBP include any female who has experienced menarche and who has not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or is not postmenopausal. Post menopause is defined as: 1) Amenorrhea >/= 12 consecutive months without another cause or 2) For women with irregular menstrual periods and on hormone replacement therapy (HRT), a documented serum follicle stimulating hormone (FSH) level > 35 mIU/mL. Women who are using oral contraceptives, other hormonal contraceptives (vaginal products, skin patches, or implanted or injectable products), or mechanical products such as an intrauterine device or barrier methods (diaphragm, condoms, spermicides) to prevent pregnancy, or are practicing abstinence or where their partner is sterile (e.g., vasectomy) should be considered to be of childbearing potential. WOCBP must have a negative serum or urine pregnancy test (minimum sensitivity 25IU/L or equivalent units of HCG) within 24 hours prior to the start of investigational product. Men who are sexually active with WOCBP must use any contraceptive method with a failure rate of less than 1% per year Men receiving study drugs and who are sexually active with WOCBP will be instructed to adhere to contraception for a period of 7 months (i.e. 90 days [duration of sperm turnover] plus the time required for the investigational drug to undergo approximately five half-lives))after the last dose of investigational product Women who are not of childbearing potential (i.e., who are postmenopausal or surgically sterile as well as azoospermic men do not require contraception).\n- Target Population Melanoma cohort A: a) Histologic diagnosis of malignant melanoma; b) Unresectable Stage III/Stage IV melanoma patients with resistance to anti-PD-1/PD-L1 and measurable lesions by CT or MRI per iRECIST/RECIST criteria that can be amenable to biopsy; c) Only one line of immunotherapy for advanced (unresectable Stage III or Stage IV) disease with anti-PD-1/PDL1 and its combinations; if BRAF mutant one line of targeted therapy is allowed prior to anti-PD-1/PDL1therapy.\n- Target Population NSCLC cohort B: a) Histologic or cytologic diagnosis of NSCLC lacking EGFR-sensitizing mutation and/or ALK/ROS1 translocation; b) Stage IV NSCLC patients with primary resistance to anti-PD-1/PD-L1 and measurable lesions by CT or MRI per iRECIST/RECIST criteria that can be amenable to biopsy; c) Only one line of immunotherapy for advanced (unresectable Stage III or Stage IV) disease with anti-PD-1/PDL1 or its combinations; one line of chemotherapy is allowed prior to anti-PD-1/PDL-1 therapy.\n- confirmed PD\n- 4 weeks or greater since last treatment and\n- Must have recovered from any acute toxicity associated with prior therapy\n- Life expectancy greater than 16 weeks\n- Subjects with adequate organ function defined as: a) WBC ≥3500/uL; b) ANC ≥2000/uL; c) Platelets ≥ 100 x 103/uL; d) Hemoglobin ≥ 9 g/dL; e) Creatinine < or <= 2.5 x ULN AND creatinine clearance (CrCl) ≥ 40 mL/min (if using the Cockcroft- Gault formula below): Female: CrCl = (140 - age in years) x weight in kg x 0.85 72 x serum creatinine in mg/dL. Male: CrCl = (140 - age in years) x weight in kg x 1.00 72 x serum creatinine in mg/dL; f) AST: < or <= 2.5 x ULN for patients without liver metastasis; < or <= 5 x ULN for patients with liver metastasis; g) Bilirubin: < or <= 3 x ULN for patients with liver metastasis ; <3.0 mg/mL for patients with Gilbert’s Syndrome; 1.5 x ULN for patients without liver metastasis\n- Negative screening tests for HIV, HepB, and HepC. If positive results are not indicative of true active or chronic infection, the patient can enter the study after discussion and agreement between the Investigator and the Medical Monitor."}

Exclusion criteria

  • {"criterion_text":"- Sex and Reproductive Status a) Women who are pregnant or breastfeeding; b) WOCBP who are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period and for up to 6 months after the study; c) Women with a positive pregnancy test on enrollment or prior to investigational product administration; d) Sexually active fertile men not using effective birth control if their partners are WOCBP."}
  • {"criterion_text":"- Target Disease Exceptions a) Any malignancy from which the patient has been disease-free for less than 2 years, with the exception of adequately treated and cured basal or squamous cell skin cancer, superficial bladder cancer, carcinoma in situ of the cervix; b) Primary ocular melanoma."}
  • {"criterion_text":"- Medical History and Concurrent Diseases a) Symptomatic brain metastases requiring immediate local intervention (radiotherapy (RT) and/or surgery); b) Leptominingeal involvement by disease; c) Autoimmune disease: Patients with a documented history of Inflammatory Bowel Disease, including ulcerative colitis and Crohn’s disease are excluded from this study as are patients with a documented history of symptomatic autoimmune disease (e.g., rheumatoid arthritis, systemic progressive sclerosis [scleroderma], Systemic Lupus Erythematosus, autoimmune vasculitis [e.g., Wegener’s Granulomatosis] and autoimmune hepatitis. Subjects with motor neuropathy considered of autoimmune origin (e.g., Guillain-Barre Syndrome) are also excluded from this study; d) Any underlying medical condition, which in the opinion of the investigator, will make the administration of study drug hazardous or obscure the interpretation of adverse events, such as a condition associated with frequent diarrhea."}
  • {"criterion_text":"- Prohibited Treatments and/or Therapies a) Concomitant therapy with any anti-cancer agent; immunosuppressive agents; any non-oncology vaccine therapy used for prevention of infectious diseases (for up to 1 month prior to or after any dose of study drug); surgery or radiotherapy (except palliative surgery and/or radiotherapy to treat a non-target symptomatic lesion or to the brain after Sponsor approval); other investigational anti-cancer therapies; or chronic use of systemic corticosteroids (used in the management of cancer or non-cancer-related illnesses); b) Previous treatment with other investigational products, including cancer immunotherapy, within 30 days; c) Prior treatment with anti-CTLA-4, except in adjuvant setting"}
  • {"criterion_text":"- Other Exclusion Criteria a) Prisoners or subjects who are involuntarily incarcerated; b) Subjects who are compulsorily detained for treatment of either a psychiatric or physical (e.g., infectious disease) illness."}

Endpoints

Primary endpoints

  • {"endpoint_text":"- Tumor assessment, using the immune-related response criteria iRECIST, is made by the investigator.","definition_or_measurement_approach":"Assessment performed using immune-related response criteria iRECIST by the investigator."}
  • {"endpoint_text":"- Tumor assessment, using the immune-related response criteria iRECIST, is made by the investigator.","definition_or_measurement_approach":"Assessment performed using immune-related response criteria iRECIST by the investigator."}

Secondary endpoints

  • {"endpoint_text":"- Endpoints for safety profile include an evaluation of AEs, SAEs, laboratory evaluations, vital signs and physical examination.","definition_or_measurement_approach":"Safety assessed by evaluation of adverse events (AEs), serious adverse events (SAEs), laboratory evaluations, vital signs and physical examination."}
  • {"endpoint_text":"- Objective Response Rate (ORR) is the proportion of treated subjects with a BOR of CR or PR per RECIST 1.1.","definition_or_measurement_approach":"ORR measured as proportion of subjects with best overall response (BOR) of complete response (CR) or partial response (PR) per RECIST 1.1."}
  • {"endpoint_text":"- Disease Control Rate (DCR) is the proportion of treated subjects with a BOR of confirmed CR, confirmed PR or SD, based on RECIST 1.1 and iRECIST.","definition_or_measurement_approach":"DCR measured as proportion with confirmed CR, confirmed PR or stable disease (SD) per RECIST 1.1 and iRECIST."}
  • {"endpoint_text":"- Time to Response (TTR) is defined as the time from first dosing date until the measurement criteria are first met for overall response of PR or CR (whichever status comes first, and provided it is subsequently confirmed), , based on RECIST 1.1 and iRECIST.","definition_or_measurement_approach":"TTR = time from first dose to first measurement meeting criteria for PR or CR (whichever occurs first), confirmed per RECIST 1.1 and iRECIST."}
  • {"endpoint_text":"- Duration of Response (DoR) for the subjects whose BOR is CR or PR will be defined as the time between the date of response of confirmed CR or confirmed PR (whichever occurs first) and the date of PD or death (whichever occurs first), , based on RECIST 1.1 and iRECIST.The onset of a confirmed CR or PR is determined by the initial assessment of response, not by the confirmatory assessment.","definition_or_measurement_approach":"DoR = time from date of confirmed CR or PR to date of progression (PD) or death, per RECIST 1.1 and iRECIST. Onset determined by initial assessment of response."}
  • {"endpoint_text":"- Progression-free Survival (PFS): Progression free survival (PFS) per RECIST 1.1 and iRECIST will be defined as the time between the date of randomization and the date of progression and or confirmed PD (according to RECIST 1.1 and iRECIST) or death, whichever occurs first.","definition_or_measurement_approach":"PFS = time from randomization to date of progression/confirmed PD per RECIST 1.1 and iRECIST or death, whichever occurs first."}
  • {"endpoint_text":"- Overall Survival (OS): Overall Survival (OS) is defined as the time from randomization until the date of death. For those subjects who have not died, OS will be censored at the recorded last date of subject contact, and for subjects with a missing recorded last date of contact, OS will be censored at the last date the subject was known to be alive. Any efforts will be made to know the date of death.","definition_or_measurement_approach":"OS = time from randomization to death; censoring at last known contact date for survivors or last known alive date if contact date missing."}

Recruitment

Planned Sample Size
148
Recruitment Window Months
101
Consent Approach
Participants must be 'Willing and able to give written informed consent.' Subject information and informed consent form documents are listed (Italian ICF versions present). Consent provided by the participant (adults >=18). No assent/parental consent procedures are described (minors excluded).

Geography

Total Number Of Sites
1
Total Number Of Participants
148

Italy

Earliest CTIS Part Ii Submission Date
10-10-2024
Latest Decision Or Authorization Date
28-01-2026
Processing Time Days
475
Number Of Sites
1
Number Of Participants
148

Sites

Site Name
Azienda Ospedaliera Universitaria Senese
Department Name
Medical Oncology and Immunotherapy Center for Immuno-Oncology - Oncologia Medica
Principal Investigator Name
Anna Maria Di Giacomo
Principal Investigator Email
annamaria.digiacomo@unisi.it
Contact Person Name
Anna Maria Di Giacomo
Contact Person Email
annamaria.digiacomo@unisi.it

Sponsor

Primary sponsor

Full Name
Fondazione NIBIT Onlus
Organisation Type
Laboratory/Research/Testing facility
Country Of Registered Address
Italy

Third parties

  • {"country":"Italy","full_name":"Fullcro S.r.l.","duties_or_roles":"sponsorDuties codes: 1,10,11,12,14,3,5,6,7,8","organisation_type":"Pharmaceutical company"}

Investigational products

Investigational Product Name
ASTX727
Active Substance
decitabine, cedazuridine
Modality
Small molecule
Routes Of Administration
ORAL USE
Route
ORAL USE
Authorisation Status
MIA (IMP) 20377 and aM-33/2025
Maximum Dose
110 mg
Investigational Product Name
Decitabine for ASTX727
Active Substance
decitabine
Modality
Small molecule
Routes Of Administration
ORAL USE
Route
ORAL USE
Authorisation Status
MIA (IMP) 20377 and aM-33/2025
Maximum Dose
10 mg
Investigational Product Name
YERVOY (ipilimumab)
Active Substance
ipilimumab
Modality
Monoclonal antibody
Routes Of Administration
INTRAVENOUS USE
Route
INTRAVENOUS USE
Authorisation Status
marketingAuthorisationNumber EU/1/11/698/001
Maximum Dose
3 mg/kg
Investigational Product Name
OPDIVO (nivolumab)
Active Substance
nivolumab
Modality
Monoclonal antibody
Routes Of Administration
INTRAVENOUS USE
Route
INTRAVENOUS USE
Authorisation Status
marketingAuthorisationNumber EU/1/15/1014/002
Maximum Dose
480 mg
Combination Treatment
Yes

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