Phase 1/2 Study of TP-0903 (an Inhibitor of AXL Kinase) in Patients With Previously Treated CLL

Overview

About this study

TP-0903 is an inhibitor of AXL kinase. TP-0903 has shown potent inhibition of AXL kinase and other TAM family members in a biochemical kinase assay. TP-0903 demonstrates corresponding activity in cancer cell lines and mouse xenograft efficacy models. TP-0903 is shown to block cancer cell epithelial-to-mesenchymal transitions. AXL was identified as a potential therapeutic target in chronic lymphocytic leukemia (CLL). TP 0903 was shown to induce apoptosis in CLL B-cells taken directly from patients.TP-0903 was equally potent against CLL cells regardless of risk-factor. TP-0903 is a novel oral inhibitor that targets AXL kinase and reverses the mesenchymal phenotype associated with advanced cancers. TP-0903 has demonstrated profound single agent activity in CLL B cells taken directly from patients even if the patient has high risk factors (ie, 17p/P53 deletions) or progressed on other agents (ie, ibrutinib). TP-0903 is currently being evaluated in patients with refractory solid tumors (TP-0903-101). This proposed study is designed to identify the maximum tolerated dose (MTD), safety profile and recommended Phase 2 dose (RP2D) of TP-0903 when administered orally once daily for 28 days on a 28 day cycle to patients with previously treated CLL. Treatment cycles may be repeated if the patient continues to show benefit and if TP-0903 is reasonably well tolerated. The study will investigate the safety, pharmacokinetics, pharmacodynamics, and clinical activity of TP-0903.

Participation eligibility

Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Guidelines differ from study to study, and identify who can or cannot participate. There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. Contact the study team to discuss study eligibility and potential participation.

Inclusion Criteria: 

  • Be ≥18 years old.
  • Have an established, pathologically confirmed diagnoses of CLL/ Small Lymphocytic Lymphoma (SLL) requiring therapy according to the 2018 IWCLL guidelines.
  • Have received at least one prior therapy for CLL/SLL and can be classified in one of two patient groups:
    • Group 1 (TP-0903 monotherapy): Patients with CLL/SLL who are intolerant to, or have progressed on B-cell receptor antagonists and/or BCL-2 antagonists; or
    • Group 2 (TP-0903 and ibrutinib combination therapy): Patients with CLL/SLL who have progression of disease on ibrutinib and the treating provider considers continuation of ibrutinib therapy to be in the best interest of the patient.
  • Have an Eastern Cooperative Oncology Group (ECOG) performance status ≤2.
  • Have adequate hematologic function:
    • Absolute neutrophil count (ANC) ≥500/μL;
    • Platelet count ≥30,000/μL;
    • Hemoglobin ≥8 g/dL in the absence of transfusions within the previous 2 weeks.
  • Have adequate organ function:
    • Creatinine clearance ≥30 mL/min;
    • Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) level ≤2.5 × upper limit of normal (ULN);
    • Have a total bilirubin level ≤1.5 × ULN (unless secondary to Gilbert syndrome, hemolysis, or leukemia).
  • Have acceptable coagulation status:
    • Activated partial thromboplastin (aPTT) and prothrombin time (PT) ≤1.5 × ULN.
  • Have a negative pregnancy test (if female of childbearing potential).
  • Be nonfertile or agree to use an adequate method of contraception. Sexually active patients and their partners must use an effective method of contraception (hormonal or barrier method of birth control, or abstinence) prior to study entry and for the duration of study participation and for at least 30 days after the last study drug dose. Should a woman become pregnant or suspect that she is pregnant while participating in this study, she should inform her treating physician immediately.
  • Have read and signed the Institutional Review Board (IRB)-approved informed consent form (ICF) prior to any study related procedure. (In the event that the patient is rescreened for study participation or a protocol amendment alters the care of an ongoing patient, a new ICF must be signed).
  • Be able to comply with the requirements of the entire study.

Exclusion Criteria:

  • Have undergone prior autologous or allogeneic stem cell transplant within ≤3 months, have not recovered from transplant associated toxicities, or requires graft versus host immunosuppressive therapy. 
  • Have known central nervous system (CNS) involvement. 
  • Have Richter's transformation of CLL. 
  • Have received any monoclonal antibody therapy directed at treatment of the patient's malignancy within 2 weeks prior to anticipated first dose. 
  • Have received any anticancer therapy including chemotherapy, radiotherapy, or an investigational anticancer drug within less than 5 half lives of the last dose of that treatment
    • This exclusion criterion is not applicable to patients requiring continuation on ibrutinib.
      • Note: Certain patients with a rapidly rising white blood cell count while on ibrutinib may need to remain on this drug for medical reasons. These patients will need to be approved by the Medical Monitor and treated in accordance with the protocol.
  • Have received >20 mg/day of prednisone and 0.1 mg/day of mineralocorticoids within 7 days prior to anticipated first dose.
  • Have a corrected QT interval of >450 msec (males) and >470 msec (females) using Fridericia's correction formula.
  • Have a significant history of renal, neurologic, psychiatric, endocrinologic, metabolic, immunologic, hepatic, or cardiovascular disease or any other medical condition that, in the opinion of the Investigator, would adversely affect his/her participation in the study. 
  • Are pregnant and/or nursing, or refuse to use appropriate contraceptives during the course of the study and for at least 30 days after the last dose of study drug. 
  • History of another malignancy in the last 5 years except for the following adequately treated:
    • Local basal cell or squamous cell carcinoma of the skin; 
    • Carcinoma in situ of the cervix or breast;
    • Papillary, noninvasive bladder cancer; 
    • Early stage prostate cancer for which observation is clinically indicated; 
    • Other Stage 1 or 2 cancers currently in complete remission;
    • Any other cancer that has been in complete remission for 2 years or surgically cured Medical Monitor may be contacted for additional determination of acceptable prior cancer history.
  • Have known gastrointestinal disorders (e.g., malabsorption syndrome), complications (eg, dysphagia), or surgery that could make consumption or absorption of oral medications problematic. 
  • Have an uncontrolled systemic infection (viral, bacterial, or fungal) or fever and neutropenia within 7 days prior to anticipated first dose. 
  • Have active and uncontrolled autoimmune cytopenias for 2 or more weeks including autoimmune hemolytic anemia or idiopathic thrombocytopenic purpura (ITP).
  • Have received prior therapy with an AXL inhibitor. 
  • Have exhibited allergic reactions to a similar structural compound, biological agent, or formulation. 
  • Are unwilling or unable to comply with procedures required in this protocol.

Participating Mayo Clinic locations

Study statuses change often. Please contact the study team for the most up-to-date information regarding possible participation.

Mayo Clinic Location Status Contact

Jacksonville, Fla.

Mayo Clinic principal investigator

Asher Alban Chanan Khan, M.B.B.S., M.D.

Closed for enrollment

Contact information:

Cancer Center Clinical Trials Referral Office

(855) 776-0015

Rochester, Minn.

Mayo Clinic principal investigator

Neil Kay, M.D.

Closed for enrollment

Contact information:

Casey Aitken CCRP

(507)284-8916

Aitken.Casey@mayo.edu

Scottsdale/Phoenix, Ariz.

Mayo Clinic principal investigator

Jose Leis, M.D., Ph.D.

Closed for enrollment

Contact information:

Cancer Center Clinical Trials Referral Office

(855) 776-0015

More information

Publications

Publications are currently not available

Study Results Summary

Not yet available

Supplemental Study Information

Not yet available

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CLS-20445690

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