A Study of APG-3288 in Relapsed/Refractory Blood Cancers

Official title

A Phase I Study to Evaluate the Safety, Pharmacokinetics, and Preliminary Efficacy of APG-3288 in Patients With Relapsed/Refractory Hematological Malignancies

Overview

This is a Phase I, multicenter, open-label, two-stage study of APG-3288 monotherapy, aiming to determine the Maximum Tolerated Dose (MTD) and Recommended Phase 2 Dose (RP2D) of APG-3288 administered orally once daily in patients with relapsed/refractory (R/R) hematologic malignancies.

Detailed description

Part 1 (Dose Escalation Phase): Patients will receive orally administered APG-3288 at specified doses once daily in 28-day cycles. This phase aims to determine the MTD or RP2D of APG-3288 for patients who have failed standard therapy and for whom no standard therapy offering clinical benefit is available.

Part 2 (Dose Expansion Phase): Following the completion of Part 1, Part 2 will be initiated to further evaluate dose safety. Doses will be determined based on a comprehensive assessment of the pharmacokinetic (PK), pharmacodynamic (PD), safety, and efficacy data of APG-3288 from Part 1. In Part 2, up to 60 patients per chosen indication will be enrolled and randomly assigned in equal proportions to 2 or 3 dose cohorts to evaluate dose safety.

Interventions

• Drug APG-3288
  Orally administered daily; 28 days per cycle.

Primary outcome measures

• Incidence of dose-limiting toxicities (DLTs) at each dose level [Time frame: From first dose through the end of Cycle 1 (e.g., Day 1 to Day 28)]
• Incidence of treatment emergent adverse events (TEAEs) [Time frame: From first dose of study treatment through 30 days after the last dose]
• Maximum tolerated dose (MTD) and/or recommended Phase 2 dose (RP2D) of APG 3288 [Time frame: During the dose escalation phase (Part 1)]

Secondary outcome measures (8)

• Peak plasma concentration (Cmax) of APG-3288 [Time frame: From first dose through 24 hours post-dose]
• Area Under the Plasma Concentration-Time Curve (AUC) of APG-3288 [Time frame: From first dose through last measurable concentration, assessed up to 24 hours post-dose]
• Pharmacodynamic (PD) profile of APG 3288 [Time frame: From baseline of study treatment through 30 days after the last dose]
• Objective response rate (ORR) [Time frame: From first dose until the first documented disease progression or end of treatment, assessed up to 24 months]
• Duration of response (DoR) [Time frame: From the first documented response until disease progression or death, assessed up to 24 months]
• Time to response (TTR) [Time frame: From first dose until the first documented response, assessed up to 24 months]
• Progression free survival (PFS) [Time frame: From first dose until the first documented disease progression or death, whichever occurs first, assessed up to 24 months]
• Overall survival (OS) [Time frame: From first dose until death from any cause, assessed up to 24 months]

Eligibility criteria

Inclusion criteria

• Eastern Cooperative Oncology Group (ECOG) status ≤ 1 in Part 1 (dose escalation), and ≤ 2 in Part 2 (dose expansion).
• Part 1 (Dose Escalation): histologically or cytologically confirmed diagnosis of R/R CLL/SLL, DLBCL (including Richter Transformation), MCL, WM, MZL, or FL.
• Prior systemic therapy: at least 2 prior lines of systemic therapy (including BTK inhibitor for approved indications) and who have failed or are not eligible for available therapies with established clinical benefit.
• Measurable disease per response criteria specific to the malignant condition.
• Adequate organ and bone marrow function.

Exclusion criteria

• Concurrent anti-cancer therapy (chemotherapy, radiation therapy, surgery, immunotherapy, hormonal therapy, targeted therapy, biologic therapy, with the exception of hormones for hypothyroidism or estrogen replacement therapy, anti-estrogen analogs, agonists required to suppress serum testosterone levels).
• Any investigational therapy within 14 days prior to the first dose of study drug or within 5 half-lives of the respective investigational drug (whichever is shorter).
• Persistent toxicities from prior radiotherapy, targeted therapy, immunotherapy, or chemotherapy agents that have not recovered to Grade <2 (except for alopecia or vitiligo).
• Symptomatic brain metastases due to tumor involvement of the central nervous system (CNS). Patients with CNS tumors who have been treated, are asymptomatic, and who have discontinued steroids (for the treatment of CNS tumors) for > 28 days may be enrolled.
• Use of therapeutic-dose anticoagulants or antiplatelet agents. (Use of low-dose anticoagulants to maintain central venous catheter patency is permitted)
• Biological growth factors within 7 days prior to the first dose of study drug.
• Patients who, in the investigator's judgment, have not adequately recovered from prior surgery, or have undergone major surgery within 28 days prior to enrollment, or minor surgery within 14 days prior to enrollment.
• Significant cardiac disease defined as:

• New York Heart Association class III or IV cardiac disease, including pre-existing uncontrolled, clinically-significant arrhythmia, congestive heart failure, or cardiomyopathy.
• Unstable angina, myocardial infarction, or a coronary revascularization procedure within ≤ 3 months prior to initiation of study treatment.
• History of left ventricular ejection fraction < 50%.
• Poorly controlled hypertension, or history of poor compliance with antihypertensive drug regimens.
• Clinically active and uncontrolled symptomatic infection; well-controlled human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV) infection may be considered for enrollment.
• Autoimmune diseases, active inflammatory bowel disease, chronic infections, or any other disease or condition associated with chronic inflammation.
• Concurrent use of QT-prolonging medications or history of torsades de pointes.
• Concurrent malignancy other than the one being treated in this study with the exception of the following: cured malignancy without recurrence within 3 years prior to study entry; completely resected basal cell and squamous cell skin cancer; completely resected carcinoma in situ of any type.
• Any severe and/or uncontrolled medical condition that, in the investigator's opinion, may compromise the individual's safety or the evaluation of study results.
• Prior treatment with: BTK degrader treatment or allogeneic stem cell transplant

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Non-randomized

Model

Sequential

Masking

Open label

Primary purpose

Treatment

Study locations

United States · 5 centers

• START Los Angele — Los Angeles
• Mayo Clinic — Jacksonville
• START Midwest — Grand Rapids
• START New Jersey — East Brunswick
• The University of TX MD Anderson Cancer Center — Houston

China · 1 center

• Henan Cancer Hospital — Zhengzhou

Identifiers

NCT: NCT07424833 · APG3288XG101

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗