Phase II study of TAK-228 in Relapsed Lymphoma
Jason R. Westin
The goal of this clinical research study is to learn if TAK-228 can help to control relapsed lymphoma. The safety of this drug will also be studied.
Disease Group: Lymphoma
Treatment Agent: TAK228
Treatment Location: Only at MDACC
Sponsor: Takeda Pharmaceuticals, Inc.
Primary Objectives Phase II: The primary objective of the Phase II portion of the trial is to define the overall response rate, defined as the combination of complete (CR) and partial (PR) response rates, of TAK228 in patients with relapsed lymphoma. Secondary Objectives Phase II: The secondary objectives of the Phase II portion of the trial are to define the safety & tolerability, progression free survival, duration of response, and overall survival of TAK228 in patients with relapsed lymphoma. Exploratory Objectives The exploratory objectives are to define: Determination of response associated clinical characteristics, The incidence of activating mutations in MTOR and related genes in patients who respond to TAK228 in their archival lymphoma biopsy tissue, The change in phosphorylation of mTORC1/2 target proteins and related signaling proteins at baseline and after therapy with TAK228 in peripheral blood mononuclear cells by utilizing reverse phase protein array, The change in phosphorylation of mTORC1/2 target proteins and related signaling proteins at baseline and after therapy with TAK228 in optional pre- and post- therapy biopsy by utilizing reverse phase protein array
IRB Review and Approval Date: 03/01/2017
Recruitment Status: Open
Projected Accrual: N/A
1) Each patient must meet all of the following inclusion criteria to be
enrolled in the study: 1. Male or female patients 18 years or older.
2) Voluntary written consent must be given before performance of any study related procedure not part of standard medical care, with the understanding that consent may be withdrawn by the patient at any time without prejudice to future medical care.
3) Female patients who: are postmenopausal for at least 1 year before the screening visit, OR are surgically sterile, OR if they are of childbearing potential, agree to practice 1 effective methods of contraception and one additional effective (barrier) method, at the same time, from the time of signing the informed consent through 90 days (or longer, as mandated bu local labeling [eg,USPI, SmPC, etc;]) after the last dose of study drug, or agree to practice true abstinence, when this is in line with the preferred and usual lifestyle of the patient (Periodic abstinence [e.g, calendar, ovulation, symptothermal, postovulation methods] and withdrawal,spermicides only, ad lactational amenorrhea are not acceptable methods of contraception.Female and male condoms should not be used together.
4) Male patients, even if surgically sterilized (ie, status post-vasectomy), who: agree to practice highly effective barrier contraception during the entire study treatment period and through 120 days after the last dose of study drug, or agree to practice true abstinence, when this is in line with the preferred and usual lifestyle of the patient (Periodic abstinence [e.g, calendar, ovulation, symptothermal, postovulation methods for the female partner] and withdrawal, spermicides only, ad lactational amenorrhea are not acceptable methods of contraception. Female and male condoms should not be used togther; Agree not to donate sperm during the course of this study or 120 days after receiving their last dose of study drug
5) Patients must have a diagnosis of prior treated diffuse large b-cell lymphoma, mantle cell lymphoma, transformed lymphoma, follicular lymphoma (any grade), small lymphocytic lymphoma, marginal zone lymphoma, or Hodgkin lymphoma with at least 2 lines of therapy without a curative treatment options.
6) Eastern Cooperative Oncology Group (ECOG) performance status and/or other performance status </= 2.
7) Adequate organ function, as specified below, within 3 weeks before the first dose of study drug: a) Bone marrow reserve consistent with: absolute neutrophil count (ANC) >/=1.5 x 10^9/L; platelet count >/=100 x 10^9/L; hemoglobin >/=9 g/dL without transfusion within 1 week preceding study drug administration; b) Hepatic: total bilirubin < /=1.5 x upper limit of normal (ULN), transaminases (aspartate aminotransferase-AST and alanine aminotransferase ALT) </= 2.5 x ULN (</= 5 x ULN if liver metastases are present); c) Renal: creatinine clearance >/= 50 mL/min based either on Cockroft-Gault estimate or based on urine collection (12 or 24 hour); d) Metabolic: fasting serum glucose (</=130 mg/dL) and fasting triglycerides </=300 mg/dL;
8) Ability to swallow oral medications;
9) Measurable disease, defined as >/=1.5 cm on imaging assessment.
1) Eligible for therapy for the lymphoid malignancy which has a high
likelihood of a curative result in the opinion of the investigator.
2) Female patients who are both lactating and breastfeeding or have a positive serum pregnancy test during the screening period
3) Any serious medical or psychiatric illness that could, in the investigator’s opinion, potentially interfere with the completion of treatment according to this protocol
4) Concurrent malignancies except basal or squamous cell carcinoma of the skin, or cervical carcinoma in situ treated with curative intent. Any cancer from which the patient has been disease free for at least 2 years is permissible.
5) Treatment with any investigational products within 14 days before the first dose of study drug
6) Failed to recover to baseline or stable grade 1 from the reversible effects of prior anticancer therapies with the exception of alopecia.
7) Manifestations of malabsorption due to prior gastrointestinal (GI) surgery, GI disease, or for an unknown reason that may alter the absorption of TAK228; such as significant chronic diarrhea. In addition, patients with enteric stomata are also excluded.
8) Poorly controlled diabetes mellitus defined as HbA1c > 7%; subjects with a history of transient glucose intolerance due to corticosteroid administration are allowed in this study if all other inclusion/exclusion criteria are met;
9) History of any of the following within the last 6 months prior to study entry: ischemic myocardial event, including angina requiring therapy and artery revascularization procedures; Ischemic cerebrovascular event, including TIA and artery revascularization procedures; Requirement for inotropic support (excluding digoxin) or serious (uncontrolled) cardiac arrhythmia (including atrial flutter/fibrillation, ventricular fibrillation or ventricular tachycardia); Placement of a pacemaker for control of rhythm; New York Heart Association (NYHA) Class III or IV heart failure; Pulmonary embolism.
10) History of any of the following within the last 6 months prior to study entry: Requirement of inotropic support; Serious uncontrolled cardiac arrhythmia (including atrial flutter/fibrillation, ventricular fibrillation or ventricular tachycardia); Placement of a pacemaker for control of rhythm
11) Significant active cardiovascular or pulmonary disease at the time of study entry, including: uncontrolled high blood pressure (i.e., systolic blood pressure >180 mm Hg, diastolic blood pressure > 95 mm Hg) Use of anti-hypertensive agents to control hypertension before cycle 1 day 1 is allowed; Pulmonary hypertension; Uncontrolled asthma or O2 saturation < 90% by ABG (Arterial Blood Gas) analysis or pulse oximetry on room air; Significant valvular disease; severe regurgitation or stenosis by imaging independent of symptom control with medical intervention, or history of valve replacement; medically significant (symptomatic) bradycardia; History of arrhythmia requiring an implantable cardiac defibrillator; Baseline prolongation of the rate-corrected QT interval (QTc) (e.g., repeated demonstration of QTc interval > 480 milliseconds, or history of congenital long QT syndrome, or torsades de pointes).
12) Treatment with strong inhibitors and/or inducers of cytochrome P450 (CYP) 3A4, CYP2C9 or CYP2C19 within 1 week preceding the first dose of study drug.
13) Patients receiving systemic corticosteroids (either IV or oral steroids, excluding inhalers or low-dose hormone replacement therapy as defined no greater than 20mg of prednisone daily) within 1 week before administration of the first dose of study drug.
14) Other clinically significant co-morbidities, such as uncontrolled pulmonary disease, active central nervous system disease, active infection, or any other condition that could compromise participation of the patient in the study.
15) Central nervous system (CNS) lymphoma.
16) Known human immunodeficiency virus infection.
17) Known hepatitis B surface antigen-positive, or known or suspected active hepatitis C infection.
18) Diagnosed or treated for another malignancy within 2 years before administration of the first dose of study drug, or previously diagnosed with another malignancy and have any evidence of residual disease. Patients with nonmelanoma skin cancer or carcinoma in situ of any type are not excluded if they have undergone complete resection
19) Daily or chronic use of a proton pump inhibitor (PPI) and/or having taken a PPI within 7 days before receiving the first dose of study drug
Information and next steps
Jason R. Westin
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