E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Advanced or recurrent solid tumors, recurrent or progressive glioblastoma, or high-grade glioma |
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E.1.1.1 | Medical condition in easily understood language |
Advanced or recurrent solid tumors or brain cancer |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10065147 |
E.1.2 | Term | Malignant solid tumor |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10018336 |
E.1.2 | Term | Glioblastoma |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objectives of this study are to determine the maximum tolerated dose (MTD) and to characterize dose-limiting toxicities (DLTs) of daily oral BAL101553, administered to adults with advanced or recurrent solid tumors who have failed standard therapy, or for whom no effective standard therapy is available, and to patients with recurrent or progressive glioblastoma (GBM) or high-grade glioma. |
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E.2.2 | Secondary objectives of the trial |
Secondary objectives:
• To evaluate the safety and tolerability of daily oral BAL101553.
• To evaluate BAL101553 and BAL27862 pharmacokinetics (PK), including the effect of fasted versus fed states.
• To assess the anti-tumor activity of daily oral BAL101553 in cancer patients.
Exploratory objectives:
• To assess the use of biomarkers to characterize pharmacodynamic effects of daily oral BAL101553.
• To explore the potential utility of biomarkers in blood and/or tumor tissue as predictive biomarkers. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Patients meeting all of the following inclusion criteria at screening will be eligible for enrollment in the study. Informed consent must be obtained within 28 days prior to the start of treatment. Screening evaluations will be performed within 15 days prior to start of treatment (within 35 days for radiology assessments).
Patients meeting all of the following:
1. Age 18 years or older.
2. Patients who have either of the following:
a. a histologically- or cytologically confirmed advanced or recurrent solid tumor, who failed standard therapy, or for whom no effective standard therapy is available to them
b. histologically-confirmed GBM or high-grade glioma, with progressive or recurrent disease after prior radiotherapy, with or without chemotherapy. This will also include patients with histologically-confirmed low-grade glioma who present with unequivocal evidence by imaging of transformation to high-grade glioma/GBM.
3. Patients with advanced solid tumors must have measurable disease (according to Response Evaluation Criteria in Solid Tumors [RECIST] v1.1) documented within 35 days prior to starting study drug, or non-measurable prostate or ovarian cancer that can be followed by prostate specific antigen (PSA) or cancer antigen-125 (CA-125), documented within 15 days prior to starting study drug.
Patients with glioblastoma or high-grade glioma must have measurable disease, defined by contrast-enhancing MRI, within 15 days prior to starting study drug. Patients with previous low-grade glioma that progressed after prior radiotherapy (with or without chemotherapy) and are found to have high-grade glioma/GBM by biopsy or imaging are also eligible.
4. Life expectancy ≥ 12 weeks.
5. Acceptable organ and marrow function documented within 15 days prior to starting study drug, defined as follows:*
• Absolute neutrophil count ≥ 1.5 × 109/L.
• Platelets ≥ 100 × 109/L.
• Hemoglobin ≥ 9 g/dL.
• Total bilirubin ≤ 1.5 × institutional upper limit of normal (ULN), unless the patient has known Gilbert’s syndrome.
• Aspartate amino transferase (AST) and alanine amino transferase (ALT) ≤ 2.5 × institutional ULN or ≤ 5 × ULN in presence of liver metastasis.
• Serum creatinine ≤ 1.5 × institutional ULN, or creatinine clearance
≥ 60 mL/min by Cockcroft-Gault formula.
• Serum sodium ≥ the institutional lower limit of normal (LLN).
* All listed laboratory parameters, and cardiac troponin (see Exclusion criterion 13), must be included in the study-specific pharmacy prescription chart. During the study, all parameters applicable for any study visit must be reviewed by the investigator and the pharmacy prior to dispensing of any study medication.
6. Patients with advanced solid tumors must have an Eastern Cooperative Oncology Group (ECOG) performance status ≤ 1 and patients with recurrent or progressive glioblastoma must have an Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2.
7. Female patients who are not pregnant or breast-feeding and meet one of the following conditions:
• Postmenopausal for at least 1 year.
• Post-hysterectomy and/or post-bilateral ovariectomy.
• Women of childbearing potential must have a negative serum human chorionic gonadotropin (hCG) pregnancy test result and must use highly effective contraceptive methods for the duration of the study and for an additional 90 days after the last dose of study drug. Highly effective contraceptive methods include male or female sterilization (bilateral tubal occlusion or vasectomy); intrauterine device (IUD); combined (estrogen and progesterone containing) hormonal contraception (oral, vaginal ring or transdermal patch) with an ethinylestradiol dose of at least 30 μg, plus use of male condoms (preferably with spermicides), female condoms, a female diaphragm or a cervical cap; or total sexual abstinence.
8. Male patients must agree not to donate sperm from the first dose of study drug until 90 days after the end of treatment. Male patients, without a vasectomy and with a partner of childbearing potential, must agree to use condoms during the study and for at least 90 days after the end of treatment. The patient should be instructed that their female partner should use another form of contraception for the duration of the study and continue this use for at least 90 days after the last dose of study drug.
9. Signed, written informed consent must be obtained and documented according to the International Conference on Harmonization’s Guideline for Good Clinical Practice E6 (ICH-GCP) [1], the local regulatory requirements, and the permission to use private health information in accordance with the Health Insurance Portability and Accountability Act (HIPAA), where required, prior to study-specific screening procedures.
10. Patients must be able and willing to comply with the required food intake restrictions (Phase 1/2a), as well as the prescribed diet (Phase 2a). |
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E.4 | Principal exclusion criteria |
Patients meeting any of the following exclusion criteria at screening must not be enrolled in the study:
1. Patients with advanced or recurrent solid tumors who have received chemotherapy, radiotherapy, immunotherapy, or investigational agents within 4 weeks (2 weeks for single fraction of palliative radiotherapy, 6 weeks for nitrosoureas or mitomycin C) prior to starting study drug, or who have not recovered to ≤ Common Terminology Criteria for Adverse Events version 4.03 (CTCAE) grade ≤ 1 from all side effects of prior therapies except for residual toxicities, such as alopecia, which do not pose an ongoing medical risk.
• Patients with prostate cancer must have discontinued anti-androgens (e.g., bicalutamide, nilutamide) for at least 6 weeks prior to starting study drug; chemical castration with luteinizing hormone-releasing hormone analogues can be continued.
Patients with recurrent or progressive GBM or high-grade glioma who have: received radiotherapy within 6 weeks, unless there is a new area of enhancement consistent with recurrent tumor outside the radiation field, or there is histological confirmation of unequivocal tumor progression; received administration of prior anti-tumor chemotherapy within 4 weeks, or within 6 weeks for nitrosoureas; undergone surgical resection within 4 weeks or a stereotactic biopsy/core biopsy within 1 week prior to starting study drug.
2. Patients who have had prior exposure to BAL101553.
3. Inability to swallow oral medication.
4. Change in steroid dose in GBM or high-grade glioma patients within 5 days prior to first study-drug administration.
5. Patients with gastrointestinal disease or those who have had a procedure that is expected to interfere with the oral absorption or tolerance of BAL101553 (e.g., functionally relevant gastrointestinal obstruction, or frequent vomiting).
6. Symptomatic brain metastases or leptomeningeal disease, indicative of active disease, in patients with advanced or recurrent solid tumors.
7. Peripheral neuropathy ≥ CTCAE grade 2.
8. Known human immunodeficiency virus (HIV) infection.
9. Known acute or chronic hepatitis B or hepatitis C infection.
10. Systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg at the screening visit. Patients with an initial clinic BP ≥ 140/90 mmHg may be included if SBP < 140 mmHg and DBP < 90 mmHg is confirmed in two subsequent BP measurements on the same day, or if subsequent daytime average from ABPM is SBP < 130 mmHg and DBP < 85 mmHg.
11. Blood pressure (BP) combination treatment with more than two antihypertensive medications.
12. Any history of cerebral hemorrhage, cerebral aneurysm, or ischemic stroke; or a history of transient ischemic attack within 24 months prior to screening in patients with advanced or recurrent solid tumors.
Acute intratumoral hemorrhage in patients with recurrent or progressive GBM or high-grade glioma, considered by the study Investigator to be clinically significant.
• Patients with MRI or CT demonstrating old hemorrhage or subacute bleed after a neurosurgical procedure (biopsy or resection) will be eligible for treatment.
13. Significant cardiac disease or abnormality, including any one of the following:
• Left ventricular ejection fraction < 50% at screening (assessed by echocardiography).
• QTcF > 470 ms on screening electrocardiogram (ECG) or a clinically relevant ECG abnormality.
• Congenital long QT syndrome.
• History of sustained ventricular tachycardia, ventricular fibrillation or torsades de pointes.
• Presence of atrial fibrillation with tachyarrhythmia (ventricular response rate > 100 bpm).
• Bradycardia (heart rate < 50 bpm).
• Complete left bundle branch block.
• Bifascicular block (complete right bundle branch block and anterior or posterior left hemiblock).
• Myocardial infarction, acute coronary syndrome (including unstable angina), coronary revascularization procedures, or coronary arterial bypass grafting within 6 months prior to starting study drug.
• Cardiac troponin (either troponin T or troponin I) above institutional ULN.
• Congestive heart failure of New York Heart Association class III or IV.
14. Uncontrolled intercurrent illness that would unduly increase the risk of toxicity or limit compliance with study requirements in the opinion of the Investigator; including but not limited to: ongoing or active symptomatic infection, uncontrolled diabetes mellitus, unstable or uncompensated cardiac, hepatic, renal, respiratory, or psychiatric illness.
15. Current anticoagulation with warfarin potassium or other coumarin derivates. Heparin/low-molecular weight heparin (at prophlylaxis or treatment doses), aspirin or other oral platelet inhibitors are permitted.
16. Women who are pregnant or breast-feeding. Men or women of reproductive potential who are not willing to apply effective birth control during the study and for at least 30 days after the last dose of study drug in both sexes. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary objectives of this study are to determine the maximum tolerated dose (MTD) and to characterize dose-limiting toxicities (DLTs) of daily oral BAL101553, administered to adults with advanced or recurrent solid tumors who have failed standard therapy, or for whom no effective standard therapy is available, and to patients with recurrent or progressive glioblastoma (GBM) or high-grade glioma. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
The MTD is determined by DLT assessment. A DLT can occur on any dosing day or at any time thereafter. |
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E.5.2 | Secondary end point(s) |
Safety and tolerability, pharmacokinetics, anti-tumor activity |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Safety and tolerability is assessed during the whole clinical trial.
Pharmacokinetics assessed at prespecified time points on day 1, day 8, day 15 and day 22 during cycle 1 and cycle 2. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | Yes |
E.7.1.1 | First administration to humans | Yes |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
Ph 2a includes randomized, crossover food effect portion on single dose PK |
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E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Information not present in EudraCT |
E.8.2.2 | Placebo | Information not present in EudraCT |
E.8.2.3 | Other | Information not present in EudraCT |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 4 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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Completion of the last study-related contact with any patient. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 5 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 5 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |