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    Clinical Trial Results:
    Double-Blind, Randomized, Vehicle-Controlled Proof of Concept Clinical Trial of Patidegib Gel 2%, 4%, and Vehicle to Decrease the Number of Surgically Eligible Basal Cell Carcinomas in Gorlin Syndrome Patients

    Summary
    EudraCT number
    2015-004274-15
    Trial protocol
    GB  
    Global end of trial date
    24 Apr 2017

    Results information
    Results version number
    v2(current)
    This version publication date
    03 Jul 2020
    First version publication date
    11 May 2018
    Other versions
    v1
    Version creation reason
    • Correction of full data set
    Revision of data set already provided

    Trial information

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    Trial identification
    Sponsor protocol code
    Pelle-926-201
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02762084
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    PellePharm, Inc.
    Sponsor organisation address
    275 Middlefield Rd., Suite 100, Menlo Park, United States, CA 94025
    Public contact
    Alix Alderman, PellePharm, Inc, +1 510-502-6144, aalderman@pellepharm.com
    Scientific contact
    Alix Alderman, PellePharm, Inc, +1 510-502-6144, aalderman@pellepharm.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    24 Apr 2017
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    24 Apr 2017
    Global end of trial reached?
    Yes
    Global end of trial date
    24 Apr 2017
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objectives of the study were to evaluate the following: 1.The clinical efficacy of patidegib gel 2% or 4% compared to vehicle as defined by the percent decrease in greatest diameter of Baseline treatment targeted Surgically Eligible basal cell carcinomas (SEBs) after 26 weeks of treatment. [SEBs were defined as clinically diagnosed BCCs 5 mm or greater in diameter on the face excluding the nose and periorbital skin, and 9 mm or greater at sites other than the face]. 2.The molecular efficacy of treatment as defined by reduction in the hedgehog (HH) signaling pathway target gene GLI1 after treatment with patidegib gel 2% or 4% or vehicle applied twice daily for 6 weeks to treatment-targeted SEBs. 3.The safety and tolerability of treatment with patidegib gel 2% or 4% or vehicle applied twice daily for 26 weeks.
    Protection of trial subjects
    The study was conducted in accordance with the ethical principles originating from the Declaration of Helsinki, ICH guidelines, GCP, and in compliance with local regulatory requirements pertinent to safety of trial subjects.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    06 Jun 2016
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United Kingdom: 17
    Worldwide total number of subjects
    17
    EEA total number of subjects
    17
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    6
    From 65 to 84 years
    11
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    This study was conducted by 2 principal investigators at 2 clinical sites in the United Kingdom. A total of 17 subjects were randomized.

    Pre-assignment
    Screening details
    -

    Pre-assignment period milestones
    Number of subjects started
    17
    Number of subjects completed
    17

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Carer
    Blinding implementation details
    The study drugs were packaged and labeled identically, and the study drug kits were numbered sequentially and dispensed randomly to the subjects entering the study within each investigational center. The Investigators, the site staff, PellePharm, and the Clinical Monitors were not aware of the treatment assigned to the individual study subjects. The treatment assignments for all enrolled subjects were unblinded only after the conclusion of the treatment phase of the study.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Patidegib Topical gel 2%
    Arm description
    Patidegib gel 2% applied topically twice daily for 26 weeks
    Arm type
    Experimental

    Investigational medicinal product name
    Patidegib
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Gel
    Routes of administration
    Cutaneous use
    Dosage and administration details
    Patidegib 2% gel applied topically twice daily for 26 weeks.

    Arm title
    Patidegib Topical gel 4%
    Arm description
    Patidegib gel 4% applied topically twice daily for 26 weeks
    Arm type
    Experimental

    Investigational medicinal product name
    Patidegib
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Gel
    Routes of administration
    Cutaneous use
    Dosage and administration details
    Patidegib 4% gel applied topically twice daily for 26 weeks.

    Arm title
    Vehicle gel
    Arm description
    Vehicle gel applied topically twice daily for 26 weeks
    Arm type
    Placebo

    Investigational medicinal product name
    Vehicle
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Gel
    Routes of administration
    Cutaneous use
    Dosage and administration details
    Vehicle gel applied topically twice daily for 26 weeks.

    Number of subjects in period 1
    Patidegib Topical gel 2% Patidegib Topical gel 4% Vehicle gel
    Started
    6
    6
    5
    Completed
    5
    6
    4
    Not completed
    1
    0
    1
         Consent withdrawn by subject
    1
    -
    -
         Adverse event, non-fatal
    -
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall trial
    Reporting group description
    -

    Reporting group values
    Overall trial Total
    Number of subjects
    17 17
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    6 6
        From 65-84 years
    11 11
        85 years and over
    0 0
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    60.8 ( 13.63 ) -
    Gender categorical
    Units: Subjects
        Female
    11 11
        Male
    6 6

    End points

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    End points reporting groups
    Reporting group title
    Patidegib Topical gel 2%
    Reporting group description
    Patidegib gel 2% applied topically twice daily for 26 weeks

    Reporting group title
    Patidegib Topical gel 4%
    Reporting group description
    Patidegib gel 4% applied topically twice daily for 26 weeks

    Reporting group title
    Vehicle gel
    Reporting group description
    Vehicle gel applied topically twice daily for 26 weeks

    Subject analysis set title
    Patidegib gel
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Patidegib: 2% or 4% gel applied topically twice daily for 26 weeks

    Primary: Clinical efficacy : Percentage change in tumor size from baseline

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    End point title
    Clinical efficacy : Percentage change in tumor size from baseline
    End point description
    Percent change in tumor size of Treatment-targeted Surgically Eligible Basal Cell Carcinomas (SEBs) Tumor Size from Baseline. SEBs were defined as clinically diagnosed basal cell carcinoma (BCC) 5 millimeters (mm) or greater in diameter on the face, excluding the nose and periorbital skin, and 9-millimeter (mm) or greater at sites other than the face. The percent change in greatest diameters of treatment-targeted surgically eligible basal cell carcinomas (SEBs) from Baseline to Week 26 was calculated as follows: (sum [Baseline] - sum [Week 26] / sum [Baseline] * 100), where sum = the greatest diameters of Baseline treatment-targeted SEBs, positive Numbers to represent decrease in tumor size and negative Numbers to represent increases in tumor size. Missing values were imputed using Last-Observation Carried Forward (LOCF).
    End point type
    Primary
    End point timeframe
    Baseline and Week 26
    End point values
    Patidegib Topical gel 2% Patidegib Topical gel 4% Vehicle gel
    Number of subjects analysed
    6
    6
    5
    Units: Percentage decrease from baseline
        arithmetic mean (standard deviation)
    38.82 ( 57.002 )
    25.57 ( 33.874 )
    33.00 ( 37.662 )
    Statistical analysis title
    Statistical analysis 1 for Clinical Efficacy
    Statistical analysis description
    Percent Decrease in Baseline Treatment-targeted Surgically Eligible Basal Cell Carcinomas (SEBs) Tumor Size from Baseline
    Comparison groups
    Patidegib Topical gel 2% v Vehicle gel
    Number of subjects included in analysis
    11
    Analysis specification
    Pre-specified
    Analysis type
    other [1]
    P-value
    = 0.909
    Method
    ANCOVA
    Confidence interval
    Notes
    [1] - Pairwise comparison ANCOVA with treatment group as a factor and Baseline value as a covariate
    Statistical analysis title
    Statistical analysis 2 for Clinical Efficacy
    Statistical analysis description
    Percent Decrease in Baseline Treatment-targeted Surgically Eligible Basal Cell Carcinomas (SEBs) Tumor Size from baseline
    Comparison groups
    Patidegib Topical gel 4% v Vehicle gel
    Number of subjects included in analysis
    11
    Analysis specification
    Pre-specified
    Analysis type
    other [2]
    P-value
    = 0.648
    Method
    ANCOVA
    Confidence interval
    Notes
    [2] - Pairwise comparison ANCOVA with treatment group as a factor and Baseline value as a covariate

    Primary: Molecular efficacy: Percent Change in GLI1 mRNA levels

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    End point title
    Molecular efficacy: Percent Change in GLI1 mRNA levels
    End point description
    Percent change in the Hedgehog (HH) Signaling Pathway Target Gene Glioma-associated Oncogene Homolog 1 (GLI1) Messenger Ribonucleic Acid (mRNA) Levels from Baseline. SEBs were defined as clinically diagnosed BCC 5 mm or greater in diameter on the face, excluding the nose and periorbital skin, and 9-mm or greater at sites other than the face. A single baseline SEB designated as a treatment targeted tumor at Baseline was biopsied first at Baseline and again following 6 weeks of treatment. This was used to assess percent decrease in GLI1 mRNA levels as follows: (Baseline - Week 6) / Baseline * 100, where positive numbers to represent decrease in GL1 mRNA level, and negative Numbers to represent increase in GL1 mRNA level. Any missing values are not imputed; all available data is summarized.
    End point type
    Primary
    End point timeframe
    Baseline and Week 6
    End point values
    Patidegib Topical gel 2% Patidegib Topical gel 4% Vehicle gel
    Number of subjects analysed
    4
    4
    4
    Units: percentage decrease in GLI1 mRNA levels
        arithmetic mean (standard deviation)
    53.83 ( 27.197 )
    20.69 ( 34.730 )
    28.53 ( 43.096 )
    Statistical analysis title
    Statistical analysis 1 for molecular efficacy
    Statistical analysis description
    Percent Decrease in the Hedgehog (HH) Signaling Pathway Target Gene Glioma-associated Oncogene Homolog 1 (GLI1) Messenger Ribonucleic Acid (mRNA) Levels from Baseline
    Comparison groups
    Patidegib Topical gel 2% v Vehicle gel
    Number of subjects included in analysis
    8
    Analysis specification
    Pre-specified
    Analysis type
    other [3]
    P-value
    = 0.5
    Method
    ANCOVA
    Confidence interval
    Notes
    [3] - Pairwise comparison With a factor of treatment group and using Baseline value as a covariate
    Statistical analysis title
    Statistical analysis 2 for molecular efficacy
    Statistical analysis description
    Percent Decrease in the Hedgehog (HH) Signaling Pathway Target Gene Glioma-associated Oncogene Homolog 1 (GLI1) Messenger Ribonucleic Acid (mRNA) Levels from Baseline
    Comparison groups
    Patidegib Topical gel 4% v Vehicle gel
    Number of subjects included in analysis
    8
    Analysis specification
    Pre-specified
    Analysis type
    other [4]
    P-value
    = 0.681
    Method
    ANCOVA
    Confidence interval
    Notes
    [4] - Pairwise comparison With a factor of treatment group and using Baseline value as a covariate

    Primary: Safety and Tolerability Assessment of Treatment With Patidegib Gel: Number of Participants With a Treatment-emergent Adverse Event Causally Related to Study Drug

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    End point title
    Safety and Tolerability Assessment of Treatment With Patidegib Gel: Number of Participants With a Treatment-emergent Adverse Event Causally Related to Study Drug [5]
    End point description
    All serious adverse events (SAEs) and all other non-serious adverse events (AEs) regardless of causality are located in the Reported AE Module. AEs considered as related where categorized by the Investigator as either definitely related, probably related, or possibly related. Treatment-emergent AEs are those with an onset after use of study drug.
    End point type
    Primary
    End point timeframe
    Baseline through Week 26
    Notes
    [5] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Additional statistical analysis is not applicable to this endpoint.
    End point values
    Patidegib Topical gel 2% Patidegib Topical gel 4% Vehicle gel
    Number of subjects analysed
    6
    6
    5
    Units: participants
    2
    5
    2
    No statistical analyses for this end point

    Primary: Safety and Tolerability Assessment of Treatment With Patidegib Gel: Number of Participants With Treatment-emergent Administrative Site Skin Condition AEs Causally Related to Study Drug

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    End point title
    Safety and Tolerability Assessment of Treatment With Patidegib Gel: Number of Participants With Treatment-emergent Administrative Site Skin Condition AEs Causally Related to Study Drug [6]
    End point description
    All SAEs and all other non-serious AEs, regardless of causality, are located in the Reported AE Module. The number of participants reporting administrative-site, skin condition treatment-emergent AEs considered related to study drug by the Investigator are presented below. Treatment-emergent AEs are those with an onset after use of study drug.
    End point type
    Primary
    End point timeframe
    Baseline through Week 26
    Notes
    [6] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Additional statistical analysis is not applicable to this endpoint.
    End point values
    Patidegib Topical gel 2% Patidegib Topical gel 4% Vehicle gel
    Number of subjects analysed
    6
    6
    5
    Units: Participants
        Application site alopecia
    0
    1
    0
        Application site dermatitis
    0
    1
    0
        Application site pain
    0
    1
    0
        Application site rash
    0
    1
    0
        Application site reaction
    0
    0
    1
    No statistical analyses for this end point

    Secondary: The Number of Participants Reporting New SEBs on the Face From Baseline for the Combined Patidegib Treatment Groups

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    End point title
    The Number of Participants Reporting New SEBs on the Face From Baseline for the Combined Patidegib Treatment Groups [7]
    End point description
    Facial SEBs were defined as clinically diagnosed BCC 5 mm or greater in diameter on the face, excluding the nose and periorbital skin. A new facial SEB was defined as an SEB first noted on the face after Week 2 that developed at a site where there was no visible BCC of any size at Baseline or Week 2. New facial SEBs were investigated for participants on vehicle gel versus participants on patidegib 2% and 4% gel. Missing values were imputed using LOCF.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 26
    Notes
    [7] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: New facial SEBs were investigated for participants on vehicle gel versus participants on patidegib 2% and 4% gel combined.
    End point values
    Vehicle gel Patidegib gel
    Number of subjects analysed
    5
    12
    Units: participants
    3
    2
    No statistical analyses for this end point

    Secondary: The Mean number of new SEBs on the face for the Combined Patidegib Treatment groups

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    End point title
    The Mean number of new SEBs on the face for the Combined Patidegib Treatment groups [8]
    End point description
    Facial SEBs were defined as clinically diagnosed BCC 5 mm or greater in diameter on the face, excluding the nose and periorbital skin. A new facial SEB was defined as an SEB first noted on the face after Week 2 that developed at a site where there was no visible BCC of any size at Baseline or Week 2. New facial SEBs were investigated for participants on vehicle gel versus participants on patidegib 2% and 4% gel. Missing values were imputed using LOCF. The mean number of new SEBs (number per participant) are presented. No measure of dispersion/precision was calculated.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 26
    Notes
    [8] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: New facial SEBs were investigated for participants on vehicle gel versus participants on patidegib 2% and 4% gel combined.
    End point values
    Vehicle gel Patidegib gel
    Number of subjects analysed
    5
    12
    Units: new SEBs
        number (not applicable)
    1.4
    0.4
    No statistical analyses for this end point

    Secondary: The Mean Number of New SEBs on the Face for the Combined Patidegib Treatment Groups by Tumor Population

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    End point title
    The Mean Number of New SEBs on the Face for the Combined Patidegib Treatment Groups by Tumor Population [9]
    End point description
    Facial SEBs were defined as clinically diagnosed BCC 5 mm or greater in diameter on the face, excluding the nose and periorbital skin. A new facial SEB was defined as an SEB first noted on the face after Week 2 that developed at a site where there was no visible BCC of any size at Baseline or Week 2. New facial SEBs were investigated for participants on vehicle gel versus participants on patidegib 2% and 4% gel. Missing values were imputed using LOCF. The mean number of new SEBs (number per participant) are presented. No measure of dispersion/precision was calculated.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 26
    Notes
    [9] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: New facial SEBs were investigated for participants on vehicle gel versus participants on patidegib 2% and 4% gel combined.
    End point values
    Vehicle gel Patidegib gel
    Number of subjects analysed
    5
    12
    Units: new SEBs
        number (not applicable)
    1.4
    0.3
    No statistical analyses for this end point

    Secondary: Percent Change in Baseline Treatment-targeted SEBs Tumor Size From Baseline

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    End point title
    Percent Change in Baseline Treatment-targeted SEBs Tumor Size From Baseline
    End point description
    SEBs were defined as clinically diagnosed BCC 5 mm or greater in diameter on the face, excluding the nose and periorbital skin, and 9 mm or greater at sites other than the face. The percent change in greatest diameters of Baseline treatment-targeted SEBs from Baseline to Week x (Week 6, 10, 14, 18, or 22) was calculated as follows: (sum [Baseline] - sum [Week x] / sum [Baseline] * 100), where sum = the greatest diameters of Baseline treatment-targeted SEBs, and positive numbers to represent decrease in tumor size and negative numbers to represent increase in tumor size. Missing values were imputed using LOCF.
    End point type
    Secondary
    End point timeframe
    Baseline and Weeks 6, 10, 14, 18, and 22
    End point values
    Patidegib Topical gel 2% Patidegib Topical gel 4% Vehicle gel
    Number of subjects analysed
    6
    6
    5
    Units: percentage decrease from Baseline
    arithmetic mean (standard deviation)
        Week 6
    16.0 ( 37.07 )
    6.1 ( 10.41 )
    8.2 ( 4.55 )
        Week 10
    30.8 ( 39.54 )
    10.7 ( 12.00 )
    10.5 ( 5.35 )
        Week 14
    36.1 ( 46.45 )
    14.1 ( 13.18 )
    10.7 ( 6.26 )
        Week 18
    26.0 ( 73.79 )
    18.4 ( 26.86 )
    19.6 ( 21.98 )
        Week 22
    32.1 ( 78.71 )
    23.2 ( 22.87 )
    23.2 ( 28.03 )
    No statistical analyses for this end point

    Secondary: Percent Change in Central Facial SEBs From Baseline

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    End point title
    Percent Change in Central Facial SEBs From Baseline
    End point description
    Central facial SEBs were defined as those located on the nose or periorbital area (eyelids) which were 3 mm or greater at Baseline. The percent change from Baseline to Week x (Week x = Weeks 6, 10, 14, 18, 22, or 26) in central facial SEBs was calculated as follows: [sum (Baseline) - sum (Week x)] / [sum (Baseline)] * 100 where sum = the greatest diameters of Baseline treatment-targeted SEBs where positive numbers to represent decrease in tumor size and negative numbers to represent increase in tumor size. Missing values were imputed using LOCF. The data presented as "99999" indicates that the standard deviation was not calculated because there was only 1 participant in the analysis population.
    End point type
    Secondary
    End point timeframe
    Baseline and Weeks 6, 10, 14, 18, 22, and 26
    End point values
    Patidegib Topical gel 2% Patidegib Topical gel 4% Vehicle gel
    Number of subjects analysed
    1
    2
    2
    Units: percent decrease in central facial SEBs
    arithmetic mean (standard deviation)
        Week 6
    5.9 ( 99999 )
    -20.0 ( 28.28 )
    8.0 ( 24.11 )
        Week 10
    5.9 ( 99999 )
    -10.0 ( 42.43 )
    12.5 ( 17.68 )
        Week 14
    5.9 ( 99999 )
    -60.0 ( 84.85 )
    29.5 ( 28.93 )
        Week 18
    5.9 ( 99999 )
    -70.0 ( 70.71 )
    17.0 ( 11.25 )
        Week 22
    5.9 ( 99999 )
    -45.0 ( 63.64 )
    29.5 ( 28.93 )
        Week 26
    5.9 ( 99999 )
    -65.0 ( 63.64 )
    20.5 ( 41.78 )
    No statistical analyses for this end point

    Secondary: Proportion of Non-central Facial BCCs Increasing to ≥ 5 mm From Baseline

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    End point title
    Proportion of Non-central Facial BCCs Increasing to ≥ 5 mm From Baseline
    End point description
    The proportion of non-central facial BCCs that at Baseline measured a greatest diameter of < 5 mm and increased to a diameter of ≥ 5 mm by Week x (Week x = Weeks 6, 10, 14, 18, 22, or 26) were calculated for each participant as follows: (Number of non−central facial BCCs with greatest diameter ≥ 5 mm at Week x) / (Number of non−central facial BCCs with greatest diameter < 5 mm at Baseline). Missing values were imputed using LOCF.
    End point type
    Secondary
    End point timeframe
    Baseline and Weeks 6, 10, 14, 18, 22, and 26
    End point values
    Patidegib Topical gel 2% Patidegib Topical gel 4% Vehicle gel
    Number of subjects analysed
    3
    2
    3
    Units: proportion of BBCs
    arithmetic mean (standard deviation)
        Week 6
    0.17 ( 0.289 )
    0 ( 0 )
    0.17 ( 0.289 )
        Week 10
    0 ( 0 )
    0.67 ( 0.474 )
    0.17 ( 0.289 )
        Week 14
    0 ( 0 )
    0 ( 0 )
    0 ( 0 )
        Week 18
    0 ( 0 )
    0.17 ( 0.233 )
    0 ( 0 )
        Week 22
    0 ( 0 )
    0.34 ( 0.474 )
    0 ( 0 )
        Week 26
    0 ( 0 )
    0 ( 0 )
    0.11 ( 0.191 )
    No statistical analyses for this end point

    Secondary: Proportion of Treatment-Targeted SEBs No Longer Classified as SEBs After 26 Weeks

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    End point title
    Proportion of Treatment-Targeted SEBs No Longer Classified as SEBs After 26 Weeks
    End point description
    SEBs were defined as clinically diagnosed BCC 5 mm or greater in diameter on the face, excluding the nose and periorbital skin, and 9 mm or greater at sites other than the face. The proportion of Baseline treatment-targeted SEBs that at the end of 26 weeks of treatment were no longer large enough to be classified as SEBs (that is, the proportion of Baseline treatment targeted SEBs on the face that became < 5 mm in greatest diameter and non-facial Baseline treatment targeted SEBs that became < 9 mm in greatest diameter) were calculated for each participant as follows: (Number of Baseline treatment-targeted facial SEBs with greatest diameter < 5 mm) + (Baseline treatment targeted non-facial SEBs with greatest diameter < 9 mm) / Number of baseline treatment targeted SEBs. Missing values were imputed using LOCF.
    End point type
    Secondary
    End point timeframe
    Baseline and Weeks 6, 10, 14, 18, 22, and 26
    End point values
    Patidegib Topical gel 2% Patidegib Topical gel 4% Vehicle gel
    Number of subjects analysed
    6
    6
    5
    Units: Proportion of SEBs
    arithmetic mean (standard deviation)
        Week 6
    0.37 ( 0.497 )
    0.13 ( 0.242 )
    0.12 ( 0.179 )
        Week 10
    0.40 ( 0.473 )
    0.13 ( 0.103 )
    0.16 ( 0.219 )
        Week 14
    0.53 ( 0.468 )
    0.23 ( 0.234 )
    0.16 ( 0.219 )
        Week 18
    0.57 ( 0.497 )
    0.23 ( 0.320 )
    0.28 ( 0.303 )
        Week 22
    0.53 ( 0.516 )
    0.30 ( 0.276 )
    0.32 ( 0.363 )
        Week 26
    0.53 ( 0.516 )
    0.30 ( 0.303 )
    0.36 ( 0.434 )
    No statistical analyses for this end point

    Secondary: Percentage of Treatment-targeted SEBs Achieving Clear or Almost Clear on the 5-point Investigator Static Global Tumor Assessment (ISGTA) Scale

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    End point title
    Percentage of Treatment-targeted SEBs Achieving Clear or Almost Clear on the 5-point Investigator Static Global Tumor Assessment (ISGTA) Scale
    End point description
    The ISGTA is a scale with scores ranging from 0 (clear), 1 (almost clear), 2 (minimal residual tumor), to 3 (clearly visible tumor). The Investigator assessed each Baseline treatment-targeted SEB at Weeks 6, 10, 14, 18, 22, and 26. SEBs were defined as clinically diagnosed BCC 5 mm or greater in diameter on the face, excluding the nose and periorbital skin, and 9 mm or greater at sites other than the face. The percentage of Baseline treatment-targeted SEBs evaluated as being clear or almost clear at Week x (Week x = Week 6, 10, 14, 18, 22 or 26) based on the ISGTA scale was calculated as follows: (Number of baseline treatment-targeted SEBs with ISGTA score of 0 or 1 at Week x) / (Number of Baseline treatment-targeted SEBs) * 100. Missing data were imputed using LOCF. The percentage of responders achieving clear (0) or almost clear (1) on the ISGTA scale are presented by Week.
    End point type
    Secondary
    End point timeframe
    Baseline and Weeks 6, 10, 14, 18, 22, and 26
    End point values
    Patidegib Topical gel 2% Patidegib Topical gel 4% Vehicle gel
    Number of subjects analysed
    6
    6
    5
    Units: Percentage of participants
    number (not applicable)
        Week 6
    23.3
    3.3
    12.0
        Week 10
    23.3
    13.3
    8.0
        Week 14
    33.3
    13.3
    8.0
        Week 18
    33.3
    23.3
    20.0
        Week 22
    36.7
    26.7
    20.0
        Week 26
    33.3
    30.0
    24.0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    26 weeks
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    19.0
    Reporting groups
    Reporting group title
    Patidegib gel 2%
    Reporting group description
    Patidegib gel 2% applied topically twice daily for 26 weeks

    Reporting group title
    Patidegib gel 4%
    Reporting group description
    Patidegib gel 4% applied topically twice daily for 26 weeks

    Reporting group title
    Vehicle gel
    Reporting group description
    Vehicle gel applied topically twice daily for 26 weeks

    Serious adverse events
    Patidegib gel 2% Patidegib gel 4% Vehicle gel
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    2 / 5 (40.00%)
         number of deaths (all causes)
    0
    0
    0
         number of deaths resulting from adverse events
    0
    0
    0
    Infections and infestations
    Pneumonia A
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pneumonia pneumococcal
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Patidegib gel 2% Patidegib gel 4% Vehicle gel
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    4 / 6 (66.67%)
    6 / 6 (100.00%)
    3 / 5 (60.00%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    0
    1
    General disorders and administration site conditions
    Application site alopecia
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    0
    1
    0
    Application site dermatitis
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    0
    1
    0
    Application site pain
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    0
    1
    0
    Application site rash
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    0
    1
    0
    Application site reaction
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    0
    1
    Fatigue
         subjects affected / exposed
    2 / 6 (33.33%)
    3 / 6 (50.00%)
    2 / 5 (40.00%)
         occurrences all number
    2
    3
    2
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    1
    0
    1
    Dysphonia
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    0
    Psychiatric disorders
    Depressed mood
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    0
    1
    0
    Nervous system disorders
    Ageusia
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    0
    Dysgeusia
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    1
    Trigeminal neuralgia
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    0
    Eye disorders
    Episcleritis
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    0
    1
    0
    Gastrointestinal disorders
    Constipation
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    0
    1
    Diarrhoea
         subjects affected / exposed
    1 / 6 (16.67%)
    2 / 6 (33.33%)
    0 / 5 (0.00%)
         occurrences all number
    1
    2
    0
    Food poisoning
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    0
    Nausea
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    1
    Skin and subcutaneous tissue disorders
    Alopecia
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    0
    1
    Hair growth abnormal
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    0
    Pruritus
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    0
    1
    Rash
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    0
    1
    0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    0
    1
    Nephrolithiasis
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    0
    1
    0
    Endocrine disorders
    Hyperthyroidism
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    0
    Hypothyroidism
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    0
    1
    Musculoskeletal and connective tissue disorders
    Arthritis
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    0
    Muscle spasms
         subjects affected / exposed
    1 / 6 (16.67%)
    1 / 6 (16.67%)
    2 / 5 (40.00%)
         occurrences all number
    1
    1
    2
    Infections and infestations
    Candida infection
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    0
    Cellulitis
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    0
    Nasopharyngitis
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    0
    1
    0
    Oral herpes
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    0
    Viral upper respiratory tract infection
         subjects affected / exposed
    1 / 6 (16.67%)
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    1
    0
    Metabolism and nutrition disorders
    Diabetes mellitus
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    0
    1
    Hypercholesterolaemia
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    0
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    27 Jan 2016
    •Section 6.1 Overall Study Design and Plan was edited to provide a rationale for the dose level and frequency of the topical gel, based on nonclinical data and the known characteristics of the oral formulation. Patidegib 2% and 4% gel applied twice daily was predicted to be effective while providing a large safety margin for both dermal and systemic safety. •Table 2 Schedule of Assessments footnote e was expanded to specify that the following clinical laboratory tests would be performed: chemistry (AST, total bilirubin, BUN, calcium, carbon dioxide, chloride, creatinine, glucose, potassium, protein, sodium), hematology (WBC, RBC, hemoglobin, hematocrit, MCV, MCH, MCHC, Red Cell Distribution Width, Platelets, Mean Platelet Volumes, Absolute/Percent Neutrophil Count, Absolute/Percent Lymphocyte count, Absolute/Percent Monocyte count, Absolute/Percent Eosinophil Count, Absolute/Percent Basophil Count), and urinalysis (including reflex microscopic examination). •Appendix 16.4 Safety Laboratory Tests was newly added to provide a detailed list of clinical laboratory assessments to be collected. •Section 8.3 Unblinding was edited to clarify that, in the case of a medical emergency, the Investigator could break the blind for the subject involved without first discussing the situation with the Medical Monitor.
    02 Mar 2016
    . •Section 1 Synopsis and Section 7.1 Subject Inclusion Criteria were edited per feedback from the MHRA to specify 2 acceptable methods of contraception: 1) barrier method in association with bilateral tubal ligation, combined oral contraceptives, or implanted or injectable contraceptives with a stable dose for at least 1 month prior to Baseline; or 2) hormonal intrauterine device inserted at least 1 month prior to Baseline. •Section 10.1.1 Screening Visit and Section 10.1.5 Week 26 were edited. Previously, subject height assessment was erroneously included at these visits; it was removed. •Section 10.1.2 Baseline Visit (Day 1) was edited. Height and weight assessments were erroneously included in item 4; they were removed as they already were present in item 5.
    18 Aug 2016
    •Synopsis/Section 7.1 Inclusion Criteria 8-Female subjects must have a negative serum pregnancy test at Screening. 9-If the subject is a male with a female sexual partner who is of childbearing potential the couple is willing to use two effective methods of birth control during the duration of the trial and for one month after the last application of the gel. A female of childbearing potential is a sexually mature woman who has not undergone a hysterectomy or bilateral oophorectomy; or has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months), must agree to use two effective methods of contraception for the duration of the study and at least 1 month after the last study drug application. The two forms of birth control authorized are defined as the use of a barrier method of contraception (condom with spermicide) in association with one of the following methods of birth control: bilateral tubal ligation; combined oral contraceptives (estrogens and progesterone) or implanted or injectable contraceptives with a stable dose for at least 1 month prior to Baseline; hormonal intra-uterine device (IUD) inserted at least 1 month prior to Baseline. •Synopsis/Section 7.2 Exclusion Criteria 1-The subject is a woman of childbearing potential. (based on the key role of the HH pathway in embryogenesis, the known preclinical teratogenic effects of systemic cyclopamine, a naturally occurring inhibitor of SMO, and the unknown level of systemic exposure following topical application of patidegib in humans) A female of childbearing potential is a sexually mature woman who has not undergone a hysterectomy or bilateral oophorectomy or has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months. 10-Female sexual partner(s) of male subjects unwilling/unable to comply with pregnancy prevention measures.
    18 Aug 2016
    •Synopsis Safety Measurements /Section 10.3.1 Dermal Safety and Tolerability were amended to specify that safety and tolerability would be evaluated, and that each of the 5 baseline treatment-targeted tumor sites, as well as the face in general, would be evaluated separately for these signs and symptoms of application site reactions. Scales for assessing local skin reactions were clarified to specify that the subjects should rate the symptoms experienced at the application site(s). •Synopsis Statistical Methods /Section 11 Statistics were edited to add that if determined appropriate by the Sponsor, limited efficacy analysis on tumor shrinkage and biomarkers might have been performed after the last subject completed 14 weeks of treatment. •Table 2 Schedule of Assessments was edited to indicate that at Baseline and Week 6, a BCC was to be identified for biopsy, and that visible BCCs were to be measured at Baseline and at Weeks 2, 6, 10, 14, 18, 22, and 26/ET. Footnote f was added: Tumors to be measured and mapped included the 5 baseline treatment-targeted tumors as well as all other facial tumors including those on the eyelids and the nose. In addition, up to 10 non treatment-targeted non-facial tumors also were measured and mapped. •Section 10 Study Procedures and Evaluations was edited to indicate that a physician must identify the treatment targeted tumor to be biopsied.
    18 Aug 2016
    •Section 10.1.2 Baseline Visit (Day 1) was edited to clarify the following procedures: 7. The Investigator will perform the clinical evaluation to identify BCCs including the 5 baseline treatment-targeted tumors, as well as, all other facial tumors (including those on the eyelids and the nose). In addition, up to 10 non treatment-targeted non facial tumors will also be clinically classified as superficial, nodular, infiltrative, morpheic or sclerosing, pigmented, or micronodular/morpheaform, circle each tumor in ink, photographed, measured, and recorded on a body diagram. The 5 baseline treatment-targeted tumors will also be evaluated based on the ISGTA. 8. Obtain 2 mm punch biopsy from the baseline treatment targeted SEB that has been designated for biomarker evaluation. The 2 mm punch biopsies can be performed by the Investigator or designee as allowed by the clinical site's normal policies and procedures. 9. The Investigator or designee will assess each of the areas to be treated by observations and questioning the subjects as necessary for the signs and symptoms of irritation including pain/burning, pruritus, erythema, edema, and scabbing/crusting. Each of the 5 treatment targeted-tumors, as well as the face in general, will be evaluated separately.
    18 Aug 2016
    •Section 10.1.3 Weeks 2, 10, 18, and 22; Section 10.1.4 Weeks 6, 14, and 26; and Section 10.1.5 Week 26 (Day 183 ± 3 Days) / Early Termination were edited to clarify the following procedures: -The Investigator will perform the clinical evaluation of the 5 baseline treatment targeted tumors, as well as, all other facial tumors (including those on the eyelids and the nose). In addition, up to 10 non treatment-targeted non-facial tumors will be circled in ink, photographed, measured, and recorded on a body diagram. The 5 baseline treatment-targeted tumors will be evaluated based on the ISGTA. -The Investigator or designee will assess each of the treated areas by observations and questioning the subjects as necessary for the signs and symptoms of irritation including pain/burning, pruritus, erythema, edema, and scabbing/crusting. Each of the 5 treatment-targeted tumors, as well as the face in general, will be evaluated separately. Section 10.1.4 Weeks 6, 14, and 26 was edited to clarify the following procedure: -Obtain a biopsy with a 2 mm punch at Week 6 from the single SEB designated as the biomarker treatment targeted tumor and previously biopsied at baseline. The 2 mm punch biopsies can be performed by the Investigator or designee as allowed by the clinical site's normal policies and procedures. •Section 10.1.5 Week 26 (Day 183 ± 3 Days) / Early Termination was edited to remove the 2 mm punch biopsy of non-responding tumors for subjects considered to be non responders. •Section 10.2 (Evaluation of Efficacy) renamed, “Evaluation of Tumors.” •Section 11 Statistics and Section 11.6 Interim Analyses were edited to remove the sentence, “No interim analyses are planned.” Text was added to Section 11.6: “If determined appropriate by the Sponsor, limited efficacy analysis on tumor shrinkage and biomarkers may be performed after the last subject completes 14 weeks of treatment.” •Section 13 (Data Monitoring Committee) was renamed, “Data Safety Monitoring Committee.”

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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