CLINICAL TRIAL / NCT03157128
A Study of Selpercatinib (LOXO-292) in Participants With Advanced Solid Tumors, RET Fusion-Positive Solid Tumors, and Medullary Thyroid Cancer (LIBRETTO-001)
- Interventional
- Recruiting
- NCT03157128
Contact Information
A Phase 1/2 Study of Oral Selpercatinib (LOXO-292) in Patients With Advanced Solid Tumors, Including RET Fusion-Positive Solid Tumors, Medullary Thyroid Cancer, and Other Tumors With RET Activation (LIBRETTO-001)
This is an open-label, first-in-human study designed to evaluate the safety, tolerability, pharmacokinetics (PK) and preliminary anti-tumor activity of selpercatinib (also known as LOXO-292) administered orally to participants with advanced solid tumors, including rearranged during transfection (RET)-fusion-positive solid tumors, medullary thyroid cancer (MTC) and other tumors with RET activation.
This is an open-label, multi-center Phase 1/2 study in participants with advanced solid
tumors, including RET fusion-positive solid tumors, MTC, and other tumors with RET
activation. The trial will be conducted in 2 parts: Phase 1 (dose escalation - completed) and
phase 2 (dose expansion). Participants with advanced cancer are eligible if they have
progressed on or are intolerant to available standard therapies, or no standard or available
curative therapy exists, or in the opinion of the Investigator, they would be unlikely to
tolerate or derive significant clinical benefit from appropriate standard of care therapy, or
they declined standard therapy. A dose of 160 milligrams (mg) twice a day (BID) has been
selected as the recommended phase 2 dose (RP2D). Approximately 875 participants with advanced
solid tumors harboring a RET gene alteration in tumor and/or blood will be enrolled to one of
seven phase 2 cohorts:
- Cohort 1: Advanced RET fusion positive solid tumor other than NSCLC or thyroid cancer
for participants who progressed on or intolerant to first line therapy (open)
- Cohort 2: Advanced RET fusion positive solid tumor other than NSCLC or thyroid cancer
for treatment naïve participants (open)
- Cohort 3: Advanced RET-mutant MTC participants who progressed on or intolerant to first
line therapy (closed)
- Cohort 4: Advanced RET-mutant MTC participants who are treatment naïve (closed)
- Cohort 5: Advanced RET-altered solid tumor for participants other than NSCLC or thyroid
cancer and RET-mutant MEN2 spectrum tumors (e.g. pheochromocytoma) otherwise ineligible
for cohorts 1-4. See details in inclusion/exclusion criteria (open)
- Cohort 6: Participants otherwise eligible for Cohorts 1-5 who discontinued another RET
inhibitor due to intolerance may be eligible with prior Sponsor approval (closed)
- Cohort 7: RET fusion positive early-stage non-small cell lung cancer (NSCLC)
participants who are candidates for definitive surgery. Participants will receive
selpercatinib in a neoadjuvant and adjuvant setting. Participants will be followed for
disease recurrence for up to 5 years from the date of surgery (closed)
Gender
All
Age Group
12 Years and up
Accepting Healthy Volunteers
No
Key Inclusion Criteria:
For Phase 1:
- Participants with a locally advanced or metastatic solid tumor that:
- Has progressed on or is intolerant to standard therapy, or
- For which no standard therapy exists, or in the opinion of the Investigator, are not
candidates for or would be unlikely to tolerate or derive significant clinical benefit
from standard therapy, or
- Decline standard therapy
- Prior multikinase inhibitors (MKIs) with anti-RET activity are allowed
- A RET gene alteration is not required initially. Once adequate PK exposure is
achieved, evidence of RET gene alteration in tumor and/or blood is required as
identified through molecular assays, as performed for clinical evaluation
- Measurable or non-measurable disease as determined by RECIST 1.1 or RANO as
appropriate to tumor type
- Eastern Cooperative Oncology Group (ECOG) score of 0, 1, or 2 or Lansky Performance
Score (LPS) greater than or equal to (≥) 40 percent (%) (age less than [<] 16 years)
with no sudden deterioration 2 weeks prior to the first dose of study treatment
- Adequate hematologic, hepatic and renal function
- Life expectancy of at least 3 months
For Phase 2: As for phase 1 with the following modifications:
- For Cohort 1: Participants must have received prior standard therapy appropriate for
their tumor type and stage of disease, or in the opinion of the Investigator, would be
unlikely to tolerate or derive clinical benefit from appropriate standard of care
therapy
- Cohorts 1 and 2:
- Enrollment will be restricted to participants with evidence of a RET gene
alteration in tumor
- At least one measurable lesion as defined by RECIST 1.1 or RANO, as appropriate
to tumor type and not previously irradiated
- Cohorts 3 and 4: Enrollment closed
- Cohort 5:
- Cohorts 1-4 without measurable disease
- MCT not meeting the requirements for Cohorts 3 or 4
- MTC syndrome spectrum cancers (e.g., MTC, pheochromocytoma), cancers with
neuroendocrine features/differentiation, or poorly differentiated thyroid cancers
with other RET alteration/activation may be allowed with prior Sponsor approval
- cfDNA positive for a RET gene alteration not known to be present in a tumor
sample
- Cohort 6: Participants who otherwise are eligible for Cohorts 1, 2 or 5 who
discontinued another RET inhibitor may be eligible with prior Sponsor approval
- Cohort 7: Participants with a histologically confirmed stage IB-IIIA NSCLC and a RET
fusion; determined to be medically operable and tumor deemed resectable by a thoracic
surgical oncologist, without prior systemic treatment for NSCLC
Key Exclusion Criteria (Phase 1 and Phase 2):
- Phase 2 Cohorts 1 and 2: an additional known oncogenic driver
- Cohorts 3 and 4: Enrollment closed
- Cohorts 1, 2 and 5: prior treatment with a selective RET inhibitor Notes: Participants
otherwise eligible for Cohorts 1, 2, and 5 who discontinued another selective RET
inhibitor may be eligible for Phase 2 Cohort 6 with prior Sponsor approval
- Investigational agent or anticancer therapy (including chemotherapy, biologic therapy,
immunotherapy, anticancer Chinese medicine or other anticancer herbal remedy) within 5
half-lives or 2 weeks (whichever is shorter) prior to planned start of LOXO-292
(selpercatinib). In addition, no concurrent investigational anti-cancer therapy is
permitted Note: Potential exception for this exclusion criterion will require a valid
scientific justification and approval from the Sponsor
- Major surgery (excluding placement of vascular access) within 2 weeks prior to planned
start of LOXO-292 (selpercatinib)
- Radiotherapy with a limited field of radiation for palliation within 1 week of planned
start of LOXO-292 (selpercatinib), with the exception of participants receiving
radiation to more than 30% of the bone marrow or with a wide field of radiation, which
must be completed at least 4 weeks prior to the first dose of study treatment
- Any unresolved toxicities from prior therapy greater than Common Terminology Criteria
for Adverse Events (CTCAE) Grade 1 at the time of starting study treatment with the
exception of alopecia and Grade 2, prior platinum-therapy related neuropathy
- Symptomatic primary CNS tumor, metastases, leptomeningeal carcinomatosis, or untreated
spinal cord compression. Participants are eligible if neurological symptoms and CNS
imaging are stable and steroid dose is stable for 14 days prior to the first dose of
LOXO-292 (selpercatinib) and no CNS surgery or radiation has been performed for 28
days, 14 days if stereotactic radiosurgery (SRS)
- Clinically significant active cardiovascular disease or history of myocardial
infarction within 6 months prior to planned start of LOXO-292 (selpercatinib) or
prolongation of the QT interval corrected (QTcF) greater than (>) 470 milliseconds
(msec)
- Participants with implanted pacemakers may enter the study without meeting QTc
criteria due to nonevaluable measurement if it is possible to monitor for QT
changes.
- Participants with bundle branch block may be considered for study entry if QTc is
appropriate by a formula other than Fridericia's and if it is possible to monitor
for QT changes.
- Required treatment with certain strong cytochrome P450 3A4 (CYP3A4) inhibitors or
inducers and certain prohibited concomitant medications
- Phase 2 Cohort 7 (neoadjuvant treatment): Participant must not have received prior
systemic therapy for NSCLC.