A Phase 1/2 interventional study of Akt/ERK Inhibitor ONC201 and Laboratory Biomarker Analysis in Central Nervous System Lymphoma, Gastric Mantle Cell Lymphoma and Recurrent Mantle Cell Lymphoma, sponsored by M.D. Anderson Cancer Center. Terminated at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2022-04-04.
Sponsored by M.D. Anderson Cancer Center · Phase 1/2, Interventional, and Treatment
This phase I/II trial studies the side effects and the best dose of v-akt murine thymoma viral oncogene homolog (Akt)/mitogen-activated protein kinase 1(ERK) inhibitor ONC201 and to see how well it works in treating patients with non-Hodgkin's lymphoma that has returned after a period of improvement or does not respond to treatment. Akt/ERK inhibitor ONC201 may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.
PRIMARY OBJECTIVES:
I. To determine recommended phase II dose for oral ONC201 (Akt/ERK inhibitor ONC201) in patients with relapsed/refractory lymphomas. (Phase I) II. To identify toxicities associated with oral ONC201 in patients with relapsed/refractory lymphomas. (Phase I) III. To determine the objective response rate to ONC201 in patients with relapsed/refractory lymphomas. (Phase II)
SECONDARY OBJECTIVES:
I. To determine the pharmacokinetics (PK) of oral ONC201 following administration. (Phase I) II. To observe the anti-tumor effects of oral ONC201, if any occur, in patients with relapsed/refractory lymphomas. (Phase I) III. Confirm tolerability of recommended phase II dose. (Phase II) IV. Assess clinical outcomes associated with ONC201 treatment in patients with relapsed/refractory lymphomas. (Phase II) V. Correlate clinical outcome with tumor and serum biomarkers. (Phase II)
OUTLINE: This is a phase I, dose-escalation study followed by a phase II study.
Patients receive Akt/ERK inhibitor ONC201 orally (PO) on day 1 of every cycle or day 1 of every week. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 3 months.
5,579 studies on the registry are indexed under Lymphoma; 825 are open to participants now.
This study's enrollment of 16 is below the median of 40 across 4,509 interventional studies indexed under Lymphoma.
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Exclusion Criteria:
Patients receive Akt/ERK inhibitor ONC201 PO on day 1 of every cycle or day 1 of every week. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Drug: Akt/ERK Inhibitor ONC201 · Other: Laboratory Biomarker Analysis · Other: Pharmacological Study
Given PO
Also known as: ONC201, TIC10
Correlative studies
Correlative studies
Recommended Phase 2 Dose (RP2D) (Phase I)
Time frame: 21 days
Number of Participants With Overall Response Rate (Phase 1 and 2)
Defined as either progressive disease or stable disease observed assessed by the Revised International Workshop Standardization Response Criteria for non-Hodgkin lymphoma.
Time frame: Up to 63 days (first 3 courses)
Overall Survival (OS)
Overall survival is the time in months from start of study treatment to date of death due to any cause.
Time frame: every 3 months for 1 year, then every 6 months, up to 3 years
Progression-free Survival (PFS)- (Phase 2)
Progression free survival is defined as time in weeks from start of study treatment to first documentation of objective tumor progression or up to death due to any cause, whichever occurs first.
Time frame: every 3 months for 1 year, then every 6 months, up to 6 years
Patients recruited at MD Anderson Lymphoma clinic from November 2015 through April 2018
| Milestone | ONC201 125 mg | ONC201 250 mg | ONC201 625 mg |
|---|---|---|---|
| Started | 4 | 2 | 5 |
| Completed | 0 | 0 | 0 |
| Not completed | 4 | 2 | 5 |
| Withdrew: Withdrawal by subject | 1 | 0 | 0 |
| Withdrew: Adverse event | 1 | 0 | 0 |
| Withdrew: Progressive disease | 2 | 2 | 4 |
| Withdrew: Death | 0 | 0 | 1 |
| mg | ONC201 125 mg |
|---|---|
| Recommended Phase 2 Dose (RP2D) (Phase I) | 125 |
Defined as either progressive disease or stable disease observed assessed by the Revised International Workshop Standardization Response Criteria for non-Hodgkin lymphoma.
| Participants | ONC201 125 mg | ONC201 250 mg | ONC201 625 mg |
|---|---|---|---|
| Progressive Disease | 3 | 1 | 3 |
| Stable Disease | 1 | 1 | 1 |
Overall survival is the time in months from start of study treatment to date of death due to any cause.
| months | ONC201 125 mg | ONC201 250 mg | ONC201 625 mg |
|---|---|---|---|
| Overall Survival (OS) | 29 (1 to 30) | 15 (1 to 30) | 24 (1 to 48) |
Progression free survival is defined as time in weeks from start of study treatment to first documentation of objective tumor progression or up to death due to any cause, whichever occurs first.
| weeks | ONC201 625 mg |
|---|---|
| Progression-free Survival (PFS)- (Phase 2) | 5 (1 to 10) |
Collected over From the first dose through every 3 months after the last dose of study medication, up to 1 year.. Non-serious events are listed at a 1% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| ONC201 125 mg | 0/4 (0%) | 0/4 (0%) | 4/4 (100%) |
| ONC201 250 mg | 0/2 (0%) | 1/2 (50%) | 2/2 (100%) |
| ONC201 625 mg | 1/5 (20%) | 1/5 (20%) | 5/5 (100%) |
| Event | ONC201 125 mg | ONC201 250 mg | ONC201 625 mg |
|---|---|---|---|
| AnemiaBlood and lymphatic system disorders | 0/4 | 1/2 | 0/5 |
| DehydrationGeneral disorders | 0/4 | 1/2 | 0/5 |
| Blood and lymphatic system disorders- OtherBlood and lymphatic system disorders | 0/4 | 1/2 | 0/5 |
| Myocardial InfarctionInfections and infestations | 0/4 | 0/2 | 1/5 |
| Edema LimbsGeneral disorders | 0/4 | 0/2 | 1/5 |
| Event | ONC201 125 mg | ONC201 250 mg | ONC201 625 mg |
|---|---|---|---|
| FatigueGeneral disorders | 3/4 | 2/2 | 4/5 |
| Numbness/TinglingNervous system disorders | 0/4 | 2/2 | 0/5 |
| DiarrheaGastrointestinal disorders | 1/4 | 0/2 | 4/5 |
| AnemiaBlood and lymphatic system disorders | 3/4 | 1/2 | 0/5 |
| Edema limbsGeneral disorders | 1/4 | 0/2 | 3/5 |
| Abdominal painGastrointestinal disorders | 0/4 | 1/2 | 1/5 |
| AST increasedGeneral disorders | 2/4 | 0/2 | 0/5 |
| Blood and lymphatic system disorderBlood and lymphatic system disorders | 0/4 | 1/2 | 0/5 |
| ConstipationGastrointestinal disorders | 1/4 | 1/2 | 1/5 |
| CoughRespiratory, thoracic and mediastinal disorders | 0/4 | 1/2 | 0/5 |
Patients enrolled on Arm A until Arm B approved in 2/9/2016 IRB amendment
| Age, Categorical(Participants) | ONC201 125 mg | ONC201 250 mg | ONC201 625 mg | Total |
|---|---|---|---|---|
| <=18 years | 0 | 0 | 0 | 0 |
| Between 18 and 65 years | 1 | 0 | 1 | 2 |
| >=65 years | 3 | 2 | 4 | 9 |
| Sex: Female, Male(Participants) | ONC201 125 mg | ONC201 250 mg | ONC201 625 mg | Total |
|---|---|---|---|---|
| Female | 1 | 0 | 2 | 3 |
| Male | 3 | 2 | 3 | 8 |
| Ethnicity (NIH/OMB)(Participants) | ONC201 125 mg | ONC201 250 mg | ONC201 625 mg | Total |
|---|---|---|---|---|
| Hispanic or Latino | 0 | 0 | 1 | 1 |
| Not Hispanic or Latino | 3 | 2 | 4 | 9 |
| Unknown or Not Reported | 1 | 0 | 0 | 1 |
| Race (NIH/OMB)(Participants) | ONC201 125 mg | ONC201 250 mg | ONC201 625 mg | Total |
|---|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 | 0 |
| Asian | 0 | 0 | 0 | 0 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 | 0 |
| Black or African American | 0 | 0 | 0 | 0 |
| White | 4 | 2 | 5 | 11 |
| More than one race | 0 | 0 | 0 | 0 |
| Unknown or Not Reported | 0 | 0 | 0 | 0 |
| Region of Enrollment(participants) | ONC201 125 mg | ONC201 250 mg | ONC201 625 mg | Total |
|---|---|---|---|---|
| United States | 4 | 2 | 5 | 11 |
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M.D. Anderson Cancer Center