A Phase 1 interventional study of CPX-POM - 30 mg/m^2 and CPX-POM - 60 mg/m^2 in Advanced Solid Tumors, sponsored by CicloMed LLC. Completed at 5 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-12-03.
Sponsored by CicloMed LLC · Phase 1, Interventional, and Treatment
This is a first-in-human, Phase I, multicenter, open label, dose escalation study to evaluate the DLTs and MTD and to determine the recommended Phase 2 dose (RP2D) of CPX-POM administered IV in patients with any histologically- or cytologically-confirmed solid tumor type.
The study will initially employ an accelerated escalation design, with a single patient enrolled in each cohort (i.e., Single-Patient Cohorts). The initial patient will receive CPX-POM at a starting dose of 30 mg/m2. Doses will be escalated (doubling), until a ≥Grade 2 toxicity (with the exception of alopecia), is encountered. Subsequently that and all subsequent cohorts will follow a classical "3+3" dose escalation design.
Note: Fosciclopirox is the generic name for CPX-POM.
Patient and his/her partner agree to use adequate contraception after providing written informed consent through 3 months after the last dose of CPX-POM, as follows:
Exclusion Criteria Include:
Patients who meet any of the following exclusion criteria are not to be enrolled in this study
Drug: CPX-POM - 30 mg/m^2
Drug: CPX-POM - 60 mg/m^2
Drug: CPX-POM - 120 mg/m^2
Drug: CPX-POM - 240 mg/m^2
Drug: CPX-POM - 360 mg/m^2
Drug: CPX-POM - 600 mg/m^2
Drug: CPX-POM - 900 mg/m^2
Drug: CPX-POM - 1200 mg/m^2
CPX-POM
CPX-POM
CPX-POM
CPX-POM
CPX-POM
CPX-POM
CPX-POM
CPX-POM
Number of Participants With Dose Limiting Toxicities (DLTs) of CPX-POM
The primary objective of this study is to evaluate the dose limiting toxicities (DLTs) of ciclopirox phosphoryloxymethyl ester (CPX-POM) administered intravenously (IV) and establish the CPX POM dose recommended for further investigation. A DLT will include some Grade 3 or 4 AEs (as assessed by CTCAE version 4.03) if deemed related to study drug. In addition, any patient who is unable to receive 80% of the expected dose of CPX-POM (i.e., patients who are unable to receive at least 4 of the 5 scheduled doses) because of AEs will be considered to have a DLT. In order to identify any DLTs, safety assessments including AEs, physical examinations, vital signs, and clinical laboratory tests will be conducted during each study visit through Day 22.
Time frame: Up to 22 days for each cohort
Determine the Maximum Tolerated Dose (MTD) of CPX-POM
The primary objective of this study is to evaluate the maximum tolerated dose (MTD) of ciclopirox phosphoryloxymethyl ester (CPX-POM) administered intravenously (IV) and establish the CPX POM dose recommended for further investigation. MTD was determined by testing increasing doses up to 1200 mg/m\^2 by IV. The MTD is defined as the dose BELOW that dose which causes DLTs in ≥33% of patients.
Time frame: Days 1, 2, 3, 4, 5, 6, 10, 22 and 28
Assess Plasma PK: Cmax (ng/mL) of the Active Metabolite, Ciclopirox (CPX), Following Five Consecutive Days of Once Daily Dosing.
Measure PK parameter Cmax (ng/mL)
Time frame: Days 5-6
Assess Plasma PK: Terminal Half-life of the Active Metabolite, Ciclopirox (CPX), Following Five Consecutive Days of Once Daily Dosing.
Determine Terminal Half-Life
Time frame: Days 5-6
Assess Plasma PK: AUCss (ng/mL/hr) of the Active Metabolite, Ciclopirox (CPX), Following Five Consecutive Days of Once Daily Dosing.
Measure PK parameter area-under-the-plasma-drug/metabolite-concentration-time curve (ng/mL/hr) following single dose (AUC) and at steady-state AUCss following single and repeat drug administration.
Time frame: Days 5-6
Assess Plasma PK: Cls (mL/hr/kg) of the Active Metabolite, Ciclopirox (CPX), Following Five Consecutive Days of Once Daily Dosing.
Measure PK parameter Cls (mL/hr/kg) - systemic clearance following single dose (Cls) following single and repeat drug administration.
Time frame: Days 5-6
Assess Plasma PK: Vd and Vss (mL/kg) of the Active Metabolite, Ciclopirox (CPX), Following Five Consecutive Days of Once Daily Dosing.
Measure PK parameters Vd (apparent volume of distribution) and Vss (steady state volume of distribution) (mL/kg)
Time frame: Days 5-6
Characterize Plasma PK: AUCss/AUCi Accumulation Ratio of the Active Metabolite, Ciclopirox (CPX), Following Five Consecutive Days of Once Daily Dosing.
Determine PK parameter AUC derived accumulation ratio (AUCss/AUCi ratio)
Time frame: Days 5-6
Assess Urine PK: Percent (%) of the CPX-POM Dose Excreted in Urine as CPX-POM and Metabolites, Following Five Consecutive Days of Once Daily Dosing.
Measure Percent Dose (%)
Time frame: Days 5-6
Assess Urine PK: Average 24-hour Urine Concentration of the Active Metabolite, Ciclopirox (CPX), Following Five Consecutive Days of Once Daily Dosing.
Measure urine CPX concentration (uM)
Time frame: Days 5-6
| Milestone | CPX-POM - 30 mg/m^2 | CPX-POM - 60 mg/m^2 | CPX-POM - 120 mg/m^2 | CPX-POM - 240 mg/m^2 | CPX-POM - 360 mg/m^2 | CPX-POM - 600 mg/m^2 | CPX-POM - 900 mg/m^2 | CPX-POM - 1200 mg/m^2 |
|---|---|---|---|---|---|---|---|---|
| Started | 1 | 1 | 1 | 1 | 3 | 4 | 6 | 2 |
| Completed | 1 | 1 | 1 | 1 | 3 | 4 | 6 | 2 |
| Not completed | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
The primary objective of this study is to evaluate the dose limiting toxicities (DLTs) of ciclopirox phosphoryloxymethyl ester (CPX-POM) administered intravenously (IV) and establish the CPX POM dose recommended for further investigation. A DLT will include some Grade 3 or 4 AEs (as assessed by CTCAE version 4.03) if deemed related to study drug. In addition, any patient who is unable to receive 80% of the expected dose of CPX-POM (i.e., patients who are unable to receive at least 4 of the 5 scheduled doses) because of AEs will be considered to have a DLT. In order to identify any DLTs, safety assessments including AEs, physical examinations, vital signs, and clinical laboratory tests will be conducted during each study visit through Day 22.
| participants | CPX-POM - 30 mg/m^2 | CPX-POM - 60 mg/m^2 | CPX-POM - 120 mg/m^2 | CPX-POM - 240 mg/m^2 | CPX-POM - 360 mg/m^2 | CPX-POM - 600 mg/m^2 | CPX-POM - 900 mg/m^2 | CPX-POM - 1200 mg/m^2 |
|---|---|---|---|---|---|---|---|---|
| Grade 3 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
| Grade 1 | 0 | 0 | 0 | 0 | 0 | 2 | 2 | 0 |
The primary objective of this study is to evaluate the maximum tolerated dose (MTD) of ciclopirox phosphoryloxymethyl ester (CPX-POM) administered intravenously (IV) and establish the CPX POM dose recommended for further investigation. MTD was determined by testing increasing doses up to 1200 mg/m\^2 by IV. The MTD is defined as the dose BELOW that dose which causes DLTs in ≥33% of patients.
| mg/m^2 | All Participants |
|---|---|
| Determine the Maximum Tolerated Dose (MTD) of CPX-POM | 900 |
Measure PK parameter Cmax (ng/mL)
| ng/mL | CPX-POM - 30 mg/m^2 | CPX-POM - 60 mg/m^2 | CPX-POM - 120 mg/m^2 | CPX-POM - 240 mg/m^2 | CPX-POM - 360 mg/m^2 | CPX-POM - 600 mg/m^2 | CPX-POM - 900 mg/m^2 | CPX-POM - 1200 mg/m^2 |
|---|---|---|---|---|---|---|---|---|
| Assess Plasma PK: Cmax (ng/mL) of the Active Metabolite, Ciclopirox (CPX), Following Five Consecutive Days of Once Daily Dosing. | 371 | 1935 | 3491 | 6792 | 5297 ± 1182 | 9457 ± 512 | 17277 ± 1913 | 15970 |
Determine Terminal Half-Life
| hours | CPX-POM - 30 mg/m^2 | CPX-POM - 60 mg/m^2 | CPX-POM - 120 mg/m^2 | CPX-POM - 240 mg/m^2 | CPX-POM - 360 mg/m^2 | CPX-POM - 600 mg/m^2 | CPX-POM - 900 mg/m^2 | CPX-POM - 1200 mg/m^2 |
|---|---|---|---|---|---|---|---|---|
| Assess Plasma PK: Terminal Half-life of the Active Metabolite, Ciclopirox (CPX), Following Five Consecutive Days of Once Daily Dosing. | 2.34 | 0.54 | 5.56 | 3.34 | 3.12 ± 1.34 | 4.61 ± 1.46 | 8.30 ± 2.63 | 7.43 |
Measure PK parameter area-under-the-plasma-drug/metabolite-concentration-time curve (ng/mL/hr) following single dose (AUC) and at steady-state AUCss following single and repeat drug administration.
| ng*hr/mL | CPX-POM - 30 mg/m^2 | CPX-POM - 60 mg/m^2 | CPX-POM - 120 mg/m^2 | CPX-POM - 240 mg/m^2 | CPX-POM - 360 mg/m^2 | CPX-POM - 600 mg/m^2 | CPX-POM - 900 mg/m^2 | CPX-POM - 1200 mg/m^2 |
|---|---|---|---|---|---|---|---|---|
| Single Dose AUCs | 589 | 1262 | 3736 | 4622 | 4731 ± 1310 | 11914 ± 1852 | 24148 ± 6067 | 34470 |
| Steady State AUCss | 515 | 1328 | 5143 | 6000 | 4856 ± 910 | 12484 ± 1182 | 23414 ± 1913 | 28048 |
Measure PK parameter Cls (mL/hr/kg) - systemic clearance following single dose (Cls) following single and repeat drug administration.
| mL/hr/kg | CPX-POM - 30 mg/m^2 | CPX-POM - 60 mg/m^2 | CPX-POM - 120 mg/m^2 | CPX-POM - 240 mg/m^2 | CPX-POM - 360 mg/m^2 | CPX-POM - 600 mg/m^2 | CPX-POM - 900 mg/m^2 | CPX-POM - 1200 mg/m^2 |
|---|---|---|---|---|---|---|---|---|
| Single Dose Cls | 614 | 581 | 361 | 515 | 1065 ± 435 | 507 ± 95 | 432 ± 142 | 375 |
| Steady State Cls | 702 | 552 | 262 | 397 | 963 ± 271 | 471 ± 113 | 421 ± 184 | 456 |
Measure PK parameters Vd (apparent volume of distribution) and Vss (steady state volume of distribution) (mL/kg)
| mL/kg | CPX-POM - 30 mg/m^2 | CPX-POM - 60 mg/m^2 | CPX-POM - 120 mg/m^2 | CPX-POM - 240 mg/m^2 | CPX-POM - 360 mg/m^2 | CPX-POM - 600 mg/m^2 | CPX-POM - 900 mg/m^2 | CPX-POM - 1200 mg/m^2 |
|---|---|---|---|---|---|---|---|---|
| Vd | 2370 | 429 | 2100 | 1966 | 4522 ± 2715 | 3090 ± 1015 | 5340 ± 3935 | 4887 |
| Vss | 2053 | 473 | 1633 | 736 | 1986 ± 802 | 1346 ± 349 | 2261 ± 1249 | 2518 |
Determine PK parameter AUC derived accumulation ratio (AUCss/AUCi ratio)
| ratio | CPX-POM - 30 mg/m^2 | CPX-POM - 60 mg/m^2 | CPX-POM - 120 mg/m^2 | CPX-POM - 240 mg/m^2 | CPX-POM - 360 mg/m^2 | CPX-POM - 600 mg/m^2 | CPX-POM - 900 mg/m^2 | CPX-POM - 1200 mg/m^2 |
|---|---|---|---|---|---|---|---|---|
| Characterize Plasma PK: AUCss/AUCi Accumulation Ratio of the Active Metabolite, Ciclopirox (CPX), Following Five Consecutive Days of Once Daily Dosing. | 0.86 | 1.05 | 1.59 | 1.30 | 1.08 ± 0.14 | 1.09 ± 0.17 | 1.03 ± 0.29 | 0.81 |
Measure Percent Dose (%)
| Percent of CPX-POM dose | CPX-POM - 30 mg/m^2 | CPX-POM - 60 mg/m^2 | CPX-POM - 120 mg/m^2 | CPX-POM - 240 mg/m^2 | CPX-POM - 360 mg/m^2 | CPX-POM - 600 mg/m^2 | CPX-POM - 900 mg/m^2 | CPX-POM - 1200 mg/m^2 |
|---|---|---|---|---|---|---|---|---|
| % CPX-POM Dose Excreted as CPX-POM over 24 hours | 0 ± 0 | 0 ± 0 | 0 ± 0 | 0 ± 0 | 0 ± 0 | 0 ± 0 | 0 ± 0 | 0 ± 0 |
| % CPX-POM Dose Excreted as ciclopirox over 24 hours | 0.81 | 0.82 | 1.74 | 1.25 | 0.80 ± 0.21 | 1.21 ± 0.11 | 4.42 ± 4.68 | 2.89 |
| % CPX-POM Dose Excreted as ciclopirox glucuronide over 24 hours | 59.74 | 69.73 | 70.21 | 73.86 | 75.99 ± 10.40 | 50.70 ± 29.28 | 69.62 ± 15.16 | 68.19 |
Measure urine CPX concentration (uM)
| uM | CPX-POM - 30 mg/m^2 | CPX-POM - 60 mg/m^2 | CPX-POM - 120 mg/m^2 | CPX-POM - 240 mg/m^2 | CPX-POM - 360 mg/m^2 | CPX-POM - 600 mg/m^2 | CPX-POM - 900 mg/m^2 | CPX-POM - 1200 mg/m^2 |
|---|---|---|---|---|---|---|---|---|
| Assess Urine PK: Average 24-hour Urine Concentration of the Active Metabolite, Ciclopirox (CPX), Following Five Consecutive Days of Once Daily Dosing. | 0.65 | 0.84 | 10.77 | 3.93 | 5.10 ± 0.86 | 22.91 ± 12.83 | 138.17 ± 157.97 | 208.65 |
Collected over 28 days. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| CPX-POM - 30 mg/m^2 | 1/1 (100%) | 1/1 (100%) | 0/1 (0%) |
| CPX-POM - 60 mg/m^2 | 0/1 (0%) | 0/1 (0%) | 0/1 (0%) |
| CPX-POM - 120 mg/m^2 | 0/1 (0%) | 0/1 (0%) | 1/1 (100%) |
| CPX-POM - 240 mg/m^2 | 0/1 (0%) | 0/1 (0%) | 1/1 (100%) |
| CPX-POM - 360 mg/m^2 | 0/3 (0%) | 1/3 (33.3%) | 1/3 (33.3%) |
| CPX-POM - 600 mg/m^2 | 0/4 (0%) | 3/4 (75%) | 3/4 (75%) |
| CPX-POM - 900 mg/m^2 | 0/6 (0%) | 1/6 (16.7%) | 6/6 (100%) |
| CPX-POM - 1200 mg/m^2 | 0/2 (0%) | 1/2 (50%) | 1/2 (50%) |
| Event | CPX-POM - 30 mg/m^2 | CPX-POM - 60 mg/m^2 | CPX-POM - 120 mg/m^2 | CPX-POM - 240 mg/m^2 | CPX-POM - 360 mg/m^2 | CPX-POM - 600 mg/m^2 | CPX-POM - 900 mg/m^2 | CPX-POM - 1200 mg/m^2 |
|---|---|---|---|---|---|---|---|---|
| PneumoniaInfections and infestations | 1/1 | 0/1 | 0/1 | 0/1 | 0/3 | 0/4 | 0/6 | 0/2 |
| Confusional StatePsychiatric disorders | 0/1 | 0/1 | 0/1 | 0/1 | 0/3 | 1/4 | 0/6 | 1/2 |
| BradycardiaCardiac disorders | 0/1 | 0/1 | 0/1 | 0/1 | 0/3 | 0/4 | 0/6 | 1/2 |
| HaemoptysisRespiratory, thoracic and mediastinal disorders | 0/1 | 0/1 | 0/1 | 0/1 | 1/3 | 0/4 | 0/6 | 0/2 |
| Meningitis bacterialInfections and infestations | 0/1 | 0/1 | 0/1 | 0/1 | 0/3 | 1/4 | 0/6 | 0/2 |
| Pneumococcal sepsisInfections and infestations | 0/1 | 0/1 | 0/1 | 0/1 | 0/3 | 1/4 | 0/6 | 0/2 |
| SepsisInfections and infestations | 0/1 | 0/1 | 0/1 | 0/1 | 0/3 | 1/4 | 0/6 | 0/2 |
| HyperbilirubinaemiaInvestigations | 0/1 | 0/1 | 0/1 | 0/1 | 0/3 | 1/4 | 0/6 | 0/2 |
| DyspnoeaRespiratory, thoracic and mediastinal disorders | 0/1 | 0/1 | 0/1 | 0/1 | 0/3 | 0/4 | 1/6 | 0/2 |
| Abdominal PainGastrointestinal disorders | 0/1 | 0/1 | 0/1 | 0/1 | 0/3 | 0/4 | 1/6 | 0/2 |
| Event | CPX-POM - 30 mg/m^2 | CPX-POM - 60 mg/m^2 | CPX-POM - 120 mg/m^2 | CPX-POM - 240 mg/m^2 | CPX-POM - 360 mg/m^2 | CPX-POM - 600 mg/m^2 | CPX-POM - 900 mg/m^2 | CPX-POM - 1200 mg/m^2 |
|---|---|---|---|---|---|---|---|---|
| NauseaGastrointestinal disorders | 0/1 | 0/1 | 0/1 | 1/1 | 1/3 | 2/4 | 1/6 | 0/2 |
| FatigueGeneral disorders | 0/1 | 0/1 | 1/1 | 0/1 | 0/3 | 1/4 | 0/6 | 0/2 |
| Muscular weaknessMusculoskeletal and connective tissue disorders | 0/1 | 0/1 | 1/1 | 0/1 | 0/3 | 0/4 | 0/6 | 0/2 |
| VomitingGastrointestinal disorders | 0/1 | 0/1 | 0/1 | 0/1 | 1/3 | 0/4 | 4/6 | 1/2 |
| Confusional statePsychiatric disorders | 0/1 | 0/1 | 0/1 | 0/1 | 0/3 | 2/4 | 2/6 | 1/2 |
| Feeling hotGeneral disorders | 0/1 | 0/1 | 0/1 | 0/1 | 0/3 | 0/4 | 0/6 | 1/2 |
| Non cardiac chest painGeneral disorders | 0/1 | 0/1 | 0/1 | 0/1 | 0/3 | 0/4 | 0/6 | 1/2 |
| AmnesiaNervous system disorders | 0/1 | 0/1 | 0/1 | 0/1 | 0/3 | 1/4 | 0/6 | 1/2 |
| DizzinessNervous system disorders | 0/1 | 0/1 | 0/1 | 0/1 | 0/3 | 1/4 | 0/6 | 1/2 |
| DysarthriaNervous system disorders | 0/1 | 0/1 | 0/1 | 0/1 | 0/3 | 0/4 | 0/6 | 1/2 |
| Age, Continuous(years) | CPX-POM - 30 mg/m^2 | CPX-POM - 60 mg/m^2 | CPX-POM - 120 mg/m^2 | CPX-POM - 240 mg/m^2 | CPX-POM - 360 mg/m^2 | CPX-POM - 600 mg/m^2 | CPX-POM - 900 mg/m^2 | CPX-POM - 1200 mg/m^2 | Total |
|---|---|---|---|---|---|---|---|---|---|
| Mean | 46 | 62 | 76 | 61 | 54 (20 to 82) | 63 (57 to 72) | 60 (38 to 70) | 82.5 (79 to 86) | 63 (20 to 86) |
| Sex: Female, Male(Participants) | CPX-POM - 30 mg/m^2 | CPX-POM - 60 mg/m^2 | CPX-POM - 120 mg/m^2 | CPX-POM - 240 mg/m^2 | CPX-POM - 360 mg/m^2 | CPX-POM - 600 mg/m^2 | CPX-POM - 900 mg/m^2 | CPX-POM - 1200 mg/m^2 | Total |
|---|---|---|---|---|---|---|---|---|---|
| Female | 0 | 1 | 1 | 1 | 2 | 4 | 4 | 0 | 13 |
| Male | 1 | 0 | 0 | 0 | 1 | 0 | 2 | 2 | 6 |
| Race (NIH/OMB)(Participants) | CPX-POM - 30 mg/m^2 | CPX-POM - 60 mg/m^2 | CPX-POM - 120 mg/m^2 | CPX-POM - 240 mg/m^2 | CPX-POM - 360 mg/m^2 | CPX-POM - 600 mg/m^2 | CPX-POM - 900 mg/m^2 | CPX-POM - 1200 mg/m^2 | Total |
|---|---|---|---|---|---|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Asian | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Black or African American | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 1 |
| White | 1 | 1 | 1 | 1 | 3 | 4 | 5 | 2 | 18 |
| More than one race | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Unknown or Not Reported | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Cancer type(Participants) | CPX-POM - 30 mg/m^2 | CPX-POM - 60 mg/m^2 | CPX-POM - 120 mg/m^2 | CPX-POM - 240 mg/m^2 | CPX-POM - 360 mg/m^2 | CPX-POM - 600 mg/m^2 | CPX-POM - 900 mg/m^2 | CPX-POM - 1200 mg/m^2 | Total |
|---|---|---|---|---|---|---|---|---|---|
| Colon | 0 | 1 | 0 | 0 | 0 | 2 | 2 | 0 | 5 |
| Bladder | 0 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 2 |
| Breast | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | 2 |
| Gastric | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 2 |
| Head and Neck | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 1 |
| Liver | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 1 |
| Ovarian | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 1 |
| Prostate | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 |
| Other | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 4 |
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Supporting information: Study protocol, Sap
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