Safety Study of TPI-287 to Treat CBS and PSP

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Brief Title

Safety Study of TPI-287 to Treat CBS and PSP

Official Title

A Phase 1, Randomized, Double-Blind, Placebo-Controlled, Sequential Cohort, Dose-Ranging Study of the Safety, Tolerability, Pharmacokinetics, Pharmacodynamics, and Preliminary Efficacy of TPI 287 in Patients With Primary Four Repeat Tauopathies: Corticobasal Syndrome or Progressive Supranuclear Palsy

Brief Summary

      The purpose of this study is to determine the safety and tolerability [maximum tolerated dose
      (MTD) within planned dosing range] of intravenous (IV) infusions of TPI 287 administered once
      every 3 weeks for 9 weeks (for a total of 4 infusions) in patients with primary four repeat
      tauopathies (4RT), corticobasal syndrome (CBS; also called corticobasal degeneration, CBD) or
      progressive supranuclear palsy (PSP).
    

Detailed Description

      The maximum tolerated dose of TPI-287 will be determined through a planned dose escalation
      over 3 sequential cohorts, each comprising of 11 participants randomized to either TPI-287 or
      placebo. TPI-287 or placebo will be administered as an intravenous infusion once every 3
      weeks for 9 weeks, for a total of 4 infusions. Participants who successfully complete this
      phase will have the option of entering into the open label extension phase during which
      TPI-287 will be administered once every 3 weeks for an additional 6 weeks, for a total of 3
      extra infusions.

      The dose of TPI 287 will be escalated in sequential cohorts. In the low dose cohort 11
      subjects each diagnosis (i.e., separate dose escalations will be performed for CBS and PSP)
      will be enrolled. The medium and high dose cohorts will be comprised of 11 subjects; combined
      CBS and PSPdiagnoses. Subjects will be assigned to cohorts in the order of study entry.

      Pre-medications of diphenhyramine 25 mg (Benadryl), dexamethasone 10 mg, and famotidine 20 mg
      (or the H2 blocker ranitidine 50 mg) will be given IV within 60 minutes prior to each study
      infusion.

      Safety and tolerability will be assessed through reporting of adverse events, physical and
      neurological testing, ECGs, as well as blood and urine analyses. Baseline and end-point
      measures of cognition and function, MRI brain scans, and cerebrospinal fluid (CSF) biomarker
      analyses will be used to determine preliminary efficacy of TPI-287 in mild-moderate AD.
      Pharmacokinetic and pharmacodynamic properties of TPI-287 will be calculated from blood
      plasma collected after the first infusion, and from CSF collected on the last visit of the
      placebo-controlled phase.
    

Study Phase

Phase 1

Study Type

Interventional


Primary Outcome

Maximum tolerated dose of TPI-287 in patients with primary 4RT; CBS or PSP.

Secondary Outcome

 TPI-287 levels in blood plasma and cerebrospinal fluid

Condition

Primary Four Repeat Tauopathies (4RT)

Intervention

TPI 287 2 mg/m2

Study Arms / Comparison Groups

 TPI-287 low dose
Description:  2 mg/m2 of TPI-287 administered as a 1-hour intravenous infusion once every 3 weeks for 9 weeks (for a total of 4 infusions)

Publications

* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.

Recruitment Information


Recruitment Status

Drug

Estimated Enrollment

44

Start Date

May 2014

Completion Date

September 2019

Primary Completion Date

September 2019

Eligibility Criteria

        Inclusion Criteria:

          1. Between 50 and 85 years of age (inclusive);

          2. Able to walk 5 steps with minimal assistance (stabilization of one arm or use of
             cane/walker);

          3. MRI at Screening is consistent with CBS or PSP (≤ 4 microhemorrhages, and no large
             strokes or severe white matter disease);

          4. MMSE at Screening is between 14 and 30 (inclusive);

          5. FDA-approved AD medications are sometimes prescribed for CBS and PSP subjects, and are
             allowed as long as the dose is stable for 2 months prior to Screening. Other
             medications (except those listed under exclusion criteria) are allowed as long as the
             dose is stable for 30 days prior to Screening;

          6. FDA-approved Parkinson's medications are allowed as long as the dose is stable for 2
             months prior to Screening;

          7. Has a reliable study partner who agrees to accompany the subject to visits, and spends
             at least 5 hours per week with the subject;

          8. Agrees to 2 lumbar punctures;

          9. Signed and dated written informed consent obtained from the subject and the subject's
             caregiver in accordance with local IRB regulations;

         10. Males and all WCBP agree to abstain from sex or use an adequate method of
             contraception for the duration of the study and for 30 days after the last dose of
             study drug.

             Adequate contraceptive methods include those with a low failure rate, i.e., less than
             1% per year, when used consistently and correctly, such as complete abstinence from
             sexual intercourse with a potentially fertile partner, and some double barrier methods
             (condom with spermicide) in conjunction with use by the partner of an intrauterine
             device (IUD), diaphragm with spermicide, oral contraceptives, birth control patch or
             vaginal ring, oral, or injectable or implanted contraceptives.

             For this study, a woman who has been surgically sterilized or who has been in a state
             of amenorrhea for more than two years will be deemed not to be of childbearing
             potential;

             For PSP Only

         11. Meets National Institute of Neurological Disorders and Stroke - Society for
             Progressive Supranuclear Palsy (NINDS-SPSP) probable or possible PSP criteria (Litvan
             et al. 1996a), as modified for the Neuroprotection and Natural History in Parkinson
             Plus Syndromes (NNIPPS) clinical trial (Bensimon et al. 2009).

        For CBS Only

        11. Meets 2013 consensus criteria for possible or probable corticobasal degeneration, CBS
        subtype (Armstrong et al. 2013).

        Exclusion Criteria:

          1. Meets National Institute on Aging-Alzheimer's Association Workgroups criteria for
             probable AD (McKhann et al. 2011);

          2. Any medical condition other than CBS or PSP that could account for cognitive deficits
             (e.g., active seizure disorder, stroke, vascular dementia);

          3. A prominent and sustained response to levodopa therapy;

          4. History of significant cardiovascular, hematologic, renal, or hepatic disease (or
             laboratory evidence thereof);

          5. History of significant peripheral neuropathy;

          6. History of major psychiatric illness or untreated depression;

          7. Neutrophil count <1,500/mm3, platelets <100,000/mm3, serum creatinine >1.5 x upper
             limit of normal (ULN), total bilirubin >1.5 x ULN, alanine aminotransferase (ALT) >3 x
             ULN, aspartate aminotransferase (AST) >3 x ULN, or INR >1.2 at Screening evaluations;

          8. Evidence of any clinically significant findings on Screening or baseline evaluations
             which, in the opinion of the Investigator would pose a safety risk or interfere with
             appropriate interpretation of study data;

          9. Current or recent history (within four weeks prior to Screening) of a clinically
             significant bacterial, fungal, or mycobacterial infection;

         10. Current clinically significant viral infection;

         11. Major surgery within four weeks prior to Screening;

         12. Unable to tolerate MRI scan at Screening;

         13. Any contraindication to or unable to tolerate lumbar puncture at Screening, including
             use of anti-coagulant medications such as warfarin. Daily administration of 81 mg
             aspirin will be allowed as long as the dose is stable for 30 days prior to Screening;

         14. Subjects who, in the opinion of the Investigator, are unable or unlikely to comply
             with the dosing schedule or study evaluations;

         15. Previous exposure to microtubule inhibitors (including TPI 287) within 5 years of
             Screening. Treatment with microtubule inhibitors other than TPI 287 while on study
             will not be allowed;

         16. Participation in another interventional clinical trial within 3 months of Screening;

         17. Treatment with another investigational drug within 30 days of Screening. Treatment
             with investigational drugs other than TPI 287 while on study will not be allowed;

         18. Known hypersensitivity to the inactive ingredients in the study drug;

         19. Pregnant or lactating;

         20. Positive pregnancy test at Screening or Baseline (Day 1);

         21. Cancer within 5 years of Screening, except for non-metastatic skin cancer or
             non-metastatic prostate cancer not expected to cause significant morbidity or
             mortality within one year of baseline.

             For CBS Only:

         22. History or evidence at Screening of cortical amyloid levels on 18F florbetapir PET
             scans consistent with underlying AD;

         23. History of serum or plasma progranulin level less than one standard deviation below
             the normal subject mean for the laboratory performing the assay;

         24. History or evidence at Screening of known disease-associated mutations in GRN or
             C9ORF72 genes to rule out CBS due to TDP-43 pathology;

         25. History of known disease-associated mutations in ribosomal protein L3 [TDP- 43 gene
             (TARBP)], chromatin modifying protein 2B (CHMPB2) or valosin containing protein (VCP)
             genes or any other frontotemporal lobar degeneration (FTLD) causative genes discovered
             during the course of the trial and not associated with underlying tau pathology.
      

Gender

All

Ages

50 Years - 85 Years

Accepts Healthy Volunteers

No

Contacts

Adam Boxer, MD, PhD, , 

Location Countries

United States

Location Countries

United States

Administrative Informations


NCT ID

NCT02133846

Organization ID

TPI287-4RT-001


Responsible Party

Principal Investigator

Study Sponsor

University of California, San Francisco

Collaborators

 CBD Solutions

Study Sponsor

Adam Boxer, MD, PhD, Principal Investigator, UCSF Memory and Aging Center


Verification Date

April 2020