Primary Outcome Measures:
- Compare the overall survival (OS) in subjects with malignant pleural mesothelioma receiving defactinib (VS-6063) or placebo [ Time Frame: From randomization to end of life, an expected average of 12 months ] [ Designated as safety issue: No ]
The median duration of OS will be estimated based on the 50th percentile of the Kaplan-Meier distribution
- Compare the progression free survival (PFS) in subjects with malignant pleural mesothelioma receiving defactinib (VS-6063) or placebo [ Time Frame: From date of randomization to earliest documented date of progression, an expected average of 4 months ] [ Designated as safety issue: No ]
PFS will be calculated based on the stratified log-rank test, and will use Kaplan-Meier estimation methods for estimation of summary statistics
Secondary Outcome Measures:
- To assess Quality of Life (QoL) in subjects treated with defactinib (VS-6063) or placebo using the Lung Cancer Symptom Scale modified formesothelioma (LCSS-Meso) [ Time Frame: Every 3-4 weeks from baseline through end of treatment, an expected average of 4 months ] [ Designated as safety issue: No ]
QoL will be assessed using the LCSS-Meso. The LCSS-Meso total score will be analyzed through a comparison of median area under the curve (AUC) between the 2 treatment groups using a Wilcoxon test.
- To determine the objective response rate (ORR) in subjects receiving defactinib (VS-6063) or placebo. [ Time Frame: Every 6-8 weeks from baseline through end of treatment, an expected average of 4 months ] [ Designated as safety issue: No ]
ORR is measured as the best overall response assessed by central review using Response Evaluation Criteria In Solid Tumors (RECIST), version 1.1.
Other Outcome Measures:
- Determine the time to new lesion in subjects receiving defactinib (VS-6063) or placebo [ Time Frame: Every 6-8 weeks from baseline until end of treatment, an expected average of 4 months ] [ Designated as safety issue: No ]
Time to new lesion will be calculated from the date of randomization to the time of CT scan documenting a new lesion or date of other unambiguous indicator of new lesion development.
- Evaluate the relationship of defactinib (VS-6063) pharmacokinetics (PK) and outcome [ Time Frame: Time points at Week 4, Week 7, Week 10 and Week 13 ] [ Designated as safety issue: No ]
PK parameters, including but not limited to plasma concentration, AUC (Area Under Curve) 0-t, Cmax, Tmax, and T1/2, compared with outcome
- Evaluate the population pharmacokinetics of defactinib (VS-6063) in subjects with malignant pleural mesothelioma [ Time Frame: Time points at Week 4, Week 7, Week 10 and Week 13 ] [ Designated as safety issue: No ]
PK parameters, including but not limited to plasma concentration, AUC (Area Under Curve) 0-t, Cmax, Tmax, and T1/2
- Evaluate the safety and tolerability of defactinib (VS-6063) in subjects with malignant pleural mesothelioma [ Time Frame: From start of treatment to end of treatment, an expected average of 4 months ] [ Designated as safety issue: Yes ]
Adverse events and their frequency, duration and severity, physical examination, laboratory parameters, vital signs and ECG change monitoring as determined based on CTCAE (Common Toxicity Criteria for Adverse Effects) 4.03
Eligibility Criteria
- Inclusion Criteria:
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- Able to understand and give written informed consent and comply with study procedures.
- Histologically proven diagnosis of MPM. All subjects must have biopsy material (archival tissue is acceptable) available for immunohistochemistry determination of Merlin status prior to enrollment
- Evaluable disease, or measurable disease as assessed by RECIST version 1.1.
- Received only one prior chemotherapy regimen consisting of ≥ 4 cycles of pemetrexed/cisplatin or pemetrexed/carboplatin; subjects must have documentation of an ongoing response (confirmed PR or SD) following completion of this regimen. Subjects changing from cisplatin to carboplatin or vice versa within the same course of treatment because of platinum toxicity will be considered to have had first-line chemotherapy. Note: Subjects may have undergone previous surgical resection of their disease providing it was completed prior to initiation of chemotherapy.
- Received last dose of pemetrexed/cisplatin or pemetrexed/carboplatin therapy within ≤ 6 weeks of study entry.
- Have completed baseline quality of life evaluation as assessed by LCSS modified for mesothelioma
- Age ≥18 years.
- Life expectancy ≥3 months.
- All prior cytotoxic toxicities must have resolved to grade ≤ 1 prior to randomization.
- Performance status according to the Karnofsky Scale of ≥ 70% (after palliative measures such as pleural drainage).
- Corrected QT interval (QTc) < 470 ms (as calculated by the Fridericia correction formula).
- Adequate bone marrow function (hemoglobin ≥ 9.0 g/dL; platelets ≥ 100 x 109/L; absolute neutrophil count [ANC] ≥ 1.5 x 109/L) without the use of hematopoietic growth factors.
- Adequate renal function (creatinine ≤ 1.5 x ULN [upper limit of normal] or glomerular filtration rate of ≥ 50mL/min).
- Adequate hepatic function (total bilirubin ≤ 1.5 x ULN for the institution; aspartate transaminase [AST] and alanine transaminase [ALT] ≤ 2.5 x ULN).
- Men and women of childbearing potential must agree to use adequate contraception(double barrier birth control) for the duration of study therapy and for 3 months after the last dose of VS-6063.
- Exclusion Criteria:
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- Currently enrolled in (or completed within 30 days before study drug administration)another investigational drug study.
- GI condition that could interfere with the swallowing or absorption of study drug.
- History of upper GI bleeding, ulceration, or perforation within 12 months prior to the first dose of study drug.
- Known history of Gilbert’s Syndrome.
- Known history of stroke or cerebrovascular accident within 6 months prior to the first dose of study drug.
- Subjects with known infection with human immunodeficiency virus or Acquired Immune Deficiency Syndrome (testing not required).
- Subjects with known infection with hepatitis A, B or C (testing not required).
- Any evidence of serious active infections.
- Major surgery within 28 days prior to the first dose of study drug.
- Uncontrolled or severe concurrent medical condition (including uncontrolled brain metastases). Stable brain metastases either previously treated or being treated with a stable dose of steroids and/or anticonvulsants (no dose change within 28 days prior to the first dose of study drug) will be allowed.
- Uncontrolled or severe cardiovascular disease, including myocardial infarct or unstable angina within 6 months prior to study treatment, New York Heart Association Class II or greater congestive heart failure, serious arrhythmias requiring medication for treatment, clinically significant pericardial disease, or cardiac amyloidosis.
- Known history of malignant hypertension.
- Psychiatric illness or social situations that would limit compliance with study requirements.
- History of another invasive malignancy in the last 5 years. Adequately treated noninvasive,non-melanoma skin cancers as well as in situ carcinoma of the cervix within the last 5 years will be allowed.
- Prior treatment with drugs an FAK inhibitor.
- Women who are pregnant or breastfeeding.
