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LDE225

Phase 2

Acute Leukemias | Small molecule | Oncology |Novartis AG|Trials Updated: Apr 3, 2023

LDE225 development status

Highest phase Phase 2
Registered trials 18 across 7 sponsors since Apr 2009

LDE225 target and mechanism

ModalitySmall molecule

Also known as Sonidegib, hedgehog inhibitor

Success Probability

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Market & Valuation

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Trial Design

RandomizedCONTROLLEDDMC
Total Trials14
Total Enrollment912

FDA Designations

No designations recorded

LDE225 clinical trials

LDE225 · 14 trials · 40 indications

Phase 2 4Phase 1 10
NCT01708174A Phase II Study of Oral LDE225 in Patients With Hedge-Hog (Hh)-Pathway Activated Relapsed Medulloblastoma (MB)Medulloblastoma
COMPLETED22 Analytics
NCT01826214Study of Efficacy and Safety of LDE225 in Adult Patients With Relapsed/Refractory Acute LeukemiaAcute Leukemias
COMPLETED70 Analytics
NCT01327053A Phase II Study of Efficacy and Safety in Patients With Locally Advanced or Metastatic Basal Cell CarcinomaBasal Cell Carcinoma
COMPLETED230 Analytics
NCT01350115Efficacy, Safety and Pharmacokinetics of Oral LDE225 in Treatment of Patients With Nevoid Basal Cell Carcinoma Syndrome (NBCCS)Basal Cell Carcinoma
COMPLETED10 Analytics
PHASE2COMPLETED
A Phase II Study of Oral LDE225 in Patients With Hedge-Hog (Hh)-Pathway Activated Relapsed Medulloblastoma (MB)
MedulloblastomaUnlock trial analytics
PHASE2COMPLETED
Study of Efficacy and Safety of LDE225 in Adult Patients With Relapsed/Refractory Acute Leukemia
Acute LeukemiasUnlock trial analytics
PHASE2COMPLETED
A Phase II Study of Efficacy and Safety in Patients With Locally Advanced or Metastatic Basal Cell Carcinoma
Basal Cell CarcinomaUnlock trial analytics
PHASE2COMPLETED
Efficacy, Safety and Pharmacokinetics of Oral LDE225 in Treatment of Patients With Nevoid Basal Cell Carcinoma Syndrome (NBCCS)
Basal Cell CarcinomaUnlock trial analytics

Study Endpoints

Primary Endpoints

Percentage of Participants With Overall Response Rate (ORR) According to Independent Review Committee (IRC) From Date First Participant Randomized, 13-Sep-2013 to Date of Data Cut-off, 15-Nov-2016
from date first participant randomized, 13-Sep-2013 to date of data cut-off, 15-Nov-2016

ORR was defined as the percentage of participants with best overall response of complete response (CR) or partial response (PR) (as per tumor response guidelines and criteria for Medulloblastoma). The IRC evaluated all radiological images and applicable clinical data (i.e., neurological examination, steroid use and cerebrospinal fluid (CSF) results as applicable). Assessments after crossover were not included for TMZ participants.

Rate of Complete Remission (CR)
at screening, every week up to Week 9, every 2 weeks thereafter until CR, every 4 weeks after CR up to 24 months

Complete Response (CR) was based on the International Working Group (IWG) criteria based on weekly peripheral blood count measurements and bone marrow biopsy/aspiration collection. Efficacy assessments were performed to determine CR. A treatment cycle was defined as 4 weeks. The outcome measure for the study is based on standardized response criteria as defined by the International Working Group (IWG) for AML. The IWG was established by a group of investigators interested in the design and conduct of clinical trials in acute myeloid leukemia (AML). The criteria established by this group (a set of recommendations for response assessment) are well established, endorsed by major institutions and Health Authorities, and are widely used in clinical trials. No statistical analysis was planned for this primary outcome.

Complete Remission With Incomplete Blood Count Recovery (CRi)
within 3 days after clearance of blasts from peripheral blood (PB), monthly thereafter until CR or reappearance of blasts in the PB, after CR every other month until discontination up to 24 months

The other primary efficacy endpoint was CRi based on the International Working Group (IWG) criteria based on weekly peripheral blood count measurements and bone marrow biopsy/aspiration collection. Efficacy assessments were performed to determine CRi. A treatment cycle was defined as 4 weeks. No statistical analysis was planned for this primary outcome.

Objective Response Rate (ORR) Based on Central Review According to mRECIST (for Locally Advanced Basal Cell Carcinoma (laBCC)) and RECIST 1.1 (for Metastatic Basal Cell Carcinoma (mBCC)) Per Primary Efficacy Analysis Set (pEAS)
6 months

ORR is the percentage of patient's objective response (ORR) by 6 months after starting LDE225 treatment. A responder was defined as a subject with confirmed partial response (PR) or confirmed complete response (CR) 6 months after starting LDE225 treatment.Treatment with sonidegib was considered sufficiently efficacious if the observed ORR on any treatment arm at the end of the study was 30% or higher. PR: At least a 30% decrease in the sum of diameter of all target lesions, taking as reference the baseline sum of diameters. CR: Disappearance of all non-nodal target lesions. In addition, any pathological lymph nodes assigned as target lesions must have a reduction in short axis to \< 10 mm.

Objective Response Rate (ORR) Based on Central Review According to mRECIST (for Locally Advanced Basal Cell Carcinoma (laBCC)) and RECIST 1.1 (Metastatic Basal Cell Carcinoma (mBCC)) Per Full Analysis Set (FAS)
6 months

ORR is the percentage of patient's objective response (ORR) by 6 months after starting LDE225 treatment. A responder was defined as a subject with confirmed partial response (PR) or confirmed complete response (CR) 6 months after starting LDE225 treatment.Treatment with sonidegib was to be considered sufficiently efficacious if the observed ORR on any treatment arm at the end of the study was 30% or higher. PR: At least a 30% decrease in the sum of diameter of all target lesions, taking as reference the baseline sum of diameters. CR: Disappearance of all non-nodal target lesions. In addition, any pathological lymph nodes assigned as target lesions must have a reduction in short axis to \< 10 mm.

Clinical Clearance Assessment of Main Target Basal Cell Carcinomas (BCCs)
Day 113

The clinical response of the main target (and secondary target, as appropriate) BCC(s) to treatment was evaluated using the following 6-point scale comparing the assessment at the visit to the clinical presentation at Baseline: 0 = Worsening, 1 = No change, 2 = Slight clearance (1-25% improvement), 3 = Moderate clearance (26-75% improvement), 4 = Marked clearance (76-99% improvement),5 = Complete clearance (100% improvement) Complete clearance was defined as no clinical residual signs of carcinoma, as evaluated by the Investigator at a post-Baseline visit, with the exception of post-inflammatory changes such as minimal residual erythema or residual hyper-pigmentation or hypo-pigmentation or residual scarring.

Incidence Rate of DLT Within the First Two Cycles of LDE225 (Sonidegib) in Combination With Docetaxel
Up to cycle 2

DLT was defined as the occurrence of any of the following adverse events or abnormal laboratory values (graded according to the NCI-CTCAE version 4.0) assessed as possibly, probably or definitively related to study drugs, occurring within the first two cycles of treatment: Neutropenia grade 4 lasting more than one week, febrile neutropenia, thrombocytopenia grade 3 with bleeding more than grade 2, thrombocytopenia grade 4, Increased plasma creatinine phosphokinase (CK) grade 3-4, any non-hematologic grade 4 toxicity, or grade 3 toxicity except nausea and vomiting, Grade 2 GI toxicity (except nausea and vomiting) lasting more than 2 weeks, Inability to resume dosing for cycles 2 or 3 at the current dose level within 14 days, due to treatment-related toxicity. Dose reductions in cycles 1 and 2 will be considered a DLT

Maximum Tolerated Dose (MTD) of LDE225 (Sonidegib) in Combination With Docetaxel
Through study treatment, an average of 2 months

MTD was determined by testing increasing doses of LDE225 on dose escalation cohorts 1 to 6 patients. MTD reflects the highest dose tested in which a DLT is experienced by 0 out of 3 or 1 out of 6 patients among the dose levels.

Recommended Phase II Dose (RP2D) of LDE225 (Sonidegib) in Combination With Docetaxel
Through study treatment, an average of 2 months

The RP2D was decided by the investigators taken into consideration the information obtained in the study and based on the MTD. To define the RP2D, information about toxicity observed during the full treatment were taken into consideration (relative dose intensity and toxicity observed).

Rate of dose limiting toxicities
occurring within 42 days of investigational treatment

A dose limiting toxicity is a clinically significant adverse event (AE) occurring within 42 days of investigational treatment that is considered by the investigator to be possibly, probably, or definitely related to LDE225.

Number of Participants With Dose Limiting Toxicities (DLTs) (Phase 1b)
6 weeks (42 days)

A dose-limiting toxicity (DLT) was defined as an adverse event or abnormal laboratory value assessed as unrelated to disease progression, inter-current illness, or concomitant medications that met certain criteria as defined in the protocol.

Percentage of Patients Achieving >= 35% Reduction in Spleen Volume in Phase Ib Expansion and Phase II Stage 1
Week 24 and Week 48

Reduction in spleen volume as measured by magnetic resonance imaging/Cat Scan (MRI/CT) in Phase Ib expansion and Phase II Stage 1 patients

Pharmacokinetics (PK) parameter AUClast for S- and R-warfarin
7 days

Pharmacokinetics of warfarin : Maximum observed plasma concentration after drug administration

PK parameter AUClast for bupropion
7 days

Pharmacokinetics bupropion : Maximum observed plasma concentration after drug administration

PK parameter AUCinf for bupropion
7 days

Pharmacokinetics of bupropion : Maximum observed plasma concentration after drug administration

PK parameter AUCinf for S- and R-warfarin
7 days

Pharmacokinetics of warfarin and bupropion : Maximum observed plasma concentration after drug administration

PK parameter Cmax for S- and R-warfarin
7 days

Pharmacokinetics of warfarin : Maximum observed plasma concentration after drug administration

PK parameters Cmax for bupropion
7 days

Pharmacokinetics of Bupropion : Maximum observed plasma concentration after drug administration

LDE225A pharmacokinetic parameter Tmax
8 weeks

Evaluate the pharmacokinetics of a single dose of LDE225 in subjects with impaired hepatic function as compared to healthy subjects for an 8 weeks follow up period

LDE225A pharmacokinetic parameter Cmax
8 weeks

Evaluate the pharmacokinetics of a single dose of LDE225 in subjects with impaired hepatic function as compared to healthy subjects for an 8 weeks follow up period

LDE225A pharmacokinetic parameter AUClast
8 weeks

Evaluate the pharmacokinetics of a single dose of LDE225 in subjects with impaired hepatic function as compared to healthy subjects for an 8 weeks follow up period

LDE225A pharmacokinetic parameter AUCinf
8 weeks

Evaluate the pharmacokinetics of a single dose of LDE225 in subjects with impaired hepatic function as compared to healthy subjects for an 8 weeks follow up period

LDE225A pharmacokinetic parameter T1/2
8 weeks

Evaluate the pharmacokinetics of a single dose of LDE225 in subjects with impaired hepatic function as compared to healthy subjects for an 8 weeks follow up period

Dose Limiting Toxicities
6 weeks (42 days)

Dose Limiting Toxicities (DLTs) during the first 6 weeks (42 days) of the combination treatment of LDE225 and BKM120.

Incidence rate and category of dose limiting toxicities (DLTs)
first 8 weeks of study treatment

Dose limiting toxicities that occur during the first 8 weeks (56 days) of treatment with LDE225+gemcitabine. Dose limiting toxicity is defined as an adverse event or abnormal laboratory value assessed as unrelated to disease, disease progression, intercurrent illness, or concomitant medications that meets study specific criteria.

Number of Participants With Dose-limiting Toxicities (DLT) in Phase I
Baseline, End of dose escalation part (Day 42)

DLT was defined as an adverse event (AE) or abnormal laboratory value assessed as unrelated to disease, disease progression, intercurrent illness, or concomitant medications. DLT included any grade 3 or 4 clinically-evident toxicity, Hematology: ≥ CTCAE grade 3 neutropenia (ANC \<1.0x10\^9/L); ≥ CTCAE grade 3 thrombocytopenia (platelets \<50x10\^9/L); ≥ CTCAE grade 3 anemia (Hgb \<80 g/L); Febrile neutropenia (ANC \<1x10\^9/L, fever ‡ 38.5°C), Renal: ≥ CTCAE grade 3 serum creatinine (\>3xULN), Hepatic: ≥ CTCAE grade 3 total bilirubin (\>3xULN); ≥ 10xULN ALT elevation; grade 2 total bilirubin (\>1.5ULN) together with ≥ grade 3 ALT elevation (\>5xULN), Cardiac: ≥ CTCAE grade 3, Other AEs: ≥ CTCAE grade 3 vomiting or nausea despite optimal antiemetic therapy, diarrhea despite optimal antidiarrheal treatment.

Maximum Tolerated Dose (MTD) of Sonidegib for Prolonged Use
Baseline, End of dose escalation part (Day 42)

MTD was defined as highest dose level for which no more than 1 participant in a dose cohort experienced dose-limiting toxicity (DLT), based on Bayesian logistic regression model (BLRM) employing the escalation with overdose control (EWOC) principle. DLT was defined as an adverse event (AE) or abnormal laboratory value assessed as unrelated to disease, disease progression, intercurrent illness, or concomitant medications.k

Percentage of Participants With Objective Response Rate (ORR) by Treatment
Baseline, Day 28 of Cycle 2, End of treatment (Within 14 days of last dose)

The tumor response to the sonidegib treatment was measured by ORR. The ORR was defined as the percentage of participants with partial response or complete response as their best overall response. Participants with stable disease, progressive disease tumor assessment were considered as non-responders. Response evaluation criteria was gadolinium chelate-enhanced brain tumor magnetic resonance imaging (Gd-MRI) for Medulloblastoma and central nervous system (CNS) tumors and response evaluation criteria in solid tumors (RECIST) version 1.0 for non-CNS tumors assessed by MRI. Complete Response (CR), Progressive Disease (PD) and Incomplete Response/Stable Disease (SD) were defined as disappearance of all non-target lesions, unequivocal progression of existing non-target lesions and Neither CR nor PD, respectively.

determine maximum tolerated dose of single agent LDE225
28 day cycles

Secondary Endpoints

Progression Free Survival (PFS) According to IRC From Date First Participant Randomized, 13-Sep-2013 to Date of Data Cut-off, 15-Nov-2016
from date first participant randomized, 13-Sep-2013 to date of data cut-off, 15-Nov-2016
PFS According to Local Investigator Assessment From Date First Participant Randomized, 13-Sep-2013 to Date of Data Cut-off, 15-Nov-2016
from date first participant randomized, 13-Sep-2013 to date of data cut-off, 15-Nov-2016
Percentage of Participants With ORR According to Local Investigator Assessment From Date First Participant Randomized, 13-Sep-2013 to Date of Data Cut-off, 15-Nov-2016
from date first participant randomized, 13-Sep-2013 to date of data cut-off, 15-Nov-2016
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Study Design & Arms

AllocationNON_RANDOMIZED
MaskingNONE
ModelSINGLE_GROUP
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
Sonidegib (LDE225)EXPERIMENTAL600 mg orally for adults and 500 mg/m2 orally for children
Temozolamide (TMZ)ACTIVE_COMPARATOR150 to 200 mg/m2 for 5 sequential days every 4 weeks according to prescribing information until the study was amended to a single arm study.
LDE225-400EXPERIMENTALPatients who were randomized to Schedule A, and received 400 mg LDE225 twice daily for the first two weeks only and then after two weeks, received 800 mg LDE225 once daily until disease progression, toxicity, withdrawal of consent, death, discretion of the investigator or early termination of the study.
LDE225-800EXPERIMENTALPatients who were randomized to Schedule B, received 800 mg LDE225 once daily until disease progression, toxicity, withdrawal of consent, death, discretion of the investigator or early termination of the study.
LDE225 200 mgEXPERIMENTALThe study was double blinded and enrolled at least 50 evaluable patients in the 200 mg LDE225 arm. The efficacy and safety of LDE225 was analyzed separately in each group. Patients who met all the inclusion and none of the exclusion criteria were treated with 200 mg LDE225 daily until disease progression, occurrence of intolerable toxicity, start of another anticancer treatment or withdrawal of consent.
LDE225 800 mgEXPERIMENTALThe study was double blinded and enrolled at least 100 evaluable patients in the 800 mg LDE225 arm. The efficacy and safety of LDE225 was analyzed separately in each group. Patients who met all the inclusion and none of the exclusion criteria were treated with 800 mg LDE225 daily until disease progression, occurrence of intolerable toxicity, start of another anticancer treatment or withdrawal of consent.
LDE225ACTIVE_COMPARATORParticipants received 400 mg once daily.
PlaceboPLACEBO_COMPARATORParticipants received matching placebo.
LDE225 (sonidegib) plus docetaxelEXPERIMENTALEligible patients will be included and treated with docetaxel intravenously (75mg/m2)in every three weeks cycles and LDE225 will be administered orally at three dose levels 400, 600 and 800mg QD. Treatment will be repeated on day 1 of a 21-day cycle until radiographic or symptomatic progression, unacceptable toxicity or withdraws informed consent.
LDE225 + INC424EXPERIMENTALLDE225 and INC424 in combination
LDE225+WarfarinEXPERIMENTALAt least 15 evaluable patients with advanced solid tumors will be enrolled into the study into the warfarin group.
LDE225+BupropionEXPERIMENTALAt least 15 evaluable patients with advanced solid tumors will be enrolled into the study into the Bupropion group
LDE225 and BKM120 in combinationEXPERIMENTALLDE225 and BKM120 in combination
LDE225+gemcitabineEXPERIMENTALIncreasing doses of LDE225 (from 400 mg) once a day + 1000 mg/m2 of gemcitabine on days 1, 8 and 15 of every 28 day cycle.
LDE225 233mg/m2 daily doseEXPERIMENTALPediatric dose.
LDE225 372mg/m2 daily doseEXPERIMENTALPediatric dose.
LDE225 425 mg/m2 daily doseEXPERIMENTALPediatric dose.
LDE225 680 mg/m2 daily doseEXPERIMENTALPediatric dose.
LDE225 800 mg/m2 daily doseEXPERIMENTALAdult dose

Interventions

NameTypeDescription
LDE225DRUGSonidegib for oral suspension was supplied in amber glass bottles. Sonidegib oral suspension was combined with the supplied reconstitution vehicle to a final concentration of 50 mg/mL.
TMZDRUGTemozolomide capsules were obtained locally by the Investigator
PlaceboDRUGsupplied in capsules
DocetaxelDRUG -
INC424DRUG -
WafarinDRUG15 mg single dose of warfarin (oral tablet) will be given to patients.
BupropionDRUG75 mg single dose of bupropion(oral tablet, from an immediate release formulation) will be given to patients
BKM120DRUG -
LDE225+gemcitabineDRUGPatients will receive increasing doses of LDE225 (from 400 mg), depending on the cohort they are assigned to, orally once daily and standard doses of gemcitabine (1000 mg/m2) on days 1, 8 and 15 of every 28-day cycle. Patients will receive the study treatment until they progressed, experience unacceptable toxicity, withdraw from the study, or the investigator decides it is in their best interest to discontinue the study treatment.
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Eligibility Criteria

Age Range4 Months to N/A
SexALL
Healthy VolunteersNo
Study Sites41

Inclusion Criteria: * Patients with histologically confirmed diagnosis of MB, who have experienced relapse or progression after standard-of-care therapy including radiotherapy. Patients currently receiving steroids must have been on a stable (or decreasing) dose for at least 5 days before initiatin...

Countries:United StatesAustraliaBrazilCanadaFranceGermanyItalyNetherlandsRussiaSpainSwedenSwitzerlandUnited KingdomAustriaBelgiumHungaryNorwayGreeceDenmarkIrelandBulgariaIsraelHong KongJapanTaiwan
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Frequently asked questions about LDE225

What is LDE225?

LDE225 is an investigational small molecule developed by Novartis AG for oncology indications. It has been studied in acute leukemias, advanced breast cancer, advanced solid tumors, basal cell carcinoma, and hepatocellular carcinoma. LDE225 is also known as sonidegib and has been evaluated both as a single agent and in combination regimens such as LDE225 plus gemcitabine.

What is LDE225 used for?

LDE225 has been studied in adults with several cancer types, including acute leukemias, advanced breast cancer, advanced solid tumors, basal cell carcinoma, and hepatocellular carcinoma. Clinical testing has covered relapsed or refractory acute leukemia, triple negative advanced breast cancer, and hepatocellular carcinoma with Child-Pugh A or B7 cirrhosis.

Who makes LDE225?

LDE225 is developed by Novartis AG, which trades under the ticker NVS. Novartis has sponsored the clinical trial program evaluating LDE225 across hematologic and solid tumor indications, including studies combining LDE225 with docetaxel and with INC424.

What phase is LDE225 in?

LDE225 has reached Phase 2 in its clinical development program. The Phase 2 study evaluated LDE225 in adults with relapsed or refractory acute leukemia. Other completed studies were Phase 1 or Phase 1b/2, and LDE225 remains an investigational agent rather than an approved therapy.

What clinical trials is LDE225 in?

Completed LDE225 trials include NCT01826214, a Phase 2 study in relapsed or refractory acute leukemia enrolling 70 patients, and NCT02151864, a Phase 1 study in hepatocellular carcinoma with cirrhosis enrolling 9 patients. NCT02027376 tested LDE225 with docetaxel in triple negative advanced breast cancer, and NCT01787552 tested LDE225 plus INC424 in myelofibrosis.