Approval Probability
TA Base Rate
Adjusted LOA
ML Risk
Also known as Sonidegib, hedgehog inhibitor
LDE225 · 14 trials · 40 indications
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.
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.
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.
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.
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.
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.
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
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.
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).
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.
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.
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 of warfarin : Maximum observed plasma concentration after drug administration
Pharmacokinetics bupropion : Maximum observed plasma concentration after drug administration
Pharmacokinetics of bupropion : Maximum observed plasma concentration after drug administration
Pharmacokinetics of warfarin and bupropion : Maximum observed plasma concentration after drug administration
Pharmacokinetics of warfarin : Maximum observed plasma concentration after drug administration
Pharmacokinetics of Bupropion : Maximum observed plasma concentration after drug administration
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
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
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
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
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 (DLTs) during the first 6 weeks (42 days) of the combination treatment of LDE225 and BKM120.
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.
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.
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
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.
| Arm | Type | Description |
|---|---|---|
| Sonidegib (LDE225) | EXPERIMENTAL | 600 mg orally for adults and 500 mg/m2 orally for children |
| Temozolamide (TMZ) | ACTIVE_COMPARATOR | 150 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. |
| LDE225-400 | EXPERIMENTAL | Patients 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. |
| LDE225-800 | EXPERIMENTAL | Patients 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 mg | EXPERIMENTAL | The 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 mg | EXPERIMENTAL | The 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. |
| LDE225 | ACTIVE_COMPARATOR | Participants received 400 mg once daily. |
| Placebo | PLACEBO_COMPARATOR | Participants received matching placebo. |
| LDE225 (sonidegib) plus docetaxel | EXPERIMENTAL | Eligible 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 + INC424 | EXPERIMENTAL | LDE225 and INC424 in combination |
| LDE225+Warfarin | EXPERIMENTAL | At least 15 evaluable patients with advanced solid tumors will be enrolled into the study into the warfarin group. |
| LDE225+Bupropion | EXPERIMENTAL | At least 15 evaluable patients with advanced solid tumors will be enrolled into the study into the Bupropion group |
| LDE225 and BKM120 in combination | EXPERIMENTAL | LDE225 and BKM120 in combination |
| LDE225+gemcitabine | EXPERIMENTAL | Increasing 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 dose | EXPERIMENTAL | Pediatric dose. |
| LDE225 372mg/m2 daily dose | EXPERIMENTAL | Pediatric dose. |
| LDE225 425 mg/m2 daily dose | EXPERIMENTAL | Pediatric dose. |
| LDE225 680 mg/m2 daily dose | EXPERIMENTAL | Pediatric dose. |
| LDE225 800 mg/m2 daily dose | EXPERIMENTAL | Adult dose |
| Name | Type | Description |
|---|---|---|
| LDE225 | DRUG | Sonidegib 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. |
| TMZ | DRUG | Temozolomide capsules were obtained locally by the Investigator |
| Placebo | DRUG | supplied in capsules |
| Docetaxel | DRUG | - |
| INC424 | DRUG | - |
| Wafarin | DRUG | 15 mg single dose of warfarin (oral tablet) will be given to patients. |
| Bupropion | DRUG | 75 mg single dose of bupropion(oral tablet, from an immediate release formulation) will be given to patients |
| BKM120 | DRUG | - |
| LDE225+gemcitabine | DRUG | Patients 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. |
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...
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.
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.
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.
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.
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.