Overview

This trial is a two-step Phase I/II study comprising:

Part 1: A dose escalation part with the aim to assess the safety of the proposed combination (N= up to 30 patients). In the dose escalation part, eligible patients will be treated with a fixed dose of pazopanib and escalating doses of HDM201.

Part 2: An extension part to collect preliminary data about the clinical activity of the proposed combination according to the 6M-PFR.

Eligibility

Inclusion Criteria:

I1. Male or female patient ≥ 18 years of age

        I2. Histologically or cytologically confirmed diagnosis of soft tissue sarcoma with
        documented p53 wild-type (wt) status and known MDM2 status (amplification or no
        amplification).
        Note: p53 wt status has to be determined by Next-generation sequencing of the full coding
        sequence using a tumor sample collected no longer than 36 months before inclusion.
        I3. Previously treated by at least one prior chemotherapy line of treatment in the
        advanced/metastatic setting.
        I4. STS subtypes eligible to pazopanib treatment according to respective SmPC Note: The
        following tumour types are eligible: Fibroblastic (adult fibrosarcoma, myxofibrosarcoma,
        sclerosing epithelioid fibrosarcoma, malignant solitary fibrous tumours), so-called
        fibrohistiocytic (pleomorphic malignant fibrous histiocytoma [MFH], giant cell MFH,
        inflammatory MFH), leiomyosarcoma, malignant glomus tumours, skeletal muscles (pleomorphic
        and alveolar rhabdomyosarcoma), vascular (epithelioid hemangioendothelioma, angiosarcoma),
        uncertain differentiation (synovial, epithelioid, alveolar soft part, clear cell,
        desmoplastic small round cell, extra-renal rhabdoid, malignant mesenchymoma, PEComa,
        intimal sarcoma), malignant peripheral nerve sheath tumours, undifferentiated soft tissue
        sarcomas not otherwise specified (NOS) and other types of sarcoma (not listed as
        ineligible)and liposarcoma.
        The following tumour types ARE NOT eligible: All rhabdomyosarcoma that are not alveolar or
        pleomorphic, chondrosarcoma, osteosarcoma, Ewing tumours/primitive neuroectodermal tumours
        (PNET), GIST, dermofibromatosis sarcoma protuberans, inflammatory myofibroblastic sarcoma,
        malignant mesothelioma and mixed mesodermal tumours of the uterus
        I5. Documented progressive disease and presence of at least one measurable lesion according
        to RECIST 1.1 (Appendix 01) based on screening tumor assessment.
        I6. Performance Status score of 0 or 1 according to the Eastern Cooperative Oncology Group
        (ECOG) scale.
        I7. Adequate organ system function as assessed by the following minimal requirements
        (within 7 days prior to first administration of study drugs (C1D1)):
        Absolute Neutrophil Count (ANC) ≥ 1.5 x 109/L Platelets ≥ 100 x 109/L Hemoglobin ≥ 9 g/dL
        (5.6 mmol/L). Transfusion is not allowed within 2 weeks of screening assessment.
        aspartate transaminase and alanine aminotransferase ≤ 2.5x Upper limit of normal or up to 5
        Upper limit of normal in case of liver metastasis Bilirubin ≤ 1.5 Upper limit of normal
        (except in the setting of isolated Gilbert syndrome) Serum creatinine clearance ≥ 30 mL/min
        (calculated by CKD-EPI -Appendix 03) Calcium, magnesium and potassium within normal limits.
        Urine Protein to Creatinine ratio (UPC) <1; if UPC ≥1, 24-hour urine protein must be <1g
        (use of urine dipstick for renal function assessment is not acceptable).
        I8. Adequate cardiovascular function:
        QTcF (corrected QT using Fridericia) ≤450ms, from 3 electrocardiograms on screening ECG,
        within 14 days prior to C1D1 Resting blood pressure systolic <140 mmHg and diastolic< 90
        mmHg, Left Ventricular Ejection Fraction ≥50% as determined by transthoracic echocardiogram
        or Multiple Gated acquisition.
        I9. Resolution (i.e. ≤ Grade 1 with the exception of alopecia all grades and Grade 2 for
        neuropathy, lab values presented in inclusion criteria) of any toxicities related to
        previous anti-cancer treatment.
        I10. Patients able to swallow orally administered medication and do not have any clinically
        significant gastrointestinal abnormalities that may alter absorption of study drugs such as
        malabsorption syndrome or major resection of the stomach or bowels.
        I11. Availability of archival Formalin Fixed Paraffin Embedded tumor sample. This sample
        must be sent to sponsor once eligibility is confirmed.
        I12. Expansion part only - Presence of at least one biopsiable lesion i.e. at least one
        lesion with a diameter ≥10 mm, visible by medical imaging and accessible to repeatable
        percutaneous or endoscopic sampling that permit core needle biopsy without unacceptable
        risk and suitable for retrieval of a minimum of three, but ideally four, cores using a
        biopsy needle of at least 16-gauge. Note: RECIST target lesion are not to be biopsied.
        I13. Women patient of child-bearing potential must have a negative serum pregnancy test
        before C1D1 and must agree to use effective forms of contraception from the time of the
        negative pregnancy test up to 6 months after the last dose of study drugs
        I14. Sexually active and fertile men must agree to use contraceptive measures up to 100
        days after the last study drugs.
        I15. Written informed consent from patient before any study-specific screening procedures,
        and willingness to comply to study visits and procedures.
        I16. Patients must be covered by a medical insurance
        Exclusion Criteria:
        Non-inclusion 1. Prior exposure to MMD2 inhibitors and/or pazopanib.
        Non-inclusion 2. Patients with significant active or uncontrolled cardiovascular disease or
        prior medical cardiac function disorders including for example uncontrolled hypertension,
        peripheral vascular disease, congestive heart failure (Class III-IV according to New York
        Heart Association scale), cardiac arrhythmia, or acute coronary syndrome within 6 months of
        C1D1 or myocardial infarction, angina pectoris, symptomatic pericarditis, within 12 months
        of C1D1, congenital long QT syndrome or family history of long QT syndrome and patients
        with drug eluting stents for cardiovascular purposes.
        Non-inclusion 3. Patients diagnosed with treatment-related interstitial lung disease or
        pneumonitis.
        Non-inclusion 4. Patients with secondary malignancy unless this malignancy is not expected
        to interfere with the evaluation of study endpoints and is approved by the sponsor.
        Examples of the latter include: basal or squamous cell carcinoma of the skin, in-situ
        carcinoma of the cervix, localized prostate cancer, prior malignancy and no evidence of
        disease for ≥ 2 years.
        Non-inclusion 5. Patient with any condition (e.g., clinically significant gastrointestinal
        abnormality or disease resulting in an inability to take oral medication, prior surgical
        procedures affecting absorption, or active peptic ulcer disease) that impairs their ability
        to swallow and retain tablets and may affect the absorption of the investigational product
        are excluded.
        Non-inclusion 6. Clinically significant gastrointestinal abnormalities that may increase
        the risk for gastrointestinal bleeding including, but not limited to:
          -  Active peptic ulcer disease
          -  Known intraluminal metastatic lesion(s) with risk of bleeding
          -  Inflammatory bowel disease (e.g. ulcerative colitis, Crohn's disease), or other
             gastrointestinal conditions with increased risk of perforation
          -  History of abdominal fistula, gastrointestinal perforation, or intra abdominal abscess
             within 28 days prior to beginning study treatment.
        Non-inclusion 7. History of hemoptysis, cerebral hemorrhage or clinically significant
        gastrointestinal (GI) hemorrhage in the past 6 months.
        Non-inclusion 8. Hypersensitivity to the active substance or to any of the excipients
        listed in section VII.1.
        Non-inclusion 9. Patients using, or requirement to use while on the study, or not
        respecting the minimal wash-out period of medications listed below:
        Forbidden concomitant medications during the study period and Minimal wash-out period
        before C1D1:
        4 weeks - Any approved anti-cancer treatment (including hormonotherapy, chemotherapy,
        biological therapy, targeted therapy or immunotherapy) Note: Concurrent use of hormones for
        non-cancer-related conditions (e.g., insulin for diabetes and hormone replacement therapy)
        is acceptable. Or Any investigational therapy other than the specified therapies in present
        protocol
        4 weeks - Radiotherapy - Note: Except palliative radiotherapy on non-target lesions after
        discussion with the Sponsor
        4 weeks - Surgery: Major surgical procedure, or significant traumatic injury. Note: If a
        patient underwent a major surgical procedure, he/she must have adequately recovered from
        the toxicity (i.e. wound healing) and/or complications from the intervention prior to
        starting therapy.
        4 weeks - Live vaccines. Note: Seasonal influenza vaccines for injection are generally
        inactivated flu vaccines and are allowed; however intranasal influenza vaccines (e.g.,
        Flu-Mist®) are live attenuated vaccines, and are not allowed.
        1 week - Medicinal products known to prolong the QT interval and/ or to induce "Torsades de
        Pointes"
        1 week - Strong and moderate inducers or inhibitors of CYP3A4/5
          1. week - Strong inhibitors of P-glycoprotein (P-gp) or breast cancer resistance protein
             (BCRP)
             Forbidden concomitant medications during the DLT period:
             unless clinically indicated by institutional and/or American Society of Clinical
             Oncology (ASCO) guidelines - Growth factors targeting the myeloid lineage
          2. weeks prior treatment start and during the DLT defined period - Prophylactic use of
             red blood cells and platelet transfusions.
        Note: Therapeutic transfusions if clinically indicated by institutional and/or ASCO
        guidelines are permitted but may qualify as DLT. Transfusions outside the above specified
        timeframe are permitted.
        Non-inclusion 10. Known active central nervous system (CNS) metastases and/or carcinomatous
        meningitis.
        Non-inclusion 11. History of (non-infectious) pneumonitis that required steroids, evidence
        of interstitial lung disease or active non-infectious pneumonitis.
        Non-inclusion 12. Known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies)
        or active Hepatitis B (e.g., HBsAg reactive) or Hepatitis C (e.g., HCV RNA [qualitative] is
        detected)
        Non-inclusion 13. Pregnant or breast-feeding female patients.