Phase 1 Safety Study of X-396, an Oral ALK Inhibitor, in Patients With Advanced Solid Tumors

Inclusion Criteria:

1. Histologically or cytologically confirmed diagnosis of advanced solid tumor malignancy that is not responsive to at least 1 prior standard regimen for advanced disease or for which there is no approved therapy or for patients that refuse standard therapy. As long as the therapy was tolerated, patients in the dose escalation portion may have received prior crizotinib and/or second generation ALK TKIs, while patients in the expanded cohort portion may have received prior crizotinib.
2. Eastern Cooperative Group (ECOG) Performance Status score of 0 or 1.
3. Ability to swallow and retain oral medication.
4. Adequate organ system function.
5. Patients with treated CNS metastases are eligible.
6. Male patients willing to use adequate contraceptive measures.
7. Female patients who are not of child-bearing potential, and female patients of child-bearing potential who agree to use adequate contraceptive measures and who have a negative serum or urine pregnancy test within 1 week prior to initial trial treatment.
8. Patients must be ≥ 18 years of age.
9. Patients must have measurable or evaluable disease for the dose escalation portion of the study and measurable disease for the expanded cohort portion of the study.
10. Patients entering this study will be asked to provide tissue for correlative testing.
11. For the expanded cohort portion of the study, patients in the cohort with ALK genomic alterations must be ALK-positive by FISH. Patients in the ALK-negative, MET-negative cohort must be negative for ALK by FISH and MET alterations by immunohistochemistry (IHC).
12. Willingness and ability to comply with the trial and follow-up procedures.
13. Ability to understand the nature of this trial and give written informed consent.

Exclusion Criteria:

1. Patients currently receiving cancer therapy.
2. Use of an investigational drug within 21 days or 5 half-lives (whichever is shorter) prior to the first dose of X-396.
3. Any major surgery, radiotherapy, or immunotherapy within the last 21 days (limited palliative radiation is allowed ≥2 weeks prior to the first dose; ≥4 weeks for whole brain radiotherapy). Chemotherapy regimens with delayed toxicity within the last 4 weeks (or within the last 6 weeks for prior nitrosourea or mitomycin C). Chemotherapy regimens given continuously or on a weekly basis with limited potential for delayed toxicity within the last 2 weeks.
4. Prior stem cell transplant.
5. Patients with a known allergy or delayed hypersensitivity reaction to drugs chemically related to X-396 (e.g., crizotinib) or to the active ingredient of X-396.
6. Patients with primary CNS tumors are ineligible.
7. Concomitant use of drugs with a risk of causing prolonged QTc and/or Torsades de Pointes.
8. Concomitant use of herbal medications (e.g., St. John's wort, Kava, ephedra [ma huang], ginko biloba) at least 7 days prior to the first dose of study drug and throughout participation in the trial.
9. Females who are pregnant or breastfeeding.
10. Presence of active gastrointestinal (GI) disease or other condition that will interfere significantly with the absorption, distribution, metabolism, or excretion of X-396.
11. Clinically significant cardiovascular disease.
12. Patients who are immunosuppressed (including known HIV infection), have a serious active infection at the time of treatment, or another serious underlying medical condition that would impair the ability of the patient to receive protocol treatment.
13. Patients that, in the investigator's opinion, have tolerated poorly prior treatment with an ALK or MET inhibitor.
14. Psychological, familial, sociological, or geographical conditions that do not permit compliance with the protocol.
15. Concurrent condition that in the investigator's opinion would jeopardize compliance with the protocol or would impart excessive risk associated with study participation that would make it inappropriate for the patient to be enrolled.
16. Inability or unwillingness to comply with study and/or follow-up procedures outlined in the protocol.