Lenvatinib for advanced GIST after imatinib, sunitinib, and regorafenib

A Single-center, Single-arm Phase II Study to Evaluate the Efficacy and Safety of Lenvatinib in Patients With Advanced Gastrointestinal Stromal Tumors (GIST) Who Have Failed Treatment With Imatinib, Sunitinib, and Regorafenib

This trial tests whether the oral drug lenvatinib can help people with metastatic or advanced GIST whose disease has progressed on imatinib, sunitinib, and regorafenib.

Quick facts

• Phase: Phase1; Phase2
• Study type: Interventional
• Enrollment: 48 (estimated)
• Ages: 20 Years and up
• Sex: All
• Sponsor: Asan Medical Center (Academic / other)
• Drugs / interventions: imatinib, sunitinib, chemotherapy, lenvatinib, ripretinib
• Locations: 1 site (Seoul)
• Trial ID: NCT07096609 on ClinicalTrials.gov

What this trial studies

This is a Phase 1/2 interventional trial giving oral lenvatinib capsules to adults with metastatic or unresectable GIST who have failed imatinib, sunitinib, and regorafenib. The Phase 1 portion determines a safe and tolerable dose, and the Phase 2 portion looks for preliminary signs of anti-tumor activity and continued safety. Eligible tumors must be CD117 or DOG-1 positive or carry KIT/PDGFRα mutations, and prior progression or intolerance to the three listed TKIs is required. The trial responds to the unmet need for additional options after standard second- and third-line TKIs and limited access to approved fourth-line therapy in some regions.

Who should consider this trial

Good fit: Adults aged 20 or older with histologically confirmed metastatic or unresectable GIST that is CD117/DOG-1 positive or has KIT/PDGFRα mutations and who progressed on or were intolerant to imatinib, sunitinib, and regorafenib are ideal candidates.

Not a fit: Patients without KIT or PDGFRα alterations or negative for CD117/DOG-1, those with resectable disease, or those unable to take oral therapy or with prohibitive organ dysfunction are unlikely to benefit from this trial.

Why it matters

Potential benefit: If successful, lenvatinib could provide an additional treatment option that prolongs disease control for patients who have exhausted other approved TKIs.

How similar studies have performed: Other multi-kinase TKIs like sunitinib and regorafenib have proven benefit in second- and third-line GIST and ripretinib showed improved progression-free survival as a fourth-line option, but lenvatinib in this specific post‑third-line setting is relatively novel with limited published data.

Eligibility criteria

Inclusion Criteria:

1. Age ≥ 20 years at the time of providing written informed consent.
2. Histologically confirmed metastatic and/or advanced (unresectable or recurrent) GIST with positivity for CD117(+), DOG-1(+), or harboring mutations in the KIT or PDGFRα genes.
3. Documented failure of prior treatment with imatinib, sunitinib, and regorafenib due to disease progression and/or intolerance.

   * Note: There is no limitation on the number of prior therapies. Prior use of other tyrosine kinase inhibitors (TKIs) or chemotherapy in combination with imatinib, sunitinib, or regorafenib is permitted.
   * Disease progression is defined as:

     1. Increase in tumor size by ≥ 20% per mRECIST version 1.1
     2. Emergence of unequivocal new lesions (excluding newly developed small cystic liver lesions within 6 months after initiation of TKI treatment)
     3. Appearance of new solid nodules within cystic masses
     4. Increase in the size of existing solid nodules within cystic masses (\>20%)
   * Intolerance to prior TKIs is defined as:

     1. Drug compliance \<75% due to ≥ Grade 2 non-hematologic toxicity, despite dose reduction to one level below the standard dose (i.e., imatinib 300 mg/day; sunitinib 37.5 mg/day on a 4-week on/2-week off schedule or 25 mg/day on a continuous schedule; regorafenib 120 mg/day)
     2. Despite the same dose reduction as above, the occurrence of febrile neutropenia, Grade 4 neutropenia lasting more than 6 days, Grade 4 thrombocytopenia, Grade 3 thrombocytopenia with clinically significant bleeding, or Grade 3-4 or persistent ≥ Grade 2 non-hematologic toxicity deemed intolerable
4. ECOG performance status of 0-2.
5. All toxicities from previous treatments must have recovered to Grade 0 or 1 as per NCI-CTCAE version 5.0.
6. At least one measurable lesion as defined by mRECIST version 1.1.
7. Adequate bone marrow, liver, renal, and other organ function:

   * Absolute neutrophil count (ANC) ≥ 1,500/mm³
   * Platelets ≥ 100,000/mm³
   * Hemoglobin ≥ 8.0 g/dL
   * Total bilirubin ≤ 1.5 × upper limit of normal (ULN)
   * AST/ALT ≤ 2.5 × ULN (or ≤ 5 × ULN in case of liver metastases)
   * Serum creatinine ≤ 1.5 × ULN
8. Life expectancy ≥ 12 weeks
9. A washout period equivalent to at least 4 times the half-life of previous TKI or chemotherapeutic agents is required(Imatinib and regorafenib: ≥ 1 week; Sunitinib: ≥ 2 weeks)
10. Signed written informed consent

Exclusion Criteria:

1. Women of childbearing potential who are pregnant or breastfeeding
2. Women or men unwilling to use effective contraception during the study treatment period and for 6 months after the last dose of the investigational drug
3. All participants (both men and women) must use barrier contraception during the treatment period and for at least 1 month after the final dose
4. Women of childbearing potential are defined as sexually mature females who have not undergone hysterectomy or who have not been naturally postmenopausal for at least 12 consecutive months (i.e., had menstruation within the past 12 months)
5. History of any of the following within 6 months prior to enrollment: myocardial infarction, severe or unstable angina, coronary or peripheral artery bypass surgery, congestive heart failure classified as NYHA Class III or IV, stroke or transient ischemic attack (TIA), or clinically significant arrhythmias requiring treatment
6. Uncontrolled active infection
7. Diabetes mellitus with clinically significant signs of peripheral vascular disease
8. Acute or chronic liver disease, or any chronic hepatic disorder (patients with stable chronic hepatitis B are eligible)
9. Uncontrolled gastrointestinal toxicities greater than Grade 2 according to NCI-CTCAE (e.g., nausea, diarrhea, vomiting)
10. Any severe acute or chronic medical or psychiatric condition, or clinically significant abnormal laboratory finding, that may increase the risk associated with study participation or investigational drug administration, or interfere with the interpretation of study results, as determined by the investigator
11. History of life-threatening bleeding or any Grade 3 or 4 bleeding event requiring transfusion, endoscopic intervention, or surgical procedure within 3 months prior to initiation of study drug
12. Treatment with clinically significant systemic anticoagulant or antithrombotic agents within 7 days prior to consent that, in the opinion of the investigator, may put the patient at risk. Use of aspirin is permitted up to a maximum dose of 325 mg/day
13. Uncontrolled hypertension (blood pressure ≥ 140/90 mmHg) that is not adequately managed with medication, or change in antihypertensive regimen within 7 days prior to consent; such patients may be at increased risk during VEGF inhibitor therapy
14. Major surgery, significant trauma (e.g., bone fracture), or non-healed wounds within 3 weeks prior to consent (procedures such as catheter insertion are not considered major)
15. History of other significant cardiovascular or vascular conditions within 6 months prior to consent that, in the opinion of the investigator, may place the patient at risk during VEGF inhibitor therapy, including but not limited to hypertensive crisis, hypertensive encephalopathy, stroke, transient ischemic attack (TIA), or clinically significant peripheral vascular disease
16. Clinically significant glomerulonephritis, biopsy-proven tubulointerstitial nephritis, crystal nephropathy, or other history of renal failure
17. Known diagnosis of HIV infection (HIV testing is not mandatory)
18. History of another primary malignancy that has recently become clinically significant or currently requires active intervention
19. Evidence of brain metastasis on radiological imaging (e.g., CT or MRI) in patients presenting with symptoms suggestive of central nervous system involvement
20. History of alcohol or substance abuse disorder

Where this trial is running

Seoul

• Asan Medical Center — Seoul, South Korea (Recruiting)

Study contacts

• Study coordinator: Jaewon Hyung

Conditions GIST; Lenvatinib