Summary

This phase I trial studies the side effects and best dose of gemcitabine and cisplatin when given together with ivosidenib or pemigatinib in treating patients with cholangiocarcinoma that cannot be removed with surgery (unresectable) or has spread to other places in the body (metastatic). Chemotherapy drugs, such as gemcitabine and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Ivosidenib and pemigatinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving gemcitabine and cisplatin with ivosidenib or pemigatinib may work better in treating patients with cholangiocarcinoma compared to gemcitabine and cisplatin alone.

Objectives

PRIMARY OBJECTIVE:
I. To evaluate the safety, tolerability, maximum tolerated dose (MTD) and/or recommended phase 2 dose, gemcitabine and cisplatin in combination with either ivosidenib or pemigatinib.

SECONDARY OBJECTIVES:
I. To evaluate median and progression free survival (PFS) for 6 months per investigator assessment.
II. To evaluate the rate of overall survival (OS) in patients treated with gemcitabine and cisplatin in combination with either ivosidenib or pemigatinib.
III. To describe the overall toxicity and adverse events profile associated with gemcitabine and cisplatin in combination with either ivosidenib or pemigatinib.
IV. To determine the best response profile per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria in patients treated with gemcitabine and cisplatin in combination with either ivosidenib or pemigatinib.

CORRELATIVE RESEARCH OBJECTIVE:
I. To measure plasma 2-hydroxglutarate (2-HG) levels =< 21 days prior to registration and at cycle 4 day 1 (+/- 2 days).

OUTLINE: This is a dose de-escalation study. Patients are assigned to 1 of 2 arms.

ARM A (IDH1 GENE MUTATION): Patients receive ivosidenib orally (PO) on days 1-21, cisplatin intravenously (IV) on days 1 and 8, and gemcitabine IV on days 1 and 8. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.

ARM B (FGFR2 GENE ALTERATION): Patients receive pemigatinib PO on days 1-21, cisplatin IV on days 1 and 8, and gemcitabine IV on days 1 and 8. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up at 30 days and then every 6 months for up to 3 years.

Eligibility

1. Histopathological diagnosis (fresh) or banked tumor biopsy sample collected within the last 3 years from the registration date consistent with nonresectable or metastatic cholangiocarcinoma and are not eligible for curative resection, transplantation, or ablative therapies
2. Documented disease without any evidence of progression following at least 3 cycles of standard-of-care chemotherapy including gemcitabine and cisplatin as part of first-line systemic therapy; NOTE: Only patients receiving standard-of-care chemotherapy including gemcitabine and cisplatin as first-line therapy for unresectable or metastatic cholangiocarcinoma will be permitted to enroll in this trial. Prior systemic adjuvant chemotherapy is allowed as long as there was no evidence of recurrence within 6 months of completing the adjuvant therapy
3. Molecular testing result from Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory (using fresh tumor biopsy or most recent banked tumor tissue available) confirming that the tumor tissue has at least one of the following: * IDH1 gene mutation (R132C/L/G/H/S mutation) * FGFR2 gene alteration
4. Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 or 1
5. Life expectancy >= 3 months
6. At least one evaluable and measurable lesion by RECIST criteria prior to beginning chemotherapy with gemcitabine and cisplatin * NOTE: Subjects who have received prior local therapy (including but not limited to embolization, chemoembolization, radiofrequency ablation, hepatic arterial infusion, or radiation therapy) are eligible provided measurable disease falls outside of the treatment
7. Recovered from toxicities associated with prior anticancer therapy to baseline unless stabilized under medical management
8. Absolute neutrophil count >= 1,500/mm^3 (obtained =< 21 days prior to registration)
9. Platelet count >= 100,000/mm^3 (obtained =< 21 days prior to registration)
10. Hemoglobin >= 8 g/dL (obtained =< 21 days prior to registration)
11. Serum total bilirubin =< 2.0 x upper limit of normal (ULN), unless considered due to Gilbert's disease. If Gilbert's disease or disease involving liver, serum total bilirubin =< 2.5 x ULN (obtained =< 21 days prior to registration)
12. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2.5 x ULN or =< 5.0 x ULN in the presence of liver metastases (obtained =< 21 days prior to registration)
13. Serum creatinine < 1.5 x ULN OR creatinine clearance >= 50 mL/min based on the Cockcroft-Gault glomerular filtration rate (GFR) estimation (obtained =< 21 days prior to registration)
14. Serum phosphate =< institutional ULN and potassium within institutional normal range for Arm B only (obtained =< 21 days prior to registration) * NOTE: Supplemental potassium may be used to correct potassium prior to registration
15. Negative serum pregnancy test done =< 7 days prior to registration for women of childbearing potential only * NOTE: Females of reproductive potential are defined as sexually mature women who have not undergone a hysterectomy, bilateral oophorectomy, or tubal occlusion or who have not been naturally postmenopausal (i.e., who have not menstruated) for >= 24 consecutive months (i.e., have not had menses at any time in the preceding 24 consecutive months)
16. Women of reproductive potential and fertile men must agree to use 2 effective forms of contraception (including at least 1 barrier form) from the time of giving informed consent throughout the study and for 90 days (both females and males) following the last dose of study drug * NOTE: Effective forms of contraception are defined as hormonal oral contraceptives, injectables, patches, intrauterine devices, intrauterine hormone-releasing systems, bilateral tubal ligation, condoms with spermicide, or male partner sterilization
17. Able to understand and willing to sign the informed consent form * NOTE: A legally authorized representative may consent on behalf of a subject who is otherwise unable to provide informed consent if acceptable to and approved by the site’s Institutional Review Board (IRB)/Independent Ethics Committee (IEC)
18. Able to comply with scheduled visits, treatment plans, procedures, and laboratory tests, including serial peripheral blood sampling during the study
19. Willing to provide blood samples for correlative research purposes

Treatment Sites in Georgia