Phase II Open-Label Multi-Cohort Study Evaluating CPI-613 (Devimistat) in Combination With Hydroxychloroquine and 5-fluorouracil or Gemcitabine in Patients With Advanced Chemorefractory Colorectal, Pancreatic, or Other Solid Cancers

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Trial Details

Sponsor: Northwestern University (other)

Phase: 2

Start date: March 8, 2023

Planned enrollment: 94

Trial ID: NCT05733000
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chevron Show for: Devimistat (CPI-613)

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Goal: Estimate antitumor activity of devimistat (CPI-613) combined with hydroxychloroquine and either 5-fluorouracil or gemcitabine in chemorefractory advanced solid tumors, and characterize progression-free survival, overall survival, duration of response, and safety.

Patients: Adults ≥18 years with metastatic, measurable, chemorefractory solid tumors and ECOG 0–1 (selected ECOG 2 allowed with PI approval). Cohort 1: colorectal cancer. Cohort 2: pancreatic cancer. Cohort 3: gastroesophageal, biliary, urothelial, ovarian, or non-small cell lung cancer (adenocarcinoma). Adequate marrow, hepatic, and renal function required; key exclusions include uncontrolled cardiac disease or QTc prolongation, active infections, symptomatic brain metastases on steroids, significant pulmonary disease, pre-existing retinopathy, and concomitant QT-prolonging drugs.

Design: Phase II, open-label, nonrandomized, multi-cohort study. Approximately 94 patients allocated to three histology-defined cohorts; no control arm. Radiographic assessments per RECIST v1.1 with time-to-event endpoints analyzed by Kaplan-Meier.

Treatments: All cohorts receive intravenous devimistat with hydroxychloroquine plus either 5-fluorouracil or gemcitabine, regimen selected by tumor cohort. Cohort 1 (colorectal) and cohort 2 (pancreatic): devimistat + 5-FU + HCQ. Cohort 3: gastroesophageal cancer receives devimistat + 5-FU + HCQ; urothelial, ovarian, or NSCLC receive devimistat + gemcitabine + HCQ; biliary tumors receive devimistat + gemcitabine or HCQ with devimistat. Devimistat (CPI-613) is an investigational lipoic acid analogue targeting tumor metabolism by inhibiting mitochondrial TCA cycle enzymes pyruvate dehydrogenase and α-ketoglutarate dehydrogenase, impairing oxidative phosphorylation and energy production. In prior studies, devimistat did not improve overall survival when added to modified FOLFIRINOX in metastatic pancreatic cancer and an AML phase III study was stopped for lack of efficacy; however, early-phase biliary tract data with gemcitabine/cisplatin showed tolerability and signals of activity. Hydroxychloroquine inhibits autophagy and can potentiate anticancer effects but carries QT prolongation and retinopathy risks. 5-FU and gemcitabine are standard cytotoxic agents used in GI and other solid tumors.

Outcomes: Primary: overall response rate per RECIST v1.1. Secondary: progression-free survival, overall survival, duration of response, and incidence of adverse events (CTCAE v5.0). Exploratory: in cohort 3, serial blood-based molecular and metabolic profiling at defined timepoints (baseline, C1D1, C1D15, C2D1, end of treatment).

Burden on patient: Moderate. Patients undergo intravenous chemotherapy and devimistat infusions with concurrent daily oral hydroxychloroquine, requiring regular clinic visits for administration, safety labs, ECG monitoring for QTc, and ophthalmologic vigilance due to HCQ risk. Imaging with CT and/or MRI is performed at standard intervals for RECIST assessments. Cohort 3 includes additional scheduled blood draws for exploratory proteomic/metabolomic/genomic analyses at multiple timepoints, increasing visit frequency and phlebotomy. No mandatory tumor biopsies are specified. Travel and time commitments are greater than standard single-agent oral therapy but comparable to multi-agent IV regimens with added research blood collections and safety monitoring.

Last updated: Oct 2025

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Northwestern University

Chicago, Illinois, 60611, United States

[email protected] / 312-695-6929

Status: Recruiting

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