Sponsor: Northwestern University (other)
Phase: 2
Start date: March 8, 2023
Planned enrollment: 94
Devimistat (CPI-613) is an investigational, intravenous lipoate analog designed to disrupt tumor mitochondrial metabolism, chiefly within the tricarboxylic acid (TCA) cycle. It has been evaluated across multiple cancers, most prominently pancreatic ductal adenocarcinoma (PDAC), acute myeloid leukemia (AML), and biliary tract cancers (BTC). A phase 3 trial in metastatic PDAC (AVENGER 500) was negative for overall survival benefit versus FOLFIRINOX alone, and a phase 3 trial in relapsed/refractory AML (ARMADA 2000) was halted for futility after interim analysis. Earlier-phase studies have reported activity signals in AML and BTC combinations. (pubmed.ncbi.nlm.nih.gov)
Devimistat targets two lipoate-dependent mitochondrial enzyme complexes, pyruvate dehydrogenase (PDH) and α‑ketoglutarate dehydrogenase (KGDH/OGDH), reducing entry of glucose- and glutamine-derived carbons into the TCA cycle. Proposed mechanisms include promoting PDH phosphorylation/inactivation and redox-dependent inhibition of KGDH, leading to impaired mitochondrial respiration and pro-apoptotic stress in tumor cells. Preclinical work shows mitochondrial disruption, decreased oxygen consumption, and synergy with genotoxic agents. (jci.org)
Phase 1 dose-escalation (n=20): In combination with modified FOLFIRINOX, the maximum tolerated devimistat dose was 500 mg/m²; among 18 patients treated at this dose, objective response rate was 61% (including complete responses) in this single-center study (hypothesis-generating). (pubmed.ncbi.nlm.nih.gov)
Acute myeloid leukemia (relapsed/refractory):
Phase 1 (n=67; 62 evaluable): High-dose cytarabine/mitoxantrone + devimistat produced an overall response rate of 50% (CR+CRi) with median survival 6.7 months; responses were seen in older and poor-risk subsets. A subsequent single-arm phase 2 reported CR+CRi 44% (21/48) and median survival 5.9 months; maintenance devimistat was not feasible. (aacrjournals.org)
Biliary tract cancers (first line, phase Ib):
Last updated: Oct 2025
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
Inclusion Criteria:
* Patients must have histologically confirmed cancer for which standard-of-care curative measures are no longer effective or be intolerant to those agents. Patients in cohort 1 must have colorectal cancer. Patients in cohort 2 must have pancreatic cancer. Patients in cohort 3 may have any of the following cancers:
* Biliary
* Gastroesophageal
* Urothelial
* Ovarian
* Non-small cell lung (adenocarcinoma only)
* Patients must have measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 disease.
* Patients must have radiographic documentation of metastatic disease with imaging within =\< 6 weeks prior to registration.
* Patients must be age \>= 18 years.
* Patients must exhibit an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. Performance Status of 2 will be allowed with approval from principle investigator (PI) on a case-by case basis.
* Note: Performance status of 2 will be allowed with approval from PI on a case-by case basis. Documentation of PI approval in these cases will be stored with inclusion/exclusion signed checklist for patient and/or in patient's shadow chart.
* Patients must have exhausted all available molecularly targeted therapies (e.g., anti-PD-1/anti-PD-L1 agents where indicated).
* Absolute neutrophil count (ANC) \>= 1,500/mcL (within the last 14 days of screening)
* Hemoglobin (Hgb) \>= 9 g/dL (within the last 14 days of screening) (Transfusions permitted. Eligibility labs should be drawn \>= 7 days from transfusion).
* Platelets (PLT) \>= 100,000/mcL (within the last 14 days of screening) (Transfusions permitted. Eligibility labs should be drawn \>= 7 days from transfusion).
* INR (international normalized ratio) =\< 1.6 (within the last 14 days of screening) (unless receiving anticoagulation therapy) If receiving anticoagulant: INR =\< 3.0 and no active bleeding, (i.e., no bleeding within 14 days prior to first dose of study therapy).
* Total bilirubin =\<1.5 x Institutional upper limit of normal (ULN) (within the last 14 days of screening)
* Note: Patients with Gilbert's Syndrome are exempt. Patients with liver metastases with no significant bilirubin obstruction may have a total bilirubin level of =\< 2.0 mg/dL.
* Aspartate aminotransferase (AST) serum glutamic-oxaloacetic transaminase (SGOT) =\< 2.5 x institutional ULN (within the last 14 days of screening)
* Note: If liver metastases are present, then =\< 5 x ULN is allowed.
* Alanine transaminase (ALT) serum glutamic-pyruvic transaminase (SGPT) =\< 2.5 x institutional ULN (within the last 14 days of screening)
* Note: If liver metastases are present, then =\< 5 x ULN is allowed.
* Serum albumin \> 3.0 g/dL (within the last 14 days of screening)
* Creatinine =\< 1.5 x ULN OR glomerular filtration rate (GFR) \>= 50 mL/min/1.73 m\^2 (within the last 14 days of screening)
* eGFR is estimated GFR calculated by the abbreviated Modification of Diet in Renal Disease (MDRD) equation
* The effects of combination treatment of CPI-613, 5-FU, gemcitabine, and HCQ on the developing human fetus are unknown. For this reason and because antineoplastic agents as well as other therapeutic agents used in this trial are known to be teratogenic, patients of child-bearing potential (POCBP) regardless of gender must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) from time of informed consent, for the duration of study participation, and for 180 days following completion of therapy. Patients who can impregnate their partners regardless of gender must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) from time of informed consent, for the duration of study participation, and for 180 days following completion of therapy. Should a patient become pregnant or suspect they are pregnant while they or their partner is participating in this study, they should inform their treating physician immediately.
* Note: At the discretion of the investigator, acceptable methods of contraception may include total abstinence in cases where the lifestyle of the patient ensures compliance. (Periodic abstinence \[e.g., calendar, ovulation, symptothermal, postovulation methods\] and withdrawal are not acceptable methods of contraception.)
* Note: A POCBP is any person with an egg-producing reproductive tract (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria:
* Has not undergone a hysterectomy or bilateral oophorectomy
* Has had menses at any time in the preceding 12 consecutive months (and therefore has not been naturally postmenopausal for \> 12 months)
* POCBP must have a negative pregnancy test prior to registration on study.
* Note: If negative pregnancy test result is \>7 days from first dose of study treatment it must be repeated at time of first dose of study treatment (with any of the four drugs used in this study).
* For patients with a known history of human immunodeficiency virus (HIV), infected patients on effective anti-retroviral therapy must have a viral load undetectable for 6 months prior to registration.
* For patients with a known history of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated.
* Patients with a known history of hepatitis C virus (HCV) infection must have been treated and cured. Patients with HCV infection who are currently on treatment, must have an undetectable HCV viral load. Patients with known history or current symptoms of cardiac disease, or history of treatment with cardio toxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. Patients must be class 2B or better.
* Note: Patients with pacemakers where corrected QT interval (QTc) is not a reliable measure will require an evaluation by a cardiologist to exclude co-existing cardiac conditions which would prohibit safe participation in the study.
* Patients must have the ability to understand and the willingness to sign a written informed consent document for the duration of the entirety of the study.
* Patients must be reliable, willing to make themselves available for the duration of the entire study and willing to follow screening procedures.
Exclusion Criteria:
* Patients who have not recovered from adverse events due to prior anti-cancer therapy (i.e., have residual toxicities \> grade 1).
* Note: Patients who experience adverse events of alopecia and peripheral neuropathy that have not recovered are eligible; patients with any lab abnormality that is above grade 1 related to previous therapy found to be not clinically significant will also be eligible.
* Patients with symptomatic brain metastases currently using corticosteroids.
* Note: Patients with brain metastases who are asymptomatic and off corticosteroids for at least one week are eligible.
* Patients with severe obstructive pulmonary disease or interstitial lung disease.
* Patients with a history of myocardial infarction that is \<90 days prior to registration.
* Patients using concomitant medications that prolong the QT/QTc intervals. For example, patients receiving amiodarone. Using amiodarone together with hydroxychloroquine can increase the risk of long QT syndrome that although rare, may be serious, and potentially life-threatening.
* Patients with a history of additional risk factors for drug-induced QT prolongation or Torsades de Pointes (TdP) (e.g., heart failure, hypokalemia, family history of long QT syndrome).
* Patients with major surgery or significant traumatic injury =\< 21 days prior to registration.
* Patients receiving treatment with low dose chemotherapy concurrent with radiation =\< 21 days prior to registration.
OR patients who have had chemotherapy or radiotherapy =\< 21 days (42 days for nitrosoureas or mitomycin C) prior to registration.
* Note: Palliative radiation before and during study participation is permissible providing it is not to a target lesion.
* Patients who have an uncontrolled intercurrent illness including, but not limited to any of the following, are not eligible:
* Ongoing or active infection requiring systemic treatment.
* Clinically significant complications such as perforation, gastrointestinal bleeding, or diverticulitis within 42 days prior to registration.
* Symptomatic congestive heart failure; symptomatic coronary artery disease, symptomatic angina pectoris, or symptomatic myocardial infarction.
* Unstable angina pectoris.
* Unstable cardiac arrhythmia.
* Psychiatric illness/social situations that would limit compliance with study requirements.
* Active substance abuse.
* Any other illness or condition that the treating investigator feels would interfere with study compliance or would compromise the patient's safety or study endpoints.
* Patients who are pregnant or nursing.
* Patients with Fridericia-corrected QT interval (QTcF) \> 470 msec (female) or \> 450 (male), or history of congenital long QT syndrome. Any electrocardiogram (ECG) abnormality that in the opinion of the investigator would preclude safe participation in the study.
* Patients who have pre-existing retinopathy of the eye.
* Patients who are unable to swallow or retain and absorb oral medication
* Patients with known hypersensitivity to any of the following: CPI or its inactive components, 4-aminoquinoline compounds, or quinine.
* Patients with poorly controlled diabetes mellitus (glycosylated hemoglobin (HbA1c) of \> 7%, pre-prandial capillary plasma glucose \> 130mg/dl, and peak postprandial capillary plasma glucose of \> 180mg/dl).
Chicago, Illinois, 60611, United States
[email protected] / 312-695-6929
Status: Recruiting