A Study of TAK-659 as a Single Agent in Adult East Asian Participants With Non-Hodgkin Lymphoma (NHL)

The drug being tested in this study is called TAK-659. TAK-659 is being tested to treat people who have NHL or people who have relapsed and/or refractory NHL. This study will assess the safety, tolerability, PK, and preliminary efficacy of single-agent TAK-659 in East Asian participants with NHL.

The study will enroll approximately 33 to 47 participants, including at least 6 Japanese at RP2D dose level. Participants will be assigned to one of the following treatment groups:

Dose Escalation Part: TAK-659 Expansion Part: TAK-659 RP2D

This multi-center trial will be conducted in Japan and Republic of Korea. The maximum duration of participation in dose escalation part of the study is up to 12 months, unless in the opinion of the investigator and sponsor the participant would derive benefit from continued therapy beyond 12 months. In expansion part, participants who stop treatment for any other reason other than PD will continue to have PFS follow-up at the site every 2 months from the last dose of study drug up to 6 months or until PD. Participants will be followed 28 days after last dose of study drug or until the start of subsequent antineoplastic therapy, whichever occurs first, for a follow up assessment.

• TAK-659 (Drug): TAK-659 Tablets.

Primary outcomes

• Percentage of Participants With Treatment-emergent Adverse Events (TEAEs) [From first dose of study drug up to 28 days after the last dose of study drug or before the start of subsequent anticancer therapy (up to Cycle 31) (Cycle length =28 days)]
• Percentage of Participants With Grade 3 or Higher TEAEs [From first dose of study drug up to 28 days after the last dose of study drug or before the start of subsequent anticancer therapy (up to Cycle 31) (Cycle length =28 days)]: TEAEs were graded as per the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) Version 4.03. As per the NCI-CTCAE, Grade 1 (mild, asymptomatic or mild symptoms); Grade 2 (moderate, minimal, local or noninvasive intervention indicated); Grade 3 (severe or medically significant but not immediately life-threatening, hospitalization or prolongation of hospitalization indicated); Grade 4 (life-threatening consequences, urgent intervention indicated); Grade 5 (death related to adverse event \[AE\]).
• Percentage of Participants With Serious TEAEs [From first dose of study drug up to 28 days after the last dose of study drug or before the start of subsequent anticancer therapy (up to Cycle 31) (Cycle length =28 days)]
• Dose Escalation Part: Percentage of Participants With Dose-limiting Toxicities (DLTs) During Cycle 1 [Cycle 1 (Cycle length =28 days)]: DLT was evaluated as per NCI-CTCAE, v4.03 and defined as any of the following events occurring during Cycle 1 that were considered by the investigator to be possibly related to therapy: Grade 4 neutropenia unresolved to less than or equal to (<=) Grade 1 or baseline for more than 7 days in the absence of growth factor support; greater than or equal to (>=) Grade 3 neutropenia with fever and/or infection;Grade 4 thrombocytopenia unresolved to <=Grade 1 or baseline for more than 7 days; >=Grade 3 thrombocytopenia with clinically significant bleeding; Grade >=3 nonhematologic toxicity except for treated >=Grade 3 nausea and/or emesis and diarrhea resolved to less than (<) Grade 3 within 3 days, Grade 3 fatigue <=72 hours, isolated asymptomatic >=Grade 3 laboratory abnormalities resolved to <=Grade 1 or baseline in <=7 days;received <75% of planned doses of study drug in Cycle 1;TAK-659-related >=Grade 2 nonhematologic toxicities that required dose reduction or discontinuation of therapy.
• Percentage of Participants Who Discontinued Study Drug Due to TEAEs [From first dose of study drug up to 28 days after the last dose of study drug or before the start of subsequent anticancer therapy (up to Cycle 31) (Cycle length =28 days)]
• Cmax: Maximum Observed Plasma Concentration for TAK-659 on Cycle 1 Day 1 [Cycle 1 Day 1: pre-dose and at multiple time points (up to 24 hours) post-dose (Cycle length= 28 days)]
• Cmax: Maximum Observed Plasma Concentration for TAK-659 on Cycle 1 Day 7 (Dosing Schedule B) and Cycle 1 Day 15 (Dosing Schedule A) [Cycle 1 Day 7 (Dosing Schedule B) and Day 15 (Dosing Schedule A): pre-dose and at multiple time points (up to 24 hours) post-dose (Cycle length= 28 days)]
• Tmax: Time to Reach the Maximum Plasma Concentration (Cmax) for TAK-659 on Cycle 1 Day 1 [Cycle 1 Day 1: pre-dose and at multiple time points (up to 24 hours) post-dose (Cycle length= 28 days)]
• Tmax: Time to Reach the Maximum Plasma Concentration (Cmax) for TAK-659 on Cycle 1 Day 7 (Dosing Schedule B) and Cycle 1 Day 15 (Dosing Schedule A) [Cycle 1 Day 7 (Dosing Schedule B) and Day 15 (Dosing Schedule A): pre-dose and at multiple time points (up to 24 hours) post-dose (Cycle length= 28 days)]
• AUCτ: Area Under the Plasma Concentration-time Curve From Time 0 to Time Tau Over the Dosing Interval for TAK-659 on Cycle 1 Day 1 [Cycle 1 Day 1: pre-dose and at multiple time points (up to 24 hours) post-dose (Cycle length= 28 days)]
• AUCτ: Area Under the Plasma Concentration-time Curve From Time 0 to Time Tau Over the Dosing Interval for TAK-659 on Cycle 1 Day 7 (Dosing Schedule B) and Day 15 (Dosing Schedule A) [Cycle 1 Day 7 (Dosing Schedule B) and Day 15 (Dosing Schedule A): pre-dose and at multiple time points (up to 24 hours) post-dose (Cycle length= 28 days)]
• CLR: Renal Clearance for TAK-659 on Cycle 1 Day 15 [Cycle 1 Day 15: pre-dose and at multiple time points (up to 8 hours) post-dose (Cycle length= 28 days)]

Sex: All, ages: 18 Years to any

Inclusion Criteria:

1. To be enrolled to the dose escalation part, participants must have histologically or cytologically confirmed diagnosis of NHL for which no effective standard treatment is available.
2. To be enrolled in the expansion part, participants must meet the following criteria:

   1. Must have pathologically confirmed FL (Grade 1, 2, or 3A) or MZL.
   2. Relapsed and/or refractory to >=2 prior lines of chemotherapy based on standard of care that include at least 1 anti-CD20-based regimen, as well as alkylating agents (example cyclophosphamide or bendamustine).
   3. Participants must be ineligible for or refusal to hematopoietic stem cell transplant.
   4. If the participants have relapsed or progressed after achieving a response (defined as CR or PR), documented, investigator-assessed relapse or progression after the last treatment is required.
3. Measurable disease per IWG 2007 criteria.
4. Eastern Cooperative Oncology Group performance status score of 0 or 1.
5. Life expectancy of longer than 3 months.
6. Adequate organ function, including the following:

   1. Bone marrow reserve: absolute neutrophil count >=1,000 per cubic millimeter (/mm\^3), platelet count >=75,000/mm\^3 (>=50,000/mm\^3 for participants with bone marrow involvement), and hemoglobin >=8 gram per deciliter (g/dL) (red blood cell \[RBC\] and platelet transfusion allowed >=14 days before assessment).
   2. Hepatic function: total bilirubin less than or equal to (<=) 1.5*the upper limit of the normal range (ULN); alanine aminotransferase and aspartate aminotransferase <=2.5*ULN.
   3. Renal function: creatinine clearance >=60 milliliter per minute (mL/min) either as estimated by the Cockcroft-Gault equation.

Exclusion Criteria:

1. Central nervous system (CNS) lymphoma; active brain or leptomeningeal metastases as indicated by positive cytology from lumbar puncture or computed tomography (CT)/magnetic resonance imaging (MRI) by local assessment.
2. Systemic anticancer treatment (including investigational agents) less than 3 weeks before the first dose of study treatment (<=4 weeks for antibody-based therapy including unconjugated antibody, antibody-drug conjugate, and bi-specific T-cell engager agent; <=8 weeks for cell-based therapy or anti-tumor vaccine).
3. Radiotherapy less than (<) 3 weeks before the first dose of study treatment. If prior radiotherapy occurred <4 to 6 weeks before the study start, as radiated lesions cannot be reliably assessed by fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET), nonradiated target lesions are required for eligibility.
4. Prior autologous stem cell transplant (ASCT) within 6 months or prior ASCT at any time without full hematopoietic recovery before Cycle 1 Day 1, or allogeneic stem cell transplant at any time.
5. Any clinically significant comorbidities, such as uncontrolled pulmonary disease (example, severe chronic obstructive pulmonary disease with hypoxemia, interstitial lung disease, radiation induced lung injury), known impaired cardiac function or clinically significant cardiac disease, active CNS disease, or any other condition that could, in the opinion of the investigator, compromise the participant's safety and participation in the study per protocol.
6. Known gastrointestinal (GI) disease or GI procedure that could interfere with the oral absorption or tolerance of TAK-659.
7. Use or consumption of any of the following substances:

Received medications, supplements, or food/beverages that are P-glycoprotein (P-gp) inhibitors or inducers or strong cytochrome P450 (CYP) 3A inhibitors or inducers within a certain time frame prior to the first dose of study drug. Depending on the substance, the washout period for P-gp inhibitors or inducers or strong CYP3A inhibitors or inducers will be either 7 days or 5 times the half-life (half-life is related to the time required for elimination from the body). The washout period for grapefruit containing food or beverages is 5 days.

Participant flow

Outcome results

• Percentage of Participants With Treatment-emergent Adverse Events (TEAEs) (Primary), Number, percentage of participants: Dose Escalation Part, Schedule Dosing A: TAK-659 40 mg 100; Dose Escalation Part, Dosing Schedule A: TAK-659 60 mg 100; Dose Escalation Part, Dosing Schedule A: TAK-659 80 mg 100; Dose Escalation Part, Dosing Schedule B: TAK-659 80 mg 100; Dose Escalation Part, Dosing Schedule B: TAK-659 100 mg 100
• Percentage of Participants With Grade 3 or Higher TEAEs (Primary), Number, percentage of participants: Dose Escalation Part, Schedule Dosing A: TAK-659 40 mg 66.7; Dose Escalation Part, Dosing Schedule A: TAK-659 60 mg 100; Dose Escalation Part, Dosing Schedule A: TAK-659 80 mg 100; Dose Escalation Part, Dosing Schedule B: TAK-659 80 mg 100; Dose Escalation Part, Dosing Schedule B: TAK-659 100 mg 0
• Percentage of Participants With Serious TEAEs (Primary), Number, percentage of participants: Dose Escalation Part, Schedule Dosing A: TAK-659 40 mg 0; Dose Escalation Part, Dosing Schedule A: TAK-659 60 mg 100; Dose Escalation Part, Dosing Schedule A: TAK-659 80 mg 75; Dose Escalation Part, Dosing Schedule B: TAK-659 80 mg 33.3; Dose Escalation Part, Dosing Schedule B: TAK-659 100 mg 100
• Dose Escalation Part: Percentage of Participants With Dose-limiting Toxicities (DLTs) During Cycle 1 (Primary), Number, percentage of participants: Dose Escalation Part, Schedule Dosing A: TAK-659 40 mg 0; Dose Escalation Part, Dosing Schedule A: TAK-659 60 mg 16.7; Dose Escalation Part, Dosing Schedule A: TAK-659 80 mg 50; Dose Escalation Part, Dosing Schedule B: TAK-659 80 mg 0; Dose Escalation Part, Dosing Schedule B: TAK-659 100 mg 0
• Percentage of Participants Who Discontinued Study Drug Due to TEAEs (Primary), Number, percentage of participants: Dose Escalation Part, Schedule Dosing A: TAK-659 40 mg 33.3; Dose Escalation Part, Dosing Schedule A: TAK-659 60 mg 50; Dose Escalation Part, Dosing Schedule A: TAK-659 80 mg 50; Dose Escalation Part, Dosing Schedule B: TAK-659 80 mg 0; Dose Escalation Part, Dosing Schedule B: TAK-659 100 mg 0
• Cmax: Maximum Observed Plasma Concentration for TAK-659 on Cycle 1 Day 1 (Primary), Geometric mean, nanogram per milliliter (ng/mL): Dose Escalation Part, Schedule Dosing A: TAK-659 40 mg 93.86 +/- 62.88; Dose Escalation Part, Dosing Schedule A: TAK-659 60 mg 127.65 +/- 22.39; Dose Escalation Part, Dosing Schedule A: TAK-659 80 mg 214.50 +/- 74.67; Dose Escalation Part, Dosing Schedule B: TAK-659 80 mg 216.00 +/- 18.01; Dose Escalation Part, Dosing Schedule B: TAK-659 100 mg 297.00
• Cmax: Maximum Observed Plasma Concentration for TAK-659 on Cycle 1 Day 7 (Dosing Schedule B) and Cycle 1 Day 15 (Dosing Schedule A) (Primary), Geometric mean, ng/mL: Dose Escalation Part, Schedule Dosing A: TAK-659 40 mg 121.18 +/- 39.57; Dose Escalation Part, Dosing Schedule A: TAK-659 60 mg 130.23 +/- 62.95; Dose Escalation Part, Dosing Schedule A: TAK-659 80 mg 308.29 +/- 53.67; Dose Escalation Part, Dosing Schedule B: TAK-659 80 mg 339.42 +/- 29.96; Dose Escalation Part, Dosing Schedule B: TAK-659 100 mg 329.00
• Tmax: Time to Reach the Maximum Plasma Concentration (Cmax) for TAK-659 on Cycle 1 Day 1 (Primary), Median, hours: Dose Escalation Part, Schedule Dosing A: TAK-659 40 mg 1.97 (1.0 to 3.0); Dose Escalation Part, Dosing Schedule A: TAK-659 60 mg 3.01 (1.9 to 4.0); Dose Escalation Part, Dosing Schedule A: TAK-659 80 mg 2.00 (0.5 to 3.0); Dose Escalation Part, Dosing Schedule B: TAK-659 80 mg 2.05 (0.5 to 2.7); Dose Escalation Part, Dosing Schedule B: TAK-659 100 mg 2.00 (2.0 to 2.0)
• Tmax: Time to Reach the Maximum Plasma Concentration (Cmax) for TAK-659 on Cycle 1 Day 7 (Dosing Schedule B) and Cycle 1 Day 15 (Dosing Schedule A) (Primary), Median, hours: Dose Escalation Part, Schedule Dosing A: TAK-659 40 mg 3.00 (0.5 to 3.1); Dose Escalation Part, Dosing Schedule A: TAK-659 60 mg 3.01 (0.0 to 4.1); Dose Escalation Part, Dosing Schedule A: TAK-659 80 mg 2.25 (0.5 to 4.0); Dose Escalation Part, Dosing Schedule B: TAK-659 80 mg 2.00 (0.9 to 2.0); Dose Escalation Part, Dosing Schedule B: TAK-659 100 mg 1.00 (1.0 to 1.0)
• AUCτ: Area Under the Plasma Concentration-time Curve From Time 0 to Time Tau Over the Dosing Interval for TAK-659 on Cycle 1 Day 1 (Primary), Geometric mean, hour*nanogram per milliliter (h*ng/mL): Dose Escalation Part, Schedule Dosing A: TAK-659 40 mg 587.2534 +/- 22.2886; Dose Escalation Part, Dosing Schedule A: TAK-659 60 mg 1207.6554 +/- 26.3167; Dose Escalation Part, Dosing Schedule A: TAK-659 80 mg 1742.7394 +/- 39.3327; Dose Escalation Part, Dosing Schedule B: TAK-659 80 mg 1899.2508 +/- 15.1827; Dose Escalation Part, Dosing Schedule B: TAK-659 100 mg 1828.4544
• AUCτ: Area Under the Plasma Concentration-time Curve From Time 0 to Time Tau Over the Dosing Interval for TAK-659 on Cycle 1 Day 7 (Dosing Schedule B) and Day 15 (Dosing Schedule A) (Primary), Geometric mean, h*ng/mL: Dose Escalation Part, Schedule Dosing A: TAK-659 40 mg 1114.2391 +/- 1.1927; Dose Escalation Part, Dosing Schedule A: TAK-659 60 mg 2016.8000 +/- 21.3348; Dose Escalation Part, Dosing Schedule A: TAK-659 80 mg 3502.3513 +/- 25.0980; Dose Escalation Part, Dosing Schedule B: TAK-659 80 mg 3349.4133 +/- 12.2891; Dose Escalation Part, Dosing Schedule B: TAK-659 100 mg
• CLR: Renal Clearance for TAK-659 on Cycle 1 Day 15 (Primary), Geometric mean, liter per hour (L/h): Dose Escalation Part, Schedule Dosing A: TAK-659 40 mg 6.7303 +/- 49.0441; Dose Escalation Part, Dosing Schedule A: TAK-659 60 mg 8.4185 +/- 114.6567; Dose Escalation Part, Dosing Schedule A: TAK-659 80 mg 9.4059 +/- 22.3501; Dose Escalation Part, Dosing Schedule B: TAK-659 80 mg ; Dose Escalation Part, Dosing Schedule B: TAK-659 100 mg

Adverse events

Time frame: Treatment-emergent adverse events were adverse events that started from first dose of study drug up to 28 days after the last dose of study drug or before the start of subsequent anticancer therapy (up to Cycle 31) (Cycle length =28 days)

Serious adverse events by term

Other adverse events by term

32 more terms not shown.

• Study Protocol (PDF, 2018-12-06)
• Statistical Analysis Plan (PDF, 2020-02-20)

• Study Director, Study director, Takeda