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Testing the Safety and Tolerability of CX-4945 in Patients With Recurrent Medulloblastoma Who May or May Not Have Surgery

Primary Purpose

Medulloblastoma, Childhood

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
CX 4945
Sponsored by
Pediatric Brain Tumor Consortium
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Medulloblastoma, Childhood focused on measuring Medulloblastoma, Sonic Hedgehog (SHH) positive

Eligibility Criteria

3 Years - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

A. Screening Criteria:

Subject must have a diagnosis of medulloblastoma that is recurrent or refractory and must have adequate tissue for SHH subgrouping.

B. Inclusion Criteria:

  1. Phase I Skeletally-immature:

    a. Patient must be skeletally-immature at the time of study enrollment, defined as females with a bone age < 14 years and males with a bone age < 16 years. Patient must be ≥3 and ≤18 years of age and BSA must meet protocol restrictions.

  2. Phase II Skeletally-mature:

    1. Patients must be skeletally-mature, defined as females with a bone age ≥14 years and males with a bone age ≥ 16 years OR have a chronological age >18 years.
    2. Must have bi-dimensionally measurable disease
  3. Surgical Study:

    1. Surgical resection must be clinically indicated.
    2. Must be ≥3 years.
    3. Must be amenable to receiving CX-4945 for 5-7 days prior to surgery
  4. All Phases:

    1. Must have a diagnosis of SHH medulloblastoma that is recurrent or progressive which was confirmed histologically and subgrouping was completed using a CLIA certified methylation based test.
    2. Prior Therapy

      • Must have received prior therapy which included radiation therapy and recovered from acute treatment related toxicities.
      • Must have received the last dose of myelosuppressive therapy at least 21 days prior to enrollment and at least 42 days if nitrosourea.
      • Must have received the last dose of another investigational or biologic agent ≥7 days prior. For agents known to have adverse events occurring beyond 7 days, the period must be extended to accommodate the longer interval. For monoclonal antibodies with prolonged half-lives, at least 3 half-lives must have elapsed.
      • Must have received last fraction of craniospinal or total body irradiation or radiation to ≥50% of the pelvis >3 months prior to enrollment. Last fraction of focal irradiation must be >4 weeks prior to enrollment.
      • Must be ≥ 6 months since allogeneic stem cell transplant with no evidence of acute graft vs. host disease.
      • Must be ≥3 months since autologous stem cell transplant.
    3. Must be off all colony-forming growth factors at least 1 week prior to enrollment. Must be off 2 weeks if the subject received a long-acting formulation.
    4. If neurological deficits are present, must have been stable for a minimum of 1 week prior to enrollment.

      • Patients with seizure disorders may be enrolled if seizures are well controlled.

    5. Must have a Karnofsky/Lansky Performance status ≥50%
    6. Must have adequate organ and marrow function
    7. Subjects receiving dexamethasone must be on a stable or decreasing dose for at least 1 week prior to enrollment.
    8. Female patients of childbearing potential must have a negative pregnancy test.
    9. Patients of child-bearing or child fathering potential must be willing to use medically acceptable form of birth control while treated on this study and for 3 months after drug cessation.
    10. Parent or legal guardian must be able to understand and willing to sign the written informed consent.

C. Exclusion Criteria:

1. All Phases

  1. Nursing mothers due to an unknown but potential risk for adverse events in nursing infants.
  2. Patients with a history of any other malignancy with the exception of patients with a secondary brain tumor if the patient's prior malignancy has been in remission for at least 5 years from the end of treatment.
  3. Patients with any of the following gastrointestinal disorders - difficulty swallowing or active malabsorption, uncontrolled diarrhea, gastritis, ulcerative colitis, Crohn's disease or hemorrhagic coloproctitis, history of gastric or small bowel surgery involving any extent of gastric or small bowel resection.
  4. Patients with any clinically significant unrelated systemic illness that would compromise the patient's ability to tolerate therapy, put them at additional risk for toxicity or interfere with the study procedures or results.
  5. Corrected QT (QTc) interval is >480ms
  6. Patients who are receiving other anti-cancer or investigational drug therapy
  7. Patients who are on warfarin or statins.

Sites / Locations

  • Children's Hospital of Los AngelesRecruiting
  • Stanford University and Lucile Packard Children's HospitalRecruiting
  • Children's National Medical CenterRecruiting
  • University of FloridaRecruiting
  • Children's Healthcare of AtlantaRecruiting
  • Ann & Robert H. Lurie Children's Hospital of ChicagoRecruiting
  • Memorial Sloan-Kettering Cancer CenterRecruiting
  • Cincinnati Children's Hospital Medical CenterRecruiting
  • Nationwide Children's HospitalRecruiting
  • Children's Hospital of Pittsburgh of UPMCRecruiting
  • St. Jude Children Research HospitalRecruiting
  • Baylor College of MedicineRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Phase I - Skeletally-immature

Phase II - Skeletally-mature

Surgical

Arm Description

Skeletally-immature children with refractory or recurrent medulloblastoma of the SHH group

Skeletally-mature subjects with refractory or recurrent medulloblastoma of the SHH group

Subjects who are eligible for the Phase I or Phase II arm of the trial and are candidates for surgery, may be enrolled in the surgical arm prior to initiation of the Phase I or Phase II treatment.

Outcomes

Primary Outcome Measures

Phase I: Maximum tolerated dose of CX-4945
Defined as the highest dose level at which six patients have been treated with at most one patient experiencing a dose limiting toxicity (DLT) and the next higher dose level has been determined to be too toxic.
Phase I: Plasma pharmacokinetics of CX-4945 in skeletally-immature children
To report the plasma drug concentration of CX-4945 on this schedule in skeletally-immature children
Surgical Study: Intratumoral PK concentrations
Average tumor CX-4945 concentrations.
Phase II: Sustained objective response rate (PR-CR) rate in the skeletally mature cohort
Percentage of patients who achieve sustained objective response.

Secondary Outcome Measures

Progression free survival
Interval of time between the date of initiation of protocol treatment and minimum date of documentation of PD, second malignancy, death due to any cause or date of last follow-up.
Objective response rate in the skeletally-immature cohort
Percentage of patients who achieve objective response in the skeletally-immature cohort
Plasma pharmacokinetics of CX-4945 in skeletally-mature subjects
To report the plasma drug concentration of CX-4945 in skeletally-mature subjects
Relative frequency of genomic alterations in archival tissue
Percentage of various genomic alterations will be reported
Surgical study: Reduction in CK2-mediated signaling in tumor.
Change in CK2 activity in tumor tissue from patients on the surgical are at baseline and after treatment.

Full Information

First Posted
April 1, 2019
Last Updated
April 26, 2023
Sponsor
Pediatric Brain Tumor Consortium
Collaborators
St. Jude Children's Research Hospital, National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT03904862
Brief Title
Testing the Safety and Tolerability of CX-4945 in Patients With Recurrent Medulloblastoma Who May or May Not Have Surgery
Official Title
PBTC-053: A Pediatric Brain Tumor Consortium Phase I/ II and Surgical Study of CX-4945 in Patients With Recurrent SHH Medulloblastoma
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Recruiting
Study Start Date
July 25, 2019 (Actual)
Primary Completion Date
September 7, 2028 (Anticipated)
Study Completion Date
November 6, 2028 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Pediatric Brain Tumor Consortium
Collaborators
St. Jude Children's Research Hospital, National Cancer Institute (NCI)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a multi center, Phase I, Phase II and surgical study of the CX-4945 drug (silmitasertib sodium) for patients with recurrent SHH (Sonic Hedgehog) medulloblastoma
Detailed Description
PRIMARY OBJECTIVES: I. To estimate the maximum tolerated dose (MTD) and/or the recommended phase II dose (RP2D) of CX-4945 administered orally daily to skeletally-immature children with recurrent SHH (sonic hedgehog) medulloblastoma (Phase I) II. To describe the toxicity profile and define the dose-limiting toxicities (DLTs) of CX-4945 in skeletally-immature children with recurrent SHH (sonic hedgehog) medulloblastoma. (Phase I) III. To characterize the pharmacokinetics of CX-4945 administered orally daily to skeletally-immature children with recurrent SHH (sonic hedgehog) medulloblastoma. (Phase I) IV. To characterize the concentrations of CX-4945 in tumor after administration of CX-4945 and surgical resection (Surgical Study). V. To establish the safety and characterize the toxicity of 1000mg BID continuous dosing of CX-4945 in skeletally-mature patients with recurrent SHH medulloblastoma (Phase II). VI. To estimate the objective response rate associated with CX-4945 in skeletally-mature patients with recurrent SHH medulloblastoma SECONDARY OBJECTIVES: I. To document preliminary antitumor activity of CX-4945 in skeletally-immature children with recurrent SHH medulloblastoma (Phase I). II. To perform a genomic analysis within the confines of a Phase I study to investigate correlation between response to treatment and the presence of specific genomic alterations. and/or specific subgroups of disease (Phase I). III. To explore the ability of CX-4945 at the MTD/ RP2D to inhibit CK2-mediated signaling in tumor (Surgical Study). IV. To characterize the pharmacokinetics of CX-4945 in skeletally-mature patients with recurrent SHH medulloblastoma (Phase II). V. To perform a genomic analysis within the confines of a Phase II study to investigate correlation between response to treatment and the presence of specific genomic alterations and/or specific subgroups of disease (Phase II). OUTLINE: Phase I component is a dose-escalation study. The Phase II component is to establish the safety of 1000mg BID given continuously. The study will open with a safety cohort of 3 subjects who are considered skeletally-mature. The initial 3 subjects will be administered CX-4945 twice a day at the adult RP2D of 1000 mg BID or at its BSA adjusted equivalent; however, the dose will be given continuously. If there are not excessive toxicities in this cohort, the study will proceed following the Phase II design for subjects who are skeletally-mature. Following the safety lead in, the Phase 1 component of this trial will be initiated. Skeletally-immature children with refractory or recurrent medulloblastoma of the SHH subgroup, will be administered CX-4945 twice a day on a continuous basis at a starting dose of 600mg/m2 BID which corresponds approximately to the BSA adjusted recommended Phase 2 dose (RP2D) of 1000mg. The Phase 1 study will escalate doses to determine the maximum tolerated dose skeletally-immature children. The surgical study will be initiated after the first 3 patients in the skeletally-mature cohort are treated for initial assessment of safety and did not experience excessive toxicity. Skeletally-mature subjects with recurrent or refractory SHH medulloblastoma will be eligible as soon the surgical study is initiated and will receive drug at 1000mg BID or its BSA adjusted equivalent depending upon age and BSA. Skeletally-immature subjects will only be eligible to enroll on the surgical trial once the MTD is defined in the Phase 1 component and will receive drug at the established MTD for this cohort. After completion of study treatment, patients are followed up to 2 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Medulloblastoma, Childhood
Keywords
Medulloblastoma, Sonic Hedgehog (SHH) positive

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Phase I - Skeletally-immature
Arm Type
Experimental
Arm Description
Skeletally-immature children with refractory or recurrent medulloblastoma of the SHH group
Arm Title
Phase II - Skeletally-mature
Arm Type
Experimental
Arm Description
Skeletally-mature subjects with refractory or recurrent medulloblastoma of the SHH group
Arm Title
Surgical
Arm Type
Experimental
Arm Description
Subjects who are eligible for the Phase I or Phase II arm of the trial and are candidates for surgery, may be enrolled in the surgical arm prior to initiation of the Phase I or Phase II treatment.
Intervention Type
Drug
Intervention Name(s)
CX 4945
Other Intervention Name(s)
Silmitasertib sodium
Intervention Description
CX-4945 is supplied as 200 mg capsules delivered orally as a formulated API
Primary Outcome Measure Information:
Title
Phase I: Maximum tolerated dose of CX-4945
Description
Defined as the highest dose level at which six patients have been treated with at most one patient experiencing a dose limiting toxicity (DLT) and the next higher dose level has been determined to be too toxic.
Time Frame
4 weeks
Title
Phase I: Plasma pharmacokinetics of CX-4945 in skeletally-immature children
Description
To report the plasma drug concentration of CX-4945 on this schedule in skeletally-immature children
Time Frame
4 weeks
Title
Surgical Study: Intratumoral PK concentrations
Description
Average tumor CX-4945 concentrations.
Time Frame
Prior to starting CX-4945 (Day -5 or -7), prior to dose on Day -3, prior to dose on Day -1, day of surgery and during surgery at the time of tissue collection
Title
Phase II: Sustained objective response rate (PR-CR) rate in the skeletally mature cohort
Description
Percentage of patients who achieve sustained objective response.
Time Frame
Up to 2 years from enrollment
Secondary Outcome Measure Information:
Title
Progression free survival
Description
Interval of time between the date of initiation of protocol treatment and minimum date of documentation of PD, second malignancy, death due to any cause or date of last follow-up.
Time Frame
Up to 3 years from enrollment
Title
Objective response rate in the skeletally-immature cohort
Description
Percentage of patients who achieve objective response in the skeletally-immature cohort
Time Frame
Up to 2 years from enrollment
Title
Plasma pharmacokinetics of CX-4945 in skeletally-mature subjects
Description
To report the plasma drug concentration of CX-4945 in skeletally-mature subjects
Time Frame
4 weeks
Title
Relative frequency of genomic alterations in archival tissue
Description
Percentage of various genomic alterations will be reported
Time Frame
At time of enrollment
Title
Surgical study: Reduction in CK2-mediated signaling in tumor.
Description
Change in CK2 activity in tumor tissue from patients on the surgical are at baseline and after treatment.
Time Frame
4 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
3 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
A. Screening Criteria: Subject must have a diagnosis of medulloblastoma that is recurrent or refractory and must have adequate tissue for SHH subgrouping. B. Inclusion Criteria: Phase I Skeletally-immature: a. Patient must be skeletally-immature at the time of study enrollment, defined as females with a bone age < 14 years and males with a bone age < 16 years. Patient must be ≥3 and ≤18 years of age and BSA must meet protocol restrictions. Phase II Skeletally-mature: Patients must be skeletally-mature, defined as females with a bone age ≥14 years and males with a bone age ≥ 16 years OR have a chronological age >18 years. Must have bi-dimensionally measurable disease Surgical Study: Surgical resection must be clinically indicated. Must be ≥3 years. Must be amenable to receiving CX-4945 for 5-7 days prior to surgery All Phases: Must have a diagnosis of SHH medulloblastoma that is recurrent or progressive which was confirmed histologically and subgrouping was completed using a CLIA certified methylation based test. Prior Therapy Must have received prior therapy which included radiation therapy and recovered from acute treatment related toxicities. Must have received the last dose of myelosuppressive therapy at least 21 days prior to enrollment and at least 42 days if nitrosourea. Must have received the last dose of another investigational or biologic agent ≥7 days prior. For agents known to have adverse events occurring beyond 7 days, the period must be extended to accommodate the longer interval. For monoclonal antibodies with prolonged half-lives, at least 3 half-lives must have elapsed. Must have received last fraction of craniospinal or total body irradiation or radiation to ≥50% of the pelvis >3 months prior to enrollment. Last fraction of focal irradiation must be >4 weeks prior to enrollment. Must be ≥ 6 months since allogeneic stem cell transplant with no evidence of acute graft vs. host disease. Must be ≥3 months since autologous stem cell transplant. Must be off all colony-forming growth factors at least 1 week prior to enrollment. Must be off 2 weeks if the subject received a long-acting formulation. If neurological deficits are present, must have been stable for a minimum of 1 week prior to enrollment. • Patients with seizure disorders may be enrolled if seizures are well controlled. Must have a Karnofsky/Lansky Performance status ≥50% Must have adequate organ and marrow function Subjects receiving dexamethasone must be on a stable or decreasing dose for at least 1 week prior to enrollment. Female patients of childbearing potential must have a negative pregnancy test. Patients of child-bearing or child fathering potential must be willing to use medically acceptable form of birth control while treated on this study and for 3 months after drug cessation. Parent or legal guardian must be able to understand and willing to sign the written informed consent. C. Exclusion Criteria: 1. All Phases Nursing mothers due to an unknown but potential risk for adverse events in nursing infants. Patients with a history of any other malignancy with the exception of patients with a secondary brain tumor if the patient's prior malignancy has been in remission for at least 5 years from the end of treatment. Patients with any of the following gastrointestinal disorders - difficulty swallowing or active malabsorption, uncontrolled diarrhea, gastritis, ulcerative colitis, Crohn's disease or hemorrhagic coloproctitis, history of gastric or small bowel surgery involving any extent of gastric or small bowel resection. Patients with any clinically significant unrelated systemic illness that would compromise the patient's ability to tolerate therapy, put them at additional risk for toxicity or interfere with the study procedures or results. Corrected QT (QTc) interval is >480ms Patients who are receiving other anti-cancer or investigational drug therapy Patients who are on warfarin or statins.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Vanetria Stokes, MS
Phone
901-595-5762
Email
vanetria.stokes@stjude.org
First Name & Middle Initial & Last Name or Official Title & Degree
Nina Butingan, MBS
Phone
901-671-6767
Email
nina.butingan@stjude.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ralph Salloum, MD
Organizational Affiliation
Children's Hospital Medical Center, Cincinnati
Official's Role
Principal Investigator
Facility Information:
Facility Name
Children's Hospital of Los Angeles
City
Los Angeles
State/Province
California
ZIP/Postal Code
90026
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Nathan Robison, MD
Phone
323-361-8147
Email
nrobison@chla.usc.edu
First Name & Middle Initial & Last Name & Degree
Ashley Margol, MD
Phone
323-361-8464
Email
amargol@chla.usc.edu
Facility Name
Stanford University and Lucile Packard Children's Hospital
City
Palo Alto
State/Province
California
ZIP/Postal Code
94304
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sonia Partap, MD
Phone
650-723-7299
Email
spartap@stanford.edu
Facility Name
Children's National Medical Center
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20010
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Gene Hwang, MD
Phone
202-476-3472
Email
EHwang@childrensnational.org
First Name & Middle Initial & Last Name & Degree
Lindsay Kilburn, MD
Phone
202-476-2800
Email
LKilburn@childrensnational.org
Facility Name
University of Florida
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32608
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Elias Sayour, MD, PhD
Phone
352-294-5272
Email
elias.sayour@neurosurgery.ufl.edu
Facility Name
Children's Healthcare of Atlanta
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30322
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jason Fangusaro, MD
Phone
404-785-6011
Email
jason.ronald.fangusaro@emory.edu
First Name & Middle Initial & Last Name & Degree
Tobey MacDonald, MD
Phone
404-785-6011
Email
tobey.macdonald@emory.edu
Facility Name
Ann & Robert H. Lurie Children's Hospital of Chicago
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Alicia Lenzen, MD
Phone
312-227-4874
Email
alenzen@luriechildrens.org
Facility Name
Memorial Sloan-Kettering Cancer Center
City
New York
State/Province
New York
ZIP/Postal Code
10065
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ira Dunkel, MD
Phone
212-639-2153
Email
dunkeli@mskcc.org
Facility Name
Cincinnati Children's Hospital Medical Center
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Natasha Pillay Smiley, DO
Phone
513-636-0673
Email
natasha.pillay-smiley@cchmc.org
Facility Name
Nationwide Children's Hospital
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43205
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ralph Salloum, MD
Phone
612-722-2490
Email
ralph.salloum@nationwidechildrens.org
Facility Name
Children's Hospital of Pittsburgh of UPMC
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15201
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Alberto Broniscer, MD
Phone
412-692-5056
Email
alberto.broniscer@chp.edu
First Name & Middle Initial & Last Name & Degree
Ian Pollack, MD
Phone
412-692-5881
Email
ian.pollack@chp.edu
Facility Name
St. Jude Children Research Hospital
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38105
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Giles Robinson, MD
Phone
901-595-2907
Email
giles.robinson@stjude.org
First Name & Middle Initial & Last Name & Degree
Amar Gajjar, MD
Facility Name
Baylor College of Medicine
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Patricia Baxter, MD
Phone
832-824-4681
Email
pabaxter@txch.org
First Name & Middle Initial & Last Name & Degree
Susan Burlingame, CCRP
Phone
832-824-1532
Email
sxburlin@txch.org
First Name & Middle Initial & Last Name & Degree
Patricia Baxter, MD

12. IPD Sharing Statement

Learn more about this trial

Testing the Safety and Tolerability of CX-4945 in Patients With Recurrent Medulloblastoma Who May or May Not Have Surgery

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