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DFMO as Maintenance Therapy for Molecular High/Very High Risk and Relapsed Medulloblastoma

Primary Purpose

Medulloblastoma

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Difluoromethylornithine
Sponsored by
Giselle Sholler
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Medulloblastoma

Eligibility Criteria

undefined - 21 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Age: 0-21 years of age at diagnosis
  2. Pathology All patients must either have a pathologically confirmed diagnosis of medulloblastoma with molecular grouping identified by either Nanostring or methylation profiling.

    Cohort 1- Molecular High Risk:

    • Metastatic non-MYC amplified Group 3
    • Metastatic Group 4
    • Metastatic non-WNT/non-SHH (Must be non-MYC amplified)

    Cohort 2- Molecular Very High Risk

    • Metastatic OR MYCN amplified OR TP53 mutant non-infant (>3 yrs) SHH
    • MYC amplified Group 3
    • Non-WNT, non-SHH infant (< 3 yrs)

    Cohort 3: Relapsed/Refractory Medulloblastoma

  3. Pre-enrollment tumor survey:

    Prior to enrollment on this study, a determination of mandatory disease staging must be performed:

    • Tumor imaging studies including: Brain and spine MRI
    • Lumbar Puncture only if previously positive
    • Bone Marrow aspiration/biopsy only if previously positive
    • This disease assessment is required for eligibility and preferably should be done within 2 weeks prior to first dose of study drug, but must be done within a maximum of 4 weeks before first dose of study drug.
  4. Disease Status: Subjects must have no evidence of disease, or stable* residual nonbulky** disease.

    *Stable residual disease defined as non-progression over 2 separate imaging studies at least 6 weeks apart

    **Non-bulky disease defined as maximal cross-sectional area < 3cm^2 at enrollment. Patients with leptomeningeal disease are allowed to participate on study.

  5. Timing from prior therapy:

    Enrollment (first dose of DFMO) no later than 60 days after last dose of conventional chemotherapy. Patients who have undergone high dose chemotherapy (HDCT) with autologous stem cell transplantation (SCT) are eligible if more than 45 days have elapsed since date of last SCT.

  6. Patients must have a Lansky or Karnofsky Performance Scale score of ≥ 50% (see Appendix II) and patients must have a life expectancy of ≥ 2 months.
  7. All clinical and laboratory studies for organ functions to determine eligibility must be performed within 7 days prior to first dose of study drug unless otherwise indicated below.
  8. Patients must have adequate organ functions at the time of registration:

    • Hematological: Hematological recovery as defined by ANC ≥750/μL, platelets ≥30 (non-transfused x 7 days)
    • Liver: Adequate liver function as defined by AST and ALT <10x upper limit of normal
    • Renal: Adequate renal function defined as (perform one of the following): Creatinine clearance or radioisotope GFR ≥ 70 mL/min/1.73 m2 or a serum creatinine based on age/gender
  9. Females of childbearing potential must have a negative pregnancy test. Patients of childbearing potential must agree to use an effective birth control method. Female patients who are lactating must agree to stop breast-feeding.
  10. Written informed consent in accordance with institutional and FDA guidelines must be obtained from all subjects (or patients' legal representative).

Exclusion Criteria:

  1. BSA of <0.25 m2
  2. Metastatic disease outside of CNS
  3. Relapsed/refractory patients who are radiation-naïve and age 5 years or older at time of enrollment
  4. Investigational Drugs: Subjects who are currently receiving another investigational drug are excluded from participation.
  5. Anti-cancer Agents: Subjects who are currently receiving other anticancer agents are not eligible. Subjects must have fully recovered from the hematological and bone marrow suppression effects of prior chemotherapy.
  6. Infection: Subjects who have an uncontrolled infection are not eligible until the infection is judged to be well controlled in the opinion of the investigator.
  7. Subjects who, in the opinion of the investigator, may not be able to comply with the safety monitoring requirements of the study, or in whom compliance is likely to be suboptimal, should be excluded.

Sites / Locations

  • Arkansas Children's HospitalRecruiting
  • UCSF Benioff Children's Hospital Oakland-Recruiting
  • Rady Children's HospitalRecruiting
  • Connecticut Children's Hospital
  • Arnold Palmer Hospital for ChildrenRecruiting
  • St. Joseph's Children's HospitalRecruiting
  • Kentucky Children's HospitalRecruiting
  • University of Louisville/Norton's Children'sRecruiting
  • Children's Mercy Hospitals and ClinicsRecruiting
  • Cardinal Glennon Children's Medical Center
  • Hackensack University Medical CenterRecruiting
  • Levine Children's HospitalRecruiting
  • Penn State Milton S. Hershey Medical Center and Children's HospitalRecruiting
  • Medical University of South CarolinaRecruiting
  • Dell Children's Blood and Cancer CenterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Difluoromethylornithine (DFMO)

Arm Description

study subjects will receive 730 Days of oral difluoromethylornithine (DFMO) at a dose of 2500 mg/m2 BID on each day of study.

Outcomes

Primary Outcome Measures

Number of participants with event free survival (EFS) during study
o To evaluate the efficacy of difluoromethylornithine (DFMO) as a single agent in preventing relapse in patients with molecular high risk and very high risk medulloblastoma, and relapsed/refractory medulloblastoma based upon the 2-year progression-free survival rate (PFS) compared to relevant historical controls.

Secondary Outcome Measures

Length of time that participants experience Overall Survival (OS)
o To evaluate the efficacy of difluoromethylornithine (DFMO) as a single agent in patients with molecular high risk and very high risk medulloblastoma, and relapsed/refractory medulloblastoma based upon overall survival
Determine the Overall Response Rate (ORR) of Participants using Modified RANO Criteria
To evaluate the efficacy of difluoromethylornithine (DFMO) as a single agent in patients with molecular high risk and very high risk medulloblastoma, and relapsed/refractory medulloblastoma based upon Response Rate for patients with non-bulky residual disease present.
Number of Participants with Adverse Events as a Measure of Safety and Tolerability
To develop a complete safety and tolerability profile of difluoromethylornithine (DFMO) in pediatric and young adult subjects with medulloblastoma.
Determine amount of DFMO in the CSF at 3 hours post dose
o To measure CSF penetration after DFMO administration in pediatric subjects with medulloblastoma

Full Information

First Posted
January 4, 2021
Last Updated
September 26, 2023
Sponsor
Giselle Sholler
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1. Study Identification

Unique Protocol Identification Number
NCT04696029
Brief Title
DFMO as Maintenance Therapy for Molecular High/Very High Risk and Relapsed Medulloblastoma
Official Title
Phase II Trial of Eflornithine/DFMO as Maintenance Therapy for Molecular High Risk/Very High Risk and Relapsed/Refractory Medulloblastoma
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
March 29, 2021 (Actual)
Primary Completion Date
March 2028 (Anticipated)
Study Completion Date
March 2029 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Giselle Sholler

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
Difluoromethylornithine (DFMO) will be used in an open label, multicenter, study as Maintenance Therapy for Molecular High Risk/Very High Risk and Relapsed/Refractory Medulloblastoma.
Detailed Description
In this study subjects will receive 730 Days of oral difluoromethylornithine (DFMO) at a dose of 2500 mg/m2 BID on each day of study. Subjects will be evaluated in 3 Cohorts: Cohort 1: Molecular High Risk Medulloblastoma Cohort 2: Molecular Very High Risk Medulloblastoma Cohort 3: Relapsed/Refractory Medulloblastoma A total of 118 subjects across all cohorts will be enrolled to ensure that there will be 107 evaluable subjects (32-39 per cohort)

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Medulloblastoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
118 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Difluoromethylornithine (DFMO)
Arm Type
Experimental
Arm Description
study subjects will receive 730 Days of oral difluoromethylornithine (DFMO) at a dose of 2500 mg/m2 BID on each day of study.
Intervention Type
Drug
Intervention Name(s)
Difluoromethylornithine
Other Intervention Name(s)
Eflornithine, DFMO
Intervention Description
DFMO (difluoromethylornithine is an inhibitor of ornithine decarboxylase (ODC) designated chemically as 2-(difluoromethyl)-DL-ornithine monohydrochloride monohydrate. The dosage form to be used in this study is provided as a convex tablet containing 192 mg eflornithine (equivalent to 250 mg of eflornithine HCl, monohydrate). The tablets are packaged and sealed in opaque white HDPE bottles, and each bottle contains 100 tablets. The DMFO tablets are supplied by USWorldMeds (USWM). The tablets are to be stored at room temperature (20-250C).
Primary Outcome Measure Information:
Title
Number of participants with event free survival (EFS) during study
Description
o To evaluate the efficacy of difluoromethylornithine (DFMO) as a single agent in preventing relapse in patients with molecular high risk and very high risk medulloblastoma, and relapsed/refractory medulloblastoma based upon the 2-year progression-free survival rate (PFS) compared to relevant historical controls.
Time Frame
2 years plus 5 years follow up
Secondary Outcome Measure Information:
Title
Length of time that participants experience Overall Survival (OS)
Description
o To evaluate the efficacy of difluoromethylornithine (DFMO) as a single agent in patients with molecular high risk and very high risk medulloblastoma, and relapsed/refractory medulloblastoma based upon overall survival
Time Frame
7 years
Title
Determine the Overall Response Rate (ORR) of Participants using Modified RANO Criteria
Description
To evaluate the efficacy of difluoromethylornithine (DFMO) as a single agent in patients with molecular high risk and very high risk medulloblastoma, and relapsed/refractory medulloblastoma based upon Response Rate for patients with non-bulky residual disease present.
Time Frame
2 years
Title
Number of Participants with Adverse Events as a Measure of Safety and Tolerability
Description
To develop a complete safety and tolerability profile of difluoromethylornithine (DFMO) in pediatric and young adult subjects with medulloblastoma.
Time Frame
2 years plus 30 days
Title
Determine amount of DFMO in the CSF at 3 hours post dose
Description
o To measure CSF penetration after DFMO administration in pediatric subjects with medulloblastoma
Time Frame
2 years

10. Eligibility

Sex
All
Maximum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age: 0-21 years of age at diagnosis Pathology All patients must either have a pathologically confirmed diagnosis of medulloblastoma with molecular grouping identified by either Nanostring or methylation profiling. Cohort 1- Molecular High Risk: Metastatic non-MYC amplified Group 3 Metastatic Group 4 Metastatic non-WNT/non-SHH (Must be non-MYC amplified) Cohort 2- Molecular Very High Risk Metastatic OR MYCN amplified OR TP53 mutant non-infant (>3 yrs) SHH MYC amplified Group 3 Non-WNT, non-SHH infant (< 3 yrs) Cohort 3: Relapsed/Refractory Medulloblastoma Pre-enrollment tumor survey: Prior to enrollment on this study, a determination of mandatory disease staging must be performed: Tumor imaging studies including: Brain and spine MRI Lumbar Puncture only if previously positive Bone Marrow aspiration/biopsy only if previously positive This disease assessment is required for eligibility and preferably should be done within 2 weeks prior to first dose of study drug, but must be done within a maximum of 4 weeks before first dose of study drug. Disease Status: Subjects must have no evidence of disease, or stable* residual nonbulky** disease. *Stable residual disease defined as non-progression over 2 separate imaging studies at least 6 weeks apart **Non-bulky disease defined as maximal cross-sectional area < 3cm^2 at enrollment. Patients with leptomeningeal disease are allowed to participate on study. Timing from prior therapy: Enrollment (first dose of DFMO) no later than 60 days after last dose of conventional chemotherapy. Patients who have undergone high dose chemotherapy (HDCT) with autologous stem cell transplantation (SCT) are eligible if more than 45 days have elapsed since date of last SCT. Patients must have a Lansky or Karnofsky Performance Scale score of ≥ 50% (see Appendix II) and patients must have a life expectancy of ≥ 2 months. All clinical and laboratory studies for organ functions to determine eligibility must be performed within 7 days prior to first dose of study drug unless otherwise indicated below. Patients must have adequate organ functions at the time of registration: Hematological: Hematological recovery as defined by ANC ≥750/μL, platelets ≥30 (non-transfused x 7 days) Liver: Adequate liver function as defined by AST and ALT <10x upper limit of normal Renal: Adequate renal function defined as (perform one of the following): Creatinine clearance or radioisotope GFR ≥ 70 mL/min/1.73 m2 or a serum creatinine based on age/gender Females of childbearing potential must have a negative pregnancy test. Patients of childbearing potential must agree to use an effective birth control method. Female patients who are lactating must agree to stop breast-feeding. Written informed consent in accordance with institutional and FDA guidelines must be obtained from all subjects (or patients' legal representative). Exclusion Criteria: BSA of <0.25 m2 Metastatic disease outside of CNS Relapsed/refractory patients who are radiation-naïve and age 5 years or older at time of enrollment Investigational Drugs: Subjects who are currently receiving another investigational drug are excluded from participation. Anti-cancer Agents: Subjects who are currently receiving other anticancer agents are not eligible. Subjects must have fully recovered from the hematological and bone marrow suppression effects of prior chemotherapy. Infection: Subjects who have an uncontrolled infection are not eligible until the infection is judged to be well controlled in the opinion of the investigator. Subjects who, in the opinion of the investigator, may not be able to comply with the safety monitoring requirements of the study, or in whom compliance is likely to be suboptimal, should be excluded.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Genevieve Bergendahl, MSN
Phone
7175310003
Email
gbergendahl@pennstatehealth.psu.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michael A Huang, MD
Organizational Affiliation
Beat Childhood Cancer at Atrium Health
Official's Role
Study Chair
Facility Information:
Facility Name
Arkansas Children's Hospital
City
Little Rock
State/Province
Arkansas
ZIP/Postal Code
72202
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Susan Hall
Phone
501-364-2760
Email
HallSF@archildrens.org
First Name & Middle Initial & Last Name & Degree
Kevin Bielamowicz, MD
Facility Name
UCSF Benioff Children's Hospital Oakland-
City
Oakland
State/Province
California
ZIP/Postal Code
94609
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Grace Wensley
Email
Grace.Wensley@ucsf.edu
First Name & Middle Initial & Last Name & Degree
Anurag Agrawal, MD
Facility Name
Rady Children's Hospital
City
San Diego
State/Province
California
ZIP/Postal Code
92123
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Franchesca Ramirez
Phone
858-966-8155
Email
framirez@rchsd.org
First Name & Middle Initial & Last Name & Degree
William Roberts, MD
Facility Name
Connecticut Children's Hospital
City
Hartford
State/Province
Connecticut
ZIP/Postal Code
06106
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Nicole McCracken
Phone
860-545-9337
Email
NMccracken@connecticutchildrens.org
First Name & Middle Initial & Last Name & Degree
Michael Isakoff, MD
Facility Name
Arnold Palmer Hospital for Children
City
Orlando
State/Province
Florida
ZIP/Postal Code
32806
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Michelle Pellet
Phone
321-841-8588
Email
Michelle.Pellett@orlandohealth.com
First Name & Middle Initial & Last Name & Degree
Amy Smith, MD
Facility Name
St. Joseph's Children's Hospital
City
Tampa
State/Province
Florida
ZIP/Postal Code
33607
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jennifer Manns
Email
Jennifer.Manns@baycare.org
First Name & Middle Initial & Last Name & Degree
Don Eslin, MD
Facility Name
Kentucky Children's Hospital
City
Lexington
State/Province
Kentucky
ZIP/Postal Code
40502
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Brittany Fuller
Email
blfull2@email.uky.edu
First Name & Middle Initial & Last Name & Degree
Tom Badgett, MD
Facility Name
University of Louisville/Norton's Children's
City
Louisville
State/Province
Kentucky
ZIP/Postal Code
40202
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jennifer Miller
Email
Jennifer.Miller4@nortonhealthcare.org
First Name & Middle Initial & Last Name & Degree
Michael A Huang, MD
Phone
502.852.8450
Email
michael.huang@louisville.edu
First Name & Middle Initial & Last Name & Degree
Huang A Michael, MD
Facility Name
Children's Mercy Hospitals and Clinics
City
Kansas City
State/Province
Missouri
ZIP/Postal Code
64108
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Nicole Harvey
Phone
816-302-6893
Email
ndharvey@cmh.edu
First Name & Middle Initial & Last Name & Degree
Kevin Ginn, MD
Facility Name
Cardinal Glennon Children's Medical Center
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63104
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Gina Martin, RN
Phone
314-268-4000
Email
gina.martin@health.slu.edu
First Name & Middle Initial & Last Name & Degree
William Ferguson, MD
Facility Name
Hackensack University Medical Center
City
Hackensack
State/Province
New Jersey
ZIP/Postal Code
07601
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sherri Mayans
Email
sherri.mayans@hmhn.org
First Name & Middle Initial & Last Name & Degree
Derek Hanson, MD
Facility Name
Levine Children's Hospital
City
Charlotte
State/Province
North Carolina
ZIP/Postal Code
28204
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jontyce Green
Phone
980-442-2356
Email
jontyce.green@atriumhealth.org
First Name & Middle Initial & Last Name & Degree
Thomas Russell, MD
Facility Name
Penn State Milton S. Hershey Medical Center and Children's Hospital
City
Hershey
State/Province
Pennsylvania
ZIP/Postal Code
17033
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Suzanne Treadway
Email
streadway@hmc.psu.edu
First Name & Middle Initial & Last Name & Degree
Valerie Brown, MD
Facility Name
Medical University of South Carolina
City
Charleston
State/Province
South Carolina
ZIP/Postal Code
29425
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Shanta Salzar, MD
Phone
843-792-2957
Email
salzers@musc.edu
First Name & Middle Initial & Last Name & Degree
Jaqueline Kraveka, MD
Facility Name
Dell Children's Blood and Cancer Center
City
Austin
State/Province
Texas
ZIP/Postal Code
78723
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Rhea Robinson, RN
Phone
512-628-1902
Email
TXAUS-DL-SFCHemonc.research@ascension.org
First Name & Middle Initial & Last Name & Degree
Virginia Harrod, MD

12. IPD Sharing Statement

Plan to Share IPD
No
Links:
URL
http://www.beatcc.org
Description
Beat Childhood Cancer Consortium website

Learn more about this trial

DFMO as Maintenance Therapy for Molecular High/Very High Risk and Relapsed Medulloblastoma

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