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A Study of Surufatinib in Combination With Gemcitabine in Pediatric, Adolescent, and Young Adult Patients With Recurrent or Refractory Solid Tumors

Primary Purpose

Solid Tumor, Lymphoma, Osteosarcoma

Status
Active
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Surufatinib in combination with Gemcitabine
Sponsored by
Hutchmed
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Solid Tumor

Eligibility Criteria

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

Inclusion Criteria:

  1. Age: At time of study enrollment, patients must be

    1. Part 1 (including PK expansion cohort): ≥2 and ≤21 years of age;
    2. Part 2: ≥2 and ≤21 years of age;
    3. Patients with osteosarcoma can enroll up to <30 years old.
  2. Diagnosis:

    1. Part 1 - Patients with any recurrent or refractory solid tumors or lymphoma (not central nervous system [CNS]) that have a known or expected dysfunction of VEGFR 1, -2, and -3; FGFR-1, or CSF-1R pathways (based on literature) are eligible. Patients must have had histologic verification of malignancy at original diagnosis or relapse.
    2. Part 2 - Recurrent or refractory osteosarcoma (US and EU), Ewing sarcoma (US and EU), RMS (US and EU), or NRSTS (EU only). Patients must have had histologic verification of malignancy at original diagnosis or relapse.
  3. Disease status: Patients must have measureable or evaluable disease for part 1 dose escalation; for part 2, patients must have measurable disease by RECIST version 1.1.
  4. Therapeutic options: Patient's current disease state must be one for which there is no known curative therapy.
  5. Performance level: Karnofsky ≥50 for patients ≥16 and <18 years of age and Lansky ≥50 for patients <16 years of age, Eastern Cooperative Oncology Group (ECOG) ≤2 for patients ≥18 years of age.
  6. Adequate organ and bone marrow function as defined in the current protocol.
  7. Adequate cardiac function as indicated as defined in the current protocol.
  8. Patients with known bone marrow metastatic disease will be eligible for the study provided they meet the blood counts in the inclusion criteria as defined in the current protocol.
  9. Adequate BP control which is defined as a BP <95th percentile (≤ grade 1) for age, height, and sex.
  10. Informed consent: Provision of signed and dated written informed consent (parent/legal guardian if patient <18 years of age) and assent (from patients aged >7 years) prior to any study-specific procedures, sampling, and analyses.
  11. Patient must meet all defined Inclusion criteria as defined in the current protocol.

Exclusion Criteria:

  1. Patient must not meet any exclusion criteria as defined in the current protocol.
  2. Pregnant, breast feeding or planning on becoming pregnant.
  3. Patients is taking and prohibitive concomitant medications as outlined in the current protocol.
  4. Patients have an uncontrolled infection.
  5. Patients has had major surgery or significant traumatic injury within 28 days of the first dose.
  6. Brain metastases and/or spinal cord compression untreated with surgery and/or radiotherapy and without clinical imaging evidence of SD for 14 days or longer.
  7. History of allergies to Surufatinib and/or Gemcitabine.

Sites / Locations

  • Children's Hospital of Alabama
  • Childrens Hospital Orange County
  • Children's National Hospital
  • Riley Hospital for Children
  • Johns Hopkins University
  • Washington University School of Medicine
  • Cincinnati Children's Hospital Medical Center
  • Children's Hospital of Philadelphia
  • UPMC Children's Hospital of Pittsburgh
  • The University of Texas Southwestern Medical Center
  • Seattle Children's Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Part 1- Dose escalation

Part 2 - Dose expansion

Arm Description

Dose escalation study with sequential dose escalation of surufatinib in combination with gemcitabine. Patients with any recurrent or refractory solid tumors or lymphoma, who have a known or expected dysfunction of VEGFR-1, -2, and -3; FGFR-1; or CSF-1R pathways may be enrolled.

Once the MTD/RP2D has been determined in the part 1 portion of the study, the part 2 disease specific cohorts for patients with refractory or recurrent osteosarcoma, Ewing Sarcoma, and RMS and non- RMS will open for enrollment.

Outcomes

Primary Outcome Measures

Part 1: Number of patients with Dose-Limiting Toxicity (DLT) at each dose level studied.
To determine maximum tolerated dose of surufatinib in combination with gemcitabine
Part 1: Number of patients with treatment-emergent adverse events as assessed by CTCAE v5.0
To determine the safety and tolerability of surufatinib in combinations with gemcitabine
Part 2: To study the rate of patients who have achieved Complete Response (CR) or Partial Response (PR) in pediatric patients with Ewing sarcoma, Rhabdomyosarcoma (RMS), or Non-RMS (NRSTS) treated with the combination of surufatinib and gemcitabine.
The rate of patients who have achieved CR or PR will be reported.
Part 2: To study the Time to Response (TTR) of the combination of surufatinib and gemcitabine in pediatric patients with Ewing sarcoma, RMS, or NRSTS.
The time to CR or PR will be reported.
Part 2: To study the duration of response (DoR) of the combination of surufatinib and gemcitabine in pediatric patients with Ewing sarcoma, RMS, or NRSTS.
The duration of CR or PR will be reported.
Part 2: To study the progression-free survival (PFS) of the combination of surufatinib and gemcitabine in pediatric patients with Ewing sarcoma, RMS, or NRSTS.
The time from enrollment in the clinical trial to disease progression or death will be reported.

Secondary Outcome Measures

To evaluate number of patients with treatment-emergent adverse events as assessed
To evaluate the safety in the pediatric patient population when treated with the combination of surufatinib and gemcitabine

Full Information

First Posted
September 20, 2021
Last Updated
June 14, 2023
Sponsor
Hutchmed
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1. Study Identification

Unique Protocol Identification Number
NCT05093322
Brief Title
A Study of Surufatinib in Combination With Gemcitabine in Pediatric, Adolescent, and Young Adult Patients With Recurrent or Refractory Solid Tumors
Official Title
An Open-Label, Multicenter Phase 1/2 Study of Surufatinib in Combination With Gemcitabine in Pediatric, Adolescent, and Young Adult Patients With Recurrent or Refractory Solid Tumors
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
November 30, 2021 (Actual)
Primary Completion Date
July 7, 2023 (Anticipated)
Study Completion Date
July 7, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Hutchmed

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
The purpose of this study is to evaluate the safety and tolerability of surufatinib, thereby identifying the Maximum Tolerated Dose (MTD) and/or Recommended Phase 2 Dose (RP2D) of surufatinib administered in combination with gemcitabine in pediatric patients with recurrent or refractory solid tumors or lymphoma. The study will be conducted in 2 parts.
Detailed Description
The purpose of this study is to evaluate the safety and tolerability of surufatinib, thereby identifying the Maximum Tolerated Dose (MTD) and/or Recommended Phase 2 Dose (RP2D) of surufatinib administered in combination with gemcitabine in pediatric patients with recurrent or refractory solid tumors or lymphoma. The study will be conducted in 2 parts: Part 1 - evaluation of tolerability and safety of surufatinib administered in combination with gemcitabine, and confirmation of the recommended clinical dose of surufatinib in pediatric patients with recurrent or refractory solid tumors or lymphoma. Part 2 - evaluation of anti-tumor activity and confirmation of tolerability of surufatinib administered in combination with gemcitabine in pediatric patients with recurrent or refractory osteosarcoma, Ewing sarcoma, RMS, and non-RMS. Part 1 will enroll 2 to 6 patients per dose level cohort (up to 4 cohorts) with recurrent or refractory solid tumors. During cycle 1, surufatinib will be administered, orally, once daily (QD), as a single agent for 14 days followed by surufatinib daily in combination with gemcitabine intravenously on days 15 and 22 (cycle 1 duration=35 days) and days 1 and 8 of all subsequent cycles (cycle duration=21 days). Assessment based on dose limiting toxicity (DLT) criteria will be performed in the first 35-day cycle (DLT Evaluation Period). This study will utilize a rolling 6 design for part 1, with 3 dose escalation levels and 1 de escalation level, if needed. Part 2 of the study will use a Simon 2-stage design with a maximum of 18 patients per cohort (osteosarcoma, Ewing sarcoma, RMS, and non-RMS). Surufatinib will be administered orally at identified MTD/RP2D daily in combination with gemcitabine (1000 mg/m2 weekly × 2 doses) intravenously on days 1 and 8. In both parts 1 and 2, patients can remain on treatment until completing cycle 17, or until progressive disease, unacceptable toxicity, or death; whichever comes first.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Solid Tumor, Lymphoma, Osteosarcoma, Ewing Sarcoma, Rhabdomyosarcoma, Non-rhabdomyosarcoma Soft Tissue Sarcoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Model Description
The study will be conducted in 2 parts: Part 1 - evaluation of tolerability and safety of surufatinib administered in combination with gemcitabine, and confirmation of the recommended clinical dose of surufatinib in pediatric patients with recurrent or refractory solid tumors or lymphoma. Part 2 - evaluation of anti-tumor activity and confirmation of tolerability of surufatinib administered in combination with gemcitabine in pediatric patients with recurrent or refractory osteosarcoma, Ewing sarcoma, RMS, and NRSTS.
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
13 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Part 1- Dose escalation
Arm Type
Experimental
Arm Description
Dose escalation study with sequential dose escalation of surufatinib in combination with gemcitabine. Patients with any recurrent or refractory solid tumors or lymphoma, who have a known or expected dysfunction of VEGFR-1, -2, and -3; FGFR-1; or CSF-1R pathways may be enrolled.
Arm Title
Part 2 - Dose expansion
Arm Type
Experimental
Arm Description
Once the MTD/RP2D has been determined in the part 1 portion of the study, the part 2 disease specific cohorts for patients with refractory or recurrent osteosarcoma, Ewing Sarcoma, and RMS and non- RMS will open for enrollment.
Intervention Type
Drug
Intervention Name(s)
Surufatinib in combination with Gemcitabine
Other Intervention Name(s)
HMPL-012, sulfatinib in combination with Gemcitabine
Intervention Description
Surufatinib in combination with Gemcitabine
Primary Outcome Measure Information:
Title
Part 1: Number of patients with Dose-Limiting Toxicity (DLT) at each dose level studied.
Description
To determine maximum tolerated dose of surufatinib in combination with gemcitabine
Time Frame
up to 90 days
Title
Part 1: Number of patients with treatment-emergent adverse events as assessed by CTCAE v5.0
Description
To determine the safety and tolerability of surufatinib in combinations with gemcitabine
Time Frame
up to 4 years
Title
Part 2: To study the rate of patients who have achieved Complete Response (CR) or Partial Response (PR) in pediatric patients with Ewing sarcoma, Rhabdomyosarcoma (RMS), or Non-RMS (NRSTS) treated with the combination of surufatinib and gemcitabine.
Description
The rate of patients who have achieved CR or PR will be reported.
Time Frame
up to 4 years
Title
Part 2: To study the Time to Response (TTR) of the combination of surufatinib and gemcitabine in pediatric patients with Ewing sarcoma, RMS, or NRSTS.
Description
The time to CR or PR will be reported.
Time Frame
up to 4 years
Title
Part 2: To study the duration of response (DoR) of the combination of surufatinib and gemcitabine in pediatric patients with Ewing sarcoma, RMS, or NRSTS.
Description
The duration of CR or PR will be reported.
Time Frame
up to 4 years
Title
Part 2: To study the progression-free survival (PFS) of the combination of surufatinib and gemcitabine in pediatric patients with Ewing sarcoma, RMS, or NRSTS.
Description
The time from enrollment in the clinical trial to disease progression or death will be reported.
Time Frame
up to 4 years
Secondary Outcome Measure Information:
Title
To evaluate number of patients with treatment-emergent adverse events as assessed
Description
To evaluate the safety in the pediatric patient population when treated with the combination of surufatinib and gemcitabine
Time Frame
up to 4 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
2 Years
Maximum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age: At time of study enrollment, patients must be Part 1 (including PK expansion cohort): ≥2 and ≤21 years of age; Part 2: ≥2 and ≤21 years of age; Patients with osteosarcoma can enroll up to <30 years old. Diagnosis: Part 1 - Patients with any recurrent or refractory solid tumors or lymphoma (not central nervous system [CNS]) that have a known or expected dysfunction of VEGFR 1, -2, and -3; FGFR-1, or CSF-1R pathways (based on literature) are eligible. Patients must have had histologic verification of malignancy at original diagnosis or relapse. Part 2 - Recurrent or refractory osteosarcoma (US and EU), Ewing sarcoma (US and EU), RMS (US and EU), or NRSTS (EU only). Patients must have had histologic verification of malignancy at original diagnosis or relapse. Disease status: Patients must have measureable or evaluable disease for part 1 dose escalation; for part 2, patients must have measurable disease by RECIST version 1.1. Therapeutic options: Patient's current disease state must be one for which there is no known curative therapy. Performance level: Karnofsky ≥50 for patients ≥16 and <18 years of age and Lansky ≥50 for patients <16 years of age, Eastern Cooperative Oncology Group (ECOG) ≤2 for patients ≥18 years of age. Adequate organ and bone marrow function as defined in the current protocol. Adequate cardiac function as indicated as defined in the current protocol. Patients with known bone marrow metastatic disease will be eligible for the study provided they meet the blood counts in the inclusion criteria as defined in the current protocol. Adequate BP control which is defined as a BP <95th percentile (≤ grade 1) for age, height, and sex. Informed consent: Provision of signed and dated written informed consent (parent/legal guardian if patient <18 years of age) and assent (from patients aged >7 years) prior to any study-specific procedures, sampling, and analyses. Patient must meet all defined Inclusion criteria as defined in the current protocol. Exclusion Criteria: Patient must not meet any exclusion criteria as defined in the current protocol. Pregnant, breast feeding or planning on becoming pregnant. Patients is taking and prohibitive concomitant medications as outlined in the current protocol. Patients have an uncontrolled infection. Patients has had major surgery or significant traumatic injury within 28 days of the first dose. Brain metastases and/or spinal cord compression untreated with surgery and/or radiotherapy and without clinical imaging evidence of SD for 14 days or longer. History of allergies to Surufatinib and/or Gemcitabine.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Josephine Haduong
Organizational Affiliation
Children's Hospital of Orange County
Official's Role
Principal Investigator
Facility Information:
Facility Name
Children's Hospital of Alabama
City
Birmingham
State/Province
Alabama
ZIP/Postal Code
35233
Country
United States
Facility Name
Childrens Hospital Orange County
City
Orange
State/Province
California
ZIP/Postal Code
92868
Country
United States
Facility Name
Children's National Hospital
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20010
Country
United States
Facility Name
Riley Hospital for Children
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46202
Country
United States
Facility Name
Johns Hopkins University
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287
Country
United States
Facility Name
Washington University School of Medicine
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
Cincinnati Children's Hospital Medical Center
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229
Country
United States
Facility Name
Children's Hospital of Philadelphia
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
UPMC Children's Hospital of Pittsburgh
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15224
Country
United States
Facility Name
The University of Texas Southwestern Medical Center
City
Dallas
State/Province
Texas
ZIP/Postal Code
75390
Country
United States
Facility Name
Seattle Children's Hospital
City
Seattle
State/Province
Washington
ZIP/Postal Code
98105
Country
United States

12. IPD Sharing Statement

Learn more about this trial

A Study of Surufatinib in Combination With Gemcitabine in Pediatric, Adolescent, and Young Adult Patients With Recurrent or Refractory Solid Tumors

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