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Testing the Anti-cancer Drug Erdafitinib for Brain Cancers That Have Recurrent or Progressed Following Treatment

Primary Purpose

Recurrent Glioblastoma, IDH-Wildtype, Recurrent WHO Grade 2 Glioma, Recurrent WHO Grade 3 Glioma

Status
Not yet recruiting
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
Biospecimen Collection
Erdafitinib
Magnetic Resonance Imaging
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Recurrent Glioblastoma, IDH-Wildtype

Eligibility Criteria

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

Inclusion Criteria: Patient must be >= 18 years of age Because no dosing or adverse event data are currently available on the use of erdafitinib in patients < 18 years of age, children are excluded from this study Patient must have histologically confirmed IDH-WT gliomas (grade 2-4) as per World Health Organization (WHO) 2016 or 2021 classification Tumor tissue should be positive for FGFR-TACC gene fusion as per any local next generation sequencing (NGS) (Clinical Laboratory Improvement Act [CLIA]-approved) assay described in background section The disease should be recurrent or progressive glioma For patients with WHO grade 3 or 4 glioma and progressive disease < 12 weeks after completion of chemoradiotherapy, progression can be defined by the following set of criteria: New enhancement outside of the radiation field (beyond the high-dose region or 80% isodose line) If there is unequivocal evidence of viable tumor on histopathologic sampling (e.g., solid tumor areas. i.e., > 70% tumor cell nuclei in areas), high or progressive increase in Ki-67 proliferation index compared with prior biopsy, or evidence for histologic progression or increased anaplasia in tumor). For patients with WHO grade 3 or 4 glioma and progressive disease >= 12 weeks after completion of chemoradiotherapy, progression can be defined by the following set of criteria: New contrast-enhancing lesion outside of radiation field on decreasing, stable, or increasing doses of corticosteroids Increase by >= 25% in the sum of the products of perpendicular diameters between the first post-radiotherapy scan, or a subsequent scan with smaller tumor size, and the scan at 12 weeks or later on stable or increasing doses of corticosteroids For patients receiving antiangiogenic therapy, significant increase in T2/FLAIR non-enhancing lesion may also be considered progressive disease. The increased T2/FLAIR must have occurred with the patient on stable or increasing doses of corticosteroids compared with baseline scan or best response after initiation of therapy and not be a result of comorbid events (e.g., effects of radiation therapy, demyelination, ischemic injury, infection, seizures, postoperative changes, or other treatment effects). For patients with WHO grade 2 glioma progression is defined by any one of the following: Development of new lesions or increase of enhancement (radiological evidence of malignant transformation) A 25% increase of the T2 or FLAIR non-enhancing lesion on stable or increasing doses of corticosteroids compared with baseline scan or best response after initiation of therapy, not attributable to radiation effect or to comorbid events There must be measurable disease (enhancing or non-enhancing as per Response Assessment in Neuro-Oncology [RANO] or low-grade glioma [LGG] RANO criteria), as evaluated on pre-treatment MRI Patient understands the procedures and investigational nature of the study drug and agrees to comply with study requirements by providing written informed consent Patient must have Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (or Karnofsky >= 60%) Absolute neutrophil count >= 1000/uL Hemoglobin > 8 g/dL (Patients are allowed to be transfused to this level) Platelets >= 100 x 10^9/L Serum total bilirubin =< 1.5 x upper limit of normal (ULN), unless considered due to Gilbert's disease or disease involvement following approval by the medical monitor Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) =< 3 x institutional ULN Creatinine clearance > 40 mL/min based on the Cockroft-Gault glomerular filtration rate (GFR) estimation Patient must have normal serum phosphate level as per local laboratory parameters. (Medical management allowed) Patient must be recovered from any clinically relevant toxic effects of any prior surgery, radiotherapy, or chemotherapy treatment with temozolomide Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load Patients should be New York Heart Association Functional Classification class 2B or better The effects of erdafitinib on the developing human fetus are unknown. For this reason and because FGFR inhibitors are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and one month after completion of erdafitinib administration. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and one month after completion of erdafitinib administration Ability to understand and the willingness to sign a written informed consent document. Legally authorized representatives may sign and give informed consent on behalf of study participants Exclusion Criteria: Patients who are receiving any other investigational agents History of allergic reactions attributed to compounds of similar chemical or biologic composition to erdafitinib Patients requiring any medications or substances that are moderate CYP2C9 inducers and strong CYP3A4 inducers are ineligible. Because the lists of these agents are constantly changing, it is important to regularly consult a frequently-updated medical reference. As part of the enrollment/informed consent procedures, the patient will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the patient is considering a new over-the-counter medicine or herbal product Patients with uncontrolled intercurrent illness Pregnant women are excluded from this study because erdafitinib is an FGFR inhibitor agent with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with erdafitinib, breastfeeding should be discontinued if the mother is treated with erdafitinib Current central serous retinopathy (CSR) or retinal pigment epithelial detachment of any grade Patients who have previously received FGFR inhibitors

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Treatment (erdafitinib)

    Arm Description

    Patients receive erdafitinib PO on study. Patients also undergo MRI, and collection of blood samples throughout the trial.

    Outcomes

    Primary Outcome Measures

    Objective response rate (ORR)
    Defined as the proportion of patients with either complete response or partial response as per Response Assessment in Neuro-Oncology (RANO) criteria. The response rate will be estimated along with the corresponding 95% confidence interval using the binomial exact method. Univariable and multivariable logistic regression models will be used to estimate the associations between study covariates and response status. Odds ratios (ORs) and corresponding 95% confidence intervals and p-values will be reported.

    Secondary Outcome Measures

    Incidence of dose-limiting toxicities (DLTs)
    Analyzed based on National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
    Incidence of adverse events (AEs) and serious AEs
    Analyzed based on NCI CTCAE version 5.0.
    Progression-free survival (PFS)
    PFS is defined as the elapsed time between the date of enrollment and the date of progression or date of death from any cause. Alive patients without progression will be censored at the last date of follow-up. Kaplan-Meier method will be used to estimate survival rates for pre-specified time points along with 95% confidence intervals. Hazard ratios (HRs) will be estimated using Cox proportional hazards regression model to examine the associations of study covariates with time-to-event outcomes along with corresponding 95% confidence intervals and p-values if these are estimable.
    Overall survival (OS)
    Kaplan-Meier method will be used to estimate survival rates for pre-specified time points along with 95% confidence intervals. Hazard ratios (HRs) will be estimated using Cox proportional hazards regression model to examine the associations of study covariates with time-to-event outcomes along with corresponding 95% confidence intervals and p-values if these are estimable.

    Full Information

    First Posted
    May 13, 2023
    Last Updated
    October 19, 2023
    Sponsor
    National Cancer Institute (NCI)
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05859334
    Brief Title
    Testing the Anti-cancer Drug Erdafitinib for Brain Cancers That Have Recurrent or Progressed Following Treatment
    Official Title
    A Phase 2 Study of Erdafitinib in Patients With Recurrent or Progressive IDH-Wild Type Glioma With an FGFR-TACC Gene Fusion
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    October 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    October 23, 2023 (Anticipated)
    Primary Completion Date
    October 23, 2026 (Anticipated)
    Study Completion Date
    October 23, 2026 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    National Cancer Institute (NCI)

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    Yes
    Studies a U.S. FDA-regulated Device Product
    No
    Product Manufactured in and Exported from the U.S.
    No
    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    This phase II trial tests how well erdafitinib works in controlling IDH-wild type (WT) glioma with FGFR-TACC gene fusion that has come back (recurrent) or that is growing, spreading, or getting worse (progressive). Erdafitinib is in a class of medications called kinase inhibitors. It works by blocking the action of an abnormal FGFR protein that signals cancer cells to multiply. This may help keep cancer cells from growing and may kill them. Giving erdafitinib may help to slow the growth of or to shrink tumor cells in patients with recurrent or progressive IDH-wild type glioma with FGFR-TACC gene fusion.
    Detailed Description
    PRIMARY OBJECTIVE: I. To assess the preliminary anti-tumor activity of erdafitinib in patients with recurrent or progressive IDH-WT glioma with FGFR-TACC gene fusion as measured by the best response at any time during treatment in terms of objective response rate (ORR). SECONDARY OBJECTIVES: I. To determine the safety and tolerability of erdafitinib in patients with recurrent or progressive IDH-WT glioma with FGFR-TACC gene fusion. II. To assess the overall survival (OS) of erdafitinib in patients with recurrent or progressive IDH-WT glioma with FGFR-TACC gene fusion. III. To assess the progression free survival (PFS) at 6 months of patient with IDH-WT glioma with FGFR-TACC gene fusion treated with erdafitinib. OUTLINE: This is a dose-escalation study of erdafitinib followed by a dose-expansion study. Patients receive erdafitinib orally (PO) on study. Patients also undergo magnetic resonance imaging (MRI), and collection of blood samples throughout the trial. After study completion, patients are followed up every 3 months for 2 years.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Recurrent Glioblastoma, IDH-Wildtype, Recurrent WHO Grade 2 Glioma, Recurrent WHO Grade 3 Glioma

    7. Study Design

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

    8. Arms, Groups, and Interventions

    Arm Title
    Treatment (erdafitinib)
    Arm Type
    Experimental
    Arm Description
    Patients receive erdafitinib PO on study. Patients also undergo MRI, and collection of blood samples throughout the trial.
    Intervention Type
    Procedure
    Intervention Name(s)
    Biospecimen Collection
    Other Intervention Name(s)
    Biological Sample Collection, Biospecimen Collected, Specimen Collection
    Intervention Description
    Undergo collection of blood samples
    Intervention Type
    Drug
    Intervention Name(s)
    Erdafitinib
    Other Intervention Name(s)
    Balversa, JNJ-42756493
    Intervention Description
    Given PO
    Intervention Type
    Procedure
    Intervention Name(s)
    Magnetic Resonance Imaging
    Other Intervention Name(s)
    Magnetic Resonance, Magnetic resonance imaging (procedure), Magnetic Resonance Imaging Scan, Medical Imaging, Magnetic Resonance / Nuclear Magnetic Resonance, MR, MR Imaging, MRI, MRI Scan, NMR Imaging, NMRI, Nuclear Magnetic Resonance Imaging
    Intervention Description
    Undergo MRI
    Primary Outcome Measure Information:
    Title
    Objective response rate (ORR)
    Description
    Defined as the proportion of patients with either complete response or partial response as per Response Assessment in Neuro-Oncology (RANO) criteria. The response rate will be estimated along with the corresponding 95% confidence interval using the binomial exact method. Univariable and multivariable logistic regression models will be used to estimate the associations between study covariates and response status. Odds ratios (ORs) and corresponding 95% confidence intervals and p-values will be reported.
    Time Frame
    Up to 2 years
    Secondary Outcome Measure Information:
    Title
    Incidence of dose-limiting toxicities (DLTs)
    Description
    Analyzed based on National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
    Time Frame
    Up to 28 days
    Title
    Incidence of adverse events (AEs) and serious AEs
    Description
    Analyzed based on NCI CTCAE version 5.0.
    Time Frame
    Up to 2 years
    Title
    Progression-free survival (PFS)
    Description
    PFS is defined as the elapsed time between the date of enrollment and the date of progression or date of death from any cause. Alive patients without progression will be censored at the last date of follow-up. Kaplan-Meier method will be used to estimate survival rates for pre-specified time points along with 95% confidence intervals. Hazard ratios (HRs) will be estimated using Cox proportional hazards regression model to examine the associations of study covariates with time-to-event outcomes along with corresponding 95% confidence intervals and p-values if these are estimable.
    Time Frame
    Time between date of enrollment and date of progression or date of death from any cause, assessed at 6 months
    Title
    Overall survival (OS)
    Description
    Kaplan-Meier method will be used to estimate survival rates for pre-specified time points along with 95% confidence intervals. Hazard ratios (HRs) will be estimated using Cox proportional hazards regression model to examine the associations of study covariates with time-to-event outcomes along with corresponding 95% confidence intervals and p-values if these are estimable.
    Time Frame
    Time between the date of enrollment and date of death from any cause, censored at the last date of follow-up, assessed up to 2 years

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Patient must be >= 18 years of age Because no dosing or adverse event data are currently available on the use of erdafitinib in patients < 18 years of age, children are excluded from this study Patient must have histologically confirmed IDH-WT gliomas (grade 2-4) as per World Health Organization (WHO) 2016 or 2021 classification Tumor tissue should be positive for FGFR-TACC gene fusion as per any local next generation sequencing (NGS) (Clinical Laboratory Improvement Act [CLIA]-approved) assay described in background section The disease should be recurrent or progressive glioma For patients with WHO grade 3 or 4 glioma and progressive disease < 12 weeks after completion of chemoradiotherapy, progression can be defined by the following set of criteria: New enhancement outside of the radiation field (beyond the high-dose region or 80% isodose line) If there is unequivocal evidence of viable tumor on histopathologic sampling (e.g., solid tumor areas. i.e., > 70% tumor cell nuclei in areas), high or progressive increase in Ki-67 proliferation index compared with prior biopsy, or evidence for histologic progression or increased anaplasia in tumor). For patients with WHO grade 3 or 4 glioma and progressive disease >= 12 weeks after completion of chemoradiotherapy, progression can be defined by the following set of criteria: New contrast-enhancing lesion outside of radiation field on decreasing, stable, or increasing doses of corticosteroids Increase by >= 25% in the sum of the products of perpendicular diameters between the first post-radiotherapy scan, or a subsequent scan with smaller tumor size, and the scan at 12 weeks or later on stable or increasing doses of corticosteroids For patients receiving antiangiogenic therapy, significant increase in T2/FLAIR non-enhancing lesion may also be considered progressive disease. The increased T2/FLAIR must have occurred with the patient on stable or increasing doses of corticosteroids compared with baseline scan or best response after initiation of therapy and not be a result of comorbid events (e.g., effects of radiation therapy, demyelination, ischemic injury, infection, seizures, postoperative changes, or other treatment effects). For patients with WHO grade 2 glioma progression is defined by any one of the following: Development of new lesions or increase of enhancement (radiological evidence of malignant transformation) A 25% increase of the T2 or FLAIR non-enhancing lesion on stable or increasing doses of corticosteroids compared with baseline scan or best response after initiation of therapy, not attributable to radiation effect or to comorbid events There must be measurable disease (enhancing or non-enhancing as per Response Assessment in Neuro-Oncology [RANO] or low-grade glioma [LGG] RANO criteria), as evaluated on pre-treatment MRI Patient understands the procedures and investigational nature of the study drug and agrees to comply with study requirements by providing written informed consent Patient must have Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (or Karnofsky >= 60%) Absolute neutrophil count >= 1000/uL Hemoglobin > 8 g/dL (Patients are allowed to be transfused to this level) Platelets >= 100 x 10^9/L Serum total bilirubin =< 1.5 x upper limit of normal (ULN), unless considered due to Gilbert's disease or disease involvement following approval by the medical monitor Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) =< 3 x institutional ULN Creatinine clearance > 40 mL/min based on the Cockroft-Gault glomerular filtration rate (GFR) estimation Patient must have normal serum phosphate level as per local laboratory parameters. (Medical management allowed) Patient must be recovered from any clinically relevant toxic effects of any prior surgery, radiotherapy, or chemotherapy treatment with temozolomide Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load Patients should be New York Heart Association Functional Classification class 2B or better The effects of erdafitinib on the developing human fetus are unknown. For this reason and because FGFR inhibitors are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and one month after completion of erdafitinib administration. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and one month after completion of erdafitinib administration Ability to understand and the willingness to sign a written informed consent document. Legally authorized representatives may sign and give informed consent on behalf of study participants Exclusion Criteria: Patients who are receiving any other investigational agents History of allergic reactions attributed to compounds of similar chemical or biologic composition to erdafitinib Patients requiring any medications or substances that are moderate CYP2C9 inducers and strong CYP3A4 inducers are ineligible. Because the lists of these agents are constantly changing, it is important to regularly consult a frequently-updated medical reference. As part of the enrollment/informed consent procedures, the patient will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the patient is considering a new over-the-counter medicine or herbal product Patients with uncontrolled intercurrent illness Pregnant women are excluded from this study because erdafitinib is an FGFR inhibitor agent with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with erdafitinib, breastfeeding should be discontinued if the mother is treated with erdafitinib Current central serous retinopathy (CSR) or retinal pigment epithelial detachment of any grade Patients who have previously received FGFR inhibitors
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Macarena I De La Fuente
    Organizational Affiliation
    University Health Network Princess Margaret Cancer Center LAO
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    Yes
    IPD Sharing Plan Description
    NCI is committed to sharing data in accordance with NIH policy. For more details on how clinical trial data is shared, access the link to the NIH data sharing policy page.
    IPD Sharing URL
    https://grants.nih.gov/policy/sharing.htm

    Learn more about this trial

    Testing the Anti-cancer Drug Erdafitinib for Brain Cancers That Have Recurrent or Progressed Following Treatment

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