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GDC-0449 in Treating Young Patients With Medulloblastoma That is Recurrent or Did Not Respond to Previous Treatment

Primary Purpose

Recurrent Childhood Medulloblastoma

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
vismodegib
laboratory biomarker analysis
pharmacological study
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Recurrent Childhood Medulloblastoma

Eligibility Criteria

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

Inclusion Criteria:

  • Histologically confirmed medulloblastoma, including posterior fossa primitive neuroectodermal tumor (PNET)
  • Recurrent, progressive, or refractory to standard therapy
  • No known curative therapy exists
  • Neurological deficits allowed provided they are stable for ≥ 1 week prior to study entry
  • No atypical teratoid/rhabdoid tumor or supratentorial PNET
  • Karnofsky performance status (PS) 60-100% (for patients > 16 years of age) OR Lansky PS 60-100% (for patients ≤ 16 years of age)
  • ANC ≥ 1,000/μL*
  • Platelet count ≥ 100,000/μL (transfusion independent)*
  • Hemoglobin ≥ 8.0 g/dL (RBC transfusion allowed)*
  • Creatinine clearance or radioisotope GFR ≥ 70 mL/min OR serum creatinine based on age as follows:

    • ≤ 0.8 mg/dL (for patients ≤ 5 years of age)
    • ≤ 1.0 mg/dL (for patients 6 to 10 years of age)
    • ≤ 1.2 mg/dL (for patients 11 to 15 years of age)
    • ≤ 1.5 mg/dL (for patients > 15 years of age)
  • Total bilirubin ≤ 1.5 times upper limit of normal (ULN) for age
  • ALT/AST ≤ 2.5 times ULN for age
  • Serum albumin ≥ 2.5 g/dL
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile female patients must use 2 effective methods of contraception during and for 12 months following study treatment
  • Fertile male patients must use effective barrier contraception during and for 12 months following study treatment
  • Body surface area > 0.67 m^2 and ≤ 2.5 m^2
  • Able to swallow capsules
  • No malabsorption syndrome or other condition that would interfere with enteral absorption
  • No history of congestive heart failure
  • No history of ventricular arrhythmia requiring medication
  • No uncontrolled hypocalcemia, hypomagnesemia, hyponatremia, or hypokalemia, defined as less than the lower limit of normal despite adequate electrolyte supplementation
  • No clinically important history of liver disease, including viral hepatitis or cirrhosis
  • No concurrent clinically significant unrelated systemic illness (e.g., serious infection) or significant cardiac, pulmonary, hepatic, or other organ dysfunction that would compromise the patient's ability to tolerate study treatment or would likely interfere with study procedures or results

    • NOTE: * In the absence of bone marrow involvement
  • Recovered from prior treatment-related toxicity
  • At least 3 months since prior craniospinal radiotherapy (at doses ≥ 23 Gy)
  • At least 8 weeks since prior local radiotherapy to primary tumor
  • At least 2 weeks since prior focal radiotherapy to symptomatic metastatic sites
  • More than 4 weeks since prior myelosuppressive chemotherapy or immunotherapy (6 weeks for nitrosoureas)
  • More than 1 week since prior colony-stimulating factors (e.g., filgrastim [G-CSF], sargramostim [GM-CSF], or erythropoietin)
  • No other concurrent anticancer or investigational drug therapy
  • Concurrent dexamethasone allowed provided dosage is stable or decreasing for ≥ 1 week prior to study entry

Sites / Locations

  • UCSF-Mount Zion
  • Children's National Medical Center
  • Lurie Children's Hospital-Chicago
  • Duke University Medical Center
  • Children's Hospital of Philadelphia
  • Children's Hospital of Pittsburgh of UPMC
  • Pediatric Brain Tumor Consortium
  • St. Jude Children's Research Hospital
  • Texas Children's Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Arm I

Arm Description

Patients receive oral hedgehog antagonist GDC-0449 once daily on days 1 and 4-28 in course 1 and on days 1-28 in all subsequent courses. Treatment repeats every 28 days for up to 26 courses in the absence of disease progression or unacceptable toxicity. Blood samples are collected periodically for pharmacokinetic studies. Archival tumor tissue samples are collected and analyzed for the expression of genes that activate the SHH (e.g., Gli1, Gli2, SFRP1, ATOH1, and PTCH2) or WNT (e.g., DKK2 and DKK4) cell signal pathways by in situ hybridization and reverse transcriptase real time-PCR.

Outcomes

Primary Outcome Measures

Mean steady-state total (protein bound and non-protein bound) GDC-0449 plasma concentrations (Css)
95% confidence interval estimates for 2 doses compared.
Pharmacokinetics of GDC-0449, including the elimination rate constant and terminal half life
We will study two BSA defined strata.

Secondary Outcome Measures

Tumor responses
Descriptive statistics will be provided describing tumor responses.
Progression-free survival
Kaplan-Meier estimates of the distribution of progression-free survival (PFS) will be constructed.

Full Information

First Posted
January 13, 2009
Last Updated
April 1, 2014
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00822458
Brief Title
GDC-0449 in Treating Young Patients With Medulloblastoma That is Recurrent or Did Not Respond to Previous Treatment
Official Title
A Phase I Pharmacokinetic and Safety Study in Children With Recurrent or Refractory Medulloblastoma to Identify a Pharmacokinetic Based Dose for GDC-0449
Study Type
Interventional

2. Study Status

Record Verification Date
June 2013
Overall Recruitment Status
Completed
Study Start Date
January 2009 (undefined)
Primary Completion Date
September 2013 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

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

4. Oversight

5. Study Description

Brief Summary
This phase I trial is studying the side effects and best dose of GDC-0449 in treating young patients with medulloblastoma that is recurrent or did not respond to previous treatment. GDC-0449 may be effective in treating young patients with medulloblastoma.
Detailed Description
PRIMARY OBJECTIVE: I. To investigate the safety and pharmacokinetics of a daily dose of hedgehog antagonist GDC-0449 using the available formulation in pediatric patients with recurrent or refractory medulloblastoma. SECONDARY OBJECTIVES: I. To document and describe toxicities associated with this drug in these patients. II. To characterize the pharmacokinetics of this drug in these patients. III. To document preliminary antitumor activity of this drug in these patients. IV. To document pathologic and genomic methods to identify CNS tumors with activation of the PTCH/SHH pathway. OUTLINE: This is a multicenter study. Patients receive oral hedgehog antagonist GDC-0449 once daily on days 1 and 4-28 in course 1 and on days 1-28 in all subsequent courses. Treatment repeats every 28 days for up to 26 courses in the absence of disease progression or unacceptable toxicity. Blood samples are collected periodically for pharmacokinetic studies. Archival tumor tissue samples are collected and analyzed for the expression of genes that activate the SHH (e.g., Gli1, Gli2, SFRP1, ATOH1, and PTCH2) or WNT (e.g., DKK2 and DKK4) cell signal pathways by in situ hybridization and reverse transcriptase real time-PCR. After completion of study therapy, patients are followed for 90 days.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
34 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm I
Arm Type
Experimental
Arm Description
Patients receive oral hedgehog antagonist GDC-0449 once daily on days 1 and 4-28 in course 1 and on days 1-28 in all subsequent courses. Treatment repeats every 28 days for up to 26 courses in the absence of disease progression or unacceptable toxicity. Blood samples are collected periodically for pharmacokinetic studies. Archival tumor tissue samples are collected and analyzed for the expression of genes that activate the SHH (e.g., Gli1, Gli2, SFRP1, ATOH1, and PTCH2) or WNT (e.g., DKK2 and DKK4) cell signal pathways by in situ hybridization and reverse transcriptase real time-PCR.
Intervention Type
Drug
Intervention Name(s)
vismodegib
Other Intervention Name(s)
Erivedge, GDC-0449, Hedgehog antagonist GDC-0449
Intervention Description
Given orally
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Intervention Type
Other
Intervention Name(s)
pharmacological study
Other Intervention Name(s)
pharmacological studies
Primary Outcome Measure Information:
Title
Mean steady-state total (protein bound and non-protein bound) GDC-0449 plasma concentrations (Css)
Description
95% confidence interval estimates for 2 doses compared.
Time Frame
21 days
Title
Pharmacokinetics of GDC-0449, including the elimination rate constant and terminal half life
Description
We will study two BSA defined strata.
Time Frame
Up to 3 months after completion of study treatment
Secondary Outcome Measure Information:
Title
Tumor responses
Description
Descriptive statistics will be provided describing tumor responses.
Time Frame
Up to 30 days after completion of study treatment
Title
Progression-free survival
Description
Kaplan-Meier estimates of the distribution of progression-free survival (PFS) will be constructed.
Time Frame
Up to 30 days after completion of study treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
3 Years
Maximum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically confirmed medulloblastoma, including posterior fossa primitive neuroectodermal tumor (PNET) Recurrent, progressive, or refractory to standard therapy No known curative therapy exists Neurological deficits allowed provided they are stable for ≥ 1 week prior to study entry No atypical teratoid/rhabdoid tumor or supratentorial PNET Karnofsky performance status (PS) 60-100% (for patients > 16 years of age) OR Lansky PS 60-100% (for patients ≤ 16 years of age) ANC ≥ 1,000/μL* Platelet count ≥ 100,000/μL (transfusion independent)* Hemoglobin ≥ 8.0 g/dL (RBC transfusion allowed)* Creatinine clearance or radioisotope GFR ≥ 70 mL/min OR serum creatinine based on age as follows: ≤ 0.8 mg/dL (for patients ≤ 5 years of age) ≤ 1.0 mg/dL (for patients 6 to 10 years of age) ≤ 1.2 mg/dL (for patients 11 to 15 years of age) ≤ 1.5 mg/dL (for patients > 15 years of age) Total bilirubin ≤ 1.5 times upper limit of normal (ULN) for age ALT/AST ≤ 2.5 times ULN for age Serum albumin ≥ 2.5 g/dL Not pregnant or nursing Negative pregnancy test Fertile female patients must use 2 effective methods of contraception during and for 12 months following study treatment Fertile male patients must use effective barrier contraception during and for 12 months following study treatment Body surface area > 0.67 m^2 and ≤ 2.5 m^2 Able to swallow capsules No malabsorption syndrome or other condition that would interfere with enteral absorption No history of congestive heart failure No history of ventricular arrhythmia requiring medication No uncontrolled hypocalcemia, hypomagnesemia, hyponatremia, or hypokalemia, defined as less than the lower limit of normal despite adequate electrolyte supplementation No clinically important history of liver disease, including viral hepatitis or cirrhosis No concurrent clinically significant unrelated systemic illness (e.g., serious infection) or significant cardiac, pulmonary, hepatic, or other organ dysfunction that would compromise the patient's ability to tolerate study treatment or would likely interfere with study procedures or results NOTE: * In the absence of bone marrow involvement Recovered from prior treatment-related toxicity At least 3 months since prior craniospinal radiotherapy (at doses ≥ 23 Gy) At least 8 weeks since prior local radiotherapy to primary tumor At least 2 weeks since prior focal radiotherapy to symptomatic metastatic sites More than 4 weeks since prior myelosuppressive chemotherapy or immunotherapy (6 weeks for nitrosoureas) More than 1 week since prior colony-stimulating factors (e.g., filgrastim [G-CSF], sargramostim [GM-CSF], or erythropoietin) No other concurrent anticancer or investigational drug therapy Concurrent dexamethasone allowed provided dosage is stable or decreasing for ≥ 1 week prior to study entry
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Amar Gajjar
Organizational Affiliation
Pediatric Brain Tumor Consortium
Official's Role
Principal Investigator
Facility Information:
Facility Name
UCSF-Mount Zion
City
San Francisco
State/Province
California
ZIP/Postal Code
94115
Country
United States
Facility Name
Children's National Medical Center
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20010
Country
United States
Facility Name
Lurie Children's Hospital-Chicago
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60614
Country
United States
Facility Name
Duke University Medical Center
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States
Facility Name
Children's Hospital of Philadelphia
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
Children's Hospital of Pittsburgh of UPMC
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15224
Country
United States
Facility Name
Pediatric Brain Tumor Consortium
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38105
Country
United States
Facility Name
St. Jude Children's Research Hospital
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38105
Country
United States
Facility Name
Texas Children's Hospital
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States

12. IPD Sharing Statement

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GDC-0449 in Treating Young Patients With Medulloblastoma That is Recurrent or Did Not Respond to Previous Treatment

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