Study of the Combination of Crizotinib and Dasatinib in Pediatric Research Participants With Diffuse Pontine Glioma (DIPG) and High-Grade Glioma (HGG)

NCT ID: NCT01644773

Last Updated: 2019-03-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Clinical Phase

PHASE1

Total Enrollment

36 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-11-27

Study Completion Date

2018-09-28

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

This is a phase I study to find the highest tolerable dose of crizotinib and dasatinib given in combination to patients with diffuse intrinsic pontine glioma (DIPG) and other types of high grade gliomas (HGG). Participants will receive escalating doses until the highest dose is determined. Participants will be enrolled in two strata: stratum A for recurrent/ progressive tumors and stratum B for recently diagnosed patients who have completed standard radiation therapy without progressive disease. Up to 7 dosage levels will be tested. Both drugs are taken orally daily, once per day. Correlative pharmacokinetic and biology studies are planned, as well as advanced methods of magnetic resonance imaging (MRI).

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

The Rolling 6 design will be used to estimate the maximum tolerated dose (MTD) and determine the dose-limiting toxicity (DLT) of the combination of escalating doses of crizotinib and dasatinib. Our goal is to accrue research participants for both stratum A and B. However, it is our expectation that the accrual of research participants to stratum B will proceed at a slower pace. Therefore, initially the strategy of dose escalation will be exclusively based on research participants treated at stratum A until the MTD of this combination is reached. Until the MTD of this combination is reached for research participants in stratum A, accrual of research participants in stratum B will be allowed at the highest dosage level which has already been deemed to be safe (i.e., no DLTs in three research participants or ≤ 1 DLT in six research participants). No research participants will be accrued to stratum B until at least one dosage level has been confirmed to be safe in stratum A. Once the MTD for stratum A is reached, we will accrue research participants at this same dosage level to stratum B following the rules of the Rolling 6 design. If the MTD for stratum A is well tolerated among research participants in stratum B, we will proceed with dose escalation for research participants in stratum B based on the same rules of the Rolling 6 design. This strategy is based on the premise that research participants who are more heavily pre-treated (stratum A) may not tolerate therapy as well as those with minimal previous treatment (stratum B).

Primary Objectives:

* To estimate the MTD of the combination of crizotinib (c-Met and ALK inhibitor) and dasatinib (bcr-abl, PDGFRA and B, src, lck, yes, and c-kit inhibitor) in pediatric research participants with recurrent or progressive DIPG and other HGGs (stratum A).
* To estimate the MTD of the combination of crizotinib and dasatinib in research participants with DIPG or HGG who completed RT within a short interval prior to enrollment but have not experienced disease progression (stratum B).

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Diffuse Intrinsic Pontine Glioma High-grade Glioma

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Chemotherapy

Research participants with high grade glioma or diffuse intrinsic pontine glioma will receive crizotinib and dasatinib.

Group Type EXPERIMENTAL

Crizotinib

Intervention Type DRUG

Starting dose level:

* Initial Treatment Plan: 130 mg/m\^2 per dose
* Modified Treatment Plan per Amendment 1.0: 165 mg/m\^2 per dose

The dose of a single agent will be increased by approximately 30% in each subsequent cohort until the MTD of this combination is reached.

The doses of each agent will not exceed their single-agent MTD already determined for children with recurrent solid tumors.

Cycle 1 (28 days): once a day for 28 days

Cycles 2-26 (28 days each): once a day

Dasatinib

Intervention Type DRUG

Starting dose level: 50 mg/m\^2 per dose

The dose of a single agent will be increased by approximately 30% in each subsequent cohort until the MTD of this combination is reached.

The doses of each agent will not exceed their single-agent MTD already determined for children with recurrent solid tumors.

Cycle 1 (28 days): starting on day 3, once a day for 28 days

Cycles 2-26 (28 days each): once a day

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Crizotinib

Starting dose level:

* Initial Treatment Plan: 130 mg/m\^2 per dose
* Modified Treatment Plan per Amendment 1.0: 165 mg/m\^2 per dose

The dose of a single agent will be increased by approximately 30% in each subsequent cohort until the MTD of this combination is reached.

The doses of each agent will not exceed their single-agent MTD already determined for children with recurrent solid tumors.

Cycle 1 (28 days): once a day for 28 days

Cycles 2-26 (28 days each): once a day

Intervention Type DRUG

Dasatinib

Starting dose level: 50 mg/m\^2 per dose

The dose of a single agent will be increased by approximately 30% in each subsequent cohort until the MTD of this combination is reached.

The doses of each agent will not exceed their single-agent MTD already determined for children with recurrent solid tumors.

Cycle 1 (28 days): starting on day 3, once a day for 28 days

Cycles 2-26 (28 days each): once a day

Intervention Type DRUG

Other Intervention Names

Discover alternative or legacy names that may be used to describe the listed interventions across different sources.

PF-02341066 Xalkori® BMS-354825 Sprycel®

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Diagnosis of high-grade glioma (HGG) or diffuse intrinsic pontine glioma (DIPG). If histologic confirmation was obtained, diagnosis must be one of the following: anaplastic astrocytoma (WHO grade 3), anaplastic oligodendroglioma (WHO grade 3), anaplastic oligoastrocytoma (WHO grade 3), anaplastic ganglioglioma (WHO grade 3), pleomorphic xanthoastrocytoma with anaplastic features (WHO grade 3), malignant glioneuronal tumor, glioblastoma, or gliosarcoma (WHO grade 4)
* Age \> or = 2 years and \< or = 21 years
* Performance score \> or = 50 (Lansky for research participants \< or = 16 years and Karnofsky for those \> 16 years).
* Adequate organ function at the time of enrollment as follows:

* Bone marrow: Hemoglobin \> or = 8g/dL \[may have received packed red blood cell transfusion\], absolute neutrophil count (ANC) \> or = 1000/mm\^3, platelets \> or = 100,000/mm\^3 \[transfusion independent\])
* Renal: Normal serum creatinine based on age as shown below or GFR \> 70ml/min/1.73m\^2:

* Age \< or = 5 years: 0.8 mg/dL maximum
* Age 5 to 10 years: 1.0 mg/dL maximum
* Age 10 to 15 years: 1.2 mg/dL maximum
* Age \> 15 years: 1.5 mg/dL maximum
* Hepatic: SGPT and SGOT \< 3x the institutional upper limit of normal (ULN), total bilirubin concentration \< 1.5x the institutional ULN, albumin \> or = 2g/dL
* Female research participants \> or = 10 years of age or post-menarchal must not be pregnant (confirmed by serum or urine pregnancy test within 1 week of study enrollment) or breastfeeding
* Female research participants of childbearing age or males research participants of child fathering potential must agree to use safe contraceptive methods for the duration of the study and for 3 months thereafter


* Diagnosis of recurrent or progressive HGG or DIPG.
* Neurological deficits must be stable on a fixed or decreasing dose of dexamethasone for ≥7 days before study enrollment.
* Recovery to ≤ grade 1 from all significant toxicities of previous therapies.
* Irradiation: Interval from the last dose of local radiation therapy (RT), craniospinal RT, and palliative RT for symptomatic disease \> or = 3 months, \> or = 6 months, and \> or = 2 weeks before study enrollment, respectively
* Myelosuppressive chemotherapy: Interval \> or = 6 weeks and \> or = 4 weeks from last dose of nitrosourea and other chemotherapy drugs before study enrollment, respectively. However, interval must be \> or = 1 week from last dose of oral etoposide and other drugs administered at low doses (metronomic regimen) before study enrollment
* Small-Molecule Inhibitors: Interval \> or = 1 week from last dose before study enrollment. If a previously used agent has a prolonged half-life, the appropriate interval will be determined after consultation with the principal investigator
* Monoclonal Antibodies: Interval \> or = 3 half-lives before study enrollment. Such cases will need to be discussed with the principal investigator
* High-Dose Chemotherapy with Stem-Cell Rescue: Interval \> or = 3 months before study enrollment
* Cancer Vaccines and Convection-Enhanced Therapies: Interval \> or = 1 month before study enrollment
* Growth Factors: Interval \> or = 1 week and \> or = 2 weeks before study enrollment for standard and long-acting growth factors (e.g., pegfilgrastim), respectively


* Completion of local RT with or without concomitant chemotherapy including temozolomide and radiosensitizing agents (e.g., carboplatin, vorinostat) outside the context of a clinical trial. Any agent administered during RT should have a short half-life so that it should already be completely eliminated by the start of this therapy. If other agents were used concurrently with RT, they will need to be discussed with the principal investigator to assess eligibility
* Interval \> or = 4 weeks and \< or = 8 weeks from the completion of radiochemotherapy

Exclusion Criteria

* Metastatic disease for stratum B only
* Concomitant use of other anticancer (except for corticosteroids) or experimental agents
* Use of enzyme-inducing anticonvulsants (EIACs). A minimum interval of 10 days between the last dose of EIAC and start of this therapy will be required for research participants who were previously receiving such medications.
* Pregnant or lactating patients
* Research participants with other clinically significant medical disorders that could compromise their ability to tolerate protocol therapy or would interfere with the study procedures or results
* Prior therapy with a PDGFR or c-Met inhibitor
* Original treatment design: Body surface area ≥ 1.8m2on dosage levels 3b, 4, and 5
* Modified treatment design: Body surface area \< 0.55 m\^2 for all dosage levels
Minimum Eligible Age

2 Years

Maximum Eligible Age

21 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

St. Jude Children's Research Hospital

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Responsibility Role SPONSOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Anna Vinitsky, MD

Role: PRINCIPAL_INVESTIGATOR

St. Jude Children's Research Hospital

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

St. Jude Children's Research Hospital

Memphis, Tennessee, United States

Site Status

Countries

Review the countries where the study has at least one active or historical site.

United States

References

Explore related publications, articles, or registry entries linked to this study.

Gibson EG, Campagne O, Selvo NS, Gajjar A, Stewart CF. Population pharmacokinetic analysis of crizotinib in children with progressive/recurrent high-grade and diffuse intrinsic pontine gliomas. Cancer Chemother Pharmacol. 2021 Dec;88(6):1009-1020. doi: 10.1007/s00280-021-04357-4. Epub 2021 Sep 29.

Reference Type DERIVED
PMID: 34586478 (View on PubMed)

Related Links

Access external resources that provide additional context or updates about the study.

http://www.stjude.org

St. Jude Children's Research Hospital

http://www.stjude.org/protocols

Clinical Trials Open at St. Jude

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

NCI-2012-01240

Identifier Type: REGISTRY

Identifier Source: secondary_id

SJHG12

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.

Fimepinostat in Treating Brain Tumors in Children and Young Adults
NCT03893487 ACTIVE_NOT_RECRUITING EARLY_PHASE1
Study of DSP-0390 in Patients With Recurrent High-Grade Glioma
NCT05023551 ACTIVE_NOT_RECRUITING EARLY_PHASE1