European Proof-of-Concept Therapeutic Stratification Trial of Molecular Anomalies in Relapsed or Refractory Tumors

NCT ID: NCT02813135

Last Updated: 2026-01-16

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

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Recruitment Status

RECRUITING

Clinical Phase

PHASE1/PHASE2

Total Enrollment

472 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-08-03

Study Completion Date

2031-02-28

Brief Summary

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This proof-of-concept platform trial is designed to cover the targeting of several survival pathways in oncogenesis that are currently not adequately employed for pediatric patients in Europe (Geoerger 2017; Geoerger 2019).

The aims of the trial are:

1. To determine the recommended phase II dose (RP2D) of a specific anticancer agent and/or a relevant combination in a pediatric population, to document its tolerability and
2. To explore first signals of activity in a molecularly enriched study population.

Detailed Description

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The first molecular profiling protocols have been launched in Europe (MOSCATO-01 (Geoerger 2014), MAPPYACTS, INFORM, iTHER, SM-PAEDS, etc.) determining multiple actionable alterations in pediatric recurrent cancers. Increasingly, stratified approaches are being implemented to enrich clinical trials of molecularly targeted agents and possibly improve outcomes in specific populations i.e. a molecularly enriched/predictive biomarker-driven approach. The diversity and heterogeneity of the detected molecular alterations and the low number of pediatric patients mandate an adapted, innovative trial design for the attributed treatment options in order to satisfy the current unmet medical need.

This basket trial is designed to cover the targeting of several survival pathways in oncogenesis that are currently not adequately employed for pediatric patients in Europe.

Conditions

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Pediatric Cancer

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Arm A. Ribociclib + Topotecan and Temozolomide

Topotecan iv QD and temozolomide capsules orally QD Days 1 to 5; Ribociclib capsules or oral solution orally QD from Day 6 to 20 of a 28 day cycle.

Group Type EXPERIMENTAL

Ribociclib

Intervention Type DRUG

Topotecan

Intervention Type DRUG

Temozolomide

Intervention Type DRUG

Arm B. Ribociclib + Everolimus

Ribociclib capsules or oral solution orally QD for 21 days of each 28 day cycle; Everolimus orodispersible tablets orally QD for 28 days.

Group Type EXPERIMENTAL

Ribociclib

Intervention Type DRUG

Everolimus

Intervention Type DRUG

ARM C. Adavosertib + Carboplatin

Adavosertib capsules orally BID 3 days on / 4 days off in week 1; Carboplatin iv QD AUC 5 on Day 1 of a 21 day cycle.

Group Type EXPERIMENTAL

Adavosertib

Intervention Type DRUG

Carboplatin

Intervention Type DRUG

Arm D. Olaparib + Irinotecan

Olaparib tablets orally BID on Day 1-10 of a 21 day cycle Irinotecan iv QD on Day 4-8 of a 21 day cycle.

Group Type EXPERIMENTAL

Olaparib

Intervention Type DRUG

Irinotecan

Intervention Type DRUG

Arm E. Vistusertib single agent

Vistusertib tablets orally BID 2 days on/5 days off per week of a 28 day cycle.

Group Type EXPERIMENTAL

Vistusertib

Intervention Type DRUG

Arm F. Vistusertib + Topotecan and Temozolomide

Topotecan iv QD and temozolomide capsules orally QD Days 1 to 5; Vistusertib tablets orally BID 3 days on/4 days off per week of a 28 day cycle.

Group Type EXPERIMENTAL

Topotecan

Intervention Type DRUG

Temozolomide

Intervention Type DRUG

Vistusertib

Intervention Type DRUG

Arm G. Nivolumab + Cyclophosphamide +/- Radiotherapy

Nivolumab iv QD every 2 weeks of a 28 day cycle (Days 1 and 15); Cyclophosphamide tablets or oral solution orally BID, 1 week on/1 week off; Palliative irradiation/radiofrequency/cryotherapy starting 2 weeks after the first nivolumab injection.

Group Type EXPERIMENTAL

Nivolumab

Intervention Type DRUG

Cyclophosphamide

Intervention Type DRUG

Arm H. Selumetinib + Vistusertib

Selumetinib capsules twice daily on a continous administration. Vistusertib orally twice daily on an intermittent schedule : 2 days on / 5 days off per week of a 28 day cycle.

Group Type EXPERIMENTAL

Vistusertib

Intervention Type DRUG

Selumetinib

Intervention Type DRUG

Arm I. Enasidenib

Enasidenib tablets or sprinkle solution orally on a continuous dosing once daily (QD) per 28 day cycle.

Group Type EXPERIMENTAL

Enasidenib

Intervention Type DRUG

Arm J. Lirilumab + Nivolumab

Nivolumab iv QD on Day 1 and 15 of a 28 day cycle; Lirilumab iv QD on Day 1 of a 28 day cycle

Group Type EXPERIMENTAL

Nivolumab

Intervention Type DRUG

Lirilumab

Intervention Type DRUG

Arm K. Fadraciclib (CYC065) + Temozolomide

Fadraciclib iv QD on Day 1 (+/- 15) of a 28 day cycle Temozolomide capsules orally QD on Day 1-5 of a 28 day cycle

Group Type EXPERIMENTAL

Temozolomide

Intervention Type DRUG

Fadraciclib

Intervention Type DRUG

Arm L. Fadraciclib (CYC065) + Cytarabine

Fadraciclib iv QD on Day 1 (+/- 15) of a 28 day cycle Cytarabine iv or sc on Day 2-5 and Day 8-11 of a 28 day cycle

Group Type EXPERIMENTAL

Fadraciclib

Intervention Type DRUG

Cytarabine

Intervention Type DRUG

Arm M. Ribociclib + Everolimus +/- Dexamethasone

Ribociclib capsules or tablets orally QD on Day 1-21 of a 28 day cycle. Everolimus dispersible tablets orally QD on a continuous dosing per 28 day cycle.

For patients with leukemia and lymphoma:

Dexamethasone orally or iv on Day 1-7 of each 28 day cycle. For patients with ALL, AML and Non-Hodgkin Lymphoma (NHL), Intrathecal chemotherapy will be administered additionally as per standard practice depending on CNS status.

Group Type EXPERIMENTAL

Ribociclib

Intervention Type DRUG

Everolimus

Intervention Type DRUG

Dexamethasone

Intervention Type DRUG

Arm N. Ceralasertib (AZD6738) + Olaparib

Olaparib tablets orally BID per 28 days Ceralasertib tablets QD or BID per 28 day cycle

Group Type EXPERIMENTAL

Olaparib

Intervention Type DRUG

Ceralasertib

Intervention Type DRUG

Arm O. Futibatinib (TAS-120)

Futibatinib tablets orally on a continuous dosing QD per 28 day cycle

Group Type EXPERIMENTAL

Futibatinib

Intervention Type DRUG

Arm P. Capmatinib (INC280) + Everolimus

Capmatinib tablets orally on a continuous dosing BID per 28 day cycle. Everolimus dispersible tablets orally QD on a continuous dosing per 28 day cycle.

Group Type EXPERIMENTAL

Everolimus

Intervention Type DRUG

Capmatinib

Intervention Type DRUG

Arm Q. Peposertib + Avelumab and Metronomic Temozolomide

Peposertib tablets orally on a continuous dosing BID per 28 day cycle Avelumab IV QD on Day 1 and Day 15 of a 28 day cycle Temozolomide capsules orally QD 5 days/week of a 28 day cycle

Group Type EXPERIMENTAL

Temozolomide

Intervention Type DRUG

Avelumab

Intervention Type DRUG

Peposertib

Intervention Type DRUG

Arm R. Capivasertib + metronomic Vinorelbine

Capivasertib tablets orally BID on Day 1-4/week (4 days on/3 days off, every week) of a 28 day cycle.

Vinorelbine soft capsules orally once daily on Day 1, 3 and 5/week of a 28 day cycle.

Group Type EXPERIMENTAL

Capivasertib

Intervention Type DRUG

Vinorelbine

Intervention Type DRUG

Interventions

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Ribociclib

Intervention Type DRUG

Topotecan

Intervention Type DRUG

Temozolomide

Intervention Type DRUG

Everolimus

Intervention Type DRUG

Adavosertib

Intervention Type DRUG

Carboplatin

Intervention Type DRUG

Olaparib

Intervention Type DRUG

Irinotecan

Intervention Type DRUG

Vistusertib

Intervention Type DRUG

Nivolumab

Intervention Type DRUG

Cyclophosphamide

Intervention Type DRUG

Selumetinib

Intervention Type DRUG

Enasidenib

Intervention Type DRUG

Lirilumab

Intervention Type DRUG

Fadraciclib

Intervention Type DRUG

Cytarabine

Intervention Type DRUG

Dexamethasone

Intervention Type DRUG

Ceralasertib

Intervention Type DRUG

Futibatinib

Intervention Type DRUG

Capmatinib

Intervention Type DRUG

Avelumab

Intervention Type DRUG

Peposertib

Intervention Type DRUG

Capivasertib

Intervention Type DRUG

Vinorelbine

Intervention Type DRUG

Other Intervention Names

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Kisqali LEE011 Hycamtin Temodar Afinitor votubia AZD1775 Paraplatin Lynparza Camptosar CPT-11 AZD2014 Opdivo Cytoxan Koselugo Idhifa BMS-986015 CYC065 Arabinosylcytosine Cytosar-U Decadron Dexasone Diodex Hexadrol Maxidex AZD6738 Tas-120 Tabrecta INC280 BAVENCIO TRUQAP AZD5363 Navelbine

Eligibility Criteria

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Inclusion Criteria

1. Patients must be diagnosed with a haematologic or solid tumor malignancy that has progressed despite standard therapy, or for which no effective standard therapy exists.
2. Age \< 18 years at inclusion; patients 18 years and older may be included after discussion with the sponsor if they have a pediatric recurrent/refractory malignancy.
3. Patient must have had advanced molecular profiling (i.e. WES/WGS +/- RNAseq) of their recurrent or refractory tumor i.e. at the time of disease progression/relapse; exceptionally patients with advanced molecular profiling at diagnosis may be allowed.
4. Evaluable or measurable disease as defined by standard imaging criteria for the patient's tumor type (RECIST v1.1, RANO criteria for patients with HGG, INRC criteria for patients with NB, Leukemia criteria, etc.).
5. Patients with relapsed or refractory leukemia are eligible for this study.
6. Performance status: Karnofsky performance status (for patients \>12 years of age) or Lansky Play score (for patients ≤12 years of age) ≥ 70%. Patients who are unable to walk because of paralysis or stable neurological disability, but who are up in a wheelchair, will be considered ambulatory for the purpose of assessing the performance score.
7. Life expectancy ≥ 3 months
8. Adequate organ function:

Hematologic criteria (Leukemia patients are excluded from hematological criteria):
* Peripheral absolute neutrophil count (ANC) ≥ 1000/μL(unsupported)
* Platelet count ≥ 100,000/μL (unsupported)
* Hemoglobin ≥ 8.0 g/dL (transfusion is allowed)

Cardiac function:
* Shortening fraction (SF) \>29% (\>35% for children \< 3 years) and left ventricular ejection fraction (LVEF) ≥50% at baseline, as determined by echocardiography (mandatory only for patients who have received cardiotoxic therapy).
* Absence of QTc prolongation (QTc \> 450 msec on baseline ECG, using the Fridericia correction \[QTcF formula\]) or other clinically significant ventricular or atrial arrhythmia.

Renal and hepatic function:
* Serum creatinine ≤ 1.5 x upper limit of normal (ULN) for age
* Total bilirubin ≤ 1.5 x ULN
* Alanine aminotransferase (ALT)/serum glutamic pyruvic transaminase (SGPT) ≤ 2,5 x ULN; aspartate aminotransferase (AST)/serum glutamic oxaloacetic transaminase/SGOT ≤ 2,5 x ULN except in patients with documented tumor involvement of the liver who must have AST/SGOT and ALT/SGPT ≤ 5 x ULN.
9. Able to comply with scheduled follow-up and with management of toxicity.
10. Females of childbearing potential must have a negative serum or urine pregnancy test within 72 hours prior to initiation of treatment. Sexually active women of childbearing potential must agree to use acceptable and appropriate contraception during the study and for at least 6 months after the last study treatment administration. Sexually active males patients must agree to use condom during the study and for at least 6 months (7 months for arm J) after the last study treatment administration. Acceptable contraception are defined in CTFG Guidelines "Recommendations related to contraception and pregnancy testing in clinical trials"
11. For all oral medications patients must be able to comfortably swallow capsules (except for those for which an oral solution is available); nasogastric or gastrostomy feeding tube administration is allowed only if indicated.
12. Written informed consent from parents/legal representative, patient, and age-appropriate assent before any study-specific screening procedures are conducted according to local, regional or national guidelines.
13. Patient affiliated to a social security regimen or beneficiary of the same according to local requirements.

Exclusion Criteria

1. Patients with symptomatic central nervous system (CNS) metastases who are neurologically unstable or require increasing doses of corticosteroids or local CNS-directed therapy to control their CNS disease. Patients on stable doses of corticosteroids for at least 7 days prior to receiving study drug may be included.
2. Impairment of gastrointestinal (GI) function or GI disease that may significantly alter drug absorption of oral drugs (e.g., ulcerative diseases, uncontrolled nausea, vomiting, diarrhea, or malabsorption syndrome).
3. Clinically significant, uncontrolled heart disease (including history of any cardiac arrhythmias, e.g., ventricular, supraventricular, nodal arrhythmias, or conduction abnormality, unstable ischemia,congestive heart failure within 12 months of screening)
4. Active viral hepatitis or known human immunodeficiency virus (HIV) infection or any other uncontrolled infection.
5. Presence of any ≥ CTCAE grade 2 treatment-related toxicity with the exception of alopecia, ototoxicity or peripheral neuropathy.
6. Systemic anticancer therapy within 21 days of the first study dose or 5 times its half-life, whichever is less.
7. Previous myeloablative therapy with autologous hematopoietic stem cell rescue within 8 weeks of the first study drug dose
8. Allogeneic stem cell transplant within 3 months prior to the first study drug dose. Patients receiving any agent to treat or prevent graft-versus host disease (GVHD) post bone marrow transplant are not eligible for this trial.
9. Radiotherapy (non-palliative) within 21 days prior to the first dose of drug (or within 6 weeks for therapeutic doses of MIBG or craniospinal irradiation).
10. Major surgery within 21 days of the first dose. Gastrostomy, ventriculo-peritoneal shunt, endoscopic ventriculostomy, tumor biopsy and insertion of central venous access devices are not considered major surgery, but for these procedures, a 48 hour interval must be maintained before the first dose of the investigational drug is administered.
11. Currently taking medications with a known risk of prolonging the QT interval or inducing Torsades de Pointes (Refer to Appendix 8).
12. Currently taking medications that are mainly metabolized by CYP3A4/5, CYP2C8, CYP2C9, CYP2C19, CYP2D6 or the drug transporters Pgp (MDR1), BCRP, OATP1B1, OATP1B3, OCT1 and OCT2 and have a low therapeutic index that cannot be discontinued at least 7 days or 5 x reported elimination half-life prior to start of treatment with any of the investigational drugs and for the duration of the study (Refer to Appendix 9).
13. Known hypersensitivity to any study drug or component of the formulation.
14. Pregnant or nursing (lactating) females.
15. Vaccinated with live, attenuated vaccines within 4 weeks of the first dose of study drug.
Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute, France

OTHER_GOV

Sponsor Role collaborator

Fight Kids Cancer

OTHER

Sponsor Role collaborator

Fondation ARC

OTHER

Sponsor Role collaborator

Gustave Roussy, Cancer Campus, Grand Paris

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Birgit Geoerger, MD

Role: STUDY_CHAIR

Gustave Roussy, Cancer Campus, Grand Paris

Locations

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Rigshospitalet

Copenhagen, , Denmark

Site Status RECRUITING

Gustave Roussy

Villejuif, Val De Marne, France

Site Status RECRUITING

CHU Angers

Angers, , France

Site Status RECRUITING

CHU Pellegrin

Bordeaux, , France

Site Status RECRUITING

Centre Oscar Lambret

Lille, , France

Site Status RECRUITING

Centre Léon Bérard

Lyon, , France

Site Status RECRUITING

Hôpital de La Timone

Marseille, , France

Site Status RECRUITING

CHU Nantes

Nantes, , France

Site Status RECRUITING

Institut Curie

Paris, , France

Site Status RECRUITING

Hôpital Armand Trousseau

Paris, , France

Site Status RECRUITING

Fondazione IRCCS Istituto Nazionale dei Tumori

Milan, , Italy

Site Status RECRUITING

Ospedale Infantile Regina Margherita

Torino, , Italy

Site Status NOT_YET_RECRUITING

Prinses Maxima Centrum

Utrecht, , Netherlands

Site Status ACTIVE_NOT_RECRUITING

Vall d'Hebron

Barcelona, , Spain

Site Status RECRUITING

Hospital del Nino Jesus

Madrid, , Spain

Site Status RECRUITING

Hospital Universitario La Fe

Valencia, , Spain

Site Status RECRUITING

Birmingham Children's Hospital

Birmingham, , United Kingdom

Site Status RECRUITING

Great Ormond Street Hospital

London, , United Kingdom

Site Status RECRUITING

Royal Manchester Children's Hospital

Manchester, , United Kingdom

Site Status RECRUITING

Royal Victoria Infirmary

Newcastle, , United Kingdom

Site Status RECRUITING

Pediatric and Adolescent Oncology The Royal Marsden Hospital

Sutton, , United Kingdom

Site Status RECRUITING

Countries

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Denmark France Italy Netherlands Spain United Kingdom

Central Contacts

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Birgit Geoerger, MD

Role: CONTACT

+33 (0)1 42 11 46 61

Estelle Jullemier, MS

Role: CONTACT

+33 (0)1 42 11 55 51

Facility Contacts

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Karsten Nyson, MD

Role: primary

+45 35 45 08 09

Michela Casanova, MD

Role: primary

+39 02 23 90 25 94

Lynley Marshall, MD

Role: primary

+44 208 661 3678

References

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Berlanga P, Pierron G, Lacroix L, Chicard M, Adam de Beaumais T, Marchais A, Harttrampf AC, Iddir Y, Larive A, Soriano Fernandez A, Hezam I, Chevassus C, Bernard V, Cotteret S, Scoazec JY, Gauthier A, Abbou S, Corradini N, Andre N, Aerts I, Thebaud E, Casanova M, Owens C, Hladun-Alvaro R, Michiels S, Delattre O, Vassal G, Schleiermacher G, Geoerger B. The European MAPPYACTS Trial: Precision Medicine Program in Pediatric and Adolescent Patients with Recurrent Malignancies. Cancer Discov. 2022 May 2;12(5):1266-1281. doi: 10.1158/2159-8290.CD-21-1136.

Reference Type DERIVED
PMID: 35292802 (View on PubMed)

Morscher RJ, Brard C, Berlanga P, Marshall LV, Andre N, Rubino J, Aerts I, De Carli E, Corradini N, Nebchi S, Paoletti X, Mortimer P, Lacroix L, Pierron G, Schleiermacher G, Vassal G, Geoerger B. First-in-child phase I/II study of the dual mTORC1/2 inhibitor vistusertib (AZD2014) as monotherapy and in combination with topotecan-temozolomide in children with advanced malignancies: arms E and F of the AcSe-ESMART trial. Eur J Cancer. 2021 Nov;157:268-277. doi: 10.1016/j.ejca.2021.08.010. Epub 2021 Sep 17.

Reference Type DERIVED
PMID: 34543871 (View on PubMed)

Bautista F, Paoletti X, Rubino J, Brard C, Rezai K, Nebchi S, Andre N, Aerts I, De Carli E, van Eijkelenburg N, Thebaud E, Corradini N, Defachelles AS, Ducassou S, Morscher RJ, Vassal G, Geoerger B. Phase I or II Study of Ribociclib in Combination With Topotecan-Temozolomide or Everolimus in Children With Advanced Malignancies: Arms A and B of the AcSe-ESMART Trial. J Clin Oncol. 2021 Nov 10;39(32):3546-3560. doi: 10.1200/JCO.21.01152. Epub 2021 Aug 4.

Reference Type DERIVED
PMID: 34347542 (View on PubMed)

Pasqualini C, Rubino J, Brard C, Cassard L, Andre N, Rondof W, Scoazec JY, Marchais A, Nebchi S, Boselli L, Grivel J, Aerts I, Thebaud E, Paoletti X, Minard-Colin V, Vassal G, Geoerger B. Phase II and biomarker study of programmed cell death protein 1 inhibitor nivolumab and metronomic cyclophosphamide in paediatric relapsed/refractory solid tumours: Arm G of AcSe-ESMART, a trial of the European Innovative Therapies for Children With Cancer Consortium. Eur J Cancer. 2021 Jun;150:53-62. doi: 10.1016/j.ejca.2021.03.032. Epub 2021 Apr 20.

Reference Type DERIVED
PMID: 33892407 (View on PubMed)

Rossoni C, Bardet A, Geoerger B, Paoletti X. Sequential or combined designs for Phase I/II clinical trials? A simulation study. Clin Trials. 2019 Dec;16(6):635-644. doi: 10.1177/1740774519872702. Epub 2019 Sep 20.

Reference Type DERIVED
PMID: 31538815 (View on PubMed)

Other Identifiers

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2016/2396

Identifier Type: OTHER

Identifier Source: secondary_id

2024-514791-40-00

Identifier Type: CTIS

Identifier Source: secondary_id

2016-000133-40

Identifier Type: -

Identifier Source: org_study_id

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