Combination of Alpelisib and Trametinib in Progressive Refractory Meningiomas

NCT ID: NCT03631953

Last Updated: 2024-08-06

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: PHASE1
• Total Enrollment: 25 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2019-09-30
• Study Completion Date: 2026-01-29

Brief Summary

Aggressive growing meningiomas resistant to multiple surgeries and radiotherapy constitute an unmet pharmaceutical need in neurooncology, leading to a fatal issue within a few months. Grade II-III meningiomas progression-free survival (PFS) 6 is at 10-15%. Median PFS grade III meningioma is approximate 3 years.

Alpelisib is a well-tolerated Phosphoinositide 3-kinase α (Pi3Kα) specific inhibitor. However, phosphatidylinositol-3-kinase (PI3K) and the mammalian target of rapamycin (mTOR) inhibition does not induce apoptosis in vitro and induces an antiproliferative effect without any radiologic response in most treated patients.

Trametinib, a mekinist (MEK) inhibitor is currently used in combined treatment for recurrent melanomas in clinical practice with a good clinical tolerance at 1-2 mg daily. In vitro, on meningioma primary cell culture, Trametinib induces cell apoptosis via caspase activity.

These results strongly suggest the relevance to combine Alpelisib and Trametinib in aggressive and recurrent meningiomas.

Alpelisib and Trametinib combination has not been studied to date, despite each drugs have been separately studied in phase 3.

Multicenter, open label, dose-finding phase I study of Alpelisib in combination with Trametinib administered at a fixed dose (1.5 mg daily), both drugs will be administered daily. Starting dose of Alpelisib will be 160mg/day and will be increased to 200mg/day or decreased to 120mg/day depending of grade 3-4 adverse events occurrence, to determine maximal tolerated dose (MTD) and recommended dose.

Primary Objective is to determine the safety profile and tolerability of Alpelisib and Trametinib given in combination in patients with aggressive and refractory meningiomas in terms of Dose-Limiting Toxicities (DLT, assessed during cycle 1).

Conditions

Meningioma

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Alpelisib in combination with Trametinib administered

A panel of 3 doses of Alpelisib could be tested in combination with fixed dose of Trametinib (1.5 mg every day).

Group Type: EXPERIMENTAL

Trametinib

Intervention Type: DRUG

Trametinib administered at a fixed dose (1.5 mg daily)

Alpelisib

Intervention Type: DRUG

A panel of 3 doses of ALPELISIB could be tested

Blood sample

Intervention Type: BIOLOGICAL

Therapeutic biomarkers

MRI

Intervention Type: DEVICE

A MRI with contrast will be performed before treatment start. Assessment of tumor growth.

Interventions

Trametinib

Trametinib administered at a fixed dose (1.5 mg daily)

Intervention Type: DRUG

Alpelisib

A panel of 3 doses of ALPELISIB could be tested

Intervention Type: DRUG

Blood sample

Therapeutic biomarkers

Intervention Type: BIOLOGICAL

MRI

A MRI with contrast will be performed before treatment start. Assessment of tumor growth.

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

• Histologically proven meningioma grade I, II and III
• Progression is defined as growing meningiomas on 2 different Magnetic Resonance Imaging (MRI) 3 to 6 months apart
• Patients must have failed surgery, and not amenable to a new curative intended surgery
• Patients must have failed radiotherapy and/or radiosurgery
• Patients who have given their written consent
• No contra indication to Alpelisib and Trametinib
• No receiving other investigational agents
• Written informed consent
• Adequate bone marrow function
• Adequate liver function as shown by
• Adequate renal function

Exclusion Criteria

• Contra indication to Alpelisib and Trametinib
• Women of child-bearing age who are using no effective means of contraception
• Pregnant or breast-feeding women
• Patients receiving other investigational agents
• Known intolerance or hypersensitivity to Alpelisib and Trametinib
• Uncontrolled diabetes mellitus
• Patients who have any severe and uncontrolled medical condition
• Patients receiving chronic treatment with immunosuppressives
• Patients with a known history of HIV seropositivity
• Patients who have a history of another primary malignancy less than or equal to 3 years, with
• the exceptions of non-melanoma skin cancer, and carcinoma in situ of uterine cervix

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Assistance Publique Hopitaux De Marseille

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Jean-Oliver ARNAUD, Director

Role: STUDY_DIRECTOR

Assistance Publique Hôpitaux de Marseille

Locations

Assistance Publique Hôpitaux de Marseille

Marseille, , France

Site Status: RECRUITING

Countries

France

Central Contacts

Thomas GRAILLON, PH

Role: CONTACT

thomas.graillon@ap-hm.fr

491385545 ext. +33

Olivier CHINOT, PU-PH

Role: CONTACT

olivier.chinot@ap-hm.fr

491385545 ext. +33

Facility Contacts

Thomas GRAILLON, PH

Role: primary

thomas.graillon@ap-hm.fr

491385545 ext. +33

Olivier CHINOT, PU-PH

Role: backup

olivier.chinot@ap-hm.fr

491385545 ext. +33

Other Identifiers

RCAPHM18_0015

Identifier Type: OTHER

Identifier Source: secondary_id

2018-05

Identifier Type: -

Identifier Source: org_study_id