Description:
This is a 2-part, study to determine the safety, tolerability and pharmacokinetics of oral
dabrafenib in children and adolescent subjects with advanced BRAF V600 mutation-positive
solid tumors. Part 1 (dose escalation study) will identify the recommended Part 2
(tumor-specific expansion study) dose and regimen using a dose-escalation procedure.
Approximately 6 to 18 subjects will participate in Part 1 and will receive a starting dose of
3 mg/kg and dose will deescalate or escalate between 1.5 milligram (mg)/kilogram (kg) and 6
mg/kg. Up to 6 subjects will be enrolled at one dose level dependent upon the number of
subjects at the current dose level, the number of subjects who have experienced a dose
limiting toxicity (DLT) at the current dose level, and the number of subjects enrolled but
with data pending at the current dose level. Escalation may proceed until either a maximum
tolerated dose (MTD) is established, or until the dose in which the median pharmacokinetic
parameters consistent with exposure in adults are achieved. Cohorts may be added in order to
evaluate additional dose levels. Part 2 consists of four disease-specific cohorts of subjects
with tumors known to have BRAF V600 activation (pediatric low-grade gliomas, pediatric
high-grade gliomas, Langerhans cell histiocytosis [LCH], and other tumors such as melanoma
and papillary thyroid carcinoma [PTC]). Each cohort will enroll at least 10 subjects with a
pre-dose and at least 1 post-dose disease assessment. In both the parts of the study, on Day
1, a single first dose will be administered, and repeat dosing will begin on Day 2. PK
sampling will be performed on Day 1 and Day 15 for subjects >=25 kg in weight. For subjects
<25 kg and >=10 kg in weight, blood samples for PK analysis will be collected on Day 1 and
Day 15. For subjects <10kg in weight, blood samples for PK analysis will be collected after
repeated administration on Day 15 only. Safety and tolerability will be assessed throughout
the study. Treatment with dabrafenib will be continued until disease progression or until no
clinical benefit or development of an unacceptable toxicity, or until they withdraw consent
or begin a new therapy. At the end of treatment, a final study visit will occur.
Title
- Brief Title: A Study to Determine Safety, Tolerability and Pharmacokinetics of Oral Dabrafenib In Children and Adolescent Subjects
- Official Title: Phase I/IIa, 2-Part, Multi-Center, Single-Arm, Open-Label Study to Determine the Safety, Tolerability and Pharmacokinetics of Oral Dabrafenib in Children and Adolescent Subjects With Advanced BRAF V600-Mutation Positive Solid Tumors
Clinical Trial IDs
- ORG STUDY ID:
116013
- SECONDARY ID:
2012-001499-12
- SECONDARY ID:
CDRB436A2102
- NCT ID:
NCT01677741
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Dabrafenib | | Part 1: Dabrafenib treatment |
Purpose
This is a 2-part, study to determine the safety, tolerability and pharmacokinetics of oral
dabrafenib in children and adolescent subjects with advanced BRAF V600 mutation-positive
solid tumors. Part 1 (dose escalation study) will identify the recommended Part 2
(tumor-specific expansion study) dose and regimen using a dose-escalation procedure.
Approximately 6 to 18 subjects will participate in Part 1 and will receive a starting dose of
3 mg/kg and dose will deescalate or escalate between 1.5 milligram (mg)/kilogram (kg) and 6
mg/kg. Up to 6 subjects will be enrolled at one dose level dependent upon the number of
subjects at the current dose level, the number of subjects who have experienced a dose
limiting toxicity (DLT) at the current dose level, and the number of subjects enrolled but
with data pending at the current dose level. Escalation may proceed until either a maximum
tolerated dose (MTD) is established, or until the dose in which the median pharmacokinetic
parameters consistent with exposure in adults are achieved. Cohorts may be added in order to
evaluate additional dose levels. Part 2 consists of four disease-specific cohorts of subjects
with tumors known to have BRAF V600 activation (pediatric low-grade gliomas, pediatric
high-grade gliomas, Langerhans cell histiocytosis [LCH], and other tumors such as melanoma
and papillary thyroid carcinoma [PTC]). Each cohort will enroll at least 10 subjects with a
pre-dose and at least 1 post-dose disease assessment. In both the parts of the study, on Day
1, a single first dose will be administered, and repeat dosing will begin on Day 2. PK
sampling will be performed on Day 1 and Day 15 for subjects >=25 kg in weight. For subjects
<25 kg and >=10 kg in weight, blood samples for PK analysis will be collected on Day 1 and
Day 15. For subjects <10kg in weight, blood samples for PK analysis will be collected after
repeated administration on Day 15 only. Safety and tolerability will be assessed throughout
the study. Treatment with dabrafenib will be continued until disease progression or until no
clinical benefit or development of an unacceptable toxicity, or until they withdraw consent
or begin a new therapy. At the end of treatment, a final study visit will occur.
Trial Arms
Name | Type | Description | Interventions |
---|
Part 1: Dabrafenib treatment | Experimental | Three subjects will receive a single dose of 3 mg/kg dabrafenib on Day 1 and repeat dose will begin from Day 2, evenly divided in two daily doses. Once all 3 subjects have been fully evaluated for the first 28 days (including Day 15 PK) and no DLTs are observed, a next subject will be enrolled at the next higher dose levels (i.e., dose escalation to 3.75 mg/kg [+1] and may be further to 4.5 mg/kg [+2] and so on). If all 3 subjects have not been fully evaluated for the first 28 days or 1 DLT occurred, the fourth subject will be enrolled at the same dose level. If 2 or more DLTs are observed, the next subject will be enrolled at the next lower dose level (i.e., de-escalated to 2.25 mg/kg [-1] and may be further to 1.5 mg/kg [-2]). Similarly, the process is repeated for the fifth and sixth subjects in a cohort. All subjects will receive treatment till end of study. | |
Part 2: Cohort 1 Low-Grade Gliomas with BRAF V600 mutations | Experimental | Subjects with low-grade gliomas with BRAF V600 mutations will receive the single selected final dose (based on MTD and the age of the subjects) from Part 1 on Day 1. Repeat dosing will begin from Day 2, twice daily till end of study. | |
Part 2: Cohort 2 High-Grade Gliomas with BRAF V600 mutations | Experimental | Subjects with high-grade gliomas with BRAF V600 mutations will receive the single selected final dose (based on MTD and the age of the subjects) from Part 1 on Day 1. Repeat dosing will begin from Day 2, twice daily till end of study. | |
Part 2: Cohort 3 LCH with BRAF V600 mutations | Experimental | Subjects with LCH with BRAF V600 mutations will receive the single selected final dose (based on MTD and the age of the subjects) from Part 1 on Day 1. Repeat dosing will begin from Day 2, twice daily till end of study. | |
Part 2: Cohort 4 Melanoma and PTC with BRAF V600 mutations | Experimental | Subjects with other tumors with BRAF V600 mutations will receive the single selected final dose (based on MTD and the age of the subjects) from Part 1 on Day 1. Repeat dosing will begin from Day 2, twice daily till end of study. | |
Eligibility Criteria
Inclusion Criteria:
- Written informed consent - a signed informed consent and/or assent (as age
appropriate) will be obtained according to institutional guidelines.
- Male or female >=12 months and <18 years of age at the time of signing the informed
consent form.
- Recurrent disease, refractory disease, or progressive disease after having received at
least one standard therapy for their disease. Note: Subjects with metastatic (and
surgically unresectable) melanoma can be enrolled for first-line treatment; Melanoma
subjects with CNS involvement may be enrolled.
- At least one evaluable lesion.
- BRAF V600 mutation-positive tumor as confirmed in a Clinical Laboratory Improvement
Amendments (CLIA)-approved laboratory or equivalent (the local BRAF testing may be
subject to subsequent verification by centralized testing; centralized testing can
confirm V600E and V600K mutations only).
- Performance score of >=50% according to the Karnofsky/Lansky performance status scale
(subjects with a performance status of <=50% can be enrolled if the subject's
confinement to bed and inability to carry out activities is due solely to
cancer-related pain, as assessed by the investigator).
- Females of child-bearing potential (with negative serum pregnancy test within 7 days
prior to the first dose of study medication) must be willing to practice acceptable
methods of birth control .
- Sexually active males, who do not agree to abstinence, must be willing to use a condom
during intercourse while taking the study drug, and for 16 weeks after stopping
treatment and should not father a child in this period.
- Must have adequate organ function as defined by the following values: Adequate bone
marrow function defined as-absolute neutrophil count (ANC) >=1000/ microliter (µL),
hemoglobin >=8.0 grams (g)/ deciliter (dL) (may receive red blood cell transfusions),
platelets >=75,000/µL (transfusion independent, defined as not receiving platelet
transfusions within a 7 day period prior to enrollment).
- Adequate renal and metabolic function defined as: calculated glomerular filtration
rate (eGFR) (Schwartz formula), or radioisotope GFR >=90 milliliters/minutes
(mL/min)/1.73 meter square (m^2); or a serum creatinine within the institutional
reference range upper limit of normal (for age/gender, if available).
- Adequate liver function defined as: bilirubin (sum of conjugated + unconjugated) <=1.5
x upper limit of normal (ULN) for age, aspartate aminotransaminase (AST) and alanine
transaminase (ALT) <=2.5 x ULN; AST/ALT may be <5 x ULN at baseline if disease under
treatment involves the liver (requires radiographic confirmation of liver
involvement).
- Adequate cardiac function defined as: left ventricular ejection fraction (LVEF) of
either >=50% by ECHO or greater than institutional lower limit of normal (LLN) by
echocardiogram (ECHO) (while not receiving medications for cardiac function),
corrected QT using Bazett's (QTcB) interval <450 milliseconds (msecs).
Exclusion Criteria:
- Part 2 ONLY: Previous treatment with dabrafenib, another RAF inhibitor, or a
mitogen-activated protein kinase (MEK) inhibitor (exception: prior treatment with
sorafenib is permitted).
- Malignancy OTHER than the BRAF mutant malignancy under study.
- Had chemotherapy or radiotherapy within 3 weeks (or 6 weeks for nitrosoureas or
mitomycin C) prior to administration of the first dose of study treatment.
- The subject has received an investigational product within the following time period
prior to the first dosing day in the current study: 28 days or 5 half-lives or twice
the duration of the biological effect of the investigational product (whichever is
warranted by the data).
- History of another malignancy. Exception: (a) Subjects who have been successfully
treated and are disease-free for 3 years, (b) a history of completely resected
non-melanoma skin cancer, (c) successfully treated in situ carcinoma, (d) CLL in
stable remission are eligible.
- Current use of a prohibited medication or herbal preparation or requires any of these
medications during the study.
- Unresolved toxicity greater than National Cancer Institute Common Terminology Criteria
for Adverse Events (NCI CTCAE) v4.0 Grade 2 or higher from previous anti-cancer
therapy, including major surgery except those that in the opinion of the investigator
are not clinically relevant given the known safety/toxicity profile of dabrafenib
(e.g., alopecia and/or peripheral neuropathy related to platinum or vinca alkaloid
based chemotherapy).
- Has leukaemia.
- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to dabrafenib and its excipients.
- Autologous or allogeneic stem cell transplant within 3 months prior to enrolment
[NOTE: subjects with evidence of active graph versus host disease are excluded].
- History of myocardial infarction, severe or unstable angina, peripheral vascular
disease or familial QTc prolongation.
- Subjects with abnormal cardiac valve morphology (>=grade 2) documented by
echocardiogram (NOTE: subjects with grade 1 abnormalities [i.e., mild
regurgitation/stenosis] can be entered on study).
- Subjects with moderate valvular thickening.
- Known, uncontrolled cardiac arrhythmias (except sinus arrhythmia) within the past 24
weeks
- Uncontrolled medical conditions (e.g., diabetes mellitus, hypertension, liver disease
or uncontrolled infection), psychological, familial, sociological, or geographical
conditions that do not permit compliance with the protocol; or unwillingness or
inability to follow the procedures required in the protocol.
- Presence of active GI disease or other condition (e.g., small bowel or large bowel
resection) that will interfere significantly with the absorption of drugs.
- Hepatitis B Virus, or Hepatitis C Virus infection (subjects with laboratory evidence
of Hepatitis B Virus clearance may be enrolled).
- Pregnant females as determined by positive human chorionic gonadotropin (hCG) test at
screening or prior to dosing.
- Lactating females who are actively breast feeding.
Maximum Eligible Age: | 17 Years |
Minimum Eligible Age: | 12 Months |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Incidence of traetment emergent Adverse Events (AEs) |
Time Frame: | Up to 6 months |
Safety Issue: | |
Description: | The distribution of adverse events will be done via the analysis of frequencies for treatment emergent Adverse Events, Serious Adverse Events and Deaths due to AEs, through the monitoring of relevant clinical and laboratory safety parameters. |
Secondary Outcome Measures
Measure: | Pre-dose (trough) concentration (C tau) of dabrafenib and its metabolites |
Time Frame: | Day 1-Predose, Day 15-Predose |
Safety Issue: | |
Description: | Pharmacokinetic data will include C trough of dabrafenib and its metabolites (hydroxy-dabrafenib [GSK2285403], carboxy-dabrafenib [GSK2298683], and desmethyl-dabrafenib [GSK2167542]). |
Measure: | The AUC(0-t) and AUC(0-tau) of dabrafenib and its metabolites |
Time Frame: | Day 1-Predose, 0.5, 2 and 4 hours post dose; Day 15-Predose, 0, 0.5, 1, 2, 3, 4, 6 and 8 hours post dose. |
Safety Issue: | |
Description: | Pharmacokinetic data will include area under the time-concentration curve from time zero (pre-dose) to last time of quantifiable concentration (AUC[0-t]), AUC(0-tau) of dabrafenib and its metabolites (hydroxy-dabrafenib [GSK2285403], carboxy-dabrafenib [GSK2298683], and desmethyl-dabrafenib [GSK2167542]). |
Measure: | Apparent clearance following oral dosing (CL/F) of dabrafenib |
Time Frame: | Day 1-Predose, 0.5, 2 and 4 hours post dose; Day 15-Predose, 0, 0.5, 1, 2, 3, 4, 6 and 8 hours post dose. |
Safety Issue: | |
Description: | Pharmacokinetic data will include CL/F of dabrafenib. |
Measure: | Cmax of dabrafenib, and its metabolites |
Time Frame: | Day 1-Predose, 0.5, 2 and 4 hours post dose; Day 15-Predose, 0, 0.5, 1, 2, 3, 4, 6 and 8 hours post dose. |
Safety Issue: | |
Description: | Pharmacokinetic data will include Cmax of dabrafenib and its metabolites (hydroxy-dabrafenib [GSK2285403], carboxy-dabrafenib [GSK2298683], and desmethyl-dabrafenib [GSK2167542]). |
Measure: | Time from administration to Cmax (tmax) of dabrafenib and its metabolites |
Time Frame: | Day 1-Predose, 0.5, 2 and 4 hours post dose; Day 15-Predose, 0, 0.5, 1, 2, 3, 4, 6 and 8 hours post dose. |
Safety Issue: | |
Description: | Pharmacokinetic data will include tmax of dabrafenib and its metabolites (hydroxy-dabrafenib [GSK2285403], carboxy-dabrafenib [GSK2298683], and desmethyl-dabrafenib [GSK2167542]). |
Measure: | Elimination half life (t½) of dabrafenib and its metabolites |
Time Frame: | Day 1-Predose, 0.5, 2 and 4 hours post dose; Day 15-Predose, 0, 0.5, 1, 2, 3, 4, 6 and 8 hours post dose. |
Safety Issue: | |
Description: | Pharmacokinetic data will include t½ of dabrafenib and its metabolites (hydroxy-dabrafenib [GSK2285403], carboxy-dabrafenib [GSK2298683], and desmethyl-dabrafenib [GSK2167542]). |
Measure: | Incidence of treatment emergent Adverse Events (safety and tolerability) |
Time Frame: | Up to 6 months |
Safety Issue: | |
Description: | The distribution of adverse events will be done via the analysis of frequencies for treatment emergent Adverse Events, Serious Adverse Event and Deaths due to AEs, through the monitoring of relevant clinical and laboratory safety parameters. |
Measure: | Overall tumor response of dabrafenib |
Time Frame: | Up to 6 months |
Safety Issue: | |
Description: | Anti-tumor activity will be assessed based on clinical evidence and the response evaluation criteria in solid tumors (RECIST) version 1.1 criteria for solid tumors, response assessment in neuro-oncology (RANO) criteria (glioma subjects) and langerhans cell histiocytosis (LCH) scoring system. |
Measure: | Effect of age and weight on CL/F of dabrafenib |
Time Frame: | Day 1-Predose, 0.5, 2 and 4 hours post dose; Day 15-Predose, 0, 0.5, 1, 2, 3, 4, 6 and 8 hours post dose. |
Safety Issue: | |
Description: | The CL/F data with the effect of age and weight using a population pharmacokinetic approach will be evaluated. |
Measure: | Effect of age and weight on volume of distribution (V/F) of dabrafenib |
Time Frame: | Day 1-Predose, 0.5, 2 and 4 hours post dose; Day 15-Predose, 0, 0.5, 1, 2, 3, 4, 6 and 8 hours post dose. |
Safety Issue: | |
Description: | The V/F data with the effect of age and weight using a population pharmacokinetic approach will be evaluated. |
Measure: | Effect of age and weight on absorption rate (ka) of dabrafenib |
Time Frame: | Day 1-Predose, 0.5, 2 and 4 hours post dose; Day 15-Predose, 0, 0.5, 1, 2, 3, 4, 6 and 8 hours post dose. |
Safety Issue: | |
Description: | The ka data with the effect of age and weight using a population pharmacokinetic approach will be evaluated. |
Measure: | Effect of age and weight on coefficients for significant covariates of dabrafenib |
Time Frame: | Day 1-Predose, 0.5, 2 and 4 hours post dose; Day 15-Predose, 0, 0.5, 1, 2, 3, 4, 6 and 8 hours post dose. |
Safety Issue: | |
Description: | The coefficients for significant covariates data with the effect of age and weight using a population pharmacokinetic approach will be evaluated. |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Completed |
Lead Sponsor: | Novartis Pharmaceuticals |
Trial Keywords
- Children and Adolescents
- BRAF
- dabrafenib
- dose escalation
- BRF116013
- V600-mutation positive
- BRF
Last Updated
March 4, 2021