Description:
This is a first-in-children phase 1 trial using indoximod, an inhibitor of the immune
"checkpoint" pathway indoleamine 2,3-dioxygenase (IDO), in combination with
temozolomide-based therapy to treat pediatric brain tumors. Using a preclinical glioblastoma
model, it was recently shown that adding IDO-blocking drugs to temozolomide plus radiation
significantly enhanced survival by driving a vigorous, tumordirected inflammatory response.
This data provided the rationale for the companion adult phase 1 trial using indoximod
(IND#120813) plus temozolomide to treat adults with glioblastoma, which is currently open
(NCT02052648). The goal of this pediatric study is to bring IDO-based immunotherapy into the
clinic for children with brain tumors. This study will provide a foundation for future
pediatric trials testing indoximod combined with radiation and temozolomide in the up-front
setting for patients with newly diagnosed central nervous system tumors.
Title
- Brief Title: Study of the IDO Pathway Inhibitor, Indoximod, and Temozolomide for Pediatric Patients With Progressive Primary Malignant Brain Tumors
- Official Title: A Phase I Trial of Indoximod and Temozolomide-Based Therapy for Children With Progressive Primary Brain Tumors
Clinical Trial IDs
- ORG STUDY ID:
NLG2105
- NCT ID:
NCT02502708
Conditions
- Glioblastoma Multiforme
- Glioma
- Gliosarcoma
- Malignant Brain Tumor
- Ependymoma
- Medulloblastoma
- Diffuse Intrinsic Pontine Glioma
- Primary CNS Tumor
Interventions
Drug | Synonyms | Arms |
---|
Indoximod | 1-methyl-D-tryptophan, D-1MT | Group 1 (CLOSED) |
Temozolomide | Temodar, Methazolastone | Group 1 (CLOSED) |
Cyclophosphamide | | Group 4 |
Etoposide | | Group 4 |
Purpose
This is a first-in-children phase 1 trial using indoximod, an inhibitor of the immune
"checkpoint" pathway indoleamine 2,3-dioxygenase (IDO), in combination with
temozolomide-based therapy to treat pediatric brain tumors. Using a preclinical glioblastoma
model, it was recently shown that adding IDO-blocking drugs to temozolomide plus radiation
significantly enhanced survival by driving a vigorous, tumordirected inflammatory response.
This data provided the rationale for the companion adult phase 1 trial using indoximod
(IND#120813) plus temozolomide to treat adults with glioblastoma, which is currently open
(NCT02052648). The goal of this pediatric study is to bring IDO-based immunotherapy into the
clinic for children with brain tumors. This study will provide a foundation for future
pediatric trials testing indoximod combined with radiation and temozolomide in the up-front
setting for patients with newly diagnosed central nervous system tumors.
Trial Arms
Name | Type | Description | Interventions |
---|
Group 1 (CLOSED) | Experimental | Core Regimen: Dose-escalation of indoximod, in combination with temozolomide, for pediatric patients with progressive brain tumors.
Indoximod will be administered in escalating doses. Initial dosing will be 12.8 mg/kg/dose BID with escalation planned to 22.4 mg/kg/dose BID.
Temozolomide to be given at 200 mg/m^2 x 5 days | |
Group 2 (CLOSED) | Experimental | Expansion cohorts: Indoximod therapy at the pediatric recommended phase 2 dose (RP2D) determined by Group 1, in combination with temozolomide.
Indoximod will be administered at the RP2D of 19.2 mg/kg/dose BID.
Temozolomide to be given at 200 mg/m^2 x 5 days | |
Group 3 (CLOSED) | Experimental | Dose-escalation of indoximod, in combination with up-front conformal radiation therapy, for pediatric patients with progressive brain tumors.
Indoximod will be administered in escalating doses. Initial dosing will be 12.8 mg/kg/dose BID with escalation planned to 22.4 mg/kg/dose BID.
Temozolomide to be given at 200 mg/m^2 x 5 days | |
Group 3b | Experimental | Indoximod, in combination with up-front conformal radiation therapy, for pediatric patients with newly diagnosed treatment-naive diffuse intrinsic pontine glioma (DIPG).
Indoximod will be administered at the RP2D of 19.2 mg/kg/dose BID.
Temozolomide to be given at 200 mg/m^2 x 5 days | |
Group 4 | Experimental | Continued access to indoximod in combination with low-dose oral cyclophosphamide and etoposide for patients with progressive disease after treatment with indoximod plus temozolomide.
Indoximod will be administered at 32 mg/kg/dose divided twice daily.
Cyclophosphamide to be given at 2.5 mg/kg/dose daily
Etoposide to be given at 50 mg/m2/dose daily | - Indoximod
- Cyclophosphamide
- Etoposide
|
Eligibility Criteria
Eligibility Criteria
- Age: 3-21 years.
- Group 1 or Group 3: histologically proven initial diagnosis of primary malignant brain
tumor, with no known curative treatment options.
- Group 2: histologically proven initial diagnosis of high-grade glioma (WHO grade III
and IV), ependymoma, medulloblastoma, or other primary central nervous system tumor.
- Group 3b: Patients with a radiographic diagnosis or histologically proven diagnosis of
diffuse intrinsic pontine glioma (DIPG).
- MRI confirmation of tumor progression or regrowth.
- Patients must be able to swallow whole capsules.
- Patients with metastatic disease are eligible for enrollment.
- Lansky or Karnofsky performance status score must be > 50%.
- Seizure disorders must be well controlled on antiepileptic medication.
- DIPG patients enrolled to Group 3b must not have been previously treated with
radiation or any medical therapy.
- Patients previously treated with temozolomide, cyclophosphamide, and/or etoposide are
eligible for enrollment.
Exclusion Criteria
- Prior invasive malignancy, other than the primary central nervous system tumor, unless
the patient has been disease free and off therapy for that disease for a minimum of 3
years
- Patients with baseline QTc interval of more than 470 msec at study entry, and patients
with congenital long QTc syndrome.
- Active autoimmune disease
Maximum Eligible Age: | 21 Years |
Minimum Eligible Age: | 3 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Incidence of regimen limiting toxicities (RLTs) |
Time Frame: | First 28 days of treatment |
Safety Issue: | |
Description: | To estimate the RP2D of indoximod combined with temozolomide |
Secondary Outcome Measures
Measure: | Pharmacokinetics: Serum concentrations (Cmax/Steady State) |
Time Frame: | First 48 hours of treatment |
Safety Issue: | |
Description: | Group 1 |
Measure: | Safety and Tolerability of Indoximod combined with Temozolomide as assessed by incidence and severity of adverse events, dose interruptions and dose reductions. |
Time Frame: | Continuous during study until 30 days after study treatment is complete. |
Safety Issue: | |
Description: | Group 1 and 2 |
Measure: | Progression Free Survival (PFS) |
Time Frame: | Up to three years |
Safety Issue: | |
Description: | Group 2 |
Measure: | Time to Progression |
Time Frame: | Start of study until disease progression follow-up, up to three years |
Safety Issue: | |
Description: | Group 2 |
Measure: | Overall Survival |
Time Frame: | Start of study until end of follow-up, up to five years |
Safety Issue: | |
Description: | Group 2 |
Measure: | Safety and Feasibility of Indoximod combined with conformal radiation as assessed by incidence and severity of adverse events, dose interruptions and dose reductions. |
Time Frame: | Continuous during study until 30 days after study treatment is complete. |
Safety Issue: | |
Description: | Group 3 |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Completed |
Lead Sponsor: | NewLink Genetics Corporation |
Trial Keywords
- glioblastoma multiforme
- glioma
- gliosarcoma
- malignant brain tumor
- ependymoma
- medulloblastoma
Last Updated
June 4, 2020