Description:
The study is being done to test the safety of a cancer drug called larotrectinib in children.
The cancer must have a change in a particular gene (NTRK1, NTRK2 or NTRK3). Larotrectinib
blocks the actions of these NTRK genes in cancer cells and can therefore be used to treat
cancer.
The first study part (Phase 1) is done to determine what dose level of larotrectinib is safe
for children, how the drug is absorbed and changed by their bodies and how well the cancer
responds to the drug. The main purpose of the second study part (Phase 2) is to investigate
how well and how long different cancer types respond to the treatment with larotrectininb.
Title
- Brief Title: A Study to Test the Safety and Efficacy of the Drug Larotrectinib for the Treatment of Tumors With NTRK-fusion in Children
- Official Title: A Phase 1/2 Study of the Oral TRK Inhibitor LOXO-101 in Pediatric Patients With Advanced Solid or Primary Central Nervous System Tumors
Clinical Trial IDs
- ORG STUDY ID:
20290
- SECONDARY ID:
LOXO-TRK-15003
- SECONDARY ID:
2016-003498-16
- NCT ID:
NCT02637687
Conditions
- Solid Tumors Harboring NTRK Fusion
Interventions
Drug | Synonyms | Arms |
---|
Larotrectinib (Vitrakvi, BAY2757556) | LOXO-101 | Phase 1 dose escalation: Dose level 1_Cohort 1 |
Purpose
The study is being done to test the safety of a cancer drug called larotrectinib in children.
The cancer must have a change in a particular gene (NTRK1, NTRK2 or NTRK3). Larotrectinib
blocks the actions of these NTRK genes in cancer cells and can therefore be used to treat
cancer.
The first study part (Phase 1) is done to determine what dose level of larotrectinib is safe
for children, how the drug is absorbed and changed by their bodies and how well the cancer
responds to the drug. The main purpose of the second study part (Phase 2) is to investigate
how well and how long different cancer types respond to the treatment with larotrectininb.
Detailed Description
The primary objectives are to determine the safety and efficacy of oral larotrectinib in
pediatric patients with advanced solid or primary central nervous system (CNS) tumors.
The secondary objectives comprise e.g. the determination of the pharmacokinetic properties,
the maximum tolerated dose/ recommended dose and the tumor-type specific efficacy of
larotrectinib. In addition, pain status and health-related quality of life of the pediatric
patients will be assessed.
Trial Arms
Name | Type | Description | Interventions |
---|
Phase 1 dose escalation: Dose level 1_Cohort 1 | Experimental | | - Larotrectinib (Vitrakvi, BAY2757556)
|
Phase 1 dose escalation: Dose level 2_Cohort 2 | Experimental | | - Larotrectinib (Vitrakvi, BAY2757556)
|
Phase 1 dose escalation: Dose level 3_Cohort 3 | Experimental | | - Larotrectinib (Vitrakvi, BAY2757556)
|
Phase 2 expansion: Patients with tumors bearing NTRK fusions (IFS)_Cohort 1 | Experimental | | - Larotrectinib (Vitrakvi, BAY2757556)
|
Phase 2 expansion: Other extra-cranial solid tumors_Cohort 2 | Experimental | | - Larotrectinib (Vitrakvi, BAY2757556)
|
Phase 2 expansion: Primary CNS tumors_Cohort 3 | Experimental | | - Larotrectinib (Vitrakvi, BAY2757556)
|
Eligibility Criteria
Inclusion Criteria:
- Phase 1 (Closed):
- Dose escalation: Birth through 21 years of age at C1D1 with a locally advanced or
metastatic solid tumor or primary CNS tumor that has relapsed, progressed or was
nonresponsive to available therapies and for which no standard or available
systemic curative therapy exists; OR Infants from birth and older with a
diagnosis of malignancy and with a documented NTRK fusion that has progressed or
was nonresponsive to available therapies, and for which no standard or available
curative therapy exists; OR Patients with locally advanced infantile fibrosarcoma
who would require, in the opinion of the investigator, disfiguring surgery or
limb amputation to achieve a complete surgical resection. Phase I dose escalation
cohorts are closed to enrollment.
- Dose expansion: In addition to the above stated inclusion criteria, patients must
have a malignancy with a documented NTRK gene fusion with the exception of
patients with infantile fibrosarcoma, congenital mesoblastic nephroma or
secretory breast cancer. Patients with infantile fibrosarcoma, congenital
mesoblastic nephroma or secretory breast cancer may enroll into this cohort with
documentation of an ETV6 rearrangement by FISH or RT-PCR or a documented NTRK
fusion by next generation sequencing.
- Phase 2:
- Infants from birth and older at C1D1 with a locally advanced or metastatic
infantile fibrosarcoma, patients with locally advanced infantile fibrosarcoma who
would require, in the opinion of the investigator, disfiguring surgery or limb
amputation to achieve a complete surgical resection; OR Birth through 21 years of
age at C1D1 with a locally advanced or metastatic solid tumor or primary CNS
tumor that has relapsed, progressed or was nonresponsive to available therapies
and for which no standard or available systemic curative therapy exists with a
documented NTRK gene fusion (or in the case of infantile fibrosarcoma, congenital
mesoblastic nephroma or secretory breast cancer with documented ETV6
rearrangement (or NTRK3 rearrangement after discussion with the sponsor) by FISH
or RT-PCR or a documented NTRK fusion by next generation sequencing) (identified
through molecular assays as routinely performed at CLIA or other similarly
certified laboratories). Patients with NTRK-fusion positive benign tumors are
also eligible; OR Potential patients older than 21 years of age with a tumor
diagnosis with histology typical of a pediatric patient and an NTRK fusion may be
considered for enrollment following discussion between the local site
Investigator and the Sponsor.
- Patients with primary CNS tumors or cerebral metastasis
- Karnofsky (those 16 years and older) or Lansky (those younger than 16 years)
performance score of at least 50.
- Adequate hematologic function
- Adequate hepatic and renal function
Exclusion Criteria:
- Major surgery within 14 days (2 weeks) prior to C1D1
- Clinically significant active cardiovascular disease or history of myocardial
infarction within 6 months prior to C1D1, ongoing cardiomyopathy; current prolonged
QTc interval > 480 milliseconds
- Active uncontrolled systemic bacterial, viral, or fungal infection
- Current treatment with a strong CYP3A4 inhibitor or inducer. Enzyme-inducing
anti-epileptic drugs (EIAEDs) and dexamethasone for CNS tumors or metastases, on a
stable dose, are allowed.
- Phase 2 only:
- Prior progression while receiving approved or investigational tyrosine kinase
inhibitors targeting TRK, including entrectinib, crizotinib and lestaurtinib.
Patients who received a TRK inhibitor for less than 28 days of treatment and
discontinued because of intolerance remain eligible.
Maximum Eligible Age: | 21 Years |
Minimum Eligible Age: | N/A |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Phase 1: Number of participants in an assigned dose cohort with treatment emergent adverse events (TEAEs) by grade assessed by NCI-CTCAE v 4.03 who experience a DLT |
Time Frame: | From Day 1 to Day 28 of Cycle 1 (1 Cycle=28 days) |
Safety Issue: | |
Description: | DLT: Dose-limiting toxicity. NCI-CTCAE: National Cancer Institute-Common Terminology Criteria for Adverse Events. |
Secondary Outcome Measures
Measure: | Phase 1: Maximum concentration of larotrectinib in plasma (Cmax) |
Time Frame: | Cohort 1 and 2: Cycle 1 Day 1 (C1D1) at 1 and 4 hours post-dose and C2D1 at pre-dose, and at 1 and 4 hours post-dose; Cohort 3 and Dose Expansion Cohort: C1D1 at 1 and 4 hours post-dose and C4D1 at pre-dose, 1 and 4 hours post-dose |
Safety Issue: | |
Description: | |
Measure: | Phase 1: Area under the concentration versus time curve from time 0 to t (AUC0-t) of larotrectinib in plasma |
Time Frame: | Cohort 1 and 2: C1D1 at 1 and 4 hours post-dose and C2D1 at pre-dose, and at 1 and 4 hours post-dose; Cohort 3 and Dose Expansion Cohort: C1D1 at 1 and 4 hours post-dose and C4D1 at pre-dose, 1 and 4 hours post-dose |
Safety Issue: | |
Description: | |
Measure: | Phase 1: Oral clearance (CL/F) |
Time Frame: | Cohort 1 and 2: C1D1 at 1 and 4 hours post-dose and C2D1 at pre-dose, and at 1 and 4 hours post-dose; Cohort 3 and Dose Expansion Cohort: C1D1 at 1 and 4 hours post-dose and C4D1 at pre-dose, 1 and 4 hours post-dos |
Safety Issue: | |
Description: | |
Measure: | Phase 1: Cerebral spinal fluid/plasma ratio of larotrectinib |
Time Frame: | C1D1 in conjunction with the post-dose 1-hour PK sample |
Safety Issue: | |
Description: | |
Measure: | Phase 1: Maximum tolerated dose (MTD) |
Time Frame: | From C1D1 to C1D28 of treatment of each participant in each of the assigned dose cohort, up to 16 months |
Safety Issue: | |
Description: | |
Measure: | Phase 1: Recommended dose for Phase 2 |
Time Frame: | From the date a participants from assigned Cohort was administered the first dose to the date of the last dose for the last patient from the dose escalation phase, up to 16 months |
Safety Issue: | |
Description: | |
Measure: | Phase 1: Overall Response Rate (ORR) |
Time Frame: | From first dose of Larotrectinib to disease progression or subsequent therapy or surgical intervention or death (due to any cause), up to 93 months |
Safety Issue: | |
Description: | Proportion of participants with best overall response (BOR) of CR and PR; PFS, CBR and maximum change in tumor burden as assessed based on RECIST 1.1, INRC or RANO as appropriate for tumor type by IRRC. |
Measure: | Phase 1: Mean change from baseline in Pain scores as assessed by the Wong-Baker Faces scale |
Time Frame: | Baseline and D1 of every cycle (1 Cycle=28 days), up to 93 months |
Safety Issue: | |
Description: | Wong-Baker Faces Scale giving a pain scale between 0 (no hurt) to 10 (hurts worst). |
Measure: | Phase 1: Mean change in Health-related quality of life scores by PedsQL-Core |
Time Frame: | Baseline and D1 of every cycle (1 Cycle=28 days), Up to 93 months |
Safety Issue: | |
Description: | The health-related quality of life (HRQoL) is assessed with the Pediatrics Quality of Life - Core Module (PedsQL-Core) questionnaire that consists of various age-related items regarding physical, emotional, social and school functioning and gives an overall score between 0 (highest HRQoL) and 144 (lowest HRQoL). |
Measure: | Phase 2: Best overall response (BOR) |
Time Frame: | From first dose of Larotrectinib to disease progression or subsequent therapy or surgical intervention or death (due to any cause), up to 76 months |
Safety Issue: | |
Description: | Participants with best overall response (BOR) of either CR or PR determined by Investigator's or IRC's response assessment based on RANO, INRC and RECIST 1.1 as appropriate for tumor type |
Measure: | Phase 2: Duration of response (DOR) |
Time Frame: | From start of first objective response of confirmed CR or PR to progression or death (due to any cause), up to 76 months |
Safety Issue: | |
Description: | DOR determined by 1) an independent radiology review committee and 2) the treating Investigator. |
Measure: | Phase 2: Proportion of patients with any tumor regression (i.e., any decrease from baseline of the longest diameters of target lesions) as a best response |
Time Frame: | From first dose of Larotrectinib, up to 76 months |
Safety Issue: | |
Description: | |
Measure: | Phase 2: Progression-free survival (PFS) |
Time Frame: | From first dose of Larotrectinib to disease progression or subsequent therapy or surgical intervention or death (due to any cause), up to 112 months |
Safety Issue: | |
Description: | |
Measure: | Phase 2: Overall survival (OS) |
Time Frame: | From first dose of Larotrectinib to death (due to any cause), up to 112 months |
Safety Issue: | |
Description: | |
Measure: | Phase 2: Number of participants with Treatment emergent adverse events (TEAEs) |
Time Frame: | From first dose of larotrectinib to discontinuation of treatment or death (due to any cayse), up to 112 months |
Safety Issue: | |
Description: | |
Measure: | Phase 2: Severity of adverse events as assessed by NCI-CTCAE grading V 4.03 |
Time Frame: | From first dose of larotrectinib to discontinuation of treatment or death (due to any cause), up to 112 months |
Safety Issue: | |
Description: | |
Measure: | Phase 2: Clinical Benefit Rate (CBR) |
Time Frame: | From first dose of Larotrectinib to disease progression or subsequent therapy or surgical intervention or death (due to any cause), up to 76 months |
Safety Issue: | |
Description: | CBR (i.e., best overall response of CR, PR or SD lasting 16 weeks or more as determined by 1) an independent radiology review committee (IRC) and 2) by the treating Investigator. |
Measure: | Phase 2: Concordance coefficient |
Time Frame: | From baseline/screening and if feasible end of treatment (EOT) and or PD and or at re-start of study treatment following a "drug holiday" and disease recurrence, up to 112 months |
Safety Issue: | |
Description: | Concordance coefficient of intra-patient molecular profile |
Measure: | Phase 2: Post-operative tumor staging |
Time Frame: | From first dose of Larotrectinib to surgical intervention, up to 112 months |
Safety Issue: | |
Description: | Post-operative stage in patients treated with larotrectinib according to the TNM Classification of malignant tumors of the Union for International Cancer Control (UICC). |
Measure: | Phase 2: Post-operative surgical margin assessment |
Time Frame: | From first dose of Larotrectinib to surgical intervention, up to 112 months |
Safety Issue: | |
Description: | Surgical margin status in patients treated with larotrectinib using the International Cancer Control (UICC)-R classification and the Intergroup Rhabdomyosarcoma Staging (IRS) systems. |
Measure: | Phase 2: Pre-treatment surgical plan to preserve function and cosmetic outcome |
Time Frame: | From first dose of Larotrectinib to surgical intervention, up to 112 months |
Safety Issue: | |
Description: | Descriptive analysis of pretreatment surgical plan. |
Measure: | Phase 2: Post-treatment plans to conserve function and cosmetic outcome |
Time Frame: | From surgical intervention to subsequent therapy, up to 112 months |
Safety Issue: | |
Description: | Descriptive analysis of post-treatment plans |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Bayer |
Trial Keywords
- Advanced solid tumors
- Central nervous system (CNS) tumor
- Extra-cranial tumor
- Infantile fibrosarcoma (IFS)
- Neurotrophic tyrosine receptor kinase (NTRK)
- NTRK1
- NTRK2
- NTRK3
- Fusion Positive
- TRK fusion
- TRKA
- TRKB
- TRKC
- ETV6
Last Updated
August 13, 2021