Description:
Lorlatinib is a novel inhibitor across ALK variants, including those resistant to crizotinib.
In this first pediatric phase 1 trial of lorlatinib, the drug will be utilized as a single
agent and in combination with chemotherapy in patients with relapsed/refractory
neuroblastoma. The dose escalation phase of this study (Cohort A1) uses a traditional Phase I
3+3 design. Once a recommended phase 2 pediatric dose is identified, an expansion cohort of 6
patients (Cohort B1), within which ALKi naïve patients will be prioritized, will be
initiated. Parallel cohorts will be initiated in adults or patients with large BSA (Cohort
A2) and in combination with chemotherapy upon establishing RP2D (Cohort B2).
Title
- Brief Title: NANT 2015-02: A Phase 1 Study of Lorlatinib (PF-06463922)
- Official Title: Phase 1 Study of Lorlatinib (PF-06463922), an Oral Small Molecule Inhibitor of ALK/ROS1, for Patients With ALK-Driven Relapsed or Refractory Neuroblastoma
Clinical Trial IDs
- ORG STUDY ID:
NANT2015-02
- NCT ID:
NCT03107988
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Lorlatinib | PF06463922 | Cohort A1 (Dose-finding) |
Cyclophosphamide | Cytoxan | Cohort B2 (Combined w/ chemotherapy) |
Topotecan | SKF-104864,Hycamtin® | Cohort B2 (Combined w/ chemotherapy) |
Purpose
Lorlatinib is a novel inhibitor across ALK variants, including those resistant to crizotinib.
In this first pediatric phase 1 trial of lorlatinib, the drug will be utilized as a single
agent and in combination with chemotherapy in patients with relapsed/refractory
neuroblastoma. The dose escalation phase of this study (Cohort A1) uses a traditional Phase I
3+3 design. Once a recommended phase 2 pediatric dose is identified, an expansion cohort of 6
patients (Cohort B1), within which ALKi naïve patients will be prioritized, will be
initiated. Parallel cohorts will be initiated in adults or patients with large BSA (Cohort
A2) and in combination with chemotherapy upon establishing RP2D (Cohort B2).
Detailed Description
Lorlatinib is a novel inhibitor across ALK variants, including those resistant to crizotinib.
An adult phase 1 study established an RP2D of 100mg QD for lorlatinib. In this first
pediatric phase 1 trial of lorlatinib, the drug will be utilized as a single agent and in
combination with chemotherapy in patients with relapsed/refractory neuroblastoma. The dose
escalation phase of this study (Cohort A1) uses a traditional Phase I 3+3 design. Once a
recommended phase 2 pediatric dose is identified, an expansion cohort of 6 patients (Cohort
B1), within which ALKi naïve patients will be prioritized, will be initiated. Parallel
cohorts will be initiated in adults or patients with large BSA (Cohort A2) and in combination
with chemotherapy upon establishing RP2D (Cohort B2).
Lorlatinib will be administered orally via tablets or via oral dispersion if patient is
unable to swallow tablets whole
All patients will participate in mandatory pharmacokinetic testing.
Trial Arms
Name | Type | Description | Interventions |
---|
Cohort A1 (Dose-finding) | Experimental | Lorlatinib will be given orally once daily continuously for 28 days. The dose level of lorlatinib will be assigned at the time of study registration. The starting dose for cohort A1 is 45 mg/m2/dose | |
Cohort A2 (Adult and large BSA) | Experimental | Lorlatinib will be given at the adult recommended phase 2 dose (RP2D) of 100 mg orally once daily continuously for 28 days. | |
Cohort B1 (Expansion) | Experimental | Lorlatinib will be given orally once daily continuously for 28 days at the RP2D defined by cohort A1. This cohort will not begin enrollment until the recommended phase 2 dose is established from the dose escalation cohort A1. | |
Cohort B2 (Combined w/ chemotherapy) | Experimental | Lorlatinib will be given orally once daily continuously for 28 days, at the RP2D defined by cohort A1. Lorlatinib should be administered at least one hour prior to conventional chemotherapy (Cyclophosphamide and Topotecan) on days 1-5 of each cycle. | - Lorlatinib
- Cyclophosphamide
- Topotecan
|
Eligibility Criteria
Inclusion Criteria:
- Patients must have a diagnosis of neuroblastoma either by histologic verification of
neuroblastoma and/or demonstration of tumor cells in the bone marrow with increased
urinary catecholamines
- Patients are required to have an activating ALK aberration in their tumor detected by
certified assay (i.e. CLIA in the US.) prior to registration. The report from this
test is required to be submitted for eligibility. Patients with at least one of the
following genetic features in their tumor will be considered to have an activating ALK
aberration:
1. An ALK activating mutation;
2. ALK amplification (> 10 signals of the ALK gene);
3. Presence of any ALK fusion protein that arises from a chromosomal translocation.
- Patients must have high risk neuroblastoma according to COG risk classification at the
time of study registration. Patients who were initially considered low or intermediate
risk, but then reclassified as high risk are also eligible.
- Patients must have at least ONE of the following: 1) Recurrent/progressive disease at
any time prior to study enrollment, 2) Refractory disease, 3) Persistent disease
- Patients must have at least ONE of the following: 1) Bone disease, 2) Any amount of
neuroblastoma tumor cells in the bone marrow, 3) At least one soft tissue lesion that
meets criteria for a TARGET lesion, 4) At least one non-target soft tissue lesion that
is not measurable, but had a biopsy positive for neuroblastoma and/or
ganglioneuroblastoma at any time prior to enrollment or is MIBG avid
- Patients must have a Lansky (≤16 years) or Karnofsky (> 16 years) score of at least 50
- Patients must have fully recovered from the acute toxic effects of all prior
chemotherapy, immunotherapy, or radiotherapy prior to entering this study.
- Patients must not have been previously treated with lorlatinib.
- Patients must not have received any of the specified therapies as stated in the
protocol in the time period prior to registration
- Patients must not be receiving any other anti-cancer agents or radiotherapy at the
time of study entry or while on study.
- Patients must not be receiving other investigational medications (covered under
another IND) within 30 days of study entry or while on study.
- Patients must not be receiving chronic systemic corticosteroids at doses greater than
physiologic dosing (inhaled corticosteroids acceptable).
- Patient must meet the organ function and system function requirements as stated in the
protocol
Exclusion Criteria:
- Pregnancy, breast feeding, or unwillingness to use effective contraception during the
study.
- Patients who, in the opinion of the investigator, may not be able to comply with the
safety monitoring requirements of the study.
- Patients with disease of any major organ system that would compromise their ability to
withstand therapy.
- Patients who have received prior allogeneic stem cell transplant
- Patients who are on hemodialysis.
- Patients with an active or uncontrolled infection.
- Known history of human immunodeficiency virus (HIV) infection, hepatitis B, or
hepatitis C.
- Patient declines participation in NANT 2004-05, the NANT Biology Study
Maximum Eligible Age: | 90 Years |
Minimum Eligible Age: | 1 Year |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Recommended phase 2 dose of lorlatinib administered orally to children and adolescents |
Time Frame: | Approximately 2 years |
Safety Issue: | |
Description: | By dose level (Dose Escalation of lorlatinib Only; The entry dose of lorlatinib at 45 mg/m2 /dose is equivalent to 75% of the adult RP2D). Two to six evaluable patients will be entered at each of the three dose levels for determination of the maximum tolerated dose. |
Secondary Outcome Measures
Measure: | Evaluation of overall response |
Time Frame: | Overall response is assessed at 8, 16, 24, 40, and 56 weeks from start of therapy, and then every 16 weeks, and at end of protocol therapy; an average of 24 weeks. |
Safety Issue: | |
Description: | Overall response is the measure that will be used to assess anti-tumor activity, and is determined by integration of the soft tissue response, bone response, and bone marrow response according to the NANT Response Criteria, Version 2.0 definitions. Responders are defined as patients with an overall response of Complete Response, Complete Response-Minimal Disease, or Partial Response. |
Measure: | Evaluation of soft tissue response |
Time Frame: | Soft tissue response is assessed at 8, 16, 24, 40, and 56 weeks from start of therapy, and then every 16 weeks, and at end of protocol therapy; an average of 24 weeks. |
Safety Issue: | |
Description: | Soft tissue response is assessed by CT/MRI scans using RECIST criteria to define measurable lesions with the addition of MIBG and/or FDG-PET (only for MIBG non-avid tumors) avidity and/or biopsy to define target lesions for response. |
Measure: | Evaluation of bone response |
Time Frame: | Bone response is assessed at 8, 16, 24, 40, and 56 weeks from start of therapy, and then every 16 weeks, and at end of protocol therapy; an average of 24 weeks. |
Safety Issue: | |
Description: | Bone response is assessed by MIBG scans for MIBG avid tumors, and by FDG-PET scans for MIBG non-avid tumors, using sectors 1-9 of the Curie scoring to determine the relative score at each response timepoint. |
Measure: | Evaluation of bone marrow response |
Time Frame: | Bone marrow response is assessed at 8, 16, 24, 40, and 56 weeks from start of therapy, and then every 16 weeks, and at end of protocol therapy; an average of 24 weeks. |
Safety Issue: | |
Description: | Bone marrow response is assessed by morphologic and immunohistologic evaluation of bilateral bone marrow aspirates and biopsies |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | New Approaches to Neuroblastoma Therapy Consortium |
Last Updated
January 20, 2021