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Ulixertinib in Treating Patients With Advanced Solid Tumors, Non-Hodgkin Lymphoma, or Histiocytic Disorders With MAPK Pathway Mutations (A Pediatric MATCH Treatment Trial)

NCT03698994

Description:

This phase II Pediatric MATCH trial studies how well ulixertinib works in treating patients with solid tumors that have spread to other places in the body (advanced), non-Hodgkin lymphoma, or histiocytic disorders that have a genetic alteration (mutation) in a signaling pathway called MAPK. A signaling pathway consists of a group of molecules in a cell that control one or more cell functions. Genes in the MAPK pathway are frequently mutated in many types of cancers. Ulixertinib may stop the growth of cancer cells that have mutations in the MAPK pathway.

Related Conditions:
  • Malignant Solid Tumor
  • Non-Hodgkin Lymphoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Ulixertinib in Treating Patients With Advanced Solid Tumors, Non-Hodgkin Lymphoma, or Histiocytic Disorders With MAPK Pathway Mutations (A Pediatric MATCH Treatment Trial)
  • Official Title: NCI-COG Pediatric MATCH (Molecular Analysis for Therapy Choice) - Phase 2 Subprotocol of BVD-523FB (Ulixertinib) in Patients With Tumors Harboring Activating MAPK Pathway Mutations

Clinical Trial IDs

  • ORG STUDY ID: NCI-2018-02150
  • SECONDARY ID: NCI-2018-02150
  • SECONDARY ID: APEC1621J
  • SECONDARY ID: APEC1621J
  • SECONDARY ID: U10CA180886
  • NCT ID: NCT03698994

Conditions

  • Advanced Malignant Solid Neoplasm
  • ARAF Gene Mutation
  • BRAF Gene Mutation
  • GNA11 Gene Mutation
  • GNAQ Gene Mutation
  • HRAS Gene Mutation
  • KRAS Gene Mutation
  • MAP2K1 Gene Mutation
  • MAPK1 Gene Mutation
  • NF1 Gene Mutation
  • NRAS Gene Mutation
  • Recurrent Ependymal Tumor
  • Recurrent Ewing Sarcoma
  • Recurrent Glioma
  • Recurrent Hepatoblastoma
  • Recurrent Histiocytic and Dendritic Cell Neoplasm
  • Recurrent Langerhans Cell Histiocytosis
  • Recurrent Malignant Central Nervous System Neoplasm
  • Recurrent Malignant Germ Cell Tumor
  • Recurrent Malignant Solid Neoplasm
  • Recurrent Medulloblastoma
  • Recurrent Neuroblastoma
  • Recurrent Non-Hodgkin Lymphoma
  • Recurrent Osteosarcoma
  • Recurrent Peripheral Primitive Neuroectodermal Tumor
  • Recurrent Rhabdoid Tumor
  • Recurrent Rhabdomyosarcoma
  • Recurrent Soft Tissue Sarcoma
  • Refractory Ependymoma
  • Refractory Ewing Sarcoma
  • Refractory Glioma
  • Refractory Hepatoblastoma
  • Refractory Histiocytic and Dendritic Cell Neoplasm
  • Refractory Langerhans Cell Histiocytosis
  • Refractory Malignant Central Nervous System Neoplasm
  • Refractory Malignant Germ Cell Tumor
  • Refractory Malignant Solid Neoplasm
  • Refractory Medulloblastoma
  • Refractory Neuroblastoma
  • Refractory Non-Hodgkin Lymphoma
  • Refractory Osteosarcoma
  • Refractory Peripheral Primitive Neuroectodermal Tumor
  • Refractory Rhabdoid Tumor
  • Refractory Rhabdomyosarcoma
  • Refractory Soft Tissue Sarcoma
  • Wilms Tumor

Interventions

DrugSynonymsArms
UlixertinibBVD-523, VRT752271Treatment (ulixertinib)

Purpose

This phase II Pediatric MATCH trial studies how well ulixertinib works in treating patients with solid tumors that have spread to other places in the body (advanced), non-Hodgkin lymphoma, or histiocytic disorders that have a genetic alteration (mutation) in a signaling pathway called MAPK. A signaling pathway consists of a group of molecules in a cell that control one or more cell functions. Genes in the MAPK pathway are frequently mutated in many types of cancers. Ulixertinib may stop the growth of cancer cells that have mutations in the MAPK pathway.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To determine the objective response rate (ORR; complete response + partial response) in
      pediatric patients treated with BVD-523FB (ulixertinib) with advanced solid tumors (including
      central nervous system [CNS] tumors), non-Hodgkin lymphomas or histiocytic disorders that
      harbor activating genetic alterations in the MAPK pathway.

      SECONDARY OBJECTIVES:

      I. To estimate the progression free survival in pediatric patients treated with BVD-523FB
      (ulixertinib) with advanced solid tumors (including CNS tumors), non-Hodgkin lymphomas or
      histiocytic disorders that harbor activating genetic alterations in the MAPK pathway.

      II. To obtain information about the tolerability of BVD-523FB (ulixertinib) in children and
      adolescents with relapsed or refractory cancer.

      III. To provide preliminary estimates of the pharmacokinetics of BVD-523FB (ulixertinib) in
      children and adolescents with relapsed or refractory cancer.

      EXPLORATORY OBJECTIVES:

      I. To evaluate other biomarkers as predictors of response to BVD-523FB (ulixertinib) and
      specifically, whether tumors that harbor different mutations or fusions will demonstrate
      differential response to BVD-523FB (ulixertinib) treatment.

      II. To explore approaches to profiling changes in tumor genomics over time through evaluation
      of circulating tumor deoxyribonucleic acid (DNA).

      OUTLINE: This is a dose-escalation study.

      Patients receive ulixertinib orally (PO) twice daily (BID). Courses repeat every 28 days for
      up to 2 years in the absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up periodically.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (ulixertinib)ExperimentalPatients receive ulixertinib PO BID. Courses repeat every 28 days for up to 2 years in the absence of disease progression or unacceptable toxicity.
  • Ulixertinib

Eligibility Criteria

        Inclusion Criteria:

          -  Patient must have enrolled onto APEC1621SC and must have been given a treatment
             assignment to MATCH to APEC1621J based on the presence of an actionable mutation.

          -  Patients must have a body surface area >= 0.54 m^2 at the time of study enrollment.

          -  Patients must have radiographically measurable disease at the time of study
             enrollment. Patients with neuroblastoma who do not have measurable disease but have
             metaiodobenzylguanidine (MIBG)+ evaluable disease are eligible. Measurable disease in
             patients with central nervous system (CNS) involvement is defined as tumor that is
             measurable in two perpendicular diameters on magnetic resonance imaging (MRI) and
             visible on more than one slice.

               -  Note: The following do not qualify as measurable disease:

                    -  Malignant fluid collections (e.g., ascites, pleural effusions)

                    -  Bone marrow infiltration except that detected by MIBG scan for neuroblastoma

                    -  Lesions only detected by nuclear medicine studies (e.g., bone, gallium or
                       positron emission tomography [PET] scans) except as noted for neuroblastoma

                    -  Elevated tumor markers in plasma or cerebrospinal fluid (CSF)

                    -  Previously radiated lesions that have not demonstrated clear progression
                       post radiation

                    -  Leptomeningeal lesions that do not meet the measurement requirements for
                       Response Evaluation Criteria in Solid Tumors (RECIST) 1.1.

          -  Karnofsky >= 50% for patients > 16 years of age and Lansky >= 50 for patients =< 16
             years of age. Note: Neurologic deficits in patients with CNS tumors must have been
             relatively stable for at least 7 days prior to study enrollment. Patients who are
             unable to walk because of paralysis, but who are up in a wheelchair, will be
             considered ambulatory for the purpose of assessing the performance score.

          -  Patients must have fully recovered from the acute toxic effects of all prior
             anti-cancer therapy and must meet the following minimum duration from prior
             anti-cancer directed therapy prior to enrollment. If after the required timeframe, the
             numerical eligibility criteria are met, e.g. blood count criteria, the patient is
             considered to have recovered adequately.

               -  Cytotoxic chemotherapy or other anti-cancer agents known to be myelosuppressive.

                    -  >= 21 days after the last dose of cytotoxic or myelosuppressive chemotherapy
                       (42 days if prior nitrosourea).

               -  Anti-cancer agents not known to be myelosuppressive (e.g. not associated with
                  reduced platelet or ANC counts): >= 7 days after the last dose of agent.

               -  Antibodies: >= 21 days must have elapsed from infusion of last dose of antibody,
                  and toxicity related to prior antibody therapy must be recovered to Grade =< 1.

               -  Corticosteroids: If used to modify immune adverse events related to prior
                  therapy, ≥ 14 days must have elapsed since last dose of corticosteroid.

               -  Hematopoietic growth factors: >= 14 days after the last dose of a long-acting
                  growth factor (e.g. pegfilgrastim) or 7 days for short-acting growth factor. For
                  growth factors that have known adverse events occurring beyond 7 days after
                  administration, this period must be extended beyond the time during which adverse
                  events are known to occur. The duration of this interval must be discussed with
                  the study chair and the study-assigned Research Coordinator.

               -  Interleukins, Interferons and Cytokines (other than hematopoietic growth
                  factors): >= 21 days after the completion of interleukins, interferon or
                  cytokines (other than hematopoietic growth factors).

               -  Stem cell Infusions (with or without TBI):

                    -  Allogeneic (non-autologous) bone marrow or stem cell transplant, or any stem
                       cell infusion including DLI or boost infusion: >= 84 days after infusion and
                       no evidence of GVHD.

                    -  Autologous stem cell infusion including boost infusion: >= 42 days.

               -  Cellular Therapy: >= 42 days after the completion of any type of cellular therapy
                  (e.g. modified T cells, natural killer [NK] cells, dendritic cells, etc.).

               -  Radiotherapy (XRT)/External Beam Irradiation including Protons: >= 14 days after
                  local XRT; >= 150 days after TBI, craniospinal XRT or if radiation to >= 50% of
                  the pelvis; >= 42 days if other substantial brain metastases (BM) radiation.

                    -  Note: Radiation may not be delivered to "measurable disease" tumor site(s)
                       being used to follow response to subprotocol treatment.

               -  Radiopharmaceutical therapy (e.g., radiolabeled antibody, 131I-MIBG): >= 42 days
                  after systemically administered radiopharmaceutical therapy.

               -  Patients must not have received prior exposure to BVD-523FB (ulixertinib) or
                  other ERK inhibitors.

          -  For patients with solid tumors without known bone marrow involvement: Peripheral
             absolute neutrophil count (ANC) >= 1000/mm^3 (within 7 days prior to enrollment).

          -  For patients with solid tumors without known bone marrow involvement: Platelet count
             >= 100,000/mm^3 (transfusion independent, defined as not receiving platelet
             transfusions for at least 7 days prior to enrollment).

          -  Patients with known bone marrow metastatic disease will be eligible for study (may
             receive transfusions provided they are not known to be refractory to red cell or
             platelet transfusions). These patients will not be evaluable for hematologic toxicity.

          -  Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70ml/min/1.73
             m^2, or (within 7 days prior to enrollment).

          -  A serum creatinine based on age/gender (within 7 days prior to enrollment).

          -  Bilirubin (sum of conjugated + unconjugated) =< 1.5 x upper limit of normal (ULN) for
             age (within 7 days prior to enrollment).

          -  Serum glutamate-pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 135
             U/L. (For the purpose of this study, the ULN for SGPT is 45 U/L.) (within 7 days prior
             to enrollment).

          -  Serum albumin >= 2 g/dL (within 7 days prior to enrollment).

          -  Shortening fraction of >= 27% by echocardiogram, or (within 7 days prior to
             enrollment).

          -  Ejection fraction of >= 50% by gated radionuclide study (within 7 days prior to
             enrollment).

          -  QTc interval =< 480 milliseconds (within 7 days prior to enrollment).

          -  Patients must be able to swallow intact capsules.

          -  All patients and/or their parents or legally authorized representatives must sign a
             written informed consent. Assent, when appropriate, will be obtained according to
             institutional guidelines.

        Exclusion Criteria:

          -  Pregnant or breast-feeding women will not be entered on this study due to risks of
             fetal and teratogenic adverse events as seen in animal/human studies. Pregnancy tests
             must be obtained in girls who are post-menarchal. Males or females of reproductive
             potential may not participate unless they have agreed to use an effective
             contraceptive method for the duration of study treatment and for 3 months after last
             dose of BVD-523FB (ulixertinib).

          -  Patients receiving corticosteroids who have not been on a stable or decreasing dose of
             corticosteroid for at least 7 days prior to enrollment are not eligible. If used to
             modify immune adverse events related to prior therapy, >= 14 days must have elapsed
             since last dose of corticosteroid.

          -  Patients who are currently receiving another investigational drug are not eligible.

          -  Patients who are currently receiving other anti-cancer agents are not eligible.

          -  Patients who are receiving cyclosporine, tacrolimus or other agents to prevent
             graft-versus-host disease post bone marrow transplant are not eligible for this trial.

          -  Patients who are currently receiving drugs that are strong inducers or inhibitors of
             CYP3A4 are not eligible. Strong inducers or inhibitors of CYP3A4 should be avoided
             from 14 days prior to enrollment to the end of the study. Note: CYP3A4 inducing
             anti-epileptic drugs and dexamethasone for CNS tumors or metastases, on a stable dose,
             are allowed.

          -  Patients who are currently receiving drugs that are strong inducers or inhibitors of
             CYP1A2 and CYP2D6 are not eligible. Strong inhibitors of CYP1A2 (eg., ciprofloxacin,
             enoxacin, fluvoxamine, zafirlukast) should be avoided from 14 days prior to enrollment
             to the end of the study. Strong inhibitors of CYP2D6 (e.g., bupropion, paroxetine,
             fluoxetine, quinidine, terbinafine) should also be avoided from 14 days prior to
             enrollment to the end of the study.

          -  Patients with known significant ophthalmologic conditions (uncontrolled glaucoma,
             history of retinal vein occlusion or retinal detachment, excluding patients with
             longstanding findings secondary to existing conditions) are not eligible.

          -  Patients who have an uncontrolled infection are not eligible.

          -  Patients who have received a prior solid organ transplantation are not eligible.

          -  Patients who in the opinion of the investigator may not be able to comply with the
             safety monitoring requirements of the study are not eligible.
      
Maximum Eligible Age:21 Years
Minimum Eligible Age:12 Months
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Objective response rate (ORR = complete response [CR] + partial response [PR]) in pediatric patients treated with BVD-523FB (ulixertinib)
Time Frame:Up to 2 years
Safety Issue:
Description:Response rates will be calculated as the percent of evaluable patients who are responders, and confidence intervals will be constructed using the Wilson score interval method

Secondary Outcome Measures

Measure:Progression free survival (PFS) in pediatric patients treated with ulixertinib
Time Frame:From initiation of treatment to disease progression, disease recurrence, or death from any cause assessed up to 2 years
Safety Issue:
Description:PFS along with the confidence intervals will be estimated using the Kaplan-Meier method.
Measure:Incidence of adverse events graded according to Common Terminology Criteria for Adverse Events version 5.0
Time Frame:Up to 2 years
Safety Issue:
Description:Toxicity tables will be constructed to summarize the observed incidence by type of toxicity and grade. A patient will be counted only once for a given toxicity for the worst grade of that toxicity reported for that patient. Toxicity information recorded will include the type, severity, time of onset, time of resolution, and the probable association with the study regimen.
Measure:Preliminary estimates of the pharmacokinetics of ulixertinib in children and adolescents with relapsed or refractory cancer
Time Frame:Pre-dose and 1, 2, 4, and 6-8 hours after dose on course 1, day 1; and pre-dose on course 1, day 2, and course 1, day 15
Safety Issue:
Description:Will be summarized with simple summary statistics, including means, medians, ranges, and standard deviations (if numbers and distribution permit).

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:National Cancer Institute (NCI)

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