Clinical Trials /

Phase 2 Clinical Trial of Crizotinib for Children and Adults With Neurofibromatosis Type 2 and Progressive Vestibular Schwannomas

NCT04283669

Description:

Subjects with Neurofibromatosis Type 2 (NF2) and progressive vestibular schwannoma (VS) will be treated with crizotinib administered orally. Crizotinib will be taken continuously until disease progression or unacceptable toxicity, in continuous treatment cycles of 28 days each, for a maximum of 12 cycles.

Related Conditions:
  • Acoustic Schwannoma
  • Neurofibromatosis Type 2
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Phase 2 Clinical Trial of Crizotinib for Children and Adults With Neurofibromatosis Type 2 and Progressive Vestibular Schwannomas
  • Official Title: Open-label, Phase 2 Clinical Trial of Crizotinib for Children and Adults With Neurofibromatosis Type 2 and Progressive Vestibular Schwannomas

Clinical Trial IDs

  • ORG STUDY ID: IRB-300003645
  • SECONDARY ID: W81XWH-17-2-0037
  • NCT ID: NCT04283669

Conditions

  • Neurofibromatosis 2
  • Progressive Vestibular Schwannoma (VS)

Interventions

DrugSynonymsArms
CrizotinibOpen Label Continuous Treatment

Purpose

Subjects with Neurofibromatosis Type 2 (NF2) and progressive vestibular schwannoma (VS) will be treated with crizotinib administered orally. Crizotinib will be taken continuously until disease progression or unacceptable toxicity, in continuous treatment cycles of 28 days each, for a maximum of 12 cycles.

Detailed Description

      Subjects with Neurofibromatosis Type 2 (NF2) and progressive vestibular schwannoma (VS) will
      be treated with crizotinib administered orally. Crizotinib will be taken continuously until
      disease progression or unacceptable toxicity, in continuous treatment cycles of 28 days each,
      for a maximum of 12 cycles. Clinical response will be assessed by MRI (volumetrics, primary
      objective) and audiology at the end of every 3rd cycle. Subjects with volumetric tumor
      progression will be taken off protocol. Patients who complete 12 cycles of treatment without
      disease progression, but within the following 24 weeks show subsequent disease progression
      (defined as >20% increase in target tumor volume compared to off-treatment volume), will be
      eligible for re-treatment on study for up to 48 additional weeks, provided they still meet
      study eligibility criteria.
    

Trial Arms

NameTypeDescriptionInterventions
Open Label Continuous TreatmentOtherSubjects with Neurofibromatosis Type 2 (NF2) and progressive vestibular schwannoma (VS) will be treated with crizotinib administered orally. Crizotinib will be taken continuously until disease progression or unacceptable toxicity, in continuous treatment cycles of 28 days each, for a maximum of 12 cycles. Clinical response will be assessed by MRI (volumetrics, primary objective) and audiology at the end of every 3rd cycle. Subjects with volumetric tumor progression will be taken off protocol. Patients who complete 12 cycles of treatment without disease progression, but within the following 24 weeks show subsequent disease progression (defined as >20% increase in target tumor volume compared to off-treatment volume), will be eligible for re-treatment on study for up to 48 additional weeks, provided they still meet study eligibility criteria.
  • Crizotinib

Eligibility Criteria

        Inclusion Criteria:

        Participants must meet the following criteria on screening examination to be eligible to
        participate in the study:

        Patients must have a confirmed diagnosis of neurofibromatosis 2 by fulfilling National
        Institute of Health (NIH) criteria or Manchester criteria, or by detection of a causative
        mutation in the NF2 gene.

        The NIH criteria include presence of:

          -  Bilateral vestibular schwannomas, OR

          -  First-degree relative with NF2 and EITHER unilateral eighth nerve mass OR

          -  Two of the following: neurofibroma, meningioma, glioma, schwannoma, juvenile posterior
             subcapsular lenticular opacity.

        The Manchester criteria include presence of:

          -  Bilateral vestibular schwannomas, OR First-degree relative with NF2 and EITHER
             unilateral eighth nerve mass OR - Two of the following: neurofibroma, meningioma,
             glioma, schwannoma, juvenile posterior subcapsular lenticular opacity OR

          -  Unilateral vestibular schwannoma AND any two of: neurofibroma, meningioma, glioma,
             schwannoma, juvenile posterior subcapsular lenticular opacity, OR

          -  Multiple meningiomas (two or more) AND unilateral vestibular schwannoma OR

          -  Any two of: schwannoma, glioma, neurofibroma, cataract.

        Patients must have progressive and measurable disease, defined as at least one VS with the
        following qualities:

          -  ≥ 0.75 ml (on volumetric analysis) that can be accurately measured by
             contrast-enhanced cranial MRI scan with fine cuts through the internal auditory canal
             (1 mm slices, no skip)

          -  MRI evidence of progression over the past 18 months (defined as ≥20% annualized
             increase in volume)

        Age ≥ 6 years on day 1 of treatment.

        Life expectancy of greater than 1 year.

        Lansky/Karnofsky performance status ≥ 60

        Organ and marrow function as defined below:

          -  Absolute neutrophil count ≥ 1,500/ μl

          -  Platelets ≥ 100,000/ μl

          -  Total bilirubin within ≤ 1.5 X institutional upper limit of normal

          -  AST (SGOT)/ALT (SGPT) ≤ 2.5 X institutional upper limit of normal

          -  Patients must have a creatinine clearance or radioisotope GFR ≥60ml/min/1.73
             ≥60ml/min/1.73 m2 or a normal serum creatinine based on age/gender described in the
             table below:

          -  Age: 6 to < 10 years with a Maximum Serum Creatinine (mg/dL) of 1 for Male and 1 for
             Female

          -  Age: 10 to < 13 years with a Maximum Serum Creatinine (mg/dL) of 1.2 for Male and 1.2
             for Female

          -  Age: 13 to < 16 years with a Maximum Serum Creatinine (mg/dL) of 1.5 for Male and 1.4
             for Female

          -  Age: ≥ 16 years with a Maximum Serum Creatinine (mg/dL) of 1.7 for Male and 1.4 for
             Female

        The threshold creatinine values in this Table were derived from the Schwartz formula for
        estimating GFR utilizing child length and stature data published by the CDC.

        Fully recovered from acute toxic effects of any prior chemotherapy, biological modifiers or
        radiotherapy

        Any neurologic deficits must be stable for ≥1 week

        Patient or parent/legal guardian must be able to provide signed informed consent and assent
        (as applicable for minors)

        Exclusion Criteria:

        Participants who exhibit any of the following conditions at screening will not be eligible
        for admission into the study.

        Patients currently receiving medical anticancer therapies or who have received medical
        anticancer therapies within 4 weeks of the start of study drug (including chemotherapy and
        molecular targeted agents), as these may interfere with the study drug

        Monoclonal antibody treatment and/or agents with prolonged half-lives: At least three
        half-lives must have elapsed from the last dose prior to enrollment

        Radiation therapy to a study target tumor within 1 year prior to enrollment, or any
        radiation therapy within 4 weeks prior to enrollment, as these may interfere with our
        ability to assess response to study drug

        Prior treatment with any investigational drug within the preceding 4 weeks, as they may
        interfere with the study drug

        Unstable or rapidly progressive disease, including patients who require glucocorticoids for
        symptomatic control of brain or spinal tumors, as this would represent a high risk for
        inability to comply with the study requirements

        Use of drugs or foods that are known potent CYP3A4 inhibitors, including but not limited to
        ketoconazole, itraconazole, miconazole, clarithromycin, erythromycin, ritonavir, indinavir,
        nelfinavir, saquinavir, amprenavir, delavirdine, nefazodone, diltiazem, verapamil, and
        grapefruit juice, as this would interfere with study drug metabolism

        Use of drugs that are known potent CYP3A4 inducers, including but not limited to
        carbamazepine, phenobarbital, phenytoin, rifabutin, rifampin, tipranavir, ritonavir, and
        St. John's wort, as this would interfere with study drug metabolism

        Use of drugs that are CYP3A4 substrates with narrow therapeutic indices, including but not
        limited to pimozide, aripiprazole, triazolam, dihydroergotamine, ergotamine, astemizole,
        cisapride, terfenadine and halofantrine, as this would interfere with study drug metabolism

        Ongoing cardiac dysrhythmias of CTCAE grade ≥2, uncontrolled atrial fibrillation of any
        grade or prolonged QTc interval (>480 msec), as patients with these conditions would be
        expected to have an increased risk for cardiac toxicity related to study drug

        Patients who have any severe and/or uncontrolled medical conditions or other conditions
        that could affect their participation in the study such as:

          -  symptomatic congestive heart failure of New York heart Association Class III or IV

          -  unstable angina pectoris, symptomatic congestive heart failure, myocardial infarction
             within 6 months of start of study drug, serious uncontrolled cardiac arrhythmia or any
             other clinically significant cardiac disease

          -  severely impaired lung function as defined as spirometry and DLCO that is 50% of the
             normal predicted value and/or O2 saturation that is 90% or less at rest on room air

          -  active (acute or chronic) or uncontrolled severe infections liver disease, such as
             cirrhosis or severe hepatic impairment (Child-Pugh class C)

        Impairment of gastrointestinal function or gastrointestinal disease that may significantly
        alter the absorption of crizotinib (e.g., ulcerative disease, uncontrolled nausea,
        vomiting, diarrhea, malabsorption syndrome or small bowel resection)

        Female patients who are pregnant or breast feeding, or adults of reproductive potential who
        are not using effective birth control methods. Adequate contraception must be used
        throughout the trial and for 90 days after the last dose of study drug, as the effects of
        crizotinib on an unborn fetus are not known. Females of childbearing potential must have a
        negative serum pregnancy test within 7 days prior to administration of crizotinib.

        Male patients whose sexual partner(s) are women of child bearing potential, who are not
        willing to use adequate contraception during the study and for 90 days after the last dose
        of study drug.

        History of significant noncompliance to medical regimens that would jeopardize compliance
        with study therapy

        Patients unwilling to or unable to comply with the study protocol
      
Maximum Eligible Age:N/A
Minimum Eligible Age:6 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Volumetric Response Rate
Time Frame:Up to 48 Weeks
Safety Issue:
Description:estimate the best objective volumetric response rates (i.e. maximum tumor shrinkage) to crizotinib in NF2 patients with VS during up to 12 cycles (48 weeks) of treatment.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:University of Alabama at Birmingham

Last Updated

February 4, 2021