Description:
This phase I trial studies the side effects and best dose of mocetinostat when given together
with vinorelbine to see how well it works in treating children, adolescents, and young adults
with rhabdomyosarcoma that has spread to nearby tissues or lymph nodes and cannot be removed
by surgery (locally advanced unresectable) or has spread to other places in the body
(metastatic), and does not respond to treatment (refractory) or has come back (relapsed).
Mocetinostat may stop the growth of tumor cells by blocking some of the enzymes needed for
cell growth. Drugs used in chemotherapy, such as vinorelbine, work in different ways to stop
the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by
stopping them from spreading. Giving mocetinostat and vinorelbine may work better in treating
children, adolescents, and young adults with rhabdomyosarcoma compared to vinorelbine alone.
Title
- Brief Title: Mocetinostat With Vinorelbine in Children, Adolescents & Young Adults With Refractory and/or Recurrent Rhabdomyosarcoma
- Official Title: A Phase I Dose Escalation/Expansion Clinical Trial of Mocetinostat in Combination With Vinorelbine in Children, Adolescents and Young Adults With Refractory and/or Recurrent Rhabdomyosarcoma (RMS)
Clinical Trial IDs
- ORG STUDY ID:
19-000353
- SECONDARY ID:
NCI-2019-08263
- NCT ID:
NCT04299113
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Vinorelbine | 3'',4''-Didehydro-4''-deoxy-C''-norvincaleukoblastine, 5''-Nor-Anhydrovinblastine, 71486-22-1, Dihydroxydeoxynorvinkaleukoblastine, nor-5''-Anhydrovinblastine, vinorelbine, VINORELBINE | Treatment (vinorelbine, mocetinostat) |
Mocetinostat | 726169-73-9, Benzamide, N-(2-aminophenyl)-4-[[[4-(3-pyridinyl)-2-pyrimidinyl]amino]methyl]-, MG-0103, MGCD0103, MGCD0103, N-(2-aminophenyl)-4-((4-pyridin-3-ylpyrimidin-2-ylamino)methyl)benzamide | Treatment (vinorelbine, mocetinostat) |
Purpose
This phase I trial studies the side effects and best dose of mocetinostat when given together
with vinorelbine to see how well it works in treating children, adolescents, and young adults
with rhabdomyosarcoma that has spread to nearby tissues or lymph nodes and cannot be removed
by surgery (locally advanced unresectable) or has spread to other places in the body
(metastatic), and does not respond to treatment (refractory) or has come back (relapsed).
Mocetinostat may stop the growth of tumor cells by blocking some of the enzymes needed for
cell growth. Drugs used in chemotherapy, such as vinorelbine, work in different ways to stop
the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by
stopping them from spreading. Giving mocetinostat and vinorelbine may work better in treating
children, adolescents, and young adults with rhabdomyosarcoma compared to vinorelbine alone.
Detailed Description
PRIMARY OBJECTIVES:
I. To determine the first cycle dose-limiting toxicities (DLTs), maximum tolerated dose
(MTD), and a biologically effective and recommended phase 2 dose (RP2D) of mocetinostat
administered orally three times per week for a total of 9 doses per 21 day cycle given in
combination with vinorelbine on days 1, 8, 15 of 21 day cycles in subjects with refractory or
recurrent rhabdomyosarcoma (RMS). (Phase 1 Dose Escalation) II. To determine the
progression-free survival (PFS), defined as time from first dose of vinorelbine to tumor
progression or death due to any cause, at the RP2D of mocetinostat administered orally three
times per week starting on day 3 for a total of 9 doses per 21 day cycle given in combination
with vinorelbine on days 1, 8, 15 of a 21 day cycle in subjects with refractory or recurrent
RMS. (Expansion Cohort)
SECONDARY OBJECTIVES:
I. Safety profile of mocetinostat in combination with vinorelbine as characterized by adverse
event (AE) type, severity, timing and relationship to study drugs, as well as laboratory
abnormalities in the first and subsequent treatment cycles. (Phase 1 Dose Escalation) II.
Pharmacokinetics (PK) of mocetinostat in plasma. (Phase 1 Dose Escalation) III. Clinical
benefit rate (CBR = complete response [CR] + partial response [PR] and stable disease [SD])
of mocetinostat + vinorelbine in metastatic/refractory/unresectable RMS. (Phase 1 Dose
Escalation) IV. Antitumor activity of mocetinostat + vinorelbine in refractory/recurrent RMS
as measured by overall response rate (ORR), duration of response (DOR), disease control (DC),
duration of disease control, as well as progression-free survival (PFS). (Phase 1 Dose
Escalation) V. Pharmacodynamics of mocetinostat on molecular targets in surrogate tissue.
(Phase 1 Dose Escalation and Expansion Cohort) VI. Exploratory biomarker development to
enable prediction of drug toxicity, tumor response and the mechanism(s) of acquired study
drug resistance. (Phase 1 Dose Escalation and Expansion Cohort) VII. Obtain RMS tissue
biological samples pre-treatment and at progression to assess for differences in gene
expression by next gen (generation) sequencing and ribonucleic acid (RNA) sequencing (seq).
(Phase 1 Dose Escalation and Expansion Cohort) VIII. Antitumor activity of mocetinostat +
vinorelbine in metastatic/refractory RMS as measured by overall response rate (ORR) and
duration of response (DOR), disease control (DC), duration of disease control, as well as
progression-free survival (PFS) according to Response Evaluation Criteria in Solid Tumors
(RECIST) version (v)1.1. (Expansion Cohort) IX. Safety and tolerability of mocetinostat and
vinorelbine as characterized by adverse event type, severity, timing and relationship to
study drug, as well as laboratory abnormalities. (Expansion Cohort)
OUTLINE: This is a phase I, dose-escalation study of mocetinostat followed by additional
studies.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment (vinorelbine, mocetinostat) | Experimental | Participants receive mocetinostat in combination with vinorelbine | |
Eligibility Criteria
Inclusion Criteria:
- Willing and able to provide written Institutional Review Board (IRB)/Independent
Ethics Committee (IEC)-approved informed consent. For subjects < 18 years of age,
their parents or legal guardians must sign a written informed consent. Assent, when
appropriate, will be obtained according to institutional guidelines
- Have histologically or cytological confirmed diagnosis of rhabdomyosarcoma with
locally advanced/unresectable, metastatic, refractory or relapsed disease who have
failed standard therapy and for whom no known curative therapy exists
- Measurable disease according to RECIST version 1.1
- Prior cancer therapy: Subjects may have received any number of prior therapy regimens.
In the investigator's opinion, subjects must have tolerated prior cytotoxic therapies
well and have adequate bone marrow reserve. At the time of treatment initiation, at
least 3 weeks must have elapsed after prior cytotoxic chemotherapy. At least 7 days
must have elapsed since completion of any prior non-cytotoxic cancer therapy and any
associated AEs must have resolved
- Prior radiotherapy is allowed if >= 2 weeks have elapsed for local palliative
radiation therapy (XRT) (small port); >= 6 months must have elapsed if prior total
body irradiation, craniospinal XRT or if > 50% radiation of the pelvis; > 6 weeks must
have elapsed if other substantial bone marrow radiation (defined per principal
investigator's [PI's] discretion). Subjects who have received brain irradiation must
have completed whole brain radiotherapy and/or gamma knife at least 4 weeks prior to
enrollment
- Subjects with controlled asymptomatic central nervous system (CNS) involvement are
allowed in absence of therapy with anticonvulsants. Subjects not requiring steroids or
requiring steroids at a stable dose (=< 4 mg/day dexamethasone or equivalent) for at
least 2 weeks are eligible
- Resolution of all acute toxic effects (excluding alopecia) of any prior anti-cancer
therapy to National Cancer Institute (NCI) Common Terminology Criteria for Adverse
Events (CTCAE) (version 4.03) grade < 1 or to the baseline laboratory values as
defined below
- Eastern Cooperative Oncology Group (ECOG) performance status (PS) =< 2 in subjects >=
17 years old; or Karnofsky/Lansky > 50 in subjects < 16 years old
- Subjects age > 18 years for first cohort. Subjects must be > 12 years old for the
second and subsequent cohorts
- Life expectancy of at least 3 months
- Absolute neutrophil count (ANC) >= 1000/mm^3 (>= 1.0 x 10^9/L)
- Platelets (PLT) >= 100,000/mm^3 (>= 100 x 10^9/L) (transfusion independent, defined as
not receiving platelet transfusions within a 7 day period prior to screening)
- Hemoglobin > 9.0 g/dL (transfusions are allowed)
- Serum creatinine =< 1.5 x upper limit of normal (ULN) or creatinine clearance > 60
mL/min
- Total serum bilirubin =< 1.5 x ULN; =< 5 x ULN if Gilbert's syndrome
- Liver transaminases (aspartate aminotransferase [AST]/alanine aminotransferase [ALT])
=< 2.5 x ULN; =< 5 x ULN if liver metastases are present
- Pregnancy test if female of child-bearing potential negative within 7 days of starting
treatment
- Cardiac ejection fraction > 50% or shortening fraction > 28% by echocardiography
(ECHO) or multigated acquisition scan (MUGA)
- Females of child-bearing potential must have a negative pregnancy test during
screening and be neither breastfeeding nor intending to become pregnant during study
participation. Females of childbearing potential must agree to avoid pregnancy during
the study and commit to abstinence from heterosexual intercourse or agree to use two
methods of birth control (one highly effective method and one additional effective
method) at least 4 weeks before the start of protocol therapy, for the duration of
study participation, and for 6 months after the last dose of mocetinostat
- Males with partner(s) of childbearing potential must take appropriate precautions to
avoid fathering a child from the screening period until 90 days after receiving the
last dose of mocetinostat. They must commit to abstinence from heterosexual
intercourse or agree to use appropriate barrier contraception
- Prior to enrollment of females or males of reproductive potential, the investigator
must document confirmation of the subject's understanding of the possible teratogenic
effects of mocetinostat
- Willingness and ability to comply with scheduled visits, treatment plan, laboratory
tests and other study procedures
Exclusion Criteria:
- Current participation in another therapeutic clinical trial
- Symptomatic brain metastases
- History of previous cancer (non RMS), except squamous cell or basal-cell carcinoma of
the skin or any in situ carcinoma that has been completely resected, which required
therapy within the previous 3 years. Other low grade cancers can be reviewed and
allowed at the discretion of the PI
- Incomplete recovery from any surgery (other than central venous catheter or port
placement) prior to treatment
- Any of the following in the past 6 months: pericarditis, pericardial effusion,
symptomatic congestive heart failure, cerebrovascular accident or transient ischemic
attack, pulmonary embolism, deep vein thrombosis, symptomatic bradycardia, requirement
for anti-arrhythmic medication
- History of prolonged corrected QT (QTc) interval (e.g., repeated demonstration of a
QTc interval > 450 milliseconds, unless associated with the use of medications known
to prolong the QTc interval). QTc will be calculated using the Bazett formula (RR
interval = 60/heart rate; QTI corrected = QT interval/sqr[RRinterval])
- History of additional risk factors for torsade de pointes (e.g., heart failure, family
history of long QT syndrome)
- Use of concomitant medications that increase or possibly increase the risk to prolong
the QTc interval and/or induce torsades de pointes ventricular arrhythmia
- Females who are breastfeeding/lactating
- Known active infections (e.g., bacterial, fungal, viral including hepatitis and human
immunodeficiency virus [HIV] positivity)
- Other severe acute or chronic medical or psychiatric condition or laboratory
abnormality that may increase the risk associated with study participation or study
drug administration or may interfere with the interpretation of study results and, in
the judgment of the investigator, would make the subject inappropriate for entry into
this study or compromise protocol objectives in the opinion of the investigator and/or
the sponsor
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 13 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | To describe any dose-limiting toxicity (DLT) |
Time Frame: | 1 year |
Safety Issue: | |
Description: | Percentage of subjects with dose-limiting toxicities (DLTs) as assessed by NCI CTCAE (Version 4.03) |
Secondary Outcome Measures
Measure: | To determine the Recommended Phase 2 Dose (RP2D) for mocetinostat in combination with vinorelbine |
Time Frame: | 1 year |
Safety Issue: | |
Description: | The RP2D may be determined by the MTD or optimal target inhibition with an acceptable safety profile |
Measure: | Incidence of Adverse Events (AEs) as assessed by NCI CTCAE (Version 4.03) |
Time Frame: | 1 year |
Safety Issue: | |
Description: | Assess incidence of all AEs by NCI CTCAE (Version 4.03) grades 1-5 |
Measure: | Objective Tumor Response |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Measured using RECIST, Version 1.1 |
Measure: | Progression Free Survival (PFS) |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Estimated using Kaplan-Meier methodology |
Measure: | Disease Control (DC) |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Proportion of subjects with a confirmed Complete Response (CR), Partial Response (PR), or Stable Disease (SD) according to RECIST v1.1 |
Measure: | Duration of Response (DOR) |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Measured from the first date a response is identified (either CR or PR) until the date of disease progression |
Measure: | Area under the Plasma Concentration versus Time Curve (AUC) of mocetinostat |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Continuous variables will be summarized with means, standard deviations, medians, minimums, and maximums |
Measure: | Clearance (CL) of mocetinostat |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Continuous variables will be summarized with means, standard deviations, medians, minimums, and maximums |
Measure: | Half-Life [T1/2] of mocetinostat |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Continuous variables will be summarized with means, standard deviations, medians, minimums, and maximums |
Measure: | Volume of Distribution (Vd) of mocetinostat |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Continuous variables will be summarized with means, standard deviations, medians, minimums, and maximums |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Jonsson Comprehensive Cancer Center |
Trial Keywords
- Locally Advanced Rhabdomyosarcoma
- Recurrent Rhabdomyosarcoma
- Refractory Rhabdomyosarcoma
- Unresectable Rhabdomyosarcoma
Last Updated
March 11, 2021