Description:
Difluoromethylornithine (DFMO) will be used in an open label, multicenter, study as
Maintenance Therapy for Molecular High Risk/Very High Risk and Relapsed/Refractory
Medulloblastoma.
Title
- Brief Title: DFMO as Maintenance Therapy for Molecular High/Very High Risk and Relapsed Medulloblastoma
- Official Title: Phase II Trial of Eflornithine/DFMO as Maintenance Therapy for Molecular High Risk/Very High Risk and Relapsed/Refractory Medulloblastoma
Clinical Trial IDs
- ORG STUDY ID:
BCC016
- NCT ID:
NCT04696029
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Difluoromethylornithine | Eflornithine, DFMO | Difluoromethylornithine (DFMO) |
Purpose
Difluoromethylornithine (DFMO) will be used in an open label, multicenter, study as
Maintenance Therapy for Molecular High Risk/Very High Risk and Relapsed/Refractory
Medulloblastoma.
Detailed Description
In this study subjects will receive 730 Days of oral difluoromethylornithine (DFMO) at a dose
of 2500 mg/m2 BID on each day of study.
Subjects will be evaluated in 3 Cohorts:
Cohort 1: Molecular High Risk Medulloblastoma Cohort 2: Molecular Very High Risk
Medulloblastoma Cohort 3: Relapsed/Refractory Medulloblastoma
A total of 118 subjects across all cohorts will be enrolled to ensure that there will be 107
evaluable subjects (32-39 per cohort)
Trial Arms
Name | Type | Description | Interventions |
---|
Difluoromethylornithine (DFMO) | Experimental | study subjects will receive 730 Days of oral difluoromethylornithine (DFMO) at a dose of 2500 mg/m2 BID on each day of study. | |
Eligibility Criteria
Inclusion Criteria:
1. Age: 0-21 years of age at diagnosis
2. Pathology All patients must either have a pathologically confirmed diagnosis of
medulloblastoma with molecular grouping identified by either Nanostring or methylation
profiling.
Cohort 1- Molecular High Risk:
- Metastatic non-MYC amplified Group 3
- Metastatic Group 4
- Metastatic non-WNT/non-SHH (Must be non-MYC amplified)
Cohort 2- Molecular Very High Risk
- Metastatic OR MYCN amplified OR TP53 mutant non-infant (>3 yrs) SHH
- MYC amplified Group 3
- Non-WNT, non-SHH infant (< 3 yrs)
Cohort 3: Relapsed/Refractory Medulloblastoma
3. Pre-enrollment tumor survey:
Prior to enrollment on this study, a determination of mandatory disease staging must
be performed:
- Tumor imaging studies including: Brain and spine MRI
- Lumbar Puncture only if previously positive
- Bone Marrow aspiration/biopsy only if previously positive
- This disease assessment is required for eligibility and preferably should be done
within 2 weeks prior to first dose of study drug, but must be done within a
maximum of 4 weeks before first dose of study drug.
4. Disease Status: Subjects must have no evidence of disease, or stable* residual
nonbulky** disease.
*Stable residual disease defined as non-progression over 2 separate imaging studies at
least 6 weeks apart
**Non-bulky disease defined as maximal cross-sectional area < 3cm^2 at enrollment.
Patients with leptomeningeal disease are allowed to participate on study.
5. Timing from prior therapy:
Enrollment (first dose of DFMO) no later than 60 days after last dose of conventional
chemotherapy. Patients who have undergone high dose chemotherapy (HDCT) with
autologous stem cell transplantation (SCT) are eligible if more than 45 days have
elapsed since date of last SCT.
6. Patients must have a Lansky or Karnofsky Performance Scale score of ≥ 50% (see
Appendix II) and patients must have a life expectancy of ≥ 2 months.
7. All clinical and laboratory studies for organ functions to determine eligibility must
be performed within 7 days prior to first dose of study drug unless otherwise
indicated below.
8. Patients must have adequate organ functions at the time of registration:
- Hematological: Hematological recovery as defined by ANC ≥750/μL, platelets ≥30
(non-transfused x 7 days)
- Liver: Adequate liver function as defined by AST and ALT <10x upper limit of
normal
- Renal: Adequate renal function defined as (perform one of the following):
Creatinine clearance or radioisotope GFR ≥ 70 mL/min/1.73 m2 or a serum
creatinine based on age/gender
9. Females of childbearing potential must have a negative pregnancy test. Patients of
childbearing potential must agree to use an effective birth control method. Female
patients who are lactating must agree to stop breast-feeding.
10. Written informed consent in accordance with institutional and FDA guidelines must be
obtained from all subjects (or patients' legal representative).
Exclusion Criteria:
1. BSA of <0.25 m2
2. Metastatic disease outside of CNS
3. Relapsed/refractory patients who are radiation-naïve and age 5 years or older at time
of enrollment
4. Investigational Drugs: Subjects who are currently receiving another investigational
drug are excluded from participation.
5. Anti-cancer Agents: Subjects who are currently receiving other anticancer agents are
not eligible. Subjects must have fully recovered from the hematological and bone
marrow suppression effects of prior chemotherapy.
6. Infection: Subjects who have an uncontrolled infection are not eligible until the
infection is judged to be well controlled in the opinion of the investigator.
7. Subjects who, in the opinion of the investigator, may not be able to comply with the
safety monitoring requirements of the study, or in whom compliance is likely to be
suboptimal, should be excluded.
Maximum Eligible Age: | 21 Years |
Minimum Eligible Age: | N/A |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Number of participants with event free survival (EFS) during study |
Time Frame: | 2 years plus 5 years follow up |
Safety Issue: | |
Description: | o To evaluate the efficacy of difluoromethylornithine (DFMO) as a single agent in preventing relapse in patients with molecular high risk and very high risk medulloblastoma, and relapsed/refractory medulloblastoma based upon the 2-year progression-free survival rate (PFS) compared to relevant historical controls. |
Secondary Outcome Measures
Measure: | Length of time that participants experience Overall Survival (OS) |
Time Frame: | 7 years |
Safety Issue: | |
Description: | o To evaluate the efficacy of difluoromethylornithine (DFMO) as a single agent in patients with molecular high risk and very high risk medulloblastoma, and relapsed/refractory medulloblastoma based upon overall survival |
Measure: | Determine the Overall Response Rate (ORR) of Participants using Modified RANO Criteria |
Time Frame: | 2 years |
Safety Issue: | |
Description: | To evaluate the efficacy of difluoromethylornithine (DFMO) as a single agent in patients with molecular high risk and very high risk medulloblastoma, and relapsed/refractory medulloblastoma based upon Response Rate for patients with non-bulky residual disease present. |
Measure: | Number of Participants with Adverse Events as a Measure of Safety and Tolerability |
Time Frame: | 2 years plus 30 days |
Safety Issue: | |
Description: | To develop a complete safety and tolerability profile of difluoromethylornithine (DFMO) in pediatric and young adult subjects with medulloblastoma. |
Measure: | Determine amount of DFMO in the CSF at 3 hours post dose |
Time Frame: | 2 years |
Safety Issue: | |
Description: | o To measure CSF penetration after DFMO administration in pediatric subjects with medulloblastoma |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Giselle SaulnierSholler |
Last Updated
August 23, 2021