Clinical Trials /

DFMO as Maintenance Therapy for Molecular High/Very High Risk and Relapsed Medulloblastoma

NCT04696029

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.

Related Conditions:
  • Medulloblastoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

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

  • Medulloblastoma

Interventions

DrugSynonymsArms
DifluoromethylornithineEflornithine, DFMODifluoromethylornithine (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

NameTypeDescriptionInterventions
Difluoromethylornithine (DFMO)Experimentalstudy subjects will receive 730 Days of oral difluoromethylornithine (DFMO) at a dose of 2500 mg/m2 BID on each day of study.
  • Difluoromethylornithine

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