A Phase 1b Study of PTC596 in Children With Newly Diagnosed Diffuse Intrinsic Pontine Glioma and High Grade Glioma

  • STATUS
    Recruiting
  • End date
    Jul 1, 2027
  • participants needed
    54
  • sponsor
    Nationwide Children's Hospital
Updated on 5 September 2021
platelet count
renal function
cancer
anticonvulsants
epilepsy
neutrophil count
blood transfusion
seizure
glioblastoma multiforme
astrocytoma
malignant glioma
brain tumor
anaplastic astrocytoma
recurrent tumor
dipg
diffuse intrinsic pontine glioma
brainstem tumor
total resection

Summary

In this research study the investigators want to learn more about the safety of the study drug, PTC596 has when taken during radiation. The investigators also want to learn about the effects, if any, these drugs have on children and young adults with brain tumors.

The investigators are asking people to be in this research study who have been diagnosed with a high grade glioma (HGG) including diffuse intrinsic pontine glioma (DIPG) to be in the research, because they have scheduled to have radiation to treat their cancer.

The study is divided into two parts. The goal of the first part is to find the dose of PTC596 that can be given with radiation without causing serious side effects. The purpose of this surgical study is to test the amount of a study drug that may be found in the tumor and blood when given prior to and during a planned surgery for removal of the recurrent tumor.

The goals of the first part:

  • Find the highest safe dose of PTC596 that can be given together with radiation therapy without causing severe side effects;
  • Learn what kind of side effects can be caused by PTC596 with radiation therapy;
  • Learn more about the pharmacology of PTC596;
  • Learn more about the biological effects of PTC596 on the cells in their body including any changes to the tumor DNA;
  • Determine whether PTC596 with radiation therapy is a beneficial treatment for their tumor;
  • Determine if there are any changes to participants quality of life when taking PTC596.

The goals of the surgical part are:

  • Learn if PTC596 is able to reach the tumor in the brain;
  • Learn what kind of side effects can be caused by PTC596 with radiation therapy;
  • Learn more about the pharmacology of PTC596;
  • Learn more about the biological effects of PTC596 on the cells in their body including any changes to the tumor DNA;
  • Determine whether PTC596 with radiation therapy is a beneficial treatment for their tumor;
  • Determine if there are any changes to their quality of life when taking PTC596.

Funding Source - FDA OOPD

Description

This study consists of two parts:

  1. The phase I, dose-finding component of the trial, to estimate the maximum tolerated dose (MTD) or recommended phase II dose (RP2D) of PTC596 in combination with radiation therapy followed by maintenance therapy with PTC596, in children with newly-diagnosed DIPG and HGG.
  2. Once the RP2D has been determined, the investigators will enroll a surgical cohort of patients with either a. newly-diagnosed DIPG who are amenable to undergo biopsy per recommendation of their treating physician OR b. Newly-diagnosed HGG for whom a second surgical resection is warranted for further debulking or to achieve a near-total or gross total resection after initial diagnosis has been made, but prior to start of therapy.

The primary objectives of the Phase I study will be to determine the MTD or RP2D of PTC596 in combination with radiation therapy and to assess pharmacokinetic (PK) and pharmacodynamics studies. Dose-modifying toxicities for maintenance therapy will also be monitored.

PK studies will be collected on days 1 and 4 (doses 1 and 2) of cycle 1 and day 1 of cycle 2.

PTC596 will be given twice weekly on Monday and Thursday or Tuesday and Friday, for 6-7 weeks, during daily radiation therapy. Once radiation therapy with concomitant PTC596 is completed, all patients will continue with maintenance therapy which will begin immediately after completion of RT for up to 25 cycles.

The objectives of the Surgical Cohort Stratum are to:

  1. Assess the ability of PTC596 to inhibit BMI-1 activity in tumor and peripheral blood mononuclear cells (PBMNCs) of children with newly-diagnosed DIPG or HGG
  2. To characterize the pharmacokinetics of PTC596 in plasma, cerebrospinal fluid (CSF), and tumor tissue of children with newly-diagnosed DIPG or HGG

Once the RP2D has been established, up to 12 patients will be enrolled on the surgical study. Patients eligible for the Surgical Stratum include:

  1. newly-diagnosed DIPG patients who are amenable to undergo biopsy per the recommendation of their treating physician OR
  2. newly-diagnosed HGG patients for whom a second surgical resection is warranted for further debulking or to achieve a near-total or gross total resection after initial diagnosis has been made, but prior to start of therapy.

Patients on the surgical cohort study will commence treatment with the surgical cycle. During the surgical cycle, patients will be treated with two doses of PTC596, on days 1 and 4 of the surgical cycle prior to biopsy or re-resection; the second dose of PTC596 should ideally be administered 3-6 hours before surgery (but may be up to 12 hours prior to surgery). The concentration of PTC596 will then be measured in the tumor and accompanying blood sample by mass spectrometry. BMI-1 expression and the effects of BMI-1 inhibition in DIPG and HGG on gene regulation through gene expression profiling and epigenetic studies will be assessed in tissue and plasma. The PK and PD studies on the surgical cohort study are mandatory. The surgical cycle will end when patients begin RT.

Patients must begin RT at least two weeks after the date of surgery and may restart PTC596 on Mondays and Thursdays or Tuesdays and Fridays (twice weekly) after starting RT. Following completion of radiotherapy, patients will immediately start maintenance therapy on a Monday and Thursday or Tuesday and Friday schedule. Patients can continue to receive therapy with PTC596 for up to 25 cycles.

Details
Condition Diffuse Intrinsic Pontine Glioma, High Grade Glioma, DIPG, malignant glioma
Treatment Radiotherapy, PTC596
Clinical Study IdentifierNCT03605550
SponsorNationwide Children's Hospital
Last Modified on5 September 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Age: Patients must be 12 months and 21 years of age at the time of study
enrollment
Diagnosis: Patients with newly-diagnosed diffuse intrinsic pontine gliomas
(DIPGs), defined as tumors with a pontine epicenter and diffuse involvement of
at least 2/3 of the pons, are eligible without histologic confirmation
Patients with brainstem tumors that do not meet radiographic criteria or are
not considered to be typical diffuse intrinsic pontine gliomas will be
eligible if the tumors are biopsied and proven to be high-grade gliomas (such
as anaplastic astrocytoma, glioblastoma, H3K27-mutant diffuse midline glioma)
or diffuse astrocytoma
Patients with newly-diagnosed non-brainstem high-grade glioma (HGG) are
eligible
Patients must have had histologically verified high-grade glioma such as
anaplastic astrocytoma, glioblastoma, H3 K27 mutant diffuse midline glioma
etc
Patients eligible for the surgical stratum include patients with
newly-diagnosed DIPG who are amenable to undergo biopsy at the recommendation of their treating physician
newly-diagnosed HGG for whom a second surgical resection is warranted for further debulking or to achieve a near-total or gross total resection after initial diagnosis has been made but prior to start of therapy
Disease Status: Patients with disseminated DIPG or HGG are not eligible, and
MRI of spine must be performed if disseminated disease is suspected clinically
by the treating physician
Performance Level: Karnofsky 50 for patients > 16 years of age and Lansky 50
for patients 16 years of age. 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
Neurologic Status: Patients must be able to swallow oral medications to be
eligible for study enrollment
Prior Therapy: Patients must not have received any prior anticancer therapy
Prior dexamethasone and/or surgery are permissible
Organ Function Requirements
Adequate Bone Marrow Function Defined as
Peripheral absolute neutrophil count (ANC) 1000/mm3
Platelet count 100,000/mm3 (transfusion independent, defined as not receiving
platelet transfusions for at least 7 days prior to enrollment)
Hemoglobin >10 g/dL (may be transfused)
Adequate Renal Function Defined as
Creatinine clearance or radioisotope GFR 70ml/min/1.73 m2 or
A serum creatinine based on age/gender as follows
to < 2 years: 0.6 (Male) 0.6 (Female)
to < 6 years: 0.8 (Male) 0.8 (Female)
to < 10 years: 1 (Male) 1 (Female)
to < 13 years: 1.2 (Male) 1.2 (Female)
to < 16 years: 1.5 (Male) 1.4 (Female)
years: 1.7 (Male) 1.4 (Female)
Adequate Liver Function Defined as
Total bilirubin must be 1.5 times institutional upper limit of normal for age
AST(SGOT)/ALT(SGPT) < 3 times institutional upper limit of normal
Serum albumin 2g/dL
Adequate Cardiac Function Defined As
Ejection fraction of 55% by echocardiogram
QTc 480 msec
Adequate Pulmonary Function Defined as
No evidence of dyspnea at rest, and a pulse oximetry > 94% in room air if there is clinical indication for determination
Adequate Neurologic Function Defined as
Patients with seizure disorder may be enrolled if on anticonvulsants and well controlled

Exclusion Criteria

Diagnosis: patients with a diagnosis of oligodendroglioma or oligoastrocytoma
are not eligible. Patients with juvenile pilocytic astrocytoma, are not
eligible
Patients with non-brainstem diffuse astrocytoma (grade 2) are not eligible for
the HGG stratum of the study
Pregnancy or breast-feeding: Pregnant or breast-feeding women will not be
entered on this study due to known or unknown 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
Patients of childbearing or child fathering potential must agree to use
adequate contraceptive methods (hormonal or barrier method of birth control
abstinence) while being treated on this study and for 3 months after
completing therapy. Note: The definition of effective contraception will be
based on the judgment of the principal investigator or a designated associate
Concomitant Medications
Corticosteroids: Patients receiving corticosteroids are eligible. The use of
corticosteroids must be reported
Investigational Drugs: Patients who are currently receiving another
investigational drug are not eligible
Anti-cancer Agents: Patients who are currently receiving other anti-cancer agents are not eligible
Anticonvulsants: Patients who are receiving enzyme inducing anticonvulsants as listed in appendix II, are not eligible
Patients who are receiving rifampin are not eligible
Patients who are receiving medications known to prolong QTc interval as listed in appendix III are not eligible
Patients who are receiving duloxetine, alosetron or theophylline (CYP1A2 inhibitors) are not eligible
Patients on beta-blockers are not eligible
Selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), Fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft) should be used with caution but are not contraindicated
Anticoagulants: patients who are receiving therapeutic anticoagulants including warfarin, low-molecular weight heparin are not eligible
Nasogastric or G tube administration of PTC596 is not permissible
Infection: Patients who have an uncontrolled infection 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
Patients with evidence of bowel obstruction, malabsorption, or other
contraindication to oral medication are not eligible
Patients with GI disease or other condition that could affect absorption or
predispose subject to gastrointestinal ulceration are not eligible
Patients with an active peptic ulcer disease or inflammatory bowel disease
(including ulcerative colitis and Crohn's disease), diverticulitis
cholecystitis, symptomatic cholangitis or appendicitis are not eligible
Patients with serious non-healing wounds, ulcers, or bone fractures are not
eligible
Patients with moderate to severe pulmonary problems generally defined by need
for medical intervention (e.g., oxygen, medications) and/or limiting
activities of daily living (generally CTCAE Grade 2 or higher) or shortness of
breath with limited exertion are not eligible Pulmonary conditions include
(but are not limited to) COPD, asthma, and hemi-pneumectomy
Patients with malignancy related to HIV or solid organ transplant: known
history of HIV, HBV surface antigen positivity or positive HCV antibody are
not eligible. Viral testing is not required unless clinically indicated in
patients without a known history
Patient with prior or ongoing clinically significant illness, medical or
psychiatric condition, medical history, physical findings, ECG findings, or
laboratory abnormality that, in the investigator's opinion, could affect the
safety of the subject, or alter the absorption, distribution, metabolism, or
excretion of the study drugs, or could impair the assessment of study results
are not eligible
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