Selpercatinib for the Treatment of Advanced Solid Tumors Lymphomas or Histiocytic Disorders With Activating RET Gene Alterations a Pediatric MATCH Treatment Trial

  • STATUS
    Recruiting
  • End date
    Sep 30, 2027
  • participants needed
    49
  • sponsor
    National Cancer Institute (NCI)
Updated on 12 September 2021
platelet count
cancer
corticosteroids
ascites
stem cell transplantation
graft versus host disease
total body irradiation
lymphoma
absolute neutrophil count
metastatic disease
nitrosoureas
tumor markers
cytokines
measurable disease
interferon
growth factor
pleural effusion
stem cell infusion
cns involvement
MRI
bone marrow procedure
glomerular filtration rate
colony stimulating factor
hematopoietic growth factors
cytotoxic chemotherapy
metastasis
neutrophil count
RET
blood transfusion
cancer treatment
nitrosourea
chemotherapeutic agents
interleukins
cancer therapy
antineoplastic
solid tumor
stem cell transplant
blood count
cns metastases
match treatment
radiopharmaceutical therapy
antibody therapy
cns tumors
platelet transfusion
radiopharmaceutical
131i-mibg
iobenguane
autologous stem cell infusion
pegfilgrastim
myelosuppressive chemotherapy
donor lymphocyte infusion
cellular therapy
platelet transfusions
anti-cancer agents
cns tumor
pleural effusions
bone marrow infiltration

Summary

This phase II pediatric MATCH trial studies how well selpercatinib works in treating patients with solid tumors that have spread to other places in the body (advanced), lymphomas, or histiocytic disorders that have activating RET gene alterations. Selpercatinib may block the growth of cancer cells that have specific genetic changes in an important signaling pathway (called the RET pathway) and may reduce tumor size.

Description

PRIMARY OBJECTIVE:

I. To determine the objective response rate (ORR; complete response + partial response) in pediatric patients treated with selpercatinib (LOXO-292) with advanced solid tumors (including central nervous system [CNS] tumors), lymphomas or histiocytic disorders that harbor activating genetic alterations in the RET pathway.

SECONDARY OBJECTIVES:

I. To estimate the progression free survival in pediatric patients treated with LOXO-292 with advanced solid tumors (including CNS tumors), lymphomas or histiocytic disorders that harbor activating genetic alterations in the RET pathway.

II. To obtain information about the tolerability of LOXO-292 in children and adolescents with relapsed or refractory cancer.

EXPLORATORY OBJECTIVE:

I. To explore approaches to profiling changes in tumor genomics over time through evaluation of circulating tumor deoxyribonucleic acid (DNA).

OUTLINE

Patients receive selpercatinib orally (PO) twice daily (BID) on days 1-28. Treatment repeats every 28 days for up to 26 cycles (2 years) in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed for 30 days, then periodically thereafter.

Details
Condition Hematologic Malignancy, Malignant neoplasm of kidney, Hereditary Neoplastic Syndrome, Nephroblastoma, Recurrent Malignant Glioma, Refractory Non Hodgkin Lymphoma, Recurrent Malignant Solid Neoplasm, Recurrent Osteosarcoma, Recurrent Neuroblastoma, Recurrent Rhabdomyosarcoma, Refractory Malignant Solid Neoplasm, Recurrent Lymphoma, Refractory Lymphoma, Recurrent Ewing Sarcoma, Recurrent Hepatoblastoma, Recurrent Medulloblastoma, Refractory Neuroblastoma, Recurrent Langerhans Cell Histiocytosis, Recurrent Peripheral Primitive Neuroectodermal Tumor, Recurrent Rhabdoid Tumor, Recurrent Soft Tissue Sarcoma, Refractory Langerhans Cell Histiocytosis, Refractory Malignant Germ Cell Tumor, Refractory Malignant Glioma, Refractory Medulloblastoma, Refractory Osteosarcoma, Refractory Peripheral Primitive Neuroectodermal Tumor, Refractory Rhabdoid Tumor, Refractory Soft Tissue Sarcoma, Recurrent Malignant Germ Cell Tumor, Refractory Ependymoma, Recurrent Ependymoma, Refractory Ewing Sarcoma, Refractory Hepatoblastoma, Refractory Rhabdomyosarcoma, Recurrent Histiocytic and Dendritic Cell Neoplasm, Refractory Histiocytic and Dendritic Cell Neoplasm, Kidney Cancer, Blood Cancer, Wilms' Tumor, Hematologic Cancer, Hereditary Cancer Syndromes, Renal Cancer, Hematologic Neoplasms, Recurrent WHO Grade II Glioma, Refractory WHO Grade II Glioma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, hematopoietic and lymphoid cell neoplasm, recurrent low grade glioma, hematopoietic malignancy, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Non-Hodgkin Lymphoma
Treatment Selpercatinib
Clinical Study IdentifierNCT04320888
SponsorNational Cancer Institute (NCI)
Last Modified on12 September 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Patient must have enrolled onto APEC1621SC and must have been given a treatment assignment to MATCH to APEC1621N based on the presence of an actionable mutation
Patients must have radiographically measurable disease at the time of study enrollment. Patients with neuroblastoma who do not have measurable disease but have metaiodobenzylguanidine (MIBG) positive (+) evaluable disease are eligible. Measurable disease in patients with CNS involvement is defined as tumor that is measurable in two perpendicular diameters on magnetic resonance imaging (MRI) and visible on more than one slice
Note: The following do not qualify as measurable disease
Malignant fluid collections (e.g., ascites, pleural effusions)
Bone marrow infiltration except that detected by MIBG scan for neuroblastoma
Lesions only detected by nuclear medicine studies (e.g., bone, gallium or positron emission tomography [PET] scans) except as noted for neuroblastoma
Elevated tumor markers in plasma or cerebral spinal fluid (CSF)
Previously radiated lesions that have not demonstrated clear progression post radiation
Leptomeningeal lesions that do not meet the measurement requirements for Response Evaluation Criteria in Solid Tumors (RECIST) 1.1
Karnofsky >= 50% for patients > 16 years of age and Lansky >= 50 for patients =< 16 years of age. Note: Neurologic deficits in patients with CNS tumors must have been relatively stable for at least 7 days prior to study enrollment. 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
Patients must have fully recovered from the acute toxic effects of all prior anti-cancer therapy and must meet the following minimum duration from prior anti-cancer directed therapy prior to enrollment. If after the required timeframe, the numerical eligibility criteria are met, e.g. blood count criteria, the patient is considered to have recovered adequately
Cytotoxic chemotherapy or other anti-cancer agents known to be myelosuppressive
>= 21 days after the last dose of cytotoxic or myelosuppressive chemotherapy (42 days if prior nitrosourea)
Anti-cancer agents not known to be myelosuppressive (e.g. not associated with reduced platelet or absolute neutrophil [ANC] counts): >= 7 days after the last dose of agent
Antibodies: >= 21 days must have elapsed from infusion of last dose of antibody, and toxicity related to prior antibody therapy must be recovered to grade =< 1
Corticosteroids: If used to modify immune adverse events related to prior therapy, >= 14 days must have elapsed since last dose of corticosteroid
Hematopoietic growth factors: >= 14 days after the last dose of a long-acting growth factor (e.g. pegfilgrastim) or 7 days for short-acting growth factor. For growth factors that have known adverse events occurring beyond 7 days after administration, this period must be extended beyond the time during which adverse events are known to occur. The duration of this interval must be discussed with the study chair and the study-assigned research coordinator
Interleukins, interferons and cytokines (other than hematopoietic growth factors): >= 21 days after the completion of interleukins, interferon or cytokines (other than hematopoietic growth factors)
Stem cell infusions (with or without total body irradiation [TBI])
Allogeneic (non-autologous) bone marrow or stem cell transplant, or any stem cell infusion including donor lymphocyte infusion (DLI) or boost infusion: >= 84 days after infusion and no evidence of graft versus host disease (GVHD)
Autologous stem cell infusion including boost infusion: >= 42 days
Cellular therapy: >= 42 days after the completion of any type of cellular therapy (e.g. modified T cells, natural killer [NK] cells, dendritic cells, etc.)
Radiation therapy (XRT)/external beam irradiation including protons: >= 14 days after local XRT; >= 150 days after TBI, craniospinal XRT or if radiation to >= 50% of the pelvis; >= 42 days if other substantial bone marrow (BM) radiation
Note: Radiation may not be delivered to "measurable disease" tumor site(s) being used to follow response to subprotocol treatment
Radiopharmaceutical therapy (e.g., radiolabeled antibody, 131I-MIBG): >= 42 days after systemically administered radiopharmaceutical therapy
Patients must not have received prior exposure to LOXO-292 or other specific RET inhibitors
For patients with solid tumors without known bone marrow involvement (within 7 days prior to enrollment)
Peripheral absolute neutrophil count (ANC) >= 1000/mm^3
For patients with solid tumors without known bone marrow involvement (within 7 days prior to enrollment)
Platelet count >= 100,000/mm^3 (transfusion independent, defined as not receiving platelet transfusions for at least 7 days prior to enrollment)
Patients with known bone marrow metastatic disease will be eligible for study provided they meet the blood counts (may receive transfusions provided they are not known to be refractory to red cell or platelet transfusions). These patients will not be evaluable for hematologic toxicity
Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 ml/min/1.73 m^2 (within 7 days prior to enrollment) or a serum creatinine based on age/gender as follows (within 7 days prior to enrollment)
Age: Maximum serum creatinine (mg/dL)
to < 2 years: male (0.6), female (0.6)
to < 6 years: male (0.8), female (0.8)
to < 10 years: male (1), female (1)
to < 13 years: male (1.2), female (1.2)
to < 16 years: male (1.5), female (1.4)
>= 16 years: male (1.7), female (1.4)
Bilirubin (sum of conjugated + unconjugated) =< 1.5 x upper limit of normal (ULN) for age (within 7 days prior to enrollment)
Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 135 U/L. (within 7 days prior to enrollment) (For the purpose of this study, the ULN for SGPT is 45 U/L.)
Serum albumin >= 2 g/dL (within 7 days prior to enrollment)
Corrected QT (QTc) interval =< 480 milliseconds (within 7 days prior to enrollment)
All patients and/or their parents or legally authorized representatives must sign a written informed consent. Assent, when appropriate, will be obtained according to institutional guidelines

Exclusion Criteria

Pregnant or breast-feeding women will not be entered on this study due to 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 two (2) highly effective contraceptive method for the duration of study treatment and for at least 3 months after the last dose of LOXO-292. Male study participants are to refrain from sperm donation during treatment and for 6 months after the last dose of LOXO-292
Patients receiving corticosteroids who have not been on a stable or decreasing dose of corticosteroid for at least 7 days prior to enrollment are not eligible. If used to modify immune adverse events related to prior therapy, >= 14 days must have elapsed since last dose of corticosteroid
Patients who are currently receiving another investigational drug are not eligible
Patients who are currently receiving other anti-cancer agents are not eligible
Patients who are receiving cyclosporine, tacrolimus or other agents to prevent graft-versus-host disease post bone marrow transplant are not eligible for this trial
Patients who are currently receiving drugs that are moderate or strong inducers or inhibitors of CYP3A4 are not eligible. Strong inducers or inhibitors of CYP3A4 should be avoided from 14 days prior to enrollment to the end of the study. Note: CYP3A4 inducing anti-epileptic drugs and dexamethasone for CNS tumors or metastases, on a stable dose, are allowed
Concomitant use of proton pump inhibitors (PPI)s during LOXO-292 therapy is prohibited. PPIs are to be discontinued at least 1 week prior to the start of protocol therapy
Patients who have major surgery within 14 days prior to cycle 1 day 1 (C1D1) are not eligible. (Central line placement or subcutaneous port placement is not considered major surgery)
Patients with known clinically significant active malabsorption syndrome or other condition likely to affect gastrointestinal absorption of LOXO-292 are excluded
Patients with known hypersensitivity to any of the components of the investigational agent, LOXO 292 are excluded
Patients with uncontrolled hypertension are excluded
Patients with uncontrolled symptomatic hyperthyroidism and hypothyroidism (i.e. the patient required a modification to current thyroid medication in 7 days prior to enrollment) are excluded
Patients with uncontrolled symptomatic hypercalcemia and hypocalcemia are excluded
Patients who have an uncontrolled infection are not eligible
Patients who have received a prior solid organ transplantation 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
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