Non Hodgkin Lymphoma Clinical Trial
Ensartinib in Treating Patients With Relapsed or Refractory Advanced Solid Tumors, Non-Hodgkin Lymphoma, or Histiocytic Disorders With ALK or ROS1 Genomic Alterations (A Pediatric MATCH Treatment Trial)
Summary
This phase II Pediatric MATCH trial studies how well ensartinib works in treating patients with solid tumors, non-Hodgkin lymphoma, or histiocytic disorders with ALK or ROS1 genomic alterations that have come back (recurrent) or do not respond to treatment (refractory) and have spread to other places in the body (advanced). Ensartinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.
Full Description
PRIMARY OBJECTIVE:
I. To determine the objective response rate (ORR; complete response + partial response) in pediatric patients treated with ensartinib with advanced solid tumors (including central nervous system [CNS] tumors), non-Hodgkin lymphomas or histiocytic disorders that harbor ALK or ROS1 fusions or that harbor ALK missense mutations.
SECONDARY OBJECTIVES:
I. To estimate the progression free survival in pediatric patients treated with ensartinib with advanced solid tumors (including CNS tumors), non-Hodgkin lymphomas or histiocytic disorders that harbor ALK or ROS1 fusions or that harbor ALK missense mutations.
II. To obtain information about the tolerability of ensartinib in children with relapsed or refractory cancer.
III. To provide preliminary estimates of the pharmacokinetics of ensartinib in children with relapsed or refractory cancer.
EXPLORATORY OBJECTIVES:
I. To evaluate other biomarkers as predictors of response to ensartinib and specifically, whether tumors that harbor different missense mutations or fusions (including the crizotinib resistant F1174L ALK variant) will demonstrate differential response to ensartinib treatment.
II. To explore approaches to profiling changes in tumor genomics over time through evaluation of circulating tumor deoxyribonucleic acid (DNA).
OUTLINE:
Patients receive ensartinib orally (PO) once daily (QD) on days 1-28. Cycles repeat every 28 days for 2 years (up to 26 cycles) in the absence of disease progression or unacceptable toxicity. Patients undergo an x-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, radionuclide imaging, and/or bone scan, as well as a bone marrow aspiration and/or biopsy during screening and on study. Patients also undergo blood sample collection on study.
Eligibility Criteria
Inclusion Criteria:
Patient must have enrolled onto APEC1621SC and must have been given a treatment assignment to Molecular Analysis for Therapy Choice (MATCH) to APEC1621F based on the presence of an actionable mutation
Patients must be >= than 12 months and =< 21 years of age at the time of study enrollment.
Patients must have a body surface area >= 0.5 m^2 at enrollment
Patients must have radiographically measurable disease at the time of study enrollment. Patients with neuroblastoma who do not have measurable disease but have iobenguane (MIBG) positive (+) evaluable disease are eligible; measurable disease in patients with CNS involvement is defined as any lesion that is at minimum 10 mm in one dimension on a standard MRI or CT
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 cerebrospinal 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 counts [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 none 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 ensartinib; prior treatment with other ALK inhibitors is permitted given that at least 5 half-lives or 21 days have elapsed since therapy discontinuation, whichever is greater
For patients with solid tumors without known bone marrow involvement:
Peripheral absolute neutrophil count (ANC) >= 1000/mm^3 (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) (within 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 1 to < 2 years: maximum serum creatinine 0.6 mg/dL for male and 0.6 mg/dL for female
Age 2 to < 6 years: maximum serum creatinine 0.8 mg/dL for male and 0.8 mg/dL for female
Age 6 to < 10 years: maximum serum creatinine 1 mg/dL for male and 1 mg/dL for female
Age 10 to < 13 years: maximum serum creatinine 1.2 mg/dL for male and 1.2 mg/dL for female
Age 13 to < 16 years: maximum serum creatinine 1.5 mg/dL for male and 1.4 mg/dL for female
Age >= 16 years: maximum serum creatinine 1.7 mg/dL for male and 1.4 mg/dL for female
Bilirubin (sum of conjugated + unconjugated) =< 1.5 x upper limit of normal (ULN) for age (within 7 days prior to enrollment)
Serum glutamic pyruvic 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)
Patients must be able to swallow intact capsules
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 because there is currently no available information regarding human fetal or teratogenic toxicities; 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 for the duration of study treatment and for one week after the last dose of ensartinib
Concomitant medications
Corticosteroids: 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
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
Anti-GVHD agents post-transplant: 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
CYP3A4 agents: patients who are currently receiving drugs that are strong inducers or strong 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
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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There are 122 Locations for this study
Birmingham Alabama, 35233, United States More Info
Principal Investigator
Anchorage Alaska, 99508, United States More Info
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Mesa Arizona, 85202, United States More Info
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Tucson Arizona, 85719, United States More Info
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Little Rock Arkansas, 72202, United States More Info
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Downey California, 90242, United States More Info
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Loma Linda California, 92354, United States More Info
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Long Beach California, 90806, United States
Los Angeles California, 90027, United States More Info
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Madera California, 93636, United States More Info
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Oakland California, 94609, United States More Info
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Oakland California, 94611, United States More Info
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Orange California, 92868, United States More Info
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Sacramento California, 95817, United States More Info
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San Francisco California, 94158, United States More Info
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Aurora Colorado, 80045, United States More Info
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Denver Colorado, 80218, United States More Info
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New Haven Connecticut, 06520, United States
Wilmington Delaware, 19803, United States More Info
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Washington District of Columbia, 20010, United States More Info
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Gainesville Florida, 32610, United States More Info
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Jacksonville Florida, 32207, United States More Info
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Miami Florida, 33136, United States More Info
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Miami Florida, 33155, United States More Info
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Orlando Florida, 32803, United States More Info
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Orlando Florida, 32806, United States More Info
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Orlando Florida, 32827, United States More Info
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Pensacola Florida, 32504, United States
Saint Petersburg Florida, 33701, United States More Info
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Tampa Florida, 33607, United States
Atlanta Georgia, 30322, United States More Info
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Boise Idaho, 83712, United States More Info
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Chicago Illinois, 60611, United States More Info
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Chicago Illinois, 60637, United States More Info
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Peoria Illinois, 61637, United States More Info
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Springfield Illinois, 62702, United States More Info
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Indianapolis Indiana, 46202, United States More Info
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Des Moines Iowa, 50309, United States More Info
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Iowa City Iowa, 52242, United States More Info
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Louisville Kentucky, 40202, United States More Info
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New Orleans Louisiana, 70118, United States More Info
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New Orleans Louisiana, 70121, United States More Info
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Bangor Maine, 04401, United States More Info
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Baltimore Maryland, 21201, United States
Baltimore Maryland, 21215, United States More Info
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Baltimore Maryland, 21287, United States More Info
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Boston Massachusetts, 02114, United States More Info
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Boston Massachusetts, 02215, United States More Info
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Ann Arbor Michigan, 48109, United States More Info
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East Lansing Michigan, 48824, United States More Info
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Grand Rapids Michigan, 49503, United States More Info
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Kalamazoo Michigan, 49007, United States More Info
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Minneapolis Minnesota, 55404, United States More Info
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Minneapolis Minnesota, 55455, United States More Info
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Rochester Minnesota, 55905, United States More Info
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Jackson Mississippi, 39216, United States More Info
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Kansas City Missouri, 64108, United States More Info
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Saint Louis Missouri, 63104, United States More Info
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Saint Louis Missouri, 63110, United States More Info
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Saint Louis Missouri, 63141, United States More Info
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Omaha Nebraska, 68114, United States More Info
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Omaha Nebraska, 68198, United States More Info
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Las Vegas Nevada, 89102, United States
Las Vegas Nevada, 89135, United States
Las Vegas Nevada, 89144, United States
Hackensack New Jersey, 07601, United States More Info
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Morristown New Jersey, 07960, United States More Info
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New Brunswick New Jersey, 08901, United States More Info
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Albany New York, 12208, United States More Info
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Bronx New York, 10467, United States More Info
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Buffalo New York, 14263, United States More Info
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New Hyde Park New York, 11040, United States More Info
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New York New York, 10032, United States More Info
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New York New York, 10065, United States More Info
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New York New York, 10065, United States More Info
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Rochester New York, 14642, United States More Info
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Syracuse New York, 13210, United States More Info
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Valhalla New York, 10595, United States More Info
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Asheville North Carolina, 28801, United States More Info
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Charlotte North Carolina, 28203, United States More Info
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Charlotte North Carolina, 28204, United States More Info
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Durham North Carolina, 27710, United States More Info
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Winston-Salem North Carolina, 27157, United States More Info
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Winston-Salem North Carolina, 27157, United States More Info
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Fargo North Dakota, 58122, United States More Info
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Cincinnati Ohio, 45229, United States More Info
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Cleveland Ohio, 44106, United States More Info
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Cleveland Ohio, 44195, United States
Columbus Ohio, 43205, United States More Info
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Dayton Ohio, 45404, United States More Info
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Toledo Ohio, 43606, United States More Info
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Oklahoma City Oklahoma, 73104, United States More Info
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Portland Oregon, 97227, United States More Info
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Portland Oregon, 97239, United States More Info
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Danville Pennsylvania, 17822, United States More Info
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Philadelphia Pennsylvania, 19104, United States More Info
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Pittsburgh Pennsylvania, 15224, United States More Info
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Columbia South Carolina, 29203, United States More Info
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Greenville South Carolina, 29605, United States More Info
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Sioux Falls South Dakota, 57117, United States More Info
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Knoxville Tennessee, 37916, United States
Memphis Tennessee, 38105, United States More Info
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Nashville Tennessee, 37203, United States More Info
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Nashville Tennessee, 37232, United States More Info
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Austin Texas, 78723, United States More Info
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Dallas Texas, 75230, United States More Info
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Dallas Texas, 75390, United States More Info
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Fort Worth Texas, 76104, United States More Info
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Houston Texas, 77030, United States More Info
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Houston Texas, 77030, United States More Info
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San Antonio Texas, 78207, United States More Info
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San Antonio Texas, 78229, United States More Info
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San Antonio Texas, 78229, United States More Info
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Salt Lake City Utah, 84113, United States More Info
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Burlington Vermont, 05405, United States More Info
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Norfolk Virginia, 23507, United States More Info
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Richmond Virginia, 23298, United States More Info
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Seattle Washington, 98105, United States More Info
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Spokane Washington, 99204, United States More Info
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Tacoma Washington, 98431, United States More Info
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Morgantown West Virginia, 26506, United States
Madison Wisconsin, 53792, United States More Info
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Marshfield Wisconsin, 54449, United States More Info
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Milwaukee Wisconsin, 53226, United States More Info
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San Juan , 00912, Puerto Rico
San Juan , 00926, Puerto Rico More Info
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