1
|
Bautista F, Verdú-Amorós J, Geoerger B, Rubio-San-Simón A, Paoletti X, Zwaan CM, Casanova M, Marshall LV, Carceller F, Doz F, Lecinse C, Vassal G, Pearson ADJ, Kearns P, Moreno L. Evolution of the Innovative Therapies for Children With Cancer Consortium Trial Portfolio for Drug Development for Children With Cancer. J Clin Oncol 2024; 42:2516-2526. [PMID: 38743911 DOI: 10.1200/jco.23.01237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/09/2024] [Accepted: 02/29/2024] [Indexed: 05/16/2024] Open
Abstract
PURPOSE The aim of the Innovative Therapies for Children with Cancer (ITCC) consortium is to improve access to novel therapies for children and adolescents with cancer. The evolution of the ITCC clinical trial portfolio since 2003 was reviewed. METHODS All ITCC-labeled phase I/II trials opened between January 1, 2003 and February 3, 2018 were analyzed in two periods (2003-2010 and 2011-2018), and data were extracted from the ITCC database, regulatory agencies' registries, and publications. RESULTS Sixty-one trials (62% industry-sponsored) enrolled 3,198 patients. The number of trials in the second period increased by almost 300% (16 v 45). All biomarker-driven trials (n = 14) were conducted in the second period. The use of rolling six and model-based designs increased (1 of 9, 11% v 21 of 31, 68%), and that of 3 + 3 designs decreased (5 of 9, 55% v 5 of 31, 16%; P = .014). The proportion of studies evaluating chemotherapeutics only decreased (5 of 16, 31% v 4 of 45, 9%), the proportion of single-agent targeted therapies did not change (9 of 16, 56.2% v 24 of 45, 53.3%), the proportion of combination targeted therapies trials increased (2 of 16, 12%, v 17 of 45, 38%), the proportion of randomized phase II trials increased (1 of 7, 14% v 8 of 14, 57%). More trials were part of a pediatric investigation plan in the second period (4 of 16, 25% v 21 of 45, 46%). The median time for Ethics Committees' approvals was 1.7 times longer for academic compared with industry-sponsored trials. CONCLUSION This study reports a shift in the paradigm of early drug development for childhood cancers, with more biologically relevant targets evaluated in biomarker-driven trials or in combination with other therapies and with more model-based or randomized designs and a greater focus on fulfilling regulatory requirements. Improvement of trial setup and recruitment could increase the number of patients benefiting from novel agents.
Collapse
Affiliation(s)
- Francisco Bautista
- Division of Pediatric Hematology and Oncology, Hospital Universitario Niño Jesús, Madrid, Spain
- Princess Máxima Center, Utrecht, the Netherlands
| | - Jaime Verdú-Amorós
- Division of Pediatric Hematology and Oncology, Hospital Universitario Niño Jesús, Madrid, Spain
- Division of Pediatric Hematology and Oncology, Hospital Clínico Universitario de Valencia, Biomedical Research Institute, INCLIVA, Valencia, Spain
| | - Birgit Geoerger
- Pediatric and Adolescent Oncology Department, Gustave Roussy Cancer Campus, INSERM U1015, Université Paris-Saclay, Villejuif, France
| | - Alba Rubio-San-Simón
- Division of Pediatric Hematology and Oncology, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Xavier Paoletti
- Institut Curie & Université Versailles St Quentin & INSERM U900 STAMPM, Paris, France
| | - C Michel Zwaan
- Princess Máxima Center, Utrecht, the Netherlands
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lynley V Marshall
- Pediatric and Adolescent Oncology Drug Development, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Fernando Carceller
- Pediatric and Adolescent Oncology Drug Development, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Francois Doz
- SIREDO Cancer Center (Care, Innovation and Research in Pediatric, Adolescents, and Young Adults Oncology), Curie Institute Paris, and University Paris Cité, Paris, France
| | - Carole Lecinse
- Innovative Therapies for Children with Cancer, Gustave Roussy Cancer Campus, Villejuif, France
| | - Gilles Vassal
- Innovative Therapies for Children with Cancer, Gustave Roussy Cancer Campus, Villejuif, France
| | - Andrew D J Pearson
- Pediatric and Adolescent Oncology Drug Development, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Pamela Kearns
- Institute of Cancer and Genomic Sciences, NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom
| | - Lucas Moreno
- Division of Pediatric Hematology and Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
2
|
Rubio-San-Simón A, Hladun Alvaro R, Juan Ribelles A, Castañeda Heredia A, Guerra-García P, Verdú-Amorós J, Andrés M, Cañete A, Rives S, Pérez-Martínez A, Mora J, Patiño-García A, Lassaleta A, Llort A, Ramírez M, Mata C, Gallego S, Martín-Broto J, Cruz O, Morales La Madrid A, Solano P, Martínez Romera I, Fernández-Teijeiro A, Bautista F, Moreno L. The paediatric cancer clinical research landscape in Spain: a 13-year multicentre experience of the new agents group of the Spanish Society of Paediatric Haematology and Oncology (SEHOP). Clin Transl Oncol 2021; 23:2489-2496. [PMID: 34076861 DOI: 10.1007/s12094-021-02649-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Early phase trials are crucial in developing innovative effective agents for childhood malignancies. We report the activity in early phase paediatric oncology trials in Spain from its beginning to the present time and incorporate longitudinal data to evaluate the trends in trial characteristics and recruitment rates. METHODS Members of SEHOP were contacted to obtain information about the open trials at their institutions. The study period was split into two equal periods for analysis: 2007-2013 and 2014-2020. RESULTS Eighty-one trials and two molecular platforms have been initiated. The number of trials has increased over the time of the study for all tumour types, with a predominance of trials available for solid tumours (66%). The number of trials addressed to tumours harbouring specific molecular alterations has doubled during the second period. The proportion of industry-sponsored compared to academic trials has increased over the same years. A total of 565 children and adolescents were included, with an increasing trend over the study period. For international trials, the median time between the first country study approval and the Spanish competent authority approval was 2 months (IQR 0-6.5). Fourteen out of 81 trials were sponsored by Spanish academic institutions. CONCLUSIONS The number of available trials, and the number of participating patients, has increased in Spain from 2007. Studies focused on molecular-specific targets are now being implemented. Barriers to accessing new drugs for all ranges of age and cancer diseases remain. Additionally, opportunities to improve academic research are still required in Spain.
Collapse
Affiliation(s)
- A Rubio-San-Simón
- Paediatric Oncology-Haematology Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - R Hladun Alvaro
- Paediatric Oncology-Haematology Department, Hospital Universitario Vall D'Hebrón, Barcelona, Spain
| | - A Juan Ribelles
- Paediatric Oncology-Haematology Department, Hospital Universitario Y Politécnico de La Fe, Valencia, Spain
| | | | - P Guerra-García
- Paediatric Oncology-Haematology Department, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain
| | - J Verdú-Amorós
- Paediatric Oncology-Haematology Department, Hospital Clínico Universitario, Valencia, Spain
| | - M Andrés
- Paediatric Oncology-Haematology Department, Hospital Universitario Y Politécnico de La Fe, Valencia, Spain
| | - A Cañete
- Paediatric Oncology-Haematology Department, Hospital Universitario Y Politécnico de La Fe, Valencia, Spain
| | - S Rives
- Paediatric Oncology-Haematology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - A Pérez-Martínez
- Paediatric Oncology-Haematology Department, Hospital La Paz, Madrid, Spain
| | - J Mora
- Paediatric Oncology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - A Patiño-García
- Paediatric Oncology-Haematology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - A Lassaleta
- Paediatric Oncology-Haematology Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - A Llort
- Paediatric Oncology-Haematology Department, Hospital Universitario Vall D'Hebrón, Barcelona, Spain
| | - M Ramírez
- Paediatric Oncology-Haematology Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - C Mata
- Paediatric Oncology-Haematology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - S Gallego
- Paediatric Oncology-Haematology Department, Hospital Universitario Vall D'Hebrón, Barcelona, Spain
| | - J Martín-Broto
- Medical Oncology Department, Fundación Jiménez Díaz, Madrid, Spain
| | - O Cruz
- Paediatric Oncology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - P Solano
- Paediatric Oncology-Haematology Department, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - I Martínez Romera
- Paediatric Oncology-Haematology Department, Hospital La Paz, Madrid, Spain
| | - A Fernández-Teijeiro
- Paediatric Oncology-Haematology Unit, Hospital Universitario Virgen Macarena, Seville, Spain
| | - F Bautista
- Paediatric Oncology-Haematology Department, Hospital Universitario Niño Jesús, Madrid, Spain. .,Paediatric Oncology, Haematology and Haematopoietic Stem Cell Transplant Department, Hospital Universitario Niño Jesús, Avenida Menéndez Pelayo, 65, 28009, Madrid, Spain.
| | - L Moreno
- Paediatric Oncology-Haematology Department, Hospital Universitario Vall D'Hebrón, Barcelona, Spain
| |
Collapse
|
3
|
Bautista F, Cañete A, Ramírez-Villar GL, Fernández JM, Fuster JL, Diaz de Heredia C, Astigarraga I, García-Ariza M, Rives S, Dapena JL, Márquez C, Molinés A, Bermúdez MDM, Gallego S, Andrés MDM, Verdu-Amoros J, Hernández C, López M, Catalá A, Lassaletta Á, Cruz O, Ramírez M, Lendínez F, Carboné A, Gomez Sirvent J, Tallón M, Acha T, Moreno L, Fernández-Teijeiro A. ECLIM-SEHOP, a new platform to set up and develop international academic clinical trials for childhood cancer and blood disorders in Spain. Clin Transl Oncol 2019; 21:1763-1770. [DOI: 10.1007/s12094-019-02221-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
Abstract
Introduction
Cancer and blood disorders in children are rare. The progressive improvement in survival over the last decades largely relies on the development of international academic clinical trials that gather the sufficient number of patients globally to elaborate solid conclusions and drive changes in clinical practice. The participation of Spain into large international academic trials has traditionally lagged behind of other European countries, mainly due to the burden of administrative tasks to open new studies, lack of financial support and limited research infrastructure in our hospitals.
Methods
The objective of ECLIM-SEHOP platform (Ensayos Clínicos Internacionales Multicéntricos-SEHOP) is to overcome these difficulties and position Spain among the European countries leading the advances in cancer and blood disorders, facilitate the access of our patients to novel diagnostic and therapeutic approaches and, most importantly, continue to improve survival and reducing long-term sequelae. ECLIM-SEHOP provides to the Spanish clinical investigators with the necessary infrastructural support to open and implement academic clinical trials and registries.
Results
In less than 3 years from its inception, the platform has provided support to 20 clinical trials and 8 observational studies, including 8 trials and 4 observational studies where the platform performs all trial-related tasks (integral support: trial setup, monitoring, etc.) with more than 150 patients recruited since 2017 to these studies. In this manuscript, we provide baseline metrics for academic clinical trial performance that permit future comparisons.
Conclusions
ECLIM-SEHOP facilitates Spanish children and adolescents diagnosed with cancer and blood disorders to access state-of-the-art diagnostic and therapeutic strategies.
Collapse
|
4
|
Carceller F, Bautista F, Jiménez I, Hladun-Álvaro R, Giraud C, Bergamaschi L, Dandapani M, Aerts I, Doz F, Frappaz D, Casanova M, Morland B, Hargrave DR, Vassal G, Pearson ADJ, Geoerger B, Moreno L, Marshall LV. Outcome of children and adolescents with central nervous system tumors in phase I trials. J Neurooncol 2017; 137:83-92. [PMID: 29236237 DOI: 10.1007/s11060-017-2698-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 11/24/2017] [Indexed: 11/25/2022]
Abstract
Central nervous system (CNS) tumors are a leading cause of death in pediatric oncology. New drugs are desperately needed to improve survival. We evaluated the outcome of children and adolescents with CNS tumors participating in phase I trials within the Innovative Therapies for Children with Cancer (ITCC) consortium. Patients with solid tumors aged < 18 years at enrollment in their first dose-finding trial between 2000 and 2014 at eight ITCC centers were included retrospectively. Survival was evaluated using univariate/multivariate analyses. Overall, 114 patients were included (109 evaluable for efficacy). Median age was 10.2 years (range 1.0-17.9). Main diagnoses included: medulloblastoma/primitive neuroectodermal tumors (32.5%) and high-grade gliomas (23.7%). Complete/partial responses (CR/PR) were reported in 7.3% patients and stable disease (SD) in 23.9%. Performance status of 90-100%, school/work attendance, normal ALT/AST and CR/PR/SD correlated with better overall survival (OS) in the univariate analysis. No variables assessable at screening/enrollment were associated with OS in the multivariate analysis. Five patients (4.5%) were discontinued from study due to toxicity. No toxic deaths occurred. Median OS was 11.9 months with CR/PR, 14.5 months with SD and 3.7 months with progressive disease (p < 0.001). The enrollment of children and adolescents with CNS tumors in phase I trials is feasible, safe and offers potential benefit for the patients. Sustained disease stabilization has a promising role as a marker of anti-tumor activity in children with CNS tumors participating in phase I trials.
Collapse
Affiliation(s)
- Fernando Carceller
- Pediatric and Adolescent Drug Development, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust - Paediatric Offices, Downs Road, Sutton, SM2 5PT, UK.
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK.
| | - Francisco Bautista
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, UMR 8203, CNRS, Univ. Paris-Sud, 114 Rue Edouard Vaillant, 94800, Villejuif, France
- Clinical Trials Unit, Pediatric Oncology Department, Hospital Infantil Universitario Niño Jesús, Avenida de Menéndez Pelayo, 65, 28009, Madrid, Spain
| | - Irene Jiménez
- Department of Pediatric, Adolescents and Young Adults Oncology, Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | - Raquel Hladun-Álvaro
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, UMR 8203, CNRS, Univ. Paris-Sud, 114 Rue Edouard Vaillant, 94800, Villejuif, France
- Department of Pediatric Oncology, Vall d'Hebron Hospital, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Cécile Giraud
- Department of Pediatric Clinical Trials and Department of Pediatric Neuro-Oncology, Institut Hématologique et d'Oncologie Pédiatrique, 1 Place Professeur Joseph Renaut, 69008, Lyon, France
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, Milan, Italy
| | - Madhumita Dandapani
- Department of Pediatric Oncology, Birmingham Children's Hospital, Steelhouse Ln, Birmingham, B4 6NH, UK
- Department of Pediatric Oncology, Notthingham Children's Hospital, Derby Road, Nottingham, NG7 2UH, UK
| | - Isabelle Aerts
- Department of Pediatric, Adolescents and Young Adults Oncology, Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | - François Doz
- Department of Pediatric, Adolescents and Young Adults Oncology, Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
- Université Paris Descartes, 12 Rue de l'École de Médecine, 75006, Paris, France
| | - Didier Frappaz
- Department of Pediatric Clinical Trials and Department of Pediatric Neuro-Oncology, Institut Hématologique et d'Oncologie Pédiatrique, 1 Place Professeur Joseph Renaut, 69008, Lyon, France
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, Milan, Italy
| | - Bruce Morland
- Department of Pediatric Oncology, Birmingham Children's Hospital, Steelhouse Ln, Birmingham, B4 6NH, UK
| | - Darren R Hargrave
- Pediatric Oncology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Gilles Vassal
- Department of Clinical Research, Gustave Roussy, Université Paris-Sud, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Andrew D J Pearson
- Pediatric and Adolescent Drug Development, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust - Paediatric Offices, Downs Road, Sutton, SM2 5PT, UK
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Birgit Geoerger
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, UMR 8203, CNRS, Univ. Paris-Sud, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Lucas Moreno
- Clinical Trials Unit, Pediatric Oncology Department, Hospital Infantil Universitario Niño Jesús, Avenida de Menéndez Pelayo, 65, 28009, Madrid, Spain
| | - Lynley V Marshall
- Pediatric and Adolescent Drug Development, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust - Paediatric Offices, Downs Road, Sutton, SM2 5PT, UK
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| |
Collapse
|
5
|
Bautista F, Fioravantti V, de Rojas T, Carceller F, Madero L, Lassaletta A, Moreno L. Medulloblastoma in children and adolescents: a systematic review of contemporary phase I and II clinical trials and biology update. Cancer Med 2017; 6:2606-2624. [PMID: 28980418 PMCID: PMC5673921 DOI: 10.1002/cam4.1171] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 12/12/2022] Open
Abstract
Survival rates for patients with medulloblastoma have improved in the last decades but for those who relapse outcome is dismal and new approaches are needed. Emerging drugs have been tested in the last two decades within the context of phase I/II trials. In parallel, advances in genetic profiling have permitted to identify key molecular alterations for which new strategies are being developed. We performed a systematic review focused on the design and outcome of early-phase trials evaluating new agents in patients with relapsed medulloblastoma. PubMed, clinicaltrials.gov, and references from selected studies were screened to identify phase I/II studies with reported results between 2000 and 2015 including patients with medulloblastoma aged <18 years. A total of 718 studies were reviewed and 78 satisfied eligibility criteria. Of those, 69% were phase I; 31% phase II. Half evaluated conventional chemotherapeutics and 35% targeted agents. Overall, 662 patients with medulloblastoma/primitive neuroectodermal tumors were included. The study designs and the response assessments were heterogeneous, limiting the comparisons among trials and the correct identification of active drugs. Median (range) objective response rate (ORR) for patients with medulloblastoma in phase I/II studies was 0% (0-100) and 6.5% (0-50), respectively. Temozolomide containing regimens had a median ORR of 16.5% (0-100). Smoothened inhibitors trials had a median ORR of 8% (3-8). Novel drugs have shown limited activity against relapsed medulloblastoma. Temozolomide might serve as backbone for new combinations. Novel and more homogenous trial designs might facilitate the development of new drugs.
Collapse
Affiliation(s)
- Francisco Bautista
- CNIO‐HNJ Clinical Research UnitPediatric Oncology, Hematology and Stem Cell Transplant DepartmentHospital Infantil Universitario Niño JesúsAvenida Menéndez Pelayo, 6528009MadridSpain
| | - Victoria Fioravantti
- CNIO‐HNJ Clinical Research UnitPediatric Oncology, Hematology and Stem Cell Transplant DepartmentHospital Infantil Universitario Niño JesúsAvenida Menéndez Pelayo, 6528009MadridSpain
| | - Teresa de Rojas
- CNIO‐HNJ Clinical Research UnitPediatric Oncology, Hematology and Stem Cell Transplant DepartmentHospital Infantil Universitario Niño JesúsAvenida Menéndez Pelayo, 6528009MadridSpain
| | - Fernando Carceller
- Pediatric and Adolescent Drug Development, Children and Young People's UnitThe Royal Marsden NHS Foundation TrustLondonUK
- Division of Clinical Studies and Cancer TherapeuticsThe Institute of Cancer ResearchLondonUK
| | - Luis Madero
- CNIO‐HNJ Clinical Research UnitPediatric Oncology, Hematology and Stem Cell Transplant DepartmentHospital Infantil Universitario Niño JesúsAvenida Menéndez Pelayo, 6528009MadridSpain
| | - Alvaro Lassaletta
- CNIO‐HNJ Clinical Research UnitPediatric Oncology, Hematology and Stem Cell Transplant DepartmentHospital Infantil Universitario Niño JesúsAvenida Menéndez Pelayo, 6528009MadridSpain
| | - Lucas Moreno
- CNIO‐HNJ Clinical Research UnitPediatric Oncology, Hematology and Stem Cell Transplant DepartmentHospital Infantil Universitario Niño JesúsAvenida Menéndez Pelayo, 6528009MadridSpain
- Instituto de Investigación La PrincesaMadridSpain
| |
Collapse
|