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Knörr F, Schellekens KPJ, Schoot RA, Landman-Parker J, Teltschik HM, Förster J, Riquelme A, Huitema ADR, Van Eijkelenburg NKA, Beishuizen A, Zwaan CM, Woessmann W, Van der Lugt J. Combination therapy with crizotinib and vinblastine for relapsed or refractory pediatric ALK-positive anaplastic large cell lymphoma. Haematologica 2023; 108:1442-1446. [PMID: 36519329 PMCID: PMC10153539 DOI: 10.3324/haematol.2022.281896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Fabian Knörr
- Pediatric Hematology and Oncology, University Medical Center Hospital Hamburg-Eppendorf, Hamburg, Germany; Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg.
| | - Kim P J Schellekens
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Erasmus Medical Center, Sophia Children's Hospital, Rotterdam
| | | | - Judith Landman-Parker
- Pediatric Hematology, Immunology, Oncology, Sorbonne université, Hôpital Armand Trousseau, APHP, Paris
| | | | - Jan Förster
- Pediatric Hematology and Oncology, University Medical Center Hospital Hamburg-Eppendorf, Hamburg
| | - Amambay Riquelme
- Pediatric Hematology and Oncology, University Medical Center Hospital Hamburg-Eppendorf, Hamburg
| | - Alwin D R Huitema
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Dept. Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Dept. Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht
| | | | - Auke Beishuizen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Erasmus Medical Center, Sophia Children's Hospital, Rotterdam
| | - C Michel Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Erasmus Medical Center, Sophia Children's Hospital, Rotterdam
| | - Wilhelm Woessmann
- Pediatric Hematology and Oncology, University Medical Center Hospital Hamburg-Eppendorf, Hamburg
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Persson M, Jackson E, Duchatel R, Bramberger L, McEwen H, Kearney P, Findlay I, Douglas A, Kobbe B, Wagener R, Larsen M, Faridi P, Holst J, Mayall J, Gedye C, Hondermarck H, Horvat J, Nixon B, Cartaxo R, Koschmann C, Valdes-Mora F, Ortega DG, Nazarian J, Alonso MM, Hulleman E, Van der Lugt J, Vitanza N, Mueller S, Dun M. TMIC-06. ANTAGONISM OF DRD2 USING ONC201 INCREASED EXPRESSION OF ANTIGEN PRESENTATION PATHWAY PROTEINS IN DIFFUSE MIDLINE GLIOMA, RECRUITING TUMOR INFILTRATING LYMPHOCYTES IN VIVO. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Diffuse midline glioma (DMG) is a high-grade glioma with a median overall survival of 9-11 months. Radiotherapy is the only recognized treatment. The DMG tumor microenvironment (TME) contains few, if any, tumor infiltrating lymphocytes (TILs) or inflammatory cytokines, thus is distinctive of an ‘immunologically cold’ tumor/TME.1 DMG lack the expression of immunosuppressive immune checkpoint proteins, likely explaining the failure of immune checkpoint inhibitors (ICI) tested under clinical trials for DMG patients, and suggestive of an alternative mechanism underpinning the cold TME. 1 Glioblastomas also harbor a cold TME, which can be somewhat explained by T cell lymphopenia, influenced by the sequestration of T cells in the bone marrow (through Beta-arrestin-induced internalization of Sphingosine-1-phosphate receptor 1 [S1PR1]). 2 Dopaminergic activation of Beta-arrestin and hence S1PR1 internalization, is potentially regulated through dopaminergic peripheral nerves in primary and secondary lymphoid organs, regulated by the Dopamine receptor D2 (DRD2), that is highly expressed on T cells. ONC201 is a potent DRD2 antagonist, currently in phase I-III clinical trials for DMG patients, alone and in combination with radiotherapy and the PI3K/AKT inhibitor paxalisib (NCT05009992). Proteomic profiling of DMG patient-derived cells +/-ONC201 showed increased expression of several antigen presenting pathway proteins, including Beta-2-microglobulin (B2M) and HLA class I histocompatibility antigen, A alpha chain (HLA-A). This was confirmed in vivo using SU-DIPG-VI patient-derived xenograft mouse model tissues +/-ONC201 alone, and together with paxalisib. Excitingly, this combination (given orally) promoted the recruitment of TILs to the tumor, revealing novel immunomodulatory effects. In vivo, ONC201 promoted the expression of EMILIN-3, a TGF-β antagonist that is known to inhibit HLA-A/B2M expression, possibly explaining the increased MHC-I activity. This study uncovers a novel link between treatment of DMG with ONC201 and paxalisib and the role dopaminergic peripheral nerves signaling may play on the sequestration of T cells within lymphoid organs and lymphopenia.
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Affiliation(s)
- Mika Persson
- Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle , Callaghan, NSW , Australia
| | - Evangeline Jackson
- Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle , Callaghan, NSW , Australia
| | - Ryan Duchatel
- Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle , Callaghan, NSW , Australia
| | - Liesl Bramberger
- Department of Medicine, School of Clinical Sciences, Monash University , Melbourne, VIC , Australia
| | - Holly McEwen
- Cancer Signalling Research Group, School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle , Callaghan, NSW , Australia
| | - Padraic Kearney
- Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle , Callaghan, NSW , Australia
| | - Izac Findlay
- Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle , Callaghan, NSW , Australia
| | - Alicia Douglas
- Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle , Callaghan, NSW , Australia
| | - Birgit Kobbe
- Center for Biochemistry, Medical Faculty, University of Cologne, Cologne, Germany , Cologne , Germany
| | - Raimund Wagener
- Center for Biochemistry, Medical Faculty, University of Cologne, Cologne, Germany , Cologne , Germany
| | - Martin Larsen
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense M, Denmark , Odense M , Denmark
| | - Pouya Faridi
- Department of Medicine, School of Clinical Sciences, Monash University , Melbourne, VIC , Australia
| | - Jeff Holst
- Translational Cancer Metabolism Laboratory, School of Medical Sciences and Prince of Wales Clinical School, UNSW Sydney, Sydney , Australia
| | - Jemma Mayall
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle , Newcastle, NSW , Australia
| | - Craig Gedye
- Department of Medical Oncology, Calvary Mater Hospital , Waratah, NSW , Australia
| | - Hubert Hondermarck
- Cancer Neurobiology Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle , Callaghan, NSW , Australia
| | - Jay Horvat
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle , Newcastle, NSW , Australia
| | - Brett Nixon
- Infertility and Reproduction Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW , Australia
| | - Rodrigo Cartaxo
- Department of Pediatrics, Michigan Medicine , Ann Arbor, MI , USA
| | - Carl Koschmann
- Department of Pediatrics, Michigan Medicine , Ann Arbor, MI , USA
| | - Fatima Valdes-Mora
- Cancer Epigenetics Biology and Therapeutics, Precision Medicine Theme, Children’s Cancer Institute , Sydney, NSW , Australia
| | - David Gallego Ortega
- University of Technology Sydney, Centre for Single Cell Technology , Sydney, New South Wales , Australia
| | - Javad Nazarian
- Department of Oncology, Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland , Zurich , Switzerland
| | - Marta M Alonso
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain , Pamplona , Spain
| | - Esther Hulleman
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands , Utrecht , Netherlands
| | - Jasper Van der Lugt
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands , Utrecht , Netherlands
| | - Nicholas Vitanza
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute , Seattle, WA , USA
| | - Sabine Mueller
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco , San Francisco, CA , USA
| | - Matthew Dun
- Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle , Callaghan, NSW , Australia
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Kilburn L, Landi D, Leary S, Ziegler D, Baxter P, Franson A, McCowage G, Waanders A, Van der Lugt J, Oren MY, Gerber N, Gottardo N, Khuong-Quang DA, Nysom K, Bailey S, Driever PH, Perreault S, Witt O, Hahn S, Hargrave D, Hassall T, Jabado N, Kang HJ, Larouche V, Toledano H, Kline C, Abdelbaki M, Chi S, Gardner S, Whipple N, Mueller S, Blackman S, Zhao X, Da Costa D, Cox M, Packer R, Hansford J. CTNI-68. FIREFLY-1 (PNOC026): PHASE 2 STUDY OF PAN-RAF INHIBITOR TOVORAFENIB IN PEDIATRIC AND YOUNG ADULT PATIENTS WITH RAF-ALTERED RECURRENT OR PROGRESSIVE LOW-GRADE GLIOMA OR ADVANCED SOLID TUMORS. Neuro Oncol 2022. [PMCID: PMC9660801 DOI: 10.1093/neuonc/noac209.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
RAF alterations are oncogenic drivers found in most pediatric low-grade gliomas (LGGs). Tovorafenib is an investigational, oral, selective, CNS-penetrant, small molecule, type II pan‑RAF inhibitor.
METHODS
FIREFLY-1 (NCT04775485) is a multicenter phase 2 study evaluating the safety and efficacy of tovorafenib monotherapy. Registrational arm 1 enrolled patients with recurrent/progressive LGG harboring an activating BRAF alteration. Patients aged 6 months–25 years who progressed following ≥ 1 prior line of systemic therapy were eligible. Tovorafenib 420 mg/m2 (≤ 600 mg) was administered weekly (tablet or liquid suspension formulation) until progression or for ≥ 26, 28-day cycles. The primary endpoint (arm 1) was overall response rate, as defined by RANO criteria, per independent review.
RESULTS
As of April 14, 2022, 25 patients were enrolled to arm 1 and had ≥ 6 months of follow-up. Median age at enrollment was 8 years (range 3–18). Most patients had astrocytomas (92%), 48% with optic pathway involvement. Patients were heavily pretreated (56% with ≥ 3 prior lines of therapy), and 72% previously received MAPK pathway-targeted agents. Tumors harbored BRAF fusions (84%) or BRAF V600E mutations (16%). Per independent assessment, partial responses (1 unconfirmed) were seen in 14 (64%) of 22 evaluable patients, with 6 additional patients having stable disease, and a clinical benefit rate of 91%. Responses were achieved in tumors with BRAF fusions and V600E mutations. Most treatment-emergent adverse events (AEs) were grade 1 or 2 (96%). The most common grade ≥ 3 AEs were anemia (12%), vomiting, increased blood creatinine phosphokinase and maculopapular rash (8% each). Seven patients (28%) required dose modification for treatment-related AEs; no patients discontinued tovorafenib due to AEs. Updated results, including efficacy per RAPNO assessments will be presented.
CONCLUSIONS
Tovorafenib was generally well tolerated and showed encouraging evidence of antitumor activity in children with pretreated BRAF-altered LGG.
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Affiliation(s)
| | - Daniel Landi
- Duke University Medical Center , Durham, NC , USA
| | - Sarah Leary
- Cancer and Blood Disorders Center, Seattle Children’s , Seattle, WA , USA
| | - David Ziegler
- Kids Cancer Centre, Sydney Children’s Hospital , Sydney , Australia
| | - Patricia Baxter
- Texas Children’s Cancer Center, Texas Children’s Hospital, Baylor College of Medicine, Houston , TX , USA
| | - Andrea Franson
- C. S. Mott Children’s Hospital, University of Michigan , Ann Arbor, MI , USA
| | - Geoffrey McCowage
- Sydney Children’s Hospitals Network , Westmead, New South Wales , Australia
| | - Angela Waanders
- Ann & Robert H Lurie Children’s Hospital , Chicago, IL , USA
| | | | | | | | | | | | - Karsten Nysom
- Juliane Marie Centre , Rigshospitalet, Copenhagen , Denmark
| | - Simon Bailey
- Northern Institute for Cancer Research, Newcastle University , Newcastle-upon-Tyne , United Kingdom
| | - Pablo Hernáiz Driever
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität , Berlin , Germany
| | | | - Olaf Witt
- Hopp Children’s Cancer Center , Heidelberg (KiTZ), Heidelberg , Germany
| | - Seungmin Hahn
- Severance Hospital, Yonsei University , Seoul , Republic of Korea
| | - Darren Hargrave
- UCL Great Ormond Street Institute of Child Health , London , United Kingdom
| | | | - Nada Jabado
- McGill University Health Centre , Montreal , Canada
| | - Hyoung Jin Kang
- Seoul National University College of Medicine, Seoul National University Cancer Research Institute, Wide River Institute of Immunology, Seoul National University Children’s Hospital , Seoul , Republic of Korea
| | - Valerie Larouche
- Centre Hospitalier Universitaire de Québec-Université Laval , Quebec City , Canada
| | - Helen Toledano
- Schneider Children’s Medical Center of Israel , Petah Tikva , Israel
| | - Cassie Kline
- Children’s Hospital of Philadelphia (CHOP) , Philadelphia, PA , USA
| | | | - Susan Chi
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center , Boston, MA , USA
| | | | | | - Sabine Mueller
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California , San Francisco, San Francisco, CA , USA
| | | | - Xin Zhao
- Day One Biopharmaceuticals , South San Francisco, CA , USA
| | | | - Michael Cox
- Day One Biopharmaceuticals , South San Francisco, CA , USA
| | - Roger Packer
- Children’s National Medical Center , Washington, DC , USA
| | - Jordan Hansford
- Children’s Cancer Centre, Royal Children’s Hospital, Victoria, Australia; Michael Rice Cancer Centre, Women’s and Children’s Hospital; South Australia Health and Medical Research Institute; South Australian Immunogenomics Cancer Institute, University of Adelaide , Victoria , Australia
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Bouffet E, Hansford J, Garré ML, Hara J, Plant-Fox A, Aerts I, Locatelli F, Van der Lugt J, Papusha L, Sahm F, Tabori U, Cohen KJ, Packer RJ, Witt O, Sandalic L, Bento Pereira da Silva A, Russo MW, Hargrave DR. Primary analysis of a phase II trial of dabrafenib plus trametinib (dab + tram) in BRAF V600–mutant pediatric low-grade glioma (pLGG). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.17_suppl.lba2002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA2002 Background: LGG is the most common pediatric brain cancer, and BRAF V600 mutation has been detected in ≈17% of cases. Most patients (pts) with pLGG have disease progression and require post-surgical therapy. The standard of care is chemotherapy, such as carboplatin + vincristine (C+V), which may be less effective in BRAF V600–mutant disease; thus, alternative treatment options are needed. Dab + tram showed encouraging efficacy in a Phase I/II study (NCT02124772) in pts with previously treated BRAF V600–mutant pLGG. We describe the results of a randomized Phase II study (NCT02684058) of first-line dab + tram vs C+V in BRAF V600–mutant pLGG. Methods: Pts aged 1 to <18 y with BRAF V600 mutation–positive gliomas and Karnofsky/Lansky performance status ≥50% were enrolled. In the pLGG cohort, pts with progressive disease after surgery or nonsurgical pts requiring systemic treatment were randomized (2:1) to receive either dab twice daily (<12 y, 5.25 mg/kg/d; ≥12 y, 4.5 mg/kg/d) + tram once daily (<6 y, 0.032 mg/kg/d; ≥6 y, 0.025 mg/kg/d) or C+V (standard dosing). The primary endpoint was overall response rate (ORR; independent review, RANO criteria). Secondary endpoints included investigator-assessed ORR, clinical benefit rate (CBR), duration of response, time to response, progression-free survival (PFS), overall survival, and safety. Results: A total of 110 pts were randomized to receive dab + tram (n=73) or C+V (n=37); 4 pts in the C+V arm withdrew before treatment. Baseline characteristics were well balanced between treatment arms. At data cutoff (August 23, 2021; median follow-up, 18.9 mo), 61 pts (84%) in the dab + tram arm and 8 (22%) in the C+V arm remained on treatment; in the C+V arm, 9 completed planned treatment and 16 discontinued before completion. The primary endpoint was met: the independently assessed ORR (CR+PR) was 47% (95% CI, 35%-59%) with dab + tram vs 11% (95% CI, 3%-25%) with C+V ( P<.001; odds ratio, 7.2 [95% CI, 2.3-22.4]), and the clinical benefit rate (CR+PR+SD ≥24 wk) was 86% (95% CI, 76%-93%) vs 46% (95% CI, 30%-63%). Median PFS was 20.1 mo (95% CI, 12.8 mo-not estimable) with dab + tram vs 7.4 mo (95% CI, 3.6-11.8 mo) with C+V ( P<.001; HR, 0.31 [95% CI, 0.17-0.55]); 12-mo Kaplan-Meier PFS rates were 67% vs 26%. There were no deaths in the dab + tram arm and 1 in the C+V arm due to LGG. Pts in the dab + tram arm had fewer grade ≥3 adverse events (AEs; 47% vs 94%) and fewer discontinuations due to AEs (4% vs 18%) than pts in the C+V arm. The most frequent AEs in the dab + tram vs chemotherapy arms were pyrexia (68% vs 18%), headache (47% vs 27%), and vomiting (34% vs 48%). Conclusions: Dab + tram significantly increased ORR and CBR and prolonged PFS compared with C+V in pts with BRAF V600 mutation–positive pLGG. These encouraging results and the tolerable safety profile suggest that dab + tram may be a promising first-line systemic treatment option for this pt population. Clinical trial information: NCT02684058.
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Affiliation(s)
- Eric Bouffet
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jordan Hansford
- The Royal Children’s Hospital, University of Melbourne, Murdoch Children’s Research Institute, Melbourne, Australia
| | | | | | - Ashley Plant-Fox
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Isabelle Aerts
- Institut Curie, SIREDO Oncology Center, PSL Research University, Paris, France
| | - Franco Locatelli
- IRCCS Bambino Gesù Children’s Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Ludmila Papusha
- Dmitry Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Felix Sahm
- Hopp Children’s Cancer Center (KiTZ), German Cancer Research Center (DKFZ), Heidelberg University Hospital, Heidelberg, Germany
| | - Uri Tabori
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Kenneth J. Cohen
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | - Olaf Witt
- Hopp Children's Cancer Center (KiTZ), German Cancer Research Center (DKFZ), and University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Mark W. Russo
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Darren R. Hargrave
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom
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Landi DB, Ziegler DS, Franson AF, Baxter PA, Leary S, Larouche V, Waanders AJ, Van der Lugt J, McCowage GB, Doz F, Jabado N, Schiavello E, Zapotocky M, Cornelio I, Blackman SC, Da Costa D, Cox MC, Witt O, Kilburn LB, Hansford JR. FIREFLY-1 (PNOC 026): A phase 2 study to evaluate the safety and efficacy of tovorafenib (DAY101) in pediatric patients with RAF-altered recurrent or progressive low-grade glioma or advanced solid tumors. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps10062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS10062 Background: RAF gene fusions ( BRAF and RAF1) and BRAF V600E mutations are oncogenic drivers found on a mutually exclusive basis in most pediatric low-grade gliomas (LGGs). In addition, RAF fusions ( BRAF and RAF1) have also been identified in other pediatric solid tumors. Tovorafenib (DAY101) is an investigational, oral, highly selective, CNS-penetrant, small molecule, type II pan-RAF inhibitor. In contrast to type I BRAF inhibitors, tovorafenib does not induce RAS-dependent paradoxical activation of the MAPK pathway. In the phase 1 PNOC014 study in pediatric patients with recurrent/progressive LGG, tovorafenib was well tolerated and 7/8 patients with tumor harboring RAF fusions had meaningful clinical benefit. Recently, a child with a novel SNX8-BRAF fusion spindle cell sarcoma demonstrated a rapid and deep response when treated with tovorafenib. Methods: FIREFLY-1 (NCT04775485) is an open-label, multicenter, phase 2 study evaluating the safety and efficacy of tovorafenib monotherapy in pediatric patients with RAF-altered recurrent or progressive LGG or advanced solid tumors. The initial design included only patients with LGG (arm 1). Two new arms have now been added; arm 2 will allow tovorafenib treatment for patients with LGG harboring an activating RAF alteration after completion of enrollment to arm 1 and prior to tovorafenib regulatory approval; arm 3 will enroll patients with advanced solid tumors harboring an activating RAF fusion. Eligible patients are 6 months to 25 years of age, who have received ≥1 prior line of systemic therapy with documented radiographic progression, have evaluable and/or measurable disease by appropriate criteria, a Karnofsky or Lansky performance score of at least 50, and adequate organ function. Patients are excluded if their tumor has other driver mutations, they have neurofibromatosis type 1, central serous retinopathy, retinal vein occlusion, clinically significant active cardiovascular disease, or are currently being treated with a strong CYP2C8 inhibitor or inducer other than those allowed per protocol. Approximately 140 patients in total will be enrolled including 60 in arm 1, 60 in arm 2 and 20 in arm 3. Tovorafenib will be administered at 420 mg/m2 (not to exceed 600 mg) weekly (days 1, 8, 15 and 22) for 26, 28-day cycles (in the absence of disease progression or unacceptable toxicity). They may then continue tovorafenib or enter a drug holiday period. The primary endpoint is overall response rate, as defined by the RANO criteria (arm 1) or RECIST v1.1 (arm 3) and as determined by an independent radiology review committee. Secondary endpoints (arms 1 and 3) include safety and tolerability, pharmacokinetics, duration of response, time to response and progression-free survival. Tovorafenib is available in tablet or liquid suspension formulations. Clinical trial information: NCT04775485.
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Affiliation(s)
| | - David S. Ziegler
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Andrea Flynn Franson
- Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Patricia Ann Baxter
- Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Sarah Leary
- Cancer and Blood Disorders Center, Seattle Children's, Seattle, WA
| | - Valérie Larouche
- Department of Paediatric Haematology/Oncology, Centre Hospitalier de Quebec-Universite Laval, Quebec City, QC, Canada
| | - Angela Jae Waanders
- Division of Hematology/Oncology, Ann & Robert H Lurie Children's Hospital, Chicago, IL
| | | | | | - Francois Doz
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie and University of Paris, Paris, France
| | - Nada Jabado
- Department of Pediatrics, McGill University, and The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Michal Zapotocky
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | | | | | | | | | - Olaf Witt
- Hopp Children's Cancer Center (KiTZ), German Cancer Research Center (DKFZ), and University Hospital Heidelberg, Heidelberg, Germany
| | | | - Jordan R. Hansford
- Michael Rice Cancer Centre, Women’s and Children’s Hospital, South Australia Health and Medical Research Institute, South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, Australia
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van Tilburg CM, Heiss M, Øra I, Beilken A, Dirksen U, Gottardo NG, Khuong-Quang DA, Hansford J, Hutter C, Van der Lugt J, Thorwarth A, Poschke I, Harting I, Sedlaczek O, Beck P, Freitag A, Jones DT, Jäger N, Kopp-Schneider A, Witt O. Phase I results of the INFORM2 combination study of nivolumab and entinostat in children and adolescents: INFORM2 NivEnt. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10034 Background: Pediatric patients with relapsed or refractory high-risk solid and CNS tumors have dismal survival. To date treatment with immune checkpoint inhibitors in this population has been disappointing. This study exploits the immune enhancing effects of entinostat on nivolumab in biomarker enriched subpopulations. The study aims to determine the pediatric recommended phase II dose (pRP2D) and to evaluate activity and safety. Methods: This is an exploratory non-randomized, open-label, multinational seamless phase I/II trial in children and adolescents with relapsed / refractory or progressive high-risk solid and CNS tumors. The phase I is divided in 2 age cohorts: 12–21 years (y) and 6–11y and follows a 3 + 3 design with two dose levels for entinostat (dose level 1: 2 mg/m2 and dose level 2: 4 mg/m2 once per week) and fixed dose nivolumab (3 mg/kg every 2 weeks). Patients entering the trial on pRP2D can seamlessly enter phase II which consists of a biomarker defined four group basket trial: high mutational load (group A), high PD-L1 mRNA expression (group B), focal MYC(N) amplification (group C), low mutational load and low PD-L1 mRNA expression and no MYC(N) amplification (group D). Results: The first patient was enrolled in May 2020 and at the time of the data cut (21-JAN-2022), 19 patients were treated. The median age at enrollment was 14 y. In the 12 – 21y cohort 15 patients were enrolled and four patients in the 6 – 11y cohort. The most frequent treatment-related AEs to date were thrombocytopenia in six (32%), nausea and vomiting both in four (21%), and neutropenia in three patients (16%). Five patients (26%) experienced grade 3/4 mostly reversible treatment-related AEs, e.g. neutropenia/leukopenia. No treatment related deaths were reported. In the 6 – 11y cohort dose escalation is ongoing. In the 12 – 21y cohort, one DLT (CTCAE grade 3 thrombocytopenia) was observed in six patients on dose level two, which was determined as the pRP2D of the combination. At the time of the data cut, 10 patients (six in arm D and four patients in which the biomarker group was not yet determined) had received at least one RECIST/RANO response evaluation by central review in phase II. One patient (17%) in arm D with metastatic relapsed renal cell carcinoma (RCC) harboring a typical PRCC-TFE3 fusion showed a PR after two cycles and finally achieved an ongoing CR. Extensive explorative analyses of immune signatures derived from INFORM RNA-Seq and WES data revealed that both the primary diagnosis and the current relapse samples harbored a remarkable high immune cell infiltration, especially CD8+ T-cells. Conclusions: The first and ongoing global INFORM2 trial has identified the pRP2D for the nivolumab and entinostat combination in the older age cohort with good tolerability. A patient with metastasized relapsed RCC experienced a CR. The role of immune infiltration as a potential predictive biomarker is currently being explored. Clinical trial information: NCT03838042.
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Affiliation(s)
- Cornelis Martinus van Tilburg
- Hopp Children’s Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Heidelberg, Germany
| | - Melanie Heiss
- Hopp Children’s Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Heidelberg, Germany
| | - Ingrid Øra
- Department of Pediatric Oncology, Skane University Hospital Lund, and HOPE-ITCC unit, Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Beilken
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Uta Dirksen
- West German Cancer Center, Pediatrics III, University Hospital Essen, Essen, Germany
| | - Nicholas G. Gottardo
- Department of Paediatric and Adolescent Oncology/Haematology, Perth Children's Hospital, Nedlands, Western Australia, and Brain Tumour Research Programme, Telethon Kids Institute, and Paediatrics, School of Medicine, University of Western Australia, Perth, Australia
| | - Dong-Anh Khuong-Quang
- Children's Cancer Center, The Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jordan Hansford
- Children's Cancer Center, The Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, Australia
| | - Caroline Hutter
- St. Anna Kinderspital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna and St. Anna Kinderkrebsforschung, Vienna, Austria
| | | | - Anne Thorwarth
- Pediatric Oncology and Hematology Department, Charité – Campus Virchow Klinikum, Berlin, Germany
| | - Isabel Poschke
- DKTK (German Cancer Consortium) Clinical Cooperation Unit (CCU) Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ); Immune Monitoring Unit, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Inga Harting
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver Sedlaczek
- Radiology Cooperation Uni/DKFZ, Division of Radiology, NCT, Heidelberg, Germany
| | - Pengbo Beck
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Angelika Freitag
- NCT Trial Center, National Center for Tumor Diseases and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T.W. Jones
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Natalie Jäger
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Olaf Witt
- Hopp Children's Cancer Center (KiTZ), German Cancer Research Center (DKFZ), and University Hospital Heidelberg, Heidelberg, Germany
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7
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Pérez-Larraya JG, Garcia-Moure M, Patiño-García A, González-Huarriz M, Van der Lugt J, Astigarraga I, García-Ariza M, López-Ibor B, Jones C, Mackay A, Diez-Valle R, Fueyo J, Gomez-Manzano C, Dobbs J, Ewald B, Alonso M, Tejada S. CTIM-08. SAFETY, EFFICACY, AND SURVIVAL RESULTS FROM A PHASE 1 STUDY OF THE ONCOLYTIC ADENOVIRUS DNX-2401 FOLLOWED BY STANDARD OF CARE RADIOTHERAPY FOR NEWLY DIAGNOSED DIFFUSE INTRINSIC PONTINE GLIOMA (DIPG). Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Diffuse intrinsic pontine glioma (DIPG) is the most lethal pediatric brain tumor. Median overall survival (OS) with standard of care radiation therapy (RT) is approximately 8-10 months and 2-year survival is < 10%. A Phase 1 single-center study was conducted to evaluate the oncolytic adenovirus, DNX-2401 (tasadenoturev), followed by RT for DIPG.
METHODS
Newly-diagnosed DIPG patients 1-18 years old received a tumor biopsy through the cerebellar peduncle followed by intratumoral injection of 1e10 – 5e10 vp DNX-2401 and conventional RT 1-3 weeks later.
RESULTS
Subjects were enrolled (n=12) from December 2017 to January 2020 and had a median age of 9 years (range 3-18) and Lansky/Karnofsky performance scores of 90-100 (n=4; 33%) or 70-80 (n=8; 67%). Genetic assessment was completed for 11 subjects (92%) and histone 3 K27M mutations were identified in 10 subjects, including H3F3A (n=8), HIST2H3C (n=1), and HIST1H3B (n=1); 1 subject was H3 wildtype (n=1). TP53 mutations were identified in 5 subjects (42%). DNX-2401 was administered followed by RT (n=11; 92%). No dose-limiting toxicities were observed and the treatment regimen was well-tolerated. The most commonly reported adverse events (≥ 5 subjects), regardless of study drug relationship, include asthenia, headache, vomiting, pyrexia, and neurological deterioration. Three serious adverse events were reported including grade 3 abdominal pain, grade 3 lymphopenia, and grade 3 clinical deterioration. Tumor reductions were reported for 9 subjects (75%), including 2 confirmed (17%) and 2 unconfirmed (17%) responses per RAPNO criteria. As of the data cutoff, median OS is 19.7 months and OS-24 is 32% with follow-up ongoing for 3 subjects (26.9, 25.6, 13.7 months).
CONCLUSIONS
DNX-2401 followed by RT can be safely administered to DIPG. Survival outcomes are encouraging, thus warranting further evaluation in a Phase 2 study.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Chris Jones
- The Institute of Cancer Research, London, United Kingdom
| | - Alan Mackay
- The Institute of Cancer Research, London, United Kingdom
| | | | - Juan Fueyo
- MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | - Sonia Tejada
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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8
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Garcia-Moure M, Pérez-Larraya JG, Patiño A, Gonzalez-Huarriz M, Jones C, MacKay A, Van der Lugt J, Hulleman E, de Andrea C, Astigarraga I, García-Ariza M, Lopez-Ibor B, Villalba M, Lang FF, Fueyo J, Gomez-Manzano C, Dobbs J, Diez-Valle R, Alonso MM, Tejada S. EPCT-04. RESULTS OF A PHASE 1 STUDY OF THE ONCOLYTIC ADENOVIRUS DNX-2401 WITH RADIOTHERAPY FOR NEWLY DIAGNOSED DIFFUSE INTRINSIC PONTINE GLIOMA (DIPG). Neuro Oncol 2021. [PMCID: PMC8263199 DOI: 10.1093/neuonc/noab090.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background A Phase 1, single center study is ongoing to evaluate the conditionally replicative oncolytic adenovirus, DNX-2401 (tasadenoturev), followed by radiotherapy (RT) in pediatric patients with newly diagnosed diffuse intrinsic pontine glioma (DIPG). Methods Patients 1–18 years with newly diagnosed DIPG with no prior treatment, Lansky/Karnofsky performance score ≥ 70, and adequate organ function were enrolled. A tumor biopsy was performed followed by a single intratumoral injection of 1e10-5e10 virus particles (vp) DNX-2401. Conventional radiotherapy was initiated within 1 month of DNX-2401 administration. Results Enrolled subjects (n=12) had a median age of 9 (range 3–18) and performance scores of 90–100 (n=4; 33%) or 70–80 (n=8; 67%). As part of a dose escalation design, subjects were treated with 1e10 vp (n=4) or 5e10 vp DNX-2401 (n=8), which was then followed by standard RT in 11 of 12 subjects (92%). No dose-limiting toxicities were observed and the treatment regimen was well-tolerated. Adverse events (AEs) have been primarily mild to moderate and consistent with underlying disease. The most commonly reported AEs (≥ 5 subjects), regardless of study drug relationship, include headache, asthenia, vomiting, anemia, leukocytosis, and fever. Two SAEs have been reported including grade 3 lymphopenia and grade 3 abdominal pain. Tumor reductions have been observed and efficacy evaluations are ongoing. As of 09Dec2020, 12-month survival (OS-12) was 71% and 4 of 12 patients had survived > 20 months. Four subjects continue to be followed for survival. Correlative analysis of tumor biopsy and peripheral samples is ongoing. Conclusions DNX-2401 followed by RT can be safely administered to pediatric subjects with newly diagnosed DIPG; clinical activity and preliminary survival are encouraging.
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Affiliation(s)
- Marc Garcia-Moure
- Program in Solid Tumors, Foundation for the Applied Medical Research, Pamplona, Spain
- Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jaime Gállego Pérez-Larraya
- Program in Solid Tumors, Foundation for the Applied Medical Research, Pamplona, Spain
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ana Patiño
- Program in Solid Tumors, Foundation for the Applied Medical Research, Pamplona, Spain
- Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain
| | - Marisol Gonzalez-Huarriz
- Program in Solid Tumors, Foundation for the Applied Medical Research, Pamplona, Spain
- Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain
| | - Chris Jones
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - Alan MacKay
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | | | - Esther Hulleman
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Department of Pediatric Oncology/Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Carlos de Andrea
- Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
- Health Research Institute of Navarra (IdiSNA), Pamplona, Spain
| | - Itziar Astigarraga
- Department of Pediatrics, Hospital Universitario Cruces, IIS Biocruces-Bizkaia, UPV/EHU, Barakaldo, Spain
| | | | - Blanca Lopez-Ibor
- Department of Pediatric Hematology and Oncology, HM Montepríncipe Hospital, Boadilla del Monte, Spain
| | - Maria Villalba
- Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Frederick F Lang
- Department of Neurosurgery and Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan Fueyo
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Candelaria Gomez-Manzano
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of NeuroOncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, Houston, TX, USA
| | | | - Ricardo Diez-Valle
- Department of Neurosurgery, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Marta M Alonso
- Program in Solid Tumors, Foundation for the Applied Medical Research, Pamplona, Spain
- Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain
| | - Sonia Tejada
- Department of Neurosurgery, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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9
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Iñigo-Marco I, Gonzalez-Huarriz M, García-Moure M, Tamayo I, Hervas S, Hernandez R, Buñales M, DeAndrea C, Villalba M, Jones C, MacKay A, Hulleman E, Van der Lugt J, Aldave G, Lopez-Ibor B, Patiño-Garcia A, Diez-Valle R, Fueyo J, Gomez-Manzano C, de Larraya JGP, Tejada S, Alonso MM. THER-09. ONCOLYTIC ADENOVIRUS, DNX-2401, FOR NAIVE DIFFUSE INTRINSIC PONTINE GLIOMAS: A PHASE I CLINICAL TRIAL. Neuro Oncol 2020. [PMCID: PMC7715674 DOI: 10.1093/neuonc/noaa222.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The objective of this trial is to determine the safety, tolerability, and toxicity of DNX-2401 in newly diagnosed DIPG patients (NCT03178032) followed by radiotherapy. Secondary endpoints are overall survival at 12 months, percentage of responses and induced immune response against tumor. Tumor biopsy was performed through the cerebellar peduncle, followed by intratumoral injection of DNX-2401 (N=12). Three patients were treated with 1x1010vp and given the lack of toxicity we escalated to 5x1010vp. The procedure was well tolerated and reduced tumor volume was demonstrated in all patients after combined treatment (virus + radiotherapy). We performed molecular studies (RNAseq and the Oncomine Childhood Research Panel from Thermo Fisher). The immune cell composition of the biopsies pre-virus injection was assessed using multiplexed quantitative immunofluorescence. T cells were hardly detectable in these tumors while macrophages were abundant. Using a multiplexed TCR-sequencing mRNA-based assay to analyze 18 available paired pre- and post-treatment samples from the trial, we detected increased clonal T cell diversity following treatment with the virus. We also measured pre and post treatment neutralizing antibodies and their relationship with survival. Finally, we performed functional studies using 2 cell lines isolated from patients included in this trial to assess the response to the virus (infectivity, viability, T-cell recognition). In summary, the virus has shown safety and efficacy in some patients. The information obtained in this clinical study would aid understanding the response of DIPG patients to viral therapies and, therefore, to better tailor this strategy to improve the survival of these patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Chris Jones
- Institute of Cancer Research, London, United Kingdom
| | - Alan MacKay
- Institute of Cancer Research, London, United Kingdom
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10
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Carceller F, Bautista F, Castañeda A, Surun A, Wasti A, Revon-Riviere G, Cortes M, Bergamaschi L, Juan Ribelles A, Millen G, Campbell Hewson Q, Amoroso L, Van der Lugt J, Fagioli F, Zwaan M, Marshall LV, Vassal G, Pearson ADJ, Geoerger B, Moreno L. Mortality and survival rates in children and adolescents enrolled in early phase trials with a dose-finding/dose-confirmation component: An innovative therapies for children with cancer (ITCC) study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e21509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21509 Background: Participation of children with advanced solid cancers in phase I trials raises ethical and logistic dilemmas. Life-expectancy beyond 8-12 weeks is a common inclusion criterion, but it can be difficult to gauge. This multicentric European study assessed the mortality and survival rates in pediatric phase I trials. Methods: Retrospective study of patients aged < 18 years with solid tumors enrolled in phase I trials in ITCC centres between 2015-2017. Outcome variables were described and prognostic factors analysed. Results: 256 patients across 12 centres in 5 countries were eligible. Median age 11.8 years (range, 0.5-17.9). Female:Male ratio 1:1.9. Tumor location: central nervous system (CNS) 66% vs extra-CNS 34%. Main diagnoses: 22% soft tissue sarcomas, 13% high grade gliomas, 11% osteosarcomas. Most frequent therapy: single targeted agent (63%). Ten cases (4%) were not evaluable for response and 128 (50%) had progressive disease at first evaluation. Best responses were complete in 12 cases (5%), partial in 29 (11%) and stable disease in 77 (30%). Median follow-up 7 months (range, 0.5-42.4). Median Time On Study (TOS) 2.1 months (range, 0.2-38.1). The 30 and 90-day mortality on trial were 3% (8/256) and 21% (54/256), respectively. The 90-day survival (95%CI) for patients with CNS vs extra-CNS tumors was 88% (78-93) vs 76% (68-82), respectively. One-year Overall Survival (95%CI) for the whole sample was 40% (33-46). No toxic deaths on trial were reported. Twenty-five cases (10%) survived ≥365 days on trial. Median TOS 21.5 months (range, 12.3-38.1). Compared to patients who died within 365 days from Cycle1-Day1, those on trial ≥365 days had lower rates of metastatic disease (74% vs 28%, respectively, p < 0.001), higher objective response rates (13% vs 44%, respectively, p < 0.001) and higher disease stabilization (27% vs 56%, respectively, p < 0.001). Conclusions: Currently few patients die within the first cycle of treatment. However a fifth of all patients died within 3 months from trial initiation. Patients with CNS tumors have comparable survival rates to those with extra-CNS and should not be excluded from phase I trials solely because of their diagnosis. The survival rates beyond one year remain modest.
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Affiliation(s)
| | | | | | - Aurore Surun
- SIREDO Oncology Center, Institut Curie, Paris, France
| | - Ajla Wasti
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Gabriel Revon-Riviere
- Paediatric Hematology-Oncology Unit, Hôpital d’Enfants de la Timone, Marseille, France
| | | | | | | | - Gerard Millen
- Department of Paediatric Oncology, Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Quentin Campbell Hewson
- The Great North Children's Hospital, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom
| | | | | | | | | | | | | | - Andrew DJ Pearson
- The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | | | - Lucas Moreno
- Hospital Universitario Niño Jesús, Madrid, Spain
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11
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Bautista F, Van der Lugt J, Kearns PR, Mussai FJ, Zwaan CM, Moreno L. The development of targeted new agents to improve the outcome for children with leukemia. Expert Opin Drug Discov 2016; 11:1111-1122. [PMID: 27670965 DOI: 10.1080/17460441.2016.1237939] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Survival rates in pediatric leukemia have greatly improved in the last decades but still a substantial number of patients will relapse and die. New agents are necessary to overcome the limitations of conventional chemotherapy and hematopoietic stem cell transplantation and to reduce their undesirable long-term toxicities. The identification of driving molecular alterations of leukemogenesis in subsets of patients will allow the incorporation of new-targeted therapies. Areas covered: In this article the authors present a detailed review of the most recent advances in targeted therapies for pediatric leukemias. A comprehensive description of the biological background, adult data and early clinical trials in pediatrics is provided. Expert opinion: Clinical trials are the way to evaluate new agents in pediatric cancer. The development of new drugs in pediatric leukemia must be preceded by a solid biological rationale. Agents in development exploit all possible vulnerabilities of leukemic cells. Drugs targeting cell surface antigens, intracellular signaling pathways and cell cycle inhibitors or epigenetic regulators are most prominent. Major advances have occurred thanks to new developments in engineering leading to optimized molecules such as anti-CD19 bi-specific T-cell engagers (e.g. blinatumomab) and antibody-drug conjugates. The integration of new-targeted therapies in pediatric chemotherapy-based regimens will lead to improved outcomes.
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Affiliation(s)
- Francisco Bautista
- a Department of Pediatric Oncology, Hematology and Stem Cell Transplantation , Hospital Niño Jesús , Madrid , Spain
| | - Jasper Van der Lugt
- b Department of Pediatric Oncology/Hematology , Erasmus-MC Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Pamela R Kearns
- c Cancer Research UK Clinical Trials Unit, School of Cancer Sciences , University of Birmingham , Birmingham , UK
| | - Francis J Mussai
- c Cancer Research UK Clinical Trials Unit, School of Cancer Sciences , University of Birmingham , Birmingham , UK
| | - C Michel Zwaan
- b Department of Pediatric Oncology/Hematology , Erasmus-MC Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Lucas Moreno
- a Department of Pediatric Oncology, Hematology and Stem Cell Transplantation , Hospital Niño Jesús , Madrid , Spain
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