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Marizomib for Recurrent Low-Grade and Anaplastic Supratentorial, Infratentorial, and Spinal Cord Ependymoma

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03727841
Recruitment Status : Recruiting
First Posted : November 1, 2018
Last Update Posted : March 25, 2020
Sponsor:
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) )

Brief Summary:

Background:

Ependymomas are rare tumors that arise from the ependyma. That is a tissue of the central nervous system. They can develop in the brain or the spine. They are usually treated with surgery, radiation, and/or chemotherapy. Researchers want to see if the new drug marizomib can help people with a certain kind of ependymoma.

Objective:

To see if marizomib stops tumor growth and prlongs the time that the tumor is controlled.

Eligibility:

Adults age 18 and older who have been diagnosed with ependymomas and have already been treated with standard therapies

Design:

Participants will be screened with the following tests or recent results from similar tests:

  • Medical history
  • Physical exam
  • Neurological assessment
  • Electrocardiogram (EKG) to evaluate the heart
  • Review of symptoms and ability to perform normal activities
  • Computed tomographic scan (CT) or magnetic resonance imaging (MRI) to produce an image of the brain or spine.
  • Blood and urine tests
  • Tests of tumor samples. Participants may have to have new tumor samples taken.

Participants will get the study drug in cycles. Each cycle is 4 weeks. Participants will have up to 24 cycles.

Participants will get the study drug through a small plastic tube in a vein on days 1, 8, and 15 of each cycle.

During each cycle, some screening tests will be repeated.

Participants will answer questions about their general well-being and functioning.

About 4 5 weeks after finishing the study drug, participants will have a follow-up visit. They will answer questions about their health, get a physical and a neurological exam, and have blood tests. They may have an MRI or CT scan.

...


Condition or disease Intervention/treatment Phase
Anaplastic Ependymoma Ependymoma Ependymomas Drug: Marizomib Phase 2

Detailed Description:

Background:

  • Ependymomas are rare primary brain tumors arising from radial glial stem cells. They comprise 5.2% of all pediatric primary brain tumors and 1.9% of all adult primary brain tumors.
  • The standard therapy for newly diagnosed ependymoma is gross total resection followed by radiation therapy. For anaplastic ependymoma, recurrence rate is high with a median progression free survival (PFS) of 2.3 years.
  • There are limited chemotherapy options for recurrent ependymomas, which have already been irradiated. Therefore, there is an unmet need to target novel pathways for treatment of ependymomas.
  • About 70% of supratentorial ependymomas have a characteristic signature C11orf95-RELA fusion which drives tumorigenesis in ependymomas by activating the NF-KB transcription pathway.
  • Marizomib is a second-generation irreversible proteasome inhibitor which penetrates across the blood-brain-barrier (BBB). It inhibits the activity of 20S proteasome in glioma cells, activates caspases, builds up reactive oxygen species and thus induces apoptosis. Marizomib blocks the NF-pathway by proteasome inhibition. Thus, it may have an additional targeted therapeutic effect in the RELA-fusion molecular subgroup of ependymomas.

Objective:

-To evaluate the efficacy of treatment with marizomib in RELA-fusion recurrent ependymoma and non RELA-fusion recurrent ependymoma as measured by progression-free survival at 6 months (PFS6).

Eligibility:

  • Histologically proven intra-cranial or spinal ependymoma.
  • Radiographic evidence of tumor progression
  • Patients must be greater than or equal to 18 years old.

Patients must have had prior radiotherapy.

Design:

  • This is a phase II study to determine the efficacy of marizomib in recurrent ependymoma.
  • A novel 2-stage sequential design will be employed to conduct the trial for recurrent ependymoma.
  • In the first stage, we will enroll 18 patients with RELA-fusion ependymoma and if 4 or more patients in Cohort 1 are progression free at 6 months, we will proceed to stage 2; otherwise we will terminate the trial and conclude that marizomib is not effective.
  • In the second stage, we will enroll 32 patients with non RELA-fusion ependymoma.
  • Patients will be treated with marizomib in cycles consistent of 28 days until disease progression or a maximum of 24 cycles.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 70 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase II Clinical Trial of Marizomib for Recurrent Low-Grade and Anaplastic Supratentorial, Infratentorial and Spinal Cord Ependymoma
Actual Study Start Date : January 22, 2020
Estimated Primary Completion Date : December 31, 2022
Estimated Study Completion Date : December 31, 2025

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: 1/Arm 1
Marizomib at days 1, 8, and 15 of each 28-day cycle
Drug: Marizomib
0.8mg/m2 IV on days 1, 8, and 15 of each 28-day cycle, 24 cycles total.




Primary Outcome Measures :
  1. Progression-free survival (PFS) [ Time Frame: 6 months ]
    Proportion of patients that are progression-free at 6 months time point after initiation of treatment


Secondary Outcome Measures :
  1. Number of toxicities by grade and type scored using CTCAE version 5.0. [ Time Frame: end of study ]
    To determine the safety of marizomib in recurrent ependymoma patients and in a subset of patients with more than 2 prior chemotherapies (RELA-fusion Cohort 2 and non-RELA-fusion Cohort 4).

  2. Proportion of patients that have progressive disease after 6, 12 months. Median amount of time subject survives after therapy [ Time Frame: 6 month, 12 month and end of study ]
    To estimate the efficacy of marizomib in recurrent ependymoma patients (RELA- fusion Cohort 2 and non RELA-fusion Cohort 4) with more than 2 prior chemotherapies as measured by PFS6, PFS12, median PFS and OS.

  3. Median amount of time subject survives without disease progression after treatment and Median amount of time subject survives 12 months after therapy [ Time Frame: 12 month and end of study ]
    To estimate the 12-month progression-free survival (PFS12), median progressionfree survival (PFS) and overall survival (OS) of RELAfusion and non RELA-fusion recurrent ependymoma patients treated with marizomib.

  4. Proportion of patients that have changes in quality of life [ Time Frame: end of study ]
    To longitudinally evaluate patient reported outcome measures using self-reported symptom severity and interference with daily activities using the MDASI-BT and/or MDASI-SP instrument.

  5. Proportion of patients assessed using the RANO Criteria for Response [ Time Frame: end of study ]
    To estimate the efficacy of marizomib in recurrent ependymoma patients (RELA- fusion Cohort 2 and non RELA-fusion Cohort 4) with more than 2 prior chemotherapies as measured by objective response.



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA:
  • Stage 1 Eligibility (Cohort 1 and 2)

Cohort 1

  • Histologically confirmed by NCI Laboratory of Pathology intra-cranial or spinal RELA- fusion ependymoma of grade I, II or III.
  • Has received two or fewer prior chemotherapy regimens

Cohort 2

  • Histologically confirmed by NCI Laboratory of Pathology intra-cranial or spinal RELA-fusion ependymoma of grade I, II or III.
  • Has received more than two prior chemotherapy regimens

    • Stage 2 Eligibility (Cohorts 3 and 4)

Cohort 3

  • Histologically confirmed by NCI Laboratory of Pathology intra-cranial or spinal non RELA-fusion ependymoma of grade I, II or III.
  • Has received two or fewer prior chemotherapy regimens

Cohort 4

  • Histologically confirmed by NCI Laboratory of Pathology intra-cranial or spinal non RELA-fusion ependymoma of grade I, II or III.
  • Has received more than two prior chemotherapy regimens .

    • Patients must have an evidence of tumor progression.
    • Patients must have had prior radiation therapy.
    • Patients must be greater than or equal to 18 years old. Currently, no dosing or adverse event data is available on the use of marizomib in patients < 18 years of age; therefore, only adults are included in this study. Patients < 18 years of age will be eligible for future pediatric trials.
    • Patients must have a Karnofsky performance status of greater than or equal to 60.
    • Patients must have adequate organ and marrow function as defined below:
    • leukocytes: greater than or equal to 3,000/microliters
    • absolute neutrophil count: greater than or equal to 1,500/microliters
    • platelets: greater than or equal to 100,000/microliters
    • hemoglobin: greater than or equal to 10 gm/dL (can be achieved by transfusion)
    • AST(SGOT)/ALT(SGPT): less than or equal to 2.5 X institutional upper limit of normal
    • Bilirubin: <1.5 mg/dL
    • Creatinine up to 1.5-times upper institutional limits OR eGFR within normal as predicted by the CKD-EPI equation (greater than or equal to 60 mL/min/1.73m(2).
    • Negative urine protein or urine protein concentration less than or equal to 60 mg/dL
    • The effects of marizomib on the developing human fetus are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation and up to 30 days after the last dose of the drug. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately.
    • Ability of subject to understand and the willingness to sign a written informed consent document.

EXCLUSION CRITERIA:

  • Anticancer treatment within designated period of time before enrollment including:

    • surgery within 14 days
    • needle or core biopsy within 7 days
    • prior cytotoxic therapy within 28 days,
    • vincristine within 14 days
    • nitrosoureas within 42 days,
    • procarbazine administration within 21 days
    • non-cytotoxic agents, e.g., interferon, tamoxifen, thalidomide, cis-retinoic acid (radiosensitizer does not count) within 7 days; Avastin within 21 days. Any questions related to the definition of non-cytotoxic agents should be directed to the NCI Principal Investigator.
  • Treatment with any investigational agent within 28 days before enrollment.
  • History of any other cancer (except non-melanoma skin cancer or carcinoma in-situ of the cervix), unless patient is in complete remission and off all therapy for that disease for a minimum of 3 years.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to marizomib.
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Inadequately controlled hypertension (defined as systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mmHg).
  • Current active hepatic or biliary disease (with exception of patients with Gilbert s syndrome, asymptomatic gallstones, or stable chronic liver disease per investigator assessment).
  • New York Heart Association (NYHA) Grade II heart failure or greater or history of hospitalization for congestive heart failure diagnosis within 12 months prior to enrollment.
  • History of myocardial infarction or unstable angina within 3 months prior to enrollment.
  • A marked baseline prolongation of QT/QTc interval (e.g., repeated demonstration of a QTc interval >480 milliseconds (ms) (CTCAE grade 1) using Frederica s QT correction

formula.

  • A history of additional risk factors for TdP (e.g., heart failure, hypokalemia, family history of Long QT Syndrome).
  • Current use of concomitant medications that prolong the QT/QTc interval
  • History of stroke or transient ischemic attack within 3 months prior to enrollment.
  • Pregnant women are excluded from this study because marizomib s potential forteratogenic or abortifacient effects is unknown. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with marizomib, breastfeeding should be discontinued if the mother is treated with marizomib.
  • Patients receiving combination antiretroviral therapy for treatment of Human Immunodeficiency Virus (HIV) or active anti-viral treatment for Hepatitis A, B or C infection. Anti-viral therapy, when combined with marizomib, poses a potential for pharmacokinetic interactions. Marizomib also increases immunosuppression, placing patients at an increased risk of acquiring lethal infections. Appropriate studies will be undertaken in patients receiving combination antiretroviral therapy when indicated.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03727841


Contacts
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Contact: Kathleen Wall (Mendoza) (240) 760-7236 kathleen.wall@nih.gov

Locations
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United States, Maryland
National Institutes of Health Clinical Center Recruiting
Bethesda, Maryland, United States, 20892
Contact: For more information at the NIH Clinical Center contact National Cancer Institute Referral Office    888-624-1937      
Sponsors and Collaborators
National Cancer Institute (NCI)
Investigators
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Principal Investigator: Mark R Gilbert, M.D. National Cancer Institute (NCI)
Additional Information:
Publications:
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Responsible Party: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT03727841    
Other Study ID Numbers: 190011
19-C-0011
First Posted: November 1, 2018    Key Record Dates
Last Update Posted: March 25, 2020
Last Verified: March 17, 2020

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) ):
Proteasome Inhibitor
Penetration Across the Blood-Brain-Barrier (BBB)
Apoptosis Induction
Targeted Therapeutic Effect
Tumor Progression
Additional relevant MeSH terms:
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Ependymoma
Glioma
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue