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Episcleral Topotecan for Treatment of Group D Retinoblastoma

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ClinicalTrials.gov Identifier: NCT04156347
Recruitment Status : Not yet recruiting
First Posted : November 7, 2019
Last Update Posted : November 7, 2019
Sponsor:
Information provided by (Responsible Party):
Targeted Therapy Technologies, LLC

Tracking Information
First Submitted Date  ICMJE November 4, 2019
First Posted Date  ICMJE November 7, 2019
Last Update Posted Date November 7, 2019
Estimated Study Start Date  ICMJE December 5, 2019
Estimated Primary Completion Date October 1, 2021   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: November 5, 2019)
The primary outcome measure of the study is safety assessment as determined by comprehensive ophthalmic exam that enables determination of maximum tolerated dose. [ Time Frame: 29 Days ]
The primary outcome measure of the study is safety assessment as determined by comprehensive ophthalmic exam that enables determination of maximum tolerated dose.
Original Primary Outcome Measures  ICMJE Same as current
Change History No Changes Posted
Current Secondary Outcome Measures  ICMJE
 (submitted: November 5, 2019)
  • To determine systemic exposure by measurement of Topotecan in plasma. [ Time Frame: 29 Days ]
    To characterize the systemic exposure of episcleral topotecan by quantifying topotecan concentration in plasma.
  • To preliminarily define the antitumor activity as determine by reduction in maximal height of the tumor in the primary quadrant where the initial Episcleral Topotecan is placed. [ Time Frame: 29 Days ]
    To preliminarily define the antitumor activity as determine by reduction in maximal height of the tumor in the primary quadrant where the initial Episcleral Topotecan is placed.
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Episcleral Topotecan for Treatment of Group D Retinoblastoma
Official Title  ICMJE A Phase I Study of Sequestered Transscleral, Controlled-Release Topotecan Delivered From An Episcleral Reservoir In Unilateral Group D Retinoblastoma Eyes
Brief Summary This phase I trial will assess primarily the safety and secondarily the efficacy of Episcleral Topotecan in patients treated for Group D Retinoblastoma.
Detailed Description Treatment of eyes with advanced intraocular retinoblastoma remains a challenge. The historic standard of care for patients with unilateral disease is enucleation and for those with bilateral disease, a variety of modalities have been tried. These include radiation therapy, systemic chemotherapy, periocular administration of chemotherapy, selective intra-arterial chemotherapy, and intravitreal chemotherapy. Unfortunately, all of these modalities are associated with significant morbidity and investigators are looking for new ways to treat these patients either with novel directed drug delivery methods or with new less toxic agents. This study will evaluate the feasibility and toxicity of topotecan delivered directly to the eye using a novel episcleral implant (also referred to as an episcleral reservoir). Children with newly diagnosed unilateral retinoblastoma classified as Group D according to the International Group Classification System will be eligible for the study if: (1) they have had no previous treatment, and (2) primary enucleation is a treatment recommendation. All enrolled eyes during a day-1 baseline EUA will be fitted with one or two episcleral implants (reservoirs) containing sustained release formulations of topotecan HCl as the only therapy for a four-week study period. Episcleral Topotecan will be supplied sterile and requires no manipulation other than placement on the eye. At a two-week EUA on day-15 of the four-week study period, if tumor response criteria are not met or if there is DLT, the Episcleral Reservoir will be removed and the patient will be off study and alternate interventions begun. In the event of enucleation remaining drug concentrations will be determined in the reservoir(s) as well as plasma concentration levels (anticipated to be below limits of detection based on preclinical studies). If tumor response criteria are met, the eye is eligible for continuing for the final two weeks of the study if there is no local, systemic or intraocular dose limiting toxicity (DLT) as defined in this protocol. At the end of the 4-week study period on study day-29 the third and final EUA will be conducted and tumor response and toxicity assessed. At that time, all reservoirs are removed and the eye is off study. Drug concentration/levels are determined in the removed reservoir(s), plasma, and tumor in the event of enucleation. The child and the eye shall then be treated at the discretion of the managing ophthalmologist and oncologist.
Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 1
Study Design  ICMJE Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Condition  ICMJE Retinoblastoma
Intervention  ICMJE Drug: Episcleral Topotecan
Transscleral Topotecan
Other Name: Sustained Release Episcleral Topotecan
Study Arms  ICMJE Experimental: Phase I Open Label Study
Phase I Single Arm
Intervention: Drug: Episcleral Topotecan
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Not yet recruiting
Estimated Enrollment  ICMJE
 (submitted: November 5, 2019)
12
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE October 14, 2021
Estimated Primary Completion Date October 1, 2021   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • Age: Patients must be < 48 months of age and at least 12 months of age at the time the consent is signed by the parent(s) or guardian.
  • Diagnosis: Intraocular retinoblastoma, unilateral (Group D) in which enucleation is a recommended therapy.
  • Must have demonstrated intraocular calcium in the tumor containing eye by ophthalmic ultrasound or by neuroimaging.
  • Demonstration of Light Perception in the tumor-bearing eye either with pupil response testing or demonstration of avoidance behavior to light presentation in the affected eye
  • There must be no previous treatment for retinoblastoma or prior therapy with Episcleral Topotecan.
  • Performance Level: Lansky ³ 50.
  • Organ Function Requirements:

Organ function criteria:

  1. Adequate Bone Marrow Function Defined as:

    • Peripheral absolute neutrophil count (ANC) ³ 1000/mm3
    • Platelet count ³ 100,000/mm3 (transfusion independent, defined as not receiving platelet transfusions for at least 7 days prior to enrollment)
    • Hemoglobin ³ 8.0 g/dL at baseline (may receive RBC transfusions)
  2. Adequate Renal Function Defined as:

    • Creatinine clearance or radioisotope GFR ³70ml/min/1.73 m2 or
    • Adequate serum creatinine based on age/gender.

      - Adequate Liver Function Defined as:

    • Bilirubin (sum of conjugated + unconjugated) £ 1.5 x upper limit of normal (ULN) for age
    • SGPT (ALT) £ 110 U/L. For the purpose of this study, the ULN for SGPT is 45 U/L.
    • Serum albumin ³ 2 g/dL.

Exclusion Criteria:

  • Reported allergy to camptothecin, topotecan, or derivatives thereof.
  • Inability to comply with required study follow-up visits and stay within 50 miles of the treating institution during the first 15 days of study period (to EUA on Day 15).
  • Family history of retinoblastoma or retinoma.
  • Patients with International Stage retinoblastoma more advanced than Stage 0 and including:

    • Extra-ocular extension into orbit or brain, or
    • Metastatic retinoblastoma with or without CNS involvement, or
    • MRI showing thickening and enhancement of the optic nerve in either eye.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 12 Months to 48 Months   (Child)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE
Contact: David Carpi, MSc 732-589-0934 dcarpi@3tophthalmics.com
Contact: Ricardo Carvalho, MD 949-533-0990 rcarvalho@3tophthalmics.com
Listed Location Countries  ICMJE Not Provided
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT04156347
Other Study ID Numbers  ICMJE 3TRB01
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: No
Responsible Party Targeted Therapy Technologies, LLC
Study Sponsor  ICMJE Targeted Therapy Technologies, LLC
Collaborators  ICMJE Not Provided
Investigators  ICMJE Not Provided
PRS Account Targeted Therapy Technologies, LLC
Verification Date November 2019

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP