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A Study of Repotrectinib in Combination With Chemotherapy in Children and Young Adults With Solid Tumor Cancer

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: NCT05004116
Recruitment Status : Recruiting
First Posted : August 13, 2021
Last Update Posted : June 14, 2022
Sponsor:
Information provided by (Responsible Party):
Memorial Sloan Kettering Cancer Center

Brief Summary:
This study will test the safety of the study drug, repotrectinib, in combination with chemotherapy (irinotecan and temozolomide) in children and young adults who have advanced or metastatic solid tumors. We researchers will try to find the highest dose of the study drug that causes few or mild side effects in study participants. When the researchers find this dose, we will evaluate it in a different group of participants to find out whether repotrectinib in combination with chemotherapy is an effective treatment for children and young adults who have advanced/metastatic solid tumors. Another purpose of the study is to look at the way the body absorbs, distributes, and gets rid of repotrectinib.

Condition or disease Intervention/treatment Phase
Advanced Cancer Metastatic Solid Tumor Drug: Repotrectinib Drug: Irinotecan and temozolomide Phase 1 Phase 2

Detailed Description:

Part A : TPX-0005 (Repotrectinib) will be given orally (without regard to food) once daily for 14 days, then increased to twice daily for remainder of cycles and concurrently administered with chemotherapy backbone described below. For patients less than 12 years old or less than 50kg, adult equivalent dosing (AED) will be used Approximately 4-24 pediatric subjects will be enrolled into 2-4 dose levels (pending if DL-1 or DL-1b are utilized), with maximum of 6 subjects per dose level according to the 'rolling 6' design. Starting dose of TPX-0005 (Repotrectinib) will begin at dose level (DL) 1.

Part B (PK expansion cohort for patients <12 years old): Up to six patients <12 years old will be included in a PK expansion cohort after the maximum tolerated dose in Part A has been determined. The number of patients included in part B will be based on the the number of patients <12 years old enrolled on part A. A minimum of 6 patients <12 will be included in parts A and B combined.

Phase 2: Patients will be enrolled into one of the following 3 cohorts and will be treated at the RP2D of TPX-0005 (Repotrectinib) plus chemotherapy as determined in Phase 1.

Cohort 1 (Neuroblastoma ALK point mutation) Cohort 2 (Desmoplastic Small Round Cell Tumor) Cohort 3 (Exploratory)

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 50 participants
Allocation: N/A
Intervention Model: Sequential Assignment
Intervention Model Description: This is a single institution phase 1/2 study of TPX-0005 (Repotrectinib) (capsule) when given in combination with irinotecan and temozolomide in pediatric and young adult patients (≥12 years old) with relapsed/refractory solid tumors, followed by a single institution phase 2 study to determine the overall response rate at the recommended phase 2 dose in primarily neuroblastoma and DSRCT patients.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase 1/2 Study of TPX-0005 (Repotrectinib) in Combination With Chemotherapy in Pediatric and Young Adult Subjects With Advanced or Metastatic Solid Tumors and Primary Central Nervous System Tumors
Actual Study Start Date : August 9, 2021
Estimated Primary Completion Date : August 2028
Estimated Study Completion Date : August 2028

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Repotrectinib

Phase 1:

Part A : TPX-0005 (Repotrectinib) will be given orally (without regard to food) once daily for 14 days, then increased to twice daily for remainder of cycles and concurrently administered with chemotherapy backbone described below. For patients less than 12 years old or less than 50kg, adult equivalent dosing (AED) will be used. Approximately 4-24 pediatric subjects will be enrolled into 2-4 dose levels (pending if DL-1 or DL-1b are utilized), with maximum of 6 subjects per dose level according to the 'rolling 6' design. Starting dose of TPX-0005 (Repotrectinib) will begin at dose level (DL) 1. Part B (combination therapy; patients less than 12 years old or ≤ 50kg): For 6 additional patients, a safety run-in will be conducted with TPX-0005 (Repotrectinib) and chemotherapy.

Drug: Repotrectinib
TPX-0005 (Repotrectinib) will be taken orally twice daily in 28-day cycles without regard to food and will be administered orally before administration of irinotecan and temozolomide (exception: C1, TPX-0005 (Repotrectinib) will be administered once daily x 14 days, then twice daily D15-D28).
Other Name: TPX-0005

Drug: Irinotecan and temozolomide
Irinotecan and temozolomide will be given as per institutional standard.




Primary Outcome Measures :
  1. incidence of Dose Limiting Toxicity (DLTs) (phase I) [ Time Frame: 8 weeks following the start of treatment ]
    DLTs will be defined as any of the following events that are possibly, probably or definitely attributable to TPX-0005 (Repotrectinib) given in combination with chemotherapy and occurring. Grading will be evaluated according to National Cancer Institute CTCAE v5.0.

  2. Maximum tolerated dose (MTD) (phase I) [ Time Frame: 1 year ]
    MTD will be defined for TPX-0005 (Repotrectinib) in combination with chemotherapy. The MTD is the highest dose level of TPX-0005 (Repotrectinib) expected to cause a DLT in not more than 1/6 treated subjects. The dose escalation will follow a standard rolling 6 design (an algorithm-based extension of a standard 3+3 design).



Information from the National Library of Medicine

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Ages Eligible for Study:   1 Year to 25 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria (ALL Patients) :

  • Prior Therapy: Patients must have fully recovered from the acute toxic effects of all previous chemotherapy, immunotherapy, or radiotherapy prior to study enrollment. Patients must not have received the therapies indicated below for the specified time period prior to the first day of administration of protocol therapy on this study:

    • Myelosuppressive chemotherapy: Last dose was given at least 21 days before the start date for protocol therapy.
    • Biologic (anti-neoplastic agent including retinoids): Last dose given at least 7 days prior to the start date for protocol therapy.
    • Monoclonal antibodies: Last dose of any monoclonal antibodies must have received at least 7 days or 3 half-lives, whichever is longer, prior to the start date for protocol therapy.
    • Immunotherapy (ex: tumor vaccine): Patient is eligible after 42 days of completion. Steroids are excluded from inclusion in immunotherapy.
    • Radiation Therapy: Patients must not have received radiation for a minimum of two weeks prior to study enrollment for small port. If extensive bone marrow radiation, at least 42 days must have elapsed.
    • Palliative radiotherapy on study is permitted for the treatment of painful bony lesions providing the lesions were known at the time of study entry and the Investigator clearly indicates that the need for palliative radiotherapy is not indicative of disease progression. In view of the current lack of data about the interaction of repotrectinib with radiotherapy, repotrectinib treatment should be interrupted during palliative radiotherapy, stopping 1 day before palliative radiotherapy and resuming treatment 1 day after completion of palliative radiotherapy and recovery from any acute radiation toxicities to baseline.
    • Hematopoietic Stem Cell Transplant (HSCT): Patients are eligible 12 weeks after date of autologous hematopoietic stem cell infusion following myeloablative therapy (timed from first day of this protocol therapy). Patients who have received an autologous hematopoietic stem cell infusion to support non- myeloablative therapy (such as ^131 I-MIBG) are eligible at any time as long as they meet the other criteria for eligibility.
    • ^131 I-MIBG therapy: A minimum of 6 weeks must have elapsed after ^131 I-MIBG therapy prior to start of protocol therapy.
    • Growth factors: Patients are eligible 14 days after last dose of long-acting growth factor (ex: peg-GCSF) or 7 days after short acting growth factor.
    • Any investigational agent or anticancer therapy other than chemotherapy and not otherwise noted: Not within 2 weeks prior to planned start of TPX-0005 (Repotrectinib) or 5 half-lives, whichever is shorter. Full recovery of clinically significant toxicities from that therapy must be evident.
    • Any prior treatment with a tyrosine kinase inhibitor (TKI) of ALK/ROS/NTRK does NOT exclude patient from study (Patients are eligible for study at least 7 days or 5 half-lives, whichever is shorter, after last dose)
  • Disease Status

    • Patients must have relapsed or refractory disease despite standard therapy.
    • Phase 1: Patients must have evaluable or measurable disease
    • Phase 2: All patients must have measurable disease (per Appendices 1-3) at time of enrollment
    • Exception: Neuroblastoma patients are permitted to have evaluable disease only (ex: bone disease only, evaluable by MIBG or FDG PET/CT)
  • Biopsy Requirement

    °Archived tissue must be available for analysis, but no fresh biopsy is required (exception: patients with DIPG do not require archived tissue). If no archival tissue is available, waiver may be permitted by study PI (phase 1 only).

  • Patients with Primary CNS Tumors:

    • Patients with primary CNS tumor or CNS metastases must be neurologically stable on a stable or decreasing dose of steroids for at least 14 days prior to enrollment
    • Archived tissue and histologic verification requirement are waived for patients with diffuse intrinsic pontine glioma (DIPG)
  • Performance Score: Patients must have a Lansky (< 16 years age) or Karnofsky (≥ 16 years age) score of at least 50. Patients who are unable to walk because of paralysis or tumor pain, but who are up in a wheelchair, will be considered ambulatory for the purpose of assessing the performance score.
  • No bone marrow involvement

    • Absolute Neutrophil Count ≥1000/mm^3 (1 x 10^9/L)
    • Platelet Count ≥100,000/mm ^3 (100 x 10^9/L); transfusions allowed
    • Hemoglobin ≥ 8.0 g/dL, transfusions are allowed
  • Known bone marrow involvement (applicable for phase 2 only)

    • Absolute Neutrophil Count ≥750/mm 3 (1.5 x 109/L)
    • Platelet Count ≥50,000/mm^3 (100 x 10^9/L), transfusions allowed
    • Hemoglobin ≥ 8.0 g/dL, transfusions are allowed
  • Serum Creatinine or Creatinine Clearance*Creatinine within normal limits for age/gender (see table below) or creatinine clearance or nuclear GFR ≥ 60 mL/min/1.73m^2
  • Total Serum Bilirubin <2.5 x ULN for age/gender
  • Liver Transaminases (AST/ALT) <2.5 x ULN for age/gender; < 5 x ULN for age/gender if liver metastasis is present
  • Alkaline phosphatase <2.5 x ULN for age/gender; < 5 x ULN for age/gender if bone metastases are present
  • Serum calcium, magnesium and potassium Normal for age/gender or ≤ CTCAE Grade 1 with or without supplementation.
  • Cardiac Function Echocardiogram with left ventricular shortening fraction >25% and QTc </= 470ms on screening electrocardiogram
  • AST/ALT = aspartate aminotransferase/alanine aminotransferase, ULN = upper limit of normal
  • Adequate Renal Function using the Schwartz formula for estimating GFR Schwartz et al. J. Peds, 106:522, 1985) utilizing child length and stature data published by the CDC.
  • Females of Childbearing potential: Must have negative serum pregnancy test during screening and be neither breastfeeding nor intending to become pregnant during study participation. Females of childbearing potential must agree to avoid pregnancy during the study and agree to the use of 2 effective contraceptive methods (hormonal and barrier method of birth control) prior to study entry, for the duration of study participation, and in the following 1 month after discontinuation of study treatment. Men with partner(s) of childbearing potential must take appropriate precautions to avoid fathering a child from screening until 6 months after discontinuation of study treatment and to use appropriate barrier contraception or abstinence.
  • Ability to comply with outpatient visits, laboratory testing, and study procedures during study participation
  • The patient, parent or guardian must voluntarily sign and date an informed consent approved (in addition to pediatric assent, if required) by an Independent Ethics Committee (IEC)/Institutional Review Board (IRB), prior to the initiation of any screening or study specific procedures.
  • Age:

    • Phase 1 (Part A): ≤ 30 years old (age at C1D1)
    • Phase 1 (Part B): < 12 years old (age at C1D1)
    • Phase 2: ≤ 30 years old (age at C1D1)
  • Disease:

    • Phase 1: Pediatric patients with relapsed/refractory solid tumors (including primary CNS tumors). Patients with ALK, ROS1, or NTRK1/2/3 fusions are permitted to enroll in this cohort if progressed on prior targeted therapy or are not eligible for a higher priority study of single agent inhibition (ex: repotrectinib monotherapy IRB#20-077). Patients with tumors not characterized by any ALK/ROS/NTRK aberration are also permitted to enroll in this cohort.
    • Phase 2
  • Cohort 1: Patients with relapsed/refractory neuroblastoma with documented ALK activating SNV (including F1174, F1245, R1275, and other SNVs deemed activating by the primary investigator).
  • Cohort 2: Patients with molecularly defined desmoplastic small round cell tumor (DSRCT)
  • Cohort 3: Exploratory cohort of patients with relapsed or refractory solid tumors (no requirement of ALK, ROS1, NTRK1-3 aberrations). Patients with ALK, ROS1, or NTRK1/2/3 fusions are permitted to enroll in this cohort if progressed on prior targeted therapy or are not eligible for a higher priority study of single agent inhibition (ex: repotrectinib monotherapy IRB# 20-077).
  • Patients treated in Phase 1 at RP2D will be evaluable in the Phase 2 cohort if they meet all other inclusion criteria for the specified cohort. Patients receiving oral capsule OR oral suspension can be included in Phase 2 cohort. Enrollment of patients of at least 12 years old can begin treatment in Phase 2 once TPX-0005 (Repotrectinib) combination therapy RP2D is defined in Phase 1A (even if Phase 1B is not yet completed)
  • Tissue Analysis

    • Phase 1: All patients must have archived tissue available for analysis (exception: DIPG patients), but ALK/ROS/NTRK status verification is not required prior to enrollment. If no archival tissue is available, waiver may be permitted by study PI (phase 1 only).
    • Phase 2: Prior to enrollment, all patients must have ALK/ROS/NTRK status evaluated in CLIA lab or equivalent by any nucleic acid-based diagnostic testing method (e.g., next-generation sequencing [NGS], Sanger sequencing, reverse transcription-polymerase chain reaction). Exception: Patients with molecularly defined DSRCT do not require ALK/ROS/NTRK status confirmed prior to enrollment.

Exclusion Criteria:

  • Phase 1- patients with known bone marrow disease
  • Concurrent participation in another therapeutic clinical trial
  • Neuroblastoma patients with only bone marrow disease evaluable only by bone marrow aspiration
  • Major surgery within 14 days (2 weeks) prior to C1D1. Central venous access (Broviac, MediPort) placement does not meet criteria for major surgery.
  • Pregnancy or lactation
  • Known active infections requiring ongoing treatment (bacterial, fungal, viral including human immunodeficiency virus positivity).
  • Gastrointestinal disease (e.g., Crohn's disease, ulcerative colitis, short gut syndrome) or other malabsorption syndromes that would impact on drug absorption.
  • Peripheral neuropathy CTCAE grade ≥ 3.
  • Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or study drug administration, or that may interfere with the interpretation of study results and, in the judgment of the Investigator, would make the subject inappropriate for entry into this study, or could compromise protocol objectives in the opinion of the Investigator and/or Turning Point Therapeutics.
  • Current use or anticipated need for drugs that are known to be strong CYP3A4 inhibitors or inducers
  • Disease progression while on treatment with irinotecan/temozolomide.
  • Gilbert Syndrome or Crigler-Najjar
  • Prolonged QTc: 450m/s for male patients and 470ms for female patients.

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): NCT05004116


Contacts
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Contact: Tara O'Donohue, MD 1-833-675-5437 odonohut@mskcc.org
Contact: Stephen Roberts, MD 1-833-675-5437

Locations
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United States, New York
Memorial Sloan Kettering Cancer Center (All Protocol Activities) Recruiting
New York, New York, United States, 10065
Contact: Tara O'Donohue, MD    833-675-5437      
Contact: Stephen Roberts, MD    1-833-675-5437      
Sponsors and Collaborators
Memorial Sloan Kettering Cancer Center
Investigators
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Principal Investigator: Tara O'Donohue, MD Memorial Sloan Kettering Cancer Center
Additional Information:
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Responsible Party: Memorial Sloan Kettering Cancer Center
ClinicalTrials.gov Identifier: NCT05004116    
Other Study ID Numbers: 21-156
First Posted: August 13, 2021    Key Record Dates
Last Update Posted: June 14, 2022
Last Verified: June 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: Memorial Sloan Kettering Cancer Center supports the international committee of medical journal editors (ICMJE) and the ethical obligation of responsible sharing of data from clinical trials. The protocol summary, a statistical summary, and informed consent form will be made available on clinicaltrials.gov when required as a condition of Federal awards, other agreements supporting the research and/or as otherwise required. Requests for deidentified individual participant data can be made beginning 12 months after publication and for up to 36 months post publication. Deidentified individual participant data reported in the manuscript will be shared under the terms of a Data Use Agreement and may only be used for approved proposals. Requests may be made to: crdatashare@mskcc.org.

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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 Memorial Sloan Kettering Cancer Center:
Repotrectinib
21-156
Additional relevant MeSH terms:
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Neoplasms
Irinotecan
Temozolomide
Topoisomerase I Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Antineoplastic Agents, Alkylating
Alkylating Agents