Adavosertib and Irinotecan Hydrochloride in Treating Younger Patients With Relapsed or Refractory Solid Tumors

Sponsor
National Cancer Institute (NCI) (NIH)
Overall Status
Active, not recruiting
CT.gov ID
NCT02095132
Collaborator
(none)
76
24
1
93.2
3.2
0

Study Details

Study Description

Brief Summary

This phase I/II trial studies the side effects and best dose of adavosertib and irinotecan hydrochloride in treating younger patients with solid tumors that have come back (relapsed) or that have not responded to standard therapy (refractory). Adavosertib and irinotecan hydrochloride may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.

Detailed Description

PRIMARY OBJECTIVES:
  1. To estimate the maximum tolerated dose (MTD) and/or recommended phase 2 dose of adavosertib (AZD1755 [MK-1775]) administered on days 1 through 5 every 21 days, in combination with oral irinotecan (irinotecan hydrochloride), to children with recurrent or refractory solid tumors.

  2. To define and describe the toxicities of AZD1755 (MK-1775) in combination with oral irinotecan administered on this schedule.

  3. To characterize the pharmacokinetics of AZD1755 (MK-1775) in children with refractory cancer.

SECONDARY OBJECTIVES:
  1. To preliminarily define the antitumor activity of AZD1755 (MK-1775) and irinotecan within the confines of a Phase 1 study.

  2. To obtain initial phase 2 efficacy data on the anti-tumor activity of AZD1755 (MK-1775) in combination with irinotecan administered to children with relapsed or refractory neuroblastoma, in children with relapsed or refractory medulloblastoma/CNS PNET (central nervous system primitive neuroectodermal tumor) and in children with relapsed or refractory rhabdomyosarcoma.

  3. To investigate checkpoint over-ride by AZD1755 (MK-1775) via the mechanism-based pharmacodynamic (PD) biomarker of decreased cyclin-dependent kinase 1 (CDK1) phosphorylation in correlative and exploratory studies.

  4. To evaluate potential predictive biomarkers of AZD1755 (MK-1775) sensitivity, including v-myc avian myelocytomatosis viral oncogene homolog (MYC), v-myc avian myelocytomatosis viral oncogene neuroblastoma derived homolog (MYCN), phosphorylated-WEE1 G2 checkpoint kinase (p-Wee1), enhancer of zeste homolog 2 (Drosophila) (EZH2) and gamma-H2A histone family, member gamma-(H2AX) in tumor tissues in correlative and exploratory studies.

OUTLINE: This is a phase I, dose-escalation followed by a phase II study.

Patients receive irinotecan hydrochloride orally (PO) and adavosertib PO on days 1-5. Treatment repeats every 21 days for up to 18 cycles in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up periodically.

Study Design

Study Type:
Interventional
Actual Enrollment :
76 participants
Allocation:
N/A
Intervention Model:
Single Group Assignment
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
A Phase 1/2 Study of AZD1775 (MK-1775) in Combination With Oral Irinotecan in Children, Adolescents, and Young Adults With Relapsed or Refractory Solid Tumors
Actual Study Start Date :
Mar 27, 2014
Actual Primary Completion Date :
Dec 31, 2020
Anticipated Study Completion Date :
Dec 31, 2021

Arms and Interventions

Arm Intervention/Treatment
Experimental: Treatment (irinotecan hydrochloride, adavosertib)

Patients receive irinotecan hydrochloride PO and adavosertib PO on days 1-5. Treatment repeats every 21 days for up to 18 cycles in the absence of disease progression or unacceptable toxicity.

Drug: Adavosertib
Given PO
Other Names:
  • AZD-1775
  • AZD1775
  • MK-1775
  • MK1775
  • Drug: Irinotecan Hydrochloride
    Given PO
    Other Names:
  • Campto
  • Camptosar
  • Camptothecin 11
  • Camptothecin-11
  • CPT 11
  • CPT-11
  • Irinomedac
  • Irinotecan Hydrochloride Trihydrate
  • Irinotecan Monohydrochloride Trihydrate
  • U-101440E
  • Outcome Measures

    Primary Outcome Measures

    1. Maximum tolerated dose (MTD) [21 days]

      MTD is defined as the maximum doses of adavosertib and irinotecan hydrochloride at which fewer than one-third of patients experience dose limiting toxicities when receiving this combination.

    2. Pharmacokinetic (PK) parameters of adavosertib in terms of systemic exposure [Cycle 1 day 1 prior to the irinotecan infusion, prior to the adavosertib dose, 4 hours after the dose of adavosertib is given, and prior to the irinotecan dose on day 2]

      The PK parameters will be summarized with simple summary statistics, including means, medians, ranges, and standard deviations (if numbers and distribution permit).

    3. PK parameters of adavosertib in terms of drug clearance [Cycle 1 day 1 prior to the irinotecan infusion, prior to the adavosertib dose, 4 hours after the dose of adavosertib is given, and prior to the irinotecan dose on day 2]

      The PK parameters will be summarized with simple summary statistics, including means, medians, ranges, and standard deviations (if numbers and distribution permit).

    Secondary Outcome Measures

    1. Response rate [Up to 1 year]

      Will be assessed according to Response Evaluation Criteria in Solid Tumors. Response rates will be calculated as the percent of patients whose best response is a complete response (CR) or partial response (PR) and confidence intervals will be constructed according to the method of Chang. A responder is defined as a patient who achieves a best confirmed response of PR or CR on the study.

    2. Change in phosphorylated-cyclin-dependent kinase 1 (p-CDK1) levels [Baseline up to 1 year]

      Decreased p-CDK1 indicating Wee1 inhibition by adavosertib will be investigated. These analyses will be descriptive and exploratory and hypotheses generating in nature.

    3. Predictive biomarkers of adavosertib sensitivity [Up to 1 year]

      These analyses will be descriptive and exploratory and hypotheses generating in nature.

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    1 Year to 21 Years
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    No
    Inclusion Criteria:
    • Patients must have had histologic verification of malignancy at original diagnosis or relapse except in patients with intrinsic brain stem tumors, optic pathway gliomas, or patients with pineal tumors and elevations of cerebrospinal fluid (CSF) or serum tumor markers including alpha-fetoprotein or beta-human chorionic gonadotropin (HCG)

    • Part A: Patients with relapsed or refractory solid tumors, including patients with primary or metastatic CNS tumors

    • Part B: Patients with relapsed or refractory neuroblastoma

    • Part C: Patients with relapsed or refractory medulloblastoma or CNS embryonal tumors formally classified as PNET (pineoblastoma, CNS neuroblastoma, CNS ganglioneuroblastoma, embryonal tumor with multi-layered rosettes, medulloepithelioma, CNS embryonal tumor with rhabdoid features [INI1 intact] and CNS embryonal tumor, not otherwise specified)

    • Part D: Patients with relapsed or refractory rhabdomyosarcoma

    • Part A: Patients must have a body surface area >= 0.35 m2 at the time of study enrollment if enrolling on dose levels 1-5; patients must have a body surface area >= 0.46 m2 at the time of study enrollment if enrolling on dose level 0

    • Parts B, C, and D: Phase 2 Expansion: Patients must have a body surface area of > 0.49 m^2 at the time of study enrollment at the recommended phase 2 dose of AZD-1775

    • Part A: Patients must have either measurable or evaluable disease

    • Part B: Patients must have either measurable disease or must be evaluable for MIBG response without evidence of Response Evaluation Criteria in Solid Tumors (RECIST) measurable lesions; patients with neuroblastoma in bone marrow only are not eligible

    • Part C: Patients must have measurable disease by computed tomography (CT) or magnetic resonance imaging (MRI)

    • Part D: Patients must have measurable disease for Part D

    • Patient's current disease state must be one for which there is no known curative therapy or therapy proven to prolong survival with an acceptable quality of life

    • Karnofsky >= 50% for patients > 16 years of age and Lansky >= 50 for patients =< 16 years of age; note: neurologic deficits in patients with CNS tumors must have been relatively stable for at least 7 days prior to study enrollment; patients who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered ambulatory for the purpose of assessing the performance score

    • Patients must have fully recovered from the acute toxic effects of all prior anti-cancer chemotherapy

    • At least 21 days after the last dose of myelosuppressive chemotherapy (42 days if prior nitrosourea)

    • At least 14 days after the last dose of a long-acting growth factor (e.g. Neulasta) or 7 days for short-acting growth factor; for agents that have known adverse events occurring beyond 7 days after administration, this period must be extended beyond the time during which adverse events are known to occur; the duration of this interval must be discussed with the study chair

    • At least 7 days after the last dose of a biologic agent; for agents that have known adverse events occurring beyond 7 days after administration, this period must be extended beyond the time during which adverse events are known to occur; the duration of this interval must be discussed with the study chair

    • At least 42 days after the completion of any type of immunotherapy, e.g. tumor vaccines

    • = 21 days must have elapsed from infusion of lase dose of antibody, and toxicity related to prior antibody therapy must be recovered to grade =< 1

    • At least 14 days after local palliative radiation therapy (XRT) (small port); at least 150 days must have elapsed if prior traumatic brain injury (TBI), craniospinal XRT or if >= 50% radiation of pelvis; at least 42 days must have elapsed if other substantial bone marrow radiation, including therapeutic doses of iobenguane (MIBG)

    • Stem cell Infusion without TBI: no evidence of active graft vs host disease and at least 84 days must have elapsed after transplant or stem cell infusion

    • Patients previously treated with irinotecan are eligible for this study

    • For patients with solid tumors without known bone marrow involvement: peripheral absolute neutrophil count (ANC) >= 1000/mm^3

    • For patients with solid tumors without known bone marrow involvement: platelet count

    = 100,000/mm^3 (transfusion independent, defined as not receiving platelet transfusions for at least 7 days prior to enrollment)

    • For patients with solid tumors without known bone marrow involvement: hemoglobin >= 8.0 g/dL (may receive red blood cell [RBC] transfusions)

    • Patients with known bone marrow metastatic disease will be eligible for study provided they meet the blood counts (may receive transfusions provided they are not known to be refractory to red cell or platelet transfusions); these patients will not be evaluable for hematologic toxicity; at least 2 of every cohort of 3 patients must be evaluable for hematologic toxicity for Part A, the dose escalation part of the study; if dose-limiting hematologic toxicity is observed, all subsequent patients enrolled must be evaluable for hematologic toxicity

    • Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 ml/min/1.73 m^2 or a serum creatinine based on age/gender as follows:

    • Age 1 to < 2 years: 0.6 mg/dL

    • Age 2 to < 6 years: 0.8 mg/dL

    • Age 6 to < 10 years: 1 mg/dL

    • Age 10 to < 13 years: 1.2 mg/dL

    • Age 13 to < 16 years: 1.5 mg/dL (males), 1.4 mg/dL (females)

    • Age >= 16 years: 1.7 mg/dL (males), 1.4 mg/dL (females)

    • Bilirubin (sum of conjugated + unconjugated) =< 1.5 x upper limit of normal (ULN) for age

    • Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 135 U/L; for the purpose of this study, the ULN for SGPT is 45 U/L

    • Serum albumin >= 2 g/dL

    • Correct QT interval (QTc) =< 480 msec; Note: Patients should avoid concomitant medication known or suspected to prolong QTc interval or cause torsades de pointes; if possible, alternative agents should be considered; patients who are receiving drugs that prolong the QTc are eligible if the drug is necessary and no alternatives are available

    • Patients with seizure disorder may be enrolled if on non-enzyme inducing anticonvulsants and well controlled

    • Nervous system disorders (Common Terminology Criteria for Adverse Events version 5.0 [CTCAE v5.0]) resulting from prior therapy must be =< grade 2, with the exception of decreased tendon reflex (DTR); any grade of DTR is eligible

    • All patients and/or their parents or legally authorized representatives must sign a written informed consent; assent, when appropriate, will be obtained according to institutional guidelines

    • Tissue blocks or slides must be sent if available, with exclusions; if tissue blocks or slides are unavailable, the study chair must be notified prior to study enrollment

    • Patients must be able to swallow capsules

    Exclusion Criteria:
    • Pregnant or breast-feeding women may not be entered on this study as there is yet no available information regarding human fetal or teratogenic toxicities; pregnancy tests must be obtained in girls who are post-menarchal

    • Males or females of reproductive potential may not participate unless they have agreed to use an effective double barrier contraceptive method for the entire duration of protocol therapy and for 3 months (males) and 1 month (females) after study drug discontinuation

    • Patients receiving corticosteroids who have not been on a stable or decreasing dose of corticosteroid for at least 7 days prior to enrollment are not eligible

    • Patients who are currently receiving another investigational drug are not eligible

    • Patients who are currently receiving other anti-cancer agents are not eligible

    • Patients who are currently receiving drugs that are strong or moderate inhibitors and/or inducers of cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4) or sensitive CYP3A4 substrates and CYP3A4 substrates with a narrow therapeutic range are not eligible; the use of aprepitant as an antiemetic is prohibited due to early drug interaction data demonstrating increased exposure to AZD1775 (MK-1775); caution should be exercised with concomitant administration of AZD1755 (MK-1775) and agents that are sensitive substrates of cytochrome P450, family 2, subfamily C, polypeptide 8 (CYP2C8), 2C9 and 2C19, or substrates of this enzyme with narrow therapeutic ranges, as well as agents that are inhibitors or substrates of permeability glycoprotein (P-gp)

    • Patients who are receiving cyclosporine, tacrolimus or other agents to prevent graft-versus-host disease post bone marrow transplant are not eligible for this trial

    • Patients must not have received enzyme inducing anticonvulsants for at least 14 days prior to enrollment

    • Patients with cardiac diseases ongoing or in the past 6 months (e.g. congestive heart failure, acute myocardial infarction, significant uncontrolled arrhythmias) are not eligible for this trial

    • Patients who have an uncontrolled infection are not eligible

    • Patients who have received a prior solid organ transplantation are not eligible

    • Patients who in the opinion of the investigator may not be able to comply with the safety monitoring requirements of the study are not eligible

    • Patients with a history of allergic reaction to irinotecan, cephalosporins or a severe penicillin allergy are not eligible

    • Patients unable to swallow capsules whole are not eligible; nasogastric or gastric (G) tube administration is not allowed

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 Children's Hospital of Alabama Birmingham Alabama United States 35233
    2 Children's Hospital Los Angeles Los Angeles California United States 90027
    3 Children's Hospital of Orange County Orange California United States 92868
    4 UCSF Medical Center-Parnassus San Francisco California United States 94143
    5 UCSF Medical Center-Mission Bay San Francisco California United States 94158
    6 Children's Hospital Colorado Aurora Colorado United States 80045
    7 Children's National Medical Center Washington District of Columbia United States 20010
    8 Children's Healthcare of Atlanta - Egleston Atlanta Georgia United States 30322
    9 Lurie Children's Hospital-Chicago Chicago Illinois United States 60611
    10 Riley Hospital for Children Indianapolis Indiana United States 46202
    11 Dana-Farber Cancer Institute Boston Massachusetts United States 02215
    12 C S Mott Children's Hospital Ann Arbor Michigan United States 48109
    13 University of Minnesota/Masonic Cancer Center Minneapolis Minnesota United States 55455
    14 Washington University School of Medicine Saint Louis Missouri United States 63110
    15 NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center New York New York United States 10032
    16 Cincinnati Children's Hospital Medical Center Cincinnati Ohio United States 45229
    17 Oregon Health and Science University Portland Oregon United States 97239
    18 Children's Hospital of Philadelphia Philadelphia Pennsylvania United States 19104
    19 Children's Hospital of Pittsburgh of UPMC Pittsburgh Pennsylvania United States 15224
    20 Saint Jude Children's Research Hospital Memphis Tennessee United States 38105
    21 Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center Houston Texas United States 77030
    22 Seattle Children's Hospital Seattle Washington United States 98105
    23 Children's Hospital of Wisconsin Milwaukee Wisconsin United States 53226
    24 Hospital for Sick Children Toronto Ontario Canada M5G 1X8

    Sponsors and Collaborators

    • National Cancer Institute (NCI)

    Investigators

    • Principal Investigator: Kristina A Cole, COG Phase I Consortium

    Study Documents (Full-Text)

    More Information

    Publications

    None provided.
    Responsible Party:
    National Cancer Institute (NCI)
    ClinicalTrials.gov Identifier:
    NCT02095132
    Other Study ID Numbers:
    • NCI-2014-00547
    • NCI-2014-00547
    • ADVL1312
    • ADVL1312
    • UM1CA097452
    First Posted:
    Mar 24, 2014
    Last Update Posted:
    Sep 16, 2021
    Last Verified:
    Sep 1, 2021

    Study Results

    No Results Posted as of Sep 16, 2021