Study Of Palbociclib Combined With Chemotherapy In Pediatric Patients With Recurrent/Refractory Solid Tumors

Phase 1

• Conditions: recurrent/refractory Ewing sarcoma; MedDRA version: 20.0Level: PTClassification code 10015560Term: Ewing's sarcomaSystem Organ Class: 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps); Therapeutic area: Diseases [C] - Cancer [C04]

• Registration Number: EUCTR2021-003444-25-SK
• Lead Sponsor: Pfizer Inc.

Brief Summary

Not available

Detailed Description

Not available

Study Timeline

• Study Start: 2021-11-09
• Last Update Posted: 26 August 2024

Recruitment & Eligibility

• Status: ot Recruiting
• Sex: All
• Target Recruitment: 75

Inclusion Criteria

Patients must meet all the following inclusion criteria to be eligible for
enrollment in the study:
1. Histologically confirmed relapsed or refractory solid tumor as follows:
•For dose escalation and dose determination parts: Histologically
confirmed relapsed or refractory solid tumor (including CNS tumors but
not lymphomas). Patients with Diffuse Intrinsic Pontine Glioma do not
require histological only radiographic confirmed relapse to enroll.
•For dose expansion cohorts: Histologically confirmed relapsed or
refractory solid tumor including but not limited to EWS, rhabdoid tumor,
rhabdomyosarcoma, neuroblastoma, and medulloblastoma. Patients with
Diffuse Intrinsic Pontine Glioma do not require histological only
radiographic confirmed relapse to enroll.
•For tumor-specific cohorts: Histologically confirmed relapsed or
refractory solid tumor including but not limited to EWS, rhabdoid tumor,
rhabdomyosarcoma, neuroblastoma, and medulloblastoma. Patients with
Diffuse Intrinsic Pontine Glioma do not require histological only
radiographic confirmed relapse to enroll.
• For randomized Phase 2 part: Histologically confirmed Ewing sarcoma
at diagnosis or at relapse, with presence of EWSR1-ETS or FUS-ETS
rearrangement. Histopathology confirmation of both EWSR1-ETS or
FUSETS rearrangement partners is required OR availability of formalin
fixed paraffin embedded (FFPE) tumor tissue sample for central testing.
Patient must have relapsed or have refractory disease and at least
evaluable disease in at least one site other than bone marrow that can
be followed by imaging.
2. Age =2 and <21 years at the time of study entry. Refer to Section 4.3
for reproductive criteria for male and female participants.
3. Lansky performance status =50% for patients =16 years of age, or
Eastern Cooperative Oncology Group (ECOG) 0, 1 or 2 for patients >16
years of age.
4. Adequate bone marrow function.
•Absolute neutrophil count =1000/mm3;
•Platelet count =75,000/mm3 (transfusion independent, no platelet
transfusion in
past 7 days prior study entry);
• Hemoglobin =8.5 g/dL (transfusion allowed).
5. Adequate renal function: Serum creatinine level based on age/gender
must be less than or equal to the following maximum upper limits as
shown in Table 10:
Table 10. Maximum Allowed Creatinine Levels
Age Maximum Serum Creatinine (mg/dL)
Male Female
2 to <6 years 0.8 0.8
6 to <10 years 1.0 1.0
10 to <13 years 1.2 1.2
13 to <16 years 1.5 1.4
16 to <21 years 1.7 1.4
The threshold creatinine values in this table were derived from the
Schwartz formula for estimating glomerular filtration rate utilizing child
length and stature data published by the CDC.
6. Adequate liver function, including:
•Aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
=2.5 × upper limit of normal (ULN) or =5 × ULN for age, if attributable
to disease involvement of the liver;
•Total bilirubin =1.5 × ULN for age unless the patient has documented
Gilbert's syndrome. Patients with documented Gilbert's syndrome are
eligible if direct bilirubin is within normal ranges (=ULN).
7. Patients enrolled to Phase 1 portion of the study and tumor specific
cohorts must have measurable disease as defined by RECIST version 1.1
or modified RANO

Exclusion Criteria

Patients with any of the following characteristics/conditions will not be
included in the study:
1. Phase 1 portion and tumor specific cohorts: For palbociclib with IRN
and TMZ combination, prior treatment with a CDK4/6 inhibitor or
progression while on treatment with an IRN-containing regimen that
includes TMZ. Patients who have
received the combination of IRN and TMZ and did not progress while on
these medications are eligible. For patients enrolling in the palbociclib
with TOPO and CTX combination, prior treatment with a CDK4/6 inhibitor
or progression while on treatment with a TOPO-containing regimen that
includes CTX. Patients who have received the combination of TOPO and
CTX and did not progress while on thesemedications are eligible. Phase 2
portion: prior treatment with a CDK4/6 inhibitor or progression while on
treatment with an IRN-containing or TMZ-containing regimen. Patients
who have received IRN and/or TMZ and did not progress while on these
medications are eligible.
2. Prior intolerability to IRN and/or TMZ for IRN and TMZ plus/minus
palbociclib combinations and prior intolerability to TOPO and/or CTX for
TOPO and CTX combination. For patients enrolled in the UK, any
contraindication for IRN and/or TMZ treatment, as per the local SmPC.
3. Use of strong cytochrome P450 (CYP) 3A inhibitors or inducers within
12 days of study entry. Patients who are receiving strong uridine
diphosphate-glucuronosyl transferase 1A1 (UGT1A1) inhibitors within 12
days of C1D1 are not eligible for the palbociclib with IRN and TMZ
combination. Patients who are receiving strong UGT1A1 inhibitors within
12 days of C1D1 are eligible for the palbociclib with TOPO and CTX
combination
4. Systemic anticancer therapy within 2 weeks prior to study entry and 6
weeks for nitrosoureas.
5. Prior irradiation to >50% of the bone marrow
6. Participation in other studies involving investigational drug(s) within
2 weeks or 5 halflives, whichever is longer, prior to study entry
7. Major surgery within 4 weeks prior to study entry. Surgical biopsies or
central line placement are not considered major surgeries.
8. For IRN and TMZ with/without palbociclib combinations: known or
suspected hypersensitivity to palbociclib, dacarbazine, IRN and/or TMZ.
For combination of palbociclib with TOPO and CTX: known or suspected
hypersensitivity to palbociclib, TOPO and/or CTX.
9. Patients with known symptomatic brain tumors or brain metastases
and require steroids, unless they have been on a stable or on a
decreasing steroid dose for >14 days.
10. Patients with previously diagnosed brain metastases are eligible if
they have completed their prior treatment and have recovered from the
acute effects of radiation therapy or surgery prior to study entry for
these metastases for at least 14 days postradiation and 4 weeks post surgery and are neurologically stable.
11. Hereditary bone marrow failure disorder.
12. QTc >470 msec.
13. History of clinically significant or uncontrolled cardiac disease,
including:
History of or active congestive heart failure; if patient had congestive
heart failure
resolve and >1 year from resolution, patient will be considered eligible;
•Clinically significant ventricular arrhythmia (such as ventricular
tachycardia,
ventricular fibrillation or Torsades de Pointes);
•Diagnosed or suspected congenital or acquired prolonged QT syndrome;
•Need for medications known to prolong the QT interval;
•Uncorrected hypomagnesemia or hypokalemia because of potential
effe

Study & Design

• Study Type: Interventional clinical trial of medicinal product
• Study Design: Not specified