RAD001 and Neurocognition in PTEN Hamartoma Tumor Syndrome

Phase 1

Completed

• Conditions: PTEN Hamartoma Tumor Syndrome; PTEN Gene Mutation
• Interventions: Drug: RAD001; Drug: Placebo

• Registration Number: NCT02991807
• Lead Sponsor: Boston Children's Hospital

Brief Summary

Phosphatase and TENsin homolog (PTEN) gene germline mutations are associated with a spectrum of clinical manifestations characterized by neurocognitive deficits, intellectual disability, autism symptomatology, skin lesions, macrocephaly, hamartomatous overgrowth of tissues, and an increased risk of cancers. Investigators are conducting research to evaluate the potential safety and efficacy of RAD001 (everolimus) in this patient population, and the potential neurocognitive benefits from treatment with RAD001 or placebo for a six month period. The investigators hope this trial will lead to a better understanding of PTEN and to new forms of treatment that may benefit children and adults with PTEN in the future.

Detailed Description

This is a signal seeking Phase I/II 6-month, randomized, double-blind placebo-controlled trial of everolimus in individuals, ages 5 to 45 years with a PTEN mutation, with safety and neurocognition as the primary endpoints.

Participant's or a legal guardian will need to sign an informed consent prior to enrollment in the study. To determine eligibility participants will undergo a series of screening tests and safety measures. If determined to be eligible for the blinded phase of the study, participants will be randomly assigned to take either the study drug or a placebo (pill with no medicine).

The blinded phase of the study involves about eight visits, five of which will occur at the study site, and three of which will be conducted over the phone. These visits will take place over a six month period. Study visits will vary in length. Baseline, three month and six month visits may last up to 8 hours, if optional measures are done, while all other visits will be less than 2 hours. The study visits include blood draws, general health exams, and neuropsychological assessments. The study will also include optional eye-tracking, EEG and auditory evoked potential (AEP) measures, and the collection of microbiome/mycobiome and biomarker blood sample. There is no fee to participate in this study. The study drug will be provided at no charge during the study.

After the 6 month treatment phase, individuals who were randomly assigned to take placebo will be offered inclusion in a 6 month open label phase where the study drug will be provided at no charge. The open label phase assessments will be similar to those done in the blinded phase, but patients/families will only need to return to the study site three times during this phase.

Participants will receive a developmental assessments report after completing the study. After all study data has been analyzed, patients and families will also be informed of the overall results. Treatment on this study may or may not improve an individual's learning skills (neurocognition) or behavior. We hope that future patients and families will benefit from what is learned by this study.

Specific Aims /Objectives Primary objective

-To evaluate the safety of everolimus compared with placebo in patients with PTEN mutations focusing on NCI CTCAE Grade 3 and 4 adverse events, serious adverse events, and Grade 3 and 4 laboratory toxicities.

Secondary objectives

-To evaluate the efficacy of everolimus on neurocognition and behavior in inividuals with PTEN mutations compared to placebo as measured by standardized, direct and indirect neurocognitive tools and behavioral measures.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study First Submitted: 2016-12-02
• Study First Submitted QC: 2016-12-09
• Study First Posted: 2016-12-14
• Study Start: 2017-06-12
• Primary Completion: 2021-02-18
• Study Completion: 2021-12-22
• Status Verified: 2022-02
• Last Update Submitted: 2022-02-07
• Last Update Posted: 2022-02-08

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 46

Inclusion Criteria

Not provided

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Exclusion Criteria

Not provided

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
RAD001	RAD001	RAD001 is formulated as tablets of 5.0 mg or 2.5mg strength, blister-packed under aluminum foil in units of 10 tablets and dosed on a regular basis.
Placebo	Placebo	Matching placebo will be provided as a matching tablet and will also be blister packed under aluminum foil in units of 10.

Primary Outcome Measures

Name	Time	Method
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]	Through study completion, an average of 6 months	The primary endpoint will be safety as measured by study drop-out rate due to side effects, comparing everolimus vs. placebo. We will also determine the frequency of adverse events by type and severity.

Secondary Outcome Measures

Name	Time	Method
Change in Impulsivity at 6 Months	6 months	Impulsivity will be measured by Conners' Continuous Performance Test-3- Commissions and Bias (B').
Change in Motor Functioning at 6 Months	6 months	Motor functioning will be measured by the Purdue Pegboard (Pegs): Dominant and non-dominant hand combined standard scores and Developmental Coordination Disorder Questionnaire (DCDQ): Total score.
Change in Global Cognitive Ability at 6 Months	6 months	Change in global cognitive ability will be measured by Stanford-Binet 5 or Mullen; Full scale, verbal and nonverbal ability (IQ)
Change in Communication Ability at 6 Months	6 months	Communication ability will be measured by using standard scores of the Peabody Picture Vocabulary Test (PPVT-4), Expressive Vocabulary Test (EVT-2)
Change in Working Memory at 6 Months	6 months	Working memory will be evaluated using the Stanford Binet 5 or Mullen Scales of Early Learning at 6 months
Change in Processing Speed at 6 Months	6 months	Processing speed will be evaluated using mean reaction time on the Conner's Continuous Performance Test (CPT)-3.
Change in Fine Motor Skills at 6 Months	6 months	Fine motor skills will be evaluated using the Purdue Pegboard sub-tests average of both hands
Change in Attention at 6 Months	6 months	Attention will be measured by Conners' Continuous Performance Test - 3 - Discriminability index (d') and Omissions

Trial Locations

Locations (3)

Stanford University; 🇺🇸 Palo Alto, California, United States

Cleveland Clinic; 🇺🇸 Cleveland, Ohio, United States

Boston Children's Hospital; 🇺🇸 Boston, Massachusetts, United States