This trial investigates a novel combination treatment regimen using immune checkpoint inhibition and epigenetic therapy in children with relapsed/refractory/progressive high-risk solid tumors or CNS tumors. Thus, this trial focuses on the pediatric population in 4 biomarker-defined cohorts, for which there is no standard of care treatment available.
Conditions
Interventions
Trade Name: Opdivo
Product Name: Nivolumab
Pharmaceutical Form: Concentrate for solution for infusion
Other descriptive name: NIVOLUMAB
Concentration unit: mg/ml milligram(s)/millilitre
Concentration
Sponsors
Heidelberg University Hospital
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: -Children and adolescents with refractory/relapsed/progressive high-risk -CNS tumors: medulloblastoma, ependymoma, ATRT, ETMR, pediatric high grade glioma (including DIPG) or other pediatric embryonal CNS tumors OR -solid tumors: neuroblastoma, nephroblastoma, rhabdoid tumor, embryonal or alveolar rhabdomyosarcoma, other embryonal small round blue cell tumors including pediatric type (bone) sarcoma, or other pediatric type solid tumors OR -Children and adolescents with newly diagnosed high grade glioma (HGG) in the context of a constitutional mismatch repair deficiency syndrome after maximum safe surgical resection with no established standard of care treatment option with curative intention available. In addition in France: ineligible to radiotherapy. - No standard of care treatment available - Age at registration = 2 to = 21 years. - Molecular analysis for biomarker identification (SNV load, high TILs or TLS positive, MYC/N amplification) in laboratories complying with DIN EN ISO/IEC 17025 or similar via INFORM molecular diagnostic platform or equivalently valid molecular pipeline. - Biomarker determined using whole exome sequencing (SNV load), IHC analysis (high TILs or TLS positive), whole genome or whole exome sequencing (MYC/N amplification). - In case molecular analysis was not performed via INFORM Registry molecular pipeline: transfer of molecular data (whole exome sequencing) - Time between biopsy/puncture/resection of the current refractory/relapsed/progressive tumor and registration = 24 weeks. In patients receiving therapy not impacting biomarker stratification, time between biopsy/puncture/resection of the current refractory/relapsed/progressive tumor and registration of = 36 weeks is allowed. - Disease that is measurable as defined by RANO criteria or RECIST v1.1 (as appropriate). - Life expectancy > 3 months, sufficient general condition score (Lansky = 70 or Karnofsky = 70). Transient states like infections can be accepted, and also stable disabilities resulting from disease/surgery (hemiparesis, amputations etc.) can be accepted and will not be considered for Lansky/Karnofsky assessments. - Laboratory requirements: - Hematology: absolute granulocytes = 1.0 × 109/l (unsupported) platelets = 100 × 109/l & stable hemoglobin = 8 g/dl or = 4.96 mmol/L - Biochemistry: Total bilirubin = 1.5 x upper limit of normal (ULN) AST(SGOT) = 3.0 x ULN ALT(SGPT) = 3.0 x ULN serum creatinine = 1.5 x ULN for age - ECG: normal QTc interval = 480 msec - Patient is able to swallow oral study medication - Ability of patient and/or legal representative(s) to understand the character and individual consequences of clinical trial - Females of childbearing potential must have a negative serum or urine pregnancy test within 7 days prior to initiation of treatment. Sexually active women of childbearing potential must agree to use acceptable and appropriate contraception during the study and for at least 6 months after the last study treatment administration. Sexually active male patients must agree to use a condom during the study and for at least 3 months after the last study treatment administration. - Absence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial - Before patient screening and registration, written infor
Exclusion criteria
Exclusion criteria: - Patients with CNS tumors or metastases who are neurologically unstable despite adequate treatment (e.g. convulsions). - Patients with low-grade gliomas or tumors of unknown malignant potential are not eligible - Evidence of > Grade 1 recent CNS hemorrhage on the baseline MRI scan. - Participants with bulky CNS tumor on imaging are ineligible; bulky tumor is defined as: - Tumor with any evidence of uncal herniation or severe midline shift - Tumor with diameter of > 6 cm in one dimension on contrast-enhanced MRI - Tumor that in the opinion of the investigator, shows significant mass effect - Previous allogeneic bone marrow, stem cell or organ transplantation - Diagnosis of immunodeficiency - Diagnosis of prior or active autoimmune disease - Evidence of interstitial lung disease - Any contraindication to oral agents or significant nausea and vomiting, malabsorption, or significant small bowel resection that, in the opinion of the investigator, would preclude adequate absorption. - Known history of human immunodeficiency virus (HIV) (HIV 1/2 antibodies). Known active hepatitis B (e.g., hepatitis B surface antigen-reactive) or hepatitis C (e.g., hepatitis C virus ribonucleic acid [qualitative]). Patients with past hepatitis B virus (HBV) infection or resolved HBV infection (defined as the presence of hepatitis B core antibody [HBc Ab] and absence of HBsAg) are eligible. HBV DNA test must be performed in these patients prior to study treatment. Patients positive for hepatitis C virus (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA. - Clinically significant, uncontrolled heart disease - Major surgery within 21 days of the first dose. Gastrostomy, ventriculo-peritoneal shunt, endoscopic ventriculostomy, tumor biopsy and insertion of central venous access devices are not considered major surgery, but for these procedures, a 48 hour interval must be maintained before the first dose of the investigational drug is administered. - Any anticancer therapy (e.g., chemotherapy, HDACi (including valproic acid), DNA methyltransferase inhibitors, other immunotherapy, targeted therapy, biological response modifiers, endocrine anticancer therapy or radiotherapy) within 2 weeks or at least 5 half-lives (whichever is longer) of study drug administration. - Radiologically confirmed radiotherapy induced pseudoprogression in CNS tumors - Traditional herbal medicines; these therapies are not fully studied and their use may result in unanticipated drug-drug interactions that may cause or confound the assessment of toxicity. As part of the enrollment/informed consent procedures, the patient will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the patient is considering a new over-the-counter medicine or herbal product. For information on CYP substrates and P-gp inhibitors or inducers see section 5.8. - History of hypersensitivity to the investigational medicinal product or to any drug with similar chemical structure or to any excipient present in the pharmaceutical form (including benzamide) of the investigational medicinal product - Participation in other ongoing clinical trials. - Pregnant or lactating females. - Presence of underlying medical condition (e.g. gastrointestinal disorders or electrolyte disturbances) that in the opinion of the Investigator or Sponsor could adversely affect the ability of the subject to comply with or tolerate study pro
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Main Objective: Phase I To determine the recommended phase II dose (RP2D) of the combination treatment with nivolumab and entinostat administered to adolescents 12-21 years with progressive, relapsed, refractory high-risk solid tumors and CNS tumors To determine the recommended phase II dose (RP2D) of the combination treatment with nivolumab and entinostat administered to children 6-11 years with progressive, relapsed, refractory high-risk solid tumors and CNS tumors Phase II To evaluate activity of the combination treatment with nivolumab and entinostat in children and adolescents age 2-21 years with refractory/relapsed/progressive high-risk solid tumors and CNS tumors with: Group A: a high mutational load (> 100 somatic SNVs/exome) Group B: enrollment closed Group C: Focal MYC(N) amplification or ATRT-MYC subgroup Group D: Patients with biomarker low tumors according to the definitions of group A, C, E Group E: high TILs or TLS positive.;Secondary Objective: •Comparison of patient outcomes in group D (biomarker low) with all biomarker positive groups A, C , E (pooled and separately) •Comparison of patient outcomes in group A, C, D, E with matching groups of the INFORM registry (pooled and separately) •Evaluation of somatic SNV count as a predictive biomarker: relation of patient outcomes to the level of somatic SNVs •Evaluation of the level of MYC(N) amplification as a predictive biomarker: relation to patient outcomes •Evaluate activity using immune related response evaluation methods •Entinostat plasma PK (CSF if appropriate);Primary end point(s): Phase I: Dose Limiting Toxicity (DLT) of the combination treatment Phase II: Best response (CR or PR) will be based on RANO criteria for all primary CNS tumors and RECIST for non-CNS tumors, defined for each patient as the best response under study combination therapy during the first 6 cycles (assessment every 2 cycles) by central review. ;Timepoint(s) of evaluation of this end point: DLT: continuously Response: e | — |
Secondary
| Measure | Time frame |
|---|---|
| Secondary end point(s): • Duration of Response (DOR) • Disease Control Rate (DCR) • Stable disease (SD) • Progression-free survival (PFS) • Time to Response (TTR) • Overall Survival (OS) • Immune related Response Rate (RR) measured by iRECIST criteria and iRANO criteria by central review • Entinostat plasma PK on 1 day, 1 week and 5 weeks after initiation of therapy;Timepoint(s) of evaluation of this end point: Response: every 2 cycles Pharmakokinetik (Entinostat): on 1 day, 1 week and 5 weeks after initiation of therapy | — |
Countries
Australia, Austria, France, Germany, Netherlands, Sweden, Switzerland
Contacts
Public ContactKiTZ Clinical Trial Unit
Hopp Children’s Cancer Center Heidelberg (KiTZ)
Outcome results
None listed