Erlotinib Versus Oral Etoposide in Patients With Recurrent or Refractory Pediatric Ependymoma (PETEY)

A Randomized, Phase 2 Study of Single-agent Erlotinib Versus Oral Etoposide in Patients With Recurrent or Refractory Pediatric Ependymoma

This is a phase 2 study to evaluate the efficacy of single-agent erlotinib versus oral etoposide in patients with recurrent or refractory pediatric ependymoma.

Study Overview

• Status: Terminated
• Conditions: Recurrent or Refractory Pediatric Ependymoma
• Intervention / Treatment: Drug: erlotinib; Drug: etoposide

Detailed Description

This is a phase 2 study involving a 1:1 randomization of 40 patients with recurrent or refractory pediatric ependymoma who will receive either erlotinib or oral etoposide.

• Study Type: Interventional
• Enrollment (Actual): 25
• Phase: Phase 2

Contacts and Locations

Study Locations

• Canada
  • Alberta
    • Edmonton, Alberta, Canada, T6G 2B7
      • Strollery Children's Hospital Division of Hematology/Oncology
  • British Columbia
    • Vancouver, British Columbia, Canada, V6H 3V4
      • Children's and Women's Health Center of BC Division of Hematology/ Oncology/ BMT
  • Ontario
    • Toronto, Ontario, Canada, M5G 1X8
      • Hospital for Sick Children
• United Kingdom
  • Birmingham, United Kingdom, B4 6NH
    • Birmingham Children's Hospital
  • Glasgow, United Kingdom, G3 8SJ
    • Royal Hospital for Sick Children
  • Leeds, United Kingdom, LS1 3EX
    • Paediatric Oncology and Haematology Offices
  • Liverpool, United Kingdom, L12 1AP
    • Alder Hey Children's NHS Foundation Trust Department of Oncology
  • Manchester, United Kingdom, M13 9W2
    • Royal Manchester Children's Hospital Ward 84
  • Nottingham, United Kingdom, NG7 2UH
    • University of Nottingham Children's Brain Tumour Research Centre
  • Sutton, United Kingdom, SM2 5PT
    • Royal Marsden Hospital
• United States
  • Alabama
    • Birmingham, Alabama, United States, 35233
      • University of Alabama at Birmingham Dept. of Pediatric-Hematology/Oncology
  • Arizona
    • Phoenix, Arizona, United States, 85016
      • Center for Cancer and Blood Disorders-Phoenix Children's Hospital
  • California
    • Orange, California, United States, 92868
      • Children's Hospital of Orange County (CHOC)
    • Palo Alto, California, United States, 94304
      • Stanford University and Lucile Packard Children's Hospital
  • Colorado
    • Aurora, Colorado, United States, 80045
      • Children's Hospital Center for Cancer and Blood Disorders
  • District of Columbia
    • Washington, District of Columbia, United States, 20010
      • Children's National Medical Center - D.C. Center for Cancer and Blood Disorders
  • Florida
    • Miami, Florida, United States, 33136
      • University of Miami
  • Georgia
    • Atlanta, Georgia, United States, 30322
      • Emory University Children's Healthcare of Atlanta Aflac Cancer Center & Blood Disorders
  • Maryland
    • Baltimore, Maryland, United States, 21287
      • Johns Hopkins University School of Medicine
  • Massachusetts
    • Boston, Massachusetts, United States, 02115
      • Dana-Farber Cancer Institute Department of Pediatric Neuro-oncology
  • Minnesota
    • Minneapolis, Minnesota, United States, 55455
      • Amplatz Children's Hospital University of Minnesota Medical Center- Pediatric Hematology Oncology
  • New York
    • New York, New York, United States, 10016
      • Steven D Hassenfeld Children's Center - New York University
    • New York, New York, United States, 10032
      • Columbia University Children's Hospital of New York Presbyterian Child & Adolescent Oncology Center
  • Oregon
    • Portland, Oregon, United States, 97124
      • Oregon Health & Sciences University Doembecher Children's Hospital
  • Pennsylvania
    • Hershey, Pennsylvania, United States, 17110
      • Penn State Hershey Children's Hospital
    • Pittsburgh, Pennsylvania, United States, 15224
      • Children's Hospital of Pittsburgh of UPMC
  • Texas
    • Dallas, Texas, United States, 75235
      • Children's Medical Center, Dallas Center for Cancer and Blood Disorders
  • Wisconsin
    • Madison, Wisconsin, United States, 53705-2275
      • University of Wisconsin Pediatric Hematology/Oncology Department

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 year to 21 years (Child, Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Recurrent of refractory ependymoma or subependymoma
• Performance Status (PS): Lansky ≥ 50% for patients ≤ 10 years of age or Karnofsky ≥ 50% for patients >10 years of age
• Measurable disease, defined as 1 measurable lesion that can be accurately measured in 2 planes that has not received radiation therapy within 12 weeks
• Recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy
• ≥ 1 year to ≤ 21 years
• Serum creatinine for patients ≤ 5 years in age is ≤ 0.8 mg/dL or Creatinine Clearance/Glomerular Filtration Rate (GFR) ≥ 70 mL/min/m^2
• Serum creatinine for patients > 5 and ≤ 10 years in age is ≤ 1.0 mg/dL or Creatinine Clearance/GFR ≥ 70 mL/min/m^2
• Serum creatinine for patients > 10 and ≤ 15 years in age is ≤ 1.2 mg/dL or Creatinine Clearance/GFR ≥ 70 mL/min/m^2
• Serum creatinine for patients > 15 years in age is ≤ 1.5 mg/dL or Creatinine Clearance/GFR ≥ 70 mL/min/m^2
• Total bilirubin is ≤ 1.5 x upper limit of normal for age
• Alanine aminotransferase (ALT) ≤ 3 x upper limit of normal
• Absolute neutrophil count > 1000/µL
• Platelet count > 100,000/µL
• Hemoglobin > 8 gm/dL
• Neurologically stable for at least 7 days prior to randomization
• If receiving corticosteroids, patients must be on a stable or decreasing dose for at least 7 days before randomization
• Patients of reproductive potential must agree to proactive effective contraceptive measures for the duration of the study and for at least 90 days after completion of study drug

Exclusion Criteria:

• Previously received epidermal growth factor receptor (EGFR)-targeted therapy
• Previously received oral etoposide
• Received craniospinal radiotherapy within 24 weeks prior to randomization
• Received field radiotherapy to the target lesion within 12 weeks prior to randomization
• Received symptomatic metastatic disease within 14 days prior to randomization
• Received myelosuppressive chemotherapy within 21 days before randomization
• Received growth factors within 7 days prior to randomization
• Participating in another investigational drug trial
• Received a biologic agent within 7 days prior to randomization
• Received a monoclonal antibody within 28 days prior to randomization
• Taking cytochrome P450 (CYP)3A4 or CYP1A2 inhibitors/inducers within 14 days prior to randomization
• Taking proton pump inhibitors within 14 days prior to randomization
• Smoking during treatment
• Pregnant or breast-feeding females

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Erlotinib; Erlotinib was administered orally at a dose of 85 mg/m^2 per day continuously until either progression, death, patient request or investigator decision to discontinue study drug or intolerable toxicity.	Drug: erlotinib; oral; Other Names: Tarceva; OSI-774
Active Comparator: Etoposide; Etoposide 50 mg/m^2 per day was administered orally for 21 days followed by a 7-day rest period until either progression, death, patient request or investigator decision to discontinue study drug or intolerable toxicity.	Drug: etoposide; oral; Other Names: VP-16

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Participants With an Objective Response	Objective response is defined as a best overall response of complete response (CR) or partial response (PR), evaluated using modified International Society of Pediatric Oncology Brain, Tumor Subcommittee for the Reporting of Trials criteria. Response was confirmed at least 28 days after the first assessment where the response criteria were met. Response was assessed by magnetic resonance imaging (MRI) every 8 weeks. CR: • Complete disappearance of all enhancing tumor and mass effect • On a stable or decreasing dose of corticosteroids (or receiving only adrenal replacement doses) • Stable or improving neurologic examination sustained for ≥ 4 weeks • If cerebral spinal fluid (CSF) evaluation was positive, it must become negative (confirmed at least 2 times at consecutive samplings). PR: • ≥ 50% reduction in tumor size by bi-dimensional measurement • On a stable or decreasing dose of corticosteroids • Stable or improving neurologic examination sustained for ≥ 4 weeks.	From randomization until the end of treatment. The median time on treatment was 52 days for erlotinib and 58 days for etoposide.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Participants With Prolonged Stable Disease	Prolonged stable disease (SD) was defined as SD with a duration of at least 16 weeks. The percentage of participants with prolonged SD was defined as participants who achieved a best overall response of CR or PR or MR or SD, and did not progress within 16 weeks from randomization. Progression was defined as a worsening of neurologic status that could not be explained by other causes, a > 25% increase in tumor size, the appearance of new lesions or CSF positivity, or increasing doses of corticosteroids required to maintain stable status.	From randomization until the end of treatment. The median time on treatment was 52 days for erlotinib and 58 days for etoposide.
Overall Survival (OS)	Overall survival was defined as the time from the date of randomization until the documented date of death. Participants who were still alive by the data cutoff date for analysis were censored on the last day the participant was known to be alive.	From randomization up to 12 months after the last dose. Median duration of follow-up was 12.9 months for erlotinib and 14.4 months for etoposide.
Area Under the Curve From Time 0 to 24 Hours Post-dose for Erlotinib	Pharmacokinetic parameters were determined from the serial plasma concentration data obtained for erlotinib. Area under the plasma concentration-time curve from time zero to 24 hours (the dosing interval) measured at steady state using sparse sampling.	Day 14 predose and 0.5 to 1.5 hours, 2 to 3 hours and 4 to 8 hours post-dose.
Maximum Observed Plasma Concentration of Erlotinib (Cmax)	Pharmacokinetic parameters were determined from the serial plasma concentration data obtained for erlotinib. Maximum observed plasma concentration of erlotinib (Cmax) was measured at steady state on Day 14 using sparse sampling.	Day 14 predose and 0.5 to 1.5 hours, 2 to 3 hours and 4 to 8 hours post-dose.
Time to Maximum Observed Plasma Concentration of Erlotinib (Tmax)	Pharmacokinetic parameters were determined from the serial plasma concentration data obtained for erlotinib. Time to the maximum observed plasma concentration of erlotinib (Tmax) was measured at steady state on Day 14 using sparse sampling.	Day 14 predose and 0.5 to 1.5 hours, 2 to 3 hours and 4 to 8 hours post-dose.
Apparent Body Clearance (CL/F) of Erlotinib	Pharmacokinetic parameters were determined from the serial plasma concentration data obtained for erlotinib. Apparent body clearance (CL/F) of erlotinib was measured at steady state on Day 14 using sparse sampling.	Day 14 predose and 0.5 to 1.5 hours, 2 to 3 hours and 4 to 8 hours post-dose.
Apparent Volume of Distribution (Vz/F) of Erlotinib	Pharmacokinetic parameters were determined from the serial plasma concentration data obtained for erlotinib. The apparent volume of distribution (Vz/F) of erlotinib was measured at steady state on Day 14 using sparse sampling.	Day 14 predose and 0.5 to 1.5 hours, 2 to 3 hours and 4 to 8 hours post-dose.
Duration of Response	Duration of response (complete or partial response [CR/PR]) was defined as the time from the date of the first documented response (CR/PR) to the first documented progression or death due to underlying cancer. If a participant had not progressed or died, the duration of overall response was censored at the date of last adequate disease assessment. Duration of response was only defined for participants whose best overall response was CR or PR. Progression was defined as a worsening of neurologic status that could not be explained by other causes, a > 25% increase in tumor size, the appearance of new lesions or CSF positivity, or increasing doses of corticosteroids required to maintain stable status.	From randomization until the end of treatment. The median time on treatment was 52 days for erlotinib and 58 days for etoposide.
Percentage of Participants With a Minor Response	Participants with a best overall response of minor response (MR), defined as: • ≥ 25% to < 50% reduction in tumor size by bi-dimensional measurement • On a stable or decreasing dose of corticosteroids • Stable or improving neurologic examination sustained for ≥ 4 weeks.	From randomization until the end of treatment. The median time on treatment was 52 days for erlotinib and 58 days for etoposide.
Percentage of Participants With Disease Control	Disease control is a best overall response of CR or PR or MR or Stable disease (SD). CR: • Complete disappearance of all enhancing tumor and mass effect • On a stable or decreasing dose of corticosteroids • Stable or improving neurologic examination sustained for ≥ 4 weeks • If CSF evaluation was positive, it must become negative (confirmed at least 2 times consecutively). PR: • ≥ 50% reduction in tumor size by bi-dimensional measurement • On a stable or decreasing dose of corticosteroids • Stable or improving neurologic examination sustained for ≥ 4 weeks. MR: • ≥ 25% to < 50% reduction in tumor size by bi-dimensional measurement • On a stable or decreasing dose of corticosteroids • Stable or improving neurologic examination sustained for ≥ 4 weeks. SD: • Neurologic examination is at least stable • Maintenance corticosteroid dose is not increased • MRI meets neither the criteria for minor response nor for progressive disease • Sustained for ≥ 8 weeks.	From randomization until the end of treatment. The median time on treatment was 52 days for erlotinib and 58 days for etoposide.
Progression Free Survival (PFS)	Progression-free survival was defined as the time from randomization to disease progression based on central nervous system (CNS)-specific evaluation criteria as assessed by the investigator or death due to any cause, whichever occurs first. Participants did not progress or die before the data cutoff date for analysis were censored at the date of last disease assessment (including both radiologic assessment and neurologic assessment) where non-progression was documented. If a participant received any further anticancer therapy without prior documentation of disease progression, the participant was censored at the date of last disease assessment before starting new anti-cancer treatment. Participants were also censored at the date of last disease assessment with no documented progression if patients discontinued treatment for undocumented progression, toxicity or other reason before the data cutoff date for analysis.	From randomization until the end of treatment. The median time on treatment was 52 days for erlotinib and 58 days for etoposide.
Duration of Stable Disease	Duration of stable disease (SD; defined as participants with an overall best response of complete, partial or minor response or stable disease) was defined as the time from the date of randomization to the first documented progression or death due to underlying cancer. If a participant had not progressed or died, the duration of SD was censored at the date of last adequate disease assessment. Duration of SD was only defined for participants whose best overall response was CR or PR or MR or SD. Progression was defined as a worsening of neurologic status that could not be explained by other causes, a > 25% increase in tumor size, the appearance of new lesions or CSF positivity, or increasing doses of corticosteroids required to maintain stable status.	From randomization until the end of treatment. The median time on treatment was 52 days for erlotinib and 58 days for etoposide.
Safety Assessed Through Evaluation of Physical Exams, Vital Signs, Clinical Laboratory Tests and Adverse Events (AEs)	An AE was defined as any untoward medical occurrence in a study participant and did not necessarily have a causal relationship with study treatment. Clinically significant vital sign assessments, findings on physical or neurological examination, and laboratory findings associated with signs and/or symptoms requiring withdrawal, dose modification or medical intervention were recorded as AEs. An AE was considered serious if it resulted in death, a life-threatening situation, inpatient hospitalization or prolongation of an existing hospitalization, persistent or significant disability/incapacity, congenital anomaly/birth defect in the offspring of a patient who received study drug or other important medical events. The relationship of each AE to study drug was assessed as either related or not related.	From the date of first dose of study drug until 30 days after the last dose. The median time on treatment was 52 days for erlotinib and 58 days for etoposide.

Collaborators and Investigators

• Sponsor: OSI Pharmaceuticals
• Investigators: Study Director: Medical Monitor, Astellas Pharma Global Development

Publications and helpful links

Helpful Links

• Link to results on Astellas Clinical Study Results website

Study record dates

Study Major Dates

• Study Start (Actual): September 27, 2010
• Primary Completion (Actual): November 26, 2012
• Study Completion (Actual): November 26, 2012

Study Registration Dates

• First Submitted: December 10, 2009
• First Submitted That Met QC Criteria: December 11, 2009
• First Posted (Estimated): December 15, 2009

Study Record Updates

• Last Update Posted (Actual): December 12, 2024
• Last Update Submitted That Met QC Criteria: November 18, 2024
• Last Verified: November 1, 2024

More Information

Terms related to this study

• Keywords: pediatric; erlotinib; etoposide; phase 2; ependymoma
• Additional Relevant MeSH Terms: Pathologic Processes; Neoplasms; Disease Attributes; Neoplasms by Histologic Type; Neoplasms, Glandular and Epithelial; Glioma; Neoplasms, Neuroepithelial; Neuroectodermal Tumors; Neoplasms, Germ Cell and Embryonal; Neoplasms, Nerve Tissue; Recurrence; Ependymoma; Tyrosine Kinase Inhibitors; Antineoplastic Agents; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Protein Kinase Inhibitors; Topoisomerase Inhibitors; Antineoplastic Agents, Phytogenic; Topoisomerase II Inhibitors; Erlotinib Hydrochloride; Etoposide
• Other Study ID Numbers: OSI-774-205; 2009-016836-11 (EudraCT Number)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Access to anonymized individual participant level data will not be provided for this trial. Further details on Astellas' data sharing policy can be found at https://www.clinicaltrials.astellas.com/transparency/.