St. Jude ELIOT: Phase 1 Evaluation of LY2606368, a Molecularly-Targeted CHK1/2 Inhibitor Therapy, in Combination With Cyclophosphamide or Gemcitabine for Children and Adolescents With Refractory or Recurrent Group 3/Group 4 or SHH Medulloblastoma Brain Tumors
Evaluation of LY2606368 Therapy in Combination With Cyclophosphamide or Gemcitabine for Children and Adolescents With Refractory or Recurrent Group 3/Group 4 or SHH Medulloblastoma Brain Tumors
Sponsors
Source
St. Jude Children's Research Hospital
Oversight Info
Has Dmc
No
Is Fda Regulated Drug
Yes
Is Fda Regulated Device
No
Brief Summary
SJELIOT is a phase 1 trial that aims to explore the combination of prexasertib with
established DNA-damaging agents used in medulloblastoma to evaluate tolerance and
pharmacokinetics in recurrent or refractory disease. Additionally, a small expansion cohort
will be incorporated into the trial at the combination MTD/RP2D (maximum tolerated
dose/recommended phase two dose) to detect a preliminary efficacy signal.
Stratum A: Prexasertib and Cyclophosphamide
Primary Objectives
- To determine the safety and tolerability and estimate the maximum tolerated dose
(MTD)/recommended phase 2 dose (RP2D) of combination treatment with prexasertib and
cyclophosphamide in participants with recurrent/refractory Group 3 and Group 4
medulloblastoma and recurrent/refractory sonic hedgehog (SHH) medulloblastoma.
- To characterize the pharmacokinetics of prexasertib in combination with
cyclophosphamide.
Secondary Objectives
- To estimate the rate and duration of objective response and progression free survival
(PFS) associated with prexasertib and cyclophosphamide treatment in this patient
population.
- To characterize the pharmacokinetics of cyclophosphamide and metabolites.
Stratum B: Prexasertib and Gemcitabine
Primary Objectives
- To determine the safety and tolerability and estimate the MTD/RP2D of combination
treatment with prexasertib and gemcitabine in participants with recurrent/refractory
Group 3 and Group 4 medulloblastoma.
- To characterize the pharmacokinetics of prexasertib in combination with gemcitabine.
Secondary Objectives
- To estimate the rate and duration of objective response and PFS associated with
prexasertib and gemcitabine treatment in this patient population.
- To characterize the pharmacokinetics of gemcitabine and gemcitabine triphosphate (only
at St. Jude Children's Research Hospital).
Detailed Description
Participants will be stratified by the biological characteristics of their tumor to one of
two treatment strata:
STRATUM A
- Combination Treatment: prexasertib and cyclophosphamide
- Patient population: Participants with recurrent/refractory Group 3 and Group 4 (G3/G4)
medulloblastoma, recurrent/refractory sonic hedgehog (SHH) medulloblastoma and
medulloblastoma participants with Indeterminate molecular subgroup
STRATUM B
- Combination Treatment: prexasertib and gemcitabine
- Patient population: Participants with recurrent/refractory Group 3 and Group 4
medulloblastoma
Participants with a diagnosis of G3/G4 medulloblastoma who qualify for both treatment strata
will be assigned per slot availability as well as institutional PI preference. If slots are
available in both stratum A and stratum B, patients will be assigned to the dose level
nearest completion.
The Rolling 6 design will be used separately in each stratum to estimate the maximum
tolerated dose (MTD) or recommended phase two dose (RP2D). Therapy will be administered in
cycles of 28 days and may be continued for up to 24 months (26 cycles) in the absence of
disease progression or unacceptable toxicity.
Participants will receive doublet therapy in cycles of 28 days. The dose-limiting toxicity
(DLT)-evaluation period will consist of the first cycle (i.e. first 5 weeks of therapy).
Participants will be evaluated at least once a week during the DLT-evaluation period and at
regular intervals thereafter. Standard tests (i.e. physical exams, blood tests, and disease
evaluations) will be undertaken at regular intervals. Research-associated evaluations (i.e.
pharmacokinetic studies, etc.) will also be carried out during therapy. Treatment may be
continued for up to 2 years in the absence of disease progression or unacceptable toxicity.
Overall Status
Recruiting
Start Date
2019-08-08
Completion Date
2026-06-01
Primary Completion Date
2025-06-01
Phase
Phase 1
Study Type
Interventional
Primary Outcome
Measure |
Time Frame |
Estimate the Maximum tolerated dose (MTD)/Recommended Phase 2 Dose (RP2D) of each doublet by stratum |
1 month after start of prexasertib and cyclophosphamide or gemcitabine treatment |
To determine the safety and tolerability of combination treatment with prexasertib and cyclophosphamide or gemcitabine. |
Up to 2 years after start of prexasertib and cyclophosphamide or gemcitabine treatment |
To characterize the area under the concentration-time curve (AUC0-∞) of prexasertib in combination with cyclophosphamide or gemcitabine. |
prexasertib and cyclophosphamide or gemcitabine treatment course 1 days 2 through 7 |
To characterize the systemic clearance (CL) of prexasertib in combination with cyclophosphamide or gemcitabine. |
prexasertib and cyclophosphamide or gemcitabine treatment course 1 days 2 through 7 |
Secondary Outcome
Measure |
Time Frame |
Rate of objective response (complete or partial response) by stratum |
Up to 1 year after completion of prexasertib and cyclophosphamide or gemcitabine treatment |
Duration of objective response by stratum |
Up to 1 year after completion of prexasertib and cyclophosphamide or gemcitabine treatment |
Progression-free survival for patients treated with prexasertib and cyclophosphamide or gemcitabine |
Up to 3 years from diagnosis |
To characterize the area under the concentration-time curve (AUC0-24h) of cyclophosphamide. |
prexasertib and cyclophosphamide treatment course 1, days 1 and 2 |
To characterize the systemic clearance (CL) of cyclophosphamide. |
prexasertib and cyclophosphamide treatment course 1, days 1 and 2 |
To characterize the area under the concentration-time curve (AUC0-24h) of 4-hydroxy-cyclophosphamide. |
prexasertib and cyclophosphamide treatment course 1, days 1 and 2 |
To characterize the area under the concentration-time curve (AUC0-24h) of carboxyethylphosphoramide mustard. |
prexasertib and cyclophosphamide treatment course 1, days 1 and 2 |
To characterize the area under the concentration-time curve (AUC0-4h) of gemcitabine. |
prexasertib and gemcitabine treatment course 1, day 1. |
To characterize the systemic clearance (CL) of gemcitabine. |
prexasertib and cyclophosphamide treatment course 1, day 1 |
To characterize the area under the concentration-time curve (AUC0-4h) of gemcitabine triphosphate (only at St. Jude Children's Research Hospital). |
prexasertib and cyclophosphamide treatment course 1, day 1 |
Enrollment
100
Conditions
Brain Tumor
, Brain Tumor, Recurrent
, Brain Tumor, Refractory
, Brain Tumor, Pediatric
, Medulloblastoma
, Medulloblastoma Recurrent
, Medulloblastoma, Non-WNT/Non-SHH
, Medulloblastoma, Non-WNT/Non-SHH, Group 3
, Medulloblastoma, Non-WNT/Non-SHH, Group 4
, Brain Cancer
, CNS Cancer
, CNS Tumor
, CNS Neoplasm 













Intervention
Intervention Type
Drug
Intervention Name
Description
IV
Arm Group Label
A: prexasertib + cyclophosphamide
B: prexasertib + gemcitabine
Other Name
LY2606368
Intervention Type
Drug
Intervention Name
Description
IV
Arm Group Label
A: prexasertib + cyclophosphamide
Other Name
Cytoxan
Intervention Type
Drug
Intervention Name
Description
IV
Arm Group Label
B: prexasertib + gemcitabine
Other Name
2'-deoxy-2',2' difluorocytidine monohydrochloride
LY18801
Gemzar®
Intervention Type
Biological
Intervention Name
Description
Given subcutaneously (SQ). Alternatively, pegfilgrastim may be given.
Arm Group Label
A: prexasertib + cyclophosphamide
B: prexasertib + gemcitabine
Other Name
G-CSF
Intervention Type
Biological
Intervention Name
Description
Given subcutaneously (SQ). Alternatively, filgrastim may be given.
Arm Group Label
A: prexasertib + cyclophosphamide
B: prexasertib + gemcitabine
Other Name
pegylated filgrastim
PEG filgrastim
Neulasta®
Eligibility
Criteria
Inclusion Criteria: Screening Phase
- Participants with recurrent, refractory, or progressive medulloblastoma.
- Age ≥ 1 year and < 25 years at the time of screening.
- Participants and/or guardian can understand and is willing to sign a written informed
consent document according to institutional guidelines.
Exclusion Criteria: Screening Phase
- Previous exposure to any CHK1 inhibitor.
- Participants with a history of clinically significant, uncontrolled heart disease
and/or repolarization abnormalities.
- Participants with any history of QTc prolongation (i.e. QTc interval of > 480 msec).
Inclusion Criteria: Strata A and B
- Participant must be ≥1 year and <25 years of age at time of screening.
- Participant must have recurrent, progressive or refractory Group 3/Group 4 or SHH
medulloblastoma (per central pathology confirmation of primary tissue and/or relapsed
tissue). Central pathology review previously completed at St. Jude Children's Research
Hospital or Hopp Children's Cancer Center Heidelberg (KiTZ) using equivalent methods
can be used for enrollment. Note: Group 3/Group 4 may be referred to as Non-WNT
Non-SHH (NWNS) in pathology reports. Medulloblastoma patients with indeterminate
molecular subgroup after central pathology review are eligible for enrollment on
stratum A.
- Participant must have measurable or evaluable disease as defined in the protocol.
- Participant must have received their last dose of myelosuppressive anticancer
chemotherapy at least 3 weeks prior to study enrollment.
- Participants must have had their last fraction of radiation (including CSI) at least 4
weeks prior to study enrollment. Participants who received radiation therapy for
palliation must have had their last fraction of radiation at least 2 weeks prior to
study enrollment.
- Participant who are receiving corticosteroids must be on a stable or decreasing dose
for at least 1 week prior to enrollment with no plans for escalation.
- Participant must have a Lansky (≤ 16 years) or Karnofsky (> 16 years) performance
score of ≥50. (Note: Participants 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).
- Participant must have adequate bone marrow and organ function as defined as:
- ANC ≥ 1.0 x 109/L without growth factor support within 7 days
- Platelet count ≥ 75x 109/L without support of a platelet transfusion within 7
days
- Hemoglobin ≥8.0 g/dL without support of a blood transfusion within 7 days
- Potassium, total calcium (corrected for serum albumin), magnesium, sodium and
phosphorus within institutional normal limits or corrected to within normal
limits with supplements before first dose of study medication
- Serum creatinine ≤ the maximum serum creatinine based on age/gender: Age: 1 to <
2 years; maximum serum creatinine (mg/dL): 0.6 (male, female); Age: 2 to < 6
years; maximum serum creatinine (mg/dL): 0.8 (male, female); Age: 6 to < 10
years; maximum serum creatinine (mg/dL): 1 (male, female); Age: 10 to < 13 years;
maximum serum creatinine (mg/dL): 1.2 (male, female); Age: 13 to < 16 years;
maximum serum creatinine (mg/dL): 1.5 (male), 1.4 (female); Age :≥ 16 years;
maximum serum creatinine (mg/dL): 1.7 (male), 1.4 (female).
- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 x ULN.
For the purposes of this study the ULN of ALT and AST is 45 U/L.
- Total bilirubin ≤ ULN; or if > ULN then direct bilirubin ≤ 1.5 x ULN
- Female participants of childbearing age must have a negative pregnancy test at the
time of enrollment.
- Participants of childbearing or child fathering potential must be willing to use
medically acceptable form of birth control during treatment and for 16 weeks after
stopping treatment.
- Participants and/or guardian have the ability to understand and the willingness to
sign a written informed consent document according to institutional guidelines.
Exclusion Criteria: Strata A and B
- Participant who is receiving any other investigational agents.
- Participants with other clinically significant medical disorders (i.e. serious
infections or significant cardiac, pulmonary, hepatic, psychiatric, or other organ
dysfunction) that could compromise their ability to tolerate protocol therapy or would
interfere with the study procedures or results.
- Participant with a history of clinically significant, uncontrolled heart disease
and/or repolarization abnormalities as documented by a standard 12-lead ECG.
- Shortening fraction of <27% by ECHO or ejection fraction of <50% by gated radionuclide
study.
- Prior history of QTc prolongation or QTc interval of > 480 msec.
- Female participants who are breastfeeding a child.
- Participants are excluded if unable to comply with guidelines listed in appendix I.
Gender
All
Minimum Age
1 Year
Maximum Age
24 Years
Healthy Volunteers
No
Overall Official
Last Name |
Role |
Affiliation |
Giles W. Robinson, MD |
Principal Investigator |
St. Jude Children's Research Hospital |
Overall Contact
Location
Facility |
Status |
Contact |
Investigator |
St. Jude Children's Research Hospital Memphis Tennessee 38105 United States |
Recruiting |
Last Name: Giles W. Robinson, MD Role: Principal Investigator |
Location Countries
Country
United States
Verification Date
2019-10-01
Lastchanged Date
N/A
Firstreceived Date
N/A
Responsible Party
Responsible Party Type
Sponsor
Keywords
Brain Tumors in Adolescents
, Brain Tumors in Children
, Brain Tumors in Young Adults
, CHK1/2 Inhibitor
, Combination therapy
, Indeterminate molecular subgroup
, Medulloblastoma, Group 3
, Medulloblastoma, Group 4
, Medulloblastoma, G3/G4
, Progressive brain tumor
, Recurrent brain tumor
, Refractory brain tumor
, Sonic hedgehog
, SHH Medulloblastoma
, St. Jude Brain Tumor Studies
, St. Jude Studies
, St. Jude Treatment
, Molecular
, Molecular therapy 



















Has Expanded Access
No
Condition Browse
Secondary Id
NCI-2019-04787
Number Of Arms
2
Intervention Browse
Mesh Term
Gemcitabine
Cyclophosphamide
Lenograstim
Arm Group
Arm Group Label
A: prexasertib + cyclophosphamide
Arm Group Type
Experimental
Description
Stratum A: Participants receive combination treatment with cyclophosphamide given intravenously (IV) on days 1 and 15 and prexasertib given intravenously (IV) on days 2 and 16. Cycles repeat every 28 days for up to 24 months (26 cycles) in the absence of disease progression or unacceptable toxicity. They may also receive growth therapy support with filgrastim or peg-filgrastim.
Arm Group Label
B: prexasertib + gemcitabine
Arm Group Type
Experimental
Description
Stratum B: Participants receive combination treatment with gemcitabine given intravenously (IV) on days 1 and 15 and prexasertib given intravenously (IV) on days 2 and 16. Cycles repeat every 28 days for up to 24 months (26 cycles) in the absence of disease progression or unacceptable toxicity. They may also receive growth therapy support with filgrastim or peg-filgrastim.
Firstreceived Results Date
N/A
Patient Data
Sharing Ipd
Yes
Ipd Description
Individual participant de-identified datasets containing the variables analyzed in the published article will be made available (related to the study primary or secondary objectives contained in the publication). Supporting documents such as the protocol, statistical analyses plan, and informed consent are available through the CTG website for the specific study. Data used to generate the published article will be made available at the time of article publication. Investigators who seek access to individual level de-identified data will contact the computing team in the Department of Biostatistics ([email protected]) who will respond to the data request.
Ipd Info Type
Study Protocol
Statistical Analysis Plan (SAP)
Informed Consent Form (ICF)
Ipd Time Frame
Data will be made available at the time of article publication.
Ipd Access Criteria
Data will be provided to researchers following a formal request with the following information: full name of requestor, affiliation, data set requested, and timing of when data is needed. As an informational point, the lead statistician and study principal investigator will be informed that primary results datasets have been requested.
Firstreceived Results Disposition Date
N/A
Study Design Info
Allocation
Non-Randomized
Intervention Model
Parallel Assignment
Primary Purpose
Treatment
Masking
None (Open Label)
Study First Submitted
July 11, 2019
Study First Submitted Qc
July 16, 2019
Study First Posted
July 17, 2019
Last Update Submitted
October 11, 2019
Last Update Submitted Qc
October 11, 2019
Last Update Posted
October 15, 2019
ClinicalTrials.gov processed this data on December 06, 2019
Conditions
Conditions usually refer to a disease, disorder, syndrome, illness, or injury. In ClinicalTrials.gov,
conditions include any health issue worth studying, such as lifespan, quality of life, health risks, etc.
Interventions
Interventions refer to the drug, vaccine, procedure, device, or other potential treatment being studied.
Interventions can also include less intrusive possibilities such as surveys, education, and interviews.
Study Phase
Most clinical trials are designated as phase 1, 2, 3, or 4, based on the type of questions
that study is seeking to answer:
In Phase 1 (Phase I) clinical trials, researchers test a new drug or treatment in a small group of people (20-80) for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.
In Phase 2 (Phase II) clinical trials, the study drug or treatment is given to a larger group of people (100-300) to see if it is effective and to further evaluate its safety.
In Phase 3 (Phase III) clinical trials, the study drug or treatment is given to large groups of people (1,000-3,000) to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely.
In Phase 4 (Phase IV) clinical trials, post marketing studies delineate additional information including the drug's risks, benefits, and optimal use.
These phases are defined by the Food and Drug Administration in the Code of Federal Regulations.
In Phase 1 (Phase I) clinical trials, researchers test a new drug or treatment in a small group of people (20-80) for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.
In Phase 2 (Phase II) clinical trials, the study drug or treatment is given to a larger group of people (100-300) to see if it is effective and to further evaluate its safety.
In Phase 3 (Phase III) clinical trials, the study drug or treatment is given to large groups of people (1,000-3,000) to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely.
In Phase 4 (Phase IV) clinical trials, post marketing studies delineate additional information including the drug's risks, benefits, and optimal use.
These phases are defined by the Food and Drug Administration in the Code of Federal Regulations.