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Molecularly Stratified Trial for Newly Diagnosed Infant-Type Hemispheric Glioma

29 ottobre 2026 aggiornato da: St. Jude Children's Research Hospital

A Molecularly Stratified Phase II Trial for Newly Diagnosed Infant-Type Hemispheric Glioma (IHG)

The purpose of this study is to test whether giving treatment before surgery helps babies who are newly diagnosed with Infant-Type Hemispheric Glioma (IHG) have safer and better surgery results.

Panoramica dello studio

Stato

Non ancora reclutamento

Condizioni

Intervento / Trattamento

Descrizione dettagliata

Primary Objective

  • To estimate the complete tumor response rate (CTR) associated with molecularly directed neoadjuvant treatment (entrectinib for NTRK1/2/3 and ROS1, alectinib for ALK, and chemotherapy for tumors with other fusions and no fusions). (Strata A, B, and C)
  • To estimate the safe surgical resection rate associated with molecular-directed neo-adjuvant treatment entrectinib for NTRK1/2/3 and ROS1, alectinib for ALK, and chemotherapy for tumors with other fusions and no fusions. (Strata A, B, and C)

Secondary Objectives

  • To estimate the stratum-specific and study-wide event-free survival (EFS) and overall survival (OS) for patients enrolled in SJIHG25 (Strata A, B, C, and D)
  • To estimate the change in neurodevelopment and cognitive performance pre- and post-primary surgery in infants with newly diagnosed IHG treated with molecularly directed neoadjuvant treatment. (Strata A, B, and C)

This is a phase II clinical trial evaluating the use of molecularly directed neoadjuvant treatment for patients with newly diagnosed Infant-Type Hemispheric Glioma (IHG) to improve surgical outcome (efficacy and safety).

Bridge Therapy is recommended for participants who are being screened (participants who have signed the screening consent) for the following reasons:

  • Participant can be enrolled on the stratum bridge and 1-4 courses of cytotoxic chemotherapy CCE (carboplatin IV day 2, cyclophosphamide IV day1, and etoposide IV days 1 and 2), which may be given prior to surgical intervention to stabilize the patient. Each cycle of CCE treatment cycle is approximately 28 days in length.
  • If the waiting period for diagnostic work-up is deemed unsafe for clinical reasons, the participant may enroll in the stratum bridge and receive one course of bridge chemotherapy with CCE before enrollment to stratum A, B, or C.
  • Where a molecular target has been identified prior to screening and confirmation of diagnosis by central pathology review, the participant can be enrolled on stratum bridge and started on treatment based on the molecular target (alectinib po day1-28, entrectinib po day1-28, or chemotherapy (CCE), with pending central pathology review, if waiting for completion of the central pathology review is deemed to put the patient at increased risk of tumor progression.

Decisions regarding bridge therapy need to be discussed and approved by the study PI/team before starting treatment.

Enrollment in strata A, B, C, and D can occur only after central pathology review at St. Jude Children's Research Hospital confirms the diagnosis. Participants will be assigned to treatment strata based on whether residual tumor is present and types of RTK fusion.

Participants with ALK fusion will receive alectinib as neoadjuvant treatment (Stratum A), participants with NTRK 1/2/3 or ROS1 fusions will receive entrectinib as neoadjuvant treatment (Stratum B), and participants with no RTK fusion or RTK fusions other than ALK, ROS1 or NTRK1/2/3 (including MET fusion) will receive chemotherapy with carboplatin, etoposide, and cyclophosphamide as neoadjuvant treatment (Stratum C). Post primary surgery all participants on Strata A, B and C will be treated with 4 courses (1 course = 28 days) of adjuvant chemotherapy with carboplatin, etoposide, and cyclophosphamide.

The participants who have no residual disease at the time of enrollment will be treated with 4 courses (1 course = 28 days) of adjuvant chemotherapy with carboplatin, etoposide, and cyclophosphamide on stratum D.

Participants will be followed for five years following enrollment.

Tipo di studio

Interventistico

Iscrizione (Stimato)

50

Fase

  • Fase 2

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Contatto studio

Luoghi di studio

    • Tennessee
      • Memphis, Tennessee, Stati Uniti, 38105
        • St. Jude Children's Research Hospital
        • Contatto:
        • Investigatore principale:
          • Aditi Bagchi, M.D., Ph.D.

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

Non più vecchio di 5 anni (Bambino)

Accetta volontari sani

No

Sessi ammissibili allo studio

Tutto

Descrizione

Inclusion Criteria: Screening

  • Patient with presumptive or suspected (new) diagnosis of Infant-Type Hemispheric Glioma (IHG)
  • Patient age at diagnosis is from birth to ≤ 60 months
  • Patient has MRI/CT scan imaging of a supra-tentorial, hemispheric tumor avail-able for review before screening consent.
  • Patient is willing to undergo a biopsy procedure to confirm tissue diagnosis.
  • Adequate tumor tissue for central review of pathology, at the St. Jude Children's Research Hospital, DNA methylation array analysis, and NGS testing should be provided, if available from previous surgery, but is not required for screening eligibility.
  • The parent or legal guardian of the patient should be able to understand and be willing to sign a written informed consent document according to institutional guidelines

Inclusion Criteria: Enrollment

  • Without a central pathology confirmed diagnosis of IHG

    • Stratum-Bridge

      • The patient should meet all screening criteria and should have signed the screening consent.
      • Meets one of the exception/modification criteria
  • Centrally confirmed diagnosis of IHG

    • Strata A and B

      • The tumor has confirmed in-frame gene fusions involving ALK (Stratum A)
      • The tumor has confirmed in-frame gene fusions involving NTRK1/2/3 or ROS1 (Stratum B).
      • A measurable primary residual tumor at the time of enrollment
    • Stratum C

      • Central pathology review doesn't detect in-frame gene fusion involving ALK, NTRK 1/2/3, or ROS1in the tumor
      • Central pathology review confirms the presence of in-frame MET gene fusion or any other in frame fusion other than those involving ALK, NTRK1/2/3, or ROS1 gene fusions
      • A measurable primary residual tumor at the time of enrollment
    • Stratum D

      • No measurable primary residual tumor at the time of enrollment

Exclusion Criteria: (All Strata)

  • Age > 60 months
  • Any prior cancer-directed therapy
  • Organ Dysfunction, or a medical condition that, in the principal investigator's judgment, could compromise their ability to tolerate or absorb protocol therapy or would interfere with study procedures and results.

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Trattamento
  • Assegnazione: Non randomizzato
  • Modello interventistico: Assegnazione parallela
  • Mascheramento: Nessuno (etichetta aperta)

Armi e interventi

Gruppo di partecipanti / Arm
Intervento / Trattamento
Sperimentale: Stratum A
  • Neoadjuvant Treatment: Participants with ALK fusions will receive neoadjuvant treatment (4 Courses) with alectinib.
  • Surgery
  • Adjuvant Therapy: Participants will receive adjuvant chemotherapy with carboplatin, etoposide, and cyclophosphamide (4 courses).

By mouth, nasogastric, or gastronomy/stomach tube, Day 1-28

Altri nomi:
  • RO5424802

Primary surgery (Strata A, B, and C) post Neoadjuvant therapy with a goal of attaining gross total (GTR) or near total resection (NTR) of the tumor.

Altri nomi:
  • Resezione chirurgica

IV (intravenous) day 1

Altri nomi:
  • Cytoxan

IV (intravenous) days 1 and 2

Altri nomi:
  • VP-16

IV (intravenous) day 2

Altri nomi:
  • Paraplatino

Subcutaneous (under the skin) or IV (intravenous) day 3

Altri nomi:
  • G-CSF

Subcutaneous (under the skin) day 3

Altri nomi:
  • Neulasta
Sperimentale: Stratum B
  • Neoadjuvant Treatment: Participants with NTRK 1/2/3 or ROS1 fusions will receive neoadjuvant (4 Courses) treatment with entrectinib.
  • Surgery
  • Adjuvant Therapy: Participants will receive adjuvant chemotherapy with carboplatin, etoposide, and cyclophosphamide (4 courses).

Primary surgery (Strata A, B, and C) post Neoadjuvant therapy with a goal of attaining gross total (GTR) or near total resection (NTR) of the tumor.

Altri nomi:
  • Resezione chirurgica

IV (intravenous) day 1

Altri nomi:
  • Cytoxan

IV (intravenous) days 1 and 2

Altri nomi:
  • VP-16

IV (intravenous) day 2

Altri nomi:
  • Paraplatino

Subcutaneous (under the skin) or IV (intravenous) day 3

Altri nomi:
  • G-CSF

Subcutaneous (under the skin) day 3

Altri nomi:
  • Neulasta

By mouth, nasogastric, or gastronomy/stomach tube, Day 1-28

Altri nomi:
  • RO7102122
Sperimentale: Stratum C
  • Neoadjuvant Treatment: Participants no RTK fusion or RTK fusions other than ALK, ROS1 or NTRK1/2/3 (including MET fusion) will receive neoadjuvant chemotherapy with carboplatin, etoposide, and cyclophosphamide (4 courses).
  • Surgery
  • Adjuvant Therapy: Participants will receive adjuvant chemotherapy with carboplatin, etoposide, and cyclophosphamide (4 courses).

Primary surgery (Strata A, B, and C) post Neoadjuvant therapy with a goal of attaining gross total (GTR) or near total resection (NTR) of the tumor.

Altri nomi:
  • Resezione chirurgica

IV (intravenous) day 1

Altri nomi:
  • Cytoxan

IV (intravenous) days 1 and 2

Altri nomi:
  • VP-16

IV (intravenous) day 2

Altri nomi:
  • Paraplatino

Subcutaneous (under the skin) day 3

Altri nomi:
  • Neulasta
Sperimentale: Stratum D

Participants who have no measurable residual disease at the time of enrollment.

  • Adjuvant Therapy: Participants will receive adjuvant chemotherapy with carboplatin, etoposide, and cyclophosphamide (4 courses).

IV (intravenous) day 1

Altri nomi:
  • Cytoxan

IV (intravenous) days 1 and 2

Altri nomi:
  • VP-16

IV (intravenous) day 2

Altri nomi:
  • Paraplatino

Subcutaneous (under the skin) or IV (intravenous) day 3

Altri nomi:
  • G-CSF

Subcutaneous (under the skin) day 3

Altri nomi:
  • Neulasta

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Rate of Complete Tumor Response (CTR) among patients in Strata A, B, and C
Lasso di tempo: approximately 4 months after enrollment

The proportion of patients whose extent of tumor resection meets criteria for gross total / near total resection (GTR/NTR) after neoadjuvant therapy and surgery.

approximately 4 months after enrollment
Rate of safe surgical resection among patients in Strata A, B, and C
Lasso di tempo: Up to 72 hours after surgery

Proportion of patients whose surgery is completed without clinically significant intra-operative blood loss/hemorrhage. Success for this outcome measure will include surgery without any of the following:

(i) Initiation of massive transfusion protocol- i.e., requiring more than one volume (80ml/Kg) of transfusion over a period of 24 hours

(ii) Hemorrhage leading to cessation of surgery

(iii) Hemorrhagic complications leading to second neurosurgery within 72 hours of the first surgery.

Up to 72 hours after surgery

Misure di risultato secondarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Event free survival (EFS)
Lasso di tempo: 2 years

EFS is defined as time from enrollment for treatment (including bridge therapy) until progression, subsequent malignancy or death for any reason or until last follow-up, whichever is earlier.

2 years
Overall survival (OS)
Lasso di tempo: 2 years

OS is defined as time from enrollment for treatment (including bridge therapy) until death for any reason or until last follow-up, whichever is earlier.

2 years
Change in neurodevelopment and cognitive performance pre- and post-primary surgery in infants with newly diagnosed IHG treated with molecularly directed neoadjuvant treatment: BSID-4
Lasso di tempo: Pre-surgery/baseline and after the intervention/procedure/primary surgery for up to 12 weeks
Pre-surgery/baseline and after the intervention/procedure/primary surgery for up to 12 weeks
Change in neurodevelopment and cognitive performance pre- and post-primary surgery in infants with newly diagnosed IHG treated with molecularly directed neoadjuvant treatment: NIH Baby Toolbox
Lasso di tempo: Pre-surgery/baseline and after the intervention/procedure/primary surgery for up to 12 weeks
Pre-surgery/baseline and after the intervention/procedure/primary surgery for up to 12 weeks

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Sponsor

Collaboratori

Investigatori

  • Investigatore principale: Aditi Bagchi, M.D., Ph.D., St. Jude Children's Research Hospital

Pubblicazioni e link utili

La persona responsabile dell'inserimento delle informazioni sullo studio fornisce volontariamente queste pubblicazioni. Questi possono riguardare qualsiasi cosa relativa allo studio.

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Inizio studio (Stimato)

1 novembre 2026

Completamento primario (Stimato)

1 novembre 2034

Completamento dello studio (Stimato)

1 novembre 2036

Date di iscrizione allo studio

Primo inviato

13 ottobre 2026

Primo inviato che soddisfa i criteri di controllo qualità

29 ottobre 2026

Primo Inserito (Effettivo)

4 novembre 2026

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Effettivo)

4 novembre 2026

Ultimo aggiornamento inviato che soddisfa i criteri QC

29 ottobre 2026

Ultimo verificato

1 ottobre 2026

Maggiori informazioni

Termini relativi a questo studio

Altri numeri di identificazione dello studio

  • SJIHG25
  • NCI-2026-07231 (Identificatore di registro: NCI Clinical Trial Registration Program)

Piano per i dati dei singoli partecipanti (IPD)

Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?

SÌ

Descrizione del piano IPD

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 (ClinTrialDataRequest@stjude.org) who will respond to the data request.

Periodo di condivisione IPD

Data will be made available at the time of article publication.

Criteri di accesso alla condivisione IPD

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.

Tipo di informazioni di supporto alla condivisione IPD

  • STUDIO_PROTOCOLLO
  • LINFA
  • ICF

Informazioni su farmaci e dispositivi, documenti di studio

Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti

Sì

Studia un dispositivo regolamentato dalla FDA degli Stati Uniti

No

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .