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후두개와 A군 (PFA) 상의세포종 환자에서 메트포르민의 표적 검증 및 효능 (PNOC041)

2026년 10월 16일 업데이트: University of California, San Francisco

재발성 또는 진행성 후두개와 A군(PFA) 상의세포종 환자를 대상으로 한 메트포르민의 표적 검증 및 효능 연구

This is a multi-site study of the pharmacodynamic effects and efficacy of metformin in children and young adults with recurrent or progressive Posterior Fossa Group A (PFA) ependymoma.

연구 개요

상태

모병

정황

개입 / 치료

상세 설명

PRIMARY OBJECTIVES:

I. To assess pharmacodynamic effect on PFA tumor cells of metformin in participants with recurrent or progressive PFA undergoing surgical resection of the tumor by determining change in H3K27me3 and/or EZHIP expression in tumor nuclei compared to pre-treatment levels (TV Phase)

II. To measure disease stabilization rate by Response Assessment in Pediatric Neuro-Oncology (RAPNO) criteria (complete (CR), partial (PR) response; ≥50% reduction in size but <CR), and Stable (SD); < 50% reduction in size but not meeting criteria for progressive disease) in participants with recurrent or progressive PFA ependymoma following metformin treatment (Efficacy Phase).

EXPLORATORY OBJECTIVES:

I. Estimate the 1-year progression-free survival and overall-survival of participants with recurrent or progressive PFA treated with single agent metformin (Efficacy Phase).

II. To assess pharmacokinetics (PK) of metformin by measuring plasma, CSF and intra-tumoral concentration of metformin, the latter two obtained at the time of surgery or at the time of further disease progression on study in consenting participants (Both cohorts).

III. Evaluate the feasibility of using MR spectroscopy (MRS) imaging to study oncometabolite profile of recurrent or progressive PFA ependymoma pre-and post-treatment with metformin.

OUTLINE:

This will be a two-part study: a TV phase and an efficacy phase. Participants will be initially enrolled in the TV phase and receive treatment prior to planned surgery. Participants already enrolled on the TV phase may continue to the efficacy phase of the study if they have measurable disease post-surgery. Participants in the efficacy phase will receive daily oral metformin until disease progression or till there are unacceptable adverse event(s). Long term/survival follow-up procedures are to be captured under the Pediatric Neuro-Oncology Consortium (PNOC) Protocol for Children and Young Adults Diagnosed with a Central Nervous System (CNS) Tumor to Assess Cognitive, Quality of Life (QOL), and Comprehensive Effects of Therapies protocol (COMP). Participants will be followed under the PNOC COMP protocol until death or withdrawal from study.

연구 유형

중재적

등록 (추정된)

30

단계

  • 2 단계

연락처 및 위치

이 섹션에서는 연구를 수행하는 사람들의 연락처 정보와 이 연구가 수행되는 장소에 대한 정보를 제공합니다.

연구 연락처

  • 이름: PNOC Operations Office
  • 전화번호: 415-502-1600
  • 이메일: PNOC041@ucsf.edu

연구 장소

  • 미국
    • Alabama
      • Birmingham, Alabama, 미국, 35233
        • 모병
        • University of Alabama at Birmingham
        • 연락하다:
        • 연락하다:
    • California
      • San Francisco, California, 미국, 94143
        • 모병
        • University of California, San Francisco
        • 수석 연구원:
          • Sabine Mueller, MD, PhD
        • 연락하다:
    • District of Columbia
      • Washington D.C., District of Columbia, 미국, 20010
    • Indiana
      • Indianapolis, Indiana, 미국, 46202
        • 아직 모집하지 않음
        • Riley Hospital for Children at Indiana University Health
        • 연락하다:
          • Brian Weiss, MD
          • 전화번호: 317-944-8784
          • 이메일: weissbd@iu.edu
        • 연락하다:
          • Alex Lion, DO, MPH
          • 전화번호: 317-944-8784
          • 이메일: alion@iu.edu
    • Maryland
      • Baltimore, Maryland, 미국, 21287
        • 모병
        • Johns Hopkins University
        • 연락하다:
          • Kenneth Cohen, MD, MBA
          • 전화번호: 410-614-5055
          • 이메일: kcohen@jhmi.edu
        • 연락하다:
    • Michigan
      • Ann Arbor, Michigan, 미국, 48109
        • 아직 모집하지 않음
        • University of Michigan
        • 연락하다:
        • 연락하다:
    • Missouri
      • St Louis, Missouri, 미국, 63110
        • 모병
        • Washington University
        • 연락하다:
        • 연락하다:
    • New Jersey
      • Hackensack, New Jersey, 미국, 07601
        • 아직 모집하지 않음
        • Hackensack Meridian Health
        • 연락하다:
        • 연락하다:
    • North Carolina
      • Durham, North Carolina, 미국, 27710
    • Tennessee
      • Memphis, Tennessee, 미국, 38105
        • 아직 모집하지 않음
        • St. Jude Children's Research Hospital
        • 연락하다:
        • 연락하다:
    • Utah
      • Salt Lake City, Utah, 미국, 84113
    • Washington

참여기준

연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.

자격 기준

공부할 수 있는 나이

1년 (어린이, 성인)

건강한 자원 봉사자를 받아들입니다

아니

연구 대상 성별

모두

설명

Inclusion Criteria:

  1. Participants must have recurrent or progressive posterior fossa A (PFA) ependymoma following surgery AND radiation treatment (RT).

  2. Participants must have a diagnosis of PFA ependymoma. Any number of previous recurrences are permissible provided the participant meets other enrollment criteria.

  3. Participants must have adequate tumor tissue available from initial diagnosis or from pre- trial enrollment. Formalin-fixed paraffin-embedded (FFPE) material (1 full block) should be provided. If FFPE material is not available, 10 unstained slides with an accompanying hematoxylin and eosin (H&E) report should be provided.

    Target Validation (TV) Phase:

    o Participants are candidates to undergo elective surgery for removal of all or a portion of their recurrent/progressive tumor.

    Efficacy Phase:

    • Participant must have measurable disease; this will be defined as lesions that can be accurately measured in two dimensions (longest diameter to be recorded) The size threshold is met if both in-plane diameters are ≥10 mm or both in-plane diameters are at least two times the MRI slice thickness, plus the interslice gap with a minimum size of no less than double the slice thickness on MRI.
    • Participants with an isolated local progression of the tumor following RT (or stereotactic radiosurgery, SRS) must be > 6 months from completion of RT to the lesion to rule out pseudo progression or must have tissue confirmation of progression prior to enrollment.
    • Previously irradiated lesions are considered non-measurable except in cases of documented progression of the lesion since the completion of radiation therapy as outlined above.

  4. Prior Therapy: Participants must not be receiving metformin for other medical indications or previous exposure to metformin following their diagnosis of PFA ependymoma. However, participants treated on the TV phase, but did not continue onto maintenance therapy will be allowed to enroll on the efficacy phase with future recurrences or progression of their disease.

  5. Age: 1 -39 years at the time of enrollment.

  6. Performance Score: Karnofsky >= 50 for participants > 16 years of age and Lansky >=50 for participants <=16 years of age. 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.

  7. Corticosteroids: Participants who are receiving dexamethasone must be on a stable or decreasing dose for at least 1 week prior to registration.

  8. Organ Function Requirements

    1. Peripheral absolute neutrophil count (ANC) >= 1000/mm^3.
    2. Platelet count >=100,000/mm^3 (transfusion independent, defined as not receiving platelet transfusions for at least 7 days prior to enrollment).
    3. Serum creatinine < 1.5 Upper Limit normal (ULN) based on age and gender
    4. Total bilirubin <= 1.5 x ULN for age; in presence of Gilbert's syndrome, total bilirubin < 3 x ULN or direct bilirubin < 1.5 x ULN
    5. alanine aminotransferase (ALT) <= 3 x ULN.
    6. aspartate aminotransferase (AST) <=3 x ULN.

  9. Participants with seizure disorder may be enrolled if well controlled and are on stable dose of anti-seizure medication for > 72 hours prior to enrollment. Participants who have neurological deficits should have deficits that are stable for a minimum of 1 week prior to registration.

  10. Participants must enroll on PNOC COMP if PNOC COMP is open to accrual at the enrolling institution.

  11. A legal parent/guardian or participant must be able to understand, and willing to sign, a written informed consent and assent document, as appropriate.

Exclusion Criteria:

  1. Participants with a history of diabetes mellitus or those meeting criteria for pre-diabetes are excluded. Pre-diabetes is defined per American Diabetes Association criteria as any of the following: fasting plasma glucose (FPG) 100-125 mg/dL (5.6-6.9 mmol/L); 2-hour plasma glucose (OGTT) 140-199 mg/dL (7.8-11.0 mmol/L); or hemoglobin A1c (HbA1c) 5.7%-6.4% (39-47 mmol/mol).
  2. Participants without any measurable disease.
  3. Participants who have had chemotherapy or have received radiotherapy to the non-target lesion within 3 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier.
  4. Participants must be at least 7 days since the completion of therapy with a biologic or small molecule agent. For any agent with known adverse events that can occur beyond 7 days after administration, the period prior to enrollment must be beyond the time during which adverse events are known to occur. Such participants should also be discussed with study chairs.
  5. Participants with rapidly progressive symptoms that require urgent surgery that in the investigators assessment cannot be safely deferred for 6 weeks are excluded from target validation phase of the study
  6. Participants who are receiving any other investigational agents.
  7. Concurrent radiation therapy in any form is not permitted while on the study drug
  8. History of allergic reactions attributed to compounds of similar chemical or biologic composition to metformin.
  9. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection.
  10. Women of childbearing potential must not be pregnant or breast-feeding.
  11. Human immunodeficiency virus- (HIV) positive participants will be ineligible if HIV therapy regimen has not been stable for at least 4 weeks or there is intent to change the regimen within 8 weeks following enrollment, or if they are severely immunocompromised.

공부 계획

이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.

연구는 어떻게 설계됩니까?

디자인 세부사항

  • 주 목적: 치료
  • 할당: 무작위화되지 않음
  • 중재 모델: 순차적 할당
  • 마스킹: 없음(오픈 라벨)

무기와 개입

참가자 그룹 / 팔
개입 / 치료
실험적: Target Validation (TV) Phase (Metformin)

Participants will each receive daily oral metformin with a weekly schedule starting at 250 mg/m^2 twice a day (BID) for the first week, then increasing to 500 mg/m^2 BID for week 2, 1000 mg/m^2 BID for week 3, and then 1666 mg/m^2 BID for week 4-6 prior to planned surgery. Participants with no measurable disease following surgical intervention may either go off treatment or continue metformin at the physician's discretion. Participants have the option of continuing on the efficacy phase of the study without undergoing planned surgery no demonstrated progressive disease on pre-surgery MRI AND if the family opts to continue treatment with metformin without undergoing surgical resection of the tumor. Participants with measurable tumor by RAPNO criteria following surgery may continue onto efficacy phase and receive maintenance metformin until disease progression or till there are unacceptable adverse event(s).
절차: Magnetic Resonance Imaging (MRI)

Undergo MRI imaging

다른 이름들:
  • MRI
의약품: Metformin

Given orally (PO)

다른 이름들:
  • 글루코파지
절차: Planned Surgical Resection

Undergo planned surgery as part of regular care

다른 이름들:
  • 외과 적 절제술
절차: Specimen Collection

Tumor Tissue, blood, and cerebral spinal fluid (CSF) may be collected for correlative analysis.

다른 이름들:
  • 시료 샘플 수집
절차: MR spectroscopy (MRS)

Undergo MRS imaging

다른 이름들:
  • 부인
실험적: Efficacy Phase (Metformin)

Participants with recurrent or progressive PFA ependymoma that have failed upfront surgery and radiation will receive daily oral metformin until disease progression or till there are unacceptable adverse event(s). Disease response will be assessed by MRI imaging using RAPNO criteria. Participants already enrolled on the TV phase may enroll in this phase if they have measurable disease post-surgery. Treatment may continue until disease progression or until there are unacceptable adverse event(s).
절차: Magnetic Resonance Imaging (MRI)

Undergo MRI imaging

다른 이름들:
  • MRI
의약품: Metformin

Given orally (PO)

다른 이름들:
  • 글루코파지
절차: Planned Surgical Resection

Undergo planned surgery as part of regular care

다른 이름들:
  • 외과 적 절제술
절차: Specimen Collection

Tumor Tissue, blood, and cerebral spinal fluid (CSF) may be collected for correlative analysis.

다른 이름들:
  • 시료 샘플 수집
절차: MR spectroscopy (MRS)

Undergo MRS imaging

다른 이름들:
  • 부인

연구는 무엇을 측정합니까?

주요 결과 측정

결과 측정
측정값 설명
기간
Proportion of participants with changes in biomarkers between the pre-and post-metformin treated samples (Target Validation Phase)
기간: From initiation of study treatment until surgical resection of tumor, approximated 6 weeks

Proportion of participants with a 10% reduction in Enhancer of Zeste Inhibitory Protein (EZHIP) and/or a 10% increase in the epigenetic modification to the DNA packaging protein histone H3, with tri-methylation of lysine 27 on histone H3 (H3K27me3) between the pre- and post-metformin treated samples by Immunohistochemistry (IHC).
From initiation of study treatment until surgical resection of tumor, approximated 6 weeks
Disease Stabilization Rate (Efficacy Phase)
기간: From initiation of study treatment until discontinuation of treatment, up to 2 years

The primary endpoint of the efficacy phase is the disease stabilization rate by RAPNO criteria (complete (CR), partial (PR); response >50% reduction in size < CR, and stable (SD) which is a < 50% reduction in size and not meeting the definition for progressive disease) tumor responses), CR+PR+SD.
From initiation of study treatment until discontinuation of treatment, up to 2 years

공동 작업자 및 조사자

여기에서 이 연구와 관련된 사람과 조직을 찾을 수 있습니다.

스폰서

University of California, San Francisco

협력자

Pediatric Neuro-Oncology Consortium
The Lilabean Foundation, Inc.

수사관

  • 수석 연구원: Sabine Mueller, MD, PhD, University of California, San Francisco
  • 연구 의자: Santhosh A Upadhyaya, MD, University of Michigan, C. S. Mott Children's Hospital

연구 기록 날짜

이 날짜는 ClinicalTrials.gov에 대한 연구 기록 및 요약 결과 제출의 진행 상황을 추적합니다. 연구 기록 및 보고된 결과는 공개 웹사이트에 게시되기 전에 특정 품질 관리 기준을 충족하는지 확인하기 위해 국립 의학 도서관(NLM)에서 검토합니다.

연구 주요 날짜

연구 시작 (실제)

2026년 5월 5일

기본 완료 (추정된)

2028년 4월 30일

연구 완료 (추정된)

2030년 3월 31일

연구 등록 날짜

최초 제출

2025년 11월 6일

QC 기준을 충족하는 최초 제출

2025년 11월 6일

처음 게시됨 (실제)

2025년 11월 10일

연구 기록 업데이트

마지막 업데이트 게시됨 (실제)

2026년 10월 20일

QC 기준을 충족하는 마지막 업데이트 제출

2026년 10월 16일

마지막으로 확인됨

2026년 10월 1일

추가 정보

이 연구와 관련된 용어

추가 관련 MeSH 약관

기타 연구 ID 번호

  • 25087
  • NCI-2025-08332 (레지스트리 식별자: NCI Clinical Trials Reporting Program (CTRP))

개별 참가자 데이터(IPD) 계획

개별 참가자 데이터(IPD)를 공유할 계획입니까?

예

IPD 계획 설명

De-identified datasets may be shared with research collaborators during the course of the study.

IPD 공유 지원 정보 유형

  • 연구_프로토콜
  • 수액
  • ICF

약물 및 장치 정보, 연구 문서

미국 FDA 규제 의약품 연구

예

미국 FDA 규제 기기 제품 연구

아니

미국에서 제조되어 미국에서 수출되는 제품

예

이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .

구독하다