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Walidacja docelowa i skuteczność metforminy u pacjentów z wyściółczakiem grupy A tylnego dołu czaszki (PFA) (PNOC041)

5 listopada 2026 zaktualizowane przez: University of California, San Francisco

Badanie walidacji celu i skuteczności metforminy u pacjentów z nawracającym lub postępującym wyściółczakiem tylnego dołu czaszki grupy A (PFA)

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.

Przegląd badań

Status

Rekrutacyjny

Warunki

Interwencja / Leczenie

Szczegółowy opis

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.

Typ studiów

Interwencyjne

Zapisy (Szacowany)

30

Faza

  • Faza 2

Kontakty i lokalizacje

Ta sekcja zawiera dane kontaktowe osób prowadzących badanie oraz informacje o tym, gdzie badanie jest przeprowadzane.

Kontakt w sprawie studiów

  • Nazwa: PNOC Operations Office
  • Numer telefonu: 415-502-1600
  • E-mail: PNOC041@ucsf.edu

Lokalizacje studiów

  • Brazylia
    • São Paulo
      • São Paulo, São Paulo, Brazylia, 04039-001
        • Jeszcze nie rekrutacja
        • GRAACC - Grupo de Apoio ao Adolescente e a Crianca com Cancer
        • Kontakt:
        • Kontakt:
  • Stany Zjednoczone
    • Alabama
      • Birmingham, Alabama, Stany Zjednoczone, 35233
        • Rekrutacyjny
        • University of Alabama at Birmingham
        • Kontakt:
        • Kontakt:
    • California
      • San Francisco, California, Stany Zjednoczone, 94143
        • Rekrutacyjny
        • University of California, San Francisco
        • Główny śledczy:
          • Sabine Mueller, MD, PhD
        • Kontakt:
    • District of Columbia
      • Washington D.C., District of Columbia, Stany Zjednoczone, 20010
    • Indiana
      • Indianapolis, Indiana, Stany Zjednoczone, 46202
        • Jeszcze nie rekrutacja
        • Riley Hospital for Children at Indiana University Health
        • Kontakt:
        • Kontakt:
          • Alex Lion, DO, MPH
          • Numer telefonu: 317-944-8784
          • E-mail: alion@iu.edu
    • Maryland
      • Baltimore, Maryland, Stany Zjednoczone, 21287
        • Rekrutacyjny
        • Johns Hopkins University
        • Kontakt:
          • Kenneth Cohen, MD, MBA
          • Numer telefonu: 410-614-5055
          • E-mail: kcohen@jhmi.edu
        • Kontakt:
    • Michigan
      • Ann Arbor, Michigan, Stany Zjednoczone, 48109
        • Jeszcze nie rekrutacja
        • University of Michigan
        • Kontakt:
        • Kontakt:
    • Missouri
      • St Louis, Missouri, Stany Zjednoczone, 63110
        • Rekrutacyjny
        • Washington University
        • Kontakt:
        • Kontakt:
    • New Jersey
      • Hackensack, New Jersey, Stany Zjednoczone, 07601
        • Jeszcze nie rekrutacja
        • Hackensack Meridian Health
        • Kontakt:
        • Kontakt:
    • North Carolina
      • Durham, North Carolina, Stany Zjednoczone, 27710
    • Tennessee
      • Memphis, Tennessee, Stany Zjednoczone, 38105
    • Utah
      • Salt Lake City, Utah, Stany Zjednoczone, 84113
    • Washington

Kryteria uczestnictwa

Badacze szukają osób, które pasują do określonego opisu, zwanego kryteriami kwalifikacyjnymi. Niektóre przykłady tych kryteriów to ogólny stan zdrowia danej osoby lub wcześniejsze leczenie.

Kryteria kwalifikacji

Wiek uprawniający do nauki

1 rok do 39 lat (Dziecko, Dorosły)

Akceptuje zdrowych ochotników

Nie

Płeć kwalifikująca się do nauki

Wszystko

Opis

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.

Plan studiów

Ta sekcja zawiera szczegółowe informacje na temat planu badania, w tym sposób zaprojektowania badania i jego pomiary.

Jak projektuje się badanie?

Szczegóły projektu

  • Główny cel: Leczenie
  • Przydział: Nielosowe
  • Model interwencyjny: Zadanie sekwencyjne
  • Maskowanie: Brak (otwarta etykieta)

Broń i interwencje

Grupa uczestników / Arm
Interwencja / Leczenie
Eksperymentalny: 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).
Procedura: Magnetic Resonance Imaging (MRI)

Undergo MRI imaging

Inne nazwy:
  • MRI
Lek: Metformin

Given orally (PO)

Inne nazwy:
  • Glukofag
Procedura: Planned Surgical Resection

Undergo planned surgery as part of regular care

Inne nazwy:
  • Resekcja chirurgiczna
Procedura: Specimen Collection

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

Inne nazwy:
  • Pobieranie Próbki Materiału Biologicznego
Procedura: MR spectroscopy (MRS)

Undergo MRS imaging

Inne nazwy:
  • PANI
Eksperymentalny: 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).
Procedura: Magnetic Resonance Imaging (MRI)

Undergo MRI imaging

Inne nazwy:
  • MRI
Lek: Metformin

Given orally (PO)

Inne nazwy:
  • Glukofag
Procedura: Planned Surgical Resection

Undergo planned surgery as part of regular care

Inne nazwy:
  • Resekcja chirurgiczna
Procedura: Specimen Collection

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

Inne nazwy:
  • Pobieranie Próbki Materiału Biologicznego
Procedura: MR spectroscopy (MRS)

Undergo MRS imaging

Inne nazwy:
  • PANI

Co mierzy badanie?

Podstawowe miary wyniku

Miara wyniku
Opis środka
Ramy czasowe
Proportion of participants with changes in biomarkers between the pre-and post-metformin treated samples (Target Validation Phase)
Ramy czasowe: 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)
Ramy czasowe: 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

Współpracownicy i badacze

Tutaj znajdziesz osoby i organizacje zaangażowane w to badanie.

Sponsor

University of California, San Francisco

Współpracownicy

Pediatric Neuro-Oncology Consortium
The Lilabean Foundation, Inc.

Śledczy

  • Główny śledczy: Sabine Mueller, MD, PhD, University of California, San Francisco
  • Krzesło do nauki: Santhosh A Upadhyaya, MD, University of Michigan, C. S. Mott Children's Hospital

Daty zapisu na studia

Daty te śledzą postęp w przesyłaniu rekordów badań i podsumowań wyników do ClinicalTrials.gov. Zapisy badań i zgłoszone wyniki są przeglądane przez National Library of Medicine (NLM), aby upewnić się, że spełniają określone standardy kontroli jakości, zanim zostaną opublikowane na publicznej stronie internetowej.

Główne daty studiów

Rozpoczęcie studiów (Rzeczywisty)

5 maja 2026

Zakończenie podstawowe (Szacowany)

30 kwietnia 2028

Ukończenie studiów (Szacowany)

31 marca 2030

Daty rejestracji na studia

Pierwszy przesłany

6 listopada 2025

Pierwszy przesłany, który spełnia kryteria kontroli jakości

6 listopada 2025

Pierwszy wysłany (Rzeczywisty)

10 listopada 2025

Aktualizacje rekordów badań

Ostatnia wysłana aktualizacja (Rzeczywisty)

9 listopada 2026

Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości

5 listopada 2026

Ostatnia weryfikacja

1 listopada 2026

Więcej informacji

Terminy związane z tym badaniem

Dodatkowe istotne warunki MeSH

Inne numery identyfikacyjne badania

  • 25087
  • NCI-2025-08332 (Identyfikator rejestru: NCI Clinical Trials Reporting Program (CTRP))

Plan dla danych uczestnika indywidualnego (IPD)

Planujesz udostępniać dane poszczególnych uczestników (IPD)?

TAK

Opis planu IPD

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

Typ informacji pomocniczych dotyczących udostępniania IPD

  • PROTOKÓŁ BADANIA
  • SOK ROŚLINNY
  • ICF

Informacje o lekach i urządzeniach, dokumenty badawcze

Bada produkt leczniczy regulowany przez amerykańską FDA

Tak

Bada produkt urządzenia regulowany przez amerykańską FDA

Nie

produkt wyprodukowany i wyeksportowany z USA

Tak

Te informacje zostały pobrane bezpośrednio ze strony internetowej clinicaltrials.gov bez żadnych zmian. Jeśli chcesz zmienić, usunąć lub zaktualizować dane swojego badania, skontaktuj się z register@clinicaltrials.gov. Gdy tylko zmiana zostanie wprowadzona na stronie clinicaltrials.gov, zostanie ona automatycznie zaktualizowana również na naszej stronie internetowej .

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