A PHASE 1/2 STUDY OF RO4929097, AN ORAL SMALL MOLECULE INHIBITOR OF GAMMA-SECRETASE, IN CHILDREN WITH RELAPSED/REFRACTORY SOLID OR CNS TUMORS, LYMPHOMA, OR T-CELL LEUKEMIA
Le RO4929097, un inhibiteur de la gamma-sécrétase, pourrait stopper la multiplication des cellules tumorales en inhibant certaines des enzymes indispensables à la croissance cellulaire.
Cet essai de phases I et II vise à déterminer l’efficacité et les effets secondaires du RO4929097, ainsi que la dose optimale à administrer dans le traitement de jeunes patients atteints d’une tumeur solide, d’une tumeur du système nerveux central, d’un lymphome ou d’une leucémie à cellules T et dont la maladie est récidivante ou réfractaire au traitement.
Description de l'essai
- Maximum tolerated dose (MTD) of RO4929097 determined according to dose-limiting toxicities (DLTs) graded using Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4.0)
- MTD of RO4929097 administered with dexamethasone determined according to DLTs graded using CTCAE v4.0
- Antitumour activity of RO4929097 with or without dexamethasone assessed by Response Evaluation Criteria for Solid Tumours (RECIST)
I. To estimate the maximum-tolerated dose (MTD) and recommend a phase II dose of
gamma-secretase inhibitor RO4929097 administered orally to children with relapsed or
refractory solid tumours or lymphoma on two schedules: once daily orally on a 3-day on/4-day
off weekly schedule (schedule A) or once daily for 5 consecutive days weekly schedule
II. To define and describe the toxicities of this drug administered on these schedules to
children with relapsed or refractory solid tumours, lymphoma, or T-cell leukemia.
III. To estimate the MTD and recommended phase II dose of gamma-secretase inhibitor
RO4929097 administered with dexamethasone.
IV. To define and describe the toxicities of gamma-secretase inhibitor RO4929097
administered with dexamethasone.
V. To characterize the pharmacokinetics of gamma-secretase inhibitor RO4929097 in children
with refractory cancer.
I. To preliminarily define the antitumour activity of gamma-secretase inhibitor RO4929097 in
children with solid or CNS tumours and lymphoma within the confines of a phase I study.
II. To obtain initial efficacy data on the antitumour activity of gamma-secretase inhibitor
RO4929097 when combined with dexamethasone in children with relapsed-refractory T-cell
leukemia (T-acute lymphoblastic leukemia [ALL]).
III. To study the effect of gamma-secretase inhibitor RO4929097 on Hes1 (hairy/enhancer of
split) and other components of the Notch signaling pathway in peripheral blood mononuclear
cells and/or T-ALL blasts. (exploratory) IV. To examine archival tumour samples for
expression of JAGGED1, JAGGED2, cleaved NOTCH1, and HES1, and HES5 by IHC and for
amplification of NOTCH1 or NOTCH2 using FISH analysis. (exploratory) V. To preliminarily
assess changes following treatment with gamma-secretase inhibitor RO4929097 using FDG PET
This is a multicentre, phase I, dose-escalation study of gamma-secretase inhibitor
RO4929097 followed by a phase II study. Patients are enrolled sequentially to group A or B.
GROUP A: Patients receive oral gamma-secretase inhibitor RO4929097 once daily on days 1-3,
8-10, 15-17, and 22-24. Treatment repeats every 28 days for up to 24 courses in the absence
of disease progression or unacceptable toxicity.
GROUP B: Patients receive oral gamma-secretase inhibitor RO4929097 once daily on days 1-5,
8-12, 15-19, and 22-26. Treatment repeats every 28 days for up to 24 courses in the absence
of disease progression or unacceptable toxicity. Patients may also receive concurrent oral
dexamethasone twice daily on the days of gamma-secretase inhibitor RO4929097 administration.
Once the MTD or recommended phase II dose of RO4929097 plus dexamethasone in children with
solid tumours, including CNS tumours, or lymphoma has been identified, this dose is used for
patients with relapsed-refractory T-ALL (phase 2 portion of the study) to evaluate RO4929097
in combination with dexamethasone using one of the studied schedules. Blood, plasma, bone
marrow, and tumour tissue samples may be collected at baseline and periodically during the
first course for correlative lab and tumour studies, including pharmacokinetics.
After completion of study treatment, patients are followed up for up to 30 days.
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