Phase 2
N=139
Study to Investigate Safety, Pharmacokinetic (PK), Pharmacodynamic (PD) and Clinical Activity of Trametinib in Subjects With Cancer or Plexiform Neurofibromas and Trametinib in Combination With Dabrafenib in Subjects With Cancers Harboring V600 Mutations
Cancer
Bottom Line
View on ClinicalTrials.gov: NCT02124772 ↗Enrolled (actual)
139
Serious AEs
48.9%
Results posted
Jul 2021
Primary outcome: Primary: Incidence of Treatment Emergent Adverse Events in Subjects Treated With Trametinib Monotherapy — 3; 19; 12; 16 Participants
Study Design & Population
- Study type
- Interventional
- Phase
- Phase 2
- Interventions
- Trametinib (Drug); Dabrafenib (Drug)
- Age
- Pediatric · 0+ yrs
- Sex
- All
- Sponsor
- Novartis Pharmaceuticals
- Primary completion
- Dec 2020
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Incidence of Treatment Emergent Adverse Events in Subjects Treated With Trametinib Monotherapy |
3; 19; 12; 16; 11; 10 | — |
| PRIMARY Average Steady State Plasma Concentration (Cavg) of Trametinib When Administered Alone (Monotherapy) |
5.76; 13.9; 15.2; 21.3; 15.1; 13.2 | — |
| SECONDARY Trough Concentration (Ctrough) of Trametinib When Administered Alone and in Combination With Dabrafenib |
4.37; 11.1; 10.2; 15.6; 10.7; 9.45 | — |
| SECONDARY Maximum Observed Plasma Concentration (Cmax) of Trametinib When Administered Alone and in Combination With Dabrafenib |
9.61; 21.1; 26.1; 32.6; 26.6; 22.1 | — |
| SECONDARY Time to Reach Maximum Plasma Concentration (Tmax) of Trametinib When Administered Alone and in Combination With Dabrafenib |
1.00; 2.00; 1.00; 2.00; 1.00; 1.50 | — |
| SECONDARY Area Under the Plasma Concentration-time Curve From Time Zero to the Time of Last Quantifiable Concentration (AUClast) of Trametinib When Administered Alone and in Combination With Dabrafenib |
138; 341; 364; 413; 362; 316 | — |
| SECONDARY Area Under the Plasma Concentration-time Curve From Time Zero to the End of the Dosing Interval Tau at Steady-state (AUCtau) of Trametinib When Administered Alone and in Combination With Dabrafenib |
138; 334; 364; 511; 362; 316 | — |
| SECONDARY Apparent Plasma Clearance (CL/F) of Trametinib When Administered Alone and in Combination With Dabrafenib |
2750; 1530; 1240; 2040; 1710; 1910 | — |
| SECONDARY Average Steady State Plasma Concentration (Cavg) of Trametinib When Administered in Combination With Dabrafenib |
12.1; 13.8; 9.83; 12.8; 7.76; 9.50 | — |
| SECONDARY Incidence of Treatment Emergent Adverse Events in Subjects Treated With Trametinib in Combination With Dabrafenib |
3; 9; 6; 20; 10; 3 | — |
| SECONDARY Best Overall Response (BOR) Based on RECIST v1.1, RANO and Dombi Criteria and as Per Investigator Assessment |
0; 0; 0; 0; 0; 0 | — |
| SECONDARY Objective Response Rate (ORR) Based on RECIST v1.1, RANO and Dombi Criteria and as Per Investigator Assessment |
0; 5.3; 8.3; 0; 9.1; 30.0 | — |
| SECONDARY Clinical Benefit Rate (CBR) Based on RECIST v1.1, RANO and Dombi Criteria and as Per Investigator Assessment |
33.3; 15.8; 33.3; 25.0; 18.2; 100 | — |
| SECONDARY Apparent Clearance (CL/F) of Trametinib Estimated With a PopPK Model |
5.07 | — |
| SECONDARY Apparent Central Volume (Vc/F) of Trametinib Estimated With a PopPK Model |
184 | — |
| SECONDARY Absorption Rate Constants (Ka1 and Ka2) of Trametinib Estimated With a PopPK Model |
0.134; 1.55 | — |
| SECONDARY Significant Covariates Estimated With a PopPK Model |
0.788; 1.24; 0.679; 0.876 | — |
| SECONDARY Trough Concentration (Ctrough) of Dabrafenib When Administered in Combination With Trametinib |
88.9; 28.6; 8.10; 38.2; 11.8; 5.36 | — |
| SECONDARY Maximum Observed Plasma Concentration (Cmax) of Dabrafenib When Administered in Combination With Trametinib |
630; 1560; 1440; 1360; 1490; 1840 | — |
| SECONDARY Time to Reach Maximum Plasma Concentration (Tmax) of Dabrafenib When Administered in Combination With Trametinib |
2.00; 1.00; 2.00; 2.00; 1.00; 1.00 | — |
| SECONDARY Area Under the Plasma Concentration-time Curve From Time Zero to the Time of Last Quantifiable Concentration (AUClast) of Dabrafenib When Administered in Combination With Trametinib |
2560; 4160; 3910; 4030; 3800; 3990 | — |
| SECONDARY Area Under the Plasma Concentration-time Curve From Time Zero to the End of the Dosing Interval Tau at Steady-state (AUCtau) of Dabrafenib When Administered in Combination With Trametinib |
2870; 4160; 4040; 4070; 3910; 4150 | — |
| SECONDARY Apparent Plasma Clearance (CL/F) of Dabrafenib When Administered in Combination With Trametinib |
22900; 20400; 10100; 25400; 12500; 10200 | — |
| SECONDARY Average Steady State Plasma Concentration (Cavg) of Dabrafenib When Administered in Combination With Trametinib |
239; 347; 337; 339; 326; 346 | — |
| SECONDARY Palatability of Trametinib Oral Solution in Pediatric Subjects Assessed by Palatability Questionnaire |
0; 1; 1; 0; 2; 26 | — |
| SECONDARY Palatability of Dabrafenib Oral Suspension in Pediatric Subjects Assessed by Palatability Questionnaire |
0; 1; 4; 5; 0; 0 | — |
Summary
This was a 4-part (Part A, Part B, Part C and Part D), Phase I/IIa, multi-center, open label, study in pediatric subjects with refractory or recurrent tumors.
Part A was a repeat dose, dose escalation and expansion phase that identified the recommended phase II dose (RP2D) of trametinib monotherapy. Part B evaluated the preliminary activity of trametinib monotherapy in 4 disease-specific cohorts of subjects. Part C was aimed to determine the safety, tolerability and preliminary activity of the RP2D of trametinib in combination with a limited dose escalation of dabrafenib. Part D evaluated the preliminary activity of trametinib in combination with dabrafenib in 2 disease-specific cohorts of subjects.
The overall goal of this trial was to efficiently establish safe, pharmacologically relevant dose of trametinib monotherapy and trametinib in combination with dabrafenib in infants, children and adolescents and determine preliminary activity of trametinib monotherapy and trametinib in combination with dabrafenib in selected recurrent, refractory or unresectable childhood tumors.
Eligibility Criteria
Inclusion Criteria
- General Eligibility Criteria (All Parts)
- Written informed consent - a signed informed consent and/or assent (as age appropriate) for study participation including PK sampling will be obtained according to institutional guidelines.
- Male or female between one month and =50% according to the Karnofsky/Lansky performance status scale.
- Females of child-bearing potential must be willing to practice acceptable methods of birth control. Additionally, females of childbearing potential must have a negative serum pregnancy test within 7 days prior to start of study drugs, throughout treatment period and for 4 months after last dose of study drugs.
- Must have adequate organ function as defined by the following values: renal function - 24 hr creatinine clearance (revised Schwartz formula), or radioisotope glomerular filtration rate (GFR) >=60 milliliter (mL) per minute per 1.73 meter square (mL/min/1.73m^2); or a serum creatinine =lower limit of normal (LLN) by ECHO.
- Able to swallow and retain enterally (per oral [PO] or nasogastric or gastric tube) administered medication and does not have any clinically significant gastrointestinal abnormalities that may alter absorption such as malabsorption syndrome or major resection of the stomach or bowels.
- Adequate Blood Pressure Control defined as: Blood pressure =1000/microliter, hemoglobin >=8.0 gram per deciliter (g/dL) (may receive red blood cell transfusions), platelets >=75,000/ microliter (transfusion independent, defined as not receiving platelet transfusions within a 7 day period prior to enrollment).
- Specific Eligibility Criteria, Part B
- Subjects must meet general eligibility criteria. The specific eligibility criteria listed here will apply to subjects enrolling to different cohorts of Part B.
- Tumor tissue (archived or fresh) is required and must be available to be shipped to GSK or site specific laboratory.
- Solid tumor cohort (B1) specific criteria
- B1: Refractory or relapsed neuroblastoma
- B2: Recurrent or unresectable low grade gliomas with BRAF tandem duplication with fusion
- B3: Neurofibromatosis Type -1 associated plexiform neurofibromas (NF-1 with PN) that are unresectable and medically significant.
- B4: BRAF V600 mutant tumors.
- Specific Eligibility Criteria, Part C - Subjects must meet general eligibility criteria.
- Tumors that have been documented by CLIA or equivalent certified laboratory test to harbor BRAF V600 mutation at diagnosis or relapse
- Measurable or evaluable disease
- Adequate bone marrow function
- Specific Eligibility Criteria, Part D - Subjects must meet general eligibility criteria
- Measurable or evaluable disease
- Recurrent or refractory BRAFV600 mutant LGG or LCH tumors
- Adequate bone marrow function
Exclusion Criteria
- Lactating or pregnant female.
- History of another malignancy including resected non-melanomatous skin cancer.
- Subjects with NF-1 associated optic pathway tumors are excluded if they are actively receiving therapy for the optic pathway tumor or do not meet criteria for PN or malignant solid tumor.
- Subjects with a history of NF-1 related cerebral vascular anomaly (such as Moyamoya).
- Subjects with NF-1 actively receiving therapy for the optic pathway tumor.
- Subjects with NF-1 and only PN lesions that cannot be evaluated by volumetric analysis (only applicable to Part B).
- Any serious and/or unstable pre-existing medical, psychiatric disorder or other conditions that could interfere with subject's safety, obtaining informed consent or compliance to the study procedures.
- Any prohibited medication(s), currently used or expected to be required.
- Any medications for treatment of left ventricular systolic dysfunction.
- Part B, Part C and Part D only: Previous treatment with dabrafenib or any BRAF inhibitor, trametinib or another MEK inhibitor, or and Extracellular signal-regulated kinase inhibitor (exception: prior treatment with sorafenib is permitted). Patients who have received p
Data sourced from ClinicalTrials.gov (NCT02124772). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.