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Phase 2 N=139 Treatment

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

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

OutcomeResultp-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
View full record on ClinicalTrials.gov →

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.

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