Prexasertib in Treating Pediatric Patients With Recurrent or Refractory Solid Tumors
Condition: Childhood Solid Neoplasm; Recurrent Malignant Solid Neoplasm; Recurrent Primary Central Nervous System Neoplasm; Refractory Malignant Solid Neoplasm; Refractory Primary Central Nervous System Neoplasm
MeSH terms: Neoplasms; Nervous System Neoplasms; Central Nervous System Neoplasms; Recurrence
Intervention: Laboratory Biomarker Analysis; Pharmacokinetic (PK) study; Prexasertib
Intervention description: Correlative studies; Correlative studies; Given IV
Intervention MeSH terms: Prexasertib
Phase: Phase 1
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 30.0
Sex: All
Minimum age: 12 Months
Maximum age: 21 Years
Healthy volunteers: No

Summary:

      This phase I trial studies the side effects and best dose of prexasertib in treating
      pediatric patients with solid tumors that have come back after a period of time during which
      the tumor could not be detected or does not respond to treatment. Checkpoint kinase 1
      inhibitor LY2606368 may stop the growth of tumor cells by blocking some of the enzymes needed
      for cell growth.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients with recurrent or refractory solid tumors, including central nervous system
             (CNS) tumors, are eligible; patients must have had histologic verification of
             malignancy at original diagnosis or relapse except in patients with intrinsic brain
             stem tumors, optic pathway gliomas, or in patients with pineal tumors and elevations
             of cerebrospinal fluid (CSF) or serum tumor markers including alpha-fetoprotein or
             beta-human chorionic gonadotropin (HCG)

          -  Patients must have either measurable or evaluable disease

          -  Patient's current disease state must be one for which there is no known curative
             therapy or therapy proven to prolong survival with an acceptable quality of life

          -  Karnofsky >= 50% for patients > 16 years of age and Lansky >= 50 % for patients =< 16
             years of age

               -  Note: Neurologic deficits in patients with CNS tumors must have been relatively
                  stable for at least 7 days prior to study enrollment; patients 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

          -  Patients must have fully recovered from the acute toxic effects of all prior
             anti-cancer therapy and must meet the following minimum duration from prior
             anti-cancer directed therapy prior to enrollment; if after the required timeframe, the
             defined eligibility criteria are met, e.g. blood count criteria, the patient is
             considered to have recovered adequately

               -  Cytotoxic chemotherapy or other anti-cancer agents known to be myelosuppressive;
                  the duration of this interval must be discussed with the study chair and the
                  study-assigned research coordinator prior to enrollment

                    -  >= 21 days after the last dose of cytotoxic or myelosuppressive chemotherapy
                       (42 days if prior nitrosourea)

               -  Anti-cancer agents not known to be myelosuppressive (e.g. not associated with
                  reduced platelet or absolute neutrophil count [ANC] counts): >= 7 days must have
                  elapsed from last dose of agent; the duration of this interval must be discussed
                  with the study chair and the study-assigned research coordinator prior to
                  enrollment

               -  Antibodies: >= 21 days must have elapsed from infusion of last dose of antibody,
                  and toxicity related to prior antibody therapy must be recovered to grade =< 1

               -  Corticosteroids: If used to modify immune adverse events related to prior
                  therapy, >= 14 days must have elapsed since last dose of corticosteroid

               -  Hematopoietic growth factors: >= 14 days must have elapsed since the last dose of
                  a long-acting growth factor (e.g. pegfilgrastim) or 7 days for short-acting
                  growth factor; for agents that have known adverse events occurring beyond 7 days
                  after administration, this period must be extended beyond the time during which
                  adverse events are known to occur; the duration of this interval must be
                  discussed with the study chair and the study-assigned research coordinator

               -  Interleukins, interferons and cytokines (other than hematopoietic growth
                  factors): >= 21 days must have elapsed since the completion of interleukins,
                  interferon or cytokines (other than hematopoietic growth factors)

               -  Stem cell infusions (with or without total body irradiation [TBI]):

                    -  Allogeneic (non-autologous) bone marrow or stem cell transplant, or any stem
                       cell infusion including donor lymphocyte infusion (DLI) or boost infusion:
                       >= 84 days must have elapsed after infusion, and no evidence of
                       graft-versus-host disease (GVHD)

                    -  Autologous stem cell infusion including boost infusion: >= 42 days must have
                       elapsed after completion

               -  Cellular therapy: >= 42 days must have elapsed since the completion of any type
                  of cellular therapy (e.g. modified T cells, natural killer [NK] cells, dendritic
                  cells, etc.)

               -  X ray (XRT)/external beam irradiation including protons: >= 14 days must have
                  elapsed after local XRT; >= 150 days after TBI, craniospinal XRT or if radiation
                  to >= 50% of the pelvis; >= 42 days if other substantial bone marrow (BM)
                  radiation

               -  Radiopharmaceutical therapy (e.g., radiolabeled antibody, 131 iodine
                  metaiodobenzylguanidine [131I-MIBG]): >= 42 days must have elapsed since
                  systemically administered radiopharmaceutical therapy

               -  Patients must not have received prior exposure to LY2606368

          -  For patients with solid tumors without known bone marrow involvement:

               -  Peripheral absolute neutrophil count (ANC) >= 1000/mm^3

               -  Platelet count >= 75,000/mm^3 (transfusion independent, defined as not receiving
                  platelet transfusions for at least 7 days prior to enrollment)

               -  Hemoglobin >= 8.0 g/dl at baseline (may receive packed red blood cell [PRBC]
                  transfusions)

          -  Patients with known bone marrow metastatic disease will be eligible for study provided
             they meet the blood counts (may receive transfusions provided they are not known to be
             refractory to red cell or platelet transfusions); these patients will not be evaluable
             for hematologic toxicity; at least 5 of every cohort of 6 patients must be evaluable
             for hematologic toxicity for the dose-escalation part of the study; if dose-limiting
             hematologic toxicity is observed, all subsequent patients enrolled must be evaluable
             for hematologic toxicity

          -  Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70ml/min/1.73
             m^2 or a serum creatinine based on age/gender as follows:

               -  Age: maximum serum creatinine (mg/dL)

               -  1 to < 2 years: 0.6 (male and female)

               -  2 to < 6 years: 0.8 (male and female)

               -  6 to < 10 years: 1 (male and female)

               -  10 to < 13 years: 1.2 (male and female)

               -  13 to < 16 years: 1.5 (male), 1.4 (female)

               -  >= 16 years: 1.7 (male), 1.4 (female)

          -  Bilirubin (sum of conjugated + unconjugated) =< 1.5 x upper limit of normal (ULN) for
             age

          -  Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 135
             U/L (3x ULN); for the purpose of this study, the ULN for SGPT is 45 U/L

          -  Serum albumin >= 2 g/dL

          -  Shortening fraction of >= 27% by echocardiogram, or ejection fraction of >= 50% by
             gated radionuclide study

          -  Corrected QT (QTc) =< 480 msec

               -  Note: Patients should avoid concomitant medication known or suspected to prolong
                  QTc interval or cause Torsades De Pointes; If possible, alternative agents should
                  be considered

               -  Patients who are receiving drugs that prolong the QTc are eligible if the drug is
                  necessary and no alternatives are available

          -  Patients with seizure disorder may be enrolled if on anticonvulsants and well
             controlled

          -  Nervous system disorders (Common Terminology Criteria for Adverse Events [CTCAE]
             version [v]4) resulting from prior therapy must be =< grade 2

          -  For patients with CNS tumors, any baseline neurologic deficit, including seizures,
             must be stable for at least one week prior to initiating study treatment

          -  All patients and/or their parents or legally authorized representatives must sign a
             written informed consent; assent, when appropriate, will be obtained according to
             institutional guidelines

          -  Tissue blocks or slides must be sent if available; if tissue blocks or slides are
             unavailable, the study chair must be notified prior to study enrollment

        Exclusion Criteria:

          -  Pregnant or breast-feeding women will not be entered on this study; pregnancy tests
             must be obtained in girls who are post-menarchal; males or females of reproductive
             potential may not participate unless they have agreed to use an effective
             contraceptive method both during and for 3 months after participation in this study;
             abstinence is an acceptable method of contraception

          -  Corticosteroids: Patients receiving corticosteroids must have been on a stable or
             decreasing dose of corticosteroid for at least 7 days prior to enrollment; if used to
             modify immune adverse events related to prior therapy, >= 14 days must have elapsed
             since last dose of corticosteroid

          -  Investigational drugs: Patients who are currently receiving another investigational
             drug are not eligible

          -  Anti-cancer agents: Patients who are currently receiving other anti-cancer agents are
             not eligible

          -  Anti-GVHD agents post-transplant: Patients who are receiving cyclosporine, tacrolimus
             or other agents to prevent graft-versus-host disease post bone marrow transplant are
             not eligible for this trial

          -  Strong CYP1A2 inhibitors: Patients must not have received strong CYP1A2 inhibitors
             (ciprofloxacin, fluvoxamine, zafirlukast) for at least 7 days prior to enrollment and
             must not receive them for the duration of the study

          -  Patients who have an uncontrolled infection are not eligible

          -  Patients who have received a prior solid organ transplantation are not eligible

          -  Patients with a history of allergic reactions attributed to compounds of similar
             chemical or biologic composition to LY2606368 or to its formulation are not eligible

          -  Patients who in the opinion of the investigator may not be able to comply with the
             safety monitoring requirements of the study are not eligible