AZD2171 in Treating Young Patients With Recurrent, Progressive, or Refractory Primary CNS Tumors

Study Overview
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Brief Summary
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This phase I trial is studying the side effects and best dose of AZD2171 in treating young patients with recurrent, progressive, or refractory primary CNS tumors. AZD2171 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor.

Detailed Description
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PRIMARY OBJECTIVES: I. Determine the maximum tolerated dose of AZD2171 in pediatric patients with recurrent, progressive, or refractory primary CNS tumors. II. Describe the toxicity profile and dose-limiting toxicities of AZD2171 in these patients. SECONDARY OBJECTIVES: I. Characterize inter-patient variability in the pharmacokinetics of AZD2171 in these patients. II. Describe changes in circulating endothelial cells (CECs) and circulating endothelial cell precursors (CEPs) in patients treated with AZD2171 at different dose levels. III. Correlate changes in CECs, CEPs, plasma, serum, and urine levels of proteins with angiogenesis, including vascular endothelial growth factor (VEGF) and VEGF receptor, in patients treated with AZD2171 at different dose levels. IV. Correlate changes in CECs, CEPs, and angiogenic modulators with changes in magnetic resonance (MR) perfusion. V. Obtain preliminary evidence of biologic activity of AZD2171 by evaluating alterations in tissue perfusion, tumor blood flow, and metabolic activity using MR perfusion and diffusion imaging, and positron-emission tomography, and correlating these findings with changes in tumor size by standard MRI. OUTLINE: This is a dose-escalation, multicenter study. Patients are stratified according to concurrent enzyme-inducing anticonvulsant drugs (yes vs no). Patients receive oral AZD2171 once daily on days 1-28. Treatment repeats every 28 days for up to 13 courses in the absence of disease progression or unacceptable toxicity. For each stratum, cohorts of 2-6 patients receive escalating doses of AZD2171 until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose at which 25% of patients experience dose-limiting toxicity. Once the MTD is determined, an additional 6 patients per stratum are enrolled and treated at the MTD. After completion of study, patients are followed at 30 days.

Official Title
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A Phase I Clinical Trial of AZD2171 in Children With Recurrent or Progressive Central Nervous System (CNS) Tumors

Conditions
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Childhood Atypical Teratoid/Rhabdoid Tumor, Childhood Central Nervous System Germ Cell Tumor, Childhood Cerebral Anaplastic Astrocytoma, Childhood Cerebral Astrocytoma, Childhood Grade I Meningioma, Childhood Grade II Meningioma, Childhood Grade III Meningioma, Childhood Infratentorial Ependymoma, Childhood Oligodendroglioma, Childhood Spinal Cord Neoplasm, Childhood Supratentorial Ependymoma, Recurrent Childhood Brain Neoplasm, Recurrent Childhood Brain Stem Glioma, Recurrent Childhood Cerebellar Astrocytoma, Recurrent Childhood Cerebral Astrocytoma, Recurrent Childhood Ependymoma, Recurrent Childhood Medulloblastoma, Recurrent Childhood Pineoblastoma, Recurrent Childhood Subependymal Giant Cell Astrocytoma, Recurrent Childhood Supratentorial Primitive Neuroectodermal Tumor, Recurrent Childhood Visual Pathway Glioma

Intervention / Treatment
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* Drug: Cediranib Maleate


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Histologically confirmed primary CNS tumor Histologically benign brain tumors (e.g., low-grade glioma) allowed Histological requirement waived for intrinsic brain stem or diffuse optic pathway tumors, but must have clinical and/or radiographic evidence of progression Recurrent, progressive, or refractory disease Absolute neutrophil count >= 1,000/mm^3 (unsupported) Platelet count >= 75,000/mm^3 (unsupported) Creatinine =< 1.5 times upper limit of normal (ULN) OR glomerular filtration rate >= 70 mL/min Bilirubin =< 1.5 times ULN ALT =< 2.5 times ULN Urine dipstick or urinalysis < 1+ protein Albumin >= 3 g/dL Karnofsky performance status (PS) 60-100% (> 16 years of age) OR Lansky PS 60-100% (=< 16 years of age) Karnofsky/Lansky PS 70-100% for patients at increased risk for compromised LVEF Hemoglobin >= 8 g/dL (transfusion support allowed) No overt renal, hepatic, cardiac, or pulmonary disease Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception QTc prolongation =< 500 msec No other significant ECG abnormality within the past 14 days No clinically significant, unrelated, systemic illness, including serious infections or significant cardiac, pulmonary, hepatic, or other organ dysfunction, that would preclude study participation No uncontrolled hypertension Defined as systolic and diastolic BP > 95th percentile for age (ages 1-17) Defined as BP > 140/90 (ages 18 and older) No New York Heart Association class III or IV disease and Karnofsky/Lansky PS < 70 Class II disease controlled with treatment and increased monitoring is allowed Recovered from all prior therapy No prior AZD2171 At least 3 weeks since prior myelosuppressive anticancer chemotherapy (6 weeks for nitrosoureas) More than 1 weeks since prior investigational or biologic agents If the investigational or biologic agent has a prolonged half-life (> 48 hours), then these patients must be discussed with the study chair prior to registration No concurrent drugs or biologics with proarrhythmic potential More than 3 months since last fraction of craniospinal radiotherapy or total-body irradiation More than 4 weeks since last fraction of focal irradiation to symptomatic metastatic sites At least 6 months since prior allogeneic bone marrow transplantation At least 3 months since prior autologous bone marrow or stem cell transplantation At least 1 week since prior filgrastim (G-CSF), sargramostim (GM-CSF), or epoetin alfa (2 weeks for pegfilgrastim) No other concurrent investigational agents Concurrent dexamethasone allowed provided patient is on a stable or decreasing dose for ≥ 1 week before study entry No concurrent chemotherapy No concurrent routine use of G-CSF, GM-CSF, or epoetin alfa Able to swallow tablets Any neurologic deficits must be stable for >= 1 week If the investigational or biologic agent has a prolonged half-life (> 48 hours), then these patients must be discussed with the study chair prior to registration Exclusion Criteria: No known curative therapy available

Ages Eligible for Study
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Maximum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Treatment (cediranib maleate)<br>Patients receive oral AZD2171 once daily on days 1-28. Treatment repeats every 28 days for up to 13 courses in the absence of disease progression or unacceptable toxicity. | Drug: Cediranib Maleate<br>* Given orally<br>* Other names: Recentin;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximum tolerated dose, defined as the dose at which the model estimates that 25% of patients will experience dose-limiting toxicity as measured by NCI CTCAE v4.0 | Estimated using the modified Continual Reassessment Method (CRM). | 42 days |