Clinical trial NCT06438614: A Study Of Naxitamab , Granulocyte Macrophage Colony Stimulating Factor For Patients With Relapsed /Refractory , Soft Tissue or Anti GD2 Immunotherapy Refractory Neuroblastoma
Official title: A Phase II Single Center Study Of Naxitamab , Granulocyte Macrophage Colony Stimulating Factor (GM CSF and Ifosfamide Carboplatin Etoposide) For Patients With Relapsed Refractory , Soft Tissue or Anti GD2 Immunotherapy Refractory Neuroblastoma
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Refractory Neuroblastoma
Soft Tissue Cancer
Lead sponsor: Fundació Sant Joan de Déu
Sponsor class: OTHER
First posted: 2024-06-03
Enrollment: 47
Sex: ALL
Minimum age (years): 18
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: Subjects will receive 2 cycles of HITS. Each cycle of HITS (4 doses of hu3F8, 5 doses of irinotecan and temozolomide and 5 doses of GM-CSF). Patients with CR after 2 or 4 cycles of HITS will receive 5 cycles of Naxitamab + GM-CSF cycles. Patients that do not have an objective response (CR/PR) will receive NICE within 3 weeks from last dose. Each cycle of NICE consists of 4 doses of hu3F8, 5 doses of GM-CSF, 1 dose of carboplatin, and 3 doses each of ifosfamide and etoposide. Patients with less than CR response (PR/SD) will receive 2 more cycles of NICE and evaluated after 4th cycle. Patients with no objective response at these timepoints will be removed from the study. Patients with CR will receive 5 cycles of Naxitamab consolidation cycles consisting of GM-CSF250mcg/m2/day SC administered from day -4 to day 0 and GM-CSF500mcg/m2/day SC administered from day 1 to day 5. Three doses of hu3F83 mg/kg IVwill be administrated, specifically on days 1, 3 and 5.
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to evaluate safety and efficacy of naxitamab, granulocyte macrophage Colony Stimulating Factor (GM CSF) and Isofosfamide/Carboplatin/Etoposide (NICE) for Patients With Relapsed /Refractory, soft tissue or anti GD2 immunotherapy refractory Neuroblastoma

Detailed description: The anti-GD2 monoclonal antibody Naxitamab (also known as hu3F8) in combination with macrophage colony-stimulating factor (GM-CSF) is currently under pivotal phase 3 investigation for the treatment of High-Risk Neuroblastoma Patients with Primary or Secondary Refractory Osteomedullary Disease.

A subset of patients with high-risk, resistant disease, i.e., relapsed or refractory Neuroblastoma with soft tissue involvement as measured by 123I-Meta-iodobenzylguanidine (MIBG), 18F-FDG avid or measurable computed tomography (CT)/ magnetic resonance imaging (MRI) tumors outside of the bone marrow, or disease refractory to Naxitamab in combination with GM-CSF has shown significant response rates to a chemoimmunotherapy combination of Naxitamab, GM-CSF, irinotecan and temozolomide (HITS- Hu3F8, irinotecan, temozolomide and sargramostim) (NCT03189706). Treatment is administered on an outpatient basis and toxicities include those expected from I/T (myelosuppression and diarrhea) as well as pain and hypertension expected with Naxitamab. No other greater than grade 2 related toxicities occurred in this study (n=46). Early responses, assessed after 2 cycles, were documented in 18 (39%) patients and here complete (n = 9), partial (n = 8), and mixed (n = 1) and 13 patients had stable disease. Responses were achieved in refractory (3/7;43%) and progressive disease (15/39;38%) subgroups, in patients who had previously received I/T (12/34;35%) and/or anti-GD2 MoAb (14/36;39%), and in soft tissue (6/22; 27%) MIBG-avid skeletal sites (20/36;56%) and on bone marrow histology (9/12;75%). While encouraging, new strategies are warranted to further treat resistant disease.

A high-dose combination of ifosfamide, carboplatin, and etoposide (ICE) has activity against Neuroblastoma without cross-resistance to widely used chemotherapy regimens.

Through compassionate use, 4 patients with progression of disease or refractory disease after HITS therapy, have been further treated with two cycles of a combination of naxitamab, Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) and ifosfamide/Carboplatin/Etoposide (NICE). The first patient showed a complete response.

Toxicity included G2 prolonged aplasia and G3 hypertension, both expected from the chemotherapy agents and hu3F8. One patient progressed after the 2 cycles and the other 2 showed stable disease, according to the revised (2017) International Neuroblastoma Response Criteria (INRC).

In this formal trial, the investigators will investigate whether the combination of Naxitamab and GM-CSF with ifosfamide/Carboplatin/Etoposide (ICE) has a synergistic treatment effect in relapsed or refractory disease. The safety and efficacy of NICE (Naxitamab, Ifosfamide/Carboplatin/Etoposide) in patients that have not achieved complete remission with HITS chemo-immunotherapy will be assessed.

Eligibility criteria: Inclusion Criteria:

1. Diagnosis of neuroblastoma (NB) as defined per INRC as

   1. histopathology of tumor biopsy, or
   2. BM aspirate or biopsy indicative of NB by histology plus high blood or urine catecholamine metabolite levels or MYCN amplification, or
   3. Fluorodeoxyglucose (FDG), MIBG avid lesion(s)
2. High-risk NB as defined as any of the following:

   1. Stage 4 with MYCN amplification
   2. Stage 4 without MYC amplification \>1.5 y of age
   3. Stage 3 with MYCN amplification
3. Relapsed/refractory Neuroblastoma with

   1. Evidence of soft tissue disease or
   2. Progessive disease/incomplete response/relapsed to previous treatment with Naxitamab plus GM-CSF
4. Prior treatment with murine and hu3F8 is allowed
5. Prior treatment with irinotecan or temozolomide or ICE is permitted
6. Evaluable (microscopic marrow metastasis, elevated tumor markers, positive MIBG or PET scans) or measurable (CT, MRI) disease documented after completion of prior systemic therapy
7. Age ≥18 months
8. Acceptable hematological status defined as:

   1. Hemoglobin ≥8 g/dL (5.0 mmol/L)
   2. White blood cell count ≥1000/μL
   3. Absolute Neutrophil Count (ANC) ≥500/μL
   4. Platelet count ≥50,000/μL
9. Acceptable liver function defined as:

   1. alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤5 times Upper Limit of Normal (ULN)
   2. Bilirubin ≤1.5 x ULN
10. Acceptable kidney function defined as:

    a. estimated Glomerular Filtration Rate (eGFR) \>60 mL/min/1.73 m2 calculated by the 2009 revised Bedside Schwartz Equation
11. Written informed consent from legal guardian(s) and/or patient in accordance with local regulations. Children must provide assent as required by local regulations (≥ 12 years old).

Exclusion Criteria:

1. Existing major organ dysfunction \> grade 2, with the exception of hearing loss and hematologic toxicity (defined as suppression of all subtypes of WBCs, RBCs, and platelets).
2. Active life-threatening infection.
3. Pregnant women or women who are breast-feeding.
4. Inability to comply with protocol requirements, including genetic studies.
5. History of allergy to GM-CSF ≥ G4 (Common Terminology Criteria for Adverse Events- CTCAE) or does not respond to treatment.
6. Absolute Neutrophil Count (ANC) \< 500/uL .
7. Platelet count \<50,000/uL.
8. Patients with relapsed/refractory Neuroblastoma with solely bone marrow/bone involvement. Only patients with B/BM compartiment disease who show progressive disease/incomplete response/relapsed to previous treatment with Naxitamab plus GM-CSF may be eligible (inclusion critèrium #3).

Primary outcomes:
measure: Number of Participants with Serious and Non-Serious Adverse Events
timeFrame: 14 months after ICF signature
measure: Best Overall Response (at the end of HITS treatment)
timeFrame: From first day of treatment with HITS until completion of HITS (39 days).
measure: Best Overall Response of Complete Response (CR) (at the end of HITS treatment)
timeFrame: From first day of treatment with HITS until completion of HITS(39 days).
measure: Objective Response Rate (at the end of HITS treatment)
timeFrame: From first day of treatment with HITS until completion of HITS (39 days).
measure: Clinical Benefit Rate (at the end of HITS treatment)
timeFrame: From first day of treatment with HITS until completion of HITS (39 days).
measure: Best Overall Response (at the end of NICE treatment)
timeFrame: From first day of treatment with NICE until completion of NICE (39 days).
measure: Best Overall Response of Complete Response (CR) (at the end of NICE treatment)
timeFrame: From first day of treatment with NICE until completion of NICE (39 days).
measure: Objective Response Rate (at the end of NICE treatment)
timeFrame: From first day of treatment with NICE until completion of NICE (39 days).
measure: Clinical Benefit Rate (at the end of NICE treatment)
timeFrame: From first day of treatment with NICE until completion of NICE (39 days).
Secondary outcomes:
measure: To evaluate serum cytokines in patients receiving NICE
timeFrame: From first day of treatment with NICE, until day 11 post administration.
measure: To measure MRD after HITS
timeFrame: From first day of treatment with HITS until completion of HITS (39 days).
measure: To measure MRD after NICE
timeFrame: From first day of treatment with NICE until completion of NICE (39 days).
Other outcomes:
Locations:
city: Esplugues De Llobregat
country: Spain
facility: Hospital Sant Joan de Déu
state: Barcelona
Study officials:
References: