Clinical trial NCT04145349: CAMPFIRE: A Study of Ramucirumab (LY3009806) in Children and Young Adults With Desmoplastic Small Round Cell Tumor
Official title: A Randomized, Open-Label Phase 1/2 Study Evaluating Ramucirumab in Pediatric Patients and Young Adults With Relapsed, Recurrent, or Refractory Desmoplastic Small Round Cell Tumor
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: PHASE1
PHASE2
Conditions: Desmoplastic Small Round Cell Tumor
Keywords: soft tissue sarcoma
adolescents and young adults (AYAs)
adolescent
Lead sponsor: Eli Lilly and Company
Sponsor class: INDUSTRY
First posted: 2019-10-30
Enrollment: 34
Sex: ALL
Minimum age (years): 12
Maximum age (years): 29
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This study is being conducted to test the safety and efficacy of ramucirumab in combination with other chemotherapy in the treatment of relapsed, recurrent, or refractory desmoplastic small round cell tumor (DSRCT) in children and young adults. This trial is part of the CAMPFIRE master protocol (NCT05999994) which is a platform to accelerate the development of new treatments for pediatric and young adult participants with cancer. Your participation in this trial could last 12 months or longer, depending on how you and your tumor respond.


Eligibility criteria: Inclusion Criteria:

* Participants must have discontinued all previous treatments for cancer or investigational agents ≥7 days after the last dose or per the type of previous treatment as stated in the protocol and must have recovered from the acute effects to ≤Grade 2 for alopecia and decreased tendon reflex and to ≤Grade 1 for all other effects at the time of enrollment, unless otherwise noted. Consult with the Lilly clinical research physician or scientist for the appropriate length of time prior to the first dose of study treatment.
* Participants with relapsed, recurrent, or refractory DSRCT.
* Participants must:

  * Have measurable disease by Response Evaluation Criteria in Solid Tumors, Version (RECIST) 1.1.
  * Have received at least one prior line of systemic treatment (including neoadjuvant and adjuvant chemotherapy). This prior treatment must include approved therapies for which they are eligible, unless the participant is not a suitable candidate for the approved therapy.
  * Not be eligible for surgical resection at time of enrollment.
* Adequate cardiac function, defined as: Shortening fraction of ≥27% by echocardiogram, or ejection fraction of ≥50% by gated radionuclide study.
* Adequate blood pressure (BP) control, defined as:

  * Participants ≥18 years: Controlled hypertension defined as systolic BP ≤150 millimeters of mercury (mmHg) or diastolic BP ≤90 mmHg where standard medical management is permitted. Please note that ≥2 serial BP readings should be obtained and averaged to determine baseline BP.
  * Participants \<18 years: A BP ≤95th percentile for age, height, and gender measured as described in National High Blood Pressure Education Program Working Group (NHBPEPWG) on High Blood Pressure in Children and Adolescents (2004), where standard medical management is permitted. Please note that ≥2 serial BP readings should be obtained and averaged to determine baseline BP.
* Adequate hematologic function, as defined as:

  * Absolute neutrophil count (ANC): ≥750/microliters (µL) granulocyte-colony stimulating factor (G-CSF) permitted up to 48 hours prior. Participants with documented history of benign ethnic neutropenia or other conditions could be considered with a lower ANC after discussion with and approval from the Lilly clinical research physician or scientist.
  * Platelets: ≥75,000/cubic millimeters. Platelet transfusion permitted up to 72 hours prior.
  * Hemoglobin: ≥8 grams per deciliter (g/dL) (≥80 g/liter). Transfusions to increase the participant's hemoglobin level to at least 8 g/dL are permitted; however, study treatment must not begin until 7 days after the transfusion, and complete blood count criteria for eligibility are confirmed within 24 hr of first study dose.
* Adequate renal function, as defined as:

  * Creatinine clearance or radioscope glomerular filtration rate (GFR) ≥60 milliliters/minute/meters squared OR serum creatinine meeting the following parameters:

    * for participants ≥18 years of age serum creatinine ≤1.5×upper limit of normal (ULN);
    * for participants \<18 years of age, serum creatinine based on age/gender as follows: Age 1 to \<2 years maximum serum creatinine 0.6, Age 2 to \<6 years maximum serum creatinine 0.8, Age 6 to \<10 years maximum serum creatinine 1.0, Age 10 to \<13 years maximum serum creatinine 1.2, Age 13 to \<16 years maximum serum creatinine 1.5 for males and 1.4 for females, Age 16 to \<18 years maximum serum creatinine 1.7 for males and 1.4 for females.
  * Urine protein meeting the following parameters:

    * for participants ≥18 years of age: \<2+ on dipstick or routine urinalysis. If urine dipstick or routine analysis indicates proteinuria ≥2+, then a 24-hour urine must be collected and must demonstrate \<2 grams of protein in 24 hours to allow participation in the study.
    * for participants \<18 years of age: ≤30 milligrams per deciliter urine analysis or \<2+ on dipstick. If urine dipstick or routine analysis indicates proteinuria ≥2+, then a 24-hour urine must be collected and must demonstrate \<1 g of protein in 24 hours to allow participation in the study.
* Adequate liver function:

  * Total bilirubin: ≤1.5×ULN. Except participants with document history of Gilbert Syndrome who must have a total bilirubin level of \<3.0×ULN.
  * Alanine aminotransferase (ALT) and aspartate aminotransferase (AST): ≤2.5×ULN OR ≤5.0×ULN if the liver has tumor involvement.
* The participant has an adequate coagulation function as defined by International Normalized Ratio ≤1.5 or prothrombin time ≤1.5×ULN, and partial thromboplastin time ≤1.5×ULN if not receiving anticoagulation therapy. For participants receiving anticoagulants, exceptions to these coagulation parameters are allowed if they are within the intended or expected range for their therapeutic use. Participants must have no history of clinically significant active bleeding (defined as within 14 days of first dose of study drug) or pathological condition that carries a high risk of bleeding (for example, tumor involving major vessels or known esophageal varices).
* The participant has adequate hematologic and organ function ≤1 week (7 days) prior to first dose of study drug.
* Female participants of childbearing potential must have a negative urine or serum pregnancy test within 7 days prior to randomization. Male and female participants must agree to use highly effective contraception for the duration of the study and up to 3 months following the last dose of ramucirumab and vinorelbine, and 12 months following the last dose of cyclophosphamide in order to prevent pregnancy.

Exclusion Criteria:

* Participants with severe and/or uncontrolled concurrent medical disease or psychiatric illness/social situation that in the opinion of the investigator could cause unacceptable safety risks or compromise compliance with the protocol.
* Participants who have active infections requiring therapy.

  * Participants with an active fungal, bacterial, and/or known severe viral infection including, but not limited to, human immunodeficiency virus (HIV) or viral (A, B, or C) hepatitis (screening is not required).
* Participants who have had allogeneic bone marrow or solid organ transplant are excluded.
* Surgery: Participants who have had, or are planning to have, the following invasive procedures are not eligible:

  * Major surgical procedure, laparoscopic procedure, or significant traumatic injury within 28 days prior to enrollment.
  * Central line placement or subcutaneous port placement is not considered major surgery.
  * Core biopsy, fine needle aspirate, and bone marrow biopsy/aspirate are not considered major surgeries.
  * Surgical or other wounds must be adequately healed prior to enrollment.
* Bleeding and thrombosis:

  * Participants with evidence of active bleeding or a history of significant (≥Grade 3) bleeding event within 3 months prior to enrollment are not eligible.
  * Participants with a bleeding diathesis or vasculitis are not eligible.
  * Participants with known or prior history in the prior 3 months of esophageal varices are not eligible.
  * Participants with a history of deep vein thrombosis requiring medical intervention (including pulmonary embolism) within 3 months prior to study enrollment are not eligible.
  * Participants with a history of hemoptysis or other signs of pulmonary hemorrhage within 3 months prior to study enrollment are not eligible.
* Cardiac:

  * Participants with a history of central nervous system (CNS) arterial/venous thromboembolic events (VTEs) including transient ischemic attack (TIA) or cerebrovascular accident (CVA) within 6 months prior to study enrollment are not eligible.
  * Participants with myocardial infarction or unstable angina within the prior 6 months.
  * Participants with New York Heart Association Grade 2 or greater congestive heart failure (CHF).
  * Participants with serious and inadequately controlled cardiac arrhythmia.
  * Participants with significant vascular disease (eg, aortic aneurysm, history of aortic dissection).
  * Participants with clinically significant peripheral vascular disease.
* Participants who have a history of fistula, gastrointestinal (GI) ulcer or perforation, or intra-abdominal abscess within 3 months of study enrollment are not eligible.
* Participants with a history of hypertensive crisis or hypertensive encephalopathy within 6 months of study enrollment are not eligible.
* Participants who have non-healing wound, unhealed or incompletely healed fracture, or a compound (open) bone fracture at the time of enrollment are not eligible.
* Participants previously treated and progressed on combination cyclophosphamide and vinorelbine regimen. Participants who received combination as maintenance therapy, without progression, would be eligible.
* Participants with a known hypersensitivity to ramucirumab, cyclophosphamide, vinorelbine or any of the excipients of the medicinal products.
* Hepatic impairment:

  * Severe liver cirrhosis Child-Pugh Class B (or worse).
  * Cirrhosis with a history of hepatic encephalopathy.
  * Clinically meaningful ascites resulting from cirrhosis and requiring ongoing treatment with diuretics and/or paracentesis.
  * History of hepatorenal syndrome.
* The participant has a bowel obstruction, history or presence of inflammatory enteropathy or extensive intestinal resection (eg, hemicolectomy or extensive small intestine resection with chronic diarrhea), Crohn's disease, ulcerative colitis, or chronic diarrhea.
* The participant has a urinary outflow obstruction.
* The participant has Grade 2 hematuria or non-infectious cystitis at the time of screening.
* Participants with central nervous system (CNS) involvement are ineligible.

Primary outcomes:
measure: Progression Free Survival (PFS)
timeFrame: Baseline to Objective Progression or Death Due to Any Cause (Estimated up to 12 Months)
Secondary outcomes:
measure: Overall Response Rate (ORR): Percentage of Participants Who Achieve Complete Response (CR) or Partial Response (PR)
timeFrame: Baseline through Measured Progressive Disease (Estimated up to 12 Months)
measure: Duration of Response (DoR)
timeFrame: Date of CR or PR to Date of Objective Disease Progression or Death Due to Any Cause (Estimated up to 12 Months)
measure: Complete Response (CR): Percentage of Participants Who Achieve CR
timeFrame: Baseline to date of CR (Estimated up to 12 Months)
measure: Pharmacokinetics (PK): Maximum Concentration (Cmax)
timeFrame: Cycle 1 through Cycle 10 (28 Day Cycles)
measure: PK: Minimum Concentration (Cmin)
timeFrame: Cycle 1 through Cycle 10 (28 Day Cycles)
measure: Number of Participants with Anti-Ramucirumab Antibodies
timeFrame: Baseline through End of Study (Estimated up to 12 Months)
Other outcomes:
Locations:
city: Phoenix
country: United States
facility: Phoenix Children's Hospital
state: Arizona
city: Los Angeles
country: United States
facility: Childrens Hospital of Los Angeles
state: California
city: Washington
country: United States
facility: Children's National Medical Center
state: District of Columbia
city: Saint Louis
country: United States
facility: Washington University
state: Missouri
city: New York
country: United States
facility: Memorial Sloan Kettering Cancer Center
state: New York
city: Philadelphia
country: United States
facility: Children's Hospital of Philadelphia (CHOP)
state: Pennsylvania
city: Parkville
country: Australia
facility: Royal Children's Hospital
state: Victoria
city: Freiburg
country: Germany
facility: Universitaetsklinikum Freiburg
state: Baden-Württemberg
city: Essen
country: Germany
facility: Universitaetsklinikum Essen
state: Nordrhein-Westfalen
city: Hamburg
country: Germany
facility: Universitaetsklinikum Hamburg-Eppendorf
city: Milan
country: Italy
facility: Fondazione IRCCS Istituto Nazionale dei Tumori
state: Lombardia
city: Rozzano
country: Italy
facility: Humanitas
state: Milano
city: Rome
country: Italy
facility: Ospedale Pediatrico Bambino Gesù
state: Roma
city: Padova
country: Italy
facility: Azienda Ospedaliera di Padova
state: Veneto
city: Chuo-ku
country: Japan
facility: National Cancer Center Hospital
state: Tokyo
city: Fukuoka
country: Japan
facility: Kyushu University Hospital
city: Barcelona
country: Spain
facility: Hospital Universitari Vall d'Hebron
state: Barcelona [Barcelona]
city: Sevilla
country: Spain
facility: Hospital Universitario Virgen Del Rocio
city: London
country: United Kingdom
facility: University College London Hospital
state: London, City Of
city: London
country: United Kingdom
facility: Royal Marsden Hospital (Sutton)
state: Sutton
city: Manchester
country: United Kingdom
facility: Royal Manchester Children's Hospital
city: Manchester
country: United Kingdom
facility: The Christie
Study officials:
affiliation: Eli Lilly and Company
name: Call 1-877-CTLILLY (1-877-285-4559) or 1-317-615-4559 Mon - Fri 9 AM - 5 PM Eastern time (UTC/GMT - 5 hours, EST)
role: STUDY_DIRECTOR
References: