Biological Medicine for Diffuse Intrinsic Pontine Glioma (DIPG) Eradication

Status: Recruiting
Location: See all (42) locations...
Intervention Type: Drug, Radiation
Study Type: Interventional
Study Phase: Phase 3
SUMMARY

The BIOMEDE 2.0 study is the second stage of the BIOMEDE multi-arm, multistage rolling programme (adaptive platform protocol). It is a multicenter, randomized, open-label, controlled phase-3 trial evaluating efficacy of ONC201 in comparison with everolimus (primary objective based on internal comparison) and subsequently to historical controls. Two treatment groups will be compared. Study treatment will be continued until centrally confirmed disease progression (either radiologically or histologically), unacceptable toxicity or consent withdrawal. A switch between treatment groups is allowed after confirmation of the disease progression (real-time central review blinded to the treatment arm allocation). The final conclusion of the trial will be successful for ONC201, if ONC201 is found significantly superior to everolimus in terms of centrally-reviewed PFS (Progression-free survival) from randomization (internal comparison) either overall, considering ND-DMG and DIPG-patients together, or in the subgroup of ND-DMG patients alone. In other cases, Everolimus will remain the standard arm unless it appears associated with an excess of toxicity compared to ONC201 which could then be discussed as a new standard.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 6 months
Healthy Volunteers: f
View:

• Diagnosis Criteria:

‣ Diagnosis of DIPG (clinical and radiological). As biopsy is not standard for these tumors, an informed consent is required for the necessary histological verification. \[Biopsy-part of BIOMEDE 2.0 trial\]. OR

⁃ Histological diagnosis of DIPG (i.e. H3K28M or EZHIP positive Diffuse Midline Glioma located in the pons) in case the biopsy was performed before study entry. The diagnosis will be defined by 1/ diffuse glioma, 2/ H3K28M mutation or loss of H3K28 trimethylation together with EZHIP overexpression. In this situation, patient will sign the consent after the diagnosis to allow central review and biomarkers assessment thereafter. OR

⁃ Non-DIPG diffuse midline gliomas (ND-DMG), H3K28M mutant or with H3K28 trimethylation loss together with EZHIP overexpression, will be eligible for the trial after biopsy or surgery. As biopsy and surgery is considered as standard practice for these locations, informed consent for the biopsy will not be necessary. Patient will sign the consent after the diagnosis to allow central review and biomarkers assessment thereafter. OR

⁃ Non-DIPG diffuse midline gliomas (ND-DMG) will be eligible for the trial before the biopsy in case the diagnosis is clinically or radiologically suspected. Informed consent for the biopsy and molecular analysis will be necessary. Then, if the central pathology review concludes to a ND-DMG with H3K28M mutant or H3K28 trimethylation loss together with EZHIP overexpression, these patients will be eligible for the treatment part of the trial.

• Eligible for a biopsy, or biopsy material available for the biomarker assessment.

• Age \> 6 months, with no upper age limit. Children between 6 months and 3 years will be discussed on a case by case basis for inclusion in the study for the feasibility of the stereotactic biopsy.

• Eligible for cerebral or craniospinal radiotherapy.

• Tumor at diagnosis: no prior chemotherapy for the present cancer; no prior cerebral radiation therapy even for another neoplasm. Surgery is allowed when performed for diagnostic or therapeutic purpose.

• Metastatic diseases or spinal tumors allowed; in this case, patients would receive craniospinal or spinal radiotherapy and medical treatment (everolimus or ONC201) will be postponed and only started after the end of radiotherapy.

• Patients must be affiliated to a social security system or beneficiary of the same according to local requirements.

• Written informed consent from parents/legal representative, patient, and age-appropriate assent before any study-specific procedures are conducted according to local, regional or national guidelines.

• Uncontrolled spontaneous massive intratumor bleeding. Patients with post-operative bleeding will be allowed to enter the study provided the hemorrhage is controled. Same rule applies for the other post-operative complications (infection, CSF leakage, absence of wound closure, subdural collection…).

• Any other concomitant anti-cancer treatment not foreseen by this protocol is not allowed, except corticosteroids and Bevacizumab which are allowed during the protocol. Bevacizumab is not allowed before and until 15 days after the surgery. The use of bevacizumab and corticosteroids will be taken into account when judging the possibility of progression/pseudoprogression.

• Any other cancer diagnosed during the last 5 years.

• Uncontrolled intercurrent illness or active infection.

• Any other co-morbid condition that in the investigator's opinion would impair study participation.

• Unable for medical follow-up (geographic, social or mental reasons).

• Patient previously treated with irradiation on the brainstem for another neoplasm.

• Participation in another clinical study with an investigational product while on study treatment.

• Patient under guardianship or deprived of his/her liberty by a judicial or administrative decision or incapable of giving his/her consent.

∙ Eligibility criteria for the randomization in BIOMEDE 2.0 study:

• Patient enrolled in the BIOMEDE 2.0 study.

• Life expectancy \> 12 weeks after the start of study treatment.

• Histological diagnosis of DIPG (as per the WHO criteria) confirmed by central pathology review, OR Typical radiology of a DIPG (mandatory central radiological review) as well as the short clinical history (less than three months of pre-existing symptoms) in case of suspected DIPG but no histological confirmation (biopsy not informative), OR Histological diagnosis of ND-DMG confirmed by central pathology review, with mutation in the histone H3.1, H3.2, H3.3 genes, or loss of H3K28me3 and EZHIP overexpression by immunohistochemistry.

• Karnofsky performance status scale or Lansky Play Scale \> 50%. The PS should not take the neurologic deficit per se into account. NB: Children and adults with a worse performance status due to glioma-related motor paresis can be included.

• Effective and appropriate contraception for patients (male and female) of reproductive potential during their entire participation in the study and during 6 months after the end of treatment.

• Negative pregnancy test (serum beta-HCG or urinary test) evaluated within one week prior randomization in sexually active females of reproductive potential.

• Absolute neutrophil count \> 1.5 x 10\^9/l, Platelets \> 100 x 10\^9/l.

• Total bilirubin \< 1.5 x ULN, AST and ALT\< 2.5 x ULN.

• Serum creatinine \< 1.5 X ULN for age. If serum creatinine \> 1.5 x ULN, creatinine clearance must be \> 70 ml/min/1.73 m² (as per local practice).

• Normal coagulation tests within the local reference ranges.

• Written informed consent from parents/legal representative, patient, and age-appropriate assent before randomization according to local, regional or national guidelines.

∙ Non Eligibility criteria for the randomization in BIOMEDE 2.0 study:

• Current organ toxicity \> grade 2 according to the NCI-CTCAE version 5.0 especially cardiovascular or renal disease (including but not limited to: congenital long QT syndrome, nephrotic syndrome, glomerulopathy, uncontrolled high blood pressure despite adequate treatment).

• ONC201 administration should be avoided for patients with:

‣ Prolongation of QT/QTcF interval (QTc interval \> 480 milliseconds) preferably using Frederica's QT correction formula on two ECGs separated by at least 48 hours.

⁃ A history of Torsades de pointes or heart failure, hypokalemia, or family history of prolonged QT Syndrome.

⁃ Required concomitant use of medication(s) known to prolong the QT/QTc interval.

∙ In this case, patients will be treated in the Everolimus arm without randomization (except if contra-indication to Everolimus).

• Pregnant or breastfeeding women.

• Patients with chronic HBV disease compatible with the trial are not excluded from the study. These patients randomized to everolimus treatment will have regular viral load monitoring throughout the study.

• Patients taking strong P450 inhibitors or inducers or PgP inhibitors are not excluded from the study but drug concentration of everolimus should be monitored carefully to avoid toxicity. Preferably alternative medications should be considered.

• Patient with known congenital galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption will not be randomized and will be treated in the ONC201 arm (except if contra-indication to ONC201).

• Patients with known hypersensitivity to any component of Everolimus (active substance, other rapamycin derivatives or excipients) will not be randomized and will be treated in the ONC201 arm (except if contra-indication to ONC201).

• Patients with known hypersensitivity to any component of ONC201 (drug product or excipients) will not be randomized and will be treated in the Everolimus arm (except if contra-indication to Everolimus).

Locations
Other Locations
Denmark
Aarhus Universitetshospital Skejby
RECRUITING
Aarhus
Rigshospitalet
RECRUITING
Copenhagen
H.C. Andersen Children's Hospital, Odense Universitetshospital
RECRUITING
Odense
France
CHU d'Amiens-Picardie Site Sud
RECRUITING
Amiens
CHU d'Angers - Bâtiment Robert Debré
RECRUITING
Angers
Institut de Cancérologie de l'Ouest (ICO) - Site Paul Papin
RECRUITING
Angers
CHU Besançon - Hôpital Jean Minjoz
RECRUITING
Besançon
CHU de Bordeaux - Groupe hospitalier Pellegrin - Hôpital des enfants
RECRUITING
Bordeaux
CHU de Bordeaux - Groupe hospitalier Saint André - Hôpital Saint André
RECRUITING
Bordeaux
CHRU de Brest - Hôpital Morvan
RECRUITING
Brest
CHU de Caen - Hôpital Côte de Nacre
RECRUITING
Caen
Centre Jean Perrin
RECRUITING
Clermont-ferrand
CHU Estaing
RECRUITING
Clermont-ferrand
CHU François Mitterrand
RECRUITING
Dijon
CHU Grenoble Alpes - Hôpital Couple-Enfant
RECRUITING
Grenoble
Centre Oscar Lambret
RECRUITING
Lille
Hôpital de la mère et de l'enfant
RECRUITING
Limoges
Centre Léon Bérard
RECRUITING
Lyon
Hôpital de La Timone
RECRUITING
Marseille
Hôpital Arnaud de Villeneuve
RECRUITING
Montpellier
CHRU Nancy - Hôpital central
RECRUITING
Nancy
CHRU Nancy Brabois - Hôpital d'enfants
RECRUITING
Nancy
CHU de Nice - Hôpital L'Archet 2
RECRUITING
Nice
Hôpital Saint Louis
RECRUITING
Paris
Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix
RECRUITING
Paris
Institut Curie
RECRUITING
Paris
CHU Poitiers
RECRUITING
Poitiers
CHU de Reims - American Memorial Hospital 2
RECRUITING
Reims
Centre Eugène Marquis
RECRUITING
Rennes
CHU Rennes - Hôpital Sud
RECRUITING
Rennes
CHU Rouen Normandie - Hôpital Charles-Nicolle
RECRUITING
Rouen
CHU de Saint-Etienne - Hôpital Nord
RECRUITING
Saint-etienne
Hôpital de Hautepierre
RECRUITING
Strasbourg
Institut de cancérologie Strasbourg Europe (ICANS) - Centre Paul Strauss
RECRUITING
Strasbourg
Hôpital des enfants
RECRUITING
Toulouse
CHRU Tours - Hôpital Bretonneau
RECRUITING
Tours
CHRU Tours - Hôpital Clocheville
RECRUITING
Tours
Gustave Roussy
RECRUITING
Villejuif
Spain
Hospital Vall D´Hebron
RECRUITING
Barcelona
Hospital Universitario Niño Jesus
RECRUITING
Madrid
Hospital Universitario y Politécnico de La Fe
RECRUITING
Valencia
Sweden
Karolinska University Hospital
RECRUITING
Stockholm
Contact Information
Primary
Jacques GRILL, MD, PhD
jacques.grill@gustaveroussy.fr
+33 (0)1 42 11 62 09
Backup
Anne-Sophie BLANC, PharmD
annesophie.blanc@gustaveroussy.fr
+33 (0)1 42 11 57 02
Time Frame
Start Date: 2022-09-29
Estimated Completion Date: 2031-09
Participants
Target number of participants: 409
Treatments
Active_comparator: everolimus
Tablets of 2.5 mg or 10 mg. The prescribed dose is 5 mg/m²/day, orally, once daily. Dose will be capped at 10 mg once daily.~Study treatment will be continued until centrally confirmed disease progression (either radiologically or histologically), unacceptable toxicity, or consent withdrawal.~At the time of centrally confirmed progression, patients will stop treatment and will be allowed to switch to the other arm in case no better option is available after considering the results of the molecular profiling. In case of switch (everolimus to ONC201 or vice-versa), the patient will observe a wash-out period before starting:~* the second treatment,~* or a reirradiation (if applicable). No treatment is allowed during reirradiation. Then, if an additional treatment is needed, the second treatment will be started within one week after the end of the reirradiation.
Experimental: ONC201
Capsules of 125 mg. The prescribed dose is 375 mg/m², once daily at Day 1 and Day 2 of each week. Dose will be capped at 625 mg per dose.~Study treatment will be continued until centrally confirmed disease progression (either radiologically or histologically), unacceptable toxicity, or consent withdrawal.~At the time of centrally confirmed progression, patients will stop treatment and will be allowed to switch to the other arm in case no better option is available after considering the results of the molecular profiling. In case of switch (everolimus to ONC201 or vice-versa), the patient will observe a wash-out period before starting:~* the second treatment,~* or a reirradiation (if applicable). No treatment is allowed during reirradiation. Then, if an additional treatment is needed, the second treatment will be started within one week after the end of the reirradiation.
Sponsors
Collaborators: Innovative Therapies For Children with Cancer Consortium, Ministry of Health, France, Jazz Pharmaceuticals
Leads: Gustave Roussy, Cancer Campus, Grand Paris

This content was sourced from clinicaltrials.gov