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PARC is an international phase I/II trial evaluating the safety and activity of pegylated recombinant human arginase (BCT-100) in children and young people with relapsed/refractory leukaemia, neuroblastoma, sarcoma and high grade gliomas (brain cancers).
Currently the outcomes for these patients are poor and the therapeutic options are limited with a significant toxicity burden. Therefore new treatments which work in different ways to standard chemotherapy are urgently needed. Research has shown that arginine (a nutrient) is important in the survival of cancer cells. BCT-100 is a drug which can deplete arginine levels and starve cancer cells - a completely new approach. BCT-100 has been tested in adults and shown to be active with almost no side-effects. This trial will test whether this dose of BCT-100 is also safe and active in children with relapsed/refractory leukaemia, neuroblastoma, sarcoma and high grade glioma. The trial will also study how BCT-100 is broken down in the body and look for new biological markers of treatment response. Up to 64 children with relapsed cancers will be recruited over 2 years.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group 1 - Leukaemia | Experimental | PEG- BCT-100 in patients with Leukaemia Starting dose 1600U/Kg IV infusion weekly |
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| Group 2 - Neuroblastoma | Experimental | PEG- BCT-100 in patients with Neuroblastoma Starting dose 1600U/Kg IV infusion weekly |
|
| Group 3 - Sarcomas | Experimental | PEG- BCT-100 in patients with Sarcomas Starting dose 1600U/Kg IV infusion weekly |
|
| Group 4 - High Grade Glioma | Experimental | PEG- BCT-100 in patients with High Grade Gliomas Starting dose 1600U/Kg IV infusion weekly |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PEG- BCT-100 | Drug | PEGylated recombinant human arginase 1 |
|
| Measure | Description | Time Frame |
|---|---|---|
| Phase I: to establish the recommended phase II dose (RP2D) of BCT-100 in children and young adults as assessed by dose limiting toxicity (DLT) and complete arginine depletion | Safety profile as measured by the occurrence/non-occurrence of DLT within 28 days of treatment with BCT-100. o Optimal dose as measured by the complete depletion of arginine. This is defined as AAD <8μM arginine in the blood after 3 doses of BCT-100. | 28 days |
| Phase II: to determine the activity of single agent BCT-100 against relapsed/refractory leukaemia, neuroblastoma, sarcoma and high grade glioma in children and young adults as measured by disease response after 8 weeks. | Disease response (Complete Response (CR) or Partial Response (PR)) after 8 weeks of treatment with BCT-100 | After 8 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| The incidence and severity of Adverse Events (AEs) as Assessed by CTCAE v4 | Incidence and severity of Adverse Events (AEs) defined by National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) v4 | 28 days after treatment completion |
| Disease response - Leukaemia |
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Inclusion Criteria:
Aged 1- <25 years old at the time of study registration
Histologically confirmed disease in one of the following four groups:
Radiological or laboratory evidence of disease progression (during or after completion of first line treatment) or any subsequent recurrence (biopsy at relapse is not mandated).
Measurable bone marrow disease (group 1) or at least one evaluable radiological site of disease (group 2, 3 and 4).
Adequate liver function defined as a total bilirubin ≤1.5x the upper limit of normal for age and ALT ≤ 3x the upper limit of normal for age
Documented negative pregnancy test for female patients of childbearing potential within 7 days of trial entry
Sexually active patients must agree to use adequate and appropriate contraception while on study drug and for 12 months following treatment discontinuation
Written informed consent given by patient and/or parents/legal representative
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Francis J Mussai, DPhil | University of Birmingham | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Women's & Children's Hospital | Adelaide | Australia | ||||
| Queensland Children's Hospital |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38357205 | Derived | Fenwick N, Weston R, Wheatley K, Hodgson J, Marshall L, Elliott M, Makin G, Ng A, Brennan B, Lowis S, Adamski J, Kilday JP, Cox R, Gattens M, Moore A, Trahair T, Ronghe M, Campbell M, Campbell H, Williams MW, Kirby M, Van Eijkelenburg N, Keely J, Scarpa U, Stavrou V, Fultang L, Booth S, Cheng P, De Santo C, Mussai F. PARC: a phase I/II study evaluating the safety and activity of pegylated recombinant human arginase BCT-100 in relapsed/refractory cancers of children and young adults. Front Oncol. 2024 Jan 31;14:1296576. doi: 10.3389/fonc.2024.1296576. eCollection 2024. |
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|
Disease response ( CR / PR) according to Cheson criteria |
| Within 1 year |
| Disease response - Sarcoma | Disease response ( CR / PR) according to RECIST criteria | Within 1 year |
| Disease response - High Grade Glioma | Disease response ( CR / PR) according to RANO criteria | Within 1 year |
| Disease response - Neuroblastoma | Disease response ( CR / PR) according to INCR criteria | Within 1 year |
| Progression free survival (PFS) | Up to three years after registration |
| Overall survival (OS). | Up to three years after registration |
| Maximum Plasma Concentration [Cmax], of BCT-100 in the paediatric population. | Up to 24 weeks |
| Time to maximum Plasma Concentration [Tmax], of BCT-100 in the paediatric population. | Up to 24 weeks |
| Minimum Plasma Concentration [Cmin], of BCT-100 in the paediatric population. | Up to 24 weeks |
| Area Under the Curve [AUC], of BCT-100 in the paediatric population. | Up to 24 weeks |
| Duration of adequate arginine depletion in blood. | BCT-100 concentration in blood | Up to 24 weeks |
| Duration of adequate arginine depletion in bone marrow . | BCT-100 concentration in bone marrow | Up to 24 weeks |
| Duration of adequate arginine depletion in cerebrospinal fluid. | BCT-100 concentration in cerebrospinal fluid | Up to 24 weeks |
| Brisbane |
| Australia |
| Royal Children's Hospital Melbourne | Melbourne | Australia |
| Perth Children's Hospital | Perth | Australia |
| Children's Hospital Westmead | Sydney | Australia |
| Sydney Children's Hospital | Sydney | Australia |
| Princes Maxima Centrum | Utrecht | Netherlands |
| Birmingham Children's Hospital | Birmingham | United Kingdom |
| Bristol Royal Hospital for Children | Bristol | United Kingdom |
| Addenbrookes Hospital | Cambridge | United Kingdom |
| Royal Hospital for Children | Glasgow | United Kingdom |
| Leeds Children's Hospital | Leeds | United Kingdom |
| Royal Manchester Children's Hospital | Manchester | United Kingdom |
| Royal Marsden Hospital | Sutton | United Kingdom |
| ID | Term |
|---|---|
| D009369 | Neoplasms |
| D054198 | Precursor Cell Lymphoblastic Leukemia-Lymphoma |
| ID | Term |
|---|---|
| D007945 | Leukemia, Lymphoid |
| D007938 | Leukemia |
| D009370 | Neoplasms by Histologic Type |
| D006402 | Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D008232 | Lymphoproliferative Disorders |
| D008206 | Lymphatic Diseases |
| D007160 | Immunoproliferative Disorders |
| D007154 | Immune System Diseases |
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| ID | Term |
|---|---|
| C000628755 | BCT-100 |
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