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The purpose of this study is to evaluate the investigational drug, silmitasertib (a pill taken by mouth), in combination with FDA approved drugs for solid tumors. An investigational drug is one that has not been approved by the U.S. Food & Drug Administration (FDA), or any other regulatory authorities around the world for use alone or in combination with any drug, for the condition or illness it is being used to treat.
The goals of this part of the study are:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Phase I- Dose level 1 | Experimental | Silmitasertib 600 mg/m2 twice a day plus Neuroblastoma: Regimen A: Irinotecan and Temozolomide Sarcoma: Regimen B: Vincristine, Irinotecan and Temozolomide |
|
| Phase I- Dose level 2 | Experimental | Silmitasertib 800 mg/m2 twice a day plus Neuroblastoma: Regimen A: Irinotecan and Temozolomide Sarcoma: Regimen B: Vincristine, Irinotecan and Temozolomide |
|
| Phase II- Relapsed/refractory Neuroblastoma | Experimental | Silmitasertib RP2D twice a day plus Irinotecan and Temozolomide |
|
| Phase II- Relapsed/refractory Ewing sarcoma | Experimental | Silmitasertib RP2D twice a day plus Vincristine, irinotecan and temozolomide |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Silmitasertib | Drug | Capsules |
|
| Measure | Description | Time Frame |
|---|---|---|
| Phase I- Number of Participants with Adverse Events as a Measure of Safety and Tolerability | To characterize the safety profile of silmitasertib in combination with chemotherapy | 2 years plus 30 days |
| Phase I- Number of Participants with Dose Limiting Toxicities to determine RP2D | To determine the Recommended Phase 2 Dose (RP2D) of silmitasertib in combination with chemotherapy | 21 days |
| Phase II- Determine the Overall Response Rate (ORR) of Participants using INRC | To evaluate the efficacy of silmitasertib in combination with chemotherapy in 2 disease cohorts, based upon Overall response rate (ORR) | 2 years |
| Measure | Description | Time Frame |
|---|---|---|
| Phase I- Determine the Overall Response Rate (ORR) of Participants using INRC | To evaluate the efficacy of silmitasertib in combination with chemotherapy in 2 disease cohorts based upon Overall response rate (ORR) | 2 years |
| Number of participants with progression free survival (PFS) during study |
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Inclusion Criteria:
Age: Less than 30 years old at initial diagnosis
Pathology All subjects must have a confirmed diagnosis of tumor type. Phase I: Relapsed/refractory solid tumors: Neuroblastoma, Ewing Sarcoma, Osteosarcoma, Rhabdomyosarcoma, Liposarcoma
Phase II:
Tumor assessment:
Disease assessment is required for eligibility and must be done after last dose of previous therapy and prior to first dose of study drug.
Disease Status:
Relapsed/Refractory Neuroblastoma Relapsed disease defined as neuroblastoma that was previously in remission after standard therapy (at least 4 cycles of aggressive multi-drug induction chemotherapy, with or without radiation and surgery, followed by immunotherapy, or according to a standard high-risk treatment/neuroblastoma protocol) and has now relapsed and is in any number of relapses.
Refractory disease defined as High-risk neuroblastoma (as defined by INRG) that failed to achieve CR after at least 4 cycles of aggressive multi-drug induction chemotherapy, progression during upfront therapy or with disease remaining after standard immunotherapy.
International Neuroblastoma Risk Group Staging System (INRG) High Risk NB defined as one of the following:
Relapsed/refractory Sarcoma Subjects that have relapsed following standard of care therapy or having progressed during standard of care therapy. Standard of care therapy for sarcoma includes multi-agent chemotherapy with local control consisting of either surgery or radiation therapy.
Measurable or evaluable disease, including at least one of the following:
Timing from prior therapy:
Subjects must have fully recovered from the acute toxic effects of all prior anti- cancer therapy and be within the following timelines:
Myelosuppressive chemotherapy: Must not have received within 2 weeks of enrollment onto this study.
Small Molecule Inhibitors (anti-neoplastic agent): At least 2 weeks from the completion of therapy with a small molecule inhibitor.
Immunotherapy: At least 4 weeks since the completion of any type of immunotherapy, e.g. tumor vaccines, CAR-T cells, anti-GD2 Monoclonal antibodies (ex. naxitamab, dinutuximab, etc.).
Radiotherapy: At least 30 days since the last treatment except for radiation delivered with palliative intent to a non-target site.
Stem Cell Transplant:
MIBG Therapy: At least 6 weeks since treatment with MIBG therapy.
Subjects must have a Lansky or Karnofsky Performance Scale score of >/= 50.
Subjects must have adequate organ function at the time of enrollment:
Subjects of childbearing potential must have a negative serum pregnancy test. Subjects of childbearing potential must agree to use effective measures to avoid pregnancy.
Written informed consent in accordance with institutional and FDA guidelines must be obtained from all subjects (or subjects' legal representative).
Exclusion Criteria:
Investigational Drugs: Subjects who are currently receiving another investigational drug are excluded from participation.
Anti-cancer Agents: Subjects who are currently receiving other anticancer agents are not eligible. Subjects must have fully recovered from the hematological and bone marrow suppression effects of prior therapy.
Subjects who are currently receiving Vitamin K antagonists (warfarin).
Subjects who are currently receiving the class of lipid-lowering medications HMG-CoA reductase inhibitors (statins).
Infection: Subjects who have an uncontrolled infection are not eligible until the infection is judged to be well controlled in the opinion of the investigator.
Subjects who, in the opinion of the investigator, may not be able to comply with the safety monitoring requirements of the study, or in whom compliance is likely to be suboptimal, should be excluded.
Subjects with any clinically significant unrelated systemic illness (serious infections or significant cardiac, pulmonary, hepatic or other organ dysfunction), that in the opinion of the investigator would compromise the subject's ability to tolerate protocol therapy, put them at additional risk for toxicity or would interfere with the study procedures or results.
Subjects with any of the following gastrointestinal disorders:
Lactating subjects are not eligible unless they have agreed to not breastfeed their infants. There is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the nursing subject with silmitasertib. (NOTE: breast milk cannot be stored for future use while the nursing subject is being treated on study.)
Subjects with a history of any other malignancy.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| BCC Enroll | Contact | 7175310003 | BCCEnroll@pennstatehealth.psu.edu |
| Name | Affiliation | Role |
|---|---|---|
| Chandrika Behura, MD | Penn State Health Children's Hospital | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Alabama/Children's of Alabama | Recruiting | Birmingham | Alabama | 35233 | United States |
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| Label | URL |
|---|---|
| Beat Childhood Cancer Research Consortium website | View source |
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|
| Irinotecan | Drug | IV |
|
| Temozolomide | Drug | Oral or IV |
|
| Vincristine | Drug | IV |
|
To evaluate the efficacy of silmitasertib in combination with chemotherapy in 2 disease cohorts based upon Progression Free Survival (PFS) |
| 2 years |
| Phase II- Length of time that participants experience Overall Survival (OS) | To evaluate the efficacy of silmitasertib in combination with chemotherapy in 2 disease cohorts based upon Overall Survival (OS) | 7 years |
| Phase II- Number of Participants with Adverse Events as a Measure of Safety and Tolerability | To characterize the safety profile of silmitasertib in combination with chemotherapy | 2 years plus 30 days |
| Phase II - Determine the Disease Control Rate (DCR) of participants based on response | Disease Control Rate (DCR): Defined as CR + PR + MR + SD for Neuroblastoma (INRC) and CR + PR + SD for Ewing Sarcoma (RECIST v1.1). | 2 years plus 30 days |
| Phoenix Children's Hospital | Recruiting | Phoenix | Arizona | 85016 | United States |
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| UCSF Benioff Children's Hospital Oakland | Recruiting | Oakland | California | 94609 | United States |
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| Rady Children's Hospital | Recruiting | San Diego | California | 92123 | United States |
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| Connecticut Children's Hospital | Recruiting | Hartford | Connecticut | 06106 | United States |
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| University of Florida | Recruiting | Gainesville | Florida | 32611 | United States |
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| Nicklaus Children's Hospital | Recruiting | Miami | Florida | 33155 | United States |
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| Arnold Palmer Hospital for Children | Recruiting | Orlando | Florida | 32806 | United States |
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| All Children's Hospital Johns Hopkins Medicine | Recruiting | St. Petersburg | Florida | 33701 | United States |
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| St. Joseph's Children's Hospital | Recruiting | Tampa | Florida | 33614 | United States |
|
| Kapiolani Medical Center for Women and Children | Recruiting | Honolulu | Hawaii | 96813 | United States |
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| Norton Children's Research Institute/Affiliated with University of Louisville School of Medicine | Recruiting | Louisville | Kentucky | 40202 | United States |
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| Children's Mercy Hospitals and Clinics | Recruiting | Kansas City | Missouri | 64108 | United States |
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| Cardinal Glennon Children's Medical Center | Recruiting | St Louis | Missouri | 63104 | United States |
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| Hackensack University Medical Center | Recruiting | Hackensack | New Jersey | 07601 | United States |
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| Penn State Milton S. Hershey Medical Center and Children's Hospital | Recruiting | Hershey | Pennsylvania | 17033 | United States |
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| Hasbro Children's Hospital | Recruiting | Providence | Rhode Island | 02903 | United States |
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| Monroe Carrell Jr. Children's Hospital at Vanderbilt | Recruiting | Nashville | Tennessee | 37232 | United States |
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| Children's Medical Center | Recruiting | Dallas | Texas | 75235 | United States |
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| Primary Children's Hospital | Recruiting | Salt Lake City | Utah | 84113 | United States |
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| Virginia Commonwealth University | Recruiting | Richmond | Virginia | 23284 | United States |
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| UHC Sainte-Justine | Recruiting | Montreal | Quebec | QC H3S 2G4 | Canada |
|
| ID | Term |
|---|---|
| D009447 | Neuroblastoma |
| D012512 | Sarcoma, Ewing |
| D012516 | Osteosarcoma |
| D012208 | Rhabdomyosarcoma |
| D008080 | Liposarcoma |
| ID | Term |
|---|---|
| D018241 | Neuroectodermal Tumors, Primitive, Peripheral |
| D018242 | Neuroectodermal Tumors, Primitive |
| D018302 | Neoplasms, Neuroepithelial |
| D017599 | Neuroectodermal Tumors |
| D009373 | Neoplasms, Germ Cell and Embryonal |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D009375 | Neoplasms, Glandular and Epithelial |
| D009380 | Neoplasms, Nerve Tissue |
| D018213 | Neoplasms, Bone Tissue |
| D009372 | Neoplasms, Connective Tissue |
| D018204 | Neoplasms, Connective and Soft Tissue |
| D012509 | Sarcoma |
| D009217 | Myosarcoma |
| D009379 | Neoplasms, Muscle Tissue |
| D018205 | Neoplasms, Adipose Tissue |
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| ID | Term |
|---|---|
| C555142 | silmitasertib |
| D000077146 | Irinotecan |
| D000077204 | Temozolomide |
| D014750 | Vincristine |
| ID | Term |
|---|---|
| D002166 | Camptothecin |
| D000470 | Alkaloids |
| D006571 | Heterocyclic Compounds |
| D003606 | Dacarbazine |
| D014226 | Triazenes |
| D009930 | Organic Chemicals |
| D007093 | Imidazoles |
| D001393 | Azoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D014748 | Vinca Alkaloids |
| D046948 | Secologanin Tryptamine Alkaloids |
| D026121 | Indole Alkaloids |
| D007211 | Indoles |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D054836 | Indolizidines |
| D007212 | Indolizines |
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