Dose escalation phase of the study : To define the safety profile, maximum tolerated dose (MTD) and recommended phase II dose (RP2D) of regorafenib administered orally as a single agent in a 3-weeks-on/1- week-off schedule in repeating cycles of 28 days in pediatric subjects with solid malignant tumors recurrent or refractory to standard therapy. To characterize the pharmacokinetics (PK) of regorafenib The dose escalation phase of the study has been completed. Expansion phase: To define the safety profile, MTD and the RP2D of regorafenib administered orally in combination with backbone chemotherapy (vincristine and irinotecan) at relapse in pediatric subjects with rhabdomyosarcoma (RMS) and other solid malignant tumors recurrent or refractory to standard therapy.
Expansion Phase of the study: Subjects must have relapsed/refractory RMS or a solid malignant tumor (Ewing sarcoma, hepatoblastoma, neuroblastoma and Wilms tumor).
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
62
Regorafenib will be given orally once a day, across cycles of 21 days each. During each cycle regorafenib is taken for 2 weeks followed by one week off the drug. Doses of the study drug used in this study are age-dependent and the children's dose will been adjusted based on the age and the body surface area and given either as tablets or granulate.
Vincristine will be given at a dose of 1.5 mg/m2 (0.05 mg/kg for subjects ≤ 10 kg, maximum 2.0 mg) on Day 1 and Day 8 in 21-day cycles.
Irinotecan will be administered at a starting dose of 50 mg/m2/day from Day 1 to Day 5, in 21 day cycles.
Unnamed facility
Lyon, France
Unnamed facility
Marseille, France
Unnamed facility
Paris, France
Unnamed facility
Villejuif, France
Unnamed facility
Genoa, Liguria, Italy
Unnamed facility
Milan, Lombardy, Italy
Unnamed facility
Madrid, Spain
Unnamed facility
Valencia, Spain
Unnamed facility
Sutton, Surrey, United Kingdom
Unnamed facility
Newcastle upon Tyne, Tyne and Wear, United Kingdom
...and 2 more locations
Safety: Maximum Tolerated Dose
MTD is defined as the dose level at which none or 1 of 6 participants experiences dose-limiting toxicity (DLT), when at least 2 of 3-6 participants experience a DLT at the next highest dose
Time frame: approximately after 21 months
Safety: Recommended Phase II Dose
In order to establish a RP2D, the MTD cohort will be expanded to have at least 12 evaluable subjects to confirm the RP2D. It is expected that at least 15 subjects evaluable for DLTs will be necessary to establish the RP2D of the combination"
Time frame: approximately after 21 months
Number of participants with Adverse Events
Individual listings of adverse events will be provided. The incidence of treatment-emergent adverse events and drug-related adverse events, respectively, will be summarized by worst NCI-CTCAE v 4.0 grade and by dose level
Time frame: Dose escalation phase:approximately after 21 months; Expansion Phase: approximately after 21 months
AUC(0-24)md based on nominal dosing
Dose escalation phase has been completed
Time frame: Dose escalation phase:Cycle 1 Day 1, Day 15 and Day 21
Overall survival
Time frame: Dose escalation phase: approximately 21 months; Expansion phase: approximately 21 months
Time to progression
Time frame: Dose escalation phase: approximately 21 months; Expansion phase: approximately 21 months
Tumor response: tumor assessment by RECIST v. 1.1
Time frame: Dose escalation phase: approximately 21 months; Expansion phase: approximately 21 months
Taste and texture questionnaire of the regorafenib formulations
Expansion phase Dose escalation phase
Time frame: Dose escalation phase: Cycle 1; Expansion phase:Concomitant: Cycle 1 Day 1;Sequential: Cycle 1 Day 8
AUC(0-24)md based on nominal dosing
Expansion phase
Time frame: Expansion Phase:Cycle 1 Day1, Day 15 and Day 21
Cmax(0-24)md based on individual dosing
Expansion phase
Time frame: Expansion Phase:Cycle 1 Day1, Day 15 and Day 21
Cav(0-24)md based on individual dosing
Expansion phase Dose escalation phase
Time frame: Expansion phase:Cycle 1 Day1, Day 15 and Day 21; Dose escalation phase:Cycle 1 Day1, Day 15 and Day 21
t1/2eff,md based on individual dosing
Expansion phase Dose escalation phase
Time frame: Expansion phase:Cycle 1 Day1, Day 15 and Day 21; Dose escalation phase:Cycle 1 Day1, Day 15 and Day 21
AUC(0-24)md based on individual dosing
Expansion phase
Time frame: Expansion Phase:Cycle 1 Day1, Day 15 and Day 21
Clearance of irinotecan and SN-38
Expansion phase
Time frame: Expansion Phase:Cycle 1 Day1, Day 15 and Day 21
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