This is a first-in-children phase 1 trial using indoximod, an inhibitor of the immune "checkpoint" pathway indoleamine 2,3-dioxygenase (IDO), in combination with temozolomide-based therapy to treat pediatric brain tumors. Using a preclinical glioblastoma model, it was recently shown that adding IDO-blocking drugs to temozolomide plus radiation significantly enhanced survival by driving a vigorous, tumordirected inflammatory response. This data provided the rationale for the companion adult phase 1 trial using indoximod (IND#120813) plus temozolomide to treat adults with glioblastoma, which is currently open (NCT02052648). The goal of this pediatric study is to bring IDO-based immunotherapy into the clinic for children with brain tumors. This study will provide a foundation for future pediatric trials testing indoximod combined with radiation and temozolomide in the up-front setting for patients with newly diagnosed central nervous system tumors.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
81
Indoximod will be administered orally twice daily.
Temozolomide will be administered on days 1-5 of every 28 day cycle.
Conformal radiation will be administered on days 3-7 of induction cycle.
Cyclophosphamide will be administered orally daily.
Etoposide will be administered orally daily.
Children's Hospital Colorado
Aurora, Colorado, United States
Arnold Palmer Hospital for Children
Orlando, Florida, United States
Children's Heathcare of Atlanta
Atlanta, Georgia, United States
Augusta University
Augusta, Georgia, United States
Children's Hospitals and Clinics of Minnesota
Minneapolis, Minnesota, United States
Incidence of regimen limiting toxicities (RLTs)
To estimate the RP2D of indoximod combined with temozolomide
Time frame: First 28 days of treatment
Objective Response Rate
To assess preliminary evidence of efficacy of indoximod and temozolomide using COG brain tumor measurement criteria.
Time frame: Up to three years
Incidence of regimen limiting toxicities (RLTs)
To estimate the RP2D of indoximod combined with conformal radiation
Time frame: First 35 days of treatment
Safety and tolerability assessed by development of AEs and laboratory parameters of indoximod in combination with cyclophosphamide and etoposide.
In patients who initially achieve prolonged stable disease or better with Indoximod plus temozolomide but then develop progressive disease
Time frame: Up to three years
Pharmacokinetics: Serum concentrations (Cmax/Steady State)
Group 1
Time frame: First 48 hours of treatment
Safety and Tolerability of Indoximod combined with Temozolomide as assessed by incidence and severity of adverse events, dose interruptions and dose reductions.
Group 1 and 2
Time frame: Continuous during study until 30 days after study treatment is complete.
Progression Free Survival (PFS)
Group 2
Time frame: Up to three years
Time to Progression
Group 2
Time frame: Start of study until disease progression follow-up, up to three years
Overall Survival
Group 2
Time frame: Start of study until end of follow-up, up to five years
Safety and Feasibility of Indoximod combined with conformal radiation as assessed by incidence and severity of adverse events, dose interruptions and dose reductions.
Group 3
Time frame: Continuous during study until 30 days after study treatment is complete.
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