This research study is evaluating a drug called ribociclib (LEE011) given in combination with everolimus and other standard of care chemotherapy drugs as a possible treatment for relapsed or refractory ALL. The names of the drugs involved in this study are: * ribociclib * everolimus * dexamethasone
This research study is a Phase I clinical trial, which tests the safety of an investigational drug or a combination of drugs. Phase I studies try to define the appropriate dose of the investigational drug to use for further studies. "Investigational" means that the drug and the combination of drugs are still being studied. The FDA (the U.S. Food and Drug Administration) has not approved the study drugs, ribociclib or everolimus, for relapsed ALL, but these drugs have been approved for other uses. Ribociclib is a chemotherapy drug that is approved by the FDA for the treatment of certain types of breast cancer. It has also been studied in children and adults with other types of cancer. Information from these research studies has suggested that ribociclib may also be effective in treating participants with leukemia that did not respond to standard treatment or participants with leukemia that has come back after standard treatment. The growth and survival of leukemia cells is controlled by proteins within the cancer cell. The study drug, ribociclib, blocks a specific type of protein called a cyclin-dependent kinases (CDK). Laboratory and other studies suggest that when ribociclib blocks CDKs, cancer cells stop growing. Everolimus is a chemotherapy drug that is approved by the FDA for the treatment of breast cancer, neuroendocrine tumor and kidney cancer. Laboratory and other studies suggest that everolimus may prevent leukemia cell growth and also that it has been shown to increase the effectiveness of other chemotherapy drugs, including ribociclib. It has been studied in hundreds of people with various types of cancer as a single agent (a drug that is used alone to treat the cancer) or in combination with a number of other drugs. The drug combination of ribociclib and everolimus has not been previously tested in children, though these agents have been used together in adults with breast cancer. In this research study the investigators are looking to learn more about how ribociclib and everolimus work in combination with other standard of care drugs commonly used to treat relapsed/refractory leukemia. The main goals of the study are: * To evaluate the side effects (good and/or bad) of giving ribociclib in combination with other standard of care drugs. * To determine the highest dose of ribociclib and everolimus that can be given safely in combination with other standard of care drugs. * To determine the amount of ribociclib and everolimus in the blood when it is given in combination with other standard of care drugs.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
45
Ribociclib, blocks a specific type of protein called a cyclin-dependent kinases (CDK)
Corticosteroids are commonly used to treat ALL.
Everolimus is an inhibitor of mTOR. mTOR inhibition blocks the translation of genes that regulate cancer cell proliferation
Children's Hospital Colorado
Aurora, Colorado, United States
Nemours/Alfred I. duPont Hospital for Children
Wilmington, Delaware, United States
Children's Healthcare of Atlanta
Atlanta, Georgia, United States
Pharmacokinetic analysis - AUC(0-24hr):
Blood samples obtained for Pharmacokinetic (PK) analysis will be used to describe how study drugs are distributed and metabolized by human subjects. Samples for PK analysis will be obtained during Cycle 1 of all Cohorts. Area under the concentration-time curve from time zero to 24 hours (AUC(0-24hr)) is a measure of a subject's exposure to study drugs.
Time frame: 3 years
Pharmacokinetic analysis - Cmax
Blood samples obtained for Pharmacokinetic (PK) analysis will be used to describe how study drugs are distributed and metabolized by human subjects. Samples for PK analysis will be obtained during Cycle 1 of all Cohorts. Maximum observed concentration (Cmax) will be determined from the plasma concentration data
Time frame: 3 years
Pharmacokinetic analysis - Tmax
Blood samples obtained for Pharmacokinetic (PK) analysis will be used to describe how study drugs are distributed and metabolized by human subjects. Samples for PK analysis will be obtained during Cycle 1 of all Cohorts. Time of first observation of Cmax (tmax) will be determined from the plasma concentration data
Time frame: 3 years
Toxicity assessments
Toxicities experience by study subjects will be reported and graded for severity using CTCAE version 5. These data will contribute to determining the Maximum tolerated dose (MTD)
Time frame: 3 years
Maximum Tolerated Dose (MTD)
This dose, determined by review of toxicity data, will define the highest dose that is tolerable in this patient population.
Time frame: 3 years
Overall Response Rate (ORR)
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Boston Children's Hospital
Boston, Massachusetts, United States
Dana Farber Cancer Institute
Boston, Massachusetts, United States
Dana-Farber Cancer Institute
Boston, Massachusetts, United States
Roswell Park Cancer Institute
Buffalo, New York, United States
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
...and 2 more locations
Preliminary anti-leukemic activity of the combinations of ribociclib, everolimus and dexamethasone will be reported. Bone marrow and cerebrospinal fluid evaluations will occur at the end of each cycle. ORR will be defined as the number of patient experiencing complete remission (CR), complete remission with incomplete platelet recovery (CRp), complete remission with incomplete count recovery (CRi) and partial response.
Time frame: 3 years