In this Phase I clinical study, the investigators plan to offer investigational treatment with the novel JAK2/STAT3 inhibitor WP1066 (Moleculin Biotech, Inc.) to pediatric patients with any progressive or recurrent malignant brain tumor that is refractory to standard treatment and is without known cure.
The goal of this clinical research study is to find the highest tolerable dose of WP1066 that can be given to pediatric patients with recurrent (has returned after treatment) cancerous brain tumors or melanoma that has gotten worse and spread to the brain. The safety of this drug will also be studied. WP1066 is designed to target the STAT3 pathway in cancer cells, which makes these cells divide, increases new blood vessels to the tumor, causes the cancer cells to move throughout the body and brain, and avoids them being detected by the immune system. Targeting this pathway may cause the immune system to kill the cancer cells. The investigators will administer five escalating doses of WP1066, starting at lowest dose currently found to be safe and tolerable in adults. WP1066 is not FDA approved or commercially available. It is currently being used for research purposes only. Up to 36 participants will be enrolled in this study. All will take part at Children's Healthcare of Atlanta (CHOA).
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
10
WP1066 is an analogue of caffeic acid that is a potent inhibitor of p-STAT3. It will be taken by mouth 2 times per day on Monday, Wednesday, and Friday of Weeks 1 and 2 of each 28-day cycle.
Children's Healthcare of Atlanta (CHOA)
Atlanta, Georgia, United States
Maximum tolerated dose (MTD) of WP1066
Maximum tolerated dose (MTD) of WP1066 in pediatric patients with recurrent or refractory and progressive malignant brain tumors for which there is no known treatment with clinical benefit. Maximum tolerated dose (MTD) is determined as the dose level at which 0/6 or 1/6 patients experience a dose-limiting toxicity (DLT) with at least 2 patients experiencing DLT at the next higher dose level. DLT is defined as an adverse event or an abnormal laboratory value assessed as being at least possibly related to the investigational agent that occurs during the first 28 days after administration of the first dose of WP1066.
Time frame: 28 Days post-intervention
Change in safety and tolerability of WP1066: Maximum tolerated dose (MTD) and Dose limiting toxicities (DLT)
The trial will investigate the maximum tolerated dose (MTD) and record the dose limiting toxicities (DLTs) at least possibly related to the investigational drug, as well as all toxicities related or unrelated that occur. MTD is defined as the dose level at which 0/6 or 1/6 subjects experience a DLT with at least 2 subjects experiencing DLT at the next higher dose level. A minimum of 6 subjects must be treated at the MTD. DLT is defined as a graded adverse event or abnormal lab value at least possibly related to the investigational drug that occurred within 28 days after the first dose of the drug was administered. All toxicities will be recorded and graded throughout the study.
Time frame: Up to 2 months after the last study drug dose
Pharmacokinetic of WP1066: Peak plasma concentration (Cmax)
Cmax is the observed maximum plasma concentration following drug administration. Individual plasma concentration-time data for WP1066 will be used to generate pharmacokinetic parameter estimates using both compartmental and non-compartmental methods.
Time frame: Days 1, 2, 14, and 15 of course 1
Pharmacokinetic of WP1066: Time to peak concentration (Tmax)
Tmax is the time to reach maximum plasma concentration after single dose administration. Individual plasma concentration-time data for WP1066 will be used to generate pharmacokinetic parameter estimates using both compartmental and non-compartmental methods.
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Time frame: Days 1, 2, 14, and 15 of course 1
Pharmacokinetic of WP1066: Area Under the Plasma Concentration-time Curve from time zero to 24 hours (AUC0-24)
AUC0-24 is the area under the plasma concentration-time curve from time zero to 24 hours after the start of WP1066 and will be calculated using the linear trapezoidal. Individual plasma concentration-time data for WP1066 will be used to generate pharmacokinetic parameter estimates using both compartmental and non-compartmental methods.
Time frame: Days 1, 2, 14, and 15 of course 1
Pharmacokinetic analysis of WP1066: Clearance from plasma (CL) following drug administration
CL is the systemic (or total body) clearance from plasma following WP1066 administration. It will be determined by dose/AUC. Individual plasma concentration-time data for WP1066 will be used to generate pharmacokinetic parameter estimates using both compartmental and non-compartmental methods.
Time frame: Days 1, 2, 14, and 15 of course 1
Pharmacokinetic analysis of WP1066: Elimination half life (t1/2)
Elimination half-life (t1/2) will be calculated by 0.693/k. Individual plasma concentration-time data for WP1066 will be used to generate pharmacokinetic parameter estimates using both compartmental and non-compartmental methods.
Time frame: Days 1, 2, 14, and 15 of course 1
Pharmacokinetic analysis of WP1066: Apparent volume of distribution
Apparent volume of distribution will be calculated by Cl/k. Individual plasma concentration-time data for WP1066 will be used to generate pharmacokinetic parameter estimates using both compartmental and non-compartmental methods.
Time frame: Days 1, 2, 14, and 15 of course 1
Pharmacokinetic analysis of WP1066: change in accumulation ratio of WP1066
Accumulation ratio of WP1066 will be calculated as the ratio of AUC0-24 on cycle 1 Day 1 vs Cycle 1 fourth dose. Individual plasma concentration-time data for WP1066 will be used to generate pharmacokinetic parameter estimates using both compartmental and non-compartmental methods.
Time frame: Day 1 of cycle 1 (each cycle is 28 days) and Day 7 of cycle 1
Pharmacodynamic analysis of WP1066: level of activated Stat3
Activated Stat3 is a transcription factor which in humans is encoded by the STAT3 gene. It is a member of the STAT protein family. The level of activated Stat3 (phospho-Stat3) will be measured in the peripheral blood mononuclear cells (PBMCs), the type of immune cells present in the blood, and the immune cytokines in the serum of subjects pre and post administration of the investigational drug.
Time frame: Hours 0, 4, 24 of Day 1 and Hours 0, 4, 24 of Day 7
Change in overall response rate (ORR) of WP1066 treatment
Change in overall response rate (ORR) of WP1066 treatment for this pediatric study population in those with radiographically measurable disease.
Time frame: Up to 2 months after the last study drug dose
Change in Immunological response
If clinically indicated and as an optional procedure, biopsy or surgery specimens of the tumors will be obtained to determine the molecular expression of p-STAT3, Ki-67 and immunological characteristics of the tumors (Treg infiltration, co-stimulator molecule expression, etc.)
Time frame: Up to 2 months after the last study drug dose
Time to radiographically assessed progression and/or response to treatment with WP1066.
The subjects will undergo imaging at baseline and again within 30 days after obtaining the MRI that aroused the suspicion of progression, or an alternative imaging method can be employed, such as MRI with spectroscopy and/or perfusion, or positron emission tomography (PET).
Time frame: Up to 2 months post-intervention
Change in progression-free survival (PFS)
The PFS will be defined radiographically as a greater than 25% increase in tumor volume (in malignant glioma) on T1-weighted MRI scans compared with the MRI obtained within 4 weeks before enrollment. Estimated using Kaplan-Meier survival curves. Cox proportional hazards regression methodology may be used to assess the association between duration of response or survival and clinical and demographic characteristics of interest.
Time frame: Up to 2 months after the last study drug dose
Change in overall survival (OS)
Estimated using Kaplan-Meier survival curves. Cox proportional hazards regression methodology may be used to assess the association between duration of response or survival and clinical and demographic characteristics of interest.
Time frame: Up to 2 months after the last study drug dose