Recent lab-based discoveries suggest that IDO (indoleamine 2,3-dioxygenase) and BTK (Bruton's tyrosine Kinase) form a closely linked metabolic checkpoint in tumor-associated antigen-presenting cells. The central clinical hypothesis for the GCC2020 study is that combining ibrutinib (BTK-inhibitor) with indoximod (IDO-inhibitor) during chemotherapy will synergistically enhance anti-tumor immune responses, leading to improvement in clinical response with manageable overlapping toxicity. The GCC2020 trial is a prospective open-label phase 1 trial to determine the best safe dose of the BTK-inhibitor ibrutinib to use in combination with previously studied chemo-immunotherapy regimens comprised of the investigational IDO-inhibitor indoximod plus oral palliative chemotherapy for participants, age 6 to 25 years, with relapsed or refractory primary brain cancer. Those previously treated with indoximod-based therapy may be eligible, including prior treatment via the phase 2 indoximod study (GCC1949, NCT04049669), the now closed phase 1 study (NLG2105, NCT02502708), or any expanded access (compassionate use) protocols. Ibrutinib will be combined with either indoximod plus oral cyclophosphamide and etoposide (Regimen A) or indoximod plus oral temozolomide (Regimen B). No cross-over between these two regimens will be allowed. Dose-escalation cohorts will determine the best safe dose of ibrutinib for each of these regimens. This will be followed by expansion cohorts, using ibrutinib at the best safe dose for each regimen, to allow assessment of preliminary evidence of efficacy.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
37
Indoximod will be taken by mouth twice daily, throughout each treatment cycle.
For Regimen A, Ibrutinib will be taken by mouth once daily, on days 1-21 of each treatment cycle.
Cyclophosphamide will be taken by mouth once daily, on days 1-21 of each treatment cycle.
Etoposide will be taken by mouth once daily, on days 1-21 of each treatment cycle.
For Regimen B, Ibrutinib will be taken by mouth once daily, on days 1-14 of each treatment cycle.
Temozolomide will be taken by mouth once daily, on days 1-5 of each treatment cycle.
Augusta University, Georgia Cancer Center
Augusta, Georgia, United States
RECRUITINGIncidence of regimen-limiting toxicity (RLT) for Regimen A
To determine the pediatric recommended phase 2 dose (RP2D) of ibrutinib, when combined with indoximod-based chemo-immunotherapy (Regimen A)
Time frame: First 90 days of treatment
Objective Response Rate (ORR) for Regimen A
Defined as the proportion of patients with a best objective response of either complete response (CR) or partial response (PR), using "immunotherapy Response Assessment for Neuro-Oncology" (iRANO) criteria
Time frame: Up to 5 years
Incidence of regimen-limiting toxicity (RLT) for Regimen B
To determine the pediatric recommended phase 2 dose (RP2D) of ibrutinib, when combined with indoximod-based chemo-immunotherapy (Regimen B)
Time frame: First 90 days of treatment
Objective Response Rate (ORR) for Regimen B
Defined as the proportion of patients with a best objective response of either complete response (CR) or partial response (PR), using "immunotherapy Response Assessment for Neuro-Oncology" (iRANO) criteria
Time frame: Up to 5 years
Adverse events (AEs)
To assess frequency, severity, and recoverability of AEs for the treatment regimen
Time frame: Up to 19 months
Frequency of cycle delays for toxicity
To assess whether the immunotherapy contributes to delays in starting subsequent cycles of the chemotherapy drugs
Time frame: Up to 18 months
Frequency of dose-reductions of the chemotherapy regimen
To assess whether the immunotherapy contributes to reductions in the doses of the chemotherapy drugs
Time frame: Up to 18 months
Complete Response Rate (CRR)
Defined as the proportion of patients with a best objective response of CR using iRANO criteria
Time frame: Up to 5 years
Partial Response Rate (PRR)
Defined as the proportion of patients with a best objective response of PR using iRANO criteria
Time frame: Up to 5 years
Modified Objective Response Rate (mORR)
Defined as the proportion of patients with best objective response of complete response (CR), partial response (PR), or stable disease (SD, on at least 2 sequential study-timed MRIs) using iRANO criteria
Time frame: Up to 5 years
iRANO-PFS
Time of Progression-Free Survival (PFS), defined as time from study entry to progression using iRANO criteria
Time frame: Up to 5 years
Overall Survival (OS)
Time from study entry to death
Time frame: Up to 5 years
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