This clinical trial tests how well entrectinib works to treat patients less than 3 years of age with NTRK 1/2/3 or ROS1 fused, high grade glioma or other central nervous system (CNS) tumors.
PRIMARY OBJECTIVE * To determine the overall response rate of entrectinib when used as first line therapy in patients who are younger than 3 years of age with NTRK1/2/3- or ROS1-fused high-grade glioma (HGG) (Cohort 1). SECONDARY OBJECTIVES * To estimate the 2-year and 5-year progression free survival (PFS) and overall survival (OS) in patients who are younger than 3 years of age with NTRK1/2/3- or ROS1-fused HGG treated with entrectinib as first line therapy (Cohort 1). * To estimate the duration of response (DOR) in patients who are younger than 3 years of age with NTRK1/2/3- or ROS1-fused HGG treated with entrectinib as first line therapy (Cohort 1). * To evaluate the fraction of patients with NTRK1/2/3- or ROS1-fused HGG treated who have second surgeries and a gross-total resection after treatment with entrectinib is achieved, overall and by country and hospital (Cohort 1). * To describe the overall response rate of entrectinib when used as first line therapy in patients who are younger than 3 years of age with NTRK1/2/3- or ROS1-fused CNS tumors other than HGG (Cohort 2). * To estimate the 2-year and 5-year PFS and OS in patients who are younger than 3 years of age with NTRK1/2/3- or ROS1-fused CNS tumors other than HGG treated with entrectinib as first line therapy (Cohort 2). * To estimate the duration of response (DOR) in patients who are younger than 3 years of age with NTRK1/2/3- or ROS1-fused CNS tumors other than HGG treated with entrectinib as first line therapy (Cohort 2). * To evaluate the fraction of patients with NTRK1/2/3- or ROS1-fused CNS tumors other than HGG who have second surgeries and a gross-total resection after treatment with entrectinib is achieved, overall and by country and hospital (Cohort 2). * To describe toxicities experienced by patients younger than 3 years of age treated with entrectinib (Cohort 1 and 2). * To evaluate number of patients that are screened for the study and eligible versus enrolled and treated with entrectinib (Cohort 1 and 2). * To measure the time intervals (days) from time of initial diagnostic surgery to screening and enrollment in this study (Cohort 1 and 2). The trial will have 2 cohorts: Cohort 1: patients diagnosed with NTRK1/2/3- or ROS1-fused high-grade glioma (HGG) and Cohort 2: patients diagnosed with NTRK1/2/3- or ROS1-fused CNS tumors other than HGG. Patients receive entrectinib enterally once daily (QD) on days 1-28 of each cycle. Treatment repeats every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity. Patients requiring bridging therapy prior to starting entrectinib may receive cyclophosphamide intravenously (IV) over 1 hour on day 1, etoposide IV over 1 hour on day 1 and 2, carboplatin IV over 1 hour on day 2, filgrastim subcutaneously (SC) or IV or pegfilgrastim SC on day 3. A gross total resection or significant debulking may become possible if a response to entrectinib is seen. If surgical resection is performed and a gross total resection is achieved, 24 cycles of entrectinib will be completed, including those before and after surgery. After treatment, patients will be followed for 5 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
52
Given orally (PO) or enterally
Given intravenous (IV)
Given IV
St. Jude Children's Research Hospital
Memphis, Tennessee, United States
RECRUITINGKing Hussein Cancer Center
Amman, Jordan
RECRUITINGOverall response rate (ORR) (Cohort 1)
ORR is defined as the percentage of patients with either partial or complete response assessed at the protocol-defined evaluation timepoint. Overall response will be determined by the central imaging review based on the scheduled evaluations.
Time frame: After cycle 4 (each cycle is 28 days).
Progression free survival (PFS) (Cohort 1)
PFS is defined as the time from initiation of protocol treatment to first event (progressive disease, death due to any cause), or date last follow-up among those who have not had an event. Described using Kaplan Meier method.
Time frame: At 2 and 5 years
Overall survival (OS) (Cohort 1)
OS is defined as the time from date of diagnosis to date of death due to any cause or date last follow-up. Described using Kaplan Meier method.
Time frame: At 2 and 5 years
Duration of response (DOR) (Cohort 1)
DOR is defined as time from date of first response (partial or complete) until the date of progression or last follow-up. Described as median time.
Time frame: Up to 5 years
Patients who have second surgeries (Cohort 1)
Percentage of patients who had second surgeries.
Time frame: Up to 5 years
Patients who undergo gross-total resection after treatment (Cohort 1)
Percentage of patients who underwent a gross-total resection.
Time frame: Up to 5 years
ORR (Cohort 2)
ORR is defined as the percentage of patients with either partial or complete response assessed at the protocol-defined evaluation timepoint. Overall response will be determined by the central imaging review based on the scheduled evaluations.
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Given IV
Given subcutaneous (SQ) or IV
Given SQ as part of recommended Bridging Therapy instead of G-CSF.
A gross total resection or significant debulking may become possible if a response to entrectinib is seen.
Time frame: After cycle 4 (each cycle is 28 days).
PFS (Cohort 2)
PFS is defined as the time from initiation of protocol treatment to first event (progressive disease, death due to any cause), or date last follow-up among those who have not had an event. Described using Kaplan Meier method.
Time frame: At 2 and 5 years
OS (Cohort 2)
OS is defined as the time from date of diagnosis to date of death due to any cause or date last follow-up. Described using Kaplan Meier method.
Time frame: At 2 and 5 years
DOR (Cohort 2)
DOR is defined as time from date of first response (partial or complete) until the date of progression or last follow-up. Described as median time.
Time frame: Up to 5 years
Patients who have second surgeries (Cohort 2)
Percentage of patients who had second surgeries. \[Time Frame: Up to 5 years\]
Time frame: Up to 5 years
Patients who undergo gross-total resection after treatment (Cohort 2)
Percentage of patients who underwent a gross-total resection.
Time frame: Up to 5 years
Incidence of adverse events (Cohort 1 and 2)
Percentage of adverse events on therapy including Entrectinib, captured using National Cancer Institute Common Terminology Criteria for Adverse Events 5.0.
Time frame: Up to 5 years
Number of patients screened versus enrolled and treated (Cohort 1 and 2)
Number of enrolled and treated patients as a percentage of number of patients screened and eligible for study.
Time frame: Up to 5 years
Time from initial diagnostic surgery to screening and enrollment (Cohort 1 and 2)
Median time in days from initial surgery to screening and enrollment on study.
Time frame: Up to 5 years