This research is being done to test a new drug called PEEL-224 in combination with two commercially available drugs, Vincristine and Temozolomide, and to determine how effective this combination of drugs is at treating Ewing Sarcoma (EWS) and Desmoplastic Small Round Cell Tumor (DSRCT), as well as multiple other kinds of sarcomas. The names of the study drugs and biological agents involved in this study are: * PEEL-224 (a type of Topoisomerase 1 inhibitor) * Vincristine (A type of vinca alkaloid) * Temozolomide (A type of alkylating agent) * Pegfilgrastim or Filgrastim (types of Myeloid growth factors)
This is an open-label, single-arm, non-randomized, phase I/II trial to test a new drug called PEEL-224 in combination with two commercially available drugs, Vincristine and Temozolomide, and to determine how effective this combination of drugs is at treating Ewing Sarcoma (EWS) and Desmoplastic Small Round Cell Tumor (DSRCT), as well as multiple other kinds of sarcomas. This is the first time that PEEL-224 will be given in combination with Vincristine and Temozolomide to humans. In Phase 1, the safety and tolerability of PEEL-224 in combination with Vincristine and Temozolomide will be assessed by dose escalation and establishment of a Recommended Phase 2 Dose. In Phase 2 the efficacy of the drug combination will be assessed in three separate cohorts of participants. The U.S. Food and Drug Administration (FDA) has not approved PEEL-224 as a treatment for Relapsed or Refractory Sarcoma. The U.S. Food and Drug Administration (FDA) has not approved Vincristine and Temozolomide for Relapsed or Refractory Sarcoma, but it has been approved for other uses. The research study procedures include screening for eligibility, study treatment in-clinic visits, X-rays, Computerized Tomography (CT) scans, Magnetic Resonance Imaging (MRI) scans, or Positron Emission Tomography (PET) scans, blood tests, urine tests, and electrocardiograms (ECGs). Participants will receive study treatment for up to 34 cycles (approximately 2 years) and will be followed for up to 1 year after the last participant has received the last dose of treatment. It is expected that about 63 people will take part in this research study. PEEL Therapeutics is funding this research study by providing the study drug, PEEL-224.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
63
Topoisomerase 1 inhibitor, 200mg amber vial, via intravenous (into the vein) infusion per protocol.
Alkylating agent, 5, 20, 100, 140, 180, or 250 mg capsule, taken orally per standard of care.
Vinca alkaloid, 1 or 2mL vials, via intravenous (into the vein) infusion per institutional policy.
Myeloid growth factor administered per institutional standards.
Myeloid growth factor administered per institutional standards.
Boston Children's Hospital
Boston, Massachusetts, United States
NOT_YET_RECRUITINGDana-Farber Cancer Institute
Boston, Massachusetts, United States
RECRUITINGBrigham and Women's Hospital
Boston, Massachusetts, United States
NOT_YET_RECRUITINGMaximum Tolerated Dose (MTD) (Phase 1)
The MTD is determined by a Continual Reassessment Method (CRM) design and defined as the dose level with the posterior probability of dose-limiting toxicity (DLT) closest to the target toxicity rate of 0.3 with a maximum sample size of 15. The DLT observation period is up to 35 days long, beginning at the first dose of any of the three drugs in cycle 1 and ending at the occurrence of a DLT.
Time frame: Up to 35 days
Number of Participants with Dose-Limiting Toxicities (Phase 1)
Any ≥ Grade 2 CTCAE v5 adverse events that are possibly, probably, or definitely attributable to the combination of Vincristine, PEEL-224, and Temozolomide and within the first 35 days, beginning at the first dose of any of the three drugs in cycle 1 and ending at the occurrence of DLT or at the start of treatment in cycle 2 (whichever occurs first). To be evaluable for dose-limiting toxicity, a participant must also receive at least 75% of prescribed agents in cycle 1 and be followed for at least 35 days during cycle 1 or to the start of cycle 2 (whichever occurs first).
Time frame: Up to 35 days
Number of Participants with DLTs (Phase 2)
A safety monitoring rule will be applied to Phase 2 of the study for the overall participant cohort. The DLT observation period is up to 35 days long, beginning at the first dose of any of the three drugs in cycle 1 and ending at the occurrence of DLT or at the start of treatment in cycle 2 (whichever occurs first).
Time frame: Up to 35 days
Objective Response Rate EWS Cohort (Phase 2)
ORR is defined as the percentage of participants achieving complete response (CR) or partial response (PR) on treatment based on RECIST 1.1 criteria. Evaluable participants must have measurable disease at screening, be treated at RP2D dose, have received at least one dose of study drug, and either have evidence of clinical progression or have had at least one follow-up disease evaluation of their RECIST measurable disease after initiation of protocol therapy. The proportion of responders is calculated as the (number of responders) / (number of evaluable participants).
Time frame: Up to 5 years (based on accrual duration of 2 years)
Objective Response Rate DSRCT Cohort (Phase 2)
ORR is defined as the percentage of participants achieving complete response (CR) or partial response (PR) on treatment based on RECIST 1.1 criteria. Evaluable participants must have measurable disease at screening, be treated at RP2D dose, have received at least one dose of study drug, and either have evidence of clinical progression or have had at least one follow-up disease evaluation of their RECIST measurable disease after initiation of protocol therapy. The proportion of responders is calculated as the (number of responders) / (number of evaluable participants).
Time frame: Up to 5 years (based on accrual duration of 2 years)
Objective Response Rate Other Sarcoma Cohort
ORR is defined as the percentage of participants achieving complete response (CR) or partial response (PR) on treatment based on RECIST 1.1 criteria. Evaluable participants must have measurable disease at screening, be treated at RP2D dose, have received at least one dose of study drug, and either have evidence of clinical progression or have had at least one follow-up disease evaluation of their RECIST measurable disease after initiation of protocol therapy. The proportion of responders is calculated as the (number of responders) / (number of evaluable participants).
Time frame: Up to 5 years (based on accrual duration of 2 years)
Median Progression-Free Survival (PFS) Other Sarcoma Cohort
Progression-Free Survival (PFS) based on the Kaplan-Meier method is defined as the time from registration to the earlier of progression or death due to any cause. Participants alive without disease progression are censored at date of last disease evaluation.
Time frame: Approximately 2 years
Overall Survival (OS) Other Sarcoma Cohort
Overall Survival (OS) based on the Kaplan-Meier method is defined as the time from registration to death due to any cause, or censored at date last known alive.
Time frame: Up to 5 years (based on accrual duration of 2 years)
Median PFS EWS Cohort
PFS based on the Kaplan-Meier method is defined as the time from registration to the earlier of progression or death due to any cause. Participants alive without disease progression are censored at date of last disease evaluation.
Time frame: Approximately 2 years
OS EWS Cohort
OS based on the Kaplan-Meier method is defined as the time from registration to death due to any cause, or censored at date last known alive.
Time frame: Up to 5 years (based on accrual duration of 2 years)
Median PFS DSRCT Cohort
PFS based on the Kaplan-Meier method is defined as the time from registration to the earlier of progression or death due to any cause. Participants alive without disease progression are censored at date of last disease evaluation.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: Approximately 2 years
OS DSRCT Cohort
OS based on the Kaplan-Meier method is defined as the time from registration to death due to any cause, or censored at date last known alive.
Time frame: Up to 5 years (based on accrual duration of 2 years)
Peak Plasma Concentration (Cmax) of PEEL-224
Cmax will be estimated within the cohort of evaluable participants 12 years and older who received PEEL-224 given on a 2-week on and 1-week off schedule.
Time frame: Days 1, 2, 3, and 8 of Cycle 1 (21 days per cycle)
Area Under the Plasma Concentration Versus Time Curve (AUC) of PEEL-224
AUC will be estimated within the cohort of evaluable participants 12 years and older who received PEEL-224 given on a 2-week on and 1-week off schedule.
Time frame: Days 1, 2, 3, and 8 of Cycle 1 (21 days per cycle)
Peak Time (Tmax) of PEEL-224
Tmax will be estimated within the cohort of evaluable participants 12 years and older who received PEEL-224 given on a 2-week on and 1-week off schedule.
Time frame: Days 1, 2, 3, and 8 of Cycle 1 (21 days per cycle)
Circulating Tumor DNA (ctDNA) Burden EWS Cohort at Baseline
ctDNA burden is the amount of circulating tumor DNA (ctDNA) present in the bloodstream, reflecting the extent of tumor-derived DNA shed into circulation. A next generation sequencing or PCR-based approach will be used to detect ctDNA.
Time frame: Baseline
ctDNA Burden EWS Cohort at Day 8
ctDNA burden is the amount of circulating tumor DNA (ctDNA) present in the bloodstream, reflecting the extent of tumor-derived DNA shed into circulation. A next generation sequencing or PCR-based approach will be used to detect ctDNA.
Time frame: Day 8
ctDNA Burden DSRCT Cohort at Baseline
ctDNA burden is the amount of circulating tumor DNA (ctDNA) present in the bloodstream, reflecting the extent of tumor-derived DNA shed into circulation. A next generation sequencing or PCR-based approach will be used to detect ctDNA.
Time frame: Baseline
ctDNA Burden DSRCT Cohort at Day 8
ctDNA burden is the amount of circulating tumor DNA (ctDNA) present in the bloodstream, reflecting the extent of tumor-derived DNA shed into circulation. A next generation sequencing or PCR-based approach will be used to detect ctDNA.
Time frame: Day 8
≥ Grade 2 Treatment-Related Toxicity Rate (Phase 1)
The percentage of participants that experience a maximum grade 2-5 treatment-related adverse event based on the Common Toxicity Criteria for Adverse events Version 5.0 (CTCAEv5) as reported on case report forms. From start of protocol therapy until 30 days after last dose of temozolomide, vincristine or PEEL-224, which ever occurs last.
Time frame: Approximately 2 years
≥ Grade 2 Treatment-Related Toxicity Rate (Phase 2)
The percentage of participants who experience ≥ Grade 2 treatment-related adverse event based on the Common Toxicity Criteria for Adverse events Version 5.0 (CTCAEv5) as reported on case report forms. From start of protocol therapy until 30 days after last dose of temozolomide, vincristine or PEEL-224, which ever occurs last.
Time frame: Approximately 2 years
Median Duration of Overall Response (DOR) (Phase 2)
The duration of overall response is measured from the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started, or death due to any cause. Participants without events reported are censored at the last disease evaluation)
Time frame: Approximately 2 years
Median Duration of Complete Response (CR) (Phase 2)
The duration of CR is measured from the time measurement criteria are first met for CR until the first date that progressive disease is objectively documented, or death due to any cause. Participants without events reported are censored at the last disease evaluation.
Time frame: Approximately 2 years
Median Duration of Stable Disease (Phase 2)
Stable disease is measured from the start of the treatment until the criteria for progression are met, taking as reference the smallest measurements recorded since the treatment started, including the baseline measurements.
Time frame: Approximately 2 years