This phase I clinical trial studies the side effects and best dose of AZD1390 and to see how well it works when given together with radiation therapy for the treatment of pediatric patients with high grade glioma, diffuse midline glioma or diffuse intrinsic pontine glioma. AZD1390 is in a class of medications called kinase inhibitors. It works by blocking the signals that cause cancer cells to multiply. This helps to stop the spread of cancer cells. Radiation therapy uses high energy x-rays, particles, or radioactive seeds to kill cancer cells and shrink tumors. Giving AZD1390 with radiation may be safe, tolerable, and/or effective in treating pediatric patients with high grade glioma, diffuse midline glioma or diffuse intrinsic pontine glioma.
PRIMARY OBJECTIVES: I. To define the recommended phase 2 dose of ATM Kinase Inhibitor AZD1390 (AZD1390) when given in combination with radiation for pediatric supratentorial high-grade gliomas. II. To define the recommended phase 2 dose of AZD1390 when given in combination with radiation for pediatric infratentorial high-grade gliomas. III. To define the toxicities and characterize the safety profile of AZD1390 when given in combination with radiation for pediatric supratentorial high-grade gliomas. IV. To define the toxicities and characterize the safety profile of AZD1390 when given in combination with radiation for pediatric infratentorial high-grade gliomas. V. To characterize the pharmacokinetic profile of AZD1390 when given in combination with radiation to pediatric patients for pediatric supratentorial and infratentorial high-grade gliomas. SECONDARY OBJECTIVES: I. To evaluate preliminary efficacy when AZD1390 is given in combination with radiation to pediatric patients with supratentorial high-grade gliomas as determined via progression free survival (PFS), overall survival (OS) and overall radiographic response (ORR) within the confines of a phase 1 trial. II. To evaluate preliminary efficacy when AZD1390 is given in combination with radiation to pediatric patients with infratentorial high-grade gliomas as determined via PFS, OS and ORR within the confines of a phase 1 trial. III. To obtain preliminary data on neurological function of patients with supratentorial and infratentorial high-grade gliomas receiving AZD1390 and focal radiation via the pediatric neurologic assessment in neuro-oncology (NANO) scale. EXPLORATORY OBJECTIVES: I. To evaluate changes in neurocognitive function from baseline (within 2 weeks of enrollment) to end of protocol directed therapy (completion of AZD1390), at 22 weeks (5.5 months) and at 44 weeks (11.5 months) after completion of radiation. II. To evaluate changes in patient reported outcomes utilizing Patient Reported Outcomes Measurement Information System (PROMIS) from baseline (within 2 weeks of enrollment) and at the time of imaging assessments. III. To evaluate the alternative lengthening of telomeres (ALT) phenotype in archival tumor and cell-free deoxyribonucleic acid (cfDNA) in patients with high grade glioma (HGG) undergoing AZD1390 and radiation therapy. IV. To evaluate the correlation of genomic, transcriptomic, proteomic, and cytokine markers, including homologous recombination deficiency (HRD) and associated mutational signatures and TP53/related DNA repair gene mutational status, with response to AZD1390 and radiation therapy. V. Evaluate differences in radiation dosimetry to organs at risk and target volumes by radiation technique and modality and its correlation with toxicity and response and survival. VI. Evaluate cfDNA in plasma and cerebrospinal fluid (CSF) (when obtained) and pharmacodynamic markers of peripheral blood mononuclear cells (PBMCs) prior, during and after therapy to better understand its correlation with treatment response. OUTLINE: This is a dose-escalation study of AZD1390 in combination with radiation. Patients receive AZD1390 orally (PO) once within 5 days prior to radiation therapy. Patients then receive AZD1390 PO once daily (QD), 5 days per week, Monday through Friday, and also receive radiation therapy on the same days for approximately 6 weeks. Patients then receive AZD1390 on days 1-14 after radiation in the absence of disease progression or unacceptable toxicity. Patients undergo magnetic resonance imaging (MRI) and blood sample collection and may optionally undergo cerebrospinal fluid collection throughout the study. After completion of study treatment, patients are followed up at 30 days and then every 8 weeks until progression or 2 years after the last dose of AZD1390 as well as at 22 and 44 weeks after completion of radiation therapy. From progression, patients are followed up will be every 6 months until year 4 from the last dose of AZD1390 then yearly until year 5.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
54
Given PO
Undergo blood and cerebrospinal fluid collection
Undergo MRI
Undergo radiation therapy
Ancillary studies
Children's Hospital of Alabama
Birmingham, Alabama, United States
RECRUITINGChildren's Hospital Los Angeles
Los Angeles, California, United States
RECRUITINGChildren's Hospital of Orange County
Orange, California, United States
RECRUITINGChildren's Hospital Colorado
Aurora, Colorado, United States
RECRUITINGChildren's National Medical Center
Washington D.C., District of Columbia, United States
RECRUITINGChildren's Healthcare of Atlanta - Arthur M Blank Hospital
Atlanta, Georgia, United States
RECRUITINGLurie Children's Hospital-Chicago
Chicago, Illinois, United States
RECRUITINGRiley Hospital for Children
Indianapolis, Indiana, United States
RECRUITINGC S Mott Children's Hospital
Ann Arbor, Michigan, United States
RECRUITINGUniversity of Minnesota/Masonic Cancer Center
Minneapolis, Minnesota, United States
RECRUITING...and 7 more locations
Maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D) of ATM Kinase Inhibitor AZD1390 (AZD1390) for pediatric supratentorial high-grade gliomas
The maximum tolerated dose or recommended phase 2 dose will be estimated by the isotonic estimates of toxicity probabilities for which the estimate of the DLT/RP2D rate is closed to the target rate of 25% in children and adolescents with supratentorial tumors.
Time frame: Up to 75 days
Maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D) of AZD1390 for pediatric infratentorial high-grade gliomas
The maximum tolerated dose or recommended phase 2 dose will be estimated by the isotonic estimates of toxicity probabilities for which the estimate of the DLT/RP2D rate is closed to the target rate of 25% in children and adolescents with infratentorial tumors.
Time frame: Up to 75 days
Incidence of adverse events for AZD1390 for pediatric supratentorial high-grade gliomas
Frequency (%) of evaluable patients with toxicity at least possibly attributable to study agent stratified by study part and dose level using Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v 5.0).
Time frame: Up to 5 years
Incidence of adverse events for AZD1390 for pediatric infratentorial high-grade gliomas
Frequency (%) of evaluable patients with toxicity at least possibly attributable to study agent stratified by study part and dose level using Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v 5.0).
Time frame: Up to 5 years
Maximum serum concentration of AZD1390
Median (min, max) of the maximum serum concentration of AZD1390 assessed at time 0, 2, 4, 6, 8, and 24-hours post dose on cycle 1 day 1.
Time frame: Up to 24 hours
Time to peak drug concentration of AZD1390
Median (min, max) of the time to peak drug concentration of AZD1390 assessed at time 0, 2, 4, 6, 8, and 24-hours post dose on cycle 1 day 1.
Time frame: Up to 24 hours
Elimination half-life of AZD1390
Median (min, max) of the elimination half-life of AZD1390 assessed at time 0, 2, 4, 6, 8, and 24-hours post dose on cycle 1 day 1.
Time frame: Up to 24 hours
Clearance of AZD1390
Median (min, max) of the clearance of AZD1390 assessed at time 0, 2, 4, 6, 8, and 24-hours post dose on cycle 1 day 1.
Time frame: Up to 24 hours
Volume of distribution of AZD1390
Median (min, max) of the volume of distribution of AZD1390 assessed at time 0, 2, 4, 6, 8, and 24-hours post dose on cycle 1 day 1.
Time frame: Up to 24 hours
Progression free survival (PFS) for patients with supratentorial high-grade gliomas
Median (95% confidence interval) of the time to progression for patients with supratentorial high-grade gliomas.
Time frame: Up to 5 years
Overall survival (OS) for patients with supratentorial high-grade gliomas
Median (95% confidence interval) of the time to death due to any cause for patients supratentorial high-grade gliomas.
Time frame: Up to 5 years
Overall radiographic response (ORR) for patients with supratentorial high-grade gliomas
Best overall response (CR, PR, SD, PD) will be summarized by frequency (%) of response-evaluable patients with supratentorial high-grade gliomas.
Time frame: Up to 5 years
PFS for patients with infratentorial high-grade gliomas
Median (95% confidence interval) of the time to progression for patients with infratentorial high-grade gliomas.
Time frame: Up to 5 years
OS for patients with infratentorial high-grade gliomas
Median (95% confidence interval) of the time to death due to any cause for patients with supratentorial high-grade gliomas.
Time frame: Up to 5 years
ORR for patients with infratentorial high-grade gliomas
Best overall response (CR, PR, SD, PD) will be summarized by frequency (%) of response-evaluable patients with infratentorial high-grade gliomas.
Time frame: Up to 5 years
Pediatric neurological assessment in neuro-oncology (pNANO)
Median (min, max) pNANO scores stratified by disease cohort (supratentorial and infratentorial) and dose level at baseline and then every 8-weeks.
Time frame: Up to 5 years
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