This phase I/II trial tests the safety, side effects, best dose and how well giving daraxonrasib works for the treatment of pediatric patients with solid tumors with RAS mutations that has come back after a period of improvement (relapsed) or that has not responded to previous treatment (refractory). Daraxonrasib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving daraxonrasib may be safe, tolerable and/or effective in treating patients with relapsed or refractory solid tumors with RAS mutations.
PRIMARY OBJECTIVES: I. To estimate the maximum tolerated dose (MTD) and/or recommended phase 2 dose (RP2D) of daraxonrasib administered as a daily oral medication to pediatric patients with recurrent or refractory RAS driven solid tumors. (Phase 1 dose escalation \[Part A\]) II. To define and describe the toxicities of daraxonrasib administered on this schedule to a pediatric population. (Phase 1 and 2 \[Part A and B\]) III. To preliminarily evaluate the antitumor activity of daraxonrasib in pediatric patients with recurrent or refractory RAS driven fusion negative rhabdomyosarcoma. (Phase 2 Dose Expansion \[Part B\]) SECONDARY OBJECTIVES: I. To preliminarily define antitumor activity of daraxonrasib in pediatric patients with recurrent or refractory RAS driven solid tumors within the confines of a Phase 1 study. (Phase 1 Dose Escalation \[Part A\]) II. To preliminarily define antitumor activity of daraxonrasib in pediatric patients with recurrent or refractory RAS driven neuroblastoma and other solid tumors (not including fusion negative rhabdomyosarcoma). (Phase 2 Dose Expansion \[Part B\]) III. To characterize the pharmacokinetics of daraxonrasib in pediatric patients with recurrent or refractory RAS driven solid tumors. (Phase 1 Dose Escalation and Phase 2 Dose Expansion \[Part A and B\]) IV. To estimate the progression-free survival (PFS), overall survival (OS), duration of response (DOR), and time to response (TTR) in pediatric patients with recurrent or refractory RAS driven solid tumors. (Phase 1 Dose Escalation and Phase 2 Dose Expansion \[Part A and B\]) EXPLORATORY OBJECTIVES: I. To estimate the frequency of detectable RAS mutations by circulating tumor deoxyribonucleic acid (ctDNA) at start of study treatment in pediatric patients with relapsed and refractory solid tumors with activating RAS mutations, and to assess mutant allele fraction in ctDNA as an exploratory response biomarker. II. To bank archival tissue for future studies. OUTLINE: This is a dose-escalation study of daraxonrasib followed by a dose-expansion study. Patients receive daraxonrasib orally (PO) once daily (QD) on days 1-21 of each cycle. Cycles repeat every 21 days for 28 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo urine sample collection during screening and undergo x-ray imaging, diagnostic imaging and blood sample collection throughout the study. Patients may also undergo bone marrow aspiration and biopsy throughout the study. After completion of study treatment, patients in phase 2 are followed up every 3 months for 12 months, every 6 months until 24 mounts then annually until 60 months.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
77
Undergo blood and urine sample collection
Undergo bone marrow aspiration
Undergo bone marrow biopsy
Given PO
Undergo diagnostic imaging
Undergo x-ray imaging
Maximum tolerated dose (MTD) (Phase 1 part A)
MTD defined as the maximum dose at which fewer than one-third of patients experience dose limiting toxicity during cycle 1 of therapy.
Time frame: Up to completion of cycle 1 (cycle length = 21 days)
Incidence of adverse events (Phase 1 and 2, parts A and B)
Toxicities for patients will be described separately. Toxicity tables will be constructed to summarize the observed incidence by type of toxicity and grade. Toxicity information recorded will include the type, severity, time of onset, time of resolution, and the probable association with the study regimen.
Time frame: Up to 5 years
Best response of disease (Phase 2 dose expansion [part B])
Disease response will be assessed according to Response Evaluation Criteira in Solid Tumors (RECIST) criteria for patients with solid tumors (International Neuroblastoma Response Criteria \[INRC\] for patients with neuroblastoma), and will be reported descriptively.
Time frame: Up to 5 years
Best response of disease (Phase 1, part A)
Disease response will be assessed according to RECIST criteria for patients with solid tumors (INRC for patients with neuroblastoma), and will be reported descriptively.
Time frame: Up to 5 years
Best response of disease (Phase 1, part B)
Disease response will be assessed according to RECIST criteria for patients with solid tumors (INRC for patients with neuroblastoma), and will be reported descriptively. For part B1 (rhabodomyosarcoma) response rate will be estimated by the uniform minimum variance unbiased estimate with one-sided 95% confidence intervals. For part B2 (neuroblastoma) and B3 (other) response rates will be estimated as the proportion of patients who are responders with one-sided exact 93% confidence intervals.
Time frame: Up to 5 years
Pharmacokinetics (Phase 1 dose escalation and phase 2 dose expansion [parts A and B])
A descriptive analysis of pharmacokinetic (PK) parameters of daraxonrasib will be performed to define systemic exposure, drug clearance, and other pharmacokinetic parameters. The PK parameters will be summarized with simple summary statistics, including means, medians, ranges, and standard deviations (if numbers and distribution permit).
Time frame: At cycle 1 day 1 (predose, 30 minutes, 2 hours, 4.5 hours, 7 hours post dose), cycle 1 day 15 predose, cycle 2 day 1 (cycle length = 21 days)
Progression free survival
Time frame: Up to 5 years
Overall survival
Time frame: Up to 5 years
Duration of response
Disease response will be assessed according to RECIST criteria for patients with solid tumors (INRC for patients with neuroblastoma), and will be reported descriptively.
Time frame: Up to 5 years
Time to response
Disease response will be assessed according to RECIST criteria for patients with solid tumors (INRC for patients with neuroblastoma), and will be reported descriptively.
Time frame: Up to 5 years
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