Pazopanib Paediatric Phase II Trial Children's Oncology Group (COG) in Solid Tumors

NCT01956669 | Completed Phase 2 Results FDA Drug

• 3 other identifiers: 1167312013-003595-12CPZP034X2203
• Study Type: interventional
• Target: 57
• Locations: 7 countries
• Sites: 31

Brief Summary

The study design was an open-label Phase II pediatric clinical study. The purpose of Study X2203 was to identify any efficacy signal in subjects with the disease subtypes under study, when treated with pazopanib monotherapy. Furthermore, it was to define the toxicities of pazopanib in children, as well as examine biological markers, e.g. cytokines and angiogenic factors, that could help further characterize any response of pazopanib in children. Pazopanib was administered as monotherapy in tablet and powder suspension formulations at daily doses of 450 mg/m2/dose or 225 mg/m2/dose, respectively. The first 6 enrolled subjects receiving oral suspension formulation were assessed for tolerability and extended PK sampling; and, only if pazopanib was tolerated, subsequent subjects were enrolled at the same starting dose with the suspension. Dose escalation was not permitted. For the tablet, a dosing nomogram was used based on the subject's BSA. Dose reduction was dependent upon the toxicity of pazopanib and disease status of the infants, toddlers, children, adolescents, and young adults. Subjects could be as young as 1 year-old infants to screen for enrollment. Subjects were assessed for initial response after 8 weeks of treatment prior to Cycle 3. A cycle was defined as 28 days of pazopanib treatment with no rest period between cycles. Treatment was administered continuously once daily. Treatment was to be discontinued if there was evidence of disease progression, unacceptable treatment-related toxicity, pregnancy. Histological classification was an important diagnostic inclusion in these subjects with a wide variety of refractory solid tumors, i.e. 7 different tumor types and each being a cohort.

Conditions

Solid Tumours

Keywords

VEGF; Pazopanib; Sarcoma; GW786034; Refractory Solid Tumors

Outcome Measures

Primary Outcomes (1)

• Percentage of Participants Achieving Objective Response Rate (ORR) in Subjects' With Tumors of Primary Interest (RMS, NRSTS or Ewing Sarcoma/pPNET)

  ORR was defined as the percentage of participants achieving either a Complete Response (CR) or partial Response (PR) based on the Investigator review. The responses were assessed by CT or MRI based on Response Evaluation Criteria In Solid Tumors Criteria (RECIST1.1). CR, disappearance of all target and non-target lesions; PR, at least a 30% decrease in the disease measurement, taking as reference the disease measurement done to confirm measurable disease at study enrollment, also no new lesion or progression of any non-target measurable lesion. Confirmation was based on the disease assessment at 1 cycle or at the next scheduled visit after the initial response. Only descriptive analysis performed.

  From date of first dose of study treatment up to 55 months

Secondary Outcomes (13)

• Percentage of Participants Achieving Objective Response Rate (ORR) in Subjects' With Tumors of Secondary Interest (Osteosarcoma, mNeuroblastoma, eNeuroblastoma or Hepatoblastoma)

  From date of first dose of study treatment up to 55 months

• Progression Free Survival (PFS) as Assessed by the Investigator by Cohort

  From date of first dose of study treatment up to 59 months

• Time to Progression (TTP) by Cohort

  From date of first dose of study treatment up to 59 months

• Percentage of Participants Achieving Clinical Benefit Rate (CBR) by Cohort

  From date of first dose of study treatment up to 55 months

• Duration of Response (DOR) by Cohort

  From date of first dose of study treatment up to 59 months

Study Arms (1)

Pazopanib

EXPERIMENTAL

All subjects were treated with pazopanib GW786034 tablets at a dose of 450 mg/m\^2/dose or as a powder in suspension at a dose of 225 mg/m\^2/dose. The maximum daily dose administered was to be 800 mg for the tablet and 400 mg for suspension. If 225 mg/m\^2/dose was not tolerated (\>=2 DLTs in 6 evaluable subjects), the dose for subjects who required suspension was reduced to 160 mg/m\^2/dose. A cycle was defined as 28 days with no rest periods between cycles.

Drug: Pazopanib

Interventions

Pazopanib DRUG

Pazopanib was supplied as a series of aqueous film-coated tablets containing 200 mg (oval-shaped, white, packaged in bottles containing 34 tablets each), and 400 mg (oval-shaped, white, packaged in bottles containing 68 tablets each). Pazopanib Powder for Oral Suspension was a white to slightly colour powder supplied to the clinical sites in amber glass (United State Pharmacopeia (USP) Type III) bottles with child-resistant closures. Each bottle contains 5 g of pazopanib.

Also known as: GW786034

Pazopanib

Eligibility Criteria

• Age: 1 Year - 18 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Subjects must be at least 1 and less than or equal to 18 years of age at the time of study entry.
• Patients must have had histologic verification of one of the malignancies listed below at original diagnosis or at relapse - a) Rhabdomyosarcoma, b) Non-rhabdomyosarcomatous Soft Tissue Sarcoma (including desmoplastic small round cell tumor), c) Ewing Sarcoma / Peripheral Primitive Neuroectodermal Tumor (PNET), d) Osteosarcoma, e) Neuroblastoma (Measurable), f) Neuroblastoma (Evaluable), g) Hepatoblastoma.
• Patient must have disease that has either relapsed or is refractory to prior therap
• Patients who will be receiving the tablet formulation must have a body surface area (BSA) \>= 0.84 m\^2 (square meter) at baseline.
• Patients must have radiographically measurable disease (with the exception of neuroblastoma), Measurable disease is defined as the presence of at least one lesion on magnetic resonance imaging (MRI) or computed tomography (CT) scan that can be accurately measured with the longest diameter a minimum of 10 mm in at least one dimension (CT scan slice thickness no greater than 5 mm).
• Patients with neuroblastoma who do not have measurable disease but have iodine-131 - meta-iodobenzylguanidine positive (MIBG+) evaluable disease are eligible.
• Patients must have a Lansky or Karnofsky performance status score of \>= 50, corresponding to Eastern Cooperative Oncology Group (ECOG) categories 0, 1 or 2. Use Karnofsky for subjects \>= 16 years of age and Lansky for subjects \<= 16 years of age.
• Patients must have fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study.
• Patients must not have received myelosuppressive chemotherapy within 3 weeks of enrollment onto this study (6 weeks if prior nitrosourea).
• At least 7 days must have elapsed since the completion of therapy with a growth factor that supports platelet or white cell number or function. At least 14 days must have elapsed after receiving peg-filgrastim.
• At least 7 days must have elapsed since the completion of therapy with a biologic agent. For biologic agents that have known adverse events occurring beyond 7 days after administration, the period prior to enrollment must be extended beyond the time during which adverse events are known to occur.
• Subjects may have received bevacizumab, VEGF-Trap, or other VEGF blocking tyrosine kinase inhibitors, provided that they did not progress while receiving one of these agents. Subjects may not have previously received pazopanib.
• At least 21 days must have elapsed since the completion of the last dose of VEGF-Trap, and at least 7 days since a VEGF blocking tyrosine kinase inhibitor. Subjects must have recovered from any VEGF blocking drug-related toxicity (e.g., proteinuria).
• \> = 21 days must have elapsed from infusion of last dose of antibody and toxicity related to prior antibody therapy must have recovered to Grade \<= 1.
• Radiotherapy: \>=2 weeks must have elapsed since local palliative radiotherapy (XRT) (small port); \>=3 months must have elapsed if prior Traumatic Brain Injury (TBI), craniospinal XRT or if \>=50% radiation of pelvis; \>=6 weeks must have elapsed if other substantial bone marrow irradiation was given.

You may not qualify if:

• Pregnant or breast-feeding women are not eligible for this study due to risks of fetal and teratogenic adverse events as seen in animal/human studies. Negative pregnancy tests must be obtained in girls who are post-menarchal. Males or females of reproductive potential may not participate unless they have agreed to use an effective contraceptive method beginning at the signing of the informed consent until at least 2 weeks after the last dose of the study drug. The definition of adequate contraception will be based on the judgment of the principal investigator or a designated associate. Study drug may also potentially be secreted in milk and therefore breastfeeding women are excluded.
• Males (including those who have had vasectomies) with partners who can become pregnant will need to use birth control while on this study, as will their partner. Men are advised to use condoms during sexual intercourse while on study drug and continue to use adequate contraception for at least 2 weeks after the last dose of protocol therapy.
• Patients requiring corticosteroids who have not been on a stable or decreasing dose of corticosteroid for the 7 days prior to enrollment are not eligible.
• Patients who are currently receiving another investigational drug are not eligible.
• Patients who are currently receiving other anti-cancer agents or radiation therapy are not eligible.
• Patients who are currently receiving more than one anti-hypertensive medication (Grade 3) or whose blood pressure is not well controlled are not eligible for study enrollment.
• Patients must not be on therapeutic anticoagulation (Warfarin \[coumadin\] and/or low molecular weight heparin are prohibited). Prophylactic anticoagulation (i.e. intraluminal heparin) of venous or arterial access devices is allowed.
• Patients receiving drugs with a known risk of torsades de pointes are not eligible.
• Patients who require thyroid replacement therapy are not eligible if they have not been receiving a stable replacement dose for at least 4 weeks prior to study enrollment.
• Patients who are unable to swallow tablets or liquid are not eligible.
• Patients who have an uncontrolled infection are not eligible.
• Patients will be excluded if any of the following are present, evidence of active bleeding, intratumoral hemorrhage, or bleeding diathesis; History (within 6 months prior to study enrollment) of arterial thromboembolic events, including transient ischemic attack (TIA) or cerebrovascular accident (CVA); history (within 6 months prior to study enrollment) of pulmonary embolism, deep venous thrombosis (DVT), or other venous thromboembolic event; history of clinically significant bleeding within 6 weeks prior to study enrollment.
• Patients with known involvement of the CNS by malignancy will be excluded.
• Patients who have had or are planning to have the following invasive procedures will be excluded- Major surgical procedure, laparoscopic procedure, open biopsy or significant traumatic injury within 28 days prior to Day 1 therapy (Subcutaneous port placement or central line placement is not considered major surgery but must be placed greater than 48 hours from planned Day 1 of therapy); Core biopsy within 7 days prior to Day 1 therapy; Fine needle aspirate or central line placement within 48 hours prior to Day 1therapy.
• Patients with serious or non-healing wound, ulcer, or bone fracture.

Sponsors & Collaborators

• Novartis Pharmaceuticals: lead
• Children's Oncology Group: collaborator

Study Sites (31)

Novartis Investigative Site

Long Beach, California, 90801, United States

Location

Novartis Investigative Site

Madera, California, 93638-8762, United States

Location

Novartis Investigative Site

Orange, California, 92868, United States

Location

Novartis Investigative Site

Palo Alto, California, 94304, United States

Location

Novartis Investigative Site

San Francisco, California, United States

Location

Novartis Investigative Site

Hartford, Connecticut, 06106, United States

Location

Novartis Investigative Site

Orlando, Florida, 32806, United States

Location

Novartis Investigative Site

St. Petersburg, Florida, 33701, United States

Location

Novartis Investigative Site

Chicago, Illinois, 60611, United States

Location

Novartis Investigative Site

Indianapolis, Indiana, 46202, United States

Location

Novartis Investigative Site

Minneapolis, Minnesota, 55404, United States

Location

Novartis Investigative Site

Kansas City, Missouri, 64108, United States

Location

Novartis Investigative Site

St Louis, Missouri, 63110, United States

Location

Novartis Investigative Site

Hackensack, New Jersey, 07601, United States

Location

Novartis Investigative Site

New York, New York, 10032, United States

Location

Novartis Investigative Site

Chapel Hill, North Carolina, 27599, United States

Location

Novartis Investigative Site

Charlotte, North Carolina, 28203, United States

Location

Novartis Investigative Site

Cincinnati, Ohio, 45229, United States

Location

Novartis Investigative Site

Nashville, Tennessee, 37212, United States

Location

Novartis Investigative Site

Dallas, Texas, 75235, United States

Location

Novartis Investigative Site

Fort Worth, Texas, 76104, United States

Location

Novartis Investigative Site

Houston, Texas, 77030, United States

Location

Novartis Investigative Site

Norfolk, Virginia, 23507, United States

Location

Novartis Investigative Site

Seattle, Washington, 98105, United States

Location

Novartis Investigative Site

Toronto, Ontario, M5G 1X8, Canada

Location

Novartis Investigative Site

Montreal, Quebec, H3T 1C5, Canada

Location

Novartis Investigative Site

Prague, 150 05, Czechia

Location

Novartis Investigative Site

Paris, 75248, France

Location

Novartis Investigative Site

Budapest, 1094, Hungary

Location

Novartis Investigative Site

Košice, 041 66, Slovakia

Location

Novartis Investigative Site

Madrid, 28009, Spain

Location

MeSH Terms

Conditions

Sarcoma

Interventions

pazopanib

Condition Hierarchy (Ancestors)

Neoplasms, Connective and Soft Tissue; Neoplasms by Histologic Type; Neoplasms

Results Point of Contact

• Title: Study Director
• Organization: Novartis Pharmaceuticals

Novartis.email@novartis.com

862-778-8300

Study Officials

• Novartis Pharmaceuticals

  Novartis Pharmaceuticals

  STUDY DIRECTOR

Publication Agreements

• PI is Sponsor Employee: No
• Restriction Type: OTHER
• Restrictive Agreement: Yes

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: INDUSTRY
• Responsible Party: SPONSOR

Model Details: The study design included a hierarchical 2-stage tumor response assessment with each cohort independent from one other. * Cohort 1: rhabdomyosarcoma (RMS) * Cohort 2: non-rhabdomyosarcomatous soft tissue sarcoma (NRSTS) * Cohort 3: Ewing sarcoma/pPNET * Cohort 4: osteosarcoma * Cohort 5: measurable neuroblastoma (mNeuroblastoma) * Cohort 6: evaluable neuroblastoma (eNeuroblastma) * Cohort 7: hepatoblastoma

Study Record Dates

• First Submitted: August 1, 2013
• First Posted: October 8, 2013
• Study Start: October 8, 2014
• Primary Completion: November 5, 2019
• Study Completion: November 5, 2019
• Last Updated: August 12, 2020
• Results First Posted: August 12, 2020

Record last verified: 2020-07

Data Sharing

• IPD Sharing: Will share

Locations

CZ (1); FR (1); SL (1); ES (1); US (24); CA (2); HU (1)