Molecularly-Guided Phase II Umbrella Trial for Children, Adolescents, and Young Adults Newly Diagnosed With High-Grade Glioma, Including Diffuse Intrinsic Pontine Glioma
Summary
The goal of this study is to perform genetic sequencing on brain tumors from children, adolescents, and young adult patients who have been newly diagnosed with a high-grade glioma. This molecular profiling will decide if patients are eligible to participate in a subsequent treatment-based clinical trial based on the genetic alterations identified in their tumor.
Detailed description
A novel, molecularly-guided, multi-arm phase umbrella II trial is proposed in children, adolescents, and young adults with newly diagnosed HGG, including DIPG, in which we will (1) conduct comprehensive molecular screening of tumor tissue using a multi-omic approach (WES/WGS, gene fusion panels/RNASeq, DNA methylation microarray) across international CONNECT genomics cores with rapid return of clinical results, (2) stratify patients to biologically-targeted treatment arms, based on the tumor molecular profile and histopathology, and (3) perform longitudinal evaluation of peripheral blood, cerebrospinal fluid (CSF), and/or tumor tissue as well as advanced neuro-imaging to determine genomic, immune, and radiologic biomarkers predictive of response, recurrence, resistance, and toxicity. Based on results of the above tumor molecular profiling and pathology-based confirmation of HGG diagnosis, eligible patients will be assigned to one of several biologically guided treatment arms on a phase II trial. Approximately 300-350 patients will be enrolled on the screening protocol through which biospecimens (paired tumor DNA/RNA and normal comparator samples) will undergo extensive molecular profiling and/or there will be comprehensive central molecular and pathology review of previously obtained molecular results to assess eligibility to any of the therapeutic subprotocols of the phase II study.
Outcome measures
Primary
Molecular profiling
Utilize molecular, clinical, and histopathologic data to assess eligibility for specific biologically-guided treatment subprotocols among pediatric, adolescent and young adult patients with newly diagnosed HGG, including DIPG.
Time frame: 4 years
Feasibility of molecular profiling and enrollment to a TarGeT treatment protocol
Determine the percent of pediatric, adolescent, and young adult patients newly diagnosed with HGG, including DIPG, who undergo screening through one of three TarGeT-SCR screening mechanisms and are assigned to a TarGeT treatment arm.
Time frame: 4 years
Secondary
Genomic Research
Time frame: 6 years
Germline susceptibility testing
Time frame: 4 years
Biobanking
Time frame: 4 years
Progression Free Survival
Time frame: 4 years
Feasibility of Assignment
Time frame: 4 years
Descriptively analyze patients not assigned
Time frame: 4 years
Overall Survival
Time frame: 4 years
Eligibility criteria
Study locations (11)
Children's Hospital Colorado
Aurora, Colorado, 80045
Children's National Medical Center
Washington D.C., District of Columbia, 20010
Ann & Robert H. Lurie Children's Hospital of Chicago
Chicago, Illinois, 60611
Dana-Farber Cancer Institute
Boston, Massachusetts, 02215
C.S. Mott Children's Hospital
Ann Arbor, Michigan, 48109
Duke University Health System
Durham, North Carolina, 27708
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, 45229
Nationwide Children's Hospital
Columbus, Ohio, 43205
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, 19104
Texas Children's Hospital
Houston, Texas, 77030
Seattle Children's Hospital
Seattle, Washington, 98105