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RecruitingInterventionalPhase 1/Phase 2

Phase I/II Study of Silmitasertib (CX-4945) in Combination With Chemotherapy in Children and Young Adults With Relapsed Refractory Solid Tumors

NCT ID: NCT06541262Sponsor: Milton S. Hershey Medical CenterLast updated: 2026-04-09

Summary

The purpose of this study is to evaluate the investigational drug, silmitasertib (a pill taken by mouth), in combination with FDA approved drugs for solid tumors. An investigational drug is one that has not been approved by the U.S. Food \& Drug Administration (FDA), or any other regulatory authorities around the world for use alone or in combination with any drug, for the condition or illness it is being used to treat. The goals of this part of the study are: * Establish a recommended dose of silmitasertib in combination with chemotherapy * Test the safety and tolerability of silmitasertib in combination with chemotherapy in subjects with cancer * To determine the activity of study treatments chosen based on: * How each subject responds to the study treatment * How long a subject lives without their disease returning/progressing

Arms & interventions

  • DrugSilmitasertib

    Capsules

  • DrugIrinotecan

    IV

  • DrugTemozolomide

    Oral

  • DrugVincristine

    IV

Outcome measures

Primary

  • Phase I- Number of Participants with Adverse Events as a Measure of Safety and Tolerability

    To characterize the safety profile of silmitasertib in combination with chemotherapy

    Time frame: 2 years plus 30 days

  • Phase I- Number of Participants with Dose Limiting Toxicities to determine RP2D

    To determine the Recommended Phase 2 Dose (RP2D) of silmitasertib in combination with chemotherapy

    Time frame: 21 days

  • Phase II- Determine the Overall Response Rate (ORR) of Participants using INRC

    To evaluate the efficacy of silmitasertib in combination with chemotherapy in 2 disease cohorts, based upon Overall response rate (ORR)

    Time frame: 2 years

Secondary

  • Phase I- Determine the Overall Response Rate (ORR) of Participants using INRC

    Time frame: 2 years

  • Number of participants with progression free survival (PFS) during study

    Time frame: 2 years

  • Phase II- Length of time that participants experience Overall Survival (OS)

    Time frame: 7 years

  • Phase II- Number of Participants with Adverse Events as a Measure of Safety and Tolerability

    Time frame: 2 years plus 30 days

  • Phase II - Determine the Disease Control Rate (DCR) of participants based on response

    Time frame: 2 years plus 30 days

Eligibility criteria

Sex: AllAge: Up to 30 YearsHealthy volunteers: No
Inclusion Criteria: 1. Age: Less than 30 years old at initial diagnosis 2. Pathology All subjects must have a confirmed diagnosis of tumor type. Phase I: Relapsed/refractory solid tumors: Neuroblastoma, Ewing Sarcoma, Osteosarcoma, Rhabdomyosarcoma, Liposarcoma Phase II: * Relapsed/refractory Neuroblastoma * Relapsed/refractory Ewing sarcoma 3. Tumor assessment: Disease assessment is required for eligibility and must be done after last dose of previous therapy and prior to first dose of study drug. 4. Disease Status: Relapsed/Refractory Neuroblastoma Relapsed disease defined as neuroblastoma that was previously in remission after standard therapy (at least 4 cycles of aggressive multi-drug induction chemotherapy, with or without radiation and surgery, followed by immunotherapy, or according to a standard high-risk treatment/neuroblastoma protocol) and has now relapsed and is in any number of relapses. Refractory disease defined as High-risk neuroblastoma (as defined by INRG) that failed to achieve CR after at least 4 cycles of aggressive multi-drug induction chemotherapy, progression during upfront therapy or with disease remaining after standard immunotherapy. International Neuroblastoma Risk Group Staging System (INRG) High Risk NB defined as one of the following: 1. Any age with International Neuroblastoma Risk Group (INRG) Stage L2, MS, or M with MYCN amplification 2. Age ≥ 547 days and INRG Stage M regardless of biologic features 3. Any age initially diagnosed with INRG Stage L1 MYCN amplified NBL who have progressed to Stage M without systemic chemotherapy 4. Age ≥ 547 days of age initially diagnosed with INRG Stage L1, L2, or MS who have progressed to Stage M without systemic chemotherapy Relapsed/refractory Sarcoma Subjects that have relapsed following standard of care therapy or having progressed during standard of care therapy. Standard of care therapy for sarcoma includes multi-agent chemotherapy with local control consisting of either surgery or radiation therapy. 5. Measurable or evaluable disease, including at least one of the following: * Measurable tumor by CT or MRI * MIBG or PET that is positive for disease * Bone Marrow biopsy/aspirate that is positive for disease 6. Timing from prior therapy: Subjects must have fully recovered from the acute toxic effects of all prior anti- cancer therapy and be within the following timelines: 1. Myelosuppressive chemotherapy: Must not have received within 2 weeks of enrollment onto this study. 2. Small Molecule Inhibitors (anti-neoplastic agent): At least 2 weeks from the completion of therapy with a small molecule inhibitor. 3. Immunotherapy: At least 4 weeks since the completion of any type of immunotherapy, e.g. tumor vaccines, CAR-T cells, anti-GD2 Monoclonal antibodies (ex. naxitamab, dinutuximab, etc.). 4. Radiotherapy: At least 30 days since the last treatment except for radiation delivered with palliative intent to a non-target site. 5. Stem Cell Transplant: * Allogeneic: No evidence of active graft vs. host disease * Allogeneic/Autologous: ≥ 2 months must have elapsed since transplant. 6. MIBG Therapy: At least 6 weeks since treatment with MIBG therapy. 7. Subjects must have a Lansky or Karnofsky Performance Scale score of \>/= 50. 8. Subjects must have adequate organ function at the time of enrollment: * Cardiac: Subjects must have a QTcF ≤ 480 msc. * Hematological: Hematological recovery as defined by ANC ≥750/μL * Liver: Adequate liver function as defined by AST and ALT \<5x upper limit of normal * Renal: Subjects must have adequate renal function defined as an estimated Glomerular Filtration rate (eGFR) as calculated from the Bedside Schwartz equation (in units of mL/min/1.73 m2) or via radioisotope GFR ≥ 70. The Bedside Schwartz equation is: \[(0.413) X (Height in cm)\] / SCr 9. Subjects of childbearing potential must have a negative serum pregnancy test. Subjects of childbearing potential must agree to use effective measures to avoid pregnancy. 10. Written informed consent in accordance with institutional and FDA guidelines must be obtained from all subjects (or subjects' legal representative). Exclusion Criteria: 1. Investigational Drugs: Subjects who are currently receiving another investigational drug are excluded from participation. 2. Anti-cancer Agents: Subjects who are currently receiving other anticancer agents are not eligible. Subjects must have fully recovered from the hematological and bone marrow suppression effects of prior therapy. 3. Subjects who are currently receiving Vitamin K antagonists (warfarin). 4. Subjects who are currently receiving the class of lipid-lowering medications HMG-CoA reductase inhibitors (statins). 5. Infection: Subjects who have an uncontrolled infection are not eligible until the infection is judged to be well controlled in the opinion of the investigator. 6. Subjects who, in the opinion of the investigator, may not be able to comply with the safety monitoring requirements of the study, or in whom compliance is likely to be suboptimal, should be excluded. 7. Subjects with any clinically significant unrelated systemic illness (serious infections or significant cardiac, pulmonary, hepatic or other organ dysfunction), that in the opinion of the investigator would compromise the subject's ability to tolerate protocol therapy, put them at additional risk for toxicity or would interfere with the study procedures or results. 8. Subjects with any of the following gastrointestinal disorders: 1. Active malabsorption (e.g. short gut) syndrome. 2. Uncontrolled diarrhea (excess of 4 stools/day) 3. Gastritis, ulcerative colitis, Chron's disease or hemorrhagic coloproctitis 4. History of gastric or small bowel surgery involving any extent of gastric or small bowel resection 9. Lactating subjects are not eligible unless they have agreed to not breastfeed their infants. There is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the nursing subject with silmitasertib. (NOTE: breast milk cannot be stored for future use while the nursing subject is being treated on study.) 10. Subjects with a history of any other malignancy.

Study locations (20)

University of Alabama/Children's of Alabama

Birmingham, Alabama, 35233

Recruiting
Bridget Tate · Contact
Elizabeth Alva · Principal Investigator

Phoenix Children's Hospital

Phoenix, Arizona, 85016

Recruiting
Brianna Lent · Contact
Francis Eshun · Principal Investigator

UCSF Benioff Children's Hospital Oakland

Oakland, California, 94609

Recruiting
Group Contact · Contact
Jennifer Michlitsch · Principal Investigator

Rady Children's Hospital

San Diego, California, 92123

Recruiting
Megan Saenz · Contact
William Roberts · Principal Investigator

University of Florida

Gainesville, Florida, 32611

Recruiting
Ashley Bayne · Contact
Joanne Lagmay · Principal Investigator

Nicklaus Children's Hospital

Miami, Florida, 33155

Recruiting
Aixa Guadarrama · Contact
Maggie Fader · Principal Investigator

Arnold Palmer Hospital for Children

Orlando, Florida, 32806

Recruiting
Marie Frankos · Contact
Jaime Libes-Bander · Principal Investigator

All Children's Hospital Johns Hopkins Medicine

St. Petersburg, Florida, 33701

Recruiting
Kevin Samnarine · Contact
Jennifer Dean · Principal Investigator

St. Joseph's Children's Hospital

Tampa, Florida, 33614

Recruiting
Jennifer Manns, RN · Contact
Don Eslin · Principal Investigator

Kapiolani Medical Center for Women and Children

Honolulu, Hawaii, 96813

Recruiting
Andrea Siu, MPH · Contact
Kelley Hutchins · Principal Investigator

Norton Children's Research Institute/Affiliated with University of Louisville School of Medicine

Louisville, Kentucky, 40202

Recruiting
Jennifer Miller · Contact
Michael Ferguson · Principal Investigator

Children's Mercy Hospitals and Clinics

Kansas City, Missouri, 64108

Recruiting
Nicole Harvey · Contact
Kevin Ginn · Principal Investigator

Cardinal Glennon Children's Medical Center

St Louis, Missouri, 63104

Recruiting
Gina Martin · Contact
William Ferguson · Principal Investigator

Hackensack University Medical Center

Hackensack, New Jersey, 07601

Recruiting
Kellie Daniel · Contact
Katharine Offer · Principal Investigator

Penn State Milton S. Hershey Medical Center and Children's Hospital

Hershey, Pennsylvania, 17033

Recruiting
Suzanne Treadway · Contact
Valerie Brown · Principal Investigator

Hasbro Children's Hospital

Providence, Rhode Island, 02903

Recruiting
Christopher Bouressa · Contact
Bradley DeNardo · Principal Investigator

Monroe Carrell Jr. Children's Hospital at Vanderbilt

Nashville, Tennessee, 37232

Recruiting
Aida Constantinescu · Contact
Daniel Benedetti · Principal Investigator

Children's Medical Center

Dallas, Texas, 75235

Recruiting
Rachel Nam · Contact
Tanya Watt · Principal Investigator

Primary Children's Hospital

Salt Lake City, Utah, 84113

Recruiting
Group Contact · Contact
Matthew Dietz · Principal Investigator

Virginia Commonwealth University

Richmond, Virginia, 23284

Recruiting
Mary Madu · Contact
Madhu Gowda · Principal Investigator