Phase 1/2 Trial to Evaluate the Safety and Efficacy of PEEL-224 in Combination With Vincristine and Temozolomide in Adolescents and Young Adults With Relapsed or Refractory Sarcomas
Summary
This research is being done to test a new drug called PEEL-224 in combination with two commercially available drugs, Vincristine and Temozolomide, and to determine how effective this combination of drugs is at treating Ewing Sarcoma (EWS) and Desmoplastic Small Round Cell Tumor (DSRCT), as well as multiple other kinds of sarcomas. The names of the study drugs and biological agents involved in this study are: * PEEL-224 (a type of Topoisomerase 1 inhibitor) * Vincristine (A type of vinca alkaloid) * Temozolomide (A type of alkylating agent) * Pegfilgrastim or Filgrastim (types of Myeloid growth factors)
Detailed description
This is an open-label, single-arm, non-randomized, phase I/II trial to test a new drug called PEEL-224 in combination with two commercially available drugs, Vincristine and Temozolomide, and to determine how effective this combination of drugs is at treating Ewing Sarcoma (EWS) and Desmoplastic Small Round Cell Tumor (DSRCT), as well as multiple other kinds of sarcomas. This is the first time that PEEL-224 will be given in combination with Vincristine and Temozolomide to humans. In Phase 1, the safety and tolerability of PEEL-224 in combination with Vincristine and Temozolomide will be assessed by dose escalation and establishment of a Recommended Phase 2 Dose. In Phase 2 the efficacy of the drug combination will be assessed in three separate cohorts of participants. The U.S. Food and Drug Administration (FDA) has not approved PEEL-224 as a treatment for Relapsed or Refractory Sarcoma. The U.S. Food and Drug Administration (FDA) has not approved Vincristine and Temozolomide for Relapsed or Refractory Sarcoma, but it has been approved for other uses. The research study procedures include screening for eligibility, study treatment in-clinic visits, X-rays, Computerized Tomography (CT) scans, Magnetic Resonance Imaging (MRI) scans, or Positron Emission Tomography (PET) scans, blood tests, urine tests, and electrocardiograms (ECGs). Participants will receive study treatment for up to 34 cycles (approximately 2 years) and will be followed for up to 1 year after the last participant has received the last dose of treatment. It is expected that about 63 people will take part in this research study. PEEL Therapeutics is funding this research study by providing the study drug, PEEL-224.
Arms & interventions
- DrugPEEL-224
Topoisomerase 1 inhibitor, 200mg amber vial, via intravenous (into the vein) infusion per protocol.
- DrugTemozolomide
Alkylating agent, 5, 20, 100, 140, 180, or 250 mg capsule, taken orally per standard of care.
- DrugVincristine
Vinca alkaloid, 1 or 2mL vials, via intravenous (into the vein) infusion per institutional policy.
- BiologicalPegfilgrastim
Myeloid growth factor administered per institutional standards.
- BiologicalFilgrastim
Myeloid growth factor administered per institutional standards.
Outcome measures
Primary
Maximum Tolerated Dose (MTD) (Phase 1)
The MTD is determined by a Continual Reassessment Method (CRM) design and defined as the dose level with the posterior probability of dose-limiting toxicity (DLT) closest to the target toxicity rate of 0.3 with a maximum sample size of 15. The DLT observation period is up to 35 days long, beginning at the first dose of any of the three drugs in cycle 1 and ending at the occurrence of a DLT.
Time frame: Up to 35 days
Number of Participants with Dose-Limiting Toxicities (Phase 1)
Any ≥ Grade 2 CTCAE v5 adverse events that are possibly, probably, or definitely attributable to the combination of Vincristine, PEEL-224, and Temozolomide and within the first 35 days, beginning at the first dose of any of the three drugs in cycle 1 and ending at the occurrence of DLT or at the start of treatment in cycle 2 (whichever occurs first). To be evaluable for dose-limiting toxicity, a participant must also receive at least 75% of prescribed agents in cycle 1 and be followed for at least 35 days during cycle 1 or to the start of cycle 2 (whichever occurs first).
Time frame: Up to 35 days
Number of Participants with DLTs (Phase 2)
A safety monitoring rule will be applied to Phase 2 of the study for the overall participant cohort. The DLT observation period is up to 35 days long, beginning at the first dose of any of the three drugs in cycle 1 and ending at the occurrence of DLT or at the start of treatment in cycle 2 (whichever occurs first).
Time frame: Up to 35 days
Objective Response Rate EWS Cohort (Phase 2)
ORR is defined as the percentage of participants achieving complete response (CR) or partial response (PR) on treatment based on RECIST 1.1 criteria. Evaluable participants must have measurable disease at screening, be treated at RP2D dose, have received at least one dose of study drug, and either have evidence of clinical progression or have had at least one follow-up disease evaluation of their RECIST measurable disease after initiation of protocol therapy. The proportion of responders is calculated as the (number of responders) / (number of evaluable participants).
Time frame: Up to 5 years (based on accrual duration of 2 years)
Objective Response Rate DSRCT Cohort (Phase 2)
ORR is defined as the percentage of participants achieving complete response (CR) or partial response (PR) on treatment based on RECIST 1.1 criteria. Evaluable participants must have measurable disease at screening, be treated at RP2D dose, have received at least one dose of study drug, and either have evidence of clinical progression or have had at least one follow-up disease evaluation of their RECIST measurable disease after initiation of protocol therapy. The proportion of responders is calculated as the (number of responders) / (number of evaluable participants).
Time frame: Up to 5 years (based on accrual duration of 2 years)
Secondary
Objective Response Rate Other Sarcoma Cohort
Time frame: Up to 5 years (based on accrual duration of 2 years)
Median Progression-Free Survival (PFS) Other Sarcoma Cohort
Time frame: Approximately 2 years
Overall Survival (OS) Other Sarcoma Cohort
Time frame: Up to 5 years (based on accrual duration of 2 years)
Median PFS EWS Cohort
Time frame: Approximately 2 years
OS EWS Cohort
Time frame: Up to 5 years (based on accrual duration of 2 years)
Median PFS DSRCT Cohort
Time frame: Approximately 2 years
OS DSRCT Cohort
Time frame: Up to 5 years (based on accrual duration of 2 years)
Peak Plasma Concentration (Cmax) of PEEL-224
Time frame: Days 1, 2, 3, and 8 of Cycle 1 (21 days per cycle)
Area Under the Plasma Concentration Versus Time Curve (AUC) of PEEL-224
Time frame: Days 1, 2, 3, and 8 of Cycle 1 (21 days per cycle)
Peak Time (Tmax) of PEEL-224
Time frame: Days 1, 2, 3, and 8 of Cycle 1 (21 days per cycle)
Circulating Tumor DNA (ctDNA) Burden EWS Cohort at Baseline
Time frame: Baseline
ctDNA Burden EWS Cohort at Day 8
Time frame: Day 8
ctDNA Burden DSRCT Cohort at Baseline
Time frame: Baseline
ctDNA Burden DSRCT Cohort at Day 8
Time frame: Day 8
≥ Grade 2 Treatment-Related Toxicity Rate (Phase 1)
Time frame: Approximately 2 years
≥ Grade 2 Treatment-Related Toxicity Rate (Phase 2)
Time frame: Approximately 2 years
Median Duration of Overall Response (DOR) (Phase 2)
Time frame: Approximately 2 years
Median Duration of Complete Response (CR) (Phase 2)
Time frame: Approximately 2 years
Median Duration of Stable Disease (Phase 2)
Time frame: Approximately 2 years
Eligibility criteria
Study locations (3)
Boston Children's Hospital
Boston, Massachusetts, 02115
Dana-Farber Cancer Institute
Boston, Massachusetts, 02115
Brigham and Women's Hospital
Boston, Massachusetts, 02215