Talazoparib and Irinotecan Hydrochloride with or without Temozolomide in Treating Younger Patients with Refractory or Recurrent Solid Malignancies
This phase I trial studies the side effects and best dose of talazoparib when given with irinotecan hydrochloride with or without temozolomide in treating younger patients with solid malignancies that do not respond to treatment or have come back after a period of time during which the cancer could not be detected. Talazoparib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as irinotecan hydrochloride and temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether talazoparib and irinotecan hydrochloride work better when given with or without temozolomide in treating younger patients with refractory or recurrent solid malignancies.
Inclusion Criteria
- Patients with refractory or recurrent solid tumors for which there is no standard therapy are eligible; patients must have had histologic verification of malignancy at original diagnosis or at the time of relapse
- Patients must have a body surface area (BSA) of >= 0.42 m^2 at the time of study enrollment
- Patients must have either measurable or evaluable disease
- Life expectancy: at least 8 weeks
- Performance status: Karnofsky >= 50 for patients > 16 years of age; Lansky >= 50 for patients =< 16 years of age
- Patients who have received prior therapy with an irinotecan-based or temozolomide-based regimen are eligible; patients who have received prior therapy with a PARP inhibitor other than talazoparib are eligible; however, patients who have progressed on a PARP inhibitor plus irinotecan regimen are not eligible
- Patients with solid tumors not metastatic to bone marrow:
- Peripheral absolute neutrophil count (ANC) >= 1,000/mm^3
- Platelet count >= 100,000/mm^3 (no transfusion within 7 days of enrollment)
- Hemoglobin >= 9 g/dL (with or without support)
- Patients with solid tumors metastatic to bone marrow will be eligible for study but not evaluable for hematologic toxicity; these patients must not be known to be refractory to red cell or platelet transfusions; at least 2 of every cohort of 3 patients must be evaluable for hematologic toxicity; if dose limiting hematologic toxicity is observed at any dose level, all subsequent patients enrolled must be evaluable for hematologic toxicity
- Serum creatinine concentration =< 3 x the institutional upper limit of normal (ULN) or creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 ml/min/1.73 m^2
- For Part A participants: serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) concentration =< 5 x the institutional ULN
- For Part A participants: total bilirubin concentration =< 2 x the institutional ULN for age
- For Part A participants: serum albumin >= 2 g/dL
- For Part B participants: SGPT (ALT) concentration < 2.5 x institutional ULN
- For Part B participants: total bilirubin concentration =< 1.5 x the institutional ULN for age
- For Part B participants: serum albumin >= 2g/dL
- Patients must have fully recovered from the acute toxic effects of chemotherapy, immunotherapy, surgery, or radiotherapy prior to entering this study: * Myelosuppressive chemotherapy: patient has not received myelosuppressive chemotherapy within 3 weeks of enrollment onto this study (6 weeks if prior nitrosourea) * Hematopoietic growth factors: at least 7 days must have elapsed since the completion of therapy with a growth factor; at least 14 days must have elapsed after receiving pegfilgrastim * Biologic (anti-neoplastic agent): at least 7 days must have elapsed since completion of therapy with a biologic agent; for agents that have known adverse events occurring beyond 7 days after administration, this period prior to enrollment must be extended beyond the time during which adverse events are known to occur * Monoclonal antibodies: at least 3 half-lives must have elapsed since prior therapy that included a monoclonal antibody * Radiotherapy: at least 2 weeks must have elapsed since any irradiation; at least 6 weeks must have elapsed since craniospinal radiation therapy (RT) or substantial bone marrow irradiation
- All patients and/or their parents or legally authorized representatives must sign a written informed consent; assent will be obtained, when appropriate, according to institutional guidelines
Exclusion Criteria
- Pregnant or breastfeeding; if sexually active and with childbearing potential, must agree to use effective method of contraception, such as intrauterine device, bilateral tubal ligation for >= 6 months before randomization, partner vasectomized for >= 6 months before randomization, and sexual abstinence when in relation to the preferred and usual lifestyle of the subject; male subjects must use a condom when having sex with a pregnant woman and when having sex with a woman of childbearing potential from the time of the first dose of study drug through 105 days after the last dose of study drug; contraception should be considered for a nonpregnant female partner of childbearing potential; male subjects with partners of childbearing potential must use a condom and contraception should be considered for the female partner from the time of the first dose of study drug through 105 days after the last dose of study drug; male subjects whose partners are pregnant should use condoms for the duration of the pregnancy Male and female subjects must agree not to donate sperm or eggs, respectively, from the first dose of study drug through 105 days and 45 days after the last dose of study drug, respectively (hormonal contraception is not allowed) prior to study entry, during treatment, and for 45 days after last dose of study drug; females considered not of childbearing potential include those who are surgically sterile (bilateral salpingectomy, bilateral oophorectomy, or hysterectomy) or who are post menopausal, defined as: < 55 years of age with no spontaneous menses for >= 12 months before randomization and with a postmenopausal follicle stimulating hormone (FSH) concentration > 30 IU/L (or meeting criteria for post-menopausal status by the local laboratory) If females with childbearing potential, a negative serum pregnancy test at screening and willing to have additional serum and urine pregnancy tests during the study [Note: Females without childbearing potential include those in menopause >= 2 years, with tubal ligation >=1 year before screening, or with total hysterectomy]
- Concomitant medications * Corticosteroids: patients receiving corticosteroids that have not been on a stable or decreasing dose for at least 7 days prior to enrollment are not eligible * Investigational drugs: patients cannot receive other investigational drugs while on this study * Anti-graft-versus-host disease (GVHD) drugs post-transplant: patients receiving cyclosporine, tacrolimus or other GVHD agents are not eligible
- Prior treatment with talazoparib
- Unable to swallow capsules
- Active, uncontrolled infection
- Prior solid organ transplant
- Prior total body irradiation (TBI)
- Unwilling or unable to comply with the safety monitoring requirements of this protocol
Study sponsor and potential other locations can be found on ClinicalTrials.gov for NCT02392793.
PRIMARY OBJECTIVES:
I. To estimate the maximum tolerated doses (MTDs) of talazoparib (daily, days 1-6) combined with irinotecan (irinotecan hydrochloride) (daily, days 2-6) given every 21 days in children with refractory or recurrent solid malignancies. (Arm A)
II. To identify and describe the dose limiting toxicities of talazoparib and irinotecan administered in combination to patients with refractory or recurrent solid malignancies. (Arm A)
III. To estimate the maximum tolerated dose (MTD) of temozolomide (given daily, days 2-6) when combined with talazoparib (daily, days 1-6) and irinotecan (daily, days 2-6) given every 21 days in children with refractory or recurrent solid malignancies. (Arm B)
IV. To identify and describe the dose limiting toxicities of temozolomide, talazoparib and irinotecan administered in combination to patients with refractory or recurrent solid malignancies. (Arm B)
SECONDARY OBJECTIVES:
I. To estimate the response rate, within the confines of a phase I study, to talazoparib plus irinotecan and talazoparib plus irinotecan and temozolomide administered in combination in pediatric patients with refractory or recurrent solid malignancies.
II. To characterize the pharmacokinetics of talazoparib plus irinotecan and talazoparib plus irinotecan and temozolomide when given in combination to children with refractory or recurrent solid malignancies.
OUTLINE: This is a dose escalation study of talazoparib and temozolomide. Patients are assigned to 1 of 2 treatment arms.
ARM A (CLOSED TO ENROLLMENT): Patients receive talazoparib orally (PO) once daily (QD) or twice daily (BID) on day 1 and QD on days 2-6. Patients also receive irinotecan hydrochloride intravenously (IV) over 60 minutes on days 2-6. Treatment repeats every 21 days for up to 34 courses in the absence of disease progression or unacceptable toxicity.
ARM B: Patients receive talazoparib and irinotecan hydrochloride as in Arm A. Patients also receive temozolomide PO QD on days 2-6. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up periodically.
Trial PhasePhase I
Trial Typetreatment
Lead OrganizationSaint Jude Children's Research Hospital
Principal InvestigatorSara Michele Federico
- Primary IDBMNIRN
- Secondary IDsNCI-2015-00255, NCI-2015-00215
- ClinicalTrials.gov IDNCT02392793