ASTX727 for the Treatment of Malignant Nerve Sheath Tumors with PRC2 Mutation Loss

Inclusion Criteria

• Patients must have pathologically confirmed PRC2 loss MPNSTs (e.g. IHC of loss H3K27me2 and/or H3K27me3 immunostaining, and/or inactivating mutations in EED, SUZ12, EZH2 by Clinical Laboratory Improvement Act [CLIA] approved genetic assays), which are advanced, unresectable or metastatic and have progressed on at least one line of standard of care systemic therapy, or administration of cytotoxic chemotherapy is not considered in the best interest for the patient
• Patients must be at least 18 years of age
• Patients must have Eastern Cooperative Oncology Group (ECOG) performance status of =< 2
• Disease must be measurable by RECIST 1.1
• Patients must be able to take oral medications
• Patient or legally authorized representative can understand and comply with the protocol and must sign an informed consent document
• Serum creatinine =< 1.5 x upper limit of normal (ULN)
• Total serum bilirubin =< 1.5 x ULN
• Serum aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) =< 2.5 x ULN (or =< 5.0 x ULN if considered due to tumor [liver metastases])
• Serum alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) =< 2.5 x ULN (or =< 5.0 x ULN if considered due to tumor [liver metastases])
• Absolute neutrophil count (ANC) >= 1500/uL
• Platelets >= 75,000/uL
• Hemoglobin >= 9 g/dL (can be transfused to achieve this)
• Prothrombin time (PT) =< 1.5 x ULN. Patients on a stable maintenance regimen of anticoagulation therapy for at least 30 days prior to screening may have PT/international normalized ratio (INR) measurements > 1.5 x ULN
• INR =< 1.5 x ULN. Patients on a stable maintenance regimen of anticoagulation therapy for at least 30 days prior to screening may have PT/INR measurements > 1.5 x ULN
• Partial thromboplastin time =< 1.5 x ULN
• Patients of childbearing potential must have a negative serum pregnancy test at screening and at cycle 1 day 1 (-3 days) prior to the first dose of study therapy being administered. Female patients of childbearing potential must agree to use two reliable methods of contraception starting at signing the Informed Consent Form (ICF), during and for 6 months following the last dose of study drug
• Women must agree not to breastfeed during treatment with study drug and for 2 weeks after the last dose
• Sexually active males must agree to use a condom during intercourse and agree to not donate sperm while taking the drug and for 3 months after stopping treatment and should not father a child in this period. A condom is required to be used also by vasectomized men to prevent delivery of the drug via seminal fluid

Exclusion Criteria

• Patients have a severe and/or uncontrolled medical disease (e.g., uncontrolled diabetes, chronic renal disease, or active uncontrolled infection)
• Patients have known active brain metastasis or leptomeningeal disease
• Active or chronic infection with hepatitis C virus (HCV) or hepatitis B virus (HBV) or known active or chronic infection with human immunodeficiency virus (HIV). Prior hepatitis infection that has been treated with highly effective therapy with no evidence of residual infection (including undetectable viral loads while on antiviral therapy) and with normal liver function (ALT, AST, total and direct bilirubin =< ULN) is allowed
• Known active tuberculosis
• Concurrent active inoperable locally advanced or metastatic malignancy (except for malignancies which the treating investigator determines are unlikely to interfere with treatment and safety analysis or are less of a treatment priority than their diagnosis of advanced MPNST)
• Patients have clinically significant cardiovascular disease, including any of the following: * History of acute coronary syndrome including myocardial infarction, unstable angina, coronary artery bypass graft (CABG), coronary angioplasty or stenting < 6 months prior to screening; * Symptomatic chronic heart failure (New York Heart Association Criteria, class II-IV); * Evidence of clinically significant cardiac arrhythmias and/or conduction abnormalities < 6 months prior to screening except atrial fibrillation (AF) and paroxysmal supraventricular tachycardia (PSVT)
• A screening Fridericia corrected QT interval (QTcF) >= 450 ms (men) or >= 470 ms (women) (average of triplicates)
• Left ventricular ejection fraction (LVEF) < 50% as determined by a multigated acquisition (MUGA) scan or echocardiogram
• History of thromboembolic or cerebrovascular events =< 3 months prior to starting study treatment, including transient ischemic attacks, cerebrovascular accidents, deep vein thrombosis or pulmonary emboli
• Impairment of gastrointestinal function or gastrointestinal disease (e.g., uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, ulcerative diseases, bowel resection with decreased intestinal absorption)
• Patients had a major surgery within 3 weeks prior to study entry or who have not recovered from side effects of such procedure
• Patients with any significant history of non-compliance to medical regimens or with inability to grant reliable informed consent
• Treatment with anti-cancer therapy within 14 days prior to the first dose of study drug therapy. For prior biological therapies, e.g., monoclonal antibodies with a half-life longer than 3 days, the interval must be at least 28 days prior to the first dose of study drug