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New treatment option for Diffuse Intrinsic Pontine Glioma
Official title Combination Therapy for the Treatment of Diffuse Midline Gliomas
ClinicalTrials.gov ID: NCT05009992
What this study is testing
What is ONC201?
ONC201 is an investigational medicine, given as an once-weekly infusion into a vein, being studied as a potential treatment for diffuse intrinsic pontine glioma.
Also referred to as TIC10, Antagonist of dopamine receptor D2 (DRD2) and caseinolytic protease proteolytic subunit (ClpP).
Plain-language explanation of the investigational treatment - it is being studied and is not an approved or proven therapy. The study team can confirm the details.
- What it's testing
- This phase II trial determines if the combination of ONC201 with different drugs is effective for treating participants with diffuse midline gliomas (DMGs). Despite years of research, little to no progress has been made to improve outcomes for participants with DMGs, and there are few treatment options.
- Phase 2: a mid-size study of how well it works
- Time commitment: about 5 years
- Which group you join is decided by chance.
A plain-language read of the study's public ClinicalTrials.gov listing. The study team confirms the details.
Who can take part
Ages 2 to 39
You may be able to join if
- --COHORTS 1, 2, AND 3 CLOSED--- COHORT 1A AND 1B:
- New diagnosis of DMG with imaging and/or pathology consistent with a DMG, including spinal cord tumors. In cohort 1B, previous tumor tissue...
- Must be within 6 weeks of diagnosis to begin standard of care radiation therapy on study. COHORT 2A AND 2B:
- Diagnosis of DMG with imaging and/or pathology consistent with a DMG, including spinal cord tumors, who have complete standard-of-care radiation...
- Participants must be within 4-14 weeks of completion of radiation. Radiation should have started within 6 weeks of diagnosis. COHORT 3A AND 3B:
You likely can't join if
- COHORT 1A AND 1B:
- Prior exposure to radiation therapy.
- Thalamic and Cerebellar H3K27M DMG. COHORT 2A AND 2B:
- For tumors that do not have a pontine or spinal cord epicenter the following specific exclusion criteria apply:
- Thalamic and Cerebellar H3K27M DMG that has undergone standard radiation without concurrent therapy (other than temozolomide). COHORT 1A AND 2A:
- Deemed not appropriate for tissue resection/biopsy. COHORT 3A AND 3B:
See the full eligibility criteria
Who can join
- --COHORTS 1, 2, AND 3 CLOSED--- COHORT 1A AND 1B:
- New diagnosis of DMG with imaging and/or pathology consistent with a DMG, including spinal cord tumors. In cohort 1B, previous tumor tissue confirmation of DMG is mandatory and pathology must be consistent with a DMG...
- Must be within 6 weeks of diagnosis to begin standard of care radiation therapy on study. COHORT 2A AND 2B:
- Diagnosis of DMG with imaging and/or pathology consistent with a DMG, including spinal cord tumors, who have complete standard-of-care radiation therapy. In Cohort 2B, previous tumor tissue confirmation of DMG is...
- Participants must be within 4-14 weeks of completion of radiation. Radiation should have started within 6 weeks of diagnosis. COHORT 3A AND 3B:
- Diagnosis of recurrent DMG with imaging and/or pathology consistent with a DMG, including spinal cord tumors, who have complete standard-of-care radiation therapy. In cohort 3B, previous tumor tissue confirmation of DMG...
- Participants must have evidence of progression and not have received any treatment for this progression and have not previously received re-irradiation. COHORT 4A AND 4B:
- Diagnosis of DMG with imaging and/or pathology consistent with a DMG, including spinal cord tumors. In cohort 4B\^1, previous tumor tissue confirmation of DMG is mandatory and pathology must be consistent with a DMG...
- Not currently eligible for any other clinical trials that include administration of ONC201. Cohort 4A\^1 and 4B\^1 (participants with newly diagnosed DMG prior to radiation): Must be able to begin standard of care...
- Diagnosis of DMG with imaging and/or pathology consistent with a DMG, including spinal cord tumors. In cohort 5\^1, previous tumor tissue confirmation of DMG is mandatory and pathology must be consistent with a DMG...
- Not currently eligible for any other clinical trials that include administration of ONC201.
- Multifocal and leptomeningeal disease will be eligible for Cohort 5.
- Participant's tumor must demonstrate one of the following molecular alterations considered targetable by an approved agent:
- BRAFV600E
- PDGFRA (DNA point mutation or amplification with \>=5 copy numbers)
- FGFR1 (DNA point mutation, gene fusions, or amplification with \>=5 copy numbers)
- NF1 Cohort 5\^1 (participants pre-radiation): Must be able to begin standard of care radiation therapy on study within 6 weeks of diagnosis. Cohort 5\^2 (participants post-radiation): Participants must be within 4-14...
- Age 2 to 39 years
- Participants must have recovered from all acute side effects of prior therapy and be beyond the window for expected ongoing acute toxicities. Any number of prior therapies are allowed.
- Prior ONC201 exposure is allowed, except in participants who have participated in Chimerix trials investigating ONC201 in the upfront setting. Participants who participated in trials investigating ONC201 in the upfront...
- Participant body weight must be above the minimum necessary for the participant to receive ONC201 (at least 10 kilograms (kg))
- From the projected start of scheduled study treatment, the following time periods must have elapsed: At least 7 days after last dose of a biologic agent or beyond time during which adverse events are known to occur for...
- Dosing limitations are as follows:
- \ Bevacizumab (or equivalent) for up to a maximum of 5 doses, dosing per institutional standard. There is no required washout period.
- Prior use of temozolomide during radiation at maximum of the standard pediatric dosing (defined as 90 mg/m2 /dose continuously during radiation therapy for 42 days) or dexamethasone is allowed. Any other agent given...
- Corticosteroids: Participants who are receiving dexamethasone must be on a stable or decreasing dose for at least 3 days prior to baseline magnetic resonance imaging (MRI) scan.
- The participant must have adequate organ function defined as:
- Peripheral absolute neutrophil count (ANC) \>= 750/mm\^3 (1.0g/l) AND
- Platelet count \>= 75,000/mm\^3 (100x10\^9/l) (transfusion independent, defined as not receiving platelet transfusions for at least 7 days prior to enrollment).
- Creatinine clearance or radioisotope glomerular filtration rate (GFR) \>= 70 mL/min/1.73 m\^2 OR
- A serum creatinine within the normal limits for age
- Bilirubin (sum of conjugated + unconjugated) =\< 1.5 x upper limit of normal (ULN) for age AND
- Serum glutamate pyruvate transaminase (SGPT)(alanine aminotransferase (ALT)) =\< 3 x ULN AND
- Serum albumin \>= 2 g/Dl
- No evidence of dyspnea at rest, no exercise intolerance due to pulmonary insufficiency, and a pulse oximetry of \> 92% while breathing room air.
- Diarrhea \< grade 2 by Common Terminology Criteria for Adverse Events (CTCAE) version (v) 5.0
- No history of congestive heart failure or family history of long QT syndrome.
- ECG must be obtained to verify the Corrected QT Interval (QTc). If an abnormal reading is obtained, the ECG should be repeated in triplicate. QTC \< 470 msec.
- Participants with history of congestive heart failure, at risk of having or have underlying cardiovascular disease, or with history of exposure to cardiotoxic drugs must have adequate cardiac function as determined by...
- Participants with seizure disorder may be enrolled if seizure disorder is well controlled
- Females of child-bearing potential and males must agree to use adequate contraception.
- Karnofsky \>= 50 for participants \> 16 years of age and Lansky \>= 50 for participants =\< 16 years of age. Participants who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered...
- Participants must be willing to provide adequate tissue. A minimum of 10-20 paraffin embedded unstained slides OR 1 block with tumor content of 40% or greater is required. Frozen tissue is also acceptable. COHORT 6
- Diagnosis of newly diagnosed thalamic or pontine located DMG with imaging and/or pathology consistent with a DMG, excluding spinal cord tumors, who have completed standard-of-care radiation therapy. If archival tissue...
- Participants must be within 4-14 weeks of completion of radiation. Radiation should have started within 6 weeks of diagnosis.
- Age 2-39 years.
- Prior use of temozolomide during radiation at maximum of the standard pediatric dosing (defined as 90 mg/m2 /dose continuously during radiation therapy for 42 days) is allowed. Any other agent given throughout radiation...
- Participants must have recovered from all acute side effects of prior therapy and be beyond the window for expected ongoing acute toxicities. Washout requirements from prior therapy include:
- At least 7 days after last dose of a biologic agent or beyond time during which adverse events are known to occur for a biologic agent, 5 half-lives from any investigational agent, 4 weeks from cytotoxic therapy (except...
- At least 4 weeks prior to study enrollment from last immune therapy
- Corticosteroids: Participants treated with corticosteroids must be on stable or decreasing dose for at least 1 week prior to enrollment, with maximum dexamethasone dose 0.1 mg/kg/day dexamethasone equivalent at time of...
- The participant must have adequate organ function defined as:
- Peripheral absolute neutrophil count (ANC) \>= 750/mm3 (1.0g/l) and
- Platelet count \>= 75,000/mm3 (100x109/l) (transfusion independent, defined as not receiving platelet transfusions for at least 7 days prior to enrollment.
- Creatinine clearance or radioisotope GFR \>= 70mL/min/1.73 m2 or
- A serum creatinine within the normal limits for age.
- Total bilirubin \<= 3 x upper limit of normal (ULN); in presence of Gilbert's syndrome, total bilirubin \</= 6 x ULN or direct bilirubin \<= 3 x ULN
- ALT \<= 5 x ULN
- AST \<= 5 x ULN.
- Serum albumin \>= 2 g/dL
- Diarrhea \< grade 2 by CTCAE v5.0.
- No history of congestive heart failure or family history of long QT syndrome.
- Participants with seizure disorder may be enrolled if seizure disorder is well controlled.
- The effects of the study drugs on the developing human fetus are unknown. For this reason, females of child-bearing potential and males must agree to use adequate contraception.
- Karnofsky \>/= 70 for Participants \> 16 years of age and Lansky \>/= 70 for participants \</= 16 years of age. Participants who are unable to walk because of paralysis, but who are up in a wheelchair, will be...
What rules you out
- COHORT 1A AND 1B:
- Prior exposure to radiation therapy.
- Thalamic and Cerebellar H3K27M DMG. COHORT 2A AND 2B:
- For tumors that do not have a pontine or spinal cord epicenter the following specific exclusion criteria apply:
- Thalamic and Cerebellar H3K27M DMG that has undergone standard radiation without concurrent therapy (other than temozolomide). COHORT 1A AND 2A:
- Deemed not appropriate for tissue resection/biopsy. COHORT 3A AND 3B:
- Prior exposure to re-irradiation for tumor progression.
- Thalamic and cerebellar H3K27M mutant DMG. COHORT 4A AND 4B: Cohort 4A\^1and 4B\^1: Prior exposure to radiation therapy Cohort 4A\^3 and 4B\^3: Prior exposure to re-irradiation for tumor progression
- Thalamic and cerebellar H3K27M mutant DMG, except those who received ONC201/ONC026 from alternative source prior to 2024 or US patients enrolled while the accelerated approval new drug application for dordaviprone to...
- Cohort 4A\^1and 4B\^1: Prior exposure to radiation therapy
- Cohort 4A\^3 and 4B\^3: Prior exposure to re-irradiation for tumor progression COHORT 5:
- Thalamic and cerebellar H3K27M mutant DMG, except those who received ONC201/ONC026 from alternative source prior to 2024 or US patients enrolled while the accelerated approval new drug application for dordaviprone to...
- Cohort 5\^1: Prior exposure to radiation therapy
- Cohort 5\^3: Prior exposure to re-irradiation for tumor progression All Cohorts (except Cohort 6):
- Diagnosis of a histone H3 wildtype grade II diffuse astrocytoma.
- Participants who are currently receiving another investigational drug. Investigational imaging agents or agents used to enhance tumor visibility on imaging or during tumor biopsy/resection should be discussed with the...
- Participants who are currently receiving other anti-cancer agents.
- Participants with a known disorder that affects their immune system, such as human immunodeficiency virus (HIV) or hepatitis B or C, or an auto-immune disorder requiring systemic cytotoxic or immunosuppressive therapy...
- Participants with uncontrolled infection or other uncontrolled systemic illness.
- Female participants of childbearing potential must not be pregnant or breast-feeding. Female participants of childbearing potential must have a negative serum or urine pregnancy test prior to the start of therapy (as...
- Active illicit drug use or diagnosis of alcoholism.
- History of allergic reactions attributed to compounds of similar chemical or biologic composition as the agents used in study.
- Evidence of disseminated disease, including diffuse leptomeningeal disease or evidence of CSF dissemination, with the exception of Cohort 5.
- Known additional malignancy that is progressing or requires active treatment within 3 years of start of study drug.
- Concomitant use of potent CYP3A4/5 inhibitors during the treatment phase of the study and within 72 hours prior to starting study drug administration.
- Concomitant use of potent CYP3A4/5 inducers, which include enzyme inducing antiepileptic drugs (EIAEDs), during the treatment phase of the study and within 2 weeks prior to starting treatment. Concurrent corticosteroids...
- DMGs located outside the thalamus and pons including bilateral thalamic tumors.
- Unacceptable anesthesia or surgery risk, as determined by the anesthesiologist or the neurosurgeon.
- Evidence of significant mass effect
- Evidence of herniation on imaging.
- Participants with a known history coagulopathy that increases risk of bleeding or a history of clinically significant hemorrhage within 12 months of registration.
- Participants must not require systemic anti-coagulation that cannot be halted for each intraoperative and perioperative biopsy time-period.
- Participants with active viral infection or who are currently receiving antiviral treatment.
- Participants with active, known, or suspected immunosuppressive disorders, such as acquired or congenital immune deficiency syndromes and autoimmune diseases.
- This virus infects cells with a deficit in the RB gene. Therefore, participants with Li-Fraumeni Syndrome or a known germ line deficit in the retinoblastoma gene or its related pathway are excluded.
- Participants must not have live or live-attenuated vaccinations within 30 days prior to DNX-2401 administration and while participating in the study. Killed vaccines are permitted.
- Participants who are currently receiving another investigational drug. Investigational imaging agents or agents used to enhance tumor visibility on imaging or during tumor biopsy/resection should be discussed with the...
- Participants with a known disorder that affects their immune system, such as HIV or Hepatitis B or C, or an auto-immune disorder requiring systemic cytotoxic or immunosuppressive therapy. Note: Participants who are...
- Participants with uncontrolled infection or other uncontrolled systemic illness.
- Female participants of childbearing potential must not be pregnant or breast-feeding. Female participants of childbearing potential must have a negative serum or urine pregnancy test prior to the start of therapy (as...
- Active illicit drug use or diagnosis of alcoholism.
- History of allergic reactions attributed to compounds of similar chemical or biologic composition as the agents used in the study.
- Evidence of disseminated disease, including multi-focal disease, diffuse leptomeningeal disease or CSF dissemination.
The study team makes the final eligibility decision.
Where it's taking place
- Birmingham, Alabama, United States
- Los Angeles, California, United States
- San Diego, California, United States
- San Francisco, California, United States
- Washington D.C., District of Columbia, United States
- Chicago, Illinois, United States
- Indianapolis, Indiana, United States
- Baltimore, Maryland, United States
- Boston, Massachusetts, United States
- Ann Arbor, Michigan, United States
- Minneapolis, Minnesota, United States
- St Louis, Missouri, United States
- Hackensack, New Jersey, United States
- New York, New York, United States
- Durham, North Carolina, United States
- Columbus, Ohio, United States
- Philadelphia, Pennsylvania, United States
- Salt Lake City, Utah, United States
- Seattle, Washington, United States
- New Lambton Heights, New South Wales, Australia
+ 12 more site(s).
Questions & answers
Do participants get paid in this trial?
This listing doesn't specify compensation. Many trials still reimburse travel or offer a stipend, so it's worth asking the study team when you connect.
Is it free to join, and do I need insurance?
Searching and applying through BridgeMD is free. In clinical trials the study-related treatment and visits are generally provided at no cost to you. You usually don't need insurance to take part - confirm specifics with the study team.
How long does this study last?
The study runs about 5 years per participant, based on its public description. The team confirms the exact schedule and number of visits before you enroll.
Who can join this trial?
This study is enrolling all sexes, 2 years to 39 years. The study team makes the final eligibility decision.
Where is this trial taking place?
Study sites include Birmingham, Alabama, United States; Los Angeles, California, United States; San Diego, California, United States; San Francisco, California, United States; Washington D.C., District of Columbia, United States; Chicago, Illinois, United States and 26 more location(s). Enter your location above to see the nearest site and check your eligibility.
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BridgeMD is an information and trial-matching tool - not medical advice, and not the study sponsor. Details come from ClinicalTrials.gov; the study team decides eligibility.