PBTC45: MK-3475 in Treating Children with Recurrent, Progressive or Refractory HGGs, DIPGs and Hypermutated Brain Tumors

Description

This clinical trial studies the side effects and best dose of MK-3475 (pembrolizumab) and to see how well it works in treating younger patients with high-grade gliomas (brain tumors), diffuse intrinsic pontine gliomas (brain stem tumors), or hypermutated brain tumors that have come back, progressed or have not responded to previous treatment. The immune system can attack tumors and suppress their growth; however many tumors are able to slow down or stop this immune response. Monoclonal antibodies such as MK-3475 may help the immune system better target the tumor. MK-3475 will be given intravenously every three weeks. MK-3475 is experimental and has been tested in adults but not in children.

Primary Objectives

• To establish the safety and describe adverse effects associated with administration of the adult recommended dose of MK-3475 (pembrolizumab) in children with recurrent, progressive or refractory non-brainstem high grade glioma (NB-HGG), diffuse intrinsic pontine glioma (DIPG) or hypermutated brain tumor
• To estimate the sustained objective response rate, (CR+PR, sustained for at least 9 weeks) associated with MK-3475 (pembrolizumab) treatment for pediatric patients with recurrent, progressive or refractory NB-HGG, DIPG or hypermutated brain tumor. This assessment will be done separately in three strata.

Eligibility Criteria

Inclusion criteria (among others):

• Diagnosis of recurrent, progressive or refractory non-brainstem DIPG, high-grade glioma (NB-HGG) or hypermutated brain tumor
• 1 to 18 years old (DIPG and NB-HGG) OR
• Younger than 30 years old (hypermutated brain tumor)
• Bi-measurable disease on MRI
• Has adequate pre-trial FFPE tumor material available (NB-HGG and hypermutated tumor)
• Received prior radiation therapy and/or chemotherapy and has recovered from the acute treatment related toxicities (defined as less than grade 1 if not defined in eligibility criteria) of all prior chemotherapy, immunotherapy or radiotherapy prior to entering this study. Note: There is no upper limit to the number of prior therapies that are allowed.
• No myelosuppressive anticancer chemotherapy for at least three 3 weeks (6 weeks for nitrosurea or mitomycin-C) prior to enrollment
• Appropriate liver and kidney function Received last dose of investigational or biologic agent at least 7 days prior to study enrollment

Exclusion criteria (among others):

• Active autoimmune disease or documented history of autoimmune disease/syndrome that requires ongoing systemic steroids or systemic immunosuppressive agents except participants with vitiligo or resolved asthma/atopy or participants with hypothyroidism stable on hormone replacement or Sjogren’s syndrome
• History of or ongoing pneumonitis or significant interstitial lung disease
• Other malignancies
• Known active Hepatitis B (HbsAg active) or Hepatitis C (HCV RNA-qualitative is detected)
• History of severe hypersensitivity reaction to a monoclonal antibody
• Bulky tumor on imaging ( not greater than 4cm in one dimension)
• Receiving any other anti-cancer or investigational drug therapy

For the current eligibility status of this clinical study, referring physicians must contact St. Jude Children's Research Hospital at 1-866-2ST-JUDE (1-866-278-5833).

Contact

Giles Robinson, MD