Using indoximod with chemotherapy and radiation for pediatric brain tumors

Phase 2 Trial of Indoximod With Chemotherapy and Radiation for Children With Progressive Brain Tumors or Newly Diagnosed DIPG

This study is testing if adding indoximod to chemotherapy and radiation can help children with relapsed brain tumors or newly diagnosed DIPG fight their cancer better than standard treatments.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 140 (estimated)
• Ages: 3 Years to 21 Years
• Sex: All
• Sponsor: Augusta University (Academic / other)
• Drugs / interventions: bevacizumab, chemotherapy, immunotherapy, radiation
• Locations: 5 sites (Augusta, Georgia and 4 other locations)
• Trial ID: NCT04049669 on ClinicalTrials.gov

What this trial studies

This clinical trial investigates the use of indoximod, an IDO pathway inhibitor, in combination with chemotherapy and radiation for children aged 3 to 21 with relapsed brain tumors or newly diagnosed diffuse intrinsic pontine glioma (DIPG). The study aims to enhance antitumor immune responses by disrupting immune tolerance, potentially improving treatment outcomes compared to standard therapies. Participants are grouped into cohorts based on their specific tumor type and treatment history, with various radiation plans tailored to their eligibility. The trial is open-label and funded by the National Cancer Institute.

Who should consider this trial

Good fit: Ideal candidates include children aged 3 to 21 with relapsed glioblastoma, medulloblastoma, ependymoma, or newly diagnosed DIPG.

Not a fit: Patients with non-progressive brain tumors or those who have not been previously treated with therapeutic radiation may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could significantly improve treatment outcomes for pediatric patients with aggressive brain tumors.

How similar studies have performed: Other studies have shown promise with immunotherapy approaches in pediatric cancers, but this specific combination is novel.

Eligibility criteria

Inclusion Criteria:

Diagnosis:

* Progressive disease with histologically proven initial diagnosis of glioblastoma, medulloblastoma, or ependymoma; With confirmation of progression by either MRI or CSF analysis; Measureable disease is not required for study entry; Patients with progressive disease must have been previously treated with therapeutic radiation as part of treatment for the initial brain cancer diagnosis or for a prior relapse.
* Newly diagnosed DIPG (diffuse intrinsic pontine glioma) with no prior therapy (including no prior radiation); Biopsy is not required for DIPG.
* Central review of tissue diagnosis is required, except non-biopsied DIPG; Archival tumor tissue must be located and available prior to study entry.
* Patients with metastatic disease are eligible.

Lansky or Karnofsky performance status score must be ≥ 50%.

Adequate renal function: creatinine ≤ 1.5-times upper limit of age-adjusted normal.

Adequate liver function:

* ALT ≤ 5-times upper limit of normal.
* Total bilirubin ≤ 1.5-times upper limit of normal.

Adequate Bone marrow function:

* Absolute neutrophil count (ANC) ≥ 750/mcL.
* Platelets ≥ 75,000/mcL (transfusion independent).
* Hemoglobin ≥ 8 g/dL (transfusion independent).

Central nervous system: seizure disorders must be well controlled on antiepileptic medication.

Prior therapy

* DIPG patients must not have been treated with any prior radiation or medical therapy.
* Patients previously treated with indoximod are excluded.
* Patients previously treated with any other immunotherapy agent, including other IDO-targeted drugs, are eligible for enrollment.
* Patients previously treated with chemotherapy drugs included in this protocol are eligible for enrollment.

Patients must be 14 days from the administration of any investigational agent or prior cytotoxic therapy with the following exceptions:

* Temozolomide dosed at or above 150 mg/m2 (allowed, but must be at least 21 days from the last dose of temozolomide).
* Must be 28 days from administration of antibody-based therapies (e.g., bevacizumab), tumor-directed vaccines, or cellular immune therapies (e.g., T cells, NK cells, etc).
* Must be 56 days from administration of tumor-directed therapies using infectious agents (e.g., viruses, bacteria, etc).

Pregnant women are excluded from this study, where pregnancy is confirmed by a positive urine or serum hCG laboratory test.

Patients must be able to swallow pills.

.

Exclusion Criteria:

Patients who cannot swallow indoximod pills are excluded.

Patients previously treated with indoximod are excluded.

Patients with DIPG who have been treated with any prior radiation or medical therapy are excluded.

Midline glioma that does not include significant brain stem involvement is not considered DIPG for enrollment purposes, and is excluded.

Patients with active systemic infection requiring treatment, including any HIV infection or toxoplasmosis, are excluded.

Patients with active autoimmune disease that requires systemic therapy are excluded.

Pregnant women are excluded

Where this trial is running

Augusta, Georgia and 4 other locations

• Augusta University, Georgia Cancer Center — Augusta, Georgia, United States (Recruiting)
• Emory University, Children's Heathcare of Atlanta — Druid Hills, Georgia, United States (Active_not_recruiting)
• Dana-Farber Cancer Institute — Boston, Massachusetts, United States (Active_not_recruiting)
• Cincinnati Children's Hospital Medical Center — Cincinnati, Ohio, United States (Active_not_recruiting)
• MD Anderson Cancer Center — Houston, Texas, United States (Recruiting)

Study contacts

• Principal investigator: Theodore S Johnson, MD, PhD — Augusta University
• Study coordinator: Theodore S Johnson, MD, PhD

Conditions Glioblastoma; Medulloblastoma; Ependymoma; Diffuse Intrinsic Pontine Glioma; IDO; indoleamine 2,3-dioxygenase; indoximod; pediatric