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Dabrafenib Combined With Trametinib After Radiation Therapy in Treating Patients With Newly-Diagnosed High-Grade Glioma

A Phase 2 Study of Dabrafenib (NSC# 763760) With Trametinib (NSC# 763093) After Local Irradiation in Newly-Diagnosed BRAF V600-Mutant High-Grade Glioma (HGG)

  • Clinical Trial Information

    Trial Contact: El-Shami, Jessica; Cevallos, Claudia; Leffin, Melissa; Spinelli, Jennifer

  • IRB No: ACNS1723

    Protocol Abbrev: ACNS1723

    Principal Investigator: Amy A Smith, MD

    Phase: Drug: Phase II

    Age Group: Adult;Pediatric

    Secondary Protocol No: ACNS1723

    Treatment: Drug: Dabrafenib Mesylate Radiation: Radiation Therapy Drug: Trametinib Dimethyl Sulfoxide

    Therapies Involved: Chemotherapy;Radiation

    ClinicalTrials.gov ID: NCT03919071

  • Objective

    To estimate the event-free survival (EFS) distribution for newly-diagnosed patients with BRAFV600-mutant high-grade glioma (HGG) without H3 K27M mutations excluding anaplastic pleomorphic xanthoastrocytoma (aPXA) and anaplastic ganglioglioma (aGG) treated with radiation therapy followed by a maintenance combination of dabrafenib mesylate (dabrafenib) and trametinib dimethyl sulfoxide (trametinib) and to compare this EFS to contemporary historical controls.

  • Key Eligibility

    •  PRE-ENROLLMENT ELIGIBILITY SCREENING (STEP 0): Patient is suspected of having localized newly-diagnosed HGG, excluding intrinsic brainstem or spinal cord tumors, excluding metastatic disease
    •  PRE-ENROLLMENT ELIGIBILITY SCREENING (STEP 0): Patient and/or their parents or legal guardians have signed informed consent for eligibility screening on APEC14B1 Part A.
    •  PRE-ENROLLMENT ELIGIBILITY SCREENING (STEP 0): Specimens obtained at the time of diagnostic biopsy must be submitted through APEC14B1 as soon as possible (ASAP), preferably within 13 calendar days of definitive surgery.
    •  Patients must be >= 3 years and =< 21 years of age at the time of enrollment

    •  Patients must have eligibility confirmed by Rapid Central Pathology and Molecular Screening Reviews performed on APEC14B1
    ◦Newly diagnosed high-grade glioma with BRAFV600-mutation
    ◦Negative results for H3 K27M by immunohistochemistry (IHC)
    ◦Histologically confirmed high-grade glioma (World Health Organization [WHO] grade III or IV) including but not limited to: anaplastic astrocytoma (AA), anaplastic pleomorphic xanthoastrocytoma (aPXA), anaplastic gangliogliomas (aGG), glioblastoma (GB), and high-grade astrocytoma, not otherwise specified (NOS)

    •  Patients must have had histologic verification of a high-grade glioma diagnosis. Cerebrospinal fluid (CSF) cytology by lumbar puncture must be done if clinically indicated and determined to be safe prior to study enrollment. If cytology proves positive, the patient would be considered to have metastatic disease and would, therefore, be ineligible.
    •  A pre- and post-operative brain magnetic resonance imaging (MRI) with and without contrast and a baseline spine MRI with contrast must be obtained prior to enrollment. The requirement for a post-operative MRI is waived for patients who undergo biopsy only. If the spine MRI is positive, the patient would be considered to have metastatic disease and would be ineligible.
    •  Patients must have a performance status corresponding to Eastern Cooperative Oncology Group (ECOG) scores of 0, 1, or 2. Use Karnofsky for patients > 16 years of age and Lansky for patients =< 16 years of age.
    •  Peripheral absolute neutrophil count (ANC) >= 1000/uL (within 7 days prior to enrollment).
    •  Platelet count >= 100,000/uL (transfusion independent) (within 7 days prior to enrollment).
    •  Hemoglobin >= 8.0 g/dL (may receive red blood cell [RBC] transfusions) (within 7 days prior to enrollment).
    •  Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 mL/min/1.73 m^2 (within 7 days prior to enrollment) or

    •  Serum creatinine based on age/gender as follows (within 7 days prior to enrollment):
    ◦Age 3 to < 6 years (Male 0.8 mg/dL, Female 0.8 mg/dL)
    ◦Age 6 to < 10 years (Male 1 mg/dL, Female 1 mg/dL)
    ◦Age 10 to < 13 years (Male 1.2 mg/dL, Female 1.2 mg/dL)
    ◦Age 13 to 16 < years (Male 1.5 mg/dL, Female 1.4 mg/dL)
    ◦Age >= 16 years (Male 1.7 mg/dL, Female 1.4 mg/dL)

    •  Total bilirubin =< 1.5 x upper limit of normal (ULN) for age (within 7 days prior to enrollment), and
    •  Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 3 x upper limit of normal (ULN) for age (within 7 days prior to enrollment). For the purpose of this study, the ULN for SGPT is 45 U/L.
    •  Patients with a seizure disorder may be enrolled if their seizures are well controlled while on non-enzyme inducing anticonvulsants permitted on this study.
    •  Patients must be enrolled and protocol therapy must be projected to begin no later than 31 days after definitive diagnostic surgery (day 0). For patients who have a biopsy followed by resection, the date of resection will be considered the date of definitive diagnostic surgery. If a biopsy only was performed, the biopsy date will be considered the date of definitive diagnostic surgery.