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Safety and Oversight of the Individually Tailored Treatment Approach: A Novel Pilot Study (TAILOR)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04801966
Recruitment Status : Recruiting
First Posted : March 17, 2021
Last Update Posted : November 7, 2022
Sponsor:
Information provided by (Responsible Party):
Peter MacCallum Cancer Centre, Australia

Brief Summary:
This study is looking at outcomes in people with advanced cancers who have exhausted standard treatment options and are accessing off indication or unregistered drugs or combinations of drugs through compassionate access from the manufacturer.

Condition or disease Intervention/treatment Phase
Cancer Drug: Trametinib Drug: Cobimetinib Drug: Binimetinib Drug: Alpelisib Drug: Vemurafenib Drug: Dabrafenib Drug: Encorafenib Drug: Palbociclib Drug: Olaparib Drug: Ribociclib Drug: Abemaciclib Drug: Talazoparib Drug: Nivolumab Drug: Atezolizumab Drug: Pembrolizumab Not Applicable

Detailed Description:

Some advanced cancers have numerous standard treatment options that have proven efficacy in clinical trials. However, in other cancers, there may be few or no standard treatment options with proven efficacy as determined in a large clinical trial. This may be particularly the case for rare cancers in which there is a lack of clinical research. When seriously ill patients run out of standard treatment options, they will often consider non-standard treatment options (such as treatments that are currently unapproved by the regulatory agency for the given indication). The majority of clinicians and researchers agree that this is best received in a clinical trial setting as this provides ethical and clinical oversight, as well as addresses prospectively defined research questions which can be publicly reported. This allows the conclusions of the research to be available to the entire clinical and research community.

In general, an access program enables patient access to a non-reimbursed therapeutic agent, outside of a clinical trial setting. Compassionate access is typically for therapeutics that are not yet approved or TGA registered, and are still considered investigational. In general, there is a negotiation between the pharmaceutical company and the clinician and patient regarding access to the therapeutic agent, as well as whether the medicine will be provided free of charge, or on some form of cost-sharing arrangement. In Australia, access to TGA non-registered medicines also requires an application via the "Special Access Scheme". For most cancer patients, the use falls under category A, for a patient defined as seriously ill. This sub-study generally pertains to compassionate access to therapeutic agents. Given the ad hoc nature of compassionate access for patients, there is relatively little reported data on clinical outcomes.

Compassionate access is an established process with increasing demands. This study is designed to provide a framework for which patients treated with compassionate access therapeutics can register, so that some of the limitations of ad hoc compassionate access programs can be overcome.

A study committee will prospectively assess each individual patient's detailed treatment approach in an objective and time-efficient manner. If approved, the patient may be eligible to register into the treatment phase of the study. The study committee is essential to provide a balanced approach to understanding the rationale for the study treatment, as well as potential safety issues that may arise. As previously reported, this is an essential component to improving patient oversight as well as equity

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 50 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Safety and Oversight of the Individually Tailored Treatment Approach: A Novel Pilot Study
Actual Study Start Date : September 23, 2021
Estimated Primary Completion Date : April 1, 2026
Estimated Study Completion Date : October 1, 2026

Arm Intervention/treatment
Experimental: Treatment

All participants will have an individualised treatment plan. The possible treatments that can be prescribed are as follows, they may be given as a single agent or in combination

  • Trametinib 2 mg/day
  • Cobimetinib 60 mg/day, on day 1-21 of each 28 day cycle (21 days on, 7 days off)
  • Binimetinib 45 mg/ twice a day
  • Alpelisib 300 mg/day
  • Vemurafenib 960 mg twice a day
  • Dabrafenib 150 mg twice a day
  • Encorafenib 450 mg/day
  • Palbociclib 125 mg/day, on day 1-21 of each 28 day cycle (21 days on, 7 days off)
  • Ribociclib 600 mg/day, on day 1-21 of each 28 day cycle (21 days on, 7 days off
  • Abemaciclib 150 mg twice a day
  • Olaparib 300 mg twice a day
  • Talazoparib 1 mg/day
  • Nivolumab 240 mg IV once every two weeks
  • Atezolizumab 1200 mg IV on day 1 of a 21 day cycle
  • Pembrolizumab 200 mg IV on day 1 of a 21 day cycle
Drug: Trametinib
2 mg per day, continuous

Drug: Cobimetinib
60 mg/day for 21 days of a 28 day cycle

Drug: Binimetinib
45 mg/twice a day, continuous

Drug: Alpelisib
300 mg/day, continuous

Drug: Vemurafenib
960 mg/twice per day, continuous

Drug: Dabrafenib
150 mg/twicce per day, continuous

Drug: Encorafenib
450 mg/day, continuous

Drug: Palbociclib
125 mg/day, day 1-21 of a 28 day cycle

Drug: Olaparib
300 mg/twice per day, continuous

Drug: Ribociclib
600 mg/day, on day 1 -21 of a 28 day cycle

Drug: Abemaciclib
150 mg twice/day, continuous

Drug: Talazoparib
1 mg/day, on day 1 -28 of each 28 day cycle

Drug: Nivolumab
240 mg IV once every 2 weeks

Drug: Atezolizumab
1200 mg IV on Day 1 of a 21 day cycle

Drug: Pembrolizumab
200 mg IV on day 1 of a 21 day cycle




Primary Outcome Measures :
  1. Safety of the study design as mechanism for administering individualised therapies to individuals with incurable malignancies [ Time Frame: At the end of the study, approximately 5 years after the first participant commences treatment ]
    Severity of adverse events as determined by NCI CTCAE v5.0

  2. Feasibility of the study design as mechanism for administering individualised therapies to individuals with incurable malignancies [ Time Frame: At the end of the study, approximately 5 years after the first participant commences treatment ]

    Feasibility measured by:

    Number of treatment plans proposed to the study committee Proportion of treatment plans proposed that are approved Proportion of approved plans for which study drug(s) were obtained Proportion of approved plans for which study drug(s) were obtained and patient was registered on the trial



Secondary Outcome Measures :
  1. Efficacy of individualised therapies in patients registered to the study [ Time Frame: At the end of the study, approximately 5 years after the first participant commences treatment ]

    Efficacy measured by:

    • Objective response rate (ORR), defined as the proportion of patients with an objective response (partial response [PR] or complete response [CR]), as determined by the Investigator by RECIST 1.1 (or RANO for primary CNS cancers or Cheson IWG for lymphomas)
    • Clinical benefit rate (CBR), defined as the proportion of patients with CR, PR, or stable disease for ≥ 4 months, as determined by the Investigator by RECIST 1.1 (or RANO for primary CNS cancers or Cheson IWG for lymphomas)
    • Progression-free survival (PFS), defined as the time from registration to the first occurrence of disease progression, as determined by the Investigator according to RECIST 1.1 or RANO for primary CNS cancers or Cheson IWG for lymphomas, or death from any cause, whichever occurs first.
    • Overall survival (OS)



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   2 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Patient or their parent(s)/legal guardian(s) has provided written informed consent using the main study PICF
  2. Continues to meet all the inclusion criteria as per the TRIAGE Framework protocol as follows:

    1. Male or female patient, aged 2 years or older
    2. Patient has pathologically confirmed locally advanced, incurable or metastatic cancer of any histological type
    3. Have an available TRIAGE sub-study with a matched therapy
    4. Documented progression following standard therapy, or for whom, in the opinion of the Investigator, no appropriate standard therapy exists
    5. Life expectancy of > 3 months
    6. Adequate performance status:

    i. For patients aged 18 years or over, Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2 (appendix 1) ii. For patients aged 17 years, Karnofsky score ≥ 50 (appendix 2) iii. For patients aged 16 years or under, Lansky score ≥ 50 (appendix 3)

  3. Treatment regimen and schedule of assessments that has been approved by the TAILOR Study Committee
  4. Approved treatment is obtainable
  5. Patient has measurable disease or evaluable disease as defined by RECIST 1.1 (or RANO criteria for primary CNS cancers or the Cheson (IWG) revised response criteria for lymphomas)
  6. Patient must have adequate bone marrow, hepatic and renal function within 7 days prior to registration:

    • ANC ≥ 1.5 x 109/L
    • Platelet count ≥ 100 x 109/L (platelet count ≥ 50 x 109/L for haematological malignancy indications)
    • ALT ≤ 2.5x ULN, unless liver metastases or invasion are present, in which case it must be ≤ 5x ULN
    • AST ≤ 2.5x ULN, unless liver metastases or invasion are present, in which case it must be ≤ 5x ULN
    • Total bilirubin ≤ 1.5x ULN except patients with Gilbert's Syndrome, who are eligible in consultation with their physician
    • Serum creatinine ≤ 1.5x ULN
  7. Patient is willing and able to comply with the protocol for the duration of the study including undergoing, treatment, and scheduled visits and examination including follow up
  8. Female patients of childbearing potential must have a negative serum pregnancy test at screening for the main study and agree to use highly effective methods of birth control while receiving approved treatment through to the time frame specified in the approved ITAP after the last dose. Patients of childbearing potential are those who have not been surgically sterilised or have not been free from menses for > 1 year.
  9. Sexually active males must agree to use a condom during intercourse while taking the approved treatment through to the time frame specified in the approved ITAP after the last dose and should not father a child in this period.

Exclusion Criteria:

  1. One or more of the exclusion criteria as per the TRIAGE Framework protocol applies as follows:

    1. Significant cardiovascular disease
    2. Any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding that contraindicates the use of an investigational drug, may affect the interpretation of the results, or may render the patient at high risk from treatment complications
    3. Other co-morbidities or conditions that may compromise assessment of key outcomes or in the opinion of the clinician, limit the ability of the patient to comply with the protocol
  2. Any unresolved toxicity (≥CTCAE grade 2) from previous anti-cancer therapy, with the exception of alopecia.

    Patients with irreversible toxicity that is not reasonably expected to be exacerbated by the investigational product(s) may be included (e.g. hearing loss, peripheral neuropathy)

  3. Symptomatic, or actively progressing CNS metastases (unless a primary brain tumour).Patients with a history of treated

    CNS lesions are eligible, provided that all of the following criteria are met:

    Measurable disease per RECIST 1.1 must be present outside the CNS Metastases are limited to the cerebellum or the supratentorial region (i.e. no metastases to the midbrain, pons, medulla, or spinal cord) There is no clinical evidence of interim progression between completion of CNS-directed therapy and registration on the study (radiological re-assessment is not required) The patient has not received radiotherapy within 14 days prior to registration Anticonvulsant therapy at a stable dose is permitted

  4. History of leptomeningeal disease unless a primary brain tumour
  5. Known active infection including tuberculosis, HBV, HCV, or HIV. Patients with a past or resolved HBV infection (defined as the presence of HBcAb and absence of HBsAg) are eligible. Patients with a past or resolved HCV infection are eligible only if polymerase chain reaction is negative for HCV RNA

Additional inclusion and/or exclusion criteria for the main study will be stipulated in the approved Individualised Treatment and Assessment Plan as each treatment regimen is expected to have specific requirements.


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04801966


Contacts
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Contact: Stephen Luen, MBBS +61385595000 stephen.luen@petermac.org
Contact: Jayesh Desai, MBBS +61385595000 jayesh.desai@petermac.org

Locations
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Australia, Victoria
Peter MacCallum Cancer Centre Recruiting
Melbourne, Victoria, Australia, 3000
Contact: Stephen Luen    +61385595000    stephen.luen@petermac.org   
Principal Investigator: Stephen Luen, MBBS         
Sub-Investigator: Jayesh Desai, MBBS         
Sponsors and Collaborators
Peter MacCallum Cancer Centre, Australia
Investigators
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Principal Investigator: Stephen Luen, MBBS Peter MacCallum Cancer Centre, Australia
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Responsible Party: Peter MacCallum Cancer Centre, Australia
ClinicalTrials.gov Identifier: NCT04801966    
Other Study ID Numbers: 20/029
First Posted: March 17, 2021    Key Record Dates
Last Update Posted: November 7, 2022
Last Verified: November 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: The Sponsor will consider individual requests to share data

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Additional relevant MeSH terms:
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Pembrolizumab
Nivolumab
Atezolizumab
Olaparib
Palbociclib
Trametinib
Vemurafenib
Dabrafenib
Talazoparib
Antineoplastic Agents, Immunological
Antineoplastic Agents
Immune Checkpoint Inhibitors
Molecular Mechanisms of Pharmacological Action
Poly(ADP-ribose) Polymerase Inhibitors
Enzyme Inhibitors
Protein Kinase Inhibitors