Phase I Study of APX005M in Pediatric Central Nervous System Tumors

Running, not enrolling · Phase 1

Conditions studied: Glioblastoma Multiforme, High-grade Astrocytoma Not Otherwise Specified (NOS), CNS Primary Tumor, Not Otherwise Specified (NOS), Ependymoma, Not Otherwise Specified (NOS), Diffuse Intrinsic Pontine Gliomas (DIPG), Medulloblastoma

In brief

This phase I trial studies the side effects and best dose of APX005M in treating younger patients with primary malignant central nervous system tumor that is growing, spreading, or getting worse (progressive), or newly diagnosed diffuse intrinsic pontine glioma. APX005M can trigger activation of B cells, monocytes, and dendritic cells and stimulate cytokine release from lymphocytes and monocytes. APX005M can mediate a direct cytotoxic effect on CD40+ tumor cells.

Key facts

Study ID

NCT03389802

Run by

Pediatric Brain Tumor Consortium

People needed

32

Starts

2018-03-01

Expected to finish

2026-06-30

Last updated by the study team

2026-06-24

Who can join

Age: 1 and older, up to 21. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Diagnosis -- Stratum 1: Recurrent or refractory primary malignant CNS tumor patients Patients with a histologically confirmed diagnosis of a primary malignant non-brainstem CNS tumor (excluding DIPG patients) that is recurrent, progressive, or refractory. All tumors must have histologic verification at either the time of diagnosis or recurrence except patients with marker (+) CNS germ cell tumors.
• Stratum 2: Newly diagnosed DIPG patients (on-hold until pediatric RP2D has been established in Stratum 1) Patients with diffuse intrinsic pontine gliomas (DIPGs) will be eligible 6 to 14 weeks post-completion of radiation therapy if they do not have any evidence of progression. Patients with newly diagnosed DIPGs, defined as tumors with a pontine epicenter and diffuse involvement of 2/3 or more of the pons, are eligible without histologic confirmation. Patients with pontine tumors that do not meet these criteria or not considered to be typical intrinsic pontine gliomas will only be eligible if the tumors have been biopsied and (1) are proven to be an anaplastic astrocytoma, glioblastoma multiforme, gliosarcoma, anaplastic mixed glioma or fibrillary astrocytoma or (2) have a histone mutation typically seen in DIPG. Patients with disseminated disease are not eligible, and MRI of spine must be performed if disseminated disease is suspected by the treating physician.
• Available Pre-trial Tumor Tissue -- Stratum 1: Recurrent or refractory primary malignant CNS tumor patients must have adequate pre-trial frozen or FFPE tumor material (minimum of 10 unstained slides) available for use in the tumor mutation burden studies (section 9.1.5).
• Stratum 2: Patients with DIPG who have pre-trial tumor tissue available are requested to submit tissue; however, this is not required for eligibility.
• Age -- Patient must be ≥ 1 and ≤ 21 years of age at the time of enrollment.
• Prior Therapy -- Newly Diagnosed DIPG patients Patients must have not received any prior therapy for treatment of their current CNS malignancy other than radiation therapy.
• Refractory/Recurrent patients Patients must have recovered from the acute treatment related toxicities (defined as < grade 1) of all prior chemotherapy, immunotherapy, radiotherapy or any other treatment modality prior to entering this study.
• Myelosuppressive chemotherapy -- Patients must have received their last dose of known myelosuppressive anticancer therapy at least 21 days prior to enrollment or at least 42 days if nitrosourea.
• Biological agent: Patient must have recovered from any acute toxicity potentially related to the agent and received their last dose of the biologic agent ≥ 7 days prior to study enrollment.
• For agents that have known adverse events occurring beyond 7 days after administration, this period must be extended beyond the time during which adverse events are known to occur.
• Monoclonal antibody treatment and agents with known prolonged half-lives: At least three half-lives must have elapsed prior to enrollment.
• Radiation --
• Patients must have had their last fraction of:
• Craniospinal irradiation (>24Gy) or total body irradiation or radiation to greater than 50% of pelvis > 3 months prior to enrollment.
• Focal irradiation >6 weeks prior to enrollment Local palliative irradiation (small port) ≥4 weeks
• Autologous Stem Cell Transplant -- Patient must be ≥ 6 months since autologous bone marrow/stem cell transplant prior to enrollment and have CD4 counts above 200/mm3.
• Surgery -- Patients must be at least 4 weeks (28 days) from major surgery and fully recovered from all acute effects of prior surgical intervention.
• Inclusion of Women and Minorities -- Both males and females of all races and ethnic groups are eligible for this study
• Neurologic Status -- Patients with neurological deficits should have deficits that are stable for a minimum of 1 week prior to enrollment.
• Patients with seizure disorders may be enrolled if seizures are well controlled.
• Performance Status -- Karnofsky Performance Scale (KPS for > 16 years of age) or Lansky Performance Score (LPS for ≤ 16 years of age) assessed within two weeks of enrollment must be ≥ 60. Patients who are unable to walk because of neurologic deficits, but who are up in a wheelchair, will be considered ambulatory for the purpose of assessing the performance score.
• Organ Function --
• Patients must have adequate organ and bone marrow function as defined below:
• Absolute Neutrophil Count (ANC) ≥ 1.0 x 109 cells/ L Platelets ≥ 100 x 109 cells/L (unsupported, defined as no platelet transfusion within 7 days) Hemoglobin ≥ 8 g/dL (may receive transfusions) Total bilirubin ≤1.5 times institutional upper limit of normal (ULN) AST(SGOT)/ALT(SGPT) ≤ 3 x institutional upper limit of normal (ULN) Albumin ≥ 3 g/dl Serum creatinine based on age/gender as noted below. Patients that do not meet the criteria below but have a 24 hour Creatinine Clearance or GFR (radioisotope or iothalamate) ≥ 70 mL/min/1.73 m2 are eligible.
• Age Maximum Serum Creatinine (mg/dL) 1 to < 2 years 0.6, 0.6 (M, F); 2 to < 6 years 0.8, 0.8 (M, F); 6 to < 10 years 1, 1 (M, F); 10 to < 13 years 1.2, 1.2 (M, F); 13 to < 16 years 1.5, 1.4 (M, F); ≥ 16 years 1.7, 1.4 (M, F).

You may not qualify if…

• Concurrent Illness -- Patients with any clinically significant unrelated systemic illness (serious infections Grade ≥ 2 or significant cardiac, pulmonary, hepatic or other organ dysfunction), that in the opinion of the investigator would compromise the patient's ability to tolerate protocol therapy, put them at additional risk for toxicity or would interfere with the study procedures or results.
• Patients with a history of any other malignancy, except patients with a secondary brain tumor if the patient's first malignancy has been in remission for at least 5 years from the end of treatment.
• Concurrent Therapy -- Patients who are receiving any other anticancer or investigational drug therapy.
• Patients requiring systemic treatment with either corticosteroids (greater than physiologic replacement, defined as dexamethasone 0.75 mg/m2/day) or other immunosuppressive medications within 14 days of study drug administration will be excluded. However, patients who require intermittent use of bronchodilators or local steroid injections will not be excluded from the study. Please see section 5.3 for a list of acceptable and unacceptable concomitant medications as well as reporting requirements.
• Presence of Bulky Tumor --
• Patients with bulky tumor on imaging are ineligible. Bulky tumor is defined as:
• Tumor with any evidence of uncal herniation or midline shift Tumor that in the opinion of the site investigator, shows significant mass effect
• Allergy -- Patients with a history of severe (Grade ≥ 3) hypersensitivity reaction to a monoclonal antibody are ineligible.
• Allogeneic Hematopoietic Stem Cell Transplantation -- Patients who have received allogeneic hematopoietic stem cell transplantation are ineligible.
• Autoimmune Diseases -- Patients with active autoimmune disease or documented history of autoimmune disease/syndrome that requires ongoing systemic steroids or systemic immunosuppressive agents, except Patients with vitiligo or well controlled asthma/atopy Patients with hypothyroidism stable on hormone replacement or Sjogren's syndrome
• Inability to Participate -- Patients who in the opinion of the investigator are unwilling or unable to return for required follow-up visits or obtain follow-up studies required to assess toxicity to therapy or to adhere to drug administration plan, other study procedures, and study restrictions.
• Bleeding Disorder -- Patients with a known coagulopathy or bleeding diathesis or require the use of systemic anticoagulant medication are not eligible.
• Pregnancy Status -- Female patients must not be pregnant or breast-feeding.

Where it is running

• Children's Hospital Los Angeles — Los Angeles, California, United States
• Lucile Packard Children Hospital Stanford University — Palo Alto, California, United States
• Children's Hospital Colorado — Aurora, Colorado, United States
• Childrens National Medical Center — Washington D.C., District of Columbia, United States
• Children's Healthcare of Atlanta — Atlanta, Georgia, United States
• Lurie Childrens Hospital-Chicago — Chicago, Illinois, United States
• Memorial Sloan Kettering Cancer Center — New York, New York, United States
• Cincinnati Children Hospital Medical Center — Cincinnati, Ohio, United States
• Children Hospital of Pittsburgh of UPMC — Pittsburgh, Pennsylvania, United States
• St. Jude Children Research Hospital — Memphis, Tennessee, United States
• Baylor College of Medicine — Houston, Texas, United States

Full record on ClinicalTrials.gov

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