Tovorafenib for Treatment of Craniopharyngioma in Children and Young Adults

Recruiting now · Phase 2

Conditions studied: Craniopharyngioma, Child, Craniopharyngioma, Recurrent Craniopharyngioma

In brief

The current study assesses the tolerability and efficacy of monotherapy with pan-RAF-kinase (Tovorafenib) inhibition for the treatment of children and young adults with craniopharyngioma.

Key facts

Study ID

NCT05465174

Run by

Sabine Mueller, MD, PhD

People needed

57

Starts

2022-09-12

Expected to finish

2028-03-01

Last updated by the study team

2026-04-23

Who can join

Age: 1 and older, up to 39. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Newly Diagnosed Participants:
• Newly diagnosed craniopharyngioma, as based on imaging characteristics and central radiology review. Participants will initially be screened within confines of a screening consent and only those participants with findings consistent with craniopharyngioma and without findings suggesting an indeterminate lesion or lesion of an alternative diagnosis (including abnormal tumor markers found in blood or cerebral spinal fluid (CSF), if completed as part of standard of care (SOC) work-up or if lesion concerning for alternate diagnosis) will move ahead with enrollment on the treatment protocol. Additionally, for participants that have undergone initial biopsy to confirm diagnosis, are within 6 weeks of radiographic diagnosis, and are planned to undergo follow up second surgery for additional tumor resection as per standard of care recommendations, these participants will also be considered eligible.
• Participants must be surgical candidates for biopsy or resection and planned for standard of care biopsy or resection.
• Recurrent Participants:
• Recurrent craniopharyngioma, as based on histologic confirmation at time of initial diagnosis (participants with Adamantinomatous craniopharyngioma (ACP) will only be eligible for the recurrent arm).
• Recurrent craniopharyngioma without prior histologic confirmation will initially be screened within confines of a screening consent and only those participants with findings consistent with craniopharyngioma and without findings suggesting an indeterminate lesion or lesion of an alternative diagnosis (including abnormal tumor markers found in blood or CSF, if completed as part of SOC work-up or if lesion concerning for alternate diagnosis) will move ahead with enrollment on the treatment protocol.
• Participants should be surgical candidates for biopsy or resection. If participants are not surgical candidates, but have available archival tumor tissue, they will be enrolled into the exploratory cohort.
• Participants must be willing to provide archival tissue, a minimum of 10-20 paraffin embedded unstained slides OR 1 block with tumor content of 40% or greater is required. Participants who do not meet this criteria may be discussed on a case-by-case basis with the Study Chair(s).
• Participants can have been previously treated with surgical resection alone, cyst drainage and biopsy alone, radiation therapy, other systemic therapies, or any combination thereof.
• Prior Therapy:
• Had their last dose of myelosuppressive chemotherapy >= 21 days prior to study registration (>=42 days if nitrosourea therapy).
• Had their last dose of hematopoietic growth factor >=14 days (long-acting growth factor) or >=7 days (short-acting growth factor) prior to study registration, or beyond the time during which adverse events (AEs) are known to occur.
• Had their last dose of biologic (anti-neoplastic agent) >=7 days prior to study registration, or beyond the time during which AEs are known to occur.
• Had their last dose of monoclonal antibodies >=21 days prior to study registration.
• Radiation:
• Had their last fraction of local irradiation to primary tumor >=12 weeks prior to registration; investigators are reminded to review potentially eligible cases to avoid confusion with pseudo-progression.
• At least 14 days after local palliative radiation (small-port).
• All Participants:
• Age 1 to 39 years.
• Participants continuing on maintenance therapy after standard of care biopsy/resection must have measurable disease, as defined as lesions that can be accurately measured in two dimensions (longest diameter to be recorded) with a minimum size of no less than double the slice thickness. Previously irradiated lesions are considered non-measurable except in cases of documented progression of the lesion since the completion of radiation therapy. Participants without measurable disease may continue on study and will be followed for study endpoints, but will not be included as part of target accrual.
• Performance Score: Karnofsky >= 50 for participants > 16 years of age and Lansky >= 50 for participants <= 16 years of age. Participants who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered ambulatory for the purpose of assessing the performance score.
• Corticosteroids: Participants who are receiving dexamethasone must be on a stable or decreasing dose for at least 1 week prior to registration. The participant steroid dose should be no more than a steroid-equivalent of dexamethasone 0.1 mg/kg/day (or maximum 4mg/day; whichever is the lower dose) at time of enrollment. Participants that have been stable on physiologic hormone replacement for hypopituitarism are allowed.
• Organ Function Requirements:
• Adequate Bone Marrow Function defined as:
• Peripheral absolute neutrophil count (ANC) >=1000/mm3.

You may not qualify if…

• Newly Diagnosed Participants:
• Participants should not have undergone any previous tumor-directed therapy.
• Recurrent Participants:
• Participants who have had chemotherapy or radiotherapy within 3 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from acute adverse events due to agents administered more than 4 weeks earlier.
• Participants must be at least 1 week since the completion of therapy with a biologic or small molecule agent. For any agent with known adverse events that can occur beyond 1 week after administration, the period prior to enrollment must be beyond the time during which adverse events are known to occur. Such participants should also be discussed with study chairs.
• Participants should not have previously received any RAS-pathway, but have not received Tovorafenib will be eligible.
• All Participants:
• Rapidly progressive symptoms that require urgent surgery or radiation therapy, which would prevent central review and or preclude participation with tumor-directed medical management alone.
• Uncontrolled symptoms of neuroendocrine dysfunction such as diabetes insipidus, hypothyroidism, panhypopituitarism (participants can be on supplemental medications for hormonal repletion; however, should be on controlled doses for at least 2 weeks prior to enrollment).
• Clinically significant active cardiovascular disease, or history of myocardial infarction, or deep vein thrombosis/pulmonary embolism within 6 months prior to registration, ongoing cardiomyopathy, or current prolonged QT interval corrected for heart rate by Fridericia's formula (QTcF) interval > 440 ms based on triplicate ECG average.
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to tovorafenib.
• Nausea and vomiting >= Grade 2, malabsorption requiring supplementation, or significant bowel or stomach resection that would preclude adequate absorption.
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection.
• Participants who are receiving any other investigational agents.
• Women of childbearing potential must not be pregnant or breast-feeding.
• Current treatment with a strong cytochrome P4502C8(CYP2C8) inhibitor or inducer other than those allowed per Section 5.6.1. Medications that are substrates of CYP2C8 are allowed but should be used with caution.
• Participants with inability to return for follow-up visits or obtain follow-up studies required to assess toxicity to therapy.

Where it is running

• University of Alabama at Birmingham — Birmingham, Alabama, United States (enrolling)
• Rady Children's Hospital/University of California, San Diego — San Diego, California, United States (enrolling)
• University of California, San Francisco — San Francisco, California, United States (enrolling)
• University of Florida — Gainesville, Florida, United States (enrolling)
• Ann & Robert H. Lurie Children's Hospital of Chicago — Chicago, Illinois, United States (enrolling)
• Riley Hospital for Children at Indiana University Health — Indianapolis, Indiana, United States (enrolling)
• John Hopkins University — Baltimore, Maryland, United States (enrolling)
• Dana-Farber/Boston Children's Harvard Medical School — Boston, Massachusetts, United States (enrolling)
• University of Michigan — Ann Arbor, Michigan, United States (enrolling)
• Children's Minnesota — Minneapolis, Minnesota, United States (enrolling)
• St. Louis Children's Hospital Washington University — St Louis, Missouri, United States (enrolling)
• NYU Langone Health — New York, New York, United States (enrolling)
• Duke University Medical Center — Durham, North Carolina, United States (enrolling)
• Children's Hospital of Philadelphia — Philadelphia, Pennsylvania, United States (enrolling)
• University of Utah — Salt Lake City, Utah, United States (enrolling)
• John Hunter Children's Hospital — New Lambton Heights, New South Wales, Australia (enrolling)
• Royal Hobart Hospital — Hobart, Tasmania, Australia (enrolling)
• Children's Cancer Centre, Monash Children's Hospital — Clayton, VIC 3168, Australia (enrolling)
• Royal Children's Hospital, Childrens' Cancer Centre — Parkville, Victoria, Australia (enrolling)
• Perth Children's Hospital — Nedlands, Western Australia, Australia (enrolling)

Full record on ClinicalTrials.gov

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