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    Clinical Trial Results:
    A Phase II Study of Sunitinib (NSC# 736511, IND# 74019) in Recurrent, Refractory or Progressive High Grade Glioma (HGG) And Ependymoma Tumors in Pediatric And Young Adult Patients

    Summary
    EudraCT number
    2018-004520-10
    Trial protocol
    Outside EU/EEA  
    Global end of trial date
    24 Jun 2013

    Results information
    Results version number
    v1(current)
    This version publication date
    22 Sep 2019
    First version publication date
    22 Sep 2019
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    ACNS1021
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01462695
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    National Cancer Institute, National Institutes of Health
    Sponsor organisation address
    BG 9609 MSC 9760, 9609 Medical Center Drive, Bethesda, United States,
    Public contact
    National Cancer Institute, National Cancer Institute, National Institutes of Health, 001 1-800-422-6237, NCIinfo@nih.gov
    Scientific contact
    National Cancer Institute, National Cancer Institute, National Institutes of Health, 001 1-800-422-6237, NCIinfo@nih.gov
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    Yes
    EMA paediatric investigation plan number(s)
    EMEA-000147-PIP20-18
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    31 Dec 2013
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    24 Jun 2013
    Global end of trial reached?
    Yes
    Global end of trial date
    24 Jun 2013
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    To estimate the objective response rate (ORR [partial response {PR} or complete response {CR} greater than or equal to 8 weeks]) to sunitinib in 2 strata of recurrent or progressive brain tumors in pediatric and young adult patients. The target tumors were: •Stratum A: Recurrent/progressive/refractory high-grade glioma (excluding diffuse intrinsic pontine glioma). •Stratum B: Recurrent/progressive/refractory ependymoma
    Protection of trial subjects
    The study was in compliance with the ethical principles derived from the Declaration of Helsinki and in compliance with all International Council for Harmonization (ICH) Good Clinical Practice (GCP) Guidelines. All the local regulatory requirements pertinent to safety of trials subjects were followed.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    30 Jan 2012
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Australia: 1
    Country: Number of subjects enrolled
    United States: 26
    Country: Number of subjects enrolled
    Canada: 1
    Country: Number of subjects enrolled
    Saudi Arabia: 1
    Worldwide total number of subjects
    29
    EEA total number of subjects
    0
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    13
    Adolescents (12-17 years)
    14
    Adults (18-64 years)
    2
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    National Cancer Institute (NCI) was the trial sponsor and Children's Oncology Group (COG) conducted the study on behalf of NCI. Pfizer performed the data analysis based on the data transferred from COG.

    Pre-assignment
    Screening details
    The study was conducted in 4 countries at multiple sites.

    Period 1
    Period 1 title
    Overall (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Stratum A: Recurrent High Grade Glioma
    Arm description
    Subjects with recurrent/progressive/refractory HGG received sunitinib, starting dose of 15 milligram per square meter (15 mg/m^2) on basis of body surface area, orally once daily for a 6-week cycle. Each cycle consisted of treatment period of 28 days and a 14 days rest period without sunitinib. Treatment continued for a maximum of 18 cycles in the absence of disease progression or unacceptable toxicity.
    Arm type
    Experimental

    Investigational medicinal product name
    Sunitinib
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule, hard
    Routes of administration
    Oral use
    Dosage and administration details
    In each cycle subjects received sunitinib, starting dose of 15 mg/m^2 orally once daily for 28 days followed by 14 days without sunitinib.

    Arm title
    Stratum B: Recurrent Ependymoma
    Arm description
    Subjects with recurrent/progressive/refractory ependymoma received sunitinib, starting dose of 15 mg/m^2 on basis of body surface area, orally once daily for a 6-week cycle. Each cycle consisted of treatment period of 28 days and a 14 days rest period without sunitinib. Treatment continued for a maximum of 18 cycles in the absence of disease progression or unacceptable toxicity.
    Arm type
    Experimental

    Investigational medicinal product name
    Sunitinib
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule, hard
    Routes of administration
    Oral use
    Dosage and administration details
    In each cycle subjects received sunitinib, starting dose of 15 mg/m^2 orally once daily for 28 days followed by 14 days without sunitinib.

    Number of subjects in period 1
    Stratum A: Recurrent High Grade Glioma Stratum B: Recurrent Ependymoma
    Started
    16
    13
    Completed
    0
    0
    Not completed
    16
    13
         Progressive disease represents >25% increase
    6
    11
         Occurrence of new/worsening hemorrhage
    1
    1
         Physician decision
    5
    1
         Consent withdrawn by subject
    2
    -
         Death
    2
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Stratum A: Recurrent High Grade Glioma
    Reporting group description
    Subjects with recurrent/progressive/refractory HGG received sunitinib, starting dose of 15 milligram per square meter (15 mg/m^2) on basis of body surface area, orally once daily for a 6-week cycle. Each cycle consisted of treatment period of 28 days and a 14 days rest period without sunitinib. Treatment continued for a maximum of 18 cycles in the absence of disease progression or unacceptable toxicity.

    Reporting group title
    Stratum B: Recurrent Ependymoma
    Reporting group description
    Subjects with recurrent/progressive/refractory ependymoma received sunitinib, starting dose of 15 mg/m^2 on basis of body surface area, orally once daily for a 6-week cycle. Each cycle consisted of treatment period of 28 days and a 14 days rest period without sunitinib. Treatment continued for a maximum of 18 cycles in the absence of disease progression or unacceptable toxicity.

    Reporting group values
    Stratum A: Recurrent High Grade Glioma Stratum B: Recurrent Ependymoma Total
    Number of subjects
    16 13 29
    Age categorical
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    6 7 13
        Adolescents (12-17 years)
    8 6 14
        Adults (18-64 years)
    2 0 2
        From 65-84 years
    0 0 0
        85 years and over
    0 0 0
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    12.5 ± 4.5 10.3 ± 4.5 -
    Gender categorical
    Units: Subjects
        Female
    4 7 11
        Male
    12 6 18

    End points

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    End points reporting groups
    Reporting group title
    Stratum A: Recurrent High Grade Glioma
    Reporting group description
    Subjects with recurrent/progressive/refractory HGG received sunitinib, starting dose of 15 milligram per square meter (15 mg/m^2) on basis of body surface area, orally once daily for a 6-week cycle. Each cycle consisted of treatment period of 28 days and a 14 days rest period without sunitinib. Treatment continued for a maximum of 18 cycles in the absence of disease progression or unacceptable toxicity.

    Reporting group title
    Stratum B: Recurrent Ependymoma
    Reporting group description
    Subjects with recurrent/progressive/refractory ependymoma received sunitinib, starting dose of 15 mg/m^2 on basis of body surface area, orally once daily for a 6-week cycle. Each cycle consisted of treatment period of 28 days and a 14 days rest period without sunitinib. Treatment continued for a maximum of 18 cycles in the absence of disease progression or unacceptable toxicity.

    Primary: Sustained Objective Response Rate

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    End point title
    Sustained Objective Response Rate [1]
    End point description
    Sustained objective response was defined as a partial response (PR) or complete response (CR) lasting at least 8 weeks. PR: greater than or equal to 50 percent decrease in the sum of the products of the 2 perpendicular diameters of all target lesions (up to 5), taking as reference the initial baseline measurements. CR: disappearance of all target lesions.
    End point type
    Primary
    End point timeframe
    Up to 2 years
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Descriptive statistics (percentage and its 95% confidence interval) were calculated.
    End point values
    Stratum A: Recurrent High Grade Glioma Stratum B: Recurrent Ependymoma
    Number of subjects analysed
    16
    13
    Units: percentage of subjects
        number (confidence interval 95%)
    0 (0.0 to 20.6)
    0 (0.0 to 24.7)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    up to 30 days after the last dose (up to 2 years)
    Adverse event reporting additional description
    The same events may occur as both an adverse event (AE) and a serious adverse event (SAE). However, what is presented are distinct events. An event may be categorized as serious in one subject and as nonserious in another subject, or one subject may have experienced both a serious and nonserious event during the study.
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    20.0
    Reporting groups
    Reporting group title
    Stratum A: Recurrent High Grade Glioma
    Reporting group description
    Subjects with recurrent/progressive/refractory HGG received sunitinib, starting dose of 15 mg/m^2 on basis of body surface area, orally once daily for a 6-week cycle. Each cycle consisted of treatment period of 28 days and a 14 days rest period without sunitinib. Treatment continued for a maximum of 18 cycles in the absence of disease progression or unacceptable toxicity.

    Reporting group title
    Stratum B: Recurrent Ependymoma
    Reporting group description
    Subjects with recurrent/progressive/refractory ependymoma received sunitinib, starting dose of 15 mg/m^2 on basis of body surface area, orally once daily for a 6-week cycle. Each cycle consisted of treatment period of 28 days and a 14 days rest period without sunitinib. Treatment continued for a maximum of 18 cycles in the absence of disease progression or unacceptable toxicity.

    Serious adverse events
    Stratum A: Recurrent High Grade Glioma Stratum B: Recurrent Ependymoma
    Total subjects affected by serious adverse events
         subjects affected / exposed
    11 / 16 (68.75%)
    3 / 13 (23.08%)
         number of deaths (all causes)
    4
    1
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Glioblastoma multiforme
         subjects affected / exposed
    1 / 16 (6.25%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Neoplasm
         subjects affected / exposed
    1 / 16 (6.25%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neoplasm progression
         subjects affected / exposed
    4 / 16 (25.00%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 4
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Dysarthria
         subjects affected / exposed
    0 / 16 (0.00%)
    1 / 13 (7.69%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Facial nerve disorder
         subjects affected / exposed
    0 / 16 (0.00%)
    1 / 13 (7.69%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Haemorrhage intracranial
         subjects affected / exposed
    2 / 16 (12.50%)
    1 / 13 (7.69%)
         occurrences causally related to treatment / all
    2 / 2
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Headache
         subjects affected / exposed
    1 / 16 (6.25%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hydrocephalus
         subjects affected / exposed
    2 / 16 (12.50%)
    1 / 13 (7.69%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Paraesthesia
         subjects affected / exposed
    0 / 16 (0.00%)
    1 / 13 (7.69%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Peripheral motor neuropathy
         subjects affected / exposed
    0 / 16 (0.00%)
    1 / 13 (7.69%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Seizure
         subjects affected / exposed
    3 / 16 (18.75%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Death
         subjects affected / exposed
    1 / 16 (6.25%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Gait disturbance
         subjects affected / exposed
    0 / 16 (0.00%)
    1 / 13 (7.69%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Rash maculo-papular
         subjects affected / exposed
    1 / 16 (6.25%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Stratum A: Recurrent High Grade Glioma Stratum B: Recurrent Ependymoma
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    9 / 16 (56.25%)
    8 / 13 (61.54%)
    Investigations
    Activated partial thromboplastin time prolonged
         subjects affected / exposed
    0 / 16 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Alanine aminotransferase increased
         subjects affected / exposed
    1 / 16 (6.25%)
    0 / 13 (0.00%)
         occurrences all number
    2
    0
    Amylase increased
         subjects affected / exposed
    1 / 16 (6.25%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Aspartate aminotransferase increased
         subjects affected / exposed
    1 / 16 (6.25%)
    0 / 13 (0.00%)
         occurrences all number
    1
    1
    Lipase increased
         subjects affected / exposed
    1 / 16 (6.25%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Lymphocyte count decreased
         subjects affected / exposed
    0 / 16 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Neutrophil count decreased
         subjects affected / exposed
    1 / 16 (6.25%)
    5 / 13 (38.46%)
         occurrences all number
    1
    5
    White blood cell count decreased
         subjects affected / exposed
    0 / 16 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Nervous system disorders
    Ataxia
         subjects affected / exposed
    1 / 16 (6.25%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Headache
         subjects affected / exposed
    1 / 16 (6.25%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Hemiparesis
         subjects affected / exposed
    1 / 16 (6.25%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Paraesthesia
         subjects affected / exposed
    0 / 16 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Peripheral motor neuropathy
         subjects affected / exposed
    0 / 16 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    2 / 16 (12.50%)
    0 / 13 (0.00%)
         occurrences all number
    2
    0
    Eye disorders
    Extraocular muscle paresis
         subjects affected / exposed
    1 / 16 (6.25%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    0 / 16 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Nausea
         subjects affected / exposed
    1 / 16 (6.25%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Vomiting
         subjects affected / exposed
    1 / 16 (6.25%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Skin and subcutaneous tissue disorders
    Acne
         subjects affected / exposed
    1 / 16 (6.25%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Dermatitis acneiform
         subjects affected / exposed
    0 / 16 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Rash
         subjects affected / exposed
    1 / 16 (6.25%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Skin striae
         subjects affected / exposed
    1 / 16 (6.25%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Musculoskeletal and connective tissue disorders
    Muscular weakness
         subjects affected / exposed
    1 / 16 (6.25%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Metabolism and nutrition disorders
    Hypoglycaemia
         subjects affected / exposed
    0 / 16 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? No

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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