1. A phase I/II study of ribociclib following radiation therapy in children with newly diagnosed diffuse intrinsic pontine glioma (DIPG)
- Author
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Blaise V. Jones, Luke Pater, Adam Lane, Trent R. Hummel, Shiva Senthil Kumar, Adam C. Carle, Ralph Salloum, James L. Leach, Phil Dexheimer, Christine Fuller, Charles B. Stevenson, David P. Witte, Maryam Fouladi, Mariko DeWire, Rachid Drissi, Sarah A. Lawson, Lionel M L Chow, Peter de Blank, John C. Breneman, and Xiaoting Zhu
- Subjects
Oncology ,Cancer Research ,medicine.medical_specialty ,Neurology ,business.industry ,medicine.medical_treatment ,Ribociclib ,Newly diagnosed ,Neutropenia ,medicine.disease ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,Tolerability ,030220 oncology & carcinogenesis ,Internal medicine ,Glioma ,Toxicity ,medicine ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Cyclin-dependent kinase-retinoblastoma (CDK-RB) pathway is dysregulated in some diffuse intrinsic pontine gliomas (DIPG). We evaluated safety, feasibility, and early efficacy of the CDK4/6-inhibitor ribociclib, administered following radiotherapy in newly-diagnosed DIPG patients. Following radiotherapy, eligible patients received ribociclib in 28-day cycles (350 mg/m2; 21 days on/7 days off). Feasibility endpoints included tolerability for at least 6 courses, and a less than 2-week delay in restarting therapy after 1 dose reduction. Early efficacy was measured by 1-year and median overall survival (OS). Patient/parent-by-proxy reported outcomes measurement information system (PROMIS) assessments were completed prospectively. The study included 10 evaluable patients, 9 DIPG and 1 diffuse midline glioma (DMG)—all 3.7 to 19.8 years of age. The median number of courses was 8 (range 3–14). Three patients required dose reduction for grade-4 neutropenia, and 1 discontinued therapy for hematological toxicity following course 4. The most common grade-3/4 toxicity was myelosuppression. After 2 courses, MRI evaluations in 4 patients revealed increased necrotic volume, associated with new neurological symptoms in 3 patients. The 1-year and median OS for DIPG was 89% and 16.1 months (range 10–30), respectively; the DMG patient died at 6 months post-diagnosis. Five patients donated brain tissue and tumor; 3 were RB+ . Ribociclib administered following radiotherapy is feasible in DIPG and DMG. Increased tumor necrosis may represent a treatment effect. These data warrant further prospective volumetric analyses of tumors with necrosis. Feasibility and stabilization findings support further investigation of ribociclib in combination therapies. NCT02607124.
- Published
- 2020
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