Combination of Alpelisib and Trametinib in Progressive Refractory Meningiomas (ALTREM)

Public Assistance-Hospitals of Marseille (AP-HM)

Status and phase

Unknown

Phase 1

Conditions

Meningioma

Treatments

Drug: Trametinib

Biological: Blood sample

Device: MRI

Drug: Alpelisib

Study type

Interventional

Funder types

Other

Identifiers

NCT03631953

RCAPHM18_0015 (Other Identifier)

2018-05

Details and patient eligibility

About

Aggressive growing meningiomas resistant to multiple surgeries and radiotherapy constitute an unmet pharmaceutical need in neurooncology, leading to a fatal issue within a few months. Grade II-III meningiomas progression-free survival (PFS) 6 is at 10-15%. Median PFS grade III meningioma is approximate 3 years.

Alpelisib is a well-tolerated Phosphoinositide 3-kinase α (Pi3Kα) specific inhibitor. However, phosphatidylinositol-3-kinase (PI3K) and the mammalian target of rapamycin (mTOR) inhibition does not induce apoptosis in vitro and induces an antiproliferative effect without any radiologic response in most treated patients.

Trametinib, a mekinist (MEK) inhibitor is currently used in combined treatment for recurrent melanomas in clinical practice with a good clinical tolerance at 1-2 mg daily. In vitro, on meningioma primary cell culture, Trametinib induces cell apoptosis via caspase activity.

These results strongly suggest the relevance to combine Alpelisib and Trametinib in aggressive and recurrent meningiomas.

Alpelisib and Trametinib combination has not been studied to date, despite each drugs have been separately studied in phase 3.

Multicenter, open label, dose-finding phase I study of Alpelisib in combination with Trametinib administered at a fixed dose (1.5 mg daily), both drugs will be administered daily. Starting dose of Alpelisib will be 160mg/day and will be increased to 200mg/day or decreased to 120mg/day depending of grade 3-4 adverse events occurrence, to determine maximal tolerated dose (MTD) and recommended dose.

Primary Objective is to determine the safety profile and tolerability of Alpelisib and Trametinib given in combination in patients with aggressive and refractory meningiomas in terms of Dose-Limiting Toxicities (DLT, assessed during cycle 1).

Enrollment

25 estimated patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Histologically proven meningioma grade I, II and III
Progression is defined as growing meningiomas on 2 different Magnetic Resonance Imaging (MRI) 3 to 6 months apart
Patients must have failed surgery, and not amenable to a new curative intended surgery
Patients must have failed radiotherapy and/or radiosurgery
Patients who have given their written consent
No contra indication to Alpelisib and Trametinib
No receiving other investigational agents
Written informed consent
Adequate bone marrow function
Adequate liver function as shown by
Adequate renal function

Exclusion criteria

Contra indication to Alpelisib and Trametinib
Women of child-bearing age who are using no effective means of contraception
Pregnant or breast-feeding women
Patients receiving other investigational agents
Known intolerance or hypersensitivity to Alpelisib and Trametinib
Uncontrolled diabetes mellitus
Patients who have any severe and uncontrolled medical condition
Patients receiving chronic treatment with immunosuppressives
Patients with a known history of HIV seropositivity
Patients who have a history of another primary malignancy less than or equal to 3 years, with
the exceptions of non-melanoma skin cancer, and carcinoma in situ of uterine cervix