Palbociclib in Treating Patients With Relapsed or Refractory Rb Positive Advanced Solid Tumors, Non-Hodgkin Lymphoma, or Histiocytic Disorders With Activating Alterations in Cell Cycle Genes (A Pediatric MATCH Treatment Trial)
Palbociclib in Treating Patients With Relapsed or Refractory Rb Positive Advanced Solid Tumors, Non-Hodgkin Lymphoma, or Histiocytic Disorders With Activating Alterations in Cell Cycle Genes (A Pediatric MATCH Treatment Trial)
This phase II Pediatric MATCH trial studies how well palbociclib works in treating patients
 with Rb positive solid tumors, non-Hodgkin lymphoma, or histiocytic disorders with activating
 alterations (mutations) in cell cycle genes that have spread to other places in the body and
 have come back or do not respond to treatment. Palbociclib may stop the growth of cancer
 cells by blocking some of the enzymes needed for cell growth.
PRIMARY OBJECTIVE:

 I. To determine the objective response rate (ORR; complete response + partial response) in
 pediatric patients treated with palbociclib with advanced solid tumors (including central
 nervous system [CNS] tumors), non-Hodgkin lymphomas or histiocytic disorders that harbor
 activating genetic alterations in cell cycle genes.

 SECONDARY OBJECTIVES:

 I. To estimate the progression free survival in pediatric patients treated with palbociclib
 with advanced solid tumors (including CNS tumors), non-Hodgkin lymphomas or histiocytic
 disorders that harbor activating genetic alterations in alterations in cell cycle genes.

 II. To obtain information about the tolerability of palbociclib in children and adolescents
 with relapsed or refractory cancer.

 EXPLORATORY OBJECTIVE:

 I. To explore approaches to profiling changes in tumor genomics over time through evaluation
 of circulating tumor deoxyribonucleic acid (DNA).

 OUTLINE:

 Patients receive palbociclib orally (PO) once daily (QD) on days 1-21. Cycles repeat every 28
 days for up to 2 years in the absence of disease progression or unacceptable toxicity.
Inclusion Criteria:

 -  Patient must have enrolled onto APEC1621SC and must have been given a treatment
 assignment to MATCH to APEC1621I based on the presence of an actionable mutation

 -  In addition to the actionable mutations, positive Rb expression by
 immunohistochemistry is required for study enrollment

 -  Patients must have a body surface area >= 0.87 m^2 at enrollment

 -  Patients must have radiographically measurable disease at the time of study
 enrollment; patients with neuroblastoma who do not have measurable disease but have
 MIBG+ evaluable disease are eligible; measurable disease in patients with CNS
 involvement is defined as tumor that is measurable in two perpendicular diameters on
 magnetic resonance imaging (MRI) and visible on more than one slice

 -  Note: The following do not qualify as measurable disease:

 -  Malignant fluid collections (e.g., ascites, pleural effusions)

 -  Bone marrow infiltration except that detected by MIBG scan for neuroblastoma

 -  Lesions only detected by nuclear medicine studies (e.g., bone, gallium or
 positron emission tomography [PET] scans) except as noted for neuroblastoma

 -  Elevated tumor markers in plasma or cerebrospinal fluid (CSF)

 -  Previously radiated lesions that have not demonstrated clear progression
 post radiation

 -  Leptomeningeal lesions that do not meet the measurement requirements for
 Response Evaluation Criteria in Solid Tumors (RECIST) 1.1

 -  Karnofsky >= 50% for patients > 16 years of age and Lansky >= 50 for patients =< 16
 years of age; Note: Neurologic deficits in patients with CNS tumors must have been
 relatively stable for at least 7 days prior to study enrollment; patients 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

 -  Patients must have fully recovered from the acute toxic effects of all prior
 anti-cancer therapy and must meet the following minimum duration from prior
 anti-cancer directed therapy prior to enrollment; if after the required timeframe, the
 numerical eligibility criteria are met, e.g. blood count criteria, the patient is
 considered to have recovered adequately

 -  Cytotoxic chemotherapy or other anti-cancer agents known to be myelosuppressive;
 for agents not listed, the duration of this interval must be discussed with the
 study chair and the study-assigned research coordinator prior to enrollment

 -  >= 21 days after the last dose of cytotoxic or myelosuppressive chemotherapy
 (42 days if prior nitrosourea)

 -  Anti-cancer agents not known to be myelosuppressive (e.g. not associated with
 reduced platelet or absolute neutrophil counts [ANC] counts): >= 7 days after the
 last dose of agent

 -  Antibodies: >= 21 days must have elapsed from infusion of last dose of antibody,
 and toxicity related to prior antibody therapy must be recovered to grade =< 1

 -  Corticosteroids: If used to modify immune adverse events related to prior
 therapy, >= 14 days must have elapsed since last dose of corticosteroid

 -  Hematopoietic growth factors: >= 14 days after the last dose of a long-acting
 growth factor (e.g. pegfilgrastim) or 7 days for short-acting growth factor; for
 growth factors 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; the duration of this interval must be discussed with
 the study chair and the study-assigned research coordinator

 -  Interleukins, interferons and cytokines (other than hematopoietic growth
 factors): >= 21 days after the completion of interleukins, interferon or
 cytokines (other than hematopoietic growth factors)

 -  Stem cell infusions (with or without total body irradiation [TBI]):

 -  Allogeneic (non-autologous) bone marrow or stem cell transplant, or any stem
 cell infusion including donor lymphocyte infusion (DLI) or boost infusion:
 >= 84 days after infusion and no evidence of graft versus host disease
 (GVHD)

 -  Autologous stem cell infusion including boost infusion: >= 42 days

 -  Cellular therapy: >= 42 days after the completion of any type of cellular therapy
 (e.g. modified T cells, natural killer [NK] cells, dendritic cells, etc.)

 -  Radiation therapy (XRT)/external beam irradiation including protons: >= 14 days
 after local XRT; >= 150 days after TBI, craniospinal XRT or if radiation to >=
 50% of the pelvis; >= 42 days if other substantial bone morrow (BM) radiation

 -  Note: Radiation may not be delivered to "measurable disease" tumor site(s)
 being used to follow response to subprotocol treatment

 -  Radiopharmaceutical therapy (e.g., radiolabeled antibody, 131I-MIBG): >= 42 days
 after systemically administered radiopharmaceutical therapy

 -  Patients must not have received prior exposure to palbociclib, ribociclib,
 abemaciclib or any other CDK4/6 inhibitors

 -  For patients with solid tumors without known bone marrow involvement:

 -  Peripheral absolute neutrophil count (ANC) >= 1000/mm^3

 -  Platelet count >= 100,000/mm^3 (transfusion independent, defined as not receiving
 platelet transfusions for at least 7 days prior to enrollment)

 -  Patients with known bone marrow metastatic disease will be eligible for study provided
 they meet the blood counts (may receive transfusions provided they are not known to be
 refractory to red cell or platelet transfusions); these patients will not be evaluable
 for hematologic toxicity

 -  Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70
 ml/min/1.73 m^2 or a serum creatinine based on age/gender as follows:

 -  Age: 1 to < 2 years; maximum serum creatinine (mg/dL): male 0.6; female 0.6

 -  Age: 2 to < 6 years; maximum serum creatinine (mg/dL): male 0.8; female 0.8

 -  Age: 6 to < 10 years; maximum serum creatinine (mg/dL): male 1; female 1

 -  Age: 10 to < 13 years; maximum serum creatinine (mg/dL): male 1.2; female 1.2

 -  Age: 13 to < 16 years; maximum serum creatinine (mg/dL): male 1.5; female 1.4

 -  Age: >= 16 years; maximum serum creatinine (mg/dL): male 1.7; female 1.4

 -  Bilirubin (sum of conjugated + unconjugated) =< 1.5 x upper limit of normal (ULN) for
 age

 -  Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 135
 U/L; (for the purpose of this study, the ULN for SGPT is 45 U/L)

 -  Serum albumin >= 2 g/dL

 -  Patients must be able to swallow intact capsules

 -  All patients and/or their parents or legally authorized representatives must sign a
 written informed consent; assent, when appropriate, will be obtained according to
 institutional guidelines

 Exclusion Criteria:

 -  Pregnant or breast-feeding women will not be entered on this study due to risks of
 fetal and teratogenic adverse events as seen in animal/human studies; pregnancy tests
 must be obtained in girls who are post-menarchal; males or females of reproductive
 potential may not participate unless they have agreed to use an effective
 contraceptive method for the duration of study treatment; females study participants
 of child-bearing potential and their partners, should agree to use highly effective
 forms of contraception for at least 3 weeks after the last dose of palbociclib; male
 study participants should avoid fathering a child, donating sperm, and should agree to
 use highly effective forms of contraception for at least 3 months after the last dose
 of palbociclib

 -  Concomitant medications

 -  Corticosteroids: Patients receiving corticosteroids who have not been on a stable
 or decreasing dose of corticosteroid for at least 7 days prior to enrollment are
 not eligible; if used to modify immune adverse events related to prior therapy,
 >= 14 days must have elapsed since last dose of corticosteroid

 -  Investigational drugs: Patients who are currently receiving another
 investigational drug are not eligible

 -  Anti-cancer agents: Patients who are currently receiving other anti-cancer agents
 are not eligible

 -  Anti-GVHD agents post-transplant: Patients who are receiving cyclosporine,
 tacrolimus or other agents to prevent graft-versus-host disease post bone marrow
 transplant are not eligible for this trial

 -  CYP3A4 agents: Patients who are currently receiving drugs that are strong
 inducers or inhibitors of CYP3A4 are not eligible; strong inducers or inhibitors
 of CYP3A4 should be avoided from 14 days prior to enrollment to the end of the
 study; Note: CYP3A4 inducing anti-epileptic drugs and dexamethasone for CNS
 tumors or metastases, on a stable dose, are allowed

 -  Patients who have an uncontrolled infection are not eligible

 -  Patients who have received a prior solid organ transplantation are not eligible

 -  Patients who in the opinion of the investigator may not be able to comply with the
 safety monitoring requirements of the study are not eligible