Targeted Therapy Directed by Genetic Testing in Treating Pediatric Patients With Relapsed or Refractory Advanced Solid Tumors, Non-Hodgkin Lymphomas, or Histiocytic Disorders (The Pediatric MATCH Screening Trial)
Targeted Therapy Directed by Genetic Testing in Treating Pediatric Patients With Relapsed or Refractory Advanced Solid Tumors, Non-Hodgkin Lymphomas, or Histiocytic Disorders (The Pediatric MATCH Screening Trial)
This Pediatric MATCH screening and multi-sub-study phase II trial studies how well treatment
 that is directed by genetic testing works in pediatric patients with solid tumors,
 non-Hodgkin lymphomas, or histiocytic disorders that have progressed following at least one
 line of standard systemic therapy and/or for which no standard treatment exists that has been
 shown to prolong survival. Genetic tests look at the unique genetic material (genes) of
 patients' tumor cells. Patients with genetic changes or abnormalities (mutations) may benefit
 more from treatment which targets their tumor's particular genetic mutation, and may help
 doctors plan better treatment for patients with solid tumors or non-Hodgkin lymphomas.
PRIMARY OBJECTIVES:

 I. To utilize clinical and biological data to screen for eligibility to phase 2
 pathway-targeting specific subprotocols of pathway-targeting agents in pediatric patients
 with advanced solid tumors, non-Hodgkin lymphomas, and histiocytic disorders.

 II. To determine the proportion of pediatric patients whose advanced tumors have pathway
 alterations that can be targeted by select anti-cancer drugs.

 III. To determine the objective response rates (ORR; complete response + partial response) in
 pediatric patients with advanced solid tumors, non-Hodgkin lymphomas, and histiocytic
 disorders harboring a priori specified genomic alterations treated with pathway-targeting
 agents.

 SECONDARY OBJECTIVES:

 I. To estimate the progression free survival in pediatric patients receiving targeted
 therapies for advanced solid tumors, non-Hodgkin lymphomas, and histiocytic disorders.

 II. To obtain preliminary or additional information about the tolerability of targeted
 therapies in children with advanced cancers.

 III. To provide preliminary estimates of the pharmacokinetics of targeted therapies in
 children with advanced cancers.

 IV. To obtain preliminary information on the response rate to targeted therapy in patients
 whose tumors lack actionable alterations as defined for the molecular analysis for therapy
 choice (MATCH) study, for selected agents for which efficacy is observed in the primary
 matched cohort.

 EXPLORATORY OBJECTIVES:

 I. To increase knowledge of the genomic landscape of advanced pediatric solid tumors,
 non-Hodgkin lymphomas, and histiocytic disorders.

 II. To describe the genomic changes that occur in advanced pediatric cancers between the time
 of initial diagnosis and relapse, in cases for which paired tumor specimens are available.

 III. To explore approaches to diagnosing and profiling genomics of advanced pediatric cancers
 through evaluation of circulating tumor deoxyribonucleic acid (DNA).

 IV. To determine the frequency and spectrum of germline cancer susceptibility mutations in
 children with relapsed solid tumors and non-Hodgkin lymphomas and assess the feasibility of
 return of those results in the National Clinical Trial Network (NCTN) group setting.

 OUTLINE:

 STEP 1 (SCREENING): Patients undergo biopsy along with tumor mutational screening of the
 biopsy material for specific, pre-defined mutations, amplifications, or translocations of
 interest via tumor sequencing and immunohistochemistry. Patients also undergo collection of
 blood samples for research purposes.

 STEP 2 (TREATMENT): Patients with a mutation targeted by one or more of the investigational
 drugs used in this study or those without mutations are assigned to 1 of 10 treatment
 subprotocols.

 APEC1621A: Patients with a NTRK1, NTRK2, or NTRK3 gene fusion receive Trk inhibitor LOXO-101
 orally (PO) or via nasogastric- or gastric-tube twice daily (BID) on days 1-28. Cycles repeat
 every 28 days for 2 years in the absence of disease progression or unacceptable toxicity.

 APEC1621B: Patients with a FGFR1, FGFR2, FGFR3, or FGFR4 gene mutation receive pan-FGFR
 tyrosine kinase inhibitor JNJ-42756493 PO once daily on days 1-28. Cycles repeat every 28
 days for up to 2 years in the absence of disease progression or unacceptable toxicity.

 APEC1621C: Patients with an EZH2, SMARCB1, or SMARCA4 gene mutation receive tazemetostat PO
 BID on days 1-28. Cycles repeat every 28 days for 2 years in the absence of disease
 progression or unacceptable toxicity.

 APEC1621D: Patients with a TSC1, TSC2, or PI3K/mTOR gene mutations receive PI3K/mTOR
 inhibitor LY3023414 PO BID on days 1-28. Cycles repeat every 28 days for 2 years in the
 absence of disease progression or unacceptable toxicity.

 APEC1621E: Patients with an activating MAPK pathway gene mutation receive selumetinib sulfate
 PO BID on days 1-28. Cycles repeat every 28 days for 2 years in the absence of disease
 progression or unacceptable toxicity.

 APEC1621F: Patients with an ALK or ROS1 gene alteration receive ensartinib (ALK Inhibitor
 X-396) PO BID on days 1-28. Cycles repeat every 28 days for 2 years in the absence of disease
 progression or unacceptable toxicity.

 APEC1621G: Patients with a BRAF V600 gene mutation receive vemurafenib PO BID on days 1-28.
 Cycles repeat every 28 days for 2 years in the absence of disease progression or unacceptable
 toxicity.

 APEC1621H: Patients with deleterious ATM, BRCA1, BRCA2, RAD51C, or RAD51D gene mutations
 receive olaparib PO BID on days 1-28. Cycles repeat every 28 days for 2 years in the absence
 of disease progression or unacceptable toxicity.

 APEC1621I: Patients with Rb positive advanced solid tumors, non-Hodgkin lymphoma, or
 histiocytic disorders with activating alterations in cell cycle genes receive palbociclib PO
 QD on days 1-21. Cycles repeat every 28 days for up to 2 years in the absence of disease
 progression or unacceptable toxicity.

 APEC1621J: Patients with MAPK Pathway Mutations receive ulixertinib PO BID. Cycles repeat
 every 28 days for up to 2 years in the absence of disease progression or unacceptable
 toxicity.

 APEC1621M: Patients with HRAS gene alterations receive tipifarnib PO or via nasogastric or
 gastric tube BID on days 1-7 and 15-21. Treatment repeats every 28 days for up to 26 cycles
 (2 years) in the absence of disease progression or unacceptable toxicity.

 APEC1621N: Patients with activating RET gene alterations receive selpercatinib PO BID on days
 1-28. Treatment repeats every 28 days for up to 26 cycles (2 years) in the absence of disease
 progression or unacceptable toxicity.

 After completion of study treatment, patients are followed up periodically.
Inclusion Criteria:

 -  ELIGIBILITY CRITERIA FOR ENROLLMENT ONTO APEC1621SC: Patients with recurrent or
 refractory solid tumors, including non-Hodgkin lymphomas, histiocytoses (e.g.
 langerhans cell histiocytosis [LCH], juvenile xanthogranuloma [JXG], histiocytic
 sarcoma), and central nervous system (CNS) tumors are eligible; patients must have had
 histologic verification of malignancy at original diagnosis or relapse except in
 patients with intrinsic brain stem tumors, optic pathway gliomas, or patients with
 pineal tumors and elevations of cerebrospinal fluid (CSF) or serum tumor markers
 including alpha-fetoprotein or beta-human chorionic gonadotropin (HCG); in cases where
 patient enrolls prior to histologic confirmation of recurrent disease, patient is
 ineligible and should be withdrawn from study if histology fails to confirm
 recurrence; please note: Patients with Hodgkin lymphoma and plexiform neurofibroma are
 not eligible

 -  ELIGIBILITY CRITERIA FOR ENROLLMENT ONTO APEC1621SC: Patients must have an
 formalin-fixed paraffin-embedded (FFPE) tumor sample available for MATCH study testing
 from a biopsy or surgery that was performed at any point after initial tumor
 recurrence/progression, or be planned to have a procedure to obtain such a sample that
 is considered to be of potential benefit by the treating clinicians; a tumor sample
 from a clinically performed diagnostic (pre-treatment) biopsy will be acceptable for
 enrollment onto Pediatric MATCH only for children with high-grade gliomas of the
 brainstem (diffuse intrinsic pontine gliomas) or thalamus

 -  Please note: Samples that have been decalcified using standardly utilized
 acid-based decalcification methods are not generally suitable for MATCH study
 testing; the nucleic acids will have been degraded in the decalcification process

 -  ELIGIBILITY CRITERIA FOR ENROLLMENT ONTO APEC1621SC: 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 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

 -  ELIGIBILITY CRITERIA FOR ENROLLMENT ONTO APEC1621SC: Patients must have
 radiographically measurable disease; measurable disease based on imaging obtained less
 than or equal to 56 days prior to enrollment; patients with neuroblastoma who do not
 have measurable disease but have metaiodobenzylguanidine (MIBG) positive (+) evaluable
 disease are eligible; measurable disease in patients with central nervous system (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 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

 -  GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: NOTE: patient does not need to meet all
 subprotocol criteria at time of enrollment onto the APEC1621SC screening protocol, but
 will need to meet all criteria prior to enrollment on any assigned treatment
 subprotocol. Patients must be enrolled onto a subprotocol within 8 weeks (56 days) of
 treatment assignment

 -  GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: 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 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

 -  GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: At the time of treatment with subprotocol
 specified therapy, the patients must have radiographically measurable disease;
 patients with neuroblastoma who do not have measurable disease but have MIBG+
 evaluable are eligible; measurable disease in patients with CNS involvement is defined
 as tumor that is measurable in two perpendicular diameters on 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 CSF

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

 -  Leptomeningeal lesions that do not meet the measurement requirements for
 RECIST 1.1

 -  GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: At the time of enrollment onto a
 subprotocol, the following general criteria for initiation of therapy will be
 required:

 -  Patients must have fully recovered from the acute toxic effects of all prior
 anticancer therapy and must meet the following minimum duration from prior
 anticancer directed therapy prior to enrollment to the subprotocol; 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 anticancer 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)

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

 -  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. Neulasta) or 7 days for short-acting growth
 factor; for agents 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, NK cells, dendritic cells, etc.)

 -  X-ray 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 marrow (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

 -  GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: 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)

 -  GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: 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

 -  GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: 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

 -  GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: Bilirubin (sum of conjugated +
 unconjugated) =< 1.5 x upper limit of normal (ULN) for age

 -  GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: Serum glutamate pyruvate transaminase
 (SGPT) (alanine transferase [ALT]) =< 135 U/L (for the purpose of this study, the ULN
 for SGPT is 45 U/L)

 -  GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: Patients must be able to swallow intact
 capsules/tablets, unless otherwise specified in the subprotocol to which they are
 assigned

 -  GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: Agent specific limitations on prior
 therapy will be included with specific treatment subprotocols

 Exclusion Criteria:

 -  GENERAL EXCLUSION CRITERIA FOR SUBPROTOCOLS: 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, or because there is currently no available information
 regarding human fetal or teratogenic toxicities; pregnancy tests must be obtained in
 females who are post-menarchal; males or females of reproductive potential may not
 participate unless they have agreed to use an effective contraceptive method

 -  GENERAL EXCLUSION CRITERIA FOR SUBPROTOCOLS: Concomitant medications

 -  Corticosteroids: at the time of consent and enrollment to regimen specific
 subprotocols, patients receiving corticosteroids who have not been on a stable or
 decreasing dose of corticosteroid for at least 7 days prior to enrollment to the
 subprotocol will not be 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 must meet criteria for prior therapy at the time
 of consent and enrollment to a subprotocol; other investigational agents may not
 be administered to patients while they are receiving study drug as part of a
 subprotocol

 -  Anticancer agents: patients must meet criteria for prior therapy at the time of
 consent and enrollment to a subprotocol; other investigational agents may not be
 administered to patients while they are receiving study drug as part of a
 subprotocol

 -  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

 -  GENERAL EXCLUSION CRITERIA FOR SUBPROTOCOLS: Patients who have an uncontrolled
 infection are not eligible

 -  GENERAL EXCLUSION CRITERIA FOR SUBPROTOCOLS: Patients who have had a prior solid organ
 transplant are not eligible

 -  GENERAL EXCLUSION CRITERIA FOR SUBPROTOCOLS: Additional agent specific criteria will
 be included with specific treatment subprotocols