ClinicalTrials.gov record NCT04079179
Cobimetinib in Refractory Langerhans Cell Histiocytosis (LCH), and Other Histiocytic Disorders
A Phase 2 Study to Assess the Safety and Efficacy of Cobimetinib in Refractory Langerhans Cell Histiocytosis, LCH-Associated Neurodegenerative Disease, and Other Histiocytic Disorders.
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AI-written from the registry record, not the study's own wording. May contain errors or omissions. Check the registry text on this page and the original record ↗ before acting on it.
This phase 2 study gives the drug cobimetinib to children and people with LCH or other histiocytic disorders — newly diagnosed in some groups, or relapsed/refractory. Participants are placed into one of four groups based on age and type of histiocytic disease. Treatment is oral cobimetinib taken in 28‑day cycles (21 days on, 7 days off) for up to 12 cycles, with response and safety monitored over about 12 months.
What it is studying. Whether cobimetinib is safe and produces tumor/lesion responses in people with LCH, LCH‑ND, and other histiocytic disorders.
What the researchers hope to learn. To assess overall response rates using modified RECIST criteria at one year, measure progression‑free survival, and characterize the nature and severity of adverse events in patients treated with cobimetinib.
What this study is about
The study's own summary, as published on ClinicalTrials.gov. Underlined terms have a short explanation.
This is a research study of a drug called cobimetinib in children and adults diagnosed with Langerhans cell histiocytosis (LCH), and other histiocytic disorders that has returned or does not respond to treatment. Cobimetinib blocks activation of a protein called Mitogen-activated protein kinase (MEK) that is part of incorrect growth signals in histiocytosis cells. Four different groups of patients will be enrolled.
Interventions being studied
Being studied in this trial does not mean the treatment or procedure is approved or available for this condition.
- Drug
- Cobimetinib
Eligibility
The criteria exactly as listed on ClinicalTrials.gov. Only the study team can say whether they apply to you.
Inclusion criteria
- Age at study entry
- For Group 1: Participant must be at least 6 months of age and less than 21 years of age at the time of enrollment
- For Group 2: Participant may be at least 6 months of age at the time of enrollment
- For Group 3: Participant must be at least 6 months of age and less than 21 years of age at the time of enrollment
- For Group 4: Participant must be 21 years of age or older at the time of enrollment
- Participant must be able to take an enteral dose and formulation of medication. Study medication is only available as an oral suspension or tablet which may be taken by mouth or other enteral route such as nasogastric or gastric tube.
- Biopsy proven LCH -AND
- Failure of at least front-line therapy for LCH with evaluable disease. -OR
- Diagnosis of LCH-associated neurodegenerative disease with radiologic or clinical progression within the past 3 months. -OR
- Biopsy proven JXG, ECD, RDD, histiocytic sarcoma, or other histiocytic lesion (newly diagnosed or relapsed/refractory disease) with evaluable active disease.
- Performance Level:
- Karnofsky ≥ 50% for patients > 16 years of age and Lansky ≥ 50% for patients ≤ 16 years of age.
- Adequate Hematologic Function Defined as:
- ANC ≥ 0.75 x 10\^9/L (unsupported/without growth factor stimulant)
- Platelet count ≥ 75 x 10\^9/L (unsupported/without transfusion within the past 7 days).
- Patients with marrow disease must have platelet count of >/= 75 x 10\^9/L (transfusion support allowed) and must not be refractory to platelet transfusions.
- Hemoglobin ≥ 8 g/dL (unsupported/without transfusion within the past 7 days)
- Patients with marrow disease must have hemoglobin ≥ 8 g/dL (transfusion support allowed).
- Adequate Renal Function Defined as:
- Calculated creatinine clearance (or radioisotope GFR) ≥ 70 mL/min/1.73m\^2 or serum creatinine based on age/gender as follows:
- Maximum Serum Creatinine (mg/dL) Age 2 to < 6 years: Male 0.8 mg/dL, Female 0.8; 6 to < 10 years: Male 1 mg/dL,Female 1; 10 to < 13 years: Male 1.2 mg/dL; Female 1.2; 13 to < 16 years: Male 1.5 mg/dL ; Female 1.4; ≥ 16 years: Male 1.7 mg/dL; Female 1.4;
- Adequate Liver Function Defined as:
- Bilirubin (sum of conjugated + unconjugated) ≤ 1.5 x upper limit of normal (ULN) for age
- AST and ALT ≤ 3x ULN (≤ 5 x ULN for participants with liver involvement)
- Serum albumin ≥ 2 g/dL.
- For patients with liver disease caused by histiocytic disorder:
- Patients may be enrolled with abnormal bilirubin, AST, ALT and albumin with documentation of histiocytic liver disease.
- Adequate Cardiac Function Defined as:
- Fractional shortening (FS) of ≥ 30% or ejection fraction of ≥ 50% by echocardiogram at baseline, as determined by echocardiography or multigated acquisition scan (MUGA) within 28 days prior to enrollment. Depending on institutional standard, either FS or LVEF is adequate for enrollment if only one value is measured; if both values are measured, then both values must meet criteria above
- Pregnancy/Birth Control
- Female patients of childbearing potential require a negative urine or serum pregnancy test for eligibility and again at database registration, if more than 2 weeks has elapsed.
- Female patients of childbearing potential must agree to follow the contraceptive requirements using two forms of effective contraceptive methods for the duration of the study treatment. Male patients with sexual partners who are pregnant or who could become pregnant (i.e., women of child-bearing potential) must agree to use two forms of effective methods of contraception (one of which must be a barrier method) during the treatment period and for at least 3 months after the last dose of the study drug to avoid pregnancy and/or potential adverse effects on a developing embryo. Agreement to true abstinence (not periodic abstinence or withdrawal method) is an acceptable method of birth control.
Exclusion criteria
- Prior and Concomitant Use of Drugs with CYP3A4 inducing/inhibiting activity: Patient taking strong inducers or inhibitors of CYP3A4 within 14 days prior to study enrollment, including but not limited to the following: erythromycin, clarithromycin, ketoconazole, azithromycin, itraconazole, grapefruit juice or St. John's wort.
- Prior Therapy Restrictions Completion of previous chemotherapy, immunotherapy, radiotherapy, or targeted therapy for LCH (or other histiocytic disorder) at least 28 days (except where specified below) prior to study enrollment, with resolution of all associated toxicity to ≤ Grade 1 prior to study enrollment (exception for alopecia and ototoxicity which do not need to be resolved ≤ Grade 1). 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 laboratory eligibility criteria are met, the patient is considered to have recovered adequately. See below for specific consideration of prednisone and corticosteroids prior to enrollment.
- Radiation therapy within the 14 days prior to enrollment.
- Any prior treatment with Cobimetinib.
- Treatment with a long-acting hematopoietic growth factor within 14 days prior to initiation of study drug or a short-acting hematopoietic growth factor within 7 days prior to enrollment.
- Treatment with hormonal therapy (except hormone replacement therapy or oral contraceptives), immunotherapy, biologic therapy, investigational therapy, or herbal cancer therapy within 28 days or < 5 half-lives, whichever is longer, prior to study enrollment.
- Treatment with high-dose chemotherapy and stem-cell rescue (autologous stem cell transplant) or allogeneic stem cell transplant within 90 days prior to enrollment. 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.
- For patients with brain tumors (intracranial masses), use of anticoagulants within 7 days prior to enrollment.
- Corticosteroid therapy less than or equal to 0.5 mg/kg/day averaged during the 28 days prior to study enrollment is permissible. Patients receiving corticosteroids must be on a stable or decreasing dose for 14 days prior to enrollment and discontinue once study treatment has started.
- Patient has received treatment with investigational therapy within 4 weeks prior to initiation of study drug.
- Patients taking anticoagulants or have a pre-existing bleeding disorder unrelated to histiocytic disease.
- Exclusions for other illness
- Other active malignancy or history of secondary malignancy.
- Refractory nausea and vomiting, malabsorption, external biliary shunt
- Infection: Patients who have a known active infection (excluding documented fungal infection of the nail beds) within 28 days prior to enrollment that has not completely resolved.
- Major surgical procedure or significant traumatic injury within 28 days prior to enrollment, or anticipation of need for major surgical procedure during the course of the study. Placement of a vascular access device or minor surgery is permitted within fourteen (14) days prior to study enrollment (provided that the wound has healed).
- History of significant bowel resection that would preclude adequate absorption or other significant malabsorptive disease.
- History of pneumonitis.
- Ophthalmologic considerations: Patients with known significant ophthalmologic conditions or known risk factors for retinal vein occlusion are not eligible. Specifically, patients with a history of retinal vein occlusion (RVO), retinal detachment, retinal pathology on ophthalmologic exam, retinopathy of prematurity, central serous chorioretinopathy (CSSCR), neovascular retinopathy, intraocular pressure > 21 mmHg, and predisposing factors to RVO (e.g., uncontrolled hypertension, diabetes, or hyperlipidemia, coagulopathy) will be excluded. Patients with longstanding and stable ophthalmologic findings secondary to existing conditions are eligible with appropriate written documentation and approval from Study Chair.
- History of solid organ transplantation: Patients who have received a prior solid organ transplantation are not eligible.
- Any other disease, metabolic or psychological dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that in the opinion of the investigator contraindicates use of an investigational drug or places the patient at unacceptable risk from treatment complications.
- History of clinically significant cardiac dysfunction, including the following:
- Clinically significant cardiac arrhythmias including brady-arrhythmias and/or patients who require anti-arrhythmic therapy (with the exception of beta blockers or digoxin). Patients with controlled atrial fibrillation are not excluded.
- Unstable arrhythmia
- Unstable angina, or new-onset angina within 3 months prior to initiation of study treatment
- Symptomatic congestive heart failure, defined as New York Heart Association Class II or higher
- Myocardial infarction within 3 months prior to initiation of study treatment
- Known chronic human immunodeficiency virus (HIV).
- History of Grade ≥ 2 CNS hemorrhage or history of any CNS hemorrhage within 28 days of enrollment.
- Female patients who are pregnant or lactating. Pregnant or lactating women will not be entered on this study because there is no available information regarding human fetal or teratogenic toxicities.
Study description and what participation involves
The study's detailed description, as published on ClinicalTrials.gov.
Detailed description from the registry
Histiocytic disorders are diseases caused by misfunctioning or buildup of particular immune cells called histiocytes. Many histiocytic disorders (LCH, juvenile xanthogranuloma (JXG), Erdheim-Chester disease (ECD), and Rosai-Dorfman Disease (RDD)) arises from blood cells that receive incorrect growth signals. These incorrect signals are caused by changes in genes (mutations) that lead to tissue damage (lesions) which causes disease. Some patients with LCH can develop neurodegeneration (LCH-ND) which is damage to neurons that results in reduced brain function, from LCH cells that go to the brain and activate inflammation. LCH arises from blood cells that receive incorrect growth signals. These incorrect signals are caused by mutations (changes in genes). The LCH blood cells can create changes in the structure of almost any organ, and can cause damage to normal organ function. The purpose of this research study is to learn whether cobimetinib is safe and effective in subjects diagnosed with LCH, LCH-ND, RDD, JXG and ECD which may have a specific mutation called BRAF-V600E. In healthy cells, certain proteins (called BRAF and MEK) are thought to help control normal cell growth. BRAF-V600E is a specific change in a gene that may cause cancer cells to grow and spread by sending constant signals to the MEK protein. Cobimetinib is designed to attach to and block the activity of MEK.
AI summaryWhat participation may involve, in plain languageShow ▾Hide ▴
AI-written from the registry record, not the study's own wording. May contain errors or omissions. Check the registry text on this page and the original record ↗ before acting on it.
Participants will take the study drug cobimetinib by mouth (tablet or oral suspension) or via an enteral tube, on a 28‑day schedule of 21 days on then 7 days off for up to 12 cycles (about 12 months). The record names baseline and periodic tests such as blood tests to check blood counts and liver/kidney function, pregnancy tests when applicable, and a heart‑function scan (echocardiogram or MUGA) before starting treatment. Disease response assessments will be done at protocol‑specified timepoints during the 12‑month period and side effects (adverse events) will be monitored and recorded. The registry record does not list every visit or test in detail; the full protocol has additional information.
How the study is structured. This is an open‑label, non‑randomized phase 2 drug trial with four parallel groups defined by age and disease: (1) children/young adults (<21) with recurrent LCH, (2) people of any age with progressive LCH‑ND, (3) children/young adults (<21) with other histiocytic disorders (JXG, ECD, RDD, histiocytic sarcoma), and (4) adults (≥21) with LCH or other histiocytic disorders. All participants receive oral cobimetinib (dosing described in the registry) on a 21‑days‑on, 7‑days‑off schedule for up to 12 cycles. The study tracks tumor/lesion responses and adverse events at protocol‑specified timepoints up to about 12 months.
Questions you could ask
These questions are suggestions for a conversation with the study team or your own clinician, not advice.
- The listed sites are in United States. Is any of them reachable for me, and does the study help with travel?
- Which of the eligibility criteria would need to be checked with tests before I could join?
More on Langerhans cell histiocytosis
This trial is also listed on this site under Erdheim-Chester disease.
Important dates
- Study start
- Apr 19, 2021
- Primary completion
- December 2025 (estimated)
- Study completion
- December 2029 (estimated)
- Target enrollment
- 90 participants (estimated)
- Last updated on registry
- Sep 18, 2025
- Data verified
- Oct 10, 2026
Sponsor and research team
The lead sponsor funds and oversees the trial. A pharmaceutical or biotech company sponsor typically means the study is testing that company's drug or device; a hospital, university, or government agency usually indicates investigator-initiated or publicly funded research.
- Lead sponsor
- Carl Allen
- Collaborators
- Baylor College of Medicine
- North American Consortium for Histiocytosis
- Genentech, Inc.
Central study contact
If you're interested in participating, the central contact can answer general questions about the study — including eligibility requirements and how to find a recruiting site near you. Actual eligibility is determined by the site's medical team.
- Carl E Allen, MD, PhD 📞 832-822-4242 ✉ ceallen@texaschildrens.org
- Olive Eckstein, MD 📞 832-822-4242 ✉ Eckstein@bcm.edu
Participating sites (12)
- Phoenix Children's HospitalRecruiting
Phoenix, Arizona, 85016 · United States
- Laura Retson, MD · (602) 933-0920 · Lretson@phoenixchildrens.com
- Arkansas Children's HospitalRecruiting
Little Rock, Arkansas, 72202 · United States
- Kevin Bielamowicz · 501-364-1494 · kjbielamowicz2@uams.edu
- Children's Hospital of Orange CountyRecruiting
Orange, California, 92868 · United States
- Lilbeth Torno, MD · 714-509-4348 · LTORNO@choc.org
- UCSF Benioff Children's HospitalRecruiting
San Francisco, California, 94158 · United States
- Karina Wong · 415-298-9434 · Karina.Wong@ucsf.edu
- Mahum Kudia · 415-290-1053 · Mahum.Kudia@ucsf.edu
- Michelle L Hermiston, MD
- Children's National HospitalRecruiting
Washington D.C., District of Columbia, 20010 · United States
- Birte Wistinghausen, MD · 2024762800 · bwistingha@childrensnational.org
- John Hopkins University School of MedicineRecruiting
Baltimore, Maryland, 21287 · United States
- Elias T Zambidis, MD PhD · (410) 614-0123 · Ezambid1@jhmi.edu
- Dana Farber Cancer Institute, Boston Children'sRecruiting
Boston, Massachusetts, 02215 · United States
- Barbara Degar, MD · 617-632-5186 · barbara_degar@dfci.harvard.edu
- Sara Galinko · 617-632-6644 · Sara_galinko@dfci.harvard.edu
- Memorial Sloan Kettering Cancer CenterRecruiting
New York, New York, 10065 · United States
- Christopher Forlenza · 212-639-5226 · forlenzc@mskcc.org
- NACHO ConsortiumNot Yet Recruiting
Memphis, Tennessee, 38105 · United States
- Sara Clyburn · 901-595-6042 · Sara.Clyburn@STJUDE.ORG
- Heidi Clough · 901-595-0362 · Heidi.Clough@STJUDE.ORG
- Children's Medical Center- UTSWRecruiting
Dallas, Texas, 75235 · United States
- Erin Butler, MD · 214-648-6332 · erin.butler@utsouthwestern.edu
Terms used on this page · explanations by MedicalUpdates.ai
- enrollment
- The number of participants a study plans to include, or has included. 'Estimated' means the planned number; 'actual' means the number who joined.
- Biopsy proven
- Removal of a small piece of tissue so it can be examined under a microscope. 'Biopsy-proven' or 'histologically confirmed' means the diagnosis was confirmed by examining tissue under a microscope.
- relapsed/refractory
- A condition that has not responded to a treatment. 'Relapsed' means it responded and then came back; 'refractory' means it did not respond in the first place.
- Karnofsky
- A scale from 100 (no complaints) down to 0 that describes how well a person can carry out daily activities. Studies often require a minimum score.
- ANC
- The number of neutrophils, a type of white blood cell that fights infection, in a blood sample. Studies often require it to be above a set level.
- creatinine clearance
- A measure of kidney function, calculated from a blood creatinine level together with age, weight and sex.
- GFR
- A blood-test estimate of how well the kidneys are filtering. Lower numbers mean reduced kidney function; many studies set a minimum value.
- upper limit of normal
- The highest value of a blood test that a laboratory considers normal. Criteria such as '≤ 3 × ULN' mean the result must be no more than three times that value.
- echocardiogram
- An ultrasound scan of the heart. A transesophageal echocardiogram is done through a probe passed into the food pipe for a closer view.
- baseline
- Measurements taken at the start of the study, before any study treatment, so that later results can be compared with them.
- childbearing potential
- Studies often ask participants who could become pregnant, or could father a child, to use contraception during the study and for a period afterwards, because the effect of the treatment on a pregnancy is unknown.
- study drug
- A treatment that is being tested and has not been approved for this use. It may be approved for a different condition. Being studied does not mean it works or is available outside the study.
- Prior Therapy
- Treatment a person has already had for the condition. A 'line of therapy' is one course of treatment; studies often require, or limit, the number of prior lines.
- timeframe
- The period over which an outcome is measured, for example 'at 12 weeks'. It is not necessarily the total length of the study.
- eligibility criteria
- The rules the study team uses to decide who may take part. They are usually split into inclusion criteria and exclusion criteria.
- prednisone
- Steroid medicines, such as prednisone, that reduce inflammation. Studies often require a stable dose at entry or measure whether the study treatment allows the dose to be reduced.
- 5 half-lives
- The time it takes for the amount of a drug in the body to fall by half. 'Five half-lives' is often used as the point at which a previous drug has essentially left the body.
- autologous stem cell transplant
- A procedure that replaces blood-forming cells after high-dose treatment. 'Autologous' uses the person's own cells collected beforehand; 'allogeneic' uses cells from a donor.
- INCLUSION CRITERIA
- The conditions a person must meet to be considered for the study, for example a confirmed diagnosis, an age range or a test result.
- EXCLUSION CRITERIA
- The conditions that rule a person out even if they meet the inclusion criteria, for example other illnesses, certain medicines or pregnancy.
The study record on this page is reproduced from ClinicalTrials.gov, a database of the U.S. National Library of Medicine, where it was submitted by the study sponsor. MedicalUpdates.ai does not own this content, is not affiliated with or endorsed by ClinicalTrials.gov, NIH, or the U.S. Government, and does not verify the record. Plain-language notes, the glossary and the questions above are added by this site; text in the boxes marked "AI summary" was written by an AI model and may contain errors. Registry records change over time. Check the original record for the current version and discuss eligibility or participation with a qualified healthcare professional.
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