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Low-grade GliomaPhase 2FIREFLY-1NCT04775485

A Study to Evaluate Tovorafenib in Pediatric and Young Adult Participants With Relapsed or Progressive Low-Grade Glioma and Advance Solid Tumors

A Phase 2 study testing Tovorafenib in people with Low-grade Glioma and Advanced Solid Tumor, run by Day One Biopharmaceuticals, Inc. at 35 sites in 11 countries.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

This is a Phase 2, multi center, open-label study to evaluate the safety and efficacy of Type II RAF (tovorafenib) in pediatric participants with low-grade glioma or advanced solid tumors. Read more about this study

Who is it for?
Ages 6 months to 25 years
Conditions the study is for
Low-grade Glioma, Advanced Solid Tumor
What is being tested?
Tovorafenib
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
141 participants
Where
35 sitesin 11 countries
Study dates
22 Apr 2021to 31 May 2027
Phase
Phase 2
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 6 months to 25 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Low Grade Glioma \& Low-Grade Glioma Extension: a relapsed or progressive LGG with documented known activating BRAF alteration.
  • Advanced Solid Tumor: locally advanced or metastatic solid tumor with documented known or expected to be activating RAF fusion.
  • Participants must have histopathologic verification of malignancy at either original diagnosis or relapse.
  • Must have received at least one line of prior systemic therapy and have documented evidence of radiographic progression.
  • Must have at least 1 measurable lesion as defined by RANO (Arms 1 \& 2) or RECIST v1.1 (Arm 3) criteria

Who cannot join

  • Participant's tumor has additional previously-known activating molecular alterations.
  • Participant has symptoms of without radiographically recurrent or radiographically progressive disease.
  • Known or suspected diagnosis of neurofibromatosis type 1 (NF-1) via genetic testing or current diagnostic criteria.
  • Other inclusion/exclusion criteria as stipulated by protocol may apply

Trial locations and contacts

35 sites in 11 countries. Contact the study team or a site near you to ask about taking part.

Day One Biopharmaceuticals, Inc. contact

650-484-0899

firefly-1@dayonebio.com

35 sites in 11 countries

United States14 sites, 12 recruiting
  • CS Mott Children's Hospital

    Ann Arbor, Michigan, 48109

    Recruiting
  • Johns Hopkins Hospital

    Baltimore, Maryland, 21231

    Terminated
  • Dana-Farber Cancer Institute

    Boston, Massachusetts, 02215

    Recruiting
  • Lurie Children's Hospital of Chicago

    Chicago, Illinois, 60611

    Recruiting
  • Duke Cancer Center

    Durham, North Carolina, 27710

    Recruiting
  • Texas Children's Hospital

    Houston, Texas, 77030

    Recruiting
  • NYU Langone Health

    New York, New York, 10016

    Recruiting
  • Children's Hospital of Philadelphia

    Philadelphia, Pennsylvania, 19104

    Recruiting
  • Doernbecher Children's Hospital Oregon & Health Science University

    Portland, Oregon, 97239

    Terminated
  • University of Utah

    Salt Lake City, Utah, 84113

    Recruiting
  • UCSF Benioff Children's Hospital

    San Francisco, California, 94143

    Recruiting
  • Seattle Children's Hospital

    Seattle, Washington, 98105

    Recruiting
  • St. Louis Children's Hospital

    St Louis, Missouri, 63110

    Recruiting
  • Children's National Medical Center

    Washington D.C., District of Columbia, 20010

    braintumorresearch@childrensnational.org, 202-476-5000

    Recruiting

Other trials in United States

Australia5 sites, 5 recruiting
  • Queensland Children's Hospital

    Brisbane, 4101

    Recruiting
  • Royal Children's Hospital

    Parkville, 3052

    Recruiting
  • Perth Children's Hospital

    Perth, WA 6009

    Recruiting
  • Sydney Children's Hospital

    Randwick, NSW 2031

    Recruiting
  • The Children's Hospital at Westmead

    Westmead, 2145

    Recruiting

Other trials in Australia

Canada3 sites, 3 recruiting
  • Centre Hospitalier Universitaire Ste-Justine

    Montreal, Quebec, H3T 1C5

    Recruiting
  • Montreal Children's Hospital

    Montreal, Quebec, H4A 3J1

    Recruiting
  • Centre Mère-Enfant Soleil du CHU

    Québec, Quebec, G1V 4G2

    Recruiting

Other trials in Canada

Israel3 sites, 3 recruiting
  • Rambam Health Care Campus

    Haifa, 3109601

    Recruiting
  • Schneider Children's Medical Center of Israel

    Petah Tikva, 4920235

    Recruiting
  • The Chaim Sheba Medical Center

    Ramat Gan, 5265601

    Recruiting

Other trials in Israel

Germany2 sites, 2 recruiting
  • Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Otto-Heubner-Centrum für Kinder

    Berlin, 13353

    Recruiting
  • Hopp-Kindertumorzentrum Heidelberg (KiTZ), KiTZ Clinical Trial Unit (ZIPO)

    Heidelberg, 69120

    Recruiting

Other trials in Germany

South Korea2 sites, 2 recruiting
  • Seoul National University Hospital

    Seoul, 3080

    Recruiting
  • Severance Hospital - Yonsei University

    Seoul, 3722

    Recruiting

Other trials in South Korea

United Kingdom2 sites, 2 recruiting
  • UCL Great Ormond Street Institute of Child Health

    London, WC1N 1EH

    Recruiting
  • Newcastle University

    Newcastle upon Tyne, NE1 7RU

    Recruiting

Other trials in United Kingdom

Denmark1 site, 1 recruiting
  • Rigshospitalet

    Copenhagen

    Recruiting

Other trials in Denmark

Netherlands1 site, 1 recruiting
  • Princess Maxima Center for Pediatric Oncology

    Utrecht, 3584 CS

    Recruiting

Other trials in Netherlands

Singapore1 site, 1 recruiting
  • KK Women's and Children's Hospital

    Singapore, 229899

    Recruiting

Other trials in Singapore

Switzerland1 site, 1 recruiting
  • Universitäts-Kinderspital Zürich - Eleonorenstiftung

    Zurich, 8032

    Recruiting

Other trials in Switzerland

About this study

Official title: FIREFLY-1: A Phase 2, Open-Label, Multicenter Study to Evaluate the Safety and Efficacy of the Oral Pan-RAF Inhibitor DAY101 in Pediatric Patients With RAF-Altered, Recurrent or Progressive Low-Grade Glioma and Advanced Solid Tumors

This is a Phase 2, multi center, open-label study to evaluate the safety and efficacy of Type II RAF (tovorafenib) in pediatric participants with low-grade glioma or advanced solid tumors. Qualifying genomic alterations will be identified through molecular assays as routinely performed at Clinical Laboratory Improvement Amendments (CLIA) of 1988 or other similarly certified laboratories prior to enrollment into any of the arms. The study will consist of a screening period, a treatment period, a long-term extension phase, end of treatment (EOT) visit(s), a safety follow-up visit, and long-term follow-up assessments.

Being tested
Tovorafenib
Keywords
Low-grade Glioma, Advanced Solid Tumor, FIREFLY-1, DAY101, Tovorafenib

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • TovorafenibDrug

    Also called DAY101

    Tovorafenib is an oral Type II RAF kinase inhibitor available in 100 mg immediate-release tablet or 25 mg/milliliter (mL) powder for reconstitution.

Study groups in NCT04775485
Study groupRoleWhat they receive
Arm 1: Low-Grade GliomaExperimentalParticipants with recurrent or progressive low-grade glioma will receive 420 milligrams/meters square (mg/m^2) of tovorafenib weekly according to dose rounding guidelines and according to their baseline body surface area (BSA).
Receives: Drug: Tovorafenib
Arm 2: Low-Grade Glioma Expanded AccessExperimentalParticipants with recurrent or progressive low-grade glioma will receive 420 mg/m^2 of tovorafenib weekly according to dose rounding guidelines and according to their baseline BSA.
Receives: Drug: Tovorafenib
Arm 3: Advanced Solid TumorExperimentalParticipants with advanced solid tumors will receive 420 mg/m^2) of tovorafenib weekly according to dose rounding guidelines and according to their baseline BSA.
Receives: Drug: Tovorafenib

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Arm 1: Overall response rate

    ORR is defined as percentage of participants with best overall confirmed response of complete response (CR) or partial response (PR) by the Response Assessment in Neuro-Oncology - high-grade glioma (RANO-HGG) criteria.

    Measured: Up to 48 months

  2. Arm 2: Number of participants reporting adverse events

    An adverse event (AE) is any untoward medical occurrence in a participant or clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention.

    Measured: Up to 48 months

  3. Arm 2: Number of participants with clinically significant changes in clinical chemistry parameters

    Measured: Up to 48 months

  4. Arm 2: Number of participants with clinically significant changes in hematology parameters

    Measured: Up to 48 months

  5. Arm 3: Overall response rate

    Determined by the treating investigator and measured by Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 or RANO-HGG criteria, as appropriate.

    Measured: Up to 48 months

Secondary outcomes (19)
  1. Arm 1 and 3: Number of participants reporting adverse events

    An adverse event (AE) is any untoward medical occurrence in a participant or clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention.

    Measured: Up to 48 months

  2. Arm 1 and 3: Number of participants with clinically significant changes in clinical chemistry parameters

    Measured: Up to 48 months

  3. Arm 1 and 3: Number of participants with clinically significant changes in hematology parameters

    Measured: Up to 48 months

  4. Arm 1: Area under the concentration-time curve (AUC) of Tovorafenib

    Measured: Cycle 1: Day 1 and Day 15; Cycles 2, 4, 7, 10 and 13: Day 1

  5. Arm 1: Minimum drug concentration (Cmin)

    Measured: Cycle 1: Day 1 and Day 15; Cycles 2, 4, 7, 10 and 13: Day 1

  6. Arm 1: Change from Baseline QT interval corrected for heart rate by Fridericia's formula (ΔQTcF)

    Measured: Baseline to 48 months

  7. Arm 1: Change from Baseline PR interval (ΔPR)

    Measured: Baseline to 48 months

  8. Arm 1: Change from Baseline QRS interval (ΔQRS)

    Measured: Baseline to 48 months

  9. Arm 1: Change from baseline heart rate (ΔHR)

    Measured: Baseline to 48 months

  10. Arm 1: Change in electrocardiogram (ECG) waveform morphology

    Measured: Baseline to 48 months

  11. Arm 1 and Arm 2: Overall response rate

    ORR is defined as percentage of participants with best overall confirmed response of CR or PR by the RANO-HGG criteria.

    Measured: Up to 48 months

  12. Arm 1, Arm 2 and Arm 3: Overall response rate in Pediatric participants

    ORR is defined as percentage of participants with best overall confirmed response of CR or PR or minor response (MR) by Response Assessment in Pediatric Neuro-Oncology (RAPNO) criteria.CR or PR by RECIST v1.1 criteria.

    Measured: Up to 48 months

  13. Arm 1, Arm 2 and Arm 3: duration of progression-free survival (PFS)

    PFS as defined by the time following initiation of tovorafenib to progression or death in participants treated with tovorafenib measured by RECIST v1.1, RAPNO, or RANO-HGG criteria as determined by the treating investigator and an IRC.

    Measured: Up to 48 months

  14. Arm 1, Arm 2 and Arm 3: Duration of response (DOR)

    DOR as defined by the length of response in participants with best overall confirmed response of CR or PR or MR and measured by RANO-HGG, RAPNO, and/or RECIST v1.1 criteria, as applicable.

    Measured: Up to 48 months

  15. Arm 1, Arm 2 and Arm 3: Time to response (TTR)

    TTR as defined as the time to first response following initiation of tovorafenib in participants with best overall confirmed response of CR or PR measured by RECIST v1.1 or RANO-HGG criteria, as applicable.

    Measured: Up to 48 months

  16. Arm 1, Arm 2 and Arm 3: Clinical benefit rate (CBR)

    CBR as defined as participants with BOR of CR, PR or stable disease (SD) measured by RECIST v1.1 or RANO-HGG, as applicable, and lasting 12 months or more following initiation of tovorafenib.

    Measured: Up to 48 months

  17. Arm 1 and Arm 2: Duration of overall survival

    Overall survival as defined by the time following initiation of tovorafenib to death of any cause in participants treated with tovorafenib.

    Measured: Up to 48 months

  18. Arm 1: Change from baseline in best corrected visual acuity (BCVA) outcomes

    Measured: Baseline to 48 months

  19. Arm 1: Changes in molecular analysis of cells obtained from archival tissue

    Measured: At Screening

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Mar 2021
  2. Study start22 Apr 2021
  3. Primary completion31 May 2027 (estimated)
  4. Study completion31 May 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Single group
Masking
None (open label)
Enrolment
141 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04775485
Sponsor's protocol ID
DAY101-001/PNOC026
Acronym
FIREFLY-1
Status last verified
Mar 2025
First submitted
3 Feb 2021
Last updated
10 Apr 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Kilburn LB, Khuong-Quang DA, Hansford JR, Landi D, van der Lugt J, Leary SES, Driever PH, Bailey S, Perreault S, McCowage G, Waanders AJ, Ziegler DS, Witt O, Baxter PA, Kang HJ, Hassall TE, Han JW, Hargrave D, Franson AT, Yalon Oren M, Toledano H, Larouche V, Kline C, Abdelbaki MS, Jabado N, Gottardo NG, Gerber NU, Whipple NS, Segal D, Chi SN, Oren L, Tan EEK, Mueller S, Cornelio I, McLeod L, Zhao X, Walter A, Da Costa D, Manley P, Blackman SC, Packer RJ, Nysom K. The type II RAF inhibitor tovorafenib in relapsed/refractory pediatric low-grade glioma: the phase 2 FIREFLY-1 trial. Nat Med. 2024 Jan;30(1):207-217. doi: 10.1038/s41591-023-02668-y. Epub 2023 Nov 17.

    PubMed 37978284

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Tovorafenib in people with Low-grade Glioma and Advanced Solid Tumor, run by Day One Biopharmaceuticals, Inc. at 35 sites in 11 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 10 Apr 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 35 sites in United States, Australia, Canada, Israel, Germany and 6 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Day One Biopharmaceuticals, Inc. (650-484-0899, firefly-1@dayonebio.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Arm 1: Overall response rate (time frame: Up to 48 months). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04775485, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Apr 2025.

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