N2007-03: Vorinostat and 131-I MIBG in Treating Patients With Resistant or Relapsed Neuroblastoma
Status: Recruiting
Phase: Phase 1
Diagnosis: Pediatric Neuroblastoma
NCT ID: NCT01019850
(View complete trial on ClinicalTrials.gov)
DFCI Protocol ID: 10-051
RATIONALE: Vorinostat may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Radioactive drugs, such as iobenguane I 131, may carry radiation directly to tumor cells and not harm normal cells. Giving vorinostat together with iobenguane I 131 may kill more tumor cells. PURPOSE: This phase I trial is studying the side effects and best dose of giving vorinostat together with iobenguane I 131 in treating patients with resistant or relapsed neuroblastoma.
Conducting Institutions:
Children's Hospital Boston, Dana-Farber Cancer Institute
Overall PI:
Suzanne Shusterman, MD,
Dana-Farber Cancer Institute
Site-responsible Investigators:
Contacts:
Dana-Farber Cancer Institute:
Childrens Hospital Pediatric Clinical Translation Investigation Program CTIP,
ctip@partners.org
Eligibility Criteria
DISEASE CHARACTERISTICS:
- Diagnosis of neuroblastoma
- Histological confirmation and/or demonstration of tumor cells in the bone marrow
with increased urinary catecholamines
- High-risk stage 3 OR metastatic disease
- No stage 4S disease
- Meets ≥ 1 of the following criteria
- Recurrent or progressive disease at any time. Biopsy not required, even if
partial response to intervening therapy
- Refractory disease (i.e., less than a partial response to front-line therapy,
including ≥ 4 courses of chemotherapy). Biopsy not required
- Persistent disease after at least a partial response to front-line therapy
(i.e., patient has had at least a partial response to front-line therapy but
still has residual disease by MIBG scan, CT scan/MRI, or bone marrow). Biopsy
(including bone marrow biopsy) of ≥ 1 residual site demonstrating viable
neuroblastoma is required.
- Evidence of MIBG uptake into tumor site within the past 4 weeks and subsequent to any
intervening therapy
- Adequate peripheral blood stem cells (PBSCs) available for autologous hematopoietic
stem cell transplantation
- At least 2 x 10^6 viable CD34+ cells/kg must be available (purged or unpurged)
- Immunomagnetically purged PBSCs allowed
- No CD34+ selected cells
- No autologous stored umbilical cord blood stem cells
- No allogeneic stem cells (other than PBSCs from an identical twin)
PATIENT CHARACTERISTICS:
- Lansky or Karnofsky performance status (PS) 50-100% required for study entry.
- Life expectancy ≥ 6 weeks
- Hemoglobin ≥ 8 g/dL* (transfusion allowed)
- ANC ≥ 750/μL*
- Platelet count ≥ 50,000/μL* (no platelet transfusions within the past week)
- Serum creatinine ≤ 1.5 times normal for age as follows:
- ≤ 0.8 mg/dL (for patients ≤ 5 years of age)
- ≤ 1.0 mg/dL (for patients 6 to 10 years of age)
- ≤ 1.2 mg/dL (for patients 11 to 15 years of age)
- ≤ 1.5 mg/dL (for patients > 15 years of age)
- Total bilirubin ≤ 1.5 times normal for age
- ALT and AST < 3 times upper limit of normal (ULN) (for ALT, the ULN is defined as 45
U/L)
- Ejection fraction ≥ 55% by ECHO or radionuclide MUGA OR fractional shortening ≥ 27%
by ECHO
- Corrected QT (QT_c) interval ≤ 450 msec
- Lung function normal (i.e., no dyspnea at rest, pleural effusion, or oxygen
requirement)
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- Able to comply with the safety monitoring requirements of the study, in the opinion
of the investigator
- Patient and family must be physically and psychologically able to cooperate with the
radiation safety isolation guidelines
- Patient must not have a weight that would require exceeding a maximum total allowable
dose of iobenguane I 131 at the assigned dose level (per institutional guidelines)
- The study committee may discuss treating such patients at a lower dose level
- Other ongoing serious medical issues are allowed provided they have been approved by
the study chair before registration
- No disease of any major organ system that would compromise the patient's ability to
withstand study therapy
- No history of idiopathic deep venous thrombosis, pulmonary embolus, thrombotic
stroke, or arterial thrombosis
- Patients with a history of central venous catheter-associated thrombosis that
has completely resolved are eligible
- No active or uncontrolled infection
- Patients on prolonged antifungal therapy are eligible provided they are culture
and biopsy negative in suspected radiographic lesions and meet other organ
function criteria
- No known HIV infection (testing not required before study entry)
- No active hepatitis B or C infection NOTE: *Regardless of bone marrow involvement
with tumor
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- Fully recovered from the acute toxic effects of all prior chemotherapy,
immunotherapy, or radiotherapy
- No prior iobenguane I 131 therapy
- No prior vorinostat or other histone deacetylase inhibitors
- No prior allogeneic stem cell transplantation
- No prior total-body irradiation
- No prior radiotherapy to the sole site of measurable or evaluable disease unless that
site has demonstrated clear progression after radiotherapy
- More than 12 weeks since prior myeloablative therapy with autologous stem cell
transplantation
- Patients who received stem cell reinfusion following non-myeloablative therapy
are eligible
- More than 30 days since prior and no other concurrent investigational medications
- More than 30 days since prior and no concurrent valproic acid
- At least 2 weeks since prior radiotherapy (12 weeks for large-field radiotherapy
[i.e., craniospinal, whole abdominal, total lung, > 50% marrow space])
- At least 2 weeks since prior myelosuppressive therapy or biologic therapy
- At least 7 days since prior cytokines or hematopoietic growth factors
- No concurrent hemodialysis
- No other concurrent anticancer agents, radiotherapy, chemotherapy, or
immunomodulating agents
- No other concurrent medications known to prolong the QT interval
- No concurrent pentamidine prophylaxis for pneumocystis pneumonia
- No medications that interfere with MIBG uptake for 1 week before, during, and for 1
week after iobenguane I 131 therapy