Vorinostat and Isotretinoin in Treating Patients With High-Risk Refractory or Recurrent Neuroblastoma
Status: Recruiting
Phase: Phase 1
Diagnosis: Pediatric Neuroblastoma
NCT ID: NCT01208454
(View complete trial on ClinicalTrials.gov)
DFCI Protocol ID: 10-408
This phase I trial is studying the side effects and the best dose of vorinostat when given together with isotretinoin to see how well it works in treating patients with high-risk refractory or recurrent neuroblastoma. Vorinostat may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Isotretinoin may help vorinostat work better by making tumor cells more sensitive to the drug. Giving vorinostat together with isotretinoin may be an effective treatment for 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:
- Histologically confirmed high-risk neuroblastoma and/or demonstration of tumor cells
in the bone marrow with increased urinary catecholamines meeting 1 of the following
criteria:
- Recurrent and/or progressive disease at any time
- Biopsy not required
- Refractory disease (i.e., less than a partial response to frontline therapy,
including a minimum of 4 courses of chemotherapy)
- Biopsy not required
- Persistent disease by MIBG scan, CT and MRI scan, or bone marrow
aspirates/biopsies after ≥ partial response to frontline therapy
- Histologic confirmation of viable neuroblastoma from at ≥ 1 residual site
required
- Tumor seen on routine bone marrow morphology allowed
- Bone marrow immunocytology alone not allowed
- Patients in expansion cohorts 1 and 2 who have had a prior relapse are eligible with
no measurable or evaluable sites of tumor (i.e., in second complete response)
- Patient must have ≥ 1 of the following disease sites (excluding patients on the
expansion cohort):
- Measurable tumor by MRI, CT scan, or X-ray
- MIBG scan with positive uptake at a minimum of 1 site
- Bone marrow with tumor cells seen on routine morphology of 1 bone marrow sample
of a bilateral aspirate and/or biopsy
PATIENT CHARACTERISTICS:
- Life expectancy ≥ 6 weeks
- Lansky performance status (PS) 50-100% (patients ≤ 16 years of age) OR Karnofsky PS
50-100% (patients > 16 years of age)
- Hemoglobin ≥ 8 g/dL (transfusion allowed)
- ANC ≥ 750/μL
- ANC ≥ 500/μL for patients with marrow metastases
- Platelet count ≥ 50,000/μL (transfusion independent)
- No platelet transfusions within 1 week
- Serum creatinine based on age as follows:
- 0.8 mg/dL (≤ 5 years of age)
- 1.0 mg/dL (> 5 and ≤ 10 years of age)
- 1.2 mg/dL (> 10 and ≤ 15 years of age)
- 1.5 mg/dL (> 15 years of age)
- Hematuria ≤ 1+ and/or proteinuria ≤ 1+
- Total bilirubin ≤ 1.5 times upper limit of normal (ULN)
- ALT and AST < 3 times ULN
- Alkaline phosphatase ≤ 2.5 times ULN
- Serum triglycerides ≤ 300 mg/dL
- Serum calcium < grade 2
- Negative pregnancy test
- Not pregnant or nursing
- Fertile patients must use effective contraception
- Normal ejection fraction (≥ 55%) by echocardiogram or radionuclide MUGA OR normal
fraction shortening (≥ 27%) by echocardiogram
- QTc interval ≤ 450 msec
- No patients who, in the opinion of the investigator, may not be able to comply with
the safety of study requirements
- No disease of any major organ system that would compromise the patient's ability to
withstand therapy
- No active or uncontrolled infection
- Patients on prolonged antifungal therapy allowed provided culture and biopsy are
negative in suspected radiographic lesions
- No allergic reactions to paraben preparations (i.e., Accutane, Sotret)
- Alternate preparations to paraben allowed
PRIOR CONCURRENT THERAPY:
- Fully recovered from the acute toxic effects of all prior chemotherapy,
immunotherapy, or radiotherapy
- At least 3 weeks since prior myelosuppressive chemotherapy, including cytotoxic
agents given on a low-dose metronomic regimen
- At least 7 days since prior biologic anti-neoplastic agent (including retinoids)
therapy
- At least 7 days or 3 half-lives, whichever is longer, since prior monoclonal
antibodies
- More than 2 weeks since prior radiotherapy (small-port)
- No prior radiotherapy in patients with 1 site of measurable or evaluable disease
unless that site has demonstrated clear progression after completion of
radiotherapy
- At least 12 weeks since prior large-field radiotherapy (i.e., total-body,
craniospinal, whole abdominal, total lung, or > 50% of marrow space irradiation)
- At least 6 weeks since prior substantial bone marrow radiotherapy
- At least 6 weeks since prior:
- Autologous stem cell infusion following myeloablative therapy
- Allogeneic stem cell transplantation without evidence of active
graft-versus-host disease
- At least 6 weeks since prior ^131I-MIBG therapy
- At least 7 days since prior cytokines or hematopoietic growth factors
- More than 30 days since prior and no concurrent valproic acid
- More than 30 days since prior and no other concurrent investigational medications
- No prior vorinostat combined with isotretinoin
- Prior vorinostat or isotretinoin single-agent or combined with alternative
agents allowed
- No other concurrent anti-cancer agents including chemotherapy, radiotherapy,
biologics, or immunomodulating agents
- No concurrent azole anti-fungal therapy
- No concurrent pentamidine therapy for PCP prophylaxis
- No concurrent enzyme-inducing anti-convulsant therapy