N2001-03: CEP-701 in Treating Young Patients With Recurrent or Refractory High-Risk Neuroblastoma

Neuroblastoma Clinical Trial

Official title:

A Phase I Study Of CEP-701 In Patients With Refractory Neuroblastoma (IND # 67,722)

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00084422
• Other study ID #: CDR0000363630
• Secondary ID: P01CA081403NANT-
• Status: Completed
• Phase: Phase 1
• Start date: August 2003
• Est. completion date: February 2011

Study information

• Verified date: April 2023
• Source: New Approaches to Neuroblastoma Therapy Consortium
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

RATIONALE: CEP-701 may stop the growth of tumor cells by blocking the enzymes necessary for their growth.

PURPOSE: This phase I trial is studying the side effects and best dose of CEP-701 in treating young patients with recurrent or refractory high-risk neuroblastoma.

Description:

OBJECTIVES:

Primary

• Determine the maximum tolerated dose of CEP-701 in pediatric patients with recurrent or refractory high-risk neuroblastoma.

• Determine the dose-limiting toxicity of this drug in these patients.

• Determine the pharmacokinetic behavior of this drug in these patients.

Secondary

• Determine the degree of TrkB tyrosine kinase inhibition activity present in the serum of patients treated with this drug.

• Correlate the degree of TrkB tyrosine kinase inhibition activity in these patients with dose level, pharmacokinetics, and antitumor activity data of this drug.

• Determine the antitumor activity of this drug in these patients.

OUTLINE: This is an open-label, dose-escalation, multicenter study.

Patients receive oral CEP-701 twice daily* on days 1-5, 8-12, 15-19, and 22-26. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

NOTE: *On day 1 of course 1 only, patients receive oral CEP-701 once instead of twice.

Cohorts of 3-6 patients receive escalating doses of CEP-701 until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Once the MTD is determined, the dose level is expanded up to 9 patients.

PROJECTED ACCRUAL: A total of 60 patients will be accrued for this study.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 47
• Est. completion date: February 2011
• Est. primary completion date: September 2009
• Accepts healthy volunteers: No
• Gender: All
• Age group: 1 Day to 30 Years

Eligibility

DISEASE CHARACTERISTICS:

• Diagnosis of neuroblastoma confirmed by at least 1 of the following:

• Histology

• Demonstrates clumps of tumor cells in the bone marrow with elevated urinary catecholamine metabolites

• Recurrent or resistant/refractory disease

• Neuroblastoma metastatic to the bone marrow with granulocytopenia, anemia, and/or thrombocytopenia allowed

• High-risk disease

• Patients in first response after completion of a prior front-line myeloablative regimen OR who were medically ineligible to receive a front-line myeloablative regimen must meet at least 1 of the following criteria:

• Viable neuroblastoma determined by biopsy of a persistent lesion as seen on CT scan, MRI, or metaiodobenzylguanidine (MIBG) scan

• If lesion was irradiated, biopsy must be performed at least 4 weeks after completion of prior radiotherapy

• Morphologic evidence of tumor in bone marrow

• Second or greater response (without histologic confirmation) allowed

• Meets at least 1 of the following criteria:

• At least 1 unidimensionally measurable lesion on CT scan, MRI, or X-ray

• At least 20 mm by conventional techniques OR at least 10 mm by spiral CT scan

• MIBG scan with positive uptake at a minimum of 1 site

• Bone marrow with tumor cells on routine morphology (not by NSE staining only) of bilateral aspirate and/or biopsy AND/OR at least 5 tumor cells/10^6 mononuclear cells in the bone marrow by immunocytologic analysis of 2 consecutive bone marrows performed at least 1 day but no more than 4 weeks apart

PATIENT CHARACTERISTICS:

Age

• 21 and under at diagnosis

Performance status

• Karnofsky 50-100% (for patients > 16 years of age)

• Lansky 50-100% (for patients = 16 years of age)

Life expectancy

• More than 2 months

Hematopoietic

• See Disease Characteristics

• Absolute neutrophil count = 1,000/mm^3

• Platelet count = 50,000/mm^3 (transfusion independent)

• Hemoglobin = 8.0 g/dL (red blood cell transfusions allowed)

Hepatic

• ALT and AST = 3.0 times upper limit of normal (ULN)

• Total bilirubin = 1.5 times ULN

Renal

• Creatinine = 1.5 times normal OR

• Creatinine clearance or radioisotope glomerular filtration rate = 60 mL/min

Cardiovascular

• Ejection fraction = 50% by echocardiogram or MUGA OR

• Fractional shortening = 28% or above lower limit of normal by echocardiogram

Pulmonary

• Lung function normal

• No dyspnea at rest

• No exercise intolerance

• No supplemental oxygen requirement

Other

• Not pregnant

• Negative pregnancy test

• Fertile patients must use effective contraception

• No uncontrolled infection

• No other concurrent illness that would preclude study treatment

PRIOR CONCURRENT THERAPY:

Biologic therapy

• See Chemotherapy

• At least 2 weeks since prior biologic or non-myelosuppressive therapy and recovered

• More than 7 days since prior growth factors

• No prior allogeneic stem cell transplantation AND no extensive chronic graft-versus-host disease

• No concurrent growth factors except filgrastim (G-CSF) or sargramostim (GM-CSF) administered for neutropenia lasting for more than 7 days or for confirmed or clinical septicemia associated with neutropenia

Chemotherapy

• At least 3 months since prior myeloablative chemotherapy with stem cell transplantation

• At least 2 weeks since prior chemotherapy and recovered

Endocrine therapy

• No concurrent corticosteroid therapy except replacement therapy for adrenal insufficiency or treatment for increased intracranial pressure

Radiotherapy

• See Disease Characteristics

• Recovered from prior radiotherapy

• At least 6 weeks since prior therapeutic-dose MIBG

• At least 6 weeks since prior craniospinal or other radiotherapy involving significant bone marrow (i.e., total pelvis or total abdomen)

• At least 4 weeks since prior radiotherapy to any site biopsied

• At least 2 weeks since prior local palliative radiotherapy (small port)

Surgery

• Not specified

Other

• No prior CEP-701

• No concurrent administration of any of the following CYP3A4 inhibitors:

• Cyclosporine

• Clotrimazole

• Ketoconazole

• Erythromycin

• Clarithromycin

• Troleandomycin

• HIV protease inhibitors

• Nefazodone

• Itraconazole

• Voriconazole

Related Conditions & MeSH terms

• Neuroblastoma

Intervention

Drug:
• lestaurtinib
Given orally twice daily x 5 consecutive days followed by a two day rest. 28 days = 1 treatment course. Courses repeated indefinitely without gap provided patient has recovered course from toxicities and no DLTs. Dose level assigned according to the planned dose escalation schedule.

Locations

Country	Name	City	State
Canada	Hospital for Sick Children	Toronto	Ontario
United States	University of Michigan Comprehensive Cancer Center	Ann Arbor	Michigan
United States	AFLAC Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta - Egleston Campus	Atlanta	Georgia
United States	Children's Hospital Boston	Boston	Massachusetts
United States	University of Chicago Comer Children's Hospital	Chicago	Illinois
United States	Cincinnati Children's Hospital Medical Center	Cincinnati	Ohio
United States	Childrens Hospital Los Angeles	Los Angeles	California
United States	Morgan Stanley Children's Hospital of New York-Presbyterian	New York	New York
United States	Lucille Salter Packer Children's Hospital, Stanford University	Palo Alto	California
United States	Children's Hospital of Philadelphia	Philadelphia	Pennsylvania
United States	UCSF Helen Diller Family Comprehensive Cancer Center	San Francisco	California
United States	Children's Hospital and Regional Medical Center - Seattle	Seattle	Washington

Sponsors (2)

Lead Sponsor	Collaborator
New Approaches to Neuroblastoma Therapy Consortium	National Cancer Institute (NCI)

Countries where clinical trial is conducted

United States,  Canada, 

References & Publications (2)

Maris J, Minturn J, Evans A, et al.: Phase I trial of the orally bioavailable TRK tyrosine kinase inhibitor CEP-701 in refractory neuroblastoma: a New Approaches to Neuroblastoma Therapy (NANT) study. [Abstract] Pediatr Blood Cancer 45 (4 Suppl 1): A-0.12

Minturn JE, Villablanca J, Yanik GA, et al.: Phase I trial of lestaurtinib for children with refractory neuroblastoma (NB): A New Approach to Neuroblastoma Therapy (NANT) Consortium study. [Abstract] J Clin Oncol 28 (Suppl 15): A-9532, 2010.

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	To determine the maximum tolerated dose (MTD) of CEP-701 given on a twice daily chronic administration schedule (two days on , two days off) to children with high risk relapsed or residual neuroblastoma.		Within 28 days of treatment at each dose level.
Primary	To determine dose limiting toxicities (DLTs) of CEP-701 given on this schedule		Within first 28 days of therapy.
Primary	To characterize the pharmacokinetic (PK) behavior of CEP-701 in children with residual or refractory high-risk neuroblastoma.	Participation in PK studies is voluntary and not a requirement for study entry.	Days 1,5 and 26 of first course only.
Secondary	To determine the degree of TrkB tyrosine kinase inhibition activity present in the serum of patients treated with CEP-701, and correlate these findings with dose level, pharmacokinetic and anti-tumor activity data.		Days 1,5 and 26 of first course only.
Secondary	To define the antitumor activity of CEP-701, within the confines of a Phase I study.		Evaluation at end of courses 1, 2, 4 and then every 4 courses until patient goes off therapy.