Neuroblastoma Clinical Trial
Official title:
A Phase One Study of Intravenous Irinotecan and Bortezomib in Children With Recurrent/Refractory High-Risk Neuroblastoma
This Phase One pediatric trial seeks to take advantage of the susceptibility of neuroblastoma to proteasome inhibitors, proven in vitro, along with the proven in vitro synergy of bortezomib with irinotecan and the successful Phase One pediatric trials of bortezomib to create a treatment using these two drugs in combination to treat refractory/recurrent neuroblastoma in children and young adults 25 and under.
In spite of intensive treatment including high-dose chemotherapy with autologous peripheral
stem cell transplantation and radiation therapy, the long-term survival of patients with
high-risk neuroblastoma remains poor. Patients who experience a relapse of their disease or
fail to achieve complete remission fare even worse. More intense chemotherapy is not the
answer. The development of new drugs with different mechanisms of action are required.
Inhibitors of the proteasome have created a considerable interest in their use in cancer
chemotherapy, either as a single agent or in combination with other chemotherapeutic agents.
The precise mechanism of action for these class of drugs is unclear, however, inhibition of
I-kB degradation by VELCADE® (bortezomib) decreases NF-kB activity in neuroblastoma cell
lines as well as other systems.
Previous studies have reported the activity of Irinotecan, a strong Topoisomerase-I
inhibitor, against murine xenografts including those with high-risk features such as MYCN
gene amplification (MYCN is also called V-Myc Myelocytomatosis Viral Related Oncogene,
Neuroblastoma Derived). Irinotecan has also been shown to be active against neuroblastoma
xenografts resistant to vincristine, melphalan, and topotecan, suggesting an alternative
mechanism of resistance to Irinotecan. In vitro synergy between bortezomib and irinotecan has
been documented in pancreatic cancer by others and in neuroblastoma by our group.
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