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Clinical Trial Details — Status: Active, not recruiting

Administrative data

NCT number NCT00110110
Other study ID # 1000005587
Secondary ID HFSC-OCRN-RB-200
Status Active, not recruiting
Phase Phase 2
First received
Last updated
Start date June 2004
Est. completion date December 31, 2024

Study information

Verified date April 2024
Source The Hospital for Sick Children
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

RATIONALE: Drugs used in chemotherapy, such as carboplatin, etoposide, and vincristine, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Sometimes when chemotherapy is given, it does not stop the growth of tumor cells. The tumor is said to be resistant to chemotherapy. Giving cyclosporine together with chemotherapy may reduce drug resistance and allow the tumor cells to be killed. Cryotherapy kills tumor cells by freezing them. Laser therapy uses light to kill tumor cells. Giving combination chemotherapy together with cyclosporine followed by cryotherapy and/or laser therapy may be an effective treatment for retinoblastoma. PURPOSE: This phase II trial is studying how well giving combination chemotherapy together with cyclosporine followed by cryotherapy and/or laser therapy works in treating patients with newly diagnosed retinoblastoma in both eyes.


Description:

OBJECTIVES: Primary - Compare the efficacy of neoadjuvant high-dose carboplatin and etoposide, vincristine, and cyclosporine (CSA) followed by ophthalmic focal therapy comprising cryotherapy and/or laser therapy to historical world data of chemotherapy treatment without CSA, in terms of increasing the proportion of eyes that remain relapse free and do not require external beam radiotherapy and/or enucleation, in patients with newly diagnosed Group B, C, or D bilateral intraocular retinoblastoma. Secondary - Determine the toxicity of this regimen in these patients. OUTLINE: This is a multicenter study. Patients receive high-dose carboplatin IV over 30 minutes on day 1; vincristine IV over 5 minutes and high-dose etoposide IV over 25 minutes on day 2; cyclosporine IV over 1 hour before chemotherapy and then over 2 hours after chemotherapy on days 1 and 2, and filgrastim (G-CSF) subcutaneously once daily beginning on day 3 and continuing until day 16 or until blood counts recover. Treatment repeats every 21 days for a total of 3 courses for patients with Group B disease and a total of 6 courses for patients with Group C or D disease. Patients undergo eye examination under anesthesia (EUA) at initial staging and then before each course of chemotherapy. Patients with small peripheral tumors in eyes without retinal detachment undergo minimal focal therapy (mainly cryotherapy) during EUA at initial staging and then after chemotherapy courses 1 and 2. At EUA after the third and subsequent courses of chemotherapy, patients with tumors that have sufficiently reduced in size undergo additional cryotherapy or laser therapy. After completion of chemotherapy, patients with any suspicious, active, or reactivated tumor undergo additional cryotherapy and/or laser therapy during EUA approximately every 4-8 weeks (or at longer intervals) for up to 5 years (as needed). After completion of study chemotherapy, patients are followed every 3 months for 2 years, every 6 months for 2 years, and then annually for 1 year. PROJECTED ACCRUAL: A total of 71 patients will be accrued for this study within 2.4 years.


Recruitment information / eligibility

Status Active, not recruiting
Enrollment 71
Est. completion date December 31, 2024
Est. primary completion date April 20, 2016
Accepts healthy volunteers No
Gender All
Age group 30 Days and older
Eligibility >>INCLUSION CRITERIA<< DISEASE CHARACTERISTICS: - Clinical diagnosis of bilateral intraocular retinoblastoma (RB) - International Intraocular Retinoblastoma Classification (IIRC) Group B, C, or D disease in 1 or both eyes - IIRC Group E disease in 1 eye allowed provided the eye was enucleated at diagnosis AND there is no extraocular RB in the enucleated eye by histologic confirmation AND there is IIRC Group B, C, or D disease in the remaining eye PATIENT CHARACTERISTICS: Age - Over 30 days Performance status - Not specified Life expectancy - Not specified Hematopoietic - Not specified Hepatic - AST and ALT < 2 times upper limit of normal (ULN) - Conjugated and unconjugated bilirubin < 2 times ULN Renal - Creatinine < 1.5 times ULN - Glomerular filtration rate (GFR) = 100 mL/min* NOTE: *A 4-hour IV hydration is allowed if GFR is low due to poor hydration or transient dehydration Other - Meets 1 of the following auditory criteria: - Normal audiogram - At least normal responses to speech by audiogram - Documentation of hearing by acoustic emission test - Recording of evoked potentials by auditory brain stem response PRIOR CONCURRENT THERAPY: Biologic therapy - Not specified Chemotherapy - Not specified Endocrine therapy - Not specified Radiotherapy - Not specified Surgery - See Disease Characteristics >>EXCLUSION CRITERIA<< - IIRC Group A disease in 1 or both eyes - unilateral RB - extraocular or metastatic RB - younger than 30 days - Glomerular filtration rate (GFR) < 100 mL/min

Study Design


Related Conditions & MeSH terms


Intervention

Biological:
filgrastim
Given after chemo cycle for 7 days or until neutrophil counts return to normal.
Drug:
Carboplatin
Given at 28 mg/kg/dose.
Cyclosporine
Given at 33 mg/kg/dose
Etoposide
Given at 12 mg/kg/dose
vincristine sulfate
Given at 0.025 mg/kg/dose for the first cycle and 0.05 mg/kg/dose for subsequent cycles if first cycle well-tolerated
Procedure:
cryosurgery
Local application of extreme cold to destroy residual tumor.
laser therapy
Local and precise application of laser beams to destroy residual tumor.

Locations

Country Name City State
Canada Montreal Children's Hospital at McGill University Health Center Montreal Quebec
Canada Hospital for Sick Children Toronto Ontario
Canada Children's and Women's Hospital of British Columbia Vancouver British Columbia
Chile Hospital San Juan de Dios Santiago
India Sankara Nethralaya Super Specialty Clinic Chennai
Singapore Kandang Kerbau Women's and Children's Hospital Singapore

Sponsors (2)

Lead Sponsor Collaborator
The Hospital for Sick Children Terry Fox Foundation

Countries where clinical trial is conducted

Canada,  Chile,  India,  Singapore, 

Outcome

Type Measure Description Time frame Safety issue
Primary Comparing efficacy of study treatment with historic world data, in terms of increasing the proportion of eyes that remains relapse-free while avoiding external beam radiation and/or enucleation Efficacy 5 year follow-up per patient
Secondary Toxicity during treatment Toxicity 5 year follow-up per patient
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