Clinical Trials /

Anti-Angiogenic Therapy Post Transplant (ASCR) for Pediatric Solid Tumors

NCT01661400

Description:

The purpose of this research study is to determine whether taking either of two low dose drugs that would prevent new blood vessels from growing after stem cell transplant is feasible, and what the side effects of taking each of these drugs after autologous transplant might be. The reason the investigators are looking at these drugs is because one of the things that allows tumors to grow quickly is their ability to stimulate the growth of new blood vessels. By suppressing the growth of new blood vessels after stem cell transplant, the investigators hope to prevent the tumors from coming back or continuing to grow.

Related Conditions:
  • Malignant Solid Tumor
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Anti-Angiogenic Therapy Post Transplant (ASCR) for Pediatric Solid Tumors
  • Official Title: Anti-Angiogenic Therapy After Autologous Stem Cell Rescue (ASCR) for Pediatric Solid Tumors

Clinical Trial IDs

  • ORG STUDY ID: 201209088
  • NCT ID: NCT01661400

Conditions

  • Glioma
  • Neuroectodermal Tumors, Primitive
  • Wilms Tumor
  • Rhabdomyosarcoma
  • Sarcoma, Ewing
  • Osteosarcoma
  • Retinoblastoma

Interventions

DrugSynonymsArms
Metronomic CyclophosphamideCytoxan®, CPMMetronomic Cyclophosphamide
ThalidomideThalomid®Thalidomide

Purpose

The purpose of this research study is to determine whether taking either of two low dose drugs that would prevent new blood vessels from growing after stem cell transplant is feasible, and what the side effects of taking each of these drugs after autologous transplant might be. The reason the investigators are looking at these drugs is because one of the things that allows tumors to grow quickly is their ability to stimulate the growth of new blood vessels. By suppressing the growth of new blood vessels after stem cell transplant, the investigators hope to prevent the tumors from coming back or continuing to grow.

Trial Arms

NameTypeDescriptionInterventions
ControlNo InterventionNo intervention
    Metronomic CyclophosphamideExperimentalCyclophosphamide will be given PO once daily at 2.5 mg/kg/day for children < 40kg or 100 mg daily for children > 40kg beginning Day + 30 (30 days post transplant) and continue until at least Day +86
    • Metronomic Cyclophosphamide
    ThalidomideExperimentalThalidomide will be initiated at 3mg/kg PO daily beginning Day + 30 (30 days post transplant) and continue until Day +86
    • Thalidomide

    Eligibility Criteria

            Inclusion Criteria:
    
              -  Patient must have an original diagnosis, benefited by autologous transplantation,
                 confirmed by biopsy* of high-grade glial tumor, low-grade glial tumor, ependymoma,
                 medulloblastoma, primitive neuro-ectodermal tumor (PNET), Wilms' tumor,
                 rhabdomyosarcoma, Ewing's sarcoma, retinoblastoma, or miscellaneous poor-prognosis
                 solid tumors. Lymphomas and other lymphoid malignancies will not be studied in this
                 protocol.
    
                 * Brain stem glioma patients who have progressed after radiation therapy do not
                 require histologic confirmation. Brain stem gliomas are defined as intrinsic tumors of
                 the pons causing diffuse enlargement. These patients are diagnosed on clinical and
                 radiographic appearance of the lesion and the biopsy requirement will be waived for
                 this group.
    
              -  Patient must be ≥ 6 months of age and ≤ 21 years of age at the time of study entry.
    
              -  Patient must have a Karnofsky performance status or Lansky* play status ≥ 50
    
                 * For purpose of determining performance scores, wheelchair-bound patients will be
                 considered ambulatory.
    
              -  Patient must have an adequate supply of stem cells for transplant harvested prior to
                 study enrollment, with adequate supply defined as 3 x 10^6 CD34+ cells/kg for
                 peripheral blood stem cells (PBSC). Cell mobilization method will be left up to the
                 treating physician's discretion and may include mobilization growth factor alone or
                 mobilization after chemotherapy. If patient is unable to mobilize the proper amount of
                 peripheral stem cells, bone marrow may be harvested as the source of hematopoietic
                 stem cells. In this instance, 3 x 10^8 mononuclear cells/kg will be considered
                 adequate. If necessary, a combination of peripheral stem cells and bone marrow can be
                 used.
    
              -  Prior radiation therapy and/or chemotherapy, including cyclophosphamide, are
                 permitted.
    
              -  Prior anti-angiogenic therapy, including thalidomide and oral cyclophosphamide, is
                 permitted.
    
              -  If on corticosteroids for mass effect and/or edema related to the tumor, patient must
                 be on a stable or decreasing dose for at least 2 weeks prior to study entry.
    
              -  Patient must have a life expectancy > 3 months.
    
              -  Patient must have an adequate bone marrow reserve as defined by:
    
                   -  Hemoglobin ≥ 8.0 g/dl and
    
                   -  Peripheral absolute neutrophil count (ANC) ≥ 750/mm3
    
              -  Patient must have adequate cardiac function tested within 4 weeks of study enrollment
                 as defined by:
    
                   -  Shortening fraction of ≥ 27% by echocardiogram or
    
                   -  Ejection fraction of ≥ 50% by radionuclide angiogram
    
              -  Patient must have adequate pulmonary function tested within 4 weeks of study
                 enrollment as defined by:
    
                   -  Pulse oximetry > 94% on room air or O2 by nasal cannula and
    
                   -  No evidence of dyspnea at rest.
    
              -  Patient must have adequate hepatic function as defined by:
    
                   -  Total bilirubin ≤ 1.5x upper limit of normal (ULN) for age and
    
                   -  SGOT (AST) or SGPT (ALT) ≤ 2.5 x ULN (SGOT ≤ 4x ULN if on Zantac)
    
              -  Patient must have adequate renal function as defined by:
    
                   -  Serum creatinine < 1.5 mg/dl
    
                   -  Glomerular filtration rate (GFR), calculated via I-125 iothalamate clearance,
                      24-hour creatinine clearance, or Schwartz formula*, ≥ 70 mL/min and ≥ 50
                      mL/min/1.73 m2 done within 4 weeks of study entry
    
                   -  The Schwartz formula is an estimated glomerular filtration rate in children based
                      upon serum creatinine and height. Height (Ht) should be measured in cm and serum
                      creatinine (Cr) in mg/dL. Proportionality constant (k) is 0.55 for children and
                      adolescent girls and 0.7 for adolescent boys aged 13-21. This constant is based
                      upon a series of evaluations performed by Schwartz. Formula: GFR= (k x Ht)/Cr
    
              -  Enrollment in the Celgene THALOMID REMSTM Program:
    
                   1. If enrolled in Arm III of this study, patient must be registered at the Celgene
                      THALOMID REMSTM Program prior to day +30 post-ASCR.
    
                   2. If enrolled in Arm III of this study, patient must be willing to practice birth
                      control as outlined in the THALOMID REMSTM Program from the beginning of the
                      thalidomide treatment until at least 4 weeks following discontinuation of
                      thalidomide therapy. Two reliable forms of contraception must be used
                      simultaneously unless continuous abstinence from heterosexual sexual contact is
                      chosen. Contraceptive methods must include at least one highly effective method
                      (e.g. oral contraceptive pills, injections, hormonal patches, IUD, or implants),
                      AND one additional effective barrier method (e.g. latex condom, diaphragm,
                      cervical cap).
    
                      If hormonal or IUD contraception is medically contraindicated, another highly
                      effective method or two barrier methods must be used at the same time.
    
                   3. Pregnancy surveillance:
    
                 i. Patient must have a negative in office pregnancy test sensitive to within 50 mIU/mL
                 (serum or urine) within 24 hours prior to beginning thalidomide even if continuous
                 abstinence is the preferred method of birth control. ii. A pregnancy test must be
                 performed weekly during the first 4 weeks of therapy and repeated monthly for patients
                 with regular menses or every 2 weeks for patients with irregular menses iii. Negative
                 pregnancy tests are valid for only 7 days. iv. If irregular bleeding or skipped
                 menses, pregnancy test should be performed and pregnancy counseling given. v. If
                 pregnancy occurs during treatment, thalidomide must be immediately discontinued. Any
                 suspected lethal exposure must be reported immediately to Celgene Customer Care Center
                 at 1-888-423-5346, and the patient referred to an OB/GYN experienced in reproductive
                 toxicity for further evaluation and counseling.
    
              -  Patient (or legally authorized representative) must be able to understand and willing
                 to sign a written informed consent document.
    
            Exclusion Criteria:
    
              -  Patient must not have any active, uncontrolled cardiac, hepatic, renal, or psychiatric
                 disease defined as ≥ grade 3 based on NCI Common Terminology Criteria for Adverse
                 Events v4.0 (CTCAE).
    
              -  Patient must not be receiving any other investigational agents.
    
              -  Patient must not have any active infection or concurrent illness obscuring toxicity or
                 dangerously altering drug metabolism.
    
              -  Patient must not have any thromboembolic event (deep vein thrombosis or pulmonary
                 embolism) less than 3 weeks prior to enrollment.
    
              -  Patient must not have a history of allergic reactions attributed to compounds of
                 similar chemical or biologic composition to any of the agents used in the study.
    
              -  Patient must not be pregnant or breastfeeding.
          
    Maximum Eligible Age:21 Years
    Minimum Eligible Age:6 Months
    Eligible Gender:All
    Healthy Volunteers:No

    Primary Outcome Measures

    Measure:Safety as measured by absence of grade 4 or 5 non-hematological or grade 5 hematological toxicity
    Time Frame:Through 1 year post-transplant
    Safety Issue:
    Description:

    Secondary Outcome Measures

    Measure:Best overall response
    Time Frame:86 days
    Safety Issue:
    Description:Assessed by Response Evaluation Criteria in Solid Tumors (RECIST) guideline version 1.1.

    Details

    Phase:Phase 1
    Primary Purpose:Interventional
    Overall Status:Recruiting
    Lead Sponsor:Washington University School of Medicine

    Trial Keywords

    • Glioma includes ependymoma and medulloblastoma

    Last Updated

    June 21, 2021