Description:
The purpose of this study is to investigate whether Bevacizumab (an anti-VEGF monoclonal
antibody) added to a backbone chemotherapy regimen (Temozolomide, Irinotecan-Temozolomide or
Topotecan-Temozolomide) demonstrates activity in children with relapsed or refractory
neuroblastoma. Also, to investigate whether the addition of Irinotecan or Topotecan to
Temozolomide increases the activity of chemotherapy.The primary objective of the study is the
best response (Complete Response or Partial Response) while trial treatment, within 18 or 24
weeks depending on the arm of the trial the participant is randomised to. Secondary endpoints
are assessing the side effects, the length of time before progression (Progression Free
Survival) and overall survival (OS).
This trial will address two important questions:
- does targeting blood vessel development using bevacizumab, (a monoclonal antibody
against the Vascular Endothelial Growth Factor (VEGF)), add to the effect on a tumour
when used with existing chemotherapy, compared to the effect of the existing
chemotherapy alone (temozolomide)? NOTE- This question has been completed.
- does the addition of a second chemotherapy drug (irinotecan or topotecan) increase the
effect on a tumour compared to the effect of one alone (temozolomide) NOTE - This
question has been completed.
- does the addition of dinutuximab beta added to a backbone chemotherapy (temozolomide or
temozolomide + topotecan) increase the effect of backbone alone.
Patients aged 1-21 years of age with relapsed or refractory high-risk neuroblastoma are
randomised to one of two treatment arms: temozolomide-topotecan (TTo) or dinutuximab
beta-temozolomide-topotecan (dBTTo). Temozolomide (T), irinotecan-temozolomide (IT),
bevacizumab-T (BT), BIT (bevacizumab-IT), bevacizumab-temozolomide-topotecan (BTTo) and
dinutuximab beta-temozolomide (dBT) are now closed to recruitment.
Title
- Brief Title: Activity Study of Bevacizumab With Temozolomide ± Irinotecan for Neuroblastoma in Children
- Official Title: A Randomised Phase IIb Trial of Bevacizumab Added to Temozolomide ± Irinotecan for Children With Refractory/Relapsed Neuroblastoma - BEACON-Neuroblastoma Trial
Clinical Trial IDs
- ORG STUDY ID:
RG_11-087
- SECONDARY ID:
2012-000072-42
- NCT ID:
NCT02308527
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Bevacizumab | Avastin | Bevacizumab + Temozolomide |
Temozolomide | Temodal | Bevacizumab + Temozolomide |
Temozolomide | Temodal | Bevacizumab + Irinotecan + Temozolomide |
Irinotecan | Campto | Bevacizumab + Irinotecan + Temozolomide |
Bevacizumab | Avastin | Bevacizumab + Irinotecan + Temozolomide |
Topotecan | | Bevacizumab + Temozolomide + Topotecan |
Temozolomide | Temodal | Bevacizumab + Temozolomide + Topotecan |
Dinutuximab Beta | Qarziba | Dinutuximab beta + Temozolomide |
Cyclophosphamide | | Dinutuximab beta + Topotecan + Cyclophosphamide |
Purpose
The purpose of this study is to investigate whether Bevacizumab (an anti-VEGF monoclonal
antibody) added to a backbone chemotherapy regimen (Temozolomide, Irinotecan-Temozolomide or
Topotecan-Temozolomide) demonstrates activity in children with relapsed or refractory
neuroblastoma. Also, to investigate whether the addition of Irinotecan or Topotecan to
Temozolomide increases the activity of chemotherapy.The primary objective of the study is the
best response (Complete Response or Partial Response) while trial treatment, within 18 or 24
weeks depending on the arm of the trial the participant is randomised to. Secondary endpoints
are assessing the side effects, the length of time before progression (Progression Free
Survival) and overall survival (OS).
This trial will address two important questions:
- does targeting blood vessel development using bevacizumab, (a monoclonal antibody
against the Vascular Endothelial Growth Factor (VEGF)), add to the effect on a tumour
when used with existing chemotherapy, compared to the effect of the existing
chemotherapy alone (temozolomide)? NOTE- This question has been completed.
- does the addition of a second chemotherapy drug (irinotecan or topotecan) increase the
effect on a tumour compared to the effect of one alone (temozolomide) NOTE - This
question has been completed.
- does the addition of dinutuximab beta added to a backbone chemotherapy (temozolomide or
temozolomide + topotecan) increase the effect of backbone alone.
Patients aged 1-21 years of age with relapsed or refractory high-risk neuroblastoma are
randomised to one of two treatment arms: temozolomide-topotecan (TTo) or dinutuximab
beta-temozolomide-topotecan (dBTTo). Temozolomide (T), irinotecan-temozolomide (IT),
bevacizumab-T (BT), BIT (bevacizumab-IT), bevacizumab-temozolomide-topotecan (BTTo) and
dinutuximab beta-temozolomide (dBT) are now closed to recruitment.
Detailed Description
This is an international open-label, randomised, multicentre phase II trial of temozolomide ±
irinotecan, with or without bevacizumab, for the treatment of patients with relapsed or
refractory neuroblastoma. The study will evaluate the safety and activity of these
combinations.
Patients will be registered into the trial and randomised at the same time to one of the
following two arms (approximately 30 patients per arm):
TTo: Temozolomide + Topotecan dBTTo: Dinuximab beta + Temozolomide + Topotecan
Arms which have now closed to recruitment:
dBT: Dinutuximab beat + Temozolomide Closed 28 ]Jan 2020 T: Temozolomide - Closed 28 Jan 2020
BT: Bevacizumab + Temozolomide - Closed 7 Feb 2019 IT: Irinotecan + Temozolomide - Closed 21
June 2018 BIT: Bevacizumab + Irinotecan + Temozolomide - Closed 21 June 2018 BTTo:
Bevacizumab + Temozolomide + Topotecan - Closed 7 Feb 2019
Randomisation will be via a secure on-line computer-based system at the Cancer Research
Clinical Trial Unit (CRCTU), University of Birmingham, United Kingdom (UK) and patients will
be allocated in a 2:1 ratio. Minimisation will be used to ensure balance across the arms for
the important prognostic factors as described by London et al. [10]: a) relapsed, refractory
disease, b) early (< 18 months), late relapse (≥18 months) and c) measurable versus evaluable
disease (i.e. disease evaluated according to RECIST versus disease detectable only by MIBG
scanning with or without bone marrow involvement as detected by local morphology) Patients
will receive treatment for 6 courses, lasting 24 weeks.
Patients with a response (CR, PR) or stable disease (SD) while on the BEACON-Neuroblastoma
trial will receive 6 cycles of trial treatment. If the patient has achieved a satisfactory
response (i.e. CR, PR or SD) with acceptable toxicity, treatment may be extended beyond 6
cycles (up to 12 cycles) after discussion with the Sponsor and the Chief Investigator (CI).
In addition, patients randomised to TTo may recieve an optional regimen of dinutuximab beta +
topotecan + cyclophosphamide (up to 6 cycles).
Trial Arms
Name | Type | Description | Interventions |
---|
Temozolomide | Active Comparator | Temozolomide Days 1-5 every 4 weeks | |
Bevacizumab + Temozolomide | Experimental | Bevacizumab Day 1 and 15 + Temozolomide Days 1-5 every 4 weeks | |
Irinotecan + Temozolomide | Experimental | Irinotecan Days 1-5 + Temozolomide Days 1-5 every 3 weeks | |
Bevacizumab + Irinotecan + Temozolomide | Experimental | Bevacizumab Day 1 + Irinotecan Days 1-5 + Temozolomide Days 1-5 every 3 weeks | - Temozolomide
- Irinotecan
- Bevacizumab
|
Temozolomide + Topotecan | Experimental | Temozolomide Days 1-5+ Topotecan Days 1-5 every 4 weeks | |
Bevacizumab + Temozolomide + Topotecan | Experimental | Bevacizumab Day 1 and 15 + Temozolomide Days 1-5 + Topotecan Days 1-5 every 4 weeks | - Bevacizumab
- Topotecan
- Temozolomide
|
Dinutuximab beta + Temozolomide | Experimental | Dinutuximab beta Days 1-7 + Temozolomide Days 1-5 every 4 weeks | - Temozolomide
- Dinutuximab Beta
|
Dinutuximab beta + Temozolomide + Topotecan | Experimental | Dinutuximab beta Days 1-7 + Temozolomide Days 1-5 + Topotecan Days 1-5 every 4 weeks | - Temozolomide
- Topotecan
- Dinutuximab Beta
|
Dinutuximab beta + Topotecan + Cyclophosphamide | Other | Dinutuximab beta Days 1-7 + Topotecan Days 1-5 + Cyclophosphamide Days 1-5 every 4 weeks | - Topotecan
- Dinutuximab Beta
- Cyclophosphamide
|
Eligibility Criteria
Inclusion Criteria
- Histologically proven neuroblastoma as per International Neuroblastoma Staging System
(INSS) definition
- Relapsed: any relapsed or progressed high-risk neuroblastoma
- Refractory high risk disease: Lack of adequate response to frontline therapy that
precludes the patient from proceeding to consolidation therapies
- Measurable disease by cross sectional imaging (RECIST) or evaluable disease
- Age ≥1 to ≤21 years
- Informed consent from patient, parent or guardian
- Performance Status:Lansky ≥ 50%, Karnofsky ≥ 50% or Eastern Cooperative Oncology Group
≤3 (Patients who are unable to walk because of paralysis, but who are able to sit
upright unassisted in a wheelchair, will be considered ambulatory for the purpose of
assessing performance score)
- Life expectancy of ≥12 weeks
- No bone marrow disease: Platelets ≥75 x 10^9/L (unsupported for 72 hours), absolute
neutrophil count ≥0.75 x10^9/L (no G-cerebrospinal fluid support for 72 hours),
Haemoglobin ≥8 g/dL (transfusions allowed) Bone marrow disease: Platelets ≥50 x10^9/L
(unsupported for 72 hours), absolute neutrophil count (ANC) ≥0.5 x 10^9/L (no
granulocyte colony stimulating factor (G-CSF) for 72 hours), Haemoglobin ≥8 g/dL
(transfusions allowed)
- Renal function (within 72 hours of eligibility assessment): Absence of clinically
significant proteinuria (early morning urine dipstick <2+). When the dipstick
urinalysis shows a proteinuria ≥2+, a protein:creatinine (Pr/Cr) ratio must be <0.5 or
a 24 hour protein excretion must be <0.5g
- Serum creatinine ≤ 1.5 upper limit of normal for age, if higher, a calculated
glomerular filtration rate (radioisotope) must be ≥60 ml/min/1.73 m2
- Liver function (within 72 hours of eligibility assessment): aspartate aminotransferase
(AST) or Alanine Aminotransferase (ALT) ≤2.5 ULN and Total bilirubin ≤1.5 upper limit
of normal (ULN). In case of liver metastases, AST or ALT ≤5 ULN and Total bilirubin
≤2.5 ULN
- Cardiac function, shortening fraction ≥29% on echocardiogram
- Coagulation, patients not on anticoagulation must have an international normalized
ratio (INR) ≤1.5 and activated partial thromboplastin time (APTT) ≤1.5 ULN for age.
Anti-coagulation is permitted as long as the INR or APTT is within therapeutic limits
(according to the medical standard of the institution) and the patient has been on a
stable dose of anticoagulants for at least two weeks at the time of study enrolment
- Blood pressure below 95th centile for age and sex. Use of antihypertensive medication
is permitted
- Males or females of reproductive potential may not participate unless they agree to
use an effective contraceptive method, for the duration of study therapy and for up to
6 months after the last dose of trial drugs. A negative urine pregnancy test must be
obtained within 72 hours prior to dosing in females who are post-menarche
- No dyspnoea at rest and pulse oximetry > 94% in room air
- Availability and willingness to place a double central venous access if needed for
trial treatment and supportive care in case of treatment with chemo-immunotherapy
Exclusion Criteria:
- Previous treatment with bevacizumab, temozolomide, irinotecan or any combination of
these drugs
- Known hypersensitivity to: Any study drug or component of the formulation, Chinese
hamster ovary products or other recombinant human or humanised antibodies, Dacarbazine
- Prior severe arterial thrombo-embolic events (e.g. cardiac ischemia, cerebral vascular
accident, peripheral arterial thrombosis)
- Any ongoing arterial thrombo-embolic events
- Patient less than (at point of planned date of randomisation): 48 hours post bone
marrow aspirate/trephine, 48 hours post central line insertion, Four weeks post major
surgery, One week post core biopsy, Two weeks from prior chemotherapy, Six weeks from
prior craniospinal radiotherapy or MIBG therapy and two weeks from radiotherapy to the
tumour bed, Eight weeks from prior myeloablative therapy with haematopoietic stem cell
rescue (autologous stem cell transplant), Three months from prior allogeneic stem cell
transplant, 14 days or 5 half-lives (whichever occurs later) from last administration
of an IMP in an IMP-trial, 6 months from presentation of lung haemorrhage/haemoptysis
- Bleeding metastases (patients with CNS metastases can be enrolled as long as the
metastases are not bleeding)
- Invasion of major blood vessels
- Use of enzyme inducing anticonvulsants within 72 hours of randomisation
- History or evidence of inherited bleeding diathesis or significant coagulopathy at
risk of bleeding (i.e. in the absence of therapeutic anticoagulation)
- History of abdominal fistula, gastrointestinal perforation, intra-abdominal abscess or
active gastrointestinal bleeding within 6 months prior to study enrolment
- Current chronic intestinal inflammatory disease/bowel obstruction
- Intolerance to galactose and fructose, lactase deficiency, and/or defect of absorption
of galactose and fructose
- Pregnant or lactating patient
- Any uncontrolled medical condition that poses an additional risk to the patient (i.e.
haemoptysis, non-healing, bone fracture, wound/ulcer)
- Low probability of treatment compliance
- Any uncontrolled medical condition that poses an additional risk to the patient
- Planned immunisation with live vaccine
Maximum Eligible Age: | 21 Years |
Minimum Eligible Age: | 1 Year |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Best response (Complete Response or Partial Response) while on trial treatment, within 18 or 24 weeks depending on the arm of the trial participant is randomised to. |
Time Frame: | Within 18 or 24 weeks depending on the arm of the trial the participant is randomised to. |
Safety Issue: | |
Description: | To test whether bevacizumab added to a backbone chemotherapy regimen (temozolomide, irinotecan-temozolomide or topotecan-temozolomide) demonstrates activity in children with relapsed or refractory neuroblastoma To test whether the addition of irinotecan to temozolomide increases the activity of chemotherapy in children with relapsed or refractory neuroblastoma |
Secondary Outcome Measures
Measure: | To evaluate the toxicity of the regimens |
Time Frame: | Assessment will be after 30 days after treatment or end of trial |
Safety Issue: | |
Description: | Safety of the regimens: Incidence and severity of Adverse Events (AE)s |
Measure: | To evaluate the safety of the regimens |
Time Frame: | Assessment will be after 30 days after treatment or end of trial |
Safety Issue: | |
Description: | Safety of the regimens: Progression-free survival (PFS) |
Measure: | To evaluate the overall safety of the regimens |
Time Frame: | Assessment will be after 30 days after treatment or end of trial |
Safety Issue: | |
Description: | Safety of the regimens: Overall survival (OS) |
Measure: | To evaluate the safety of the regimens |
Time Frame: | Assessment will be after 30 days after treatment or end of trial |
Safety Issue: | |
Description: | Safety of the regimens: Event-free survival (EFS) |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | University of Birmingham |
Trial Keywords
Last Updated
April 29, 2021