Clinical Trials /

Nab-paclitaxel in Combination With Gemcitabine for Pediatric Relapsed and Refractory Solid Tumors

NCT03507491

Description:

This is a research study for people who have a solid tumor that was not effectively treated by conventional therapy or for which there is no known effective therapy. This is a phase I study of a drug called nab-paclitaxel used together with gemcitabine. Gemcitabine and nab-paclitaxel will be given intravenously, once a week for 3 out of 4 weeks, for a 28-day cycle. The goals of this study are: - To find the highest dose of nab-paclitaxel that can be safely given in combination with gemcitabine without causing severe side effects - To learn what kind of side effects nab-paclitaxel given in combination with gemcitabine can cause - To learn more about the pharmacology (how the body handles the drug) of nab-paclitaxel given in combination with gemcitabine - To evaluate tumor tissue for levels of certain proteins that may help with predicting who will benefit most from treatment with nab-paclitaxel - To determine whether nab-paclitaxel given in combination with gemcitabine is a beneficial treatment for relapsed and/or refractory solid tumors

Related Conditions:
  • Malignant Solid Tumor
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Nab-paclitaxel in Combination With Gemcitabine for Pediatric Relapsed and Refractory Solid Tumors
  • Official Title: AflacST1603: A Phase 1 Study Using Nab-paclitaxel (Abraxane®) in Combination With Gemcitabine for Pediatric Relapsed and Refractory Solid Tumors

Clinical Trial IDs

  • ORG STUDY ID: IRB00098777
  • NCT ID: NCT03507491

Conditions

  • Cancer

Interventions

DrugSynonymsArms
GemcitabineGemzarGemcitabine + Nab-paclitaxel
Nab-paclitaxelAbraxaneGemcitabine + Nab-paclitaxel

Purpose

This is a research study for people who have a solid tumor that was not effectively treated by conventional therapy or for which there is no known effective therapy. This is a phase I study of a drug called nab-paclitaxel used together with gemcitabine. Gemcitabine and nab-paclitaxel will be given intravenously, once a week for 3 out of 4 weeks, for a 28-day cycle. The goals of this study are: - To find the highest dose of nab-paclitaxel that can be safely given in combination with gemcitabine without causing severe side effects - To learn what kind of side effects nab-paclitaxel given in combination with gemcitabine can cause - To learn more about the pharmacology (how the body handles the drug) of nab-paclitaxel given in combination with gemcitabine - To evaluate tumor tissue for levels of certain proteins that may help with predicting who will benefit most from treatment with nab-paclitaxel - To determine whether nab-paclitaxel given in combination with gemcitabine is a beneficial treatment for relapsed and/or refractory solid tumors

Detailed Description

      Relapsed and refractory non-central nervous system (non-CNS) solid tumors have poor outcomes,
      and novel therapies are needed. Many relapsed/refractory solid tumor patients desire further
      therapy; however, they often wish to also preserve a high quality of life. Thus therapeutic
      strategies that offer relatively minimal treatment-related toxicities are also desirable. The
      combination of gemcitabine, a pyrimidine analog, and docetaxel, an antimitotic taxane, is an
      attractive combination because of non-overlapping toxicities. This combination has shown
      activity and tolerability in adult Phase II trials for solid tumors. Favorable experiences
      with this regimen in pediatrics have been described retrospectively by several institutions.
      Nab-paclitaxel is an albumin-bound, solvent-free taxane that allows higher dosing and shorter
      infusion duration than solvent-bound taxanes (docetaxel and paclitaxel) by removing exposure
      to toxic solvent carriers. Albumin binding of the agent also increases drug delivery to
      tumors through increased albumin-initiated transcytosis, and may also increase tumoral
      accumulation of drug through binding of secreted protein acidic and rich in cysteine (SPARC).
      The combination of gemcitabine and nab-paclitaxel has been studied extensively in adults with
      pancreatic adenocarcinoma, with the combination providing superior outcomes to treatment with
      gemcitabine alone. There is also preclinical evidence of potent anti-tumor activity of
      nab-paclitaxel alone and in combination with gemcitabine in pediatric solid tumor models.
      Therefore, the researchers hypothesize that the combination of nab-paclitaxel with
      gemcitabine will improve the anti-tumor efficacy observed with gemcitabine/docetaxel in
      relapsed/refractory solid tumors.

      This is a Phase 1 study of nab-paclitaxel in combination with gemcitabine for children,
      adolescents, and young adults with relapsed or refractory non-central nervous system (CNS)
      solid tumors in which the researchers will define toxicity, pharmacokinetics, and evaluate
      SPARC expression in pediatric tumors as a biomarker of disease response.

      Nab-paclitaxel will be administered intravenously (IV) once weekly on days 1,8, and 15 of a
      28 day cycle. The starting dose of nab-paclitaxel will be 180 mg/m2/dose which is 75% of the
      pediatric, single agent MTD of 240 mg/m2/dose. The researchers will then dose escalate up to
      240 mg/m2/dose. Dose Level 1 of the protocol prior to Amendment 2 utilized nab-paclitaxel at
      180 mg/m2/dose and gemcitabine and 1000 mg/m2/dose given on days 1, 8, and 15 of 28 day
      cycles. The study enrolled 5 patients at Dose Level 1 and two patients experienced
      hematologic dose limiting toxicities (DLTs). Amendment 2 decreases the starting dose of
      gemcitabine on Dose Level 1 to 675 mg/m2/dose on days 1, 8, and 15 of the 28 day cycle. If
      Dose Level 1 is tolerated, then the dose of nab-paclitaxel will escalated on subsequent dose
      levels. If two or more participants experience DLTs at Dose Level 1, then the study will
      de-escalate to Dose Level 0 by decreasing the gemcitabine dose to 500 mg/m2/dose IV days 1,
      8, and 15. If Dose Level 0 is tolerated, then a dose escalation of nab-paclitaxel will occur.

      Participants may continue on therapy until there is evidence of progressive disease or
      toxicity that requires removal from therapy. Therapy may otherwise continue for up to 24
      cycles.
    

Trial Arms

NameTypeDescriptionInterventions
Gemcitabine + Nab-paclitaxelExperimentalParticipants receiving gemcitabine and nab-paclitaxel for refractory and/or relapsed solid tumors of childhood.
  • Gemcitabine
  • Nab-paclitaxel

Eligibility Criteria

        Inclusion Criteria:

          -  Subjects must be ≥ than 6 months and ≤ 30 years of age at the time of study
             enrollment.

          -  Subjects must have had histologic verification of a malignancy at original diagnosis
             or relapse.

               -  All subjects with relapsed or refractory solid tumors are eligible, excluding
                  primary CNS tumors.

               -  Patients with solid tumors and a history of intraparenchymal CNS disease are
                  eligible if their CNS disease was treated surgically or with radiotherapy and
                  stable with no recurrent lesions for at least 3 months from the start of protocol
                  therapy.

               -  Newly diagnosed patients with ≤15% chance of cure if given standard-of-care
                  chemotherapy are eligible. (Prognosis to be determined at the discretion of the
                  treating physician.)

          -  Subjects must have either measurable or evaluable disease.

          -  Karnofsky ≥ 60 for subjects > 16 years of age and Lansky ≥ 50 for subjects ≤ 16 years
             of age. Subjects who are unable to walk because of paralysis, but who are up in a
             wheelchair, will be considered ambulatory for the purpose of assessing the performance
             score.

          -  Subjects must have fully recovered from the acute toxic effects of all prior
             anti-cancer chemotherapy.

               -  At least 21 days after the last dose of myelosuppressive chemotherapy (42 days if
                  prior nitrosourea).

               -  At least 14 days after the last dose of a long-acting growth factor (e.g.
                  Pegfilgrastim) or 7 days for short acting growth factor. For agents that have
                  known adverse events occurring beyond 7 days after administration, this period
                  must be extended beyond the time during which adverse events are known to occur.
                  The duration of this interval must be discussed with the study chair.

               -  At least 7 days after the last dose of a biologic agent. For agents that have
                  known adverse events occurring beyond 7 days after administration, this period
                  must be extended beyond the time during which adverse events are known to occur.
                  The duration of this interval must be discussed with the study chair.

               -  ≥ 42 days must have elapsed from last dose of any type of cellular therapy (e.g.
                  modified T cells, natural killer (NK) cells, dendritic cells, etc.)

               -  ≥ 21 days must have elapsed from the last dose of interleukins, interferon or
                  cytokines (other than Hematopoietic Growth Factors).

               -  ≥ 21 days must have elapsed from infusion of last dose of antibody, and toxicity
                  related to prior antibody therapy must be recovered to Grade ≤ 1.

               -  At least 14 days after local palliative radiation therapy (XRT) (small port); 6
                  weeks must have elapsed since treatment with therapeutic doses of iodine-131
                  metaiodobenzylguanidine (131I-MIBG); At least 42 days must have elapsed if other
                  substantial bone marrow (BM) radiation.

               -  No evidence of active graft vs. host disease and at least 84 days must have
                  elapsed after transplant and 42 days for autologous stem cell infusion after
                  131I-MIBG therapy.

               -  Patients who have previously received a taxane, including nab-paclitaxel, or a
                  nucleoside analogue, including gemcitabine, are eligible as long as they have not
                  received gemcitabine in combination with nab-paclitaxel.

               -  ≥72 hours must have elapsed since the last administration of medical cannabis and
                  cannabidiol (CBD Oil).

               -  ≥30 days must have elapsed since the last dose of any agents not specified above.
                  For agents with an uncertain washout period or for any questions or uncertainty
                  the study PI should be notified.

          -  Adequate bone marrow function defined as:

               -  For subjects with solid tumors without known bone marrow involvement: Peripheral
                  absolute neutrophil count (ANC) ≥ 750/mm3. Platelet count ≥ 75,000/mm3
                  (transfusion independent, defined as not receiving platelet transfusions for at
                  least 7 days prior to enrollment)

               -  Subjects with known bone marrow metastatic disease will be eligible for study
                  provided they meet the blood counts of peripheral absolute neutrophil count (ANC)
                  ≥ 750/mm3 and platelet count ≥ 75,000/mm3 (may receive transfusions provided they
                  are not known to be refractory to red cell or platelet transfusions). These
                  subjects will not be evaluable for hematologic toxicity. At least 5 of every
                  cohort of 6 patients must be evaluable for hematologic toxicity for the
                  dose-escalation part of the study. If dose-limiting hematologic toxicity is
                  observed, all subsequent subjects enrolled must be evaluable for hematologic
                  toxicity.

          -  Adequate renal function defined as:

               -  Creatinine clearance or radioisotope glomerular filtration rate (GFR)
                  70ml/min/1.73 m^2 or

               -  A serum creatinine based on age/gender using threshold creatinine values derived
                  from the Schwartz formula for estimating GFR utilizing child length and stature
                  data published by the Centers for Disease Control and Prevention (CDC).

          -  Adequate liver function defined as:

               -  Bilirubin (sum of conjugated + unconjugated) ≤ 1.5 x upper limit of normal (ULN)
                  for age

               -  Serum glutamic pyruvic transaminase (SGPT) (ALT) ≤ 5 x the ULN. For the purpose
                  of this study, the ULN for SGPT is 45 U/L.

        Exclusion Criteria:

          -  Female patients who are pregnant are ineligible for study. Lactating females are not
             eligible unless they have agreed not to breastfeed their infants from the time of
             informed consent through the duration and at least 1 month following the last dose of
             investigational agent. Female patients of childbearing potential are not eligible
             unless a negative pregnancy test result has been obtained. Sexually active patients of
             reproductive potential are not eligible unless they have agreed to use an effective
             contraceptive method from the time of informed consent through the duration and for 1
             month following the last dose of investigational agent. The definition of an effective
             contraceptive method will be at the discretion of the institutional investigator.

          -  Patients taking any the following concomitant medications are not eligible:

               -  Subjects who are currently receiving another investigational drug.

               -  Subjects who are currently receiving other anti-cancer agents.

               -  Subjects who are receiving cyclosporine, tacrolimus, or other agents to prevent
                  graft-versus-host disease post bone marrow transplant.

               -  Subjects using medications which interfere with CYP3A4 and CYP2C8 metabolism,
                  which metabolize nab-paclitaxel. Paclitaxel is metabolized by CYP3A4 and CYP2C8,
                  so strong inhibitors or inducers of these enzymes should be avoided.

          -  Patients with any of the following adverse events at the time of enrollment are not
             eligible:

               -  Grade ≥ 2 Motor, sensory or peripheral neuropathy. This does not apply to
                  patients with neuropathic symptoms related to tumor or prior therapy, i.e.
                  surgery or radiation. Patients with mild neuropathy well controlled with
                  medications are eligible.

               -  Grade ≥3 Hyponatremia (serum Na ≤ 130 mmol/L)

          -  Subjects who have an uncontrolled infection are not eligible.

          -  Subjects who have received prior solid organ transplantation are not eligible.

          -  Subjects who in the opinion of the investigator may not be able to comply with the
             safety monitoring requirements of the study are not eligible.
      
Maximum Eligible Age:30 Years
Minimum Eligible Age:6 Months
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Maximum dose tolerated of nab-paclitaxel
Time Frame:Up to Day 28
Safety Issue:
Description:The maximum tolerated dose (MTD) of nab-paclitaxel administered intravenously weekly every 3 of 4 weeks in combination with gemcitabine in children with refractory/relapsed non-CNS solid tumors will be determined. The MTD is empirically defined as the highest dose level at which there is no more than one patient experiencing a dose-limiting toxicity (DLT) and the next higher dose level has been determined to be too toxic. The MTD will be determined during Cycle 1 (each cycle is 28 days)

Secondary Outcome Measures

Measure:Antitumor activity of nab-paclitaxel
Time Frame:Up to 96 weeks
Safety Issue:
Description:The antitumor activity (tumor growth) of nab-paclitaxel in combination with gemcitabine will be preliminarily defined, within the confines of a Phase 1 study.
Measure:Change in secreted protein acidic and rich in cysteine (SPARC) expression
Time Frame:Up to 96 weeks
Safety Issue:
Description:The expression of SPARC in tumor tissue from pediatric solid tumors will be evaluated. Archived tumor samples obtained as part of routine subject care will be evaluated for immunohistochemical expression of SPARC. Samples will be evaluated from all surgical procedures to evaluate if expression of these factors changes over time and can predict tumor responsiveness to therapy. Specifically, samples from diagnosis, post-therapy resection, and relapse (when performed for clinical reasons) will be evaluated.
Measure:Blood concentrations of paclitaxel
Time Frame:Up to Day 3
Safety Issue:
Description:Blood samples will be collected for the first dose (Cycle 1, Day 1) from all patients on study to analyze paclitaxel concentrations in blood. Blood samples will be obtained on Day 1 of Cycle 1 at 1-2 min prior to end of infusion, and 0.25, 1, 3, 5, 7, 24, and 48 hours after end of the nab-paclitaxel infusion.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Emory University

Trial Keywords

  • Pediatric
  • Sarcoma
  • Neuroblastoma
  • Ewing sarcoma
  • Osteosarcoma
  • Rhabdomyosarcoma
  • Wilms tumor
  • Hepatoblastoma
  • Adolescent and young adult
  • Germ cell tumor

Last Updated

July 17, 2020