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
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
Interventions
Drug | Synonyms | Arms |
---|
Gemcitabine | Gemzar | Gemcitabine + Nab-paclitaxel |
Nab-paclitaxel | Abraxane | Gemcitabine + 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
Name | Type | Description | Interventions |
---|
Gemcitabine + Nab-paclitaxel | Experimental | Participants 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 21, 2020