Description:
Difluoromethylornithine (DFMO) will be used in an open label, multicenter, study in
combination with etoposide for subjects with relapsed/refractory neuroblastoma.
Title
- Brief Title: Eflornithine (DFMO) and Etoposide for Relapsed/Refractory Neuroblastoma
- Official Title: Phase II Trial of Eflornithine (DFMO) and Etoposide for Relapsed/Refractory Neuroblastoma
Clinical Trial IDs
- ORG STUDY ID:
BCC015
- NCT ID:
NCT04301843
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Eflornithine | DFMO, difluoromethylornithine | Eflornithine (DFMO) |
Purpose
Difluoromethylornithine (DFMO) will be used in an open label, multicenter, study in
combination with etoposide for subjects with relapsed/refractory neuroblastoma.
Detailed Description
Difluoromethylornithine (DFMO) will be used in an open label, multicenter, study in
combination with etoposide for subjects with relapsed/refractory neuroblastoma.
In this study subjects will receive six 21-day cycles of Etoposide and DFMO followed by an
additional 630 days of DFMO alone.
Subjects will be evaluated in 3 arms:
• Arm 1: Subjects who show no active disease after receiving any additional therapy for
neuroblastoma that was refractory to standard induction/consolidation therapy.
Refractory: Subjects with progressive disease on upfront therapy OR did not have at least PR
on induction OR required additional second line therapy to achieve remission who are now in
first remission.
- Arm 2: Subjects who have previously relapsed and currently show no active disease (in
CR2 or greater).
- Arm 3: Subjects who are relapsed or refractory with active disease.
Trial Arms
Name | Type | Description | Interventions |
---|
Eflornithine (DFMO) | Experimental | In this study subjects will receive six 21-day cycles of Etoposide and DFMO followed by an additional 630 days of DFMO alone.
Etoposide will be given at 50 mg/m2/dose PO daily for the first 14 days of each 21 days until 6 cycles of etoposide are completed.
DFMO (difluoromethylornithine) will be given at a dose of 1000 mg/m2 BID on each day of study. | |
Eligibility Criteria
Inclusion Criteria:
- All patients must have a pathologically confirmed diagnosis of neuroblastoma, ≤ 30.99
years of age with history of relapsed/refractory neuroblastoma.
- All patients must have completed upfront therapy with at least 4 cycles of aggressive
multi-drug chemotherapy.
- Specific Criteria by Arm:
Arms 1 and 2:
Subjects with no active disease:
i. No evidence of residual disease by CT/MRI and MIBG scan (or PET for patients who have a
history of MIBG non-avid disease).
o Note: Patients with residual masses detected by CT/MRI may be considered in CR if their
MIBG is negative or if MIBG positive and evaluated by PET and found to have negative PET
scans; biopsy confirmation may be considered if there is still reasonable concern for
persistent disease but is not required.
ii. No evidence of disease metastatic to bone marrow.
Arm 3:
Measurable or evaluable disease, including at least one of the following:
Measurable tumor by CT or MRI; or a positive MIBG and PET; or positive bone marrow
biopsy/aspirate in at least one site.
- Timing from prior therapy: Enrollment (first dose of DFMO) no later than 60 days from
last dose of the most recent therapy.
- Subjects must have fully recovered from the acute toxic effects of all prior anti-
cancer chemotherapy and be within the following timelines:
1. Myelosuppressive chemotherapy: Must not have received within 2 weeks of
enrollment onto this study (6 weeks if prior nitrosourea).
2. Hematopoietic growth factors: At least 5 days since the completion of therapy
with a growth factor.
3. Biologic (anti-neoplastic agent): At least 7 days since the completion of therapy
with 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.
4. Immunotherapy: At least 6 weeks since the completion of any type of
immunotherapy, e.g. tumor vaccines, CAR-T cells.
5. Anti-GD2 Monoclonal antibodies: At least 2 weeks must have elapsed since prior
treatment with a monoclonal antibody.
6. XRT: At least 14 days since the last treatment except for radiation delivered
with palliative intent to a non-target site.
7. Stem Cell Transplant:
1. Allogeneic: No evidence of active graft vs. host disease
2. Allo/Auto: ≥ 2 months must have elapsed since transplant.
8. MIBG Therapy: At least 8 weeks since treatment with MIBG therapy
- Subjects must have a Lansky or Karnofsky Performance Scale score of 60% or higher.
- Life expectancy > 2 months
- All clinical and laboratory studies for organ functions to determine eligibility must
be performed within 7 days prior to first dose of study drug unless otherwise
indicated below.
- Subjects must have adequate organ functions at the time of registration:
- Hematological: Total absolute neutrophil count ANC ≥750/μL
- Liver: Subjects must have adequate liver function as defined by AST and ALT <5x
upper limit of normal (Normal=45), Bilirubin <1.5x upper limit normal
(Normal=1.0). Normal PT, PTT, fibrinogen.
- Renal: Adequate renal function defined as (perform one of the following):
Creatinine clearance or radioisotope GFR 70 mL/min/1.73 m2 or greater or a serum
creatinine based on age/gender
- Females of childbearing potential must have a negative pregnancy test. Patients of
childbearing potential must agree to use an effective birth control method. Female
patients who are lactating must agree to stop breast-feeding.
- Written informed consent in accordance with institutional and FDA guidelines must be
obtained from all subjects (or patients' legal representative).
Exclusion Criteria:
- BSA of <0.25 m2.
- Subjects that received DFMO at a dose higher than 1000mg/m2 BID prior to this study
are not eligible.
- Subjects that received a dose of DFMO in combination with etoposide are not eligible.
- Investigational Drugs: Subjects who are currently receiving another investigational
drug are excluded from participation.
- Anti-cancer Agents: Subjects who are currently receiving other anticancer agents are
not eligible. Subjects must have fully recovered from hematological and bone marrow
suppression effects of prior chemotherapy.
- Infection: Subjects who have an uncontrolled infection are not eligible until the
infection is judged to be well controlled in the opinion of the investigator.
- Subjects who, in the opinion of the investigator, may not be able to comply with the
safety monitoring requirements of the study, or in whom compliance is likely to be
suboptimal, should be excluded.
Maximum Eligible Age: | 31 Years |
Minimum Eligible Age: | N/A |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Number of participants with event free survival (EFS) during study |
Time Frame: | 2 years plus 5 years follow up |
Safety Issue: | |
Description: | To evaluate the efficacy of difluoromethylornithine (DFMO) in combination with etoposide in patients with relapsed/refractory neuroblastoma, based upon:
o Event free survival (EFS) from time of enrollment. |
Secondary Outcome Measures
Measure: | Length of time that participants experience Overall Survival (OS) |
Time Frame: | 7 years |
Safety Issue: | |
Description: | To evaluate the efficacy of difluoromethylornithine (DFMO) in combination with etoposide in patients with relapsed/refractory neuroblastoma, based upon:
o Overall Survival (OS) from time of enrollment. |
Measure: | Determine the Overall Response Rate (ORR) of Participants using INSS Response Evaluation Criteria. |
Time Frame: | 2 years |
Safety Issue: | |
Description: | To evaluate the efficacy of difluoromethylornithine (DFMO) in combination with etoposide in patients with relapsed/refractory neuroblastoma, based upon:
o Response Rate for patients with active disease (Arm 3) using International Neuroblastoma Staging System (INSS) Response Evaluation Criteria. |
Measure: | Number of Participants with Adverse Events as a Measure of Safety and Tolerability |
Time Frame: | 2 years plus 30 days |
Safety Issue: | |
Description: | To monitor the safety and tolerability profile of difluoromethylornithine (DFMO) in combination with etoposide in pediatric and young adult patients with relapsed/refractory neuroblastoma. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Giselle SaulnierSholler |
Last Updated
August 23, 2021