Clinical Trials /

Eflornithine (DFMO) and Etoposide for Relapsed/Refractory Neuroblastoma

NCT04301843

Description:

Difluoromethylornithine (DFMO) will be used in an open label, multicenter, study in combination with etoposide for subjects with relapsed/refractory neuroblastoma.

Related Conditions:
  • Neuroblastoma
Recruiting Status:

Not yet recruiting

Phase:

Phase 2

Trial Eligibility

Document

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

  • Neuroblastoma

Interventions

DrugSynonymsArms
EflornithineDFMO, difluoromethylornithineEflornithine (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

NameTypeDescriptionInterventions
Eflornithine (DFMO)ExperimentalIn 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.
  • Eflornithine

Eligibility Criteria

        Inclusion Criteria:

          -  1. All patients must have a pathologically confirmed diagnosis of neuroblastoma, ≤
             30.99 years of age with history of relapsed/refractory neuroblastoma.

             2. All patients must have completed upfront therapy with at least 4 cycles of
             aggressive multi-drug chemotherapy.

             3. 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.

        4. Timing from prior therapy: Enrollment (first dose of DFMO) no later than 60 days from
        last dose of the most recent therapy.

        5. 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

             6. Subjects must have a Lansky or Karnofsky Performance Scale score of 60% or higher.

             7. Life expectancy > 2 months

             8. 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.

             9. 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

                  10. 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.

                  11. Written informed consent in accordance with institutional and FDA guidelines
                  must be obtained from all subjects (or patients' legal representative).

             Exclusion Criteria:

               1. BSA of <0.25 m2.

               2. Subjects that received DFMO at a dose higher than 1000mg/m2 BID prior to this
                  study are not eligible.

               3. Subjects that received a dose of DFMO in combination with etoposide are not
                  eligible.

               4. Investigational Drugs: Subjects who are currently receiving another
                  investigational drug are excluded from participation.

               5. 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.

               6. 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.

               7. 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:Not yet recruiting
Lead Sponsor:Giselle Sholler

Last Updated

March 6, 2020