This study plans to learn more about the use of Granulocyte Macrophage Colony Stimulation Factor (GM-CSF) on ependymoma tumors. The use of GM-CSF is a potential way of increasing the infiltration of immune cells and this study is looking at whether or not this will improve the outcome of patients with an ependymoma
Recruiting
Early Phase 1
| Drug | Synonyms | Arms |
|---|---|---|
| Granulocyte Macrophage Colony Stimulation Factor | GM-CSF | GM-CSF treatment at recurrence arm. |
To study whether Granulocyte Macrophage Colony Stimulation Factor (GM-CSF) increases
macrophage infiltration in children with ependymoma (EPN) who are to have planned surgery as
a standard procedure for incomplete resection or recurrent tumor. To correlate the extent of
macrophage infiltration with other immune markers of the tumor at subsequent surgery with
outcome. This is intended as a pilot protocol with the potential to be incorporated in the
next COG (Children's Oncology Group) national ependymoma studies.
Recombinant Granulocyte Macrophage Colony Stimulation Factor (rGM-CSF) is a hematopoietic
growth factor which supports survival, clonal expansion, and differentiation of hematopoietic
progenitor cells. rGM-CSF induces partially committed progenitor cells to divide and
differentiate in the granulocyte-macrophage pathways. rGM-CSF stimulates the production of
monocytes, granulocytes, erythrocytes, and sometimes, megakaryocytes in the bone marrow. It
also induces mature macrophages to increase phagocytosis, superoxide generation, Antibody
Dependent Cell-mediated Cytotoxicity (ADCC), tumoricidal killing and cytokine production
(IL-1 and tumor necrosis factor).
Registration of all participants must occur before any study-related procedures. Staff will
be available to register participants Monday thru Friday, from 8:00 AM to 5:00 PM Mountain
Standard Time.
| Name | Type | Description | Interventions |
|---|---|---|---|
| GM-CSF treatment at second-look surgery arm | Experimental | Newly diagnosed patients with EPN who have a subtotal resection at initial presentation and are without evidence of metastatic tumor will be enrolled in this stratum. Total patient population in this stratum will be 10 patients. It should be noted that prior experience suggests that about 1/3 of newly presenting patients still have residual tumor after the initial surgery |
|
| GM-CSF treatment at recurrence arm. | Experimental | EPN patients with a first regional relapse and without evidence of metastatic tumor will be enrolled in this stratum. Total patient population will be 10 patients. Patients with a first recurrence will have the recurrence confirmed by the local institutional neuro-radiologists. They will have the entire neuro-axis scanned and a spinal tap performed (where safe) to exclude metastatic tumor. They will then receive 5 days of GM-CSF and then proceed to surgery if deemed clinically indicated by the treating physician |
|
Inclusion Criteria:
- Age > 12 months and < 21 years at the time of study enrollment.
- Patients must be one of the following:
• Newly diagnosed with posterior fossa ependymoma with a subtotal resection at initial
surgery. These patients will be eligible for stratum 1.
- Be in first relapse of their posterior fossa ependymoma. These patients will be
eligible for stratum 2.
- Histologically confirmed diagnosis of intracranial ependymoma .
- Pre or post-operative MR imaging of the brain demonstrates no evidence of
non-contiguous spread beyond the primary site
- Pre or post-operative MR imaging of the spine demonstrates no evidence of
non-contiguous spread beyond the primary site
- Pre-operative CSF cytology obtained from the lumbar CSF space demonstrated no evidence
of non-contiguous spread beyond the primary site.
• The requirement for lumbar CSF examination may be waived if deemed to be medically
contraindicated.
- Patients must meet one of the following performance scores.
• ECOG performance status scores of 0, 1, or 2.
- Karnofsky score of ≥ 50 for patients > 16 years of age or Lansky score of ≥ 50
for patients ≤ 16 years of age
- Organ Function Requirements:
Adequate renal function defined as:
- Creatinine clearance or radioisotope GFR ³ 70ml/min/1.73 m2 or
- A serum creatinine based on age/gender as follows:
Age Maximum Serum Creatinine (mg/dL) Male Female
1 month to < 6 months 0.4 0.4 6 months to < 1 year 0.5 0.5
1 to < 2 years 0.6 0.6 2 to < 6 years 0.8 0.8 6 to < 10 years 1 1 10 to < 13 years 1.2 1.2
13 to < 16 years 1.5 1.4
≥ 16 years 1.7 1.4 The threshold creatinine values in this Table were derived from the
Schwartz formula for estimating GFR (Schwartz et al. J. Peds, 106:522, 1985) utilizing
child length and stature data published by the CDC.
- Adequate liver function defined as:
- Total bilirubin =< 1.5 x upper limit of normal (ULN) for age, and
- SGOT (AST) or SGPT (ALT) < 3 x upper limit of normal (ULN) for age.
- Patients with Gilbert syndrome or hemolytic anemia are eligible if total bilirubin is
< 3 x upper limit of normal (ULN) for age.
- Adequate Bone Marrow Function defined as:
- Peripheral absolute neutrophil count (ANC) >= 1,000/uL
- Platelet count >= 100,000/uL (transfusion independent).
Exclusion Criteria:
- Patients with a diagnosis of spinal cord ependymoma, myxopapillary ependymoma,
subependymoma, ependymoblastoma, supratentorial ependymoma, or mixed glioma are NOT
eligible.
- Patients with evidence of metastatic disease by MRI or CSF cytology are NOT eligible
| Maximum Eligible Age: | 21 Years |
| Minimum Eligible Age: | 12 Months |
| Eligible Gender: | All |
| Healthy Volunteers: | No |
| Measure: | Number of participants with increased M/M infiltration compared to institutional and ACNS0121 controls |
| Time Frame: | 8 years |
| Safety Issue: | |
| Description: | Outcome measure is met if cell count is >50 AIF1+ microglia per high power field (40x) |
| Phase: | Early Phase 1 |
| Primary Purpose: | Interventional |
| Overall Status: | Recruiting |
| Lead Sponsor: | University of Colorado, Denver |
May 5, 2021
