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Radiolabeled Octreotide in Treating Children With Advanced or Refractory Solid Tumors

Primary Purpose

Brain and Central Nervous System Tumors, Gastrointestinal Carcinoid Tumor, Islet Cell Tumor

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
90Y-DOTA-tyr3-OCTREOTIDE
Sponsored by
O'Dorisio, M S
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Brain and Central Nervous System Tumors focused on measuring childhood grade III meningioma, disseminated neuroblastoma, localized unresectable neuroblastoma, metastatic pheochromocytoma, metastatic Ewing sarcoma/peripheral primitive neuroectodermal tumor, recurrent childhood brain tumor, recurrent childhood medulloblastoma, recurrent neuroblastoma, recurrent pheochromocytoma, recurrent Ewing sarcoma/peripheral primitive neuroectodermal tumor, regional neuroblastoma, regional pheochromocytoma, unspecified childhood solid tumor, protocol specific, recurrent childhood ependymoma, childhood infratentorial ependymoma, childhood supratentorial ependymoma, recurrent islet cell carcinoma, gastrinoma, insulinoma, metastatic gastrointestinal carcinoid tumor, recurrent gastrointestinal carcinoid tumor, regional gastrointestinal carcinoid tumor

Eligibility Criteria

2 Years - 25 Years (Child, Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: Histologically or cytologically confirmed malignant neoplasm Not amenable to standard therapy or has failed existing first- and second-line therapies Tumor positive for somatostatin receptors by OctreoScan within the past 4 weeks At least 1 measurable lesion Lesions that have been previously irradiated must demonstrate progression since radiation At least 1 measurable somatostatin receptor-positive lesion that has not been irradiated within the past 4 weeks AND has not had full craniospinal radiation within the past 3 months Bone marrow with at least 40% cellularity OR at least 20% cellularity with one million CD34+ stem cells/kg stored No diffuse bone marrow involvement by OctreoScan scintigraphy PATIENT CHARACTERISTICS: Age 2 to 25 Performance status COG 0-2 OR Karnofsky 60-100% OR Lansky 60-100% Life expectancy 2-12 months Hematopoietic See Disease Characteristics Absolute neutrophil count at least 1,000/mm^3 Platelet count at least 100,000/mm^3 Hepatic Bilirubin less than 1.5 times normal AST and ALT less than 2.5 times upper limit of normal Renal Creatinine no greater than 1 mg/dL (children less than 5 years of age) Creatinine less than 1.2 mg/dL (children 5 to 10 years of age) Creatinine less than 1.7 mg/dL (children over 10 years of age) AND Glomerular filtration rate at least 80 mL/min/m^2 Cardiovascular Shortening fraction at least 28% by echocardiogram Ejection fraction at least 50% by bi-plane method of echocardiogram No prior congestive heart failure unless ejection fraction at least 40% No unstable angina pectoris No cardiac arrhythmia No symptomatic congestive heart failure Other No other concurrent malignancy No other significant uncontrolled medical, psychiatric, or surgical condition that would preclude study compliance No antibodies to yttrium Y 90-DOTA-tyr3-octreotide or octreotide No prior allergic reactions to compounds of similar chemical or biologic composition to yttrium Y 90-DOTA-tyr3-octreotide No ongoing or active infection Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for 6 months after study participation PRIOR CONCURRENT THERAPY: Biologic therapy Not specified Chemotherapy At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin) Endocrine therapy More than 28 days since prior long-acting somatostatin analogues No concurrent somatostatin analogues 12 hours before or 12 hours after study drug administration Concurrent hormonal therapy (other than somatostatin analogue) allowed provided patient received hormonal therapy for at least 2 months and has stable disease or progressive disease Radiotherapy See Disease Characteristics At least 4 weeks since prior radiotherapy No prior radiotherapy to 25% or more of bone marrow No prior external beam radiotherapy to both kidneys (scatter doses of less than 500 cGy to a single kidney or radiation to less than 50% of a single kidney is allowed) Surgery At least 4 weeks since prior surgery Other Recovered from prior therapy At least 4 weeks since prior investigational drugs No other concurrent approved or investigational anti-neoplastic therapies except for bisphosphonates No concurrent combination antiretroviral therapy for HIV-positive patients

Sites / Locations

  • Holden Comprehensive Cancer Center at University of Iowa

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

90Y-DOTA-tyr3-OCTREOTIDE

Arm Description

Dose escalation will proceed so that the single-cycle and three-cycle maximum tolerated doses of 90Y-DOTA-tyr3-Octreotide can be determined. The initial dose of 90Y-DOTA-tyr3-Octreotide to be administered is 30 mCi/m2 in each of three cycles. Dose escalation will proceed in 10 mCi/m2 intervals and will be permitted for the next cohort of subjects pending completion of Cycle 3 by 2 members of the previous cohort with no DLTs. A DLT is defined as a Grade 3 renal toxicity, Grade 4 bone marrow toxicity, or any other Grade 3 toxicity whether or not related to study drug and regardless of duration. Lymphopenia will not be used to define a DLT.

Outcomes

Primary Outcome Measures

Establish the three-cycle maximum-tolerated dose of 90Y-DOTA-tyr3-Octreotide
Establish the three-cycle maximum-tolerated dose of 90Y-DOTA-tyr3-Octreotide administered by intravenous infusion to children with refractory somatostatin-receptor positive tumors based upon the 6 week/cycle dose-limiting-toxicity profile.
Evaluate the short term and long term safety (mild/moderate/severe/life-threatening adverse events, premature discontinuations and serious adverse events)
2. Evaluate the short-term (6 weeks/cycle) and long term (4-6 months) safety (mild/moderate/severe/life-threatening adverse events, premature discontinuations and serious adverse events) serious adverse event profile of three-cycles of 90Y-DOTA-tyr3-Octreotide administered by intravenous infusion to children with refractory somatostatin-receptor positive tumors.

Secondary Outcome Measures

Full Information

First Posted
November 12, 2002
Last Updated
June 17, 2016
Sponsor
O'Dorisio, M S
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00049023
Brief Title
Radiolabeled Octreotide in Treating Children With Advanced or Refractory Solid Tumors
Official Title
A Phase I, Open Label, Maximum Tolerated Dose-Finding Study to Evaluate the Safety and Tolerability of 90Y-DOTA-tyr3-Octreotide Administered by Intravenous Infusion to Children With Refractory Somatostatin-Receptor Positive Tumors
Study Type
Interventional

2. Study Status

Record Verification Date
June 2016
Overall Recruitment Status
Completed
Study Start Date
January 2002 (undefined)
Primary Completion Date
August 2011 (Actual)
Study Completion Date
August 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
O'Dorisio, M S
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Radiolabeled octreotide can locate tumor cells and deliver radioactive tumor-killing substances to them without harming normal cells. PURPOSE: This phase I trial is to study the safety and effectiveness of radiolabeled octreotide in treating children who have advanced or refractory solid tumors.
Detailed Description
OBJECTIVES: Determine the maximum tolerated dose of yttrium Y 90-DOTA-tyr3-octreotide in children with advanced or refractory somatostatin receptor-positive tumors. Determine the short-term and long-term safety and the serious adverse-event profiles of this drug in these patients. Determine any potential antitumor effect of this drug in these patients. Correlate level of somatostatin receptor type 2 expression with response in patients treated with this drug. OUTLINE: This is a dose-escalation study. Patients receive yttrium Y 90-DOTA-tyr3-octreotide IV over 5-10 minutes on day 1. Treatment repeats every 6 weeks for up to 3 courses in the absence of unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of yttrium Y 90-DOTA-tyr3-octreotide until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which at least 2 of 6 patients experience dose-limiting toxicity. Patients are followed weekly after each treatment course, 6 weeks after the last course, and then every 6 months thereafter for life. PROJECTED ACCRUAL: Approximately 25-35 patients will be accrued for this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Brain and Central Nervous System Tumors, Gastrointestinal Carcinoid Tumor, Islet Cell Tumor, Neuroblastoma, Pheochromocytoma, Sarcoma, Unspecified Childhood Solid Tumor, Protocol Specific
Keywords
childhood grade III meningioma, disseminated neuroblastoma, localized unresectable neuroblastoma, metastatic pheochromocytoma, metastatic Ewing sarcoma/peripheral primitive neuroectodermal tumor, recurrent childhood brain tumor, recurrent childhood medulloblastoma, recurrent neuroblastoma, recurrent pheochromocytoma, recurrent Ewing sarcoma/peripheral primitive neuroectodermal tumor, regional neuroblastoma, regional pheochromocytoma, unspecified childhood solid tumor, protocol specific, recurrent childhood ependymoma, childhood infratentorial ependymoma, childhood supratentorial ependymoma, recurrent islet cell carcinoma, gastrinoma, insulinoma, metastatic gastrointestinal carcinoid tumor, recurrent gastrointestinal carcinoid tumor, regional gastrointestinal carcinoid tumor

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
27 (Actual)

8. Arms, Groups, and Interventions

Arm Title
90Y-DOTA-tyr3-OCTREOTIDE
Arm Type
Experimental
Arm Description
Dose escalation will proceed so that the single-cycle and three-cycle maximum tolerated doses of 90Y-DOTA-tyr3-Octreotide can be determined. The initial dose of 90Y-DOTA-tyr3-Octreotide to be administered is 30 mCi/m2 in each of three cycles. Dose escalation will proceed in 10 mCi/m2 intervals and will be permitted for the next cohort of subjects pending completion of Cycle 3 by 2 members of the previous cohort with no DLTs. A DLT is defined as a Grade 3 renal toxicity, Grade 4 bone marrow toxicity, or any other Grade 3 toxicity whether or not related to study drug and regardless of duration. Lymphopenia will not be used to define a DLT.
Intervention Type
Radiation
Intervention Name(s)
90Y-DOTA-tyr3-OCTREOTIDE
Primary Outcome Measure Information:
Title
Establish the three-cycle maximum-tolerated dose of 90Y-DOTA-tyr3-Octreotide
Description
Establish the three-cycle maximum-tolerated dose of 90Y-DOTA-tyr3-Octreotide administered by intravenous infusion to children with refractory somatostatin-receptor positive tumors based upon the 6 week/cycle dose-limiting-toxicity profile.
Time Frame
6 weeks per cycle
Title
Evaluate the short term and long term safety (mild/moderate/severe/life-threatening adverse events, premature discontinuations and serious adverse events)
Description
2. Evaluate the short-term (6 weeks/cycle) and long term (4-6 months) safety (mild/moderate/severe/life-threatening adverse events, premature discontinuations and serious adverse events) serious adverse event profile of three-cycles of 90Y-DOTA-tyr3-Octreotide administered by intravenous infusion to children with refractory somatostatin-receptor positive tumors.
Time Frame
short term (6 weeks/cycle); long term (4-6 mos./cycle)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
2 Years
Maximum Age & Unit of Time
25 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically or cytologically confirmed malignant neoplasm Not amenable to standard therapy or has failed existing first- and second-line therapies Tumor positive for somatostatin receptors by OctreoScan within the past 4 weeks At least 1 measurable lesion Lesions that have been previously irradiated must demonstrate progression since radiation At least 1 measurable somatostatin receptor-positive lesion that has not been irradiated within the past 4 weeks AND has not had full craniospinal radiation within the past 3 months Bone marrow with at least 40% cellularity OR at least 20% cellularity with one million CD34+ stem cells/kg stored No diffuse bone marrow involvement by OctreoScan scintigraphy PATIENT CHARACTERISTICS: Age 2 to 25 Performance status COG 0-2 OR Karnofsky 60-100% OR Lansky 60-100% Life expectancy 2-12 months Hematopoietic See Disease Characteristics Absolute neutrophil count at least 1,000/mm^3 Platelet count at least 100,000/mm^3 Hepatic Bilirubin less than 1.5 times normal AST and ALT less than 2.5 times upper limit of normal Renal Creatinine no greater than 1 mg/dL (children less than 5 years of age) Creatinine less than 1.2 mg/dL (children 5 to 10 years of age) Creatinine less than 1.7 mg/dL (children over 10 years of age) AND Glomerular filtration rate at least 80 mL/min/m^2 Cardiovascular Shortening fraction at least 28% by echocardiogram Ejection fraction at least 50% by bi-plane method of echocardiogram No prior congestive heart failure unless ejection fraction at least 40% No unstable angina pectoris No cardiac arrhythmia No symptomatic congestive heart failure Other No other concurrent malignancy No other significant uncontrolled medical, psychiatric, or surgical condition that would preclude study compliance No antibodies to yttrium Y 90-DOTA-tyr3-octreotide or octreotide No prior allergic reactions to compounds of similar chemical or biologic composition to yttrium Y 90-DOTA-tyr3-octreotide No ongoing or active infection Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for 6 months after study participation PRIOR CONCURRENT THERAPY: Biologic therapy Not specified Chemotherapy At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin) Endocrine therapy More than 28 days since prior long-acting somatostatin analogues No concurrent somatostatin analogues 12 hours before or 12 hours after study drug administration Concurrent hormonal therapy (other than somatostatin analogue) allowed provided patient received hormonal therapy for at least 2 months and has stable disease or progressive disease Radiotherapy See Disease Characteristics At least 4 weeks since prior radiotherapy No prior radiotherapy to 25% or more of bone marrow No prior external beam radiotherapy to both kidneys (scatter doses of less than 500 cGy to a single kidney or radiation to less than 50% of a single kidney is allowed) Surgery At least 4 weeks since prior surgery Other Recovered from prior therapy At least 4 weeks since prior investigational drugs No other concurrent approved or investigational anti-neoplastic therapies except for bisphosphonates No concurrent combination antiretroviral therapy for HIV-positive patients
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
M. Sue O'Dorisio, MD, PhD
Organizational Affiliation
Holden Comprehensive Cancer Center
Official's Role
Study Chair
Facility Information:
Facility Name
Holden Comprehensive Cancer Center at University of Iowa
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242-1002
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
20847174
Citation
Menda Y, O'Dorisio MS, Kao S, Khanna G, Michael S, Connolly M, Babich J, O'Dorisio T, Bushnell D, Madsen M. Phase I trial of 90Y-DOTATOC therapy in children and young adults with refractory solid tumors that express somatostatin receptors. J Nucl Med. 2010 Oct;51(10):1524-31. doi: 10.2967/jnumed.110.075226. Epub 2010 Sep 16.
Results Reference
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Radiolabeled Octreotide in Treating Children With Advanced or Refractory Solid Tumors

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