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Pyrazoloacridine and Stem Cell or Bone Marrow Transplantation in Treating Young Patients With High-Risk Neuroblastoma

Primary Purpose

Disseminated Neuroblastoma, Recurrent Neuroblastoma

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
pyrazoloacridine
filgrastim
autologous bone marrow transplantation
peripheral blood stem cell transplantation
laboratory biomarker analysis
pharmacological study
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Disseminated Neuroblastoma

Eligibility Criteria

1 Year - 30 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Patients must have a diagnosis of neuroblastoma (ICD-O morphology 9500/3) verified by histology and/or demonstration of clumps of tumor cells in bone marrow with elevated urinary catecholamine metabolites Patients must meet one of the two following disease status criteria to enter on study; Current or prior progressive disease (PD) by INRC criteria Either mixed response (MR) or no response (NR) by INRC criteria following completion of minimum of 4 courses of induction therapy Patients meeting disease status criteria in either category A or B must also have at least one of the following sites of disease present to enter on study: At least one tumor lesion on CT or MRI scan that is >= 20mm in at least one dimension (spiral CT lesion must be >= 10mm in at least one dimension) MIBG scan with positive uptake at a minimum of one site Bone marrow disease documented by standard histology of bilateral bone marrow aspirate and biopsy specimens Patients > 16 years of age: Karnofsky >= 50%; Patients =< 16 years of age: Lansky >= 50%; patients 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; life expectancy must be >= 2 months for all patients Patients must have fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study Chemotherapy and/or biologics: Must not have received treatment within 3 weeks of entry onto this study (4 weeks if prior nitrosureas Radiation: At least 4 weeks since last dose of radiation therapy to at least one lesion being used as criteria for study eligibility; only 2 weeks must elapse since the last dose of radiation (small port) to a lesion not used for study eligibility; at least 6 months must have elapsed since the last dose of prior craniospinal XRT and radiation to >= 50% of the pelvis or TBI Stem Cell Transplant (SCT): >= 9 months must have elapsed since autologous hematopoietic stem cell transplant (aHSCT) Prior MIBG therapy: At least 12 weeks must have elapsed since treatment with therapeutic doses of MIBG Study specific limitations on prior therapy: patients who have a history of allogeneic HSCT are not eligible Growth factor(s): At least 7 days since the last dose of any myeloid growth factor was given Any patient considered for this protocol must meet the following criteria for minimum number of autologous stem cells sufficient to rescue hematopoiesis; a combination of products may be used to meet this requirement All stem cell products infused on this protocol must meet the following criteria for tumor analysis: No tumor cells detectable by immunocytology OR for patients who had a PBSC collection done previously and no immunocytological testing was done on the product at the time of collection: This product may be used for infusion on this study if the patient's bilateral bone marrow aspirate and biopsy specimens can be shown to be tumor free by standard histology within 4 weeks of PBSC collection Glomerular filtration rate (GFR) using blood draw method or 12 hour urine collection for creatinine clearance >= 100 ml/min/1.73 m^2 Serum creatinine =< 1.5 x upper limit of normal for age Normal ejection fraction (>= 55%) documented by echocardiogram or radionuclide MUGA evaluation OR normal fractional shortening (>= 27%) documented by echocardiogram Total bilirubin < 1.5 x upper limit of normal AST/ALT =< 3 x upper limit of normal Platelets >= 75,000/uL (transfusion independent) Hemoglobin >= 8 g/dl (transfusion allowed) Because evaluation of hematopoietic toxicity is essential to this study, the same criteria will be applied to patients with tumor infiltration of the bone marrow Normal lung function as manifested by no dyspnea at rest and no oxygen requirement Exclusion Criteria: No patients who are pregnant or lactating will be allowed to enter on study; pregnancy tests must be obtained in females who are post-menarchal; males and females of reproductive potential may not participate unless they have agreed to use an effective method of contraception while receiving therapy Patients with active infections requiring intravenous antivirals, antibiotics, or antifungals; patients on prolonged antifungal therapy are still eligible if they are culture negative and biopsy negative in suspected residual radiographic lesions and they meet other organ function criteria; patients who are known HIV seropositive with stable disease and lack of major health problems who are not on anti-retroviral therapy, may be eligible at the discretion of the Study Chair Prior treatment with Pyrazoloacridine (PZA) Prior history of allogeneic HSCT Neurologic Exclusions: Acute or chronic CNS disease History of seizures History of cerebral bleeding or stroke CNS parenchymal metastases as documented by head CT with contrast or head MRI with gadolinium performed within 30 days of study entry. Patients with epidural metastases causing mass effect on the brain are also excluded (skull metastases are allowed provided they are not associated with intracranial disease compressing or displacing the brain

Sites / Locations

  • New Approaches to Neuroblastoma Treatment (NANT)

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Cohort I

Cohort II

Arm Description

Groups of 3-6 patients receive escalating doses of PZA at a fixed infusion time until the MTD is determined. In both cohorts the MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Patients receive G-CSF IV or subcutaneously beginning on day 4 and continuing until blood counts recover. Patients also undergo reinfusion of stem cells over 15-30 minutes on day 4 as needed per protocol.

Groups of 3-6 patients receive PZA at the dose/hour established in cohort I at escalating infusion times until another MTD is determined. In both cohorts the MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Patients receive G-CSF IV or subcutaneously beginning on day 4 and continuing until blood counts recover. Patients also undergo reinfusion of stem cells over 15-30 minutes on day 4 as needed per protocol.

Outcomes

Primary Outcome Measures

Maximum tolerated dose determined by dose-limiting toxicities by NCI Common Toxicity Criteria

Secondary Outcome Measures

Time to engraftment (hematopoietic recovery)
Will be summarized with tables and with Kaplan-Meier plots.
Response by RECIST or MIBG-scans
Survival
Time to progression
Time to failure
Pharmacokinetic (such as AUC, Cmax, Tmax, and clearance in the plasma) determinations
Will be summarized by dose level with simple summary statistics: means (possibly after transformation) or medians, ranges, and standard deviations.

Full Information

First Posted
February 5, 2003
Last Updated
April 8, 2013
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00053950
Brief Title
Pyrazoloacridine and Stem Cell or Bone Marrow Transplantation in Treating Young Patients With High-Risk Neuroblastoma
Official Title
A Phase I Study of High-dose Pyrazoloacridine (PZA) (NSC 366140) Supported With Autologous Hematopoietic Stem Cell Rescue in Children With Recurrent or Resistant Neuroblastoma (IND # 36325)
Study Type
Interventional

2. Study Status

Record Verification Date
April 2013
Overall Recruitment Status
Terminated
Why Stopped
Administratively complete.
Study Start Date
December 2002 (undefined)
Primary Completion Date
March 2007 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
This phase I trial is studying the side effects and best dose of pyrazoloacridine given together with peripheral stem cell or bone marrow transplantation in treating young patients with high-risk neuroblastoma. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining chemotherapy with peripheral stem cell or bone marrow transplantation may allow the doctor to give higher doses of chemotherapy drugs and kill more tumor cells.
Detailed Description
PRIMARY OBJECTIVES: I. To determine the maximum tolerated dose (MTD) of PZA given as a single prolonged infusion (>= 6 hours) with autologous hematopoietic stem cell (aHSC) support to children with high risk neuroblastoma with recurrent or refractory disease. II. To determine the dose limiting toxicity (DLT) of PZA given on this schedule. III. To characterize the pharmacokinetics of PZA given on this schedule. SECONDARY OBJECTIVES: I. To obtain preliminary data on the antitumor activity of PZA within the confines of a Phase I study. II. To determine the TP53 mutation status of tumor cells in bone marrow if > 10% are present; to evaluate expression of p53 and MDM2 proteins by flow cytometry if >= 0.1% to < 10% are present at study entry. OUTLINE: This is a two-stage, dose-escalation study. Patients without adequate cryopreserved hematopoietic stem cells undergo peripheral blood stem cell harvest or bone marrow harvest for autologous stem cells at least 2 weeks before study therapy. Patients receive high-dose pyrazoloacridine (PZA) IV on day 0. Cohort 1: Groups of 3-6 patients receive escalating doses of PZA at a fixed infusion time until the maximum tolerated dose (MTD) is determined. Cohort 2: Groups of 3-6 patients receive PZA at the dose/hour established in cohort I at escalating infusion times until another MTD is determined. In both cohorts the MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Patients receive filgrastim (G-CSF) IV or subcutaneously beginning on day 4 and continuing until blood counts recover. Patients also undergo reinfusion of stem cells over 15-30 minutes on day 4 as needed per protocol. Patients are followed at days 28-35, every 3 months for 3 years, and then every 6 months thereafter.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Disseminated Neuroblastoma, Recurrent Neuroblastoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
42 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cohort I
Arm Type
Experimental
Arm Description
Groups of 3-6 patients receive escalating doses of PZA at a fixed infusion time until the MTD is determined. In both cohorts the MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Patients receive G-CSF IV or subcutaneously beginning on day 4 and continuing until blood counts recover. Patients also undergo reinfusion of stem cells over 15-30 minutes on day 4 as needed per protocol.
Arm Title
Cohort II
Arm Type
Experimental
Arm Description
Groups of 3-6 patients receive PZA at the dose/hour established in cohort I at escalating infusion times until another MTD is determined. In both cohorts the MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Patients receive G-CSF IV or subcutaneously beginning on day 4 and continuing until blood counts recover. Patients also undergo reinfusion of stem cells over 15-30 minutes on day 4 as needed per protocol.
Intervention Type
Drug
Intervention Name(s)
pyrazoloacridine
Other Intervention Name(s)
PZA
Intervention Description
Given IV
Intervention Type
Biological
Intervention Name(s)
filgrastim
Other Intervention Name(s)
G-CSF, Neupogen
Intervention Description
Given IV or SC
Intervention Type
Procedure
Intervention Name(s)
autologous bone marrow transplantation
Other Intervention Name(s)
ABMT, bone marrow transplantation, autologous, transplantation, autologous bone marrow
Intervention Description
Undergo autologous bone marrow transplantation
Intervention Type
Procedure
Intervention Name(s)
peripheral blood stem cell transplantation
Other Intervention Name(s)
PBPC transplantation, PBSC transplantation, peripheral blood progenitor cell transplantation, transplantation, peripheral blood stem cell
Intervention Description
Undergo peripheral blood stem cell transplantation
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Intervention Description
Correlative studies
Intervention Type
Other
Intervention Name(s)
pharmacological study
Other Intervention Name(s)
pharmacological studies
Intervention Description
Correlative studies
Primary Outcome Measure Information:
Title
Maximum tolerated dose determined by dose-limiting toxicities by NCI Common Toxicity Criteria
Time Frame
28 days
Secondary Outcome Measure Information:
Title
Time to engraftment (hematopoietic recovery)
Description
Will be summarized with tables and with Kaplan-Meier plots.
Time Frame
Up to 4 years
Title
Response by RECIST or MIBG-scans
Time Frame
28 days
Title
Survival
Time Frame
Up to 4 years
Title
Time to progression
Time Frame
Up to 4 years
Title
Time to failure
Time Frame
Time from start of treatment until death for any cause or disease progression, assessed up to 4 years
Title
Pharmacokinetic (such as AUC, Cmax, Tmax, and clearance in the plasma) determinations
Description
Will be summarized by dose level with simple summary statistics: means (possibly after transformation) or medians, ranges, and standard deviations.
Time Frame
3, 24, 72,and 192 hours after starting infusion

10. Eligibility

Sex
All
Minimum Age & Unit of Time
1 Year
Maximum Age & Unit of Time
30 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must have a diagnosis of neuroblastoma (ICD-O morphology 9500/3) verified by histology and/or demonstration of clumps of tumor cells in bone marrow with elevated urinary catecholamine metabolites Patients must meet one of the two following disease status criteria to enter on study; Current or prior progressive disease (PD) by INRC criteria Either mixed response (MR) or no response (NR) by INRC criteria following completion of minimum of 4 courses of induction therapy Patients meeting disease status criteria in either category A or B must also have at least one of the following sites of disease present to enter on study: At least one tumor lesion on CT or MRI scan that is >= 20mm in at least one dimension (spiral CT lesion must be >= 10mm in at least one dimension) MIBG scan with positive uptake at a minimum of one site Bone marrow disease documented by standard histology of bilateral bone marrow aspirate and biopsy specimens Patients > 16 years of age: Karnofsky >= 50%; Patients =< 16 years of age: Lansky >= 50%; patients 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; life expectancy must be >= 2 months for all patients Patients must have fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study Chemotherapy and/or biologics: Must not have received treatment within 3 weeks of entry onto this study (4 weeks if prior nitrosureas Radiation: At least 4 weeks since last dose of radiation therapy to at least one lesion being used as criteria for study eligibility; only 2 weeks must elapse since the last dose of radiation (small port) to a lesion not used for study eligibility; at least 6 months must have elapsed since the last dose of prior craniospinal XRT and radiation to >= 50% of the pelvis or TBI Stem Cell Transplant (SCT): >= 9 months must have elapsed since autologous hematopoietic stem cell transplant (aHSCT) Prior MIBG therapy: At least 12 weeks must have elapsed since treatment with therapeutic doses of MIBG Study specific limitations on prior therapy: patients who have a history of allogeneic HSCT are not eligible Growth factor(s): At least 7 days since the last dose of any myeloid growth factor was given Any patient considered for this protocol must meet the following criteria for minimum number of autologous stem cells sufficient to rescue hematopoiesis; a combination of products may be used to meet this requirement All stem cell products infused on this protocol must meet the following criteria for tumor analysis: No tumor cells detectable by immunocytology OR for patients who had a PBSC collection done previously and no immunocytological testing was done on the product at the time of collection: This product may be used for infusion on this study if the patient's bilateral bone marrow aspirate and biopsy specimens can be shown to be tumor free by standard histology within 4 weeks of PBSC collection Glomerular filtration rate (GFR) using blood draw method or 12 hour urine collection for creatinine clearance >= 100 ml/min/1.73 m^2 Serum creatinine =< 1.5 x upper limit of normal for age Normal ejection fraction (>= 55%) documented by echocardiogram or radionuclide MUGA evaluation OR normal fractional shortening (>= 27%) documented by echocardiogram Total bilirubin < 1.5 x upper limit of normal AST/ALT =< 3 x upper limit of normal Platelets >= 75,000/uL (transfusion independent) Hemoglobin >= 8 g/dl (transfusion allowed) Because evaluation of hematopoietic toxicity is essential to this study, the same criteria will be applied to patients with tumor infiltration of the bone marrow Normal lung function as manifested by no dyspnea at rest and no oxygen requirement Exclusion Criteria: No patients who are pregnant or lactating will be allowed to enter on study; pregnancy tests must be obtained in females who are post-menarchal; males and females of reproductive potential may not participate unless they have agreed to use an effective method of contraception while receiving therapy Patients with active infections requiring intravenous antivirals, antibiotics, or antifungals; patients on prolonged antifungal therapy are still eligible if they are culture negative and biopsy negative in suspected residual radiographic lesions and they meet other organ function criteria; patients who are known HIV seropositive with stable disease and lack of major health problems who are not on anti-retroviral therapy, may be eligible at the discretion of the Study Chair Prior treatment with Pyrazoloacridine (PZA) Prior history of allogeneic HSCT Neurologic Exclusions: Acute or chronic CNS disease History of seizures History of cerebral bleeding or stroke CNS parenchymal metastases as documented by head CT with contrast or head MRI with gadolinium performed within 30 days of study entry. Patients with epidural metastases causing mass effect on the brain are also excluded (skull metastases are allowed provided they are not associated with intracranial disease compressing or displacing the brain
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Anna Butturini
Organizational Affiliation
New Approaches to Neuroblastoma Treatment (NANT)
Official's Role
Principal Investigator
Facility Information:
Facility Name
New Approaches to Neuroblastoma Treatment (NANT)
City
Los Angeles
State/Province
California
ZIP/Postal Code
90027-6016
Country
United States

12. IPD Sharing Statement

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Pyrazoloacridine and Stem Cell or Bone Marrow Transplantation in Treating Young Patients With High-Risk Neuroblastoma

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