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Decitabine, Doxorubicin, and Cyclophosphamide in Treating Children With Relapsed or Refractory Solid Tumors or Neuroblastoma

Primary Purpose

Recurrent Neuroblastoma, Unspecified Childhood Solid Tumor, Protocol Specific

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
decitabine
doxorubicin hydrochloride
cyclophosphamide
filgrastim
pegfilgrastim
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 Recurrent Neuroblastoma

Eligibility Criteria

1 Year - 21 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Histologically confirmed diagnosis of either of the following: Solid tumor (part A) No lymphoma Neuroblastoma (part B) Original diagnosis may be based on elevated urine vanillylmandelic acid (VMA) and homovanillic acid (HVA) and bone marrow examination Accessible disease by bone marrow aspirate or tumor biopsy No laparotomy, thoracotomy, endoscopy, or craniotomy for biopsy No known curative therapy OR therapy proven to prolong survival with an acceptable quality of life available No known brain or spinal cord metastases No CNS tumors Performance status - Karnofsky 50-100% (patients 11 to 21 years of age) Performance status - Lansky 50-100% (patients ≤ 10 years of age) Parts A and B without bone marrow infiltration: Absolute neutrophil count ≥ 1,000/mm^3 Platelet count ≥ 100,000/mm^3 (transfusion independent) Part B with bone marrow infiltration (i.e., tumor metastatic to bone marrow with granulocytopenia, anemia, and/or thrombocytopenia): Absolute neutrophil count ≥ 750/mm^3 Platelet count ≥ 50,000/mm^3 (transfusion independent) Hemoglobin ≥ 8.0 g/dL (transfusion allowed) No sickle cell anemia Bilirubin ≤ 1.5 mg/dL ALT ≤ 5 times upper limit of normal No significant hepatic dysfunction that would compromise the tolerability of decitabine or interfere with study procedures or results Creatinine based on age as follows: ≤ 0.8 mg/dL (5 years of age and under) ≤ 1.0 mg/dL (6 to 10 years of age) ≤ 1.2 mg/dL (11 to 15 years of age) ≤ 1.5 mg/dL (16 to 21 years of age) Creatinine clearance or radioisotope glomerular filtration rate ≥ 70 mL/min No significant renal dysfunction that would compromise the tolerability of decitabine or interfere with study procedures or results Shortening fraction ≥ 28% by echocardiogram Ejection fraction of ≥ 45% by MUGA No significant pulmonary dysfunction that would compromise the tolerability of decitabine or interfere with study procedures or results Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No prior allergic reaction attributed to compounds of similar chemical or biological composition to agents used in this study No uncontrolled serious infection No significant end-organ dysfunction that would compromise the tolerability of decitabine or interfere with study procedures or results Recovered from prior immunotherapy At least 7 days since prior biologic therapy More than 1 week since prior growth factor therapy (2 weeks for pegfilgrastim) More than 2 weeks since prior epoetin alfa At least 6 months since prior autologous stem cell transplantation At least 6 months since prior allogeneic bone marrow transplantation Patients must have full organ recovery and no evidence of graft-versus-host disease No concurrent immunomodulating agents No concurrent immunotherapy No concurrent biologic therapy No concurrent epoetin alfa Recovered from prior chemotherapy More than 2 weeks since prior myelosuppressive chemotherapy (6 weeks for nitrosoureas) Prior total lifetime cumulative anthracycline dose ≤ 450 mg/m^2 of doxorubicin or equivalent No other concurrent chemotherapy No concurrent hydroxyurea Recovered from prior radiotherapy More than 2 weeks since prior local palliative small port radiotherapy More than 6 months since prior substantial bone marrow irradiation (e.g., cranio-spinal irradiation, total body irradiation, or hemi-pelvic irradiation) No concurrent radiotherapy No other concurrent anticancer therapy No other concurrent investigational agents Concurrent oral iron supplementation for patients with a known iron deficiency or a microcytic hypochromic anemia allowed

Sites / Locations

  • Children's Oncology Group

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Arm I

Arm Description

PART A (solid tumor patients): Patients receive decitabine IV over 1 hour on days 0-6 and doxorubicin IV over 15 minutes and cyclophosphamide IV over 1 hour on day 7. Patients then receive filgrastim (G-CSF) subcutaneously (SC) beginning on day 8 and continuing until blood counts recover OR pegfilgrastim SC once on day 8 or 9*. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. PART B (neuroblastoma patients): Once the MTD is determined for part A, patients are treated as in part A at the MTD.

Outcomes

Primary Outcome Measures

MTD of decitabine, based on incidence of DLT graded according to NCI CTCAE version 3.0 (Part A)
Caspase-8 expression in bone marrow or tumor biopsy samples (Part B)

Secondary Outcome Measures

Objective response rate
Confidence intervals will be reported in addition to the estimated response rates.
Percent of apoptotic cells as assessed by a TUNEL assay
A sign test or other appropriate nonparametric test may be used to assess whether there was an increase in the percent of apoptotic cells after treatment.

Full Information

First Posted
January 9, 2004
Last Updated
September 27, 2013
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00075634
Brief Title
Decitabine, Doxorubicin, and Cyclophosphamide in Treating Children With Relapsed or Refractory Solid Tumors or Neuroblastoma
Official Title
A Phase I Study of Decitabine (NSC# 127716, IND# 50733) in Combination With Doxorubicin and Cyclophosphamide in the Treatment of Relapsed or Refractory Solid Tumors
Study Type
Interventional

2. Study Status

Record Verification Date
September 2013
Overall Recruitment Status
Completed
Study Start Date
December 2003 (undefined)
Primary Completion Date
September 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 decitabine when given together with doxorubicin and cyclophosphamide in treating children with relapsed or refractory solid tumors or neuroblastoma. Drugs used in chemotherapy, such as decitabine, doxorubicin, and cyclophosphamide, work in different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells.
Detailed Description
PRIMARY OBJECTIVES: I. Determine the maximum tolerated dose of decitabine in combination with doxorubicin and cyclophosphamide in children with relapsed or refractory solid tumors or neuroblastoma. II. Determine the toxic effects of this regimen in these patients. III. Determine whether decitabine induces tumor caspase-8 demethylation and expression in these patients. SECONDARY OBJECTIVES: I. Determine the pharmacokinetics of low-dose decitabine in these patients. II. Determine the biological and clinical response in patients treated with this regimen. III. Compare patterns of peripheral blood gene expression, using gene expression profiling, in patients before and after treatment with decitabine. OUTLINE: This is a multicenter, dose-escalation study of decitabine. PART A (solid tumor patients): Patients receive decitabine IV over 1 hour on days 0-6 and doxorubicin IV over 15 minutes and cyclophosphamide IV over 1 hour on day 7. Patients then receive filgrastim (G-CSF) subcutaneously (SC) beginning on day 8 and continuing until blood counts recover OR pegfilgrastim SC once on day 8 or 9*. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of decitabine until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. NOTE: *For patients > 45 kg PART B (neuroblastoma patients): Once the MTD is determined for part A, patients are treated as in part A at the MTD. Patients are followed at 30 days.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Recurrent Neuroblastoma, Unspecified Childhood Solid Tumor, Protocol Specific

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Arm I
Arm Type
Experimental
Arm Description
PART A (solid tumor patients): Patients receive decitabine IV over 1 hour on days 0-6 and doxorubicin IV over 15 minutes and cyclophosphamide IV over 1 hour on day 7. Patients then receive filgrastim (G-CSF) subcutaneously (SC) beginning on day 8 and continuing until blood counts recover OR pegfilgrastim SC once on day 8 or 9*. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. PART B (neuroblastoma patients): Once the MTD is determined for part A, patients are treated as in part A at the MTD.
Intervention Type
Drug
Intervention Name(s)
decitabine
Other Intervention Name(s)
5-aza-dCyd, 5AZA, DAC
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
doxorubicin hydrochloride
Other Intervention Name(s)
ADM, ADR, Adria, Adriamycin PFS, Adriamycin RDF
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
cyclophosphamide
Other Intervention Name(s)
CPM, CTX, Cytoxan, Endoxan, Endoxana
Intervention Description
Given IV
Intervention Type
Biological
Intervention Name(s)
filgrastim
Other Intervention Name(s)
G-CSF, Neupogen
Intervention Description
Given SC
Intervention Type
Biological
Intervention Name(s)
pegfilgrastim
Other Intervention Name(s)
Filgrastim SD-01, GCSF-SD01, Neulasta, SD-01 sustained duration G-CSF
Intervention Description
Given SC
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
MTD of decitabine, based on incidence of DLT graded according to NCI CTCAE version 3.0 (Part A)
Time Frame
Up to 28 days
Title
Caspase-8 expression in bone marrow or tumor biopsy samples (Part B)
Time Frame
Up to 28 days
Secondary Outcome Measure Information:
Title
Objective response rate
Description
Confidence intervals will be reported in addition to the estimated response rates.
Time Frame
Up to 56 days
Title
Percent of apoptotic cells as assessed by a TUNEL assay
Description
A sign test or other appropriate nonparametric test may be used to assess whether there was an increase in the percent of apoptotic cells after treatment.
Time Frame
Up to 1 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
1 Year
Maximum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically confirmed diagnosis of either of the following: Solid tumor (part A) No lymphoma Neuroblastoma (part B) Original diagnosis may be based on elevated urine vanillylmandelic acid (VMA) and homovanillic acid (HVA) and bone marrow examination Accessible disease by bone marrow aspirate or tumor biopsy No laparotomy, thoracotomy, endoscopy, or craniotomy for biopsy No known curative therapy OR therapy proven to prolong survival with an acceptable quality of life available No known brain or spinal cord metastases No CNS tumors Performance status - Karnofsky 50-100% (patients 11 to 21 years of age) Performance status - Lansky 50-100% (patients ≤ 10 years of age) Parts A and B without bone marrow infiltration: Absolute neutrophil count ≥ 1,000/mm^3 Platelet count ≥ 100,000/mm^3 (transfusion independent) Part B with bone marrow infiltration (i.e., tumor metastatic to bone marrow with granulocytopenia, anemia, and/or thrombocytopenia): Absolute neutrophil count ≥ 750/mm^3 Platelet count ≥ 50,000/mm^3 (transfusion independent) Hemoglobin ≥ 8.0 g/dL (transfusion allowed) No sickle cell anemia Bilirubin ≤ 1.5 mg/dL ALT ≤ 5 times upper limit of normal No significant hepatic dysfunction that would compromise the tolerability of decitabine or interfere with study procedures or results Creatinine based on age as follows: ≤ 0.8 mg/dL (5 years of age and under) ≤ 1.0 mg/dL (6 to 10 years of age) ≤ 1.2 mg/dL (11 to 15 years of age) ≤ 1.5 mg/dL (16 to 21 years of age) Creatinine clearance or radioisotope glomerular filtration rate ≥ 70 mL/min No significant renal dysfunction that would compromise the tolerability of decitabine or interfere with study procedures or results Shortening fraction ≥ 28% by echocardiogram Ejection fraction of ≥ 45% by MUGA No significant pulmonary dysfunction that would compromise the tolerability of decitabine or interfere with study procedures or results Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No prior allergic reaction attributed to compounds of similar chemical or biological composition to agents used in this study No uncontrolled serious infection No significant end-organ dysfunction that would compromise the tolerability of decitabine or interfere with study procedures or results Recovered from prior immunotherapy At least 7 days since prior biologic therapy More than 1 week since prior growth factor therapy (2 weeks for pegfilgrastim) More than 2 weeks since prior epoetin alfa At least 6 months since prior autologous stem cell transplantation At least 6 months since prior allogeneic bone marrow transplantation Patients must have full organ recovery and no evidence of graft-versus-host disease No concurrent immunomodulating agents No concurrent immunotherapy No concurrent biologic therapy No concurrent epoetin alfa Recovered from prior chemotherapy More than 2 weeks since prior myelosuppressive chemotherapy (6 weeks for nitrosoureas) Prior total lifetime cumulative anthracycline dose ≤ 450 mg/m^2 of doxorubicin or equivalent No other concurrent chemotherapy No concurrent hydroxyurea Recovered from prior radiotherapy More than 2 weeks since prior local palliative small port radiotherapy More than 6 months since prior substantial bone marrow irradiation (e.g., cranio-spinal irradiation, total body irradiation, or hemi-pelvic irradiation) No concurrent radiotherapy No other concurrent anticancer therapy No other concurrent investigational agents Concurrent oral iron supplementation for patients with a known iron deficiency or a microcytic hypochromic anemia allowed
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rani George
Organizational Affiliation
COG Phase I Consortium
Official's Role
Principal Investigator
Facility Information:
Facility Name
Children's Oncology Group
City
Arcadia
State/Province
California
ZIP/Postal Code
91006-3776
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Decitabine, Doxorubicin, and Cyclophosphamide in Treating Children With Relapsed or Refractory Solid Tumors or Neuroblastoma

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