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Tanespimycin in Treating Young Patients With Recurrent or Refractory Leukemia or Solid Tumors

Primary Purpose

Childhood Chronic Myelogenous Leukemia, Childhood Desmoplastic Small Round Cell Tumor, Disseminated Neuroblastoma

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
tanespimycin
pharmacological study
laboratory biomarker analysis
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Childhood Chronic Myelogenous Leukemia

Eligibility Criteria

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

Inclusion Criteria: Histologically confirmed diagnosis of 1 of the following malignancies: Leukemia Lymphoid, myeloid, or mixed lineage Relapsed (in second or greater relapse) or refractory disease, confirmed by 1 of the following: Bone marrow relapse, defined as either M3 bone marrow (> 25% blasts in the bone marrow aspirate) OR M2 bone marrow (5-25% blasts in the bone marrow aspirate) at any time after complete remission is attained CNS relapse, defined as at least 5 WBC/mL by cytospin of any cerebrospinal fluid (CSF) specimen OR less than 5 WBC/mL by cytospin of 2 consecutive CSF specimens obtained >= 4 weeks apart and having definitive confirmation that blasts are derived from the original leukemic clone by molecular cytogenetics, multiparameter flow cytometry, or immunostaining of >= 2 antigens Patients with underlying chronic myeloid leukemia must have > 25% blasts in the bone marrow aspirate Patients with M3 bone marrow AND extramedullary sites of disease, other than leptomeningeal disease, are eligible Solid tumor One of the following tumor types: Neuroblastoma Ewing's sarcoma Osteosarcoma Desmoplastic small round cell tumor Rhabdomyosarcoma Progressed after prior standard therapy OR no effective standard therapy exists Measurable or nonmeasurable disease No known brain metastases No active leptomeningeal leukemia, defined by the following criteria: WBC > 5/mm^3 in cerebrospinal fluid (CSF) Unequivocal confirmation of leukemic blasts in CSF by cell morphology No symptomatic CNS disease (e.g., cranial nerve abnormalities) without cytologic abnormality in CSF Performance status - Karnofsky 70-100% (for patients > 10 years of age) Performance status - Lansky 70-100% (for patients =< 10 years of age) More than 8 weeks Absolute neutrophil count >= 750/mm^3 Platelet count >= 75,000/mm^3 (transfusion independent) Hemoglobin >= 8.5 g/dL (transfusion allowed) Bilirubin < 1.5 mg/dL ALT and AST =< 2.5 times upper limit of normal (ULN) INR =< 1.5 times ULN Albumin > 2.0 g/dL Creatinine =< 1.5 times ULN for age Creatinine clearance or radioisotope glomerular filtration rate > 60 mL/min Ejection fraction >= 50% Shortening fraction >= 28% QTc < 450 msec for men (470 msec for women) No congenital long QT syndrome LVEF > 40% by MUGA No symptomatic congestive heart failure No cardiac arrhythmia No New York Heart Association class III or IV heart failure No myocardial infarction within the past year No uncontrolled dysrhythmias No poorly controlled angina More than 12 months since active ischemic heart disease No history of serious ventricular arrhythmia (ventricular tachycardia or ventricular fibrillation >= 3 beats in a row) No left bundle branch block No other significant cardiac disease No pulmonary fibrosis by radiography No ongoing or active bacterial or fungal infection No other uncontrolled illness No psychiatric illness or social situation that would preclude study compliance No history of serious allergic reaction attributed to eggs or dimethyl sulfoxide Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception Recovered from all immunotherapy At least 6 months since prior allogeneic stem cell transplantation At least 3 months since prior autologous stem cell transplantation At least 2 weeks since prior biologic agents (e.g., monoclonal antibodies) At least 1 week since prior filgrastim (G-CSF) or sargramostim (GM-CSF) Recovered from all prior chemotherapy At least 2 weeks since prior chemotherapy (for patients with leukemia only) At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin) (for patients with solid tumors) No prior oxaliplatin No concurrent corticosteroids except for the treatment of adrenal crises in patients with suppressed hypothalamic-pituitary-adrenal axis response OR for treatment of allergic reactions to medications or blood products Recovered from all prior radiotherapy At least 6 months since prior radiotherapy to >= 50% of the pelvis At least 6 months since prior radiotherapy to substantial bone marrow, including total body irradiation At least 4 weeks since prior local (small port) radiotherapy No prior radiotherapy to the heart At least 1 week since prior retinoids No concurrent antiretroviral therapy for HIV-positive patients No concurrent medication to control arrhythmias No concurrent medications that prolong or may prolong QTc interval No other concurrent investigational agents No other concurrent anticancer therapy

Sites / Locations

  • Memorial Sloan-Kettering Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (tanespimycin)

Arm Description

Patients receive tanespimycin IV over 2-6 hours on days 1, 4, 8, and 11 (for patients with solid tumors) OR days 1, 4, 8, 11, 15, and 18 (for patients with leukemia). Courses for all patients repeat every 21 days in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of tanespimycin until the 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. At least 15 patients are treated at the MTD.

Outcomes

Primary Outcome Measures

MTD, defined as the highest dose level with an observed incidence of DLT in no more than 1 out of 6 patients treated at a particular dose level

Secondary Outcome Measures

Change in Hsp90 client protein levels in relation to dose of tanespimycin

Full Information

First Posted
October 6, 2004
Last Updated
June 3, 2013
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00093821
Brief Title
Tanespimycin in Treating Young Patients With Recurrent or Refractory Leukemia or Solid Tumors
Official Title
A Multicenter Phase I Trial of 17-N-allylamino-17-demethoxy Geldanamycin (17-AAG, NSC #330507) in Patients With Recurrent/Refractory Pediatric Solid Tumors (Ewing's Sarcoma, Desmoplastic Small Round Cell Tumor, Osteosarcoma, Neuroblastoma, and Rhabdomyosarcoma) and Leukemia
Study Type
Interventional

2. Study Status

Record Verification Date
June 2013
Overall Recruitment Status
Completed
Study Start Date
September 2004 (undefined)
Primary Completion Date
August 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 tanespimycin in treating young patients with recurrent or refractory leukemia or selected solid tumors. Drugs used in chemotherapy, such as tanespimycin, work in different ways to stop cancer cells from dividing so they stop growing or die.
Detailed Description
PRIMARY OBJECTIVES: I. Determine the dose-limiting toxicity and maximum tolerated dose (MTD) of 17-N-allylamino-17-demethoxygeldanamycin (17-AAG) in pediatric patients with recurrent or refractory leukemia or selected solid tumors. II. Determine the levels of key proteins known to influence cancer cell survival and proliferation in patients treated with this drug at the MTD. SECONDARY OBJECTIVES: I. Determine the pharmacokinetics of this drug in these patients. II. Evaluate effects of genetic polymorphisms known to alter the activity of enzymes involved in the metabolism of this drug. III. Correlate the alteration of fludeoxyglucose F18 accumulation with tumor response in patients treated with this drug. OUTLINE: This is a dose-escalation, multicenter study. Patients are stratified according to diagnosis (leukemia vs solid tumor). Patients receive tanespimycin IV over 2-6 hours on days 1, 4, 8, and 11 (for patients with solid tumors) OR days 1, 4, 8, 11, 15, and 18 (for patients with leukemia). Courses for all patients repeat every 21 days in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of tanespimycin 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. At least 15 patients are treated at the MTD. Patients are followed for 30 days.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Childhood Chronic Myelogenous Leukemia, Childhood Desmoplastic Small Round Cell Tumor, Disseminated Neuroblastoma, Metastatic Childhood Soft Tissue Sarcoma, Metastatic Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor, Metastatic Osteosarcoma, Previously Treated Childhood Rhabdomyosarcoma, Recurrent Childhood Acute Lymphoblastic Leukemia, Recurrent Childhood Acute Myeloid Leukemia, Recurrent Childhood Rhabdomyosarcoma, Recurrent Childhood Soft Tissue Sarcoma, Recurrent Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor, Recurrent Neuroblastoma, Recurrent Osteosarcoma

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Treatment (tanespimycin)
Arm Type
Experimental
Arm Description
Patients receive tanespimycin IV over 2-6 hours on days 1, 4, 8, and 11 (for patients with solid tumors) OR days 1, 4, 8, 11, 15, and 18 (for patients with leukemia). Courses for all patients repeat every 21 days in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of tanespimycin until the 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. At least 15 patients are treated at the MTD.
Intervention Type
Drug
Intervention Name(s)
tanespimycin
Other Intervention Name(s)
17-AAG
Intervention Description
Given IV
Intervention Type
Other
Intervention Name(s)
pharmacological study
Other Intervention Name(s)
pharmacological studies
Intervention Description
Correlative studies
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Intervention Description
Correlative studies
Primary Outcome Measure Information:
Title
MTD, defined as the highest dose level with an observed incidence of DLT in no more than 1 out of 6 patients treated at a particular dose level
Time Frame
21 days
Secondary Outcome Measure Information:
Title
Change in Hsp90 client protein levels in relation to dose of tanespimycin
Time Frame
Baseline to 21 days

10. Eligibility

Sex
All
Maximum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically confirmed diagnosis of 1 of the following malignancies: Leukemia Lymphoid, myeloid, or mixed lineage Relapsed (in second or greater relapse) or refractory disease, confirmed by 1 of the following: Bone marrow relapse, defined as either M3 bone marrow (> 25% blasts in the bone marrow aspirate) OR M2 bone marrow (5-25% blasts in the bone marrow aspirate) at any time after complete remission is attained CNS relapse, defined as at least 5 WBC/mL by cytospin of any cerebrospinal fluid (CSF) specimen OR less than 5 WBC/mL by cytospin of 2 consecutive CSF specimens obtained >= 4 weeks apart and having definitive confirmation that blasts are derived from the original leukemic clone by molecular cytogenetics, multiparameter flow cytometry, or immunostaining of >= 2 antigens Patients with underlying chronic myeloid leukemia must have > 25% blasts in the bone marrow aspirate Patients with M3 bone marrow AND extramedullary sites of disease, other than leptomeningeal disease, are eligible Solid tumor One of the following tumor types: Neuroblastoma Ewing's sarcoma Osteosarcoma Desmoplastic small round cell tumor Rhabdomyosarcoma Progressed after prior standard therapy OR no effective standard therapy exists Measurable or nonmeasurable disease No known brain metastases No active leptomeningeal leukemia, defined by the following criteria: WBC > 5/mm^3 in cerebrospinal fluid (CSF) Unequivocal confirmation of leukemic blasts in CSF by cell morphology No symptomatic CNS disease (e.g., cranial nerve abnormalities) without cytologic abnormality in CSF Performance status - Karnofsky 70-100% (for patients > 10 years of age) Performance status - Lansky 70-100% (for patients =< 10 years of age) More than 8 weeks Absolute neutrophil count >= 750/mm^3 Platelet count >= 75,000/mm^3 (transfusion independent) Hemoglobin >= 8.5 g/dL (transfusion allowed) Bilirubin < 1.5 mg/dL ALT and AST =< 2.5 times upper limit of normal (ULN) INR =< 1.5 times ULN Albumin > 2.0 g/dL Creatinine =< 1.5 times ULN for age Creatinine clearance or radioisotope glomerular filtration rate > 60 mL/min Ejection fraction >= 50% Shortening fraction >= 28% QTc < 450 msec for men (470 msec for women) No congenital long QT syndrome LVEF > 40% by MUGA No symptomatic congestive heart failure No cardiac arrhythmia No New York Heart Association class III or IV heart failure No myocardial infarction within the past year No uncontrolled dysrhythmias No poorly controlled angina More than 12 months since active ischemic heart disease No history of serious ventricular arrhythmia (ventricular tachycardia or ventricular fibrillation >= 3 beats in a row) No left bundle branch block No other significant cardiac disease No pulmonary fibrosis by radiography No ongoing or active bacterial or fungal infection No other uncontrolled illness No psychiatric illness or social situation that would preclude study compliance No history of serious allergic reaction attributed to eggs or dimethyl sulfoxide Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception Recovered from all immunotherapy At least 6 months since prior allogeneic stem cell transplantation At least 3 months since prior autologous stem cell transplantation At least 2 weeks since prior biologic agents (e.g., monoclonal antibodies) At least 1 week since prior filgrastim (G-CSF) or sargramostim (GM-CSF) Recovered from all prior chemotherapy At least 2 weeks since prior chemotherapy (for patients with leukemia only) At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin) (for patients with solid tumors) No prior oxaliplatin No concurrent corticosteroids except for the treatment of adrenal crises in patients with suppressed hypothalamic-pituitary-adrenal axis response OR for treatment of allergic reactions to medications or blood products Recovered from all prior radiotherapy At least 6 months since prior radiotherapy to >= 50% of the pelvis At least 6 months since prior radiotherapy to substantial bone marrow, including total body irradiation At least 4 weeks since prior local (small port) radiotherapy No prior radiotherapy to the heart At least 1 week since prior retinoids No concurrent antiretroviral therapy for HIV-positive patients No concurrent medication to control arrhythmias No concurrent medications that prolong or may prolong QTc interval No other concurrent investigational agents No other concurrent anticancer therapy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Tanya Trippett
Organizational Affiliation
Memorial Sloan Kettering Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Memorial Sloan-Kettering Cancer Center
City
New York
State/Province
New York
ZIP/Postal Code
10065
Country
United States

12. IPD Sharing Statement

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Tanespimycin in Treating Young Patients With Recurrent or Refractory Leukemia or Solid Tumors

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