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Thalidomide and Temozolomide in Relapsed or Progressive CNS Disease or Neuroblastoma

Primary Purpose

Central Nervous System Tumor, Pediatric, Neuroblastoma

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
temozolomide
thalidomide
Sponsored by
Dana-Farber Cancer Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Central Nervous System Tumor, Pediatric

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Histologically confirmed* diagnosis of 1 of the following: Poor prognosis brain tumor Relapsed or progressive disease No curative therapy exists Neuroblastoma Recurrent disease NOTE: *Histologic confirmation not required for brain stem glioma; patients with brain stem glioma must have clinical and radiographic evidence of disease Patients with brain stem glioma must have symptoms lasting < 3 months comprising cranial nerve deficits (often VI or VII) and/or ataxia and/or long tract signs PATIENT CHARACTERISTICS: Age 21 and under Performance status Karnofsky 50-100% OR Lansky 50-100% Life expectancy More than 2 months Hematopoietic Hemoglobin ≥ 9.0 g/dL Platelet count > 75,000/mm^3 WBC > 2,000/mm^3 Absolute neutrophil count > 1,000/mm^3 Hepatic Bilirubin ≤ 1.5 mg/dL SGOT and SGPT ≤ 2 times normal (SGOT ≤ 4 times normal for patients taking Zantac) Alkaline phosphatase ≤ 2 times normal No active hepatic disease ≥ grade 3 Renal Creatinine < 1.5 mg/dL OR Creatinine clearance ≥ 70 mL/min No active renal disease ≥ grade 3 Cardiovascular No active cardiac disease ≥ grade 3 Pulmonary No active pulmonary disease ≥ grade 3 Other Not pregnant or nursing Fertile patients must use effective contraception during and for 4 weeks after study participation Willing and able to participate in the System for Thalidomide Education and Prescription Safety (S.T.E.P.S.^®) program No active psychiatric disease ≥ grade 3 PRIOR CONCURRENT THERAPY: Biologic therapy Prior biologic therapy allowed No prior thalidomide Chemotherapy Prior chemotherapy allowed No prior temozolomide Endocrine therapy Concurrent steroids allowed Radiotherapy Prior radiotherapy allowed Surgery Prior surgery allowed Other Concurrent antiseizure medications allowed No other concurrent investigational agents

Sites / Locations

  • Dana Farber Cancer Institute

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Thalidomide and Temozolomide

Arm Description

Thalidomide: Oral thalidomide on days 1-28 of a 28 day cycle initiated at 3 mg/kg and increased to maximum dose of 24 mg/kg or 1000 mg as tolerated. Temozolomide: Oral temozolomide on days 1-5 of 28 day cycle given at 200 mg/m2 or 150 mg/m2 for patients who had previously received significant therapy to the bone marrow (chemotherapy or radiation) or cranial spinal radiation. Patients were treated for 6 cycles unless disease progression or excessive toxicity. Treatment could continue beyond 6 cycles if absent disease progression

Outcomes

Primary Outcome Measures

Therapy Completion Rate
Feasibility in this study was defined as completion of 6 months of thalidomide with temozolomide therapy. The corresponding therapy completion rate is defined as the proportion of patients who completed 6 months of therapy.

Secondary Outcome Measures

Overall Response
Overall response is the best response during 6 months of therapy measured by radiographic response. Complete Response (CR): Disappearance of all detectable tumors by imaging, if initially positive, as well as 2 consecutively negative CSF cytologic examinations (if the initial cytology was positive). Partial Response (PR): > 50% reduction in the sum of the products of the maximum perpendicular diameter of all measurable lesions; or 2 consecutively negative CSF cytologies and a < 50% reduction in tumor size. Stable Disease (SD): < 50% reduction in the sum of the products of the maximum perpendicular diameters of all measurable lesions, and persistently negative or positive CSF cytology Progressive Disease (PD): > 25% increase in the size of any measurable lesion, the appearance of a new radiographically demonstrable lesion, or the conversion of negative CSF cytology to positive, as confirmed by at least one repeat CSF cytology
Overall Survival
Time from registration to death. Patients alive at last follow-up were censored.

Full Information

First Posted
December 8, 2004
Last Updated
September 28, 2014
Sponsor
Dana-Farber Cancer Institute
Collaborators
National Cancer Institute (NCI), Boston Children's Hospital, Celgene Corporation
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1. Study Identification

Unique Protocol Identification Number
NCT00098865
Brief Title
Thalidomide and Temozolomide in Relapsed or Progressive CNS Disease or Neuroblastoma
Official Title
A Phase II Pilot Study Of Thalidomide With Temozolomide In Patients With Relapsed Or Progressive Brain Tumors Or Neuroblastoma
Study Type
Interventional

2. Study Status

Record Verification Date
September 2014
Overall Recruitment Status
Completed
Study Start Date
September 2002 (undefined)
Primary Completion Date
June 2010 (Actual)
Study Completion Date
June 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Dana-Farber Cancer Institute
Collaborators
National Cancer Institute (NCI), Boston Children's Hospital, Celgene Corporation

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Thalidomide may stop the growth of tumor cells by stopping blood flow to the tumor. Drugs used in chemotherapy, such as temozolomide, work in different ways to stop tumor cells from dividing so they stop growing or die. Combining thalidomide with temozolomide may kill more tumor cells. PURPOSE: This phase II trial is studying the effectiveness of combining thalidomide with temozolomide in treating young patients who have relapsed or progressive brain tumors or recurrent neuroblastoma.
Detailed Description
OBJECTIVES: Primary Determine the feasibility of thalidomide and temozolomide in pediatric patients with relapsed or progressive poor prognosis brain tumors or recurrent neuroblastomas. Secondary Determine preliminarily evidence of biologic activity of this regimen in these patients. Determine the toxic effects of this regimen in these patients. STATISTICAL DESIGN: The primary data analysis will estimate the percentage of patients who can complete 6 months of therapy in the mixed population. With a target accrual of 20 patients the 90% confidence for the true feasibility rate will be no wider than 40%.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Central Nervous System Tumor, Pediatric, Neuroblastoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
15 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Thalidomide and Temozolomide
Arm Type
Experimental
Arm Description
Thalidomide: Oral thalidomide on days 1-28 of a 28 day cycle initiated at 3 mg/kg and increased to maximum dose of 24 mg/kg or 1000 mg as tolerated. Temozolomide: Oral temozolomide on days 1-5 of 28 day cycle given at 200 mg/m2 or 150 mg/m2 for patients who had previously received significant therapy to the bone marrow (chemotherapy or radiation) or cranial spinal radiation. Patients were treated for 6 cycles unless disease progression or excessive toxicity. Treatment could continue beyond 6 cycles if absent disease progression
Intervention Type
Drug
Intervention Name(s)
temozolomide
Other Intervention Name(s)
Temodar
Intervention Description
The lower 150/m2 Temozolomide dose was for patients who had previously received significant therapy to the bone marrow (chemotherapy or radiation) or cranial spinal raditation.
Intervention Type
Drug
Intervention Name(s)
thalidomide
Other Intervention Name(s)
Thalamid
Intervention Description
Calculated dose was rounded down to the nearest 50mg, or up to 50mg if calculated dose was less than 50mg. Patients increased the daily dose by 50mg (one capsule) on a weekly basis unitl either unacceptable toxicity or a maximum dose.
Primary Outcome Measure Information:
Title
Therapy Completion Rate
Description
Feasibility in this study was defined as completion of 6 months of thalidomide with temozolomide therapy. The corresponding therapy completion rate is defined as the proportion of patients who completed 6 months of therapy.
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Overall Response
Description
Overall response is the best response during 6 months of therapy measured by radiographic response. Complete Response (CR): Disappearance of all detectable tumors by imaging, if initially positive, as well as 2 consecutively negative CSF cytologic examinations (if the initial cytology was positive). Partial Response (PR): > 50% reduction in the sum of the products of the maximum perpendicular diameter of all measurable lesions; or 2 consecutively negative CSF cytologies and a < 50% reduction in tumor size. Stable Disease (SD): < 50% reduction in the sum of the products of the maximum perpendicular diameters of all measurable lesions, and persistently negative or positive CSF cytology Progressive Disease (PD): > 25% increase in the size of any measurable lesion, the appearance of a new radiographically demonstrable lesion, or the conversion of negative CSF cytology to positive, as confirmed by at least one repeat CSF cytology
Time Frame
Assessed every 8 weeks while on treatment and every 3 months for one year off-study
Title
Overall Survival
Description
Time from registration to death. Patients alive at last follow-up were censored.
Time Frame
Assessed after treatment discontinued every 3 months up to 2 years.

10. Eligibility

Sex
All
Maximum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed* diagnosis of 1 of the following: Poor prognosis brain tumor Relapsed or progressive disease No curative therapy exists Neuroblastoma Recurrent disease NOTE: *Histologic confirmation not required for brain stem glioma; patients with brain stem glioma must have clinical and radiographic evidence of disease Patients with brain stem glioma must have symptoms lasting < 3 months comprising cranial nerve deficits (often VI or VII) and/or ataxia and/or long tract signs PATIENT CHARACTERISTICS: Age 21 and under Performance status Karnofsky 50-100% OR Lansky 50-100% Life expectancy More than 2 months Hematopoietic Hemoglobin ≥ 9.0 g/dL Platelet count > 75,000/mm^3 WBC > 2,000/mm^3 Absolute neutrophil count > 1,000/mm^3 Hepatic Bilirubin ≤ 1.5 mg/dL SGOT and SGPT ≤ 2 times normal (SGOT ≤ 4 times normal for patients taking Zantac) Alkaline phosphatase ≤ 2 times normal No active hepatic disease ≥ grade 3 Renal Creatinine < 1.5 mg/dL OR Creatinine clearance ≥ 70 mL/min No active renal disease ≥ grade 3 Cardiovascular No active cardiac disease ≥ grade 3 Pulmonary No active pulmonary disease ≥ grade 3 Other Not pregnant or nursing Fertile patients must use effective contraception during and for 4 weeks after study participation Willing and able to participate in the System for Thalidomide Education and Prescription Safety (S.T.E.P.S.^®) program No active psychiatric disease ≥ grade 3 PRIOR CONCURRENT THERAPY: Biologic therapy Prior biologic therapy allowed No prior thalidomide Chemotherapy Prior chemotherapy allowed No prior temozolomide Endocrine therapy Concurrent steroids allowed Radiotherapy Prior radiotherapy allowed Surgery Prior surgery allowed Other Concurrent antiseizure medications allowed No other concurrent investigational agents
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mark W. Kieran, MD, PhD
Organizational Affiliation
Dana-Farber Cancer Institute
Official's Role
Study Chair
Facility Information:
Facility Name
Dana Farber Cancer Institute
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States

12. IPD Sharing Statement

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Thalidomide and Temozolomide in Relapsed or Progressive CNS Disease or Neuroblastoma

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