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Lenalidomide in Treating Young Patients With Relapsed or Refractory Solid Tumors or Myelodysplastic Syndromes

Primary Purpose

Childhood Myelodysplastic Syndromes, de Novo Myelodysplastic Syndromes, Previously Treated Myelodysplastic Syndromes

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
lenalidomide
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Childhood Myelodysplastic Syndromes

Eligibility Criteria

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

Inclusion Criteria: Diagnosis of 1 of the following: Histologically confirmed solid tumor No brain tumors Myelodysplastic syndromes (MDS) No refractory anemia with excess blasts in transformation or other forms of acute myeloid leukemia (AML) No FAB diagnosis of refractory anemia with excess blasts in transition and other forms of AML Newly diagnosed MDS with chromosome 5q abnormalities Relapsed or refractory disease including relapse after stem cell transplantation Measurable or evaluable disease (solid tumor patients only) No known curative or life-prolonging therapy exists No bone marrow involvement by tumor (solid tumor patients only) No CNS tumors Performance status - Karnofsky 50-100% (for patients > 10 years of age) Performance status - Lansky 50-100% (for patients ≤ 10 years of age) Absolute neutrophil count ≥ 1,000/mm^3 (for patients with solid tumors) Platelet count ≥ 100,000/mm^3 (30,000 for patients with MDS) Only patients with MDS may receive transfusions to support platelet counts Hemoglobin ≥ 8.0 g/dL (transfusions allowed) Bilirubin ≤ 1.5 times upper limit of normal (ULN) ALT ≤ 110* Albumin ≥ 2 g/dL Creatinine clearance OR radioisotope glomerular filtration rate ≥ 70 mL/min Creatinine based on age as follows: Creatinine ≤ 0.8 mg/dL (for patients ≤ 5 years of age) Creatinine ≤ 1 mg/dL (for patients 6 to 10 years of age) Creatinine ≤ 1.2 mg/dL (for patients 11 to 15 years of age) Creatinine ≤ 1.5 mg/dL (for patients over 15 years of age) No parent or sibling with a known history of venous thrombosis before the age of 50 OR arterial thrombosis before the age of 40 No thromboembolic event except catheter-related thrombosis Not pregnant or nursing Negative pregnancy test Fertile patients must use effective double-method contraception 4 weeks before, during, and for ≥ 4 weeks after completion of study treatment Body surface area ≥ 0.4m^2 No uncontrolled infection No active graft-vs-host disease from prior stem cell transplant or rescue Recovered from prior immunotherapy At least 1 week since prior biologic agents At least 1 week since prior hematologic growth factors (2 weeks for pegfilgrastim) At least 3 months since prior stem cell transplant or rescue (without total body irradiation [TBI]) Prior thalidomide allowed No other concurrent immunotherapy No other concurrent biologic therapy More than 3 weeks since prior myelosuppressive chemotherapy (6 weeks for nitrosoureas) and recovered No concurrent chemotherapy Concurrent dexamethasone allowed provided the dose has been either decreasing or stable for the past 7 days See Biologic therapy Recovered from prior radiotherapy At least 2 weeks since prior local palliative (small port) radiotherapy At least 6 months since prior TBI, craniospinal radiotherapy, or radiotherapy to ≥ 50% of the pelvis At least 6 weeks since other prior substantial bone marrow radiotherapy No concurrent radiotherapy No other concurrent investigational drugs or agents No other concurrent anticancer agents

Sites / Locations

  • COG Phase I Consortium

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (lenalidomide)

Arm Description

Patients receive oral lenalidomide once daily on days 1-21. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Maximum tolerated dose of lenolidomide defined as the maximum dose at which fewer than one-third of patients experience DLT
Graded using the CTCAE version 3.0.

Secondary Outcome Measures

Overall response assessed using RECIST criteria
A patient will be considered to have responded if she or he demonstrates either a bone marrow or cytogenetic response. Each patient will be classified according to the maximum response of the two criteria, where the classification from maximum to minimum will be: CR, PR or nonresponse.
Adverse events defined using the NCI CTCAE version 3.0

Full Information

First Posted
March 3, 2005
Last Updated
June 10, 2014
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00104962
Brief Title
Lenalidomide in Treating Young Patients With Relapsed or Refractory Solid Tumors or Myelodysplastic Syndromes
Official Title
Phase I Study of CC-5013 (Lenalidomide NSC# 703813) in Pediatric Patients With Relapsed/Refractory Solid Tumors or Myelodysplastic Syndrome
Study Type
Interventional

2. Study Status

Record Verification Date
December 2012
Overall Recruitment Status
Completed
Study Start Date
March 2005 (undefined)
Primary Completion Date
June 2009 (Actual)
Study Completion Date
June 2009 (Actual)

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 lenalidomide in treating young patients with relapsed or refractory solid tumors or myelodysplastic syndromes. Lenalidomide may stop the growth of solid tumors or myelodysplastic syndromes by blocking blood flow to the cancer. It may also stimulate the immune system in different ways and stop cancer cells from growing.
Detailed Description
PRIMARY OBJECTIVES: I. Determine the maximum tolerated dose and recommended phase II dose of lenalidomide in pediatric patients with relapsed or refractory solid tumors. II. Determine the toxic effects of this drug in these patients. III. Determine the pharmacokinetics of this drug in these patients. SECONDARY OBJECTIVES: I. Determine, preliminarily, the feasibility of administering this drug to pediatric patients with relapsed or refractory myelodysplastic syndromes. II. Determine, preliminarily, the antitumor activity of this drug in both patient populations. III. Determine immunologic changes in patients treated with this drug. OUTLINE: This is a dose-escalation, multicenter study. Patients are stratified according to diagnosis (solid tumor vs myelodysplastic syndromes [MDS]). Patients receive oral lenalidomide once daily on days 1-21. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients with solid tumors receive escalating doses of lenalidomide until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 6 patients experience dose-limiting toxicity. Patients with MDS receive a fixed dose (do not undergo dose escalation) of lenalidomide. After completion of study treatment, patients are followed annually. PROJECTED ACCRUAL: A total of 24 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
Childhood Myelodysplastic Syndromes, de Novo Myelodysplastic Syndromes, Previously Treated Myelodysplastic Syndromes, Refractory Anemia, Refractory Anemia With Excess Blasts, Refractory Anemia With Ringed Sideroblasts, Refractory Cytopenia With Multilineage Dysplasia, Secondary Myelodysplastic Syndromes, 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
24 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment (lenalidomide)
Arm Type
Experimental
Arm Description
Patients receive oral lenalidomide once daily on days 1-21. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.
Intervention Type
Drug
Intervention Name(s)
lenalidomide
Other Intervention Name(s)
CC-5013, IMiD-1, Revlimid
Intervention Description
Given orally
Primary Outcome Measure Information:
Title
Maximum tolerated dose of lenolidomide defined as the maximum dose at which fewer than one-third of patients experience DLT
Description
Graded using the CTCAE version 3.0.
Time Frame
28 days
Secondary Outcome Measure Information:
Title
Overall response assessed using RECIST criteria
Description
A patient will be considered to have responded if she or he demonstrates either a bone marrow or cytogenetic response. Each patient will be classified according to the maximum response of the two criteria, where the classification from maximum to minimum will be: CR, PR or nonresponse.
Time Frame
Up to 30 days after completion of study treatment
Title
Adverse events defined using the NCI CTCAE version 3.0
Time Frame
Up to 30 days after completion of study treatment

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: Diagnosis of 1 of the following: Histologically confirmed solid tumor No brain tumors Myelodysplastic syndromes (MDS) No refractory anemia with excess blasts in transformation or other forms of acute myeloid leukemia (AML) No FAB diagnosis of refractory anemia with excess blasts in transition and other forms of AML Newly diagnosed MDS with chromosome 5q abnormalities Relapsed or refractory disease including relapse after stem cell transplantation Measurable or evaluable disease (solid tumor patients only) No known curative or life-prolonging therapy exists No bone marrow involvement by tumor (solid tumor patients only) No CNS tumors Performance status - Karnofsky 50-100% (for patients > 10 years of age) Performance status - Lansky 50-100% (for patients ≤ 10 years of age) Absolute neutrophil count ≥ 1,000/mm^3 (for patients with solid tumors) Platelet count ≥ 100,000/mm^3 (30,000 for patients with MDS) Only patients with MDS may receive transfusions to support platelet counts Hemoglobin ≥ 8.0 g/dL (transfusions allowed) Bilirubin ≤ 1.5 times upper limit of normal (ULN) ALT ≤ 110* Albumin ≥ 2 g/dL Creatinine clearance OR radioisotope glomerular filtration rate ≥ 70 mL/min Creatinine based on age as follows: Creatinine ≤ 0.8 mg/dL (for patients ≤ 5 years of age) Creatinine ≤ 1 mg/dL (for patients 6 to 10 years of age) Creatinine ≤ 1.2 mg/dL (for patients 11 to 15 years of age) Creatinine ≤ 1.5 mg/dL (for patients over 15 years of age) No parent or sibling with a known history of venous thrombosis before the age of 50 OR arterial thrombosis before the age of 40 No thromboembolic event except catheter-related thrombosis Not pregnant or nursing Negative pregnancy test Fertile patients must use effective double-method contraception 4 weeks before, during, and for ≥ 4 weeks after completion of study treatment Body surface area ≥ 0.4m^2 No uncontrolled infection No active graft-vs-host disease from prior stem cell transplant or rescue Recovered from prior immunotherapy At least 1 week since prior biologic agents At least 1 week since prior hematologic growth factors (2 weeks for pegfilgrastim) At least 3 months since prior stem cell transplant or rescue (without total body irradiation [TBI]) Prior thalidomide allowed No other concurrent immunotherapy No other concurrent biologic therapy More than 3 weeks since prior myelosuppressive chemotherapy (6 weeks for nitrosoureas) and recovered No concurrent chemotherapy Concurrent dexamethasone allowed provided the dose has been either decreasing or stable for the past 7 days See Biologic therapy Recovered from prior radiotherapy At least 2 weeks since prior local palliative (small port) radiotherapy At least 6 months since prior TBI, craniospinal radiotherapy, or radiotherapy to ≥ 50% of the pelvis At least 6 weeks since other prior substantial bone marrow radiotherapy No concurrent radiotherapy No other concurrent investigational drugs or agents No other concurrent anticancer agents
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Stacey Berg
Organizational Affiliation
COG Phase I Consortium
Official's Role
Principal Investigator
Facility Information:
Facility Name
COG Phase I Consortium
City
Arcadia
State/Province
California
ZIP/Postal Code
91006-3776
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
21149673
Citation
Berg SL, Cairo MS, Russell H, Ayello J, Ingle AM, Lau H, Chen N, Adamson PC, Blaney SM. Safety, pharmacokinetics, and immunomodulatory effects of lenalidomide in children and adolescents with relapsed/refractory solid tumors or myelodysplastic syndrome: a Children's Oncology Group Phase I Consortium report. J Clin Oncol. 2011 Jan 20;29(3):316-23. doi: 10.1200/JCO.2010.30.8387. Epub 2010 Dec 13.
Results Reference
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Lenalidomide in Treating Young Patients With Relapsed or Refractory Solid Tumors or Myelodysplastic Syndromes

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