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Valproic Acid in Treating Young Patients With Recurrent or Refractory Solid Tumors or CNS Tumors

Primary Purpose

Brain and Central Nervous System Tumors, Unspecified Childhood Solid Tumor, Protocol Specific

Status
Completed
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
valproic acid
Sponsored by
Children's Oncology Group
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Brain and Central Nervous System Tumors focused on measuring recurrent childhood brain stem glioma, recurrent childhood brain tumor, recurrent childhood cerebellar astrocytoma, recurrent childhood cerebral astrocytoma, recurrent childhood ependymoma, recurrent childhood medulloblastoma, recurrent childhood supratentorial primitive neuroectodermal tumor, unspecified childhood solid tumor, protocol specific, recurrent childhood visual pathway and hypothalamic glioma, childhood high-grade cerebral astrocytoma, childhood low-grade cerebral astrocytoma, childhood infratentorial ependymoma, childhood supratentorial ependymoma, childhood spinal cord neoplasm, childhood grade I meningioma, childhood grade II meningioma, childhood grade III meningioma, childhood craniopharyngioma, childhood central nervous system germ cell tumor

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Histologically confirmed* malignant solid tumor, including CNS tumors, at original diagnosis or relapse Recurrent or refractory disease NOTE: *Histologic confirmation not required for intrinsic brain stem or optic pathway tumors Measurable or evaluable disease, defined by 1 of the following criteria: Any unidimensionally measurable lesion ≥ 10 mm by standard MRI or CT scan for either solid or CNS tumors At least 1 nonmeasurable lesion that is evaluable by nuclear medicine, immunocytochemistry, tumor markers, cerebrospinal fluid cytology, or other reliable measures No known curative therapy exists No documented tumor involvement in the bone marrow PATIENT CHARACTERISTICS: Age 2 to 21 Performance status* Lansky 50-100% (for patients ≤ 10 years of age) Karnofsky 50-100% (for patients > 10 years of age) Life expectancy Not specified Hematopoietic Absolute neutrophil count ≥ 1,000/mm^3 Platelet count ≥ 100,000/mm^3 (transfusion independent) Hemoglobin ≥ 8.0 g/dL (transfusions allowed) Hepatic Bilirubin ≤ 1.5 times upper limit of normal (ULN) ALT ≤ 110 (ULN for this study is 45 U/L) Albumin ≥ 2 g/dL Renal Creatinine clearance or radioisotope glomerular filtration rate ≥ 70 mL/min OR Creatinine based on age as follows: No greater than 0.8 mg/dL (for patients ≤ 5 years of age) No greater than 1.0 mg/dL (for patients 6 to 10 years of age) No greater than 1.2 mg/dL (for patients 11 to 15 years of age) No greater than 1.5 mg/dL (for patients over 15 years of age) Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception Neurologic deficits in patients with CNS tumors must be stable for ≥ 1 week before study entry No uncontrolled infection No known urea cycle disorders or other metabolic disorders No other condition that would preclude study compliance PRIOR CONCURRENT THERAPY: Biologic therapy Recovered from prior immunotherapy At least 7 days since prior hematopoietic growth factors that support platelet or WBC number or function At least 7 days since prior antineoplastic biologic agents At least 3 months since prior stem cell transplantation or rescue without total body irradiation No evidence of active graft vs host disease No other concurrent anticancer biologic therapy or immunotherapy Chemotherapy More than 3 weeks since prior myelosuppressive chemotherapy (6 weeks for nitrosoureas) and recovered No other concurrent anticancer chemotherapy Endocrine therapy Patients with CNS tumors must be on a stable or decreasing dose of dexamethasone for the past 7 days Radiotherapy See Biologic therapy Recovered from prior radiotherapy At least 6 months since prior total body irradiation, craniospinal radiotherapy, or radiotherapy to ≥ 50% of the pelvis At least 6 weeks since other prior substantial bone marrow radiotherapy At least 2 weeks since prior local palliative small port radiotherapy No concurrent anticancer radiotherapy Surgery Not specified Other No other concurrent investigational agents No other concurrent anticancer agents No other concurrent anticonvulsants Patients receiving valproic acid (VPA) before study entry must have a total trough VPA concentration < 100 mcg/mL within the past 7 days

Sites / Locations

  • Children's Hospital of Orange County
  • Stanford Comprehensive Cancer Center - Stanford
  • Children's National Medical Center
  • Children's Memorial Hospital - Chicago
  • Indiana University Melvin and Bren Simon Cancer Center
  • Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute
  • University of Minnesota Children's Hospital - Fairview
  • Mayo Clinic Cancer Center
  • Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center
  • SUNY Upstate Medical University Hospital
  • Cincinnati Children's Hospital Medical Center
  • Oregon Health & Science University Cancer Institute
  • Children's Hospital of Philadelphia
  • Baylor University Medical Center - Houston
  • Children's Hospital and Regional Medical Center - Seattle
  • Hospital for Sick Children
  • Hopital Sainte Justine

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Treatment 1

Treatment 10

Treatment 20

Arm Description

VPA Target Trough Concentration 75-100 mcg/mL, week 1 VPA dose: 15 mg/kg/day, divided tid

VPA Target Trough Concentration 100-150 mcg/mL, week 1 VPA dose: 15 mg/kg/day, divided tid

VPA Target Trough Concentration 150-200 mcg/mL

Outcomes

Primary Outcome Measures

Efficacy of oral etoposide at 50 mg/m2/day given concurrently with radiotherapy

Secondary Outcome Measures

Full Information

First Posted
April 5, 2005
Last Updated
August 6, 2014
Sponsor
Children's Oncology Group
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00107458
Brief Title
Valproic Acid in Treating Young Patients With Recurrent or Refractory Solid Tumors or CNS Tumors
Official Title
A Phase I Study of Valproic Acid in Children With Recurrent/Progressive Solid Tumors Including CNS Tumors
Study Type
Interventional

2. Study Status

Record Verification Date
August 2014
Overall Recruitment Status
Completed
Study Start Date
May 2005 (undefined)
Primary Completion Date
October 2007 (Actual)
Study Completion Date
March 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Children's Oncology Group
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Drugs used in chemotherapy, such as valproic acid, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Valproic acid may also stop the growth of solid tumors or CNS tumors by blocking blood flow to the tumor. PURPOSE: This phase I trial is studying the side effects and best dose of valproic acid in treating patients with recurrent or refractory solid tumors or CNS tumors.
Detailed Description
OBJECTIVES: Primary Determine the toxic effects of valproic acid (VPA) administered at doses required to maintain serum trough VPA concentrations of 100-150 mcg/mL or 150-200 mcg/mL in young patients with recurrent or refractory solid tumors or CNS tumors. Secondary Determine the steady-state serum trough concentration of free and total VPA at the targeted total trough VPA concentration in these patients. Determine the steady state histone acetylation status of peripheral blood monocytes at the targeted trough VPA concentration in these patients. Determine the pharmacokinetic profile of this drug in these patients. Correlate histone acetylation with free or total trough VPA concentration in these patients. Determine, preliminarily, the antitumor activity of this drug in these patients. OUTLINE: This is a dose-escalation, multicenter study. For course 1, patients receive escalating doses of oral valproic acid (VPA) twice daily until a target serum trough VPA concentration range is maintained for 28 days. Patients who achieve the target serum trough VPA concentration range receive subsequent courses of oral VPA twice daily (at the dose found to maintain the target serum trough VPA concentration range) on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. The first cohort of 6 patients receives VPA to achieve an initial target trough serum VPA concentration. If fewer than 2 of 6 patients in the first cohort experience dose-limiting toxicity (DLT), then a second cohort of 6 patients receives VPA to achieve the next higher target trough serum VPA concentration. If fewer than 2 patients from the second cohort experience DTL, then 6 additional patients are enrolled in this cohort to better define pharmacokinetics and DLT at this VPA concentration range. After completion of study treatment, patients are followed annually. PROJECTED ACCRUAL: A total of 12-18 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
Brain and Central Nervous System Tumors, Unspecified Childhood Solid Tumor, Protocol Specific
Keywords
recurrent childhood brain stem glioma, recurrent childhood brain tumor, recurrent childhood cerebellar astrocytoma, recurrent childhood cerebral astrocytoma, recurrent childhood ependymoma, recurrent childhood medulloblastoma, recurrent childhood supratentorial primitive neuroectodermal tumor, unspecified childhood solid tumor, protocol specific, recurrent childhood visual pathway and hypothalamic glioma, childhood high-grade cerebral astrocytoma, childhood low-grade cerebral astrocytoma, childhood infratentorial ependymoma, childhood supratentorial ependymoma, childhood spinal cord neoplasm, childhood grade I meningioma, childhood grade II meningioma, childhood grade III meningioma, childhood craniopharyngioma, childhood central nervous system germ cell tumor

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
Participant
Allocation
Randomized
Enrollment
26 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment 1
Arm Type
Experimental
Arm Description
VPA Target Trough Concentration 75-100 mcg/mL, week 1 VPA dose: 15 mg/kg/day, divided tid
Arm Title
Treatment 10
Arm Type
Experimental
Arm Description
VPA Target Trough Concentration 100-150 mcg/mL, week 1 VPA dose: 15 mg/kg/day, divided tid
Arm Title
Treatment 20
Arm Type
Experimental
Arm Description
VPA Target Trough Concentration 150-200 mcg/mL
Intervention Type
Drug
Intervention Name(s)
valproic acid
Primary Outcome Measure Information:
Title
Efficacy of oral etoposide at 50 mg/m2/day given concurrently with radiotherapy

10. Eligibility

Sex
All
Minimum Age & Unit of Time
2 Years
Maximum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed* malignant solid tumor, including CNS tumors, at original diagnosis or relapse Recurrent or refractory disease NOTE: *Histologic confirmation not required for intrinsic brain stem or optic pathway tumors Measurable or evaluable disease, defined by 1 of the following criteria: Any unidimensionally measurable lesion ≥ 10 mm by standard MRI or CT scan for either solid or CNS tumors At least 1 nonmeasurable lesion that is evaluable by nuclear medicine, immunocytochemistry, tumor markers, cerebrospinal fluid cytology, or other reliable measures No known curative therapy exists No documented tumor involvement in the bone marrow PATIENT CHARACTERISTICS: Age 2 to 21 Performance status* Lansky 50-100% (for patients ≤ 10 years of age) Karnofsky 50-100% (for patients > 10 years of age) Life expectancy Not specified Hematopoietic Absolute neutrophil count ≥ 1,000/mm^3 Platelet count ≥ 100,000/mm^3 (transfusion independent) Hemoglobin ≥ 8.0 g/dL (transfusions allowed) Hepatic Bilirubin ≤ 1.5 times upper limit of normal (ULN) ALT ≤ 110 (ULN for this study is 45 U/L) Albumin ≥ 2 g/dL Renal Creatinine clearance or radioisotope glomerular filtration rate ≥ 70 mL/min OR Creatinine based on age as follows: No greater than 0.8 mg/dL (for patients ≤ 5 years of age) No greater than 1.0 mg/dL (for patients 6 to 10 years of age) No greater than 1.2 mg/dL (for patients 11 to 15 years of age) No greater than 1.5 mg/dL (for patients over 15 years of age) Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception Neurologic deficits in patients with CNS tumors must be stable for ≥ 1 week before study entry No uncontrolled infection No known urea cycle disorders or other metabolic disorders No other condition that would preclude study compliance PRIOR CONCURRENT THERAPY: Biologic therapy Recovered from prior immunotherapy At least 7 days since prior hematopoietic growth factors that support platelet or WBC number or function At least 7 days since prior antineoplastic biologic agents At least 3 months since prior stem cell transplantation or rescue without total body irradiation No evidence of active graft vs host disease No other concurrent anticancer biologic therapy or immunotherapy Chemotherapy More than 3 weeks since prior myelosuppressive chemotherapy (6 weeks for nitrosoureas) and recovered No other concurrent anticancer chemotherapy Endocrine therapy Patients with CNS tumors must be on a stable or decreasing dose of dexamethasone for the past 7 days Radiotherapy See Biologic therapy Recovered from prior radiotherapy At least 6 months since prior total body irradiation, craniospinal radiotherapy, or radiotherapy to ≥ 50% of the pelvis At least 6 weeks since other prior substantial bone marrow radiotherapy At least 2 weeks since prior local palliative small port radiotherapy No concurrent anticancer radiotherapy Surgery Not specified Other No other concurrent investigational agents No other concurrent anticancer agents No other concurrent anticonvulsants Patients receiving valproic acid (VPA) before study entry must have a total trough VPA concentration < 100 mcg/mL within the past 7 days
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jack M. Su, MD
Organizational Affiliation
Texas Children's Cancer Center
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Heidi V. Russell, MD
Organizational Affiliation
Texas Children's Cancer Center
Official's Role
Study Chair
Facility Information:
Facility Name
Children's Hospital of Orange County
City
Orange
State/Province
California
ZIP/Postal Code
92868
Country
United States
Facility Name
Stanford Comprehensive Cancer Center - Stanford
City
Stanford
State/Province
California
ZIP/Postal Code
94305
Country
United States
Facility Name
Children's National Medical Center
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20010-2970
Country
United States
Facility Name
Children's Memorial Hospital - Chicago
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60614
Country
United States
Facility Name
Indiana University Melvin and Bren Simon Cancer Center
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46202-5289
Country
United States
Facility Name
Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Facility Name
University of Minnesota Children's Hospital - Fairview
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55455
Country
United States
Facility Name
Mayo Clinic Cancer Center
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Facility Name
Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center
City
New York
State/Province
New York
ZIP/Postal Code
10032
Country
United States
Facility Name
SUNY Upstate Medical University Hospital
City
Syracuse
State/Province
New York
ZIP/Postal Code
13210
Country
United States
Facility Name
Cincinnati Children's Hospital Medical Center
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229-3039
Country
United States
Facility Name
Oregon Health & Science University Cancer Institute
City
Portland
State/Province
Oregon
ZIP/Postal Code
97239-3098
Country
United States
Facility Name
Children's Hospital of Philadelphia
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104-9786
Country
United States
Facility Name
Baylor University Medical Center - Houston
City
Houston
State/Province
Texas
ZIP/Postal Code
77030-2399
Country
United States
Facility Name
Children's Hospital and Regional Medical Center - Seattle
City
Seattle
State/Province
Washington
ZIP/Postal Code
98105
Country
United States
Facility Name
Hospital for Sick Children
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 1X8
Country
Canada
Facility Name
Hopital Sainte Justine
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H3T 1C5
Country
Canada

12. IPD Sharing Statement

Citations:
PubMed Identifier
21115653
Citation
Su JM, Li XN, Thompson P, Ou CN, Ingle AM, Russell H, Lau CC, Adamson PC, Blaney SM. Phase 1 study of valproic acid in pediatric patients with refractory solid or CNS tumors: a children's oncology group report. Clin Cancer Res. 2011 Feb 1;17(3):589-97. doi: 10.1158/1078-0432.CCR-10-0738. Epub 2010 Nov 29.
Results Reference
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Valproic Acid in Treating Young Patients With Recurrent or Refractory Solid Tumors or CNS Tumors

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