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Temozolomide, Vincristine, and Irinotecan in Treating Young Patients With Refractory Solid 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
irinotecan hydrochloride
temozolomide
vincristine sulfate
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 unspecified childhood solid tumor, protocol specific, recurrent childhood cerebellar astrocytoma, recurrent childhood cerebral astrocytoma, recurrent childhood brain stem glioma, recurrent childhood brain tumor, recurrent childhood ependymoma, recurrent childhood medulloblastoma, recurrent childhood supratentorial primitive neuroectodermal tumor, recurrent childhood visual pathway and hypothalamic glioma, childhood oligodendroglioma, childhood craniopharyngioma, childhood choroid plexus tumor, childhood infratentorial ependymoma, childhood supratentorial ependymoma, childhood high-grade cerebral astrocytoma, childhood low-grade cerebral astrocytoma, childhood central nervous system germ cell tumor, childhood grade I meningioma, childhood grade II meningioma, childhood grade III meningioma, recurrent childhood subependymal giant cell astrocytoma, childhood atypical teratoid/rhabdoid tumor

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Histologically confirmed* malignant solid tumor, including brain tumor, at original diagnosis or relapse Refractory disease NOTE: *Histologic confirmation not required for intrinsic brain stem tumors Measurable or evaluable disease No known curative therapy OR therapy proven to prolong survival with an acceptable quality of life exists No known bone marrow metastases PATIENT CHARACTERISTICS: Age 1 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 (RBC transfusions allowed) Hepatic ALT ≤ 110 U/L (upper limit of normal [ULN] for ALT is 45 U/L) Bilirubin ≤ 1.5 times ULN 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 > 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 prior to study entry No uncontrolled infection No documented allergy to cephalosporins or dacarbazine PRIOR CONCURRENT THERAPY: Biologic therapy Recovered from prior immunotherapy At least 3 months since prior stem cell transplantation or rescue without total-body irradiation No evidence of active graft-versus-host disease At least 7 days since prior antineoplastic biologic agents At least 7 days since prior hematopoietic growth factors No concurrent biologic therapy or immunotherapy No concurrent prophylactic filgrastim (G-CSF) during the first course of study treatment Chemotherapy Recovered from prior chemotherapy Prior temozolomide, vincristine, irinotecan, or topotecan allowed No prior coadministration of temozolomide and irinotecan No disease progression during treatment with either irinotecan or temozolomide More than 3 weeks since prior myelosuppressive chemotherapy (6 weeks for nitrosoureas) No other concurrent chemotherapy Endocrine therapy Patients with CNS tumors must be on a stable or decreasing dose of dexamethasone for ≥ 7 days prior to study entry Radiotherapy 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 radiotherapy (small port) No concurrent radiotherapy Surgery Not specified Other No other concurrent investigational drugs No other concurrent anticancer therapy No concurrent enzyme-inducing anticonvulsants, including any of the following: Phenobarbital Phenytoin Carbamazepine Oxcarbazepine No concurrent administration of any of the following: Rifampin Voriconazole Itraconazole Ketoconazole Aprepitant Hypericum perforatum (St. John's wort) No concurrent treatment for clostridium difficile infection

Sites / Locations

  • Lurleen Wallace Comprehensive Cancer at University of Alabama - Birmingham
  • Children's Hospital of Orange County
  • Stanford Cancer Center
  • Children's Memorial Hospital - Chicago
  • Indiana University Melvin and Bren Simon Cancer Center
  • Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute
  • Masonic Cancer Center at University of Minnesota
  • 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 and Science University Cancer Institute
  • Lehigh Valley Hospital - Muhlenberg
  • Children's Hospital of Philadelphia
  • Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas
  • Children's Hospital and Regional Medical Center - Seattle
  • Hospital for Sick Children
  • Hopital Sainte Justine

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Oral Irinotecan, temozolomide and vincristine sulfate

Arm Description

see detailed description

Outcomes

Primary Outcome Measures

Determine maximum tolerated dose (MTD) of oral irinotecan
To estimate the maximum tolerated dose (MTD) of oral irinotecan administered on two different schedules together with fixed-dose temozolomide and vincristine in children with refractory solid tumors or brain tumors

Secondary Outcome Measures

To preliminarily define the antitumor activity
To preliminarily define the antitumor activity of this drug combination within the confines of a Phase 1 study.

Full Information

First Posted
August 29, 2005
Last Updated
September 28, 2023
Sponsor
Children's Oncology Group
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00138216
Brief Title
Temozolomide, Vincristine, and Irinotecan in Treating Young Patients With Refractory Solid Tumors
Official Title
A Phase I Study of Temozolomide, Oral Irinotecan, and Vincristine for Children With Refractory Solid Tumors
Study Type
Interventional

2. Study Status

Record Verification Date
February 2014
Overall Recruitment Status
Completed
Study Start Date
October 2005 (undefined)
Primary Completion Date
June 2009 (Actual)
Study Completion Date
January 2011 (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 temozolomide, vincristine, and irinotecan, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) may kill more tumor cells. PURPOSE: This phase I trial is studying the side effects and best dose of irinotecan when given together with temozolomide and vincristine in treating young patients with refractory solid tumors.
Detailed Description
OBJECTIVES: Primary Determine the maximum tolerated dose and recommended phase II dose of irinotecan when administered with temozolomide and vincristine in young patients with refractory solid tumors, including brain tumors. Determine the toxic effects of this regimen in these patients. Compare the toxic effects of this regimen in patients with low- vs high-risk UGT1A1 genotypes. Determine the pharmacokinetics of irinotecan in these patients. Secondary Determine, preliminarily, the antitumor activity of this regimen in these patients. Correlate UGT1A1, UGT1A7, UGT1A9, and BCRP genotypes with the pharmacokinetics and pharmacodynamics of irinotecan and its metabolites in these patients. OUTLINE: This is a multicenter, dose-escalation study of irinotecan. Patients are stratified according to UGT1A1 genotype (high-risk [7/7 or 6/7 genotype AND bilirubin ≥ 0.6 mg/dL] vs low-risk [absence of high-risk criteria]) if a high-risk patient experiences a dose-limiting toxicity (DLT). Patients receive oral temozolomide on days 1-5 and oral irinotecan on days 1-5 and 8-12. Patients also receive vincristine IV over 1 minute on days 1 and 8. Treatment repeats every 21 days for up to 17 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of irinotecan until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 6 patients experience DLT. After completion of study treatment, patients are followed for 1 month and then annually thereafter. PROJECTED ACCRUAL: A total of 3-36 patients will be accrued for this study within 18 months.

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
unspecified childhood solid tumor, protocol specific, recurrent childhood cerebellar astrocytoma, recurrent childhood cerebral astrocytoma, recurrent childhood brain stem glioma, recurrent childhood brain tumor, recurrent childhood ependymoma, recurrent childhood medulloblastoma, recurrent childhood supratentorial primitive neuroectodermal tumor, recurrent childhood visual pathway and hypothalamic glioma, childhood oligodendroglioma, childhood craniopharyngioma, childhood choroid plexus tumor, childhood infratentorial ependymoma, childhood supratentorial ependymoma, childhood high-grade cerebral astrocytoma, childhood low-grade cerebral astrocytoma, childhood central nervous system germ cell tumor, childhood grade I meningioma, childhood grade II meningioma, childhood grade III meningioma, recurrent childhood subependymal giant cell astrocytoma, childhood atypical teratoid/rhabdoid tumor

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Oral Irinotecan, temozolomide and vincristine sulfate
Arm Type
Experimental
Arm Description
see detailed description
Intervention Type
Drug
Intervention Name(s)
irinotecan hydrochloride
Intervention Type
Drug
Intervention Name(s)
temozolomide
Intervention Type
Drug
Intervention Name(s)
vincristine sulfate
Primary Outcome Measure Information:
Title
Determine maximum tolerated dose (MTD) of oral irinotecan
Description
To estimate the maximum tolerated dose (MTD) of oral irinotecan administered on two different schedules together with fixed-dose temozolomide and vincristine in children with refractory solid tumors or brain tumors
Time Frame
length of study
Secondary Outcome Measure Information:
Title
To preliminarily define the antitumor activity
Description
To preliminarily define the antitumor activity of this drug combination within the confines of a Phase 1 study.
Time Frame
Length of study

10. Eligibility

Sex
All
Minimum Age & Unit of Time
1 Year
Maximum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed* malignant solid tumor, including brain tumor, at original diagnosis or relapse Refractory disease NOTE: *Histologic confirmation not required for intrinsic brain stem tumors Measurable or evaluable disease No known curative therapy OR therapy proven to prolong survival with an acceptable quality of life exists No known bone marrow metastases PATIENT CHARACTERISTICS: Age 1 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 (RBC transfusions allowed) Hepatic ALT ≤ 110 U/L (upper limit of normal [ULN] for ALT is 45 U/L) Bilirubin ≤ 1.5 times ULN 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 > 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 prior to study entry No uncontrolled infection No documented allergy to cephalosporins or dacarbazine PRIOR CONCURRENT THERAPY: Biologic therapy Recovered from prior immunotherapy At least 3 months since prior stem cell transplantation or rescue without total-body irradiation No evidence of active graft-versus-host disease At least 7 days since prior antineoplastic biologic agents At least 7 days since prior hematopoietic growth factors No concurrent biologic therapy or immunotherapy No concurrent prophylactic filgrastim (G-CSF) during the first course of study treatment Chemotherapy Recovered from prior chemotherapy Prior temozolomide, vincristine, irinotecan, or topotecan allowed No prior coadministration of temozolomide and irinotecan No disease progression during treatment with either irinotecan or temozolomide More than 3 weeks since prior myelosuppressive chemotherapy (6 weeks for nitrosoureas) No other concurrent chemotherapy Endocrine therapy Patients with CNS tumors must be on a stable or decreasing dose of dexamethasone for ≥ 7 days prior to study entry Radiotherapy 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 radiotherapy (small port) No concurrent radiotherapy Surgery Not specified Other No other concurrent investigational drugs No other concurrent anticancer therapy No concurrent enzyme-inducing anticonvulsants, including any of the following: Phenobarbital Phenytoin Carbamazepine Oxcarbazepine No concurrent administration of any of the following: Rifampin Voriconazole Itraconazole Ketoconazole Aprepitant Hypericum perforatum (St. John's wort) No concurrent treatment for clostridium difficile infection
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lars M. Wagner, MD
Organizational Affiliation
Children's Hospital Medical Center, Cincinnati
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
John P. Perentesis, MD
Organizational Affiliation
Children's Hospital Medical Center, Cincinnati
Official's Role
Study Chair
Facility Information:
Facility Name
Lurleen Wallace Comprehensive Cancer at University of Alabama - Birmingham
City
Birmingham
State/Province
Alabama
ZIP/Postal Code
35294
Country
United States
Facility Name
Children's Hospital of Orange County
City
Orange
State/Province
California
ZIP/Postal Code
92868
Country
United States
Facility Name
Stanford Cancer Center
City
Stanford
State/Province
California
ZIP/Postal Code
94305-5824
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
Masonic Cancer Center at University of Minnesota
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 and Science University Cancer Institute
City
Portland
State/Province
Oregon
ZIP/Postal Code
97239-3098
Country
United States
Facility Name
Lehigh Valley Hospital - Muhlenberg
City
Bethlehem
State/Province
Pennsylvania
ZIP/Postal Code
18107
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
Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas
City
Dallas
State/Province
Texas
ZIP/Postal Code
75390
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
20049936
Citation
Wagner LM, Perentesis JP, Reid JM, Ames MM, Safgren SL, Nelson MD Jr, Ingle AM, Blaney SM, Adamson PC. Phase I trial of two schedules of vincristine, oral irinotecan, and temozolomide (VOIT) for children with relapsed or refractory solid tumors: a Children's Oncology Group phase I consortium study. Pediatr Blood Cancer. 2010 Apr;54(4):538-45. doi: 10.1002/pbc.22407.
Results Reference
result

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Temozolomide, Vincristine, and Irinotecan in Treating Young Patients With Refractory Solid Tumors

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