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Vorinostat With or Without Isotretinoin in Treating Young Patients With Recurrent or Refractory Solid Tumors, Lymphoma, or Leukemia

Primary Purpose

Childhood Acute Promyelocytic Leukemia (M3), Childhood Atypical Teratoid/Rhabdoid Tumor, Childhood Burkitt Lymphoma

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

About this trial

This is an interventional treatment trial for Childhood Acute Promyelocytic Leukemia (M3)

Eligibility Criteria

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

Inclusion Criteria: Histologically confirmed* diagnosis of 1 of the following: Recurrent or refractory solid tumor or lymphoma (for patients in group 1) Measurable or evaluable disease Recurrent or refractory leukemia (for patients in group 2) Greater than 25% blasts in the bone marrow (i.e., M3 bone marrow) Active extramedullary disease allowed except leptomeningeal disease Recurrent or refractory CNS tumor of 1 of the following types (for patients in group 3): Neuroblastoma Medulloblastoma/CNS primitive neuroectodermal tumor Atypical teratoid rhabdoid tumor No known curative therapy or therapy proven to prolong survival with an acceptable quality of life exists No bone marrow involvement by disease (for patients in groups 1 and 3) No active CNS leukemia Performance status - Lansky 50-100% (for patients ≤ 10 years of age) Performance status - Karnofsky 60-100% (for patients > 10 years of age) Absolute neutrophil count ≥ 1,000/mm^3 (for solid tumor patients) Platelet count ≥ 100,000/mm^3* (for solid tumor patients) (20,000/mm^3** for leukemia patients) Hemoglobin ≥ 8.0 g/dL (RBC transfusion allowed) (for solid tumor and leukemia patients) Triglycerides < 300 mg/dL (for patients in group 3) Bilirubin ≤ 1.5 times upper limit of normal (ULN) ALT ≤ 5 times ULN Albumin ≥ 2 g/dL Creatinine clearance or radioisotope glomerular filtration rate ≥ 70 mL/min 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) Negative dipstick for protein OR < 1,000 mg protein/24 hour urine collection (for patients in group 3) No evidence of gross hematuria (for patients in group 3) Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception Body surface area ≥ 0.5 m^2 Neurologic deficits in patients with CNS tumors must be stable for ≥ 1 week before study entry Able to swallow whole capsules No uncontrolled infection Skin toxicity < grade 1 (for patients in group 3) Recovered from prior immunotherapy At least 7 days since prior hematopoietic growth factors At least 7 days since prior antineoplastic biologic agents At least 2 months since prior stem cell transplantation or rescue No evidence of active graft-versus-host disease No other concurrent biologic therapy or immunotherapy More than 3 weeks since prior myelosuppressive chemotherapy (6 weeks for nitrosoureas) and recovered No concurrent chemotherapy Patients with CNS tumors must be on a stable or decreasing dose of dexamethasone for ≥ 7 days prior to study entry No concurrent dexamethasone for antinausea or antiemetic therapy Recovered from prior radiotherapy At least 2 weeks since prior local, palliative, small-port radiotherapy At least 3 months since prior total-body irradiation, radiotherapy to the craniospinal area, or radiotherapy to ≥ 50% of the pelvis At least 6 weeks since other prior substantial radiotherapy to the bone marrow No concurrent radiotherapy At least 2 weeks since prior valproic acid No other concurrent investigational agents No other concurrent anticancer therapy No concurrent enzyme-inducing anticonvulsants

Sites / Locations

  • Children's Oncology Group

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Arm I

Arm II

Arm III

Arm Description

Group 1 (solid tumor or lymphoma patients): Patients receive oral SAHA once daily on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.Cohorts of 3-6 patients receive escalating doses of SAHA 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. An additional 6 patients may be treated at the MTD.

Group 2 (leukemia patients): Patients receive SAHA as in group 1 at the MTD.

Group 3 (select solid tumor patients): Patients receive oral isotretinoin twice daily on days 1-14. Patients also receive SAHA once daily on days 1-28 OR once on days 1, 3, 5, 8, 10, 12, 15, 17, 19, 22, 24, and 26. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.The MTD of SAHA is determined as in group 1. An additional 6 patients may be treated at the MTD.

Outcomes

Primary Outcome Measures

Maximum tolerated dose (MTD) defined as the maximum dose at which fewer than one-third of patients experience dose-limiting toxicities DLT graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 3.0

Secondary Outcome Measures

The proportion of patients who demonstrate each polymorphism

Full Information

First Posted
September 20, 2005
Last Updated
June 16, 2014
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00217412
Brief Title
Vorinostat With or Without Isotretinoin in Treating Young Patients With Recurrent or Refractory Solid Tumors, Lymphoma, or Leukemia
Official Title
A Phase 1 Study of SAHA (NSC# 701852) in Pediatric Patients With Recurrent or Refractory Solid Tumors (Including Lymphomas) and Leukemia Followed by a Phase I Study of SAHA in Combination With 13-Cis-Retinoic Acid for Patients With Selected Recurrent/Refractory Solid Tumors
Study Type
Interventional

2. Study Status

Record Verification Date
April 2013
Overall Recruitment Status
Completed
Study Start Date
August 2005 (undefined)
Primary Completion Date
September 2009 (Actual)
Study Completion Date
September 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 vorinostat when given together with isotretinoin in treating young patients with recurrent or refractory solid tumors, lymphoma, or leukemia. Drugs used in chemotherapy, such as vorinostat, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Vorinostat may also stop the growth of cancer cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the cancer. Isotretinoin may cause cancer cells to look more like normal cells, and to grow and spread more slowly. Giving vorinostat together with isotretinoin may be an effective treatment for cancer.
Detailed Description
PRIMARY OBJECTIVES: I. Determine the maximum tolerated dose (MTD) of vorinostat (SAHA) in young patients with recurrent or refractory solid tumors or lymphomas. II. Determine the MTD of SAHA administered in combination with isotretinoin in young patients with recurrent or refractory neuroblastoma, medulloblastoma/CNS primitive neuroectodermal tumor, or atypical teratoid rhabdoid tumor. III. Determine the tolerability of the solid tumor MTD of SAHA in young patients with recurrent or refractory leukemia. IV. Determine the toxic effects of SAHA administered with or without isotretinoin in these patients. V. Determine the pharmacokinetics of this drug in these patients. SECONDARY OBJECTIVES: I. Determine, preliminarily, the antitumor activity of SAHA administered with or without isotretinoin in these patients. II. Correlate the pharmacokinetics of this drug with genetic polymorphisms (e.g., UGT1A1) in these patients. OUTLINE: This is a multicenter, dose-escalation study of vorinostat (SAHA). Group 1 (solid tumor or lymphoma patients): Patients receive oral SAHA once daily on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.Cohorts of 3-6 patients receive escalating doses of SAHA 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. An additional 6 patients may be treated at the MTD. Group 2 (leukemia patients): Patients receive SAHA as in group 1 at the MTD. Group 3 (select solid tumor patients): Patients receive oral isotretinoin twice daily on days 1-14. Patients also receive SAHA once daily on days 1-28 OR once on days 1, 3, 5, 8, 10, 12, 15, 17, 19, 22, 24, and 26. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.The MTD of SAHA is determined as in group 1. An additional 6 patients may be treated at the MTD. After completion of study treatment, patients are followed periodically.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Childhood Acute Promyelocytic Leukemia (M3), Childhood Atypical Teratoid/Rhabdoid Tumor, Childhood Burkitt Lymphoma, Childhood Chronic Myelogenous Leukemia, Childhood Diffuse Large Cell Lymphoma, Childhood Immunoblastic Large Cell Lymphoma, Juvenile Myelomonocytic Leukemia, Recurrent Childhood Acute Lymphoblastic Leukemia, Recurrent Childhood Acute Myeloid Leukemia, Recurrent Childhood Grade III Lymphomatoid Granulomatosis, Recurrent Childhood Large Cell Lymphoma, Recurrent Childhood Lymphoblastic Lymphoma, Recurrent Childhood Medulloblastoma, Recurrent Childhood Small Noncleaved Cell Lymphoma, Recurrent Childhood Supratentorial Primitive Neuroectodermal Tumor, Recurrent Neuroblastoma, Recurrent/Refractory Childhood Hodgkin Lymphoma, Relapsing Chronic Myelogenous Leukemia, Unspecified Childhood Solid Tumor, Protocol Specific

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
60 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm I
Arm Type
Experimental
Arm Description
Group 1 (solid tumor or lymphoma patients): Patients receive oral SAHA once daily on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.Cohorts of 3-6 patients receive escalating doses of SAHA 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. An additional 6 patients may be treated at the MTD.
Arm Title
Arm II
Arm Type
Experimental
Arm Description
Group 2 (leukemia patients): Patients receive SAHA as in group 1 at the MTD.
Arm Title
Arm III
Arm Type
Experimental
Arm Description
Group 3 (select solid tumor patients): Patients receive oral isotretinoin twice daily on days 1-14. Patients also receive SAHA once daily on days 1-28 OR once on days 1, 3, 5, 8, 10, 12, 15, 17, 19, 22, 24, and 26. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.The MTD of SAHA is determined as in group 1. An additional 6 patients may be treated at the MTD.
Intervention Type
Drug
Intervention Name(s)
vorinostat
Other Intervention Name(s)
L-001079038, SAHA, suberoylanilide hydroxamic acid, Zolinza
Intervention Description
Given orally
Intervention Type
Drug
Intervention Name(s)
isotretinoin
Other Intervention Name(s)
13-CRA, Amnesteem, Cistane, Claravis, Sotret
Intervention Description
Given orally
Primary Outcome Measure Information:
Title
Maximum tolerated dose (MTD) defined as the maximum dose at which fewer than one-third of patients experience dose-limiting toxicities DLT graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 3.0
Time Frame
28 days
Secondary Outcome Measure Information:
Title
The proportion of patients who demonstrate each polymorphism
Time Frame
Up to 4 years

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: Histologically confirmed* diagnosis of 1 of the following: Recurrent or refractory solid tumor or lymphoma (for patients in group 1) Measurable or evaluable disease Recurrent or refractory leukemia (for patients in group 2) Greater than 25% blasts in the bone marrow (i.e., M3 bone marrow) Active extramedullary disease allowed except leptomeningeal disease Recurrent or refractory CNS tumor of 1 of the following types (for patients in group 3): Neuroblastoma Medulloblastoma/CNS primitive neuroectodermal tumor Atypical teratoid rhabdoid tumor No known curative therapy or therapy proven to prolong survival with an acceptable quality of life exists No bone marrow involvement by disease (for patients in groups 1 and 3) No active CNS leukemia Performance status - Lansky 50-100% (for patients ≤ 10 years of age) Performance status - Karnofsky 60-100% (for patients > 10 years of age) Absolute neutrophil count ≥ 1,000/mm^3 (for solid tumor patients) Platelet count ≥ 100,000/mm^3* (for solid tumor patients) (20,000/mm^3** for leukemia patients) Hemoglobin ≥ 8.0 g/dL (RBC transfusion allowed) (for solid tumor and leukemia patients) Triglycerides < 300 mg/dL (for patients in group 3) Bilirubin ≤ 1.5 times upper limit of normal (ULN) ALT ≤ 5 times ULN Albumin ≥ 2 g/dL Creatinine clearance or radioisotope glomerular filtration rate ≥ 70 mL/min 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) Negative dipstick for protein OR < 1,000 mg protein/24 hour urine collection (for patients in group 3) No evidence of gross hematuria (for patients in group 3) Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception Body surface area ≥ 0.5 m^2 Neurologic deficits in patients with CNS tumors must be stable for ≥ 1 week before study entry Able to swallow whole capsules No uncontrolled infection Skin toxicity < grade 1 (for patients in group 3) Recovered from prior immunotherapy At least 7 days since prior hematopoietic growth factors At least 7 days since prior antineoplastic biologic agents At least 2 months since prior stem cell transplantation or rescue No evidence of active graft-versus-host disease No other concurrent biologic therapy or immunotherapy More than 3 weeks since prior myelosuppressive chemotherapy (6 weeks for nitrosoureas) and recovered No concurrent chemotherapy Patients with CNS tumors must be on a stable or decreasing dose of dexamethasone for ≥ 7 days prior to study entry No concurrent dexamethasone for antinausea or antiemetic therapy Recovered from prior radiotherapy At least 2 weeks since prior local, palliative, small-port radiotherapy At least 3 months since prior total-body irradiation, radiotherapy to the craniospinal area, or radiotherapy to ≥ 50% of the pelvis At least 6 weeks since other prior substantial radiotherapy to the bone marrow No concurrent radiotherapy At least 2 weeks since prior valproic acid No other concurrent investigational agents No other concurrent anticancer therapy No concurrent enzyme-inducing anticonvulsants
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Maryam Fouladi
Organizational Affiliation
Children's Oncology Group
Official's Role
Principal Investigator
Facility Information:
Facility Name
Children's Oncology Group
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Vorinostat With or Without Isotretinoin in Treating Young Patients With Recurrent or Refractory Solid Tumors, Lymphoma, or Leukemia

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