Irinotecan and Temozolomide in Treating Young Patients With Recurrent Neuroblastoma
Neuroblastoma
About this trial
This is an interventional treatment trial for Neuroblastoma focused on measuring recurrent neuroblastoma
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed neuroblastoma AND/OR demonstration of tumor cells in the bone marrow with increased urinary catecholamines at initial diagnosis Patients with elevated catecholamines only are not eligible Meets 1 of the following criteria: Recurrent disease following aggressive, multidrug, frontline chemotherapy, defined as chemotherapy given with ≥ 2 agents, including an alkylating agent and a platinum-containing compound Resistant/refractory disease during aggressive, multidrug, frontline chemotherapy Must meet 1 of the following criteria for documentation of disease: Unidimensionally measurable tumor ≥ 20 mm by MRI (Magnetic Resonance Imaging), CT scan (Computed Tomography), or x-ray OR ≥ 10 mm by spiral CT scan within 4 weeks prior to study entry Patients with residual stable tumor upon completion of frontline therapy must undergo biopsy to document presence of a viable neuroblastoma If the measurable target lesion was previously radiated, a biopsy must be performed ≥ 4 weeks after radiation was completed AND the biopsy must demonstrate viable neuroblastoma MIBG scan (metaiodobenzylguanidine scan, a radiopharmaceutical) with positive uptake at ≥ 1 site within 4 weeks prior to study entry Patients with residual stable MIBG-positive lesions upon completion of frontline therapy must undergo biopsy to document presence of viable neuroblastoma If the patient has only 1 MIBG-positive lesion, and that lesion was previously radiated, a biopsy must be performed ≥ 4 weeks after radiation was completed AND the biopsy must demonstrate viable neuroblastoma Bone marrow with tumor cells on routine morphology (not by neuron-specific enolase staining only) of bilateral aspirate and/or biopsy on 1 bone marrow sample within 2 weeks prior to study entry No extensive marrow disease No myelodysplastic syndrome PATIENT CHARACTERISTICS: Karnofsky performance status (PS) 50-100% (for patients > 16 years of age) OR Lansky PS 50-100% (for patients ≤ 16 years of age) Life expectancy ≥ 8 weeks Absolute neutrophil count ≥ 750/mm^3 Platelet count ≥ 75,000/mm^3 (transfusion independent) Hemoglobin ≥ 8.5 mg/dL (transfusion allowed) Creatinine adjusted according to age as follows: No greater than 0.4 mg/dL (≤ 5 months) No greater than 0.5 mg/dL (6 months -11 months) No greater than 0.6 mg/dL (1 year-23 months) No greater than 0.8 mg/dL (2 years-5 years) No greater than 1.0 mg/dL (6 years-9 years) No greater than 1.2 mg/dL (10 years-12 years) No greater than 1.4 mg/dL (13 years and over [female]) No greater than 1.5 mg/dL (13 years to 15 years [male]) No greater than 1.7 mg/dL (16 years and over [male]) OR Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min Bilirubin ≤ 1.5 times upper limit of normal (ULN) for age ALT < 2.5 times ULN for age Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception Seizure disorder allowed provided seizures are well controlled on non-EIAC medication No active diarrhea or uncontrolled infection No other malignancy, including secondary malignancy PRIOR CONCURRENT THERAPY: See Disease Characteristics Prior front-line therapy (e.g., surgery, chemotherapy, immunotherapy, radiotherapy, or retinoids) allowed Recovered from prior therapy More than 4 weeks since prior radiation therapy to the site of any lesion that will be identified as a target lesion to measure tumor response At least 2 weeks since prior myelosuppressive therapy (4 weeks for nitrosourea) At least 1 week since prior therapy with an antineoplastic biologic agent or retinoid At least 1 week since prior growth factors At least 1 week since prior and no other concurrent anticancer agents At least 1 week since prior and no concurrent enzyme-inducing anticonvulsants (EIAC), including phenytoin, phenobarbital, valproic acid, or carbamazepine Concurrent gabapentin or levetiracetam allowed Concurrent palliative radiation therapy to sites not used to measure tumor response allowed No prior allogeneic stem cell transplantation (SCT) Prior autologous SCT allowed No prior second-line chemotherapy for relapsed or refractory disease No concurrent immunomodulating agents Concurrent steroids for transfusion/infusion reactions or for treatment of edema associated with CNS lesions allowed
Sites / Locations
- Lurleen Wallace Comprehensive Cancer at University of Alabama - Birmingham
- Arizona Cancer Center at University of Arizona Health Sciences Center
- Arkansas Cancer Research Center at University of Arkansas for Medical Sciences
- Southern California Permanente Medical Group
- Loma Linda University Cancer Institute at Loma Linda University Medical Center
- Jonathan Jaques Children's Cancer Center at Miller Children's Hospital
- Childrens Hospital Los Angeles
- Children's Hospital Central California
- Children's Hospital and Research Center Oakland
- Children's Hospital of Orange County
- Sutter Cancer Center
- Kaiser Permanente Medical Center - Oakland
- UCSF Helen Diller Family Comprehensive Cancer Center
- Stanford Cancer Center
- Children's Hospital Center for Cancer and Blood Disorders
- Carole and Ray Neag Comprehensive Cancer Center at the University of Connecticut Health Center
- Alfred I. duPont Hospital for Children
- Children's National Medical Center
- Lee Cancer Care of Lee Memorial Health System
- University of Florida Shands Cancer Center
- Nemours Children's Clinic
- University of Miami Sylvester Comprehensive Cancer Center - Miami
- Miami Children's Hospital
- Florida Hospital Cancer Institute at Florida Hospital Orlando
- Sacred Heart Cancer Center at Sacred Heart Hospital
- All Children's Hospital
- St. Joseph's Cancer Institute at St. Joseph's Hospital
- Kaplan Cancer Center at St. Mary's Medical Center
- Winship Cancer Institute of Emory University
- Cancer Research Center of Hawaii
- Mountain States Tumor Institute at St. Luke's Regional Medical Center
- University of Illinois Cancer Center
- Children's Memorial Hospital - Chicago
- University of Chicago Cancer Research Center
- Indiana University Melvin and Bren Simon Cancer Center
- Blank Children's Hospital
- Holden Comprehensive Cancer Center at University of Iowa
- Lucille P. Markey Cancer Center at University of Kentucky
- Kosair Children's Hospital
- Children's Hospital of New Orleans
- Alvin and Lois Lapidus Cancer Institute at Sinai Hospital
- Floating Hospital for Children at Tufts - New England Medical Center
- Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute
- C.S. Mott Children's Hospital at University of Michigan Medical Center
- Barbara Ann Karmanos Cancer Institute
- Hurley Medical Center
- Butterworth Hospital at Spectrum Health
- Van Elslander Cancer Center at St. John Hospital and Medical Center
- CCOP - Kalamazoo
- Breslin Cancer Center at Ingham Regional Medical Center
- Children's Hospitals and Clinics of Minnesota - Minneapolis
- Masonic Cancer Center at University of Minnesota
- Mayo Clinic Cancer Center
- University of Mississippi Cancer Clinic
- Children's Mercy Hospital
- Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis
- Children's Hospital
- Sunrise Hospital and Medical Center
- Hackensack University Medical Center Cancer Center
- Overlook Hospital
- Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School
- Newark Beth Israel Medical Center
- University of New Mexico Cancer Center
- Albert Einstein Cancer Center at Albert Einstein College of Medicine
- Maimonides Cancer Center at Maimonides Medical Center
- Roswell Park Cancer Institute
- Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center
- James P. Wilmot Cancer Center at University of Rochester Medical Center
- Stony Brook University Cancer Center
- SUNY Upstate Medical University Hospital
- New York Medical College
- Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill
- Blumenthal Cancer Center at Carolinas Medical Center
- Presbyterian Cancer Center at Presbyterian Hospital
- Duke Comprehensive Cancer Center
- Akron Children's Hospital
- Cincinnati Children's Hospital Medical Center
- Rainbow Babies and Children's Hospital
- Cleveland Clinic Taussig Cancer Center
- Nationwide Children's Hospital
- Children's Medical Center - Dayton
- Lehigh Valley Hospital - Muhlenberg
- Geisinger Cancer Institute at Geisinger Health
- Penn State Cancer Institute at Milton S. Hershey Medical Center
- Children's Hospital of Philadelphia
- St. Christopher's Hospital for Children
- Children's Hospital of Pittsburgh
- Hollings Cancer Center at Medical University of South Carolina
- Palmetto Health South Carolina Cancer Center
- East Tennessee Children's Hospital
- Vanderbilt-Ingram Cancer Center
- Dell Children's Medical Center of Central Texas
- Driscoll Children's Hospital
- Medical City Dallas Hospital
- Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas
- Cook Children's Medical Center - Fort Worth
- M. D. Anderson Cancer Center at University of Texas
- Covenant Children's Hospital
- University of Texas Health Science Center at San Antonio
- Methodist Children's Hospital of South Texas
- CCOP - Scott and White Hospital
- Primary Children's Medical Center
- Fletcher Allen Health Care - University Health Center Campus
- Children's Hospital of The King's Daughters
- Virginia Commonwealth University Massey Cancer Center
- Children's Hospital and Regional Medical Center - Seattle
- Providence Cancer Center at Sacred Heart Medical Center
- West Virginia University Health Sciences Center - Charleston
- St. Vincent Hospital Regional Cancer Center
- Midwest Children's Cancer Center
- John Hunter Hospital
- Westmead Institute for Cancer Research at Westmead Hospital
- Royal Children's Hospital
- Royal Children's Hospital
- Princess Margaret Hospital for Children
- University of Alberta Hospital
- Children's & Women's Hospital of British Columbia
- CancerCare Manitoba
- IWK Health Centre
- McMaster Children's Hospital at Hamilton Health Sciences
- Children's Hospital of Western Ontario
- Children's Hospital of Eastern Ontario
- Hospital for Sick Children
- Montreal Children's Hospital at McGill University Health Center
- Hopital Sainte Justine
- Allan Blair Cancer Centre at Pasqua Hospital
- Saskatoon Cancer Centre at the University of Saskatchewan
- Centre Hospitalier Universitaire de Quebec
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Disease measurable by CT or MRI scan (Irinotecan/Temozolomide)
Disease eval by bone marrow or MIBG (Irinotecan/Temozolomide)
Measurable by CT scan (Computed Tomography) or MRI scan (Magnetic Resonance Imaging). Patients receive irinotecan hydrochloride IV (10 mg/m2/dose) over 1 hour on days 1-5 and 8-12 and oral temozolomide (100 mg/m2/dose) on days 1-5. Treatment repeats every 3 weeks for up to 6 courses in the absence of disease progression or unacceptable toxicity.
Evaluation by bone marrow or MIBG scan (metaiodobenzylguanidine scan, a radiopharmaceutical). Patients receive irinotecan hydrochloride IV (10 mg/m2/dose) over 1 hour on days 1-5 and 8-12 and oral temozolomide (100 mg/m2/dose) on days 1-5. Treatment repeats every 3 weeks for up to 6 courses in the absence of disease progression or unacceptable toxicity.