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Dasatinib in Treating Young Patients With Recurrent or Refractory Solid Tumors or Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia or Chronic Myelogenous Leukemia That Did Not Respond to Imatinib Mesylate

Primary Purpose

Accelerated Phase Chronic Myelogenous Leukemia, Blastic Phase Chronic Myelogenous Leukemia, Childhood Chronic Myelogenous Leukemia

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
dasatinib
pharmacological study
laboratory biomarker analysis
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Accelerated Phase Chronic Myelogenous Leukemia

Eligibility Criteria

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

Inclusion Criteria: Histologically confirmed diagnosis of 1 of the following: Malignant extracranial solid tumor Recurrent or refractory disease Known bone marrow metastases* allowed Imatinib mesylate-resistant Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL), defined as M3 bone marrow in a patient who previously received imatinib mesylate-containing treatment regimen Imatinib mesylate-resistant Ph+ chronic myelogenous leukemia (CML), as defined by any of the following: Increasing WBC or platelet count while on imatinib mesylate therapy Lack of any cytogenetic response after an adequate duration of imatinib mesylate therapy, as defined by 1 of the following: Failed to achieve a complete hematologic response after completion of 3 months of imatinib mesylate treatment Failed to achieve a partial or complete cytogenetic response (i.e., ≤ 35% Ph+ cells) after 6 months of imatinib mesylate treatment Appearance of accelerated or blastic feature while on imatinib mesylate therapy Reappearance of Ph+ clones after an initial complete cytogenetic response to imatinib mesylate More than 30% increase in Ph+ cells in peripheral blood or bone marrow cytogenetics while on imatinib mesylate therapy Imatinib mesylate intolerance, as defined by development of adverse effects requiring discontinuation of imatinib mesylate therapy Measurable disease (for patients with CML or ALL) Determined by hematologic, cytogenetic, and molecular studies for CML Determined by bone marrow blast percentage for ALL Measurable or evaluable disease (for patients with solid tumors) No known curative therapy or survival-prolonging therapy with an acceptable quality of life No CNS solid tumors CNS-positive leukemia allowed Karnofsky performance status (PS) ≥ 50% (for patients > 10 years of age) Lansky PS ≥ 50% (for patients ≤ 10 years of age) No evidence of graft-vs-host disease Solid tumors: Absolute neutrophil count ≥ 1,000/mm^3 (750/mm^3 if bone marrow infiltration) Platelet count ≥ 100,000/mm^3 (transfusion independent) (50,000/mm^3 if bone marrow infiltration) Hemoglobin ≥ 8.0 g/dL (red blood cell [RBC] transfusions allowed) ALL/CML: Platelet count ≥ 20,000/mm^3 (platelet transfusions allowed) Hemoglobin ≥ 8.0 g/dL (RBC transfusions allowed) Creatinine clearance or radioisotope glomerular filtration rate ≥ 70 mL/min OR creatinine based on age, as follows: No greater than 0.6 mg/dL (1-23 months of age) No greater than 0.8 mg/dL (2- 5 years of age) No greater than 1.0 mg/dL (6-9 years of age) No greater than 1.2 mg/dL (10-12 years of age) No greater than 1.4 mg/dL (13 years of age and over [female]) No greater than 1.5 mg/dL (13-15 years of age [male]) No greater than 1.7 mg/dL (16 years of age and over [male]) Bilirubin ≤ 1.5 times upper limit of normal (ULN) ALT ≤ 110 U/L Albumin ≥ 2 g/dL Normal 12-lead EKG with corrected QTc < 450 msec AND meets 1 of the following criteria: Shortening fraction normal Ejection fraction normal No evidence of dyspnea at rest No exercise intolerance Pulse oximetry > 94% if there is a clinical indication for determination Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No uncontrolled infection No swallowing dysfunction that would prevent taking an oral or liquid medication See Disease Characteristics Recovered from prior chemotherapy, immunotherapy, or radiotherapy No myelosuppressive chemotherapy within the past 3 weeks (6 weeks for nitrosoureas) At least 7 days since prior growth factors At least 14 days since prior pegfilgrastim At least 7 days since prior biologic agents At least 2 weeks since prior local small-port palliative radiotherapy At least 3 months since prior total-body irradiation, craniospinal radiation, or radiation to ≥ 50% of the pelvis At least 6 weeks since other prior substantial bone marrow radiation At least 3 months since prior stem cell transplantation Hydroxyurea cytoreduction for Ph+ leukemia allowed provided it is discontinued 24 hours before first dose of dasatinib Prior intrathecal (IT) therapy allowed (for patients with CNS-positive leukemia) Concurrent IT therapy comprising hydrocortisone, cytarabine, methotrexate, or cytarabine (liposomal) allowed (for patients with CNS-positive leukemia) No other concurrent investigational drugs No other concurrent anticancer agents, including chemotherapy, radiotherapy, immunotherapy, or biologic therapy No concurrent enzyme-inducing anticonvulsants, including any of the following: Phenytoin Phenobarbital Carbamazepine Felbamate Primdone Oxcarbazepine No concurrent antithrombotic or antiplatelet agents, including any of the following: Warfarin Heparin Low-molecular weight heparin Aspirin Ibuprofen Other nonsteroidal anti-inflammatory drugs No concurrent CYP3A4 inhibitors, including itraconazole, ketoconazole, and voriconazole No concurrent highly active antiretroviral treatment for HIV-positive patients

Sites / Locations

  • Children's Oncology Group

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Stratum 1 (solid tumors)

Stratum 2 (leukemia)

Arm Description

Patients receive oral dasatinib twice daily on days 1-28. Treatment repeats every 28 days for up to 24 courses in the absence of disease progression or unacceptable toxicity.

Patients receive dasatinib as in stratum 1. Cohorts of 3-12 patients receive escalating or de-escalating doses of dasatinib. The MTD is defined as the dose preceding that at which 7 of 12 patients experience DLT.

Outcomes

Primary Outcome Measures

Maximum tolerated dose defined as the maximum dose at which fewer than 1/3 patients experience dose-limiting toxicities (DLT) graded according to CTCAE
Time to disease progression
Will be estimated separately for patients on the solid tumor and on the refractory Ph+ leukemia strata with the Kaplan Meier method.

Secondary Outcome Measures

Full Information

First Posted
April 19, 2006
Last Updated
February 4, 2013
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00316953
Brief Title
Dasatinib in Treating Young Patients With Recurrent or Refractory Solid Tumors or Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia or Chronic Myelogenous Leukemia That Did Not Respond to Imatinib Mesylate
Official Title
A Phase I Study of BMS-354825 (Dasatinib) in Children With Recurrent/Refractory Solid Tumors or Imatinib Resistant Ph+ Leukemia (BMS Trial CA180038)
Study Type
Interventional

2. Study Status

Record Verification Date
January 2013
Overall Recruitment Status
Completed
Study Start Date
March 2006 (undefined)
Primary Completion Date
September 2009 (Actual)
Study Completion Date
undefined (undefined)

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 dasatinib in treating young patients with recurrent or refractory solid tumors or Philadelphia chromosome-positive acute lymphoblastic leukemia or chronic myelogenous leukemia that did not respond to imatinib mesylate. Dasatinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth
Detailed Description
PRIMARY OBJECTIVES: I. Determine the toxicities and estimate the maximum tolerated dose or the recommended phase 2 dose of dasatinib in pediatric patients with refractory solid tumors. II. Determine the toxicities of dasatinib in pediatric patients with imatinib mesylate-resistant Philadelphia chromosome-positive (Ph+) leukemia. III. Characterize the pharmacokinetics of dasatinib in pediatric patients with refractory solid tumors or imatinib-resistant Ph+ leukemia. SECONDARY OBJECTIVES: I. Preliminarily define the antitumor activity of dasatinib in pediatric patients with refractory solid tumors within the confines of a phase I study. II. Obtain pilot data on the activity of dasatinib administered in pediatric patients with Ph+ leukemia. III. Assess the biologic activity of dasatinib on tumor cells when available. IV. Determine the phosphotyrosine state of SRC and ABL substrates and correlate this with dasatinib dosage and antitumor activity (pharmacodynamics study). OUTLINE: This is a multicenter, dose-escalation study. Patients are stratified according to disease (solid tumors vs leukemia). Stratum 1 (solid tumors): Patients receive oral dasatinib twice daily on days 1-28. Treatment repeats every 28 days for up to 24 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of dasatinib 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 (DLT). Stratum 2 (leukemia): Patients receive dasatinib as in stratum 1. Cohorts of 3-12 patients receive escalating or de-escalating doses of dasatinib. The MTD is defined as the dose preceding that at which 7 of 12 patients experience DLT. After completing study treatment, patients are followed for 1 month.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Accelerated Phase Chronic Myelogenous Leukemia, Blastic Phase Chronic Myelogenous Leukemia, Childhood Chronic Myelogenous Leukemia, Chronic Myelogenous Leukemia, BCR-ABL1 Positive, Meningeal Chronic Myelogenous Leukemia, Recurrent Childhood Acute Lymphoblastic Leukemia, 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
48 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Stratum 1 (solid tumors)
Arm Type
Experimental
Arm Description
Patients receive oral dasatinib twice daily on days 1-28. Treatment repeats every 28 days for up to 24 courses in the absence of disease progression or unacceptable toxicity.
Arm Title
Stratum 2 (leukemia)
Arm Type
Experimental
Arm Description
Patients receive dasatinib as in stratum 1. Cohorts of 3-12 patients receive escalating or de-escalating doses of dasatinib. The MTD is defined as the dose preceding that at which 7 of 12 patients experience DLT.
Intervention Type
Drug
Intervention Name(s)
dasatinib
Other Intervention Name(s)
BMS-354825, Sprycel
Intervention Description
Given orally
Intervention Type
Other
Intervention Name(s)
pharmacological study
Other Intervention Name(s)
pharmacological studies
Intervention Description
Correlative studies
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Intervention Description
Correlative studies
Primary Outcome Measure Information:
Title
Maximum tolerated dose defined as the maximum dose at which fewer than 1/3 patients experience dose-limiting toxicities (DLT) graded according to CTCAE
Time Frame
28 days
Title
Time to disease progression
Description
Will be estimated separately for patients on the solid tumor and on the refractory Ph+ leukemia strata with the Kaplan Meier method.
Time Frame
Interval from enrollment to disease progression, death, occurrence of a second malignant neoplasm or last patient contact, assessed up to 1 month

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: Malignant extracranial solid tumor Recurrent or refractory disease Known bone marrow metastases* allowed Imatinib mesylate-resistant Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL), defined as M3 bone marrow in a patient who previously received imatinib mesylate-containing treatment regimen Imatinib mesylate-resistant Ph+ chronic myelogenous leukemia (CML), as defined by any of the following: Increasing WBC or platelet count while on imatinib mesylate therapy Lack of any cytogenetic response after an adequate duration of imatinib mesylate therapy, as defined by 1 of the following: Failed to achieve a complete hematologic response after completion of 3 months of imatinib mesylate treatment Failed to achieve a partial or complete cytogenetic response (i.e., ≤ 35% Ph+ cells) after 6 months of imatinib mesylate treatment Appearance of accelerated or blastic feature while on imatinib mesylate therapy Reappearance of Ph+ clones after an initial complete cytogenetic response to imatinib mesylate More than 30% increase in Ph+ cells in peripheral blood or bone marrow cytogenetics while on imatinib mesylate therapy Imatinib mesylate intolerance, as defined by development of adverse effects requiring discontinuation of imatinib mesylate therapy Measurable disease (for patients with CML or ALL) Determined by hematologic, cytogenetic, and molecular studies for CML Determined by bone marrow blast percentage for ALL Measurable or evaluable disease (for patients with solid tumors) No known curative therapy or survival-prolonging therapy with an acceptable quality of life No CNS solid tumors CNS-positive leukemia allowed Karnofsky performance status (PS) ≥ 50% (for patients > 10 years of age) Lansky PS ≥ 50% (for patients ≤ 10 years of age) No evidence of graft-vs-host disease Solid tumors: Absolute neutrophil count ≥ 1,000/mm^3 (750/mm^3 if bone marrow infiltration) Platelet count ≥ 100,000/mm^3 (transfusion independent) (50,000/mm^3 if bone marrow infiltration) Hemoglobin ≥ 8.0 g/dL (red blood cell [RBC] transfusions allowed) ALL/CML: Platelet count ≥ 20,000/mm^3 (platelet transfusions allowed) Hemoglobin ≥ 8.0 g/dL (RBC transfusions allowed) Creatinine clearance or radioisotope glomerular filtration rate ≥ 70 mL/min OR creatinine based on age, as follows: No greater than 0.6 mg/dL (1-23 months of age) No greater than 0.8 mg/dL (2- 5 years of age) No greater than 1.0 mg/dL (6-9 years of age) No greater than 1.2 mg/dL (10-12 years of age) No greater than 1.4 mg/dL (13 years of age and over [female]) No greater than 1.5 mg/dL (13-15 years of age [male]) No greater than 1.7 mg/dL (16 years of age and over [male]) Bilirubin ≤ 1.5 times upper limit of normal (ULN) ALT ≤ 110 U/L Albumin ≥ 2 g/dL Normal 12-lead EKG with corrected QTc < 450 msec AND meets 1 of the following criteria: Shortening fraction normal Ejection fraction normal No evidence of dyspnea at rest No exercise intolerance Pulse oximetry > 94% if there is a clinical indication for determination Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No uncontrolled infection No swallowing dysfunction that would prevent taking an oral or liquid medication See Disease Characteristics Recovered from prior chemotherapy, immunotherapy, or radiotherapy No myelosuppressive chemotherapy within the past 3 weeks (6 weeks for nitrosoureas) At least 7 days since prior growth factors At least 14 days since prior pegfilgrastim At least 7 days since prior biologic agents At least 2 weeks since prior local small-port palliative radiotherapy At least 3 months since prior total-body irradiation, craniospinal radiation, or radiation to ≥ 50% of the pelvis At least 6 weeks since other prior substantial bone marrow radiation At least 3 months since prior stem cell transplantation Hydroxyurea cytoreduction for Ph+ leukemia allowed provided it is discontinued 24 hours before first dose of dasatinib Prior intrathecal (IT) therapy allowed (for patients with CNS-positive leukemia) Concurrent IT therapy comprising hydrocortisone, cytarabine, methotrexate, or cytarabine (liposomal) allowed (for patients with CNS-positive leukemia) No other concurrent investigational drugs No other concurrent anticancer agents, including chemotherapy, radiotherapy, immunotherapy, or biologic therapy No concurrent enzyme-inducing anticonvulsants, including any of the following: Phenytoin Phenobarbital Carbamazepine Felbamate Primdone Oxcarbazepine No concurrent antithrombotic or antiplatelet agents, including any of the following: Warfarin Heparin Low-molecular weight heparin Aspirin Ibuprofen Other nonsteroidal anti-inflammatory drugs No concurrent CYP3A4 inhibitors, including itraconazole, ketoconazole, and voriconazole No concurrent highly active antiretroviral treatment for HIV-positive patients
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Richard Aplenc
Organizational Affiliation
Children's Oncology Group
Official's Role
Principal Investigator
Facility Information:
Facility Name
Children's Oncology Group
City
Arcadia
State/Province
California
ZIP/Postal Code
91006-3776
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Dasatinib in Treating Young Patients With Recurrent or Refractory Solid Tumors or Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia or Chronic Myelogenous Leukemia That Did Not Respond to Imatinib Mesylate

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