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Study of Vinblastine and Sirolimus in Children With Recurrent/Refractory Solid Tumours Including CNS Tumours

Primary Purpose

Solid Tumors, Central Nervous System Tumors

Status
Completed
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
Vinblastine and Sirolimus
Sponsored by
The Hospital for Sick Children
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Solid Tumors focused on measuring pediatrics, Solid Tumors, CNS Tumors, Vinblastine, Sirolimus, Recurrent, Refractory

Eligibility Criteria

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

Inclusion Criteria:

  1. Age: 0-21 years at the time of diagnosis
  2. Diagnosis: Histologic verification at either the time of original diagnosis or relapse of solid tumor including CNS tumors or lymphomas
  3. Disease Status: All refractory/recurrent solid tumors including CNS tumors (all Diffuse Intrinsic Brain Stem Gliomas excluded) and lymphomas that have relapsed after, or are refractory to, a chemotherapy-containing treatment regimen
  4. Measurable disease:

    • Measurable tumor by CT or MRI defined as >10 mm by spiral CT in at least one dimension
  5. Current disease state must be one for which there is currently no known curative therapy
  6. A negative urine pregnancy test is required for female participants of child bearing potential
  7. Organ Function Requirements:

    • adequate liver function as defined by AST or ALT < 5 x upper limit of normal, bilirubin ≤1.5 X upper limit of normal
    • adequate renal function: Serum creatinine < 1.5 X upper limit of normal for age
  8. Adequate Bone Marrow Function Defined as:

    • ANC ≥ 1000/mm3, platelets ≥ 75,000/mm3 and hemoglobin ≥ 90 g/L
    • Transfusions are permitted to meet these platelet and Hgb criteria, if the patient is known to have a history of bone marrow involvement with tumor
    • Patients with platelet counts < 75,000/ mm3 who are refractory to platelet transfusions are not eligible for this study
    • Patients requiring transfusions of platelets or RBC to meet eligibility criteria will not be evaluable for platelet or hgb/hct hematological toxicity
  9. Lansky Play Score (for patients < 16 years of age) must be more than 50 and/or ECOG performance status (for patients ≥ 16 years of age) must be 0 to 2
  10. Specific requirements for Neuroblastoma patients Stratum:

    • MIBG scan with positive uptake at minimum of one site (MIBG not required if subject's neuroblastoma is previously determined to not uptake MIBG and no measurable disease)
    • Bone marrow with tumor cells seen on routine morphology (not by NSE staining only) of bilateral aspirate and /or biopsy on one bone marrow sample
  11. Written informed consent

Exclusion Criteria:

  1. Lansky score <50%
  2. Investigational Drugs: Patients who are currently receiving another investigational drug(s)
  3. Previous treatment with Vinblastine and/or mTor inhibitors
  4. Anti-cancer Agents: Patients who are currently receiving other anticancer agents. Patients must have fully recovered from the effects of prior chemotherapy, generally at least 3 weeks from the most recent administration (6 weeks for nitrosoureas)
  5. Infection: Patients who have an uncontrolled infection are not eligible until the infection is judged to be well controlled
  6. Patients who, in the opinion of the investigator, may not be able to comply with the safety monitoring requirements of the study, or in whom compliance is likely to be suboptimal
  7. One week from usage of hematopoietic Growth Factor
  8. Patients who are refractory to platelet transfusions
  9. Brain Stem Glioma patients

Sites / Locations

  • Rady Children's Hospital-San Diego
  • SSM Cardinal Glennon Children's Medical Center
  • Fletcher Allen Health Care
  • The Hospital for Sick Children
  • CHU Sainte-Justine

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Vinblastine and Sirolimus

Arm Description

The standard 3+3 Phase 1 trial design will be used for the conduct of this study. Three to six patients can be concurrently enrolled onto a dose level. Accrual is suspended when a cohort of three has been enrolled until toxicity data for that cohort have been reported, or when the study endpoints have been met.

Outcomes

Primary Outcome Measures

Maximum tolerated dose of vinblastine in combination with sirolimus
Maximum tolerated dose (as defined by protocol) of vinblastine in combination with sirolimus

Secondary Outcome Measures

Safety data
Safety data will be described for all patients receiving at least one dose of vinblastine and sirolimus. Safety data will include values for hematology, serum chemistry, vital signs, and adverse events. The proportion of patients experiencing adverse events, serious adverse events, dose limiting toxicities and treatment delays will be summarized for each dosing cohort.
Response Rate
The proportion of patients experiencing progressive disease, stable disease, partial responses or complete responses will be summarized in tabular format. Progression free survival and duration of any responses will also be summarized.

Full Information

First Posted
June 1, 2010
Last Updated
September 17, 2019
Sponsor
The Hospital for Sick Children
Collaborators
Solving Kids' Cancer
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1. Study Identification

Unique Protocol Identification Number
NCT01135563
Brief Title
Study of Vinblastine and Sirolimus in Children With Recurrent/Refractory Solid Tumours Including CNS Tumours
Official Title
A Phase I Study of Vinblastine and Sirolimus in Pediatric Patients With Recurrent or Refractory Solid Tumors Including CNS Tumors
Study Type
Interventional

2. Study Status

Record Verification Date
September 2019
Overall Recruitment Status
Completed
Study Start Date
April 2010 (undefined)
Primary Completion Date
April 2012 (Actual)
Study Completion Date
April 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
The Hospital for Sick Children
Collaborators
Solving Kids' Cancer

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study is a Phase I study using vinblastine and sirolimus in patients with relapsed solid tumors including selected brain tumors and lymphoma. The investigators hypothesis is that the combination administration of weekly vinblastine and sirolimus is safe.
Detailed Description
Published data demonstrating a survival advantage of the vinblastine-sirolimus regimen vs single agent in an orthopotic neuroblastoma mouse model and our unpublished data support a VBL in vitro pro-apoptotic plasma concentration of 1-2 nM range and an anti angiogenic concentration of 2pM. These plasma concentrations are achievable with a 6 mg/m2 (apoptosis) and 1 mg/m2 VBL regimen (anti-angiogenesis) weekly regimen. We expect that vinblastine delivered at any given dose, as described in the protocol, will carry both anti-apoptotic and antiangiogenic activity. Safety and preliminary efficacy of both drugs in pediatric tumors support the development of a clinical trial.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Solid Tumors, Central Nervous System Tumors
Keywords
pediatrics, Solid Tumors, CNS Tumors, Vinblastine, Sirolimus, Recurrent, Refractory

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Vinblastine and Sirolimus
Arm Type
Experimental
Arm Description
The standard 3+3 Phase 1 trial design will be used for the conduct of this study. Three to six patients can be concurrently enrolled onto a dose level. Accrual is suspended when a cohort of three has been enrolled until toxicity data for that cohort have been reported, or when the study endpoints have been met.
Intervention Type
Drug
Intervention Name(s)
Vinblastine and Sirolimus
Other Intervention Name(s)
Vinblastine Sulfate Injection, Rapamune
Intervention Description
Patients will be enrolled to receive vinblastine and sirolimus in 28 day cycles. Using the 3+3 standard Phase1 design, vinblastine will be administered via IV push on Days 1, 8, 15, 22. The starting dose of 4 mg/m2 (Dose Level 1) is 67% of the established MTD (6 mg/m2) for this schedule in pediatrics. Dose escalation will take place in a standard 3+3 design, in which doses will increase by approximately 20 to 25% in successive 3-patient cohorts. Sirolimus (rapamycin) will be given by mouth (tablet or suspension) once daily throughout the cycle. Ideally patients will remain on the same dose form (tablet or suspension) for the duration of the study. All patients will be assigned a target sirolimus serum trough
Primary Outcome Measure Information:
Title
Maximum tolerated dose of vinblastine in combination with sirolimus
Description
Maximum tolerated dose (as defined by protocol) of vinblastine in combination with sirolimus
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Safety data
Description
Safety data will be described for all patients receiving at least one dose of vinblastine and sirolimus. Safety data will include values for hematology, serum chemistry, vital signs, and adverse events. The proportion of patients experiencing adverse events, serious adverse events, dose limiting toxicities and treatment delays will be summarized for each dosing cohort.
Time Frame
12 months
Title
Response Rate
Description
The proportion of patients experiencing progressive disease, stable disease, partial responses or complete responses will be summarized in tabular format. Progression free survival and duration of any responses will also be summarized.
Time Frame
12 months

10. Eligibility

Sex
All
Maximum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age: 0-21 years at the time of diagnosis Diagnosis: Histologic verification at either the time of original diagnosis or relapse of solid tumor including CNS tumors or lymphomas Disease Status: All refractory/recurrent solid tumors including CNS tumors (all Diffuse Intrinsic Brain Stem Gliomas excluded) and lymphomas that have relapsed after, or are refractory to, a chemotherapy-containing treatment regimen Measurable disease: Measurable tumor by CT or MRI defined as >10 mm by spiral CT in at least one dimension Current disease state must be one for which there is currently no known curative therapy A negative urine pregnancy test is required for female participants of child bearing potential Organ Function Requirements: adequate liver function as defined by AST or ALT < 5 x upper limit of normal, bilirubin ≤1.5 X upper limit of normal adequate renal function: Serum creatinine < 1.5 X upper limit of normal for age Adequate Bone Marrow Function Defined as: ANC ≥ 1000/mm3, platelets ≥ 75,000/mm3 and hemoglobin ≥ 90 g/L Transfusions are permitted to meet these platelet and Hgb criteria, if the patient is known to have a history of bone marrow involvement with tumor Patients with platelet counts < 75,000/ mm3 who are refractory to platelet transfusions are not eligible for this study Patients requiring transfusions of platelets or RBC to meet eligibility criteria will not be evaluable for platelet or hgb/hct hematological toxicity Lansky Play Score (for patients < 16 years of age) must be more than 50 and/or ECOG performance status (for patients ≥ 16 years of age) must be 0 to 2 Specific requirements for Neuroblastoma patients Stratum: MIBG scan with positive uptake at minimum of one site (MIBG not required if subject's neuroblastoma is previously determined to not uptake MIBG and no measurable disease) Bone marrow with tumor cells seen on routine morphology (not by NSE staining only) of bilateral aspirate and /or biopsy on one bone marrow sample Written informed consent Exclusion Criteria: Lansky score <50% Investigational Drugs: Patients who are currently receiving another investigational drug(s) Previous treatment with Vinblastine and/or mTor inhibitors Anti-cancer Agents: Patients who are currently receiving other anticancer agents. Patients must have fully recovered from the effects of prior chemotherapy, generally at least 3 weeks from the most recent administration (6 weeks for nitrosoureas) Infection: Patients who have an uncontrolled infection are not eligible until the infection is judged to be well controlled Patients who, in the opinion of the investigator, may not be able to comply with the safety monitoring requirements of the study, or in whom compliance is likely to be suboptimal One week from usage of hematopoietic Growth Factor Patients who are refractory to platelet transfusions Brain Stem Glioma patients
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sylvain Baruchel, MD
Organizational Affiliation
The Hospital for Sick Children, Toronto Canada
Official's Role
Principal Investigator
Facility Information:
Facility Name
Rady Children's Hospital-San Diego
City
San Diego
State/Province
California
ZIP/Postal Code
92123
Country
United States
Facility Name
SSM Cardinal Glennon Children's Medical Center
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63104
Country
United States
Facility Name
Fletcher Allen Health Care
City
Burlington
State/Province
Vermont
ZIP/Postal Code
05401
Country
United States
Facility Name
The Hospital for Sick Children
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 1X8
Country
Canada
Facility Name
CHU Sainte-Justine
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H3T 1C5
Country
Canada

12. IPD Sharing Statement

Citations:
PubMed Identifier
23956145
Citation
Morgenstern DA, Marzouki M, Bartels U, Irwin MS, Sholler GL, Gammon J, Yankanah R, Wu B, Samson Y, Baruchel S. Phase I study of vinblastine and sirolimus in pediatric patients with recurrent or refractory solid tumors. Pediatr Blood Cancer. 2014 Jan;61(1):128-33. doi: 10.1002/pbc.24656. Epub 2013 Aug 17.
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Study of Vinblastine and Sirolimus in Children With Recurrent/Refractory Solid Tumours Including CNS Tumours

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