Vorinostat and Radiation Therapy Followed by Maintenance Therapy With Vorinostat in Treating Younger Patients With Newly Diagnosed Diffuse Intrinsic Pontine Glioma
Anaplastic Astrocytoma, Anaplastic Oligoastrocytoma, Diffuse Intrinsic Pontine Glioma
About this trial
This is an interventional treatment trial for Anaplastic Astrocytoma
Eligibility Criteria
Inclusion Criteria:
- Patients with newly diagnosed diffuse intrinsic pontine gliomas (DIPGs), defined as tumors with a pontine epicenter and diffuse involvement of at least 2/3 of the pons, are eligible without histologic confirmation; patients with brainstem tumors that do not meet these criteria or not considered to be typical intrinsic pontine gliomas will only be eligible if the tumors are biopsied and proven to be an anaplastic astrocytoma, glioblastoma multiforme, gliosarcoma, or anaplastic mixed glioma; patients with juvenile pilocytic astrocytoma, fibrillary astrocytoma, gangliogliomas, or other mixed gliomas without anaplasia are not eligible; patients with disseminated disease are not eligible, and magnetic resonance imaging (MRI) of spine must be performed if disseminated disease is suspected by the treating physician
- Karnofsky >= 50% for patients > 16 years of age and Lansky >= 50 for patients =< 16 years of age; patients who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered ambulatory for the purpose of assessing the performance score
- Patients must not have received any prior treatment except dexamethasone and/or surgery
- Peripheral absolute neutrophil count (ANC) >= 1000/uL
- Platelet count >= 100,000/uL (transfusion independent, defined as not receiving platelet transfusions within a 7 day period prior to enrollment)
- Hemoglobin >= 8.0 g/dL (may receive red blood cell [RBC] transfusions)
Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70ml/min/1.73 m^2 or a serum creatinine based on age/gender as follows:
- 0.8 mg/dL (3 to < 6 years of age)
- 1 mg/dL (6 to < 10 years of age)
- 1.2 mg/dL (10 to < 13 years of age)
- 1.5 mg/dL (male) or 1.4 mg/dL (female) (13 to < 16 years of age)
- 1.7 mg/dL (male) or 1.4 mg/dL (female) (>= 16 years of age)
- Bilirubin (sum of conjugated + unconjugated) =< 1.5 x upper limit of normal (ULN) for age
- Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 110 U/L; for the purpose of this study, the ULN for SGPT (ALT) is 45 U/L
- Serum albumin >= 2 g/dL
- Patients with seizure disorder may be enrolled if on non-enzyme inducing anticonvulsants (with the exception of valproic acid) and seizures are well controlled
- Patients must be able to swallow capsules or liquids; patients dependent on nasogastric (NG) tube feeding are not permitted to receive protocol therapy
- Enrollment must be no later than 28 days after the date of radiographic diagnosis or surgery, whichever is the later date
Exclusion Criteria:
- Pregnant or breast-feeding women will not be entered on this study; pregnancy tests must be obtained in girls who are post-menarchal; males or females of reproductive potential may not participate unless they have agreed to use an effective contraceptive method
- Growth factors that support platelet or white cell number or function must not have been administered within the 7 days prior to enrollment
- Patients who are currently receiving another investigational drug are not eligible
- Patients who are currently receiving other anti-cancer agents are not eligible
- Patients must not currently be receiving enzyme inducing anticonvulsants
- Patients on valproic acid must discontinue valproic acid for at least 2 weeks before starting protocol therapy
- Patients receiving coumadin, heparin, low-molecular weight heparin, or any other anti-coagulants are not eligible for study entry
- Patients receiving acetylsalicylic acid (ASA) (> 81 mg/day), non-steroidal anti-inflammatory drugs, clopidogrel (Plavix), dipyridamole (Persantine), or any other drug that inhibits platelet function are not eligible for study entry
- Patients who have an uncontrolled infection are not eligible
- Patients who in the opinion of the investigator may not be able to comply with the safety monitoring requirements of the study are not eligible
Sites / Locations
- Children's Hospital of Alabama
- University of Alabama at Birmingham Cancer Center
- Providence Hospital
- Arkansas Children's Hospital
- University of Arkansas for Medical Sciences
- Highlands Oncology Group
- Kaiser Permanente-Deer Valley Medical Center
- Kaiser Permanente Downey Medical Center
- Kaiser Permanente-Fremont
- Kaiser Permanente-Fresno
- Miller Children's and Women's Hospital Long Beach
- Cedars Sinai Medical Center
- Valley Children's Hospital
- Contra Costa Regional Medical Center
- El Camino Hospital
- Highland General Hospital
- Alta Bates Summit Medical Center - Summit Campus
- Bay Area Tumor Institute
- UCSF Benioff Children's Hospital Oakland
- Kaiser Permanente-Oakland
- Children's Hospital of Orange County
- Kaiser Permanente-Redwood City
- Kaiser Permanente-Richmond
- Kaiser Permanente-Roseville
- Kaiser Permanente-South Sacramento
- Kaiser Permanente - Sacramento
- Rady Children's Hospital - San Diego
- Kaiser Permanente-San Francisco
- UCSF Medical Center-Parnassus
- UCSF Medical Center-Mission Bay
- Kaiser Permanente-Santa Teresa-San Jose
- Kaiser Permanente San Leandro
- Doctors Medical Center- JC Robinson Regional Cancer Center
- Kaiser Permanente-San Rafael
- Kaiser Permanente Medical Center - Santa Clara
- Kaiser Permanente-Santa Rosa
- Kaiser Permanente-South San Francisco
- Kaiser Permanente-Stockton
- Kaiser Permanente Medical Center-Vacaville
- Kaiser Permanente-Vallejo
- Kaiser Permanente-Walnut Creek
- Children's Hospital Colorado
- Smilow Cancer Hospital Care Center at Saint Francis
- Alfred I duPont Hospital for Children
- Children's National Medical Center
- Lee Memorial Health System
- Golisano Children's Hospital of Southwest Florida
- Nemours Children's Clinic-Jacksonville
- AdventHealth Orlando
- Arnold Palmer Hospital for Children
- Nemours Children's Clinic - Orlando
- Orlando Health Cancer Institute
- Nemours Children's Hospital
- Nemours Children's Clinic - Pensacola
- Johns Hopkins All Children's Hospital
- Children's Healthcare of Atlanta - Egleston
- Memorial Health University Medical Center
- University of Hawaii Cancer Center
- Kaiser Permanente Moanalua Medical Center
- Saint Alphonsus Cancer Care Center-Boise
- Saint Anthony's Health
- Lurie Children's Hospital-Chicago
- Decatur Memorial Hospital
- Loyola University Medical Center
- Good Samaritan Regional Health Center
- Edward Hospital/Cancer Center
- Saint Jude Midwest Affiliate
- Memorial Medical Center
- Riley Hospital for Children
- Blank Children's Hospital
- Baptist Health Lexington
- University of Kentucky/Markey Cancer Center
- Norton Children's Hospital
- Dana-Farber Cancer Institute
- Michigan Cancer Research Consortium NCORP
- Saint Joseph Mercy Hospital
- C S Mott Children's Hospital
- Beaumont Hospital - Dearborn
- Ascension Saint John Hospital
- Hurley Medical Center
- Genesys Regional Medical Center-West Flint Campus
- Helen DeVos Children's Hospital at Spectrum Health
- Allegiance Health
- Sparrow Hospital
- Saint Mary Mercy Hospital
- Saint Joseph Mercy Oakland
- Lake Huron Medical Center
- Ascension Saint Mary's Hospital
- Saint John Macomb-Oakland Hospital
- University of Minnesota/Masonic Cancer Center
- University of Mississippi Medical Center
- Singing River Hospital
- Saint Francis Medical Center
- Children's Mercy Hospitals and Clinics
- Cardinal Glennon Children's Medical Center
- Saint Louis Cancer and Breast Institute-South City
- Washington University School of Medicine
- Saint Louis-Cape Girardeau CCOP
- Cancer Research for the Ozarks NCORP
- Mercy Hospital Springfield
- CoxHealth South Hospital
- Billings Clinic Cancer Center
- Saint Vincent Healthcare
- Montana Cancer Consortium NCORP
- Saint Vincent Frontier Cancer Center
- Bozeman Deaconess Hospital
- Benefis Healthcare- Sletten Cancer Institute
- Great Falls Clinic
- Saint Peter's Community Hospital
- Glacier Oncology PLLC
- Kalispell Regional Medical Center
- Saint Patrick Hospital - Community Hospital
- CHI Health Good Samaritan
- Morristown Medical Center
- Saint Peter's University Hospital
- Newark Beth Israel Medical Center
- Overlook Hospital
- University of New Mexico Cancer Center
- Montefiore Medical Center - Moses Campus
- Roswell Park Cancer Institute
- Laura and Isaac Perlmutter Cancer Center at NYU Langone
- NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
- Mission Hospital
- Carolinas Medical Center/Levine Cancer Institute
- Wayne Memorial Hospital
- Margaret R Pardee Memorial Hospital
- Iredell Memorial Hospital
- Southeast Clinical Oncology Research Consortium NCORP
- Wake Forest University Health Sciences
- Cleveland Clinic Akron General
- Children's Hospital Medical Center of Akron
- Cincinnati Children's Hospital Medical Center
- Nationwide Children's Hospital
- Saint Charles Health System
- Legacy Emanuel Children's Hospital
- Oregon Health and Science University
- Penn State Children's Hospital
- Children's Hospital of Philadelphia
- AnMed Health Hospital
- Prisma Health Richland Hospital
- Saint Francis Hospital
- BI-LO Charities Children's Cancer Center
- Greenville Cancer Treatment Center
- Carolina Blood and Cancer Care Associates PA-Lancaster
- Spartanburg Medical Center
- Saint Jude Children's Research Hospital
- Vanderbilt University/Ingram Cancer Center
- Driscoll Children's Hospital
- Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
- Methodist Children's Hospital of South Texas
- Primary Children's Hospital
- Children's Hospital of The King's Daughters
- Cancer Care Center at Island Hospital
- PeaceHealth Saint Joseph Medical Center
- Harrison HealthPartners Hematology and Oncology-Bremerton
- Highline Medical Center-Main Campus
- Kadlec Clinic Hematology and Oncology
- Skagit Valley Hospital
- Harrison HealthPartners Hematology and Oncology-Poulsbo
- Harborview Medical Center
- Minor and James Medical PLLC
- Seattle Children's Hospital
- Fred Hutchinson Cancer Research Center
- Kaiser Permanente Washington
- Swedish Medical Center-First Hill
- University of Washington Medical Center - Montlake
- PeaceHealth United General Medical Center
- Cancer Care Northwest - Spokane South
- Evergreen Hematology and Oncology PS
- Mary Bridge Children's Hospital and Health Center
- Wenatchee Valley Hospital and Clinics
- North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
- Children's Hospital of Wisconsin
- Welch Cancer Center
- Royal Children's Hospital-Brisbane
- Queensland Children's Hospital
- Princess Margaret Hospital for Children
- Hospital for Sick Children
- The Montreal Children's Hospital of the MUHC
- Centre Hospitalier Universitaire Sainte-Justine
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
Experimental
Arm 1 Phase I Vorinostat 180 mg/m^2
Arm 2 Phase 1 Vorinostat 230 mg/m^2
Arm 3 Phase II Evaluation Vorinostat 230 mg/m^2
Patients in phase I received vorinostat at 180 mg/m^2/day PO on Monday through Friday weekly for the duration of radiation therapy (6-7 weeks). Patients underwent 3D conformal or intensity-modulated radiation therapy 5 days per week for 6 weeks. After completing concurrent vorinostat and radiation therapy, patients then received maintenance therapy comprising of vorinostat at 230 mg/m^2/day PO on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.
Patients received a higher dose of vorinostat at 230 mg/m^2/day PO on Monday through Friday weekly for the duration of radiation therapy (6-7 weeks). Patients underwent 3D conformal or intensity-modulated radiation therapy 5 days per week for 6 weeks. After completing concurrent vorinostat and radiation therapy, patients then received maintenance therapy comprising of vorinostat at 230 mg/m^2/day PO on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.
Patients received a higher dose of vorinostat at 230 mg/m^2/day PO on Monday through Friday weekly for the duration of radiation therapy (6-7 weeks). Patients underwent 3D conformal or intensity-modulated radiation therapy 5 days per week for 6 weeks. After completing concurrent vorinostat and radiation therapy, patients then received maintenance therapy comprising of vorinostat at 230 mg/m^2/ day PO on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.