Preventative Trial of Difluoromethylornithine (DFMO) in High Risk Patients With Neuroblastoma That is in Remission
Primary Purpose
Neuroblastoma
Status
Active
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
DFMO
Sponsored by
About this trial
This is an interventional prevention trial for Neuroblastoma focused on measuring Neuroblastoma in remission, Relapsed Neuroblastoma, Refractory Neuroblastoma
Eligibility Criteria
Inclusion Criteria:
- Age: 0-21 years at the time of diagnosis.
- Diagnosis: histologic verification at either the time of original diagnosis or a previous relapse of high risk neuroblastoma.
- Disease Status: Neuroblastoma that is in remission
- First dose of study medication must be greater than 30 days from completion of cytotoxic and antibody therapy and less than 120 days from previous therapy
- A negative serum or urine pregnancy test is required for female subjects of child bearing potential (onset of menses or ≥13 years of age).
- Both male and female post-pubertal study subjects need to agree to use one of the more effective birth control methods during treatment and for six months after treatment is stopped. These methods include total abstinence (no sex), oral contraceptives ("the pill"), an intrauterine device (IUD), levonorgestrel implants (Norplant), or medroxyprogesterone acetate injections (Depo-provera shots). If one of these cannot be used, contraceptive foam with a condom is recommended.
- Absolute Neutrophil Count (ANC) > 500/μl and platelet count >50,000/μl
Organ Function Requirements: Subjects must have adequate liver function as defined by:
- Aspartate Aminotransferase (AST) and Alanine transaminase (ALT) <10x upper limit of normal
- Serum bilirubin must be ≤ 2.0 mg/dl
- Serum creatinine based on age/gender
- Informed Consent: All subjects and/or legal guardians must sign informed written consent. Assent, when appropriate, will be obtained according to institutional guidelines
Exclusion Criteria:
- Lansky score < 60%
- Body Surface Area (BSA) (m2) of <0.25
- Investigational Drugs: Subjects who are currently receiving another investigational drug are excluded from participation.
- Anti-cancer Agents: Subjects who are currently receiving other anticancer agents are not eligible. Subjects must have fully recovered from the effects of prior chemotherapy (hematological and bone marrow suppression effects).
- Infection: Subjects who have an uncontrolled infection are not eligible until the infection is judged to be well controlled in the opinion of the investigator.
- Subjects 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, should be excluded.
Sites / Locations
- Phoenix Children's Hospital
- Arkansas Children's Hospital
- Rady Children's Hospital
- Connecticut Children's Hospital
- Arnold Palmer Hospital for Children
- All Children's Hospital Johns Hopkins Medicine
- Kapiolani Medical Center for Women and Children
- Tufts Medical Center
- Helen DeVos Children's Hospital
- Children's Hospital and Clinics on Minnesota
- Children's Mercy Hospitals and Clinics
- Cardinal Glennon Children's Medical Center
- The Children's Hospital at Montefiore
- Levine Children's Hospital
- Nationwide Children's Hospital
- Penn State Milton S. Hershey Medical Center and Children's Hospital
- Medical University of South Carolina
- Monroe Carrell Jr. Children's Hospital at Vanderbilt
- Dell Children's Blood and Cancer Center
- Children's Medical Center
- Texas Children's Cancer and Hematology Centers
- Primary Children's Hospital
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
DFMO twice daily
Arm Description
Subjects will receive twenty-seven (27) cycles of oral DFMO at a dose of 500 to 1000 mg/m2 BID on each day of a 28 day cycle.
Outcomes
Primary Outcome Measures
Number of Participants With Event Free Survival (EFS) During Study.
To evaluate the preventative activity of DFMO as a single agent in patients that are in remission based on: Event free survival (EFS)
Secondary Outcome Measures
Percentage of Participants With Overall Survival (OS)
To evaluate the preventative activity of DFMO as a single agent in patients with neuroblastoma who are in remission based on: Overall Survival (OS)
Number of Participants With Adverse Events as a Measure of Safety and Tolerability
To continue to determine the safety and tolerability of DFMO as a single agent and in pediatric and young adult patients with high risk neuroblastoma that is in remission.
Test the Association of Survival With ODC1 Genotype
Tests (p-value) of the association of survival with ODC1 single nucleotide polymorphism rs2302616 genotype.
Blood: microRNA analysis as predictor of DFMO effect, ornithine decarboxylase (ODC) single nucleotide polymorphism (SNP) analysis in DNA isolated from nucleated cells
Circulating Tumor Cell Analysis
circulating tumor cell analysis
Peak Plasma Concentration (Cmax)
Pharmacokinetic assay Cmax/D
Samples drawn at 5 timepoints: (0 (pre dose), 30min, 1 hour, 3 hours, and 6 hours post-dose) on two different days.
Area Under the Plasma Concentration Versus Time Curve (AUC)
Pharmacokinetic assay AUC(0-6 hr)/D
Samples drawn at 5 timepoints: (0 (pre dose), 30min, 1 hour, 3 hours, and 6 hours post-dose) on two different days
Time to Reach Peak Plasma Concentration (Tmax)
Pharmacokinetic assay- tmax, hr
Samples drawn at 5 timepoints: (0 (pre dose), 30min, 1 hour, 3 hours, and 6 hours post-dose) on two different days
Full Information
NCT ID
NCT02395666
First Posted
March 5, 2015
Last Updated
September 26, 2023
Sponsor
Giselle Sholler
Collaborators
Beat NB Cancer Foundation, Because of Ezra, K C Pharmaceuticals Inc.
1. Study Identification
Unique Protocol Identification Number
NCT02395666
Brief Title
Preventative Trial of Difluoromethylornithine (DFMO) in High Risk Patients With Neuroblastoma That is in Remission
Official Title
A Phase II Preventative Trial of DFMO (Eflornithine HCl) as a Single Agent in Patients With High Risk Neuroblastoma in Remission
Study Type
Interventional
2. Study Status
Record Verification Date
September 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
March 5, 2015 (Actual)
Primary Completion Date
March 1, 2018 (Actual)
Study Completion Date
October 30, 2023 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Giselle Sholler
Collaborators
Beat NB Cancer Foundation, Because of Ezra, K C Pharmaceuticals Inc.
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The purpose of this research study is to evaluate a new investigational drug to prevent reoccurrence of neuroblastoma that is in remission. This study drug is called DFMO. The objectives of this study will be to monitor for safety and look at efficacy of DFMO.
The safety of the proposed dosing regimen in this trial will be tested by an on-going risk/benefit assessment during the study. A patient benefiting from treatment, not progressing on therapy, and in the absence of any safety issues associated with DFMO may continue on treatment up to 27 cycles with the expectation that there will be an overall clinical benefit.
The procedures involved in this study include Medical history, Physical exam, Vital signs (blood pressure, pulse, temperature), Blood tests, Urine tests, MRI or CT scan of the tumor(s), meta-iodobenzylguanidine (MIBG) scans, and Bone marrow aspirations. All of these tests and procedures are considered standard of care for this population. Drug administration is also part of this protocol, including an investigational new drug called DFMO.
The proposed dosing regimen is an oral dose of DFMO tablets two times a day for each day while on study. There will be 27 cycles. Each cycle will be 28 days in length.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Neuroblastoma
Keywords
Neuroblastoma in remission, Relapsed Neuroblastoma, Refractory Neuroblastoma
7. Study Design
Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
140 (Actual)
8. Arms, Groups, and Interventions
Arm Title
DFMO twice daily
Arm Type
Experimental
Arm Description
Subjects will receive twenty-seven (27) cycles of oral DFMO at a dose of 500 to 1000 mg/m2 BID on each day of a 28 day cycle.
Intervention Type
Drug
Intervention Name(s)
DFMO
Other Intervention Name(s)
eflornithine HCl, Difluoromethylornithine
Intervention Description
Subjects will receive twenty-seven (27) cycles of oral DFMO at a dose of 500 to 1000 mg/m2 BID on each day of a 28 day cycle.
Primary Outcome Measure Information:
Title
Number of Participants With Event Free Survival (EFS) During Study.
Description
To evaluate the preventative activity of DFMO as a single agent in patients that are in remission based on: Event free survival (EFS)
Time Frame
2 Years
Secondary Outcome Measure Information:
Title
Percentage of Participants With Overall Survival (OS)
Description
To evaluate the preventative activity of DFMO as a single agent in patients with neuroblastoma who are in remission based on: Overall Survival (OS)
Time Frame
2 Years
Title
Number of Participants With Adverse Events as a Measure of Safety and Tolerability
Description
To continue to determine the safety and tolerability of DFMO as a single agent and in pediatric and young adult patients with high risk neuroblastoma that is in remission.
Time Frame
2 years
Title
Test the Association of Survival With ODC1 Genotype
Description
Tests (p-value) of the association of survival with ODC1 single nucleotide polymorphism rs2302616 genotype.
Blood: microRNA analysis as predictor of DFMO effect, ornithine decarboxylase (ODC) single nucleotide polymorphism (SNP) analysis in DNA isolated from nucleated cells
Time Frame
2 years
Title
Circulating Tumor Cell Analysis
Description
circulating tumor cell analysis
Time Frame
5 years
Title
Peak Plasma Concentration (Cmax)
Description
Pharmacokinetic assay Cmax/D
Samples drawn at 5 timepoints: (0 (pre dose), 30min, 1 hour, 3 hours, and 6 hours post-dose) on two different days.
Time Frame
Samples drawn at 5 timepoints: (0 (pre dose), 30min, 1 hour, 3 hours, and 6 hours post-dose) on two different days
Title
Area Under the Plasma Concentration Versus Time Curve (AUC)
Description
Pharmacokinetic assay AUC(0-6 hr)/D
Samples drawn at 5 timepoints: (0 (pre dose), 30min, 1 hour, 3 hours, and 6 hours post-dose) on two different days
Time Frame
0 (pre dose), 30min, 1 hour, 3 hours, and 6 hours post-dose on two different days
Title
Time to Reach Peak Plasma Concentration (Tmax)
Description
Pharmacokinetic assay- tmax, hr
Samples drawn at 5 timepoints: (0 (pre dose), 30min, 1 hour, 3 hours, and 6 hours post-dose) on two different days
Time Frame
0 (pre dose), 30min, 1 hour, 3 hours, and 6 hours post-dose on two different days
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 a previous relapse of high risk neuroblastoma.
Disease Status: Neuroblastoma that is in remission
First dose of study medication must be greater than 30 days from completion of cytotoxic and antibody therapy and less than 120 days from previous therapy
A negative serum or urine pregnancy test is required for female subjects of child bearing potential (onset of menses or ≥13 years of age).
Both male and female post-pubertal study subjects need to agree to use one of the more effective birth control methods during treatment and for six months after treatment is stopped. These methods include total abstinence (no sex), oral contraceptives ("the pill"), an intrauterine device (IUD), levonorgestrel implants (Norplant), or medroxyprogesterone acetate injections (Depo-provera shots). If one of these cannot be used, contraceptive foam with a condom is recommended.
Absolute Neutrophil Count (ANC) > 500/μl and platelet count >50,000/μl
Organ Function Requirements: Subjects must have adequate liver function as defined by:
Aspartate Aminotransferase (AST) and Alanine transaminase (ALT) <10x upper limit of normal
Serum bilirubin must be ≤ 2.0 mg/dl
Serum creatinine based on age/gender
Informed Consent: All subjects and/or legal guardians must sign informed written consent. Assent, when appropriate, will be obtained according to institutional guidelines
Exclusion Criteria:
Lansky score < 60%
Body Surface Area (BSA) (m2) of <0.25
Investigational Drugs: Subjects who are currently receiving another investigational drug are excluded from participation.
Anti-cancer Agents: Subjects who are currently receiving other anticancer agents are not eligible. Subjects must have fully recovered from the effects of prior chemotherapy (hematological and bone marrow suppression effects).
Infection: Subjects who have an uncontrolled infection are not eligible until the infection is judged to be well controlled in the opinion of the investigator.
Subjects 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, should be excluded.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Giselle Saulnier-Sholler, MD
Organizational Affiliation
Beat Childhood Cancer
Official's Role
Study Chair
Facility Information:
Facility Name
Phoenix Children's Hospital
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85016
Country
United States
Facility Name
Arkansas Children's Hospital
City
Little Rock
State/Province
Arkansas
ZIP/Postal Code
72202
Country
United States
Facility Name
Rady Children's Hospital
City
San Diego
State/Province
California
ZIP/Postal Code
92123
Country
United States
Facility Name
Connecticut Children's Hospital
City
Hartford
State/Province
Connecticut
ZIP/Postal Code
06106
Country
United States
Facility Name
Arnold Palmer Hospital for Children
City
Orlando
State/Province
Florida
ZIP/Postal Code
32806
Country
United States
Facility Name
All Children's Hospital Johns Hopkins Medicine
City
Saint Petersburg
State/Province
Florida
ZIP/Postal Code
33701
Country
United States
Facility Name
Kapiolani Medical Center for Women and Children
City
Honolulu
State/Province
Hawaii
ZIP/Postal Code
96813
Country
United States
Facility Name
Tufts Medical Center
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02111
Country
United States
Facility Name
Helen DeVos Children's Hospital
City
Grand Rapids
State/Province
Michigan
ZIP/Postal Code
49503
Country
United States
Facility Name
Children's Hospital and Clinics on Minnesota
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55404
Country
United States
Facility Name
Children's Mercy Hospitals and Clinics
City
Kansas City
State/Province
Missouri
ZIP/Postal Code
64108
Country
United States
Facility Name
Cardinal Glennon Children's Medical Center
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63104
Country
United States
Facility Name
The Children's Hospital at Montefiore
City
Bronx
State/Province
New York
ZIP/Postal Code
10467
Country
United States
Facility Name
Levine Children's Hospital
City
Charlotte
State/Province
North Carolina
ZIP/Postal Code
28204
Country
United States
Facility Name
Nationwide Children's Hospital
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43205
Country
United States
Facility Name
Penn State Milton S. Hershey Medical Center and Children's Hospital
City
Hershey
State/Province
Pennsylvania
ZIP/Postal Code
17033
Country
United States
Facility Name
Medical University of South Carolina
City
Charleston
State/Province
South Carolina
ZIP/Postal Code
29425
Country
United States
Facility Name
Monroe Carrell Jr. Children's Hospital at Vanderbilt
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37232
Country
United States
Facility Name
Dell Children's Blood and Cancer Center
City
Austin
State/Province
Texas
ZIP/Postal Code
78723
Country
United States
Facility Name
Children's Medical Center
City
Dallas
State/Province
Texas
ZIP/Postal Code
75235
Country
United States
Facility Name
Texas Children's Cancer and Hematology Centers
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
Primary Children's Hospital
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84113
Country
United States
12. IPD Sharing Statement
Citations:
PubMed Identifier
34522028
Citation
Urban-Wojciuk Z, Graham A, Barker K, Kwok C, Sbirkov Y, Howell L, Campbell J, Woster PM, Poon E, Petrie K, Chesler L. The biguanide polyamine analog verlindamycin promotes differentiation in neuroblastoma via induction of antizyme. Cancer Gene Ther. 2022 Jul;29(7):940-950. doi: 10.1038/s41417-021-00386-6. Epub 2021 Sep 14.
Results Reference
derived
PubMed Identifier
32506485
Citation
Batth IS, Dao L, Satelli A, Mitra A, Yi S, Noh H, Li H, Brownlee Z, Zhou S, Bond J, Wang J, Gill J, Sholler GS, Li S. Cell surface vimentin-positive circulating tumor cell-based relapse prediction in a long-term longitudinal study of postremission neuroblastoma patients. Int J Cancer. 2020 Dec 15;147(12):3550-3559. doi: 10.1002/ijc.33140. Epub 2020 Jun 23. Erratum In: Int J Cancer. 2021 Mar 15;148(6):E6.
Results Reference
derived
PubMed Identifier
32391579
Citation
Lewis EC, Kraveka JM, Ferguson W, Eslin D, Brown VI, Bergendahl G, Roberts W, Wada RK, Oesterheld J, Mitchell D, Foley J, Zage P, Rawwas J, Rich M, Lorenzi E, Broglio K, Berry D, Saulnier Sholler GL. A subset analysis of a phase II trial evaluating the use of DFMO as maintenance therapy for high-risk neuroblastoma. Int J Cancer. 2020 Dec 1;147(11):3152-3159. doi: 10.1002/ijc.33044. Epub 2020 May 24.
Results Reference
derived
Links:
URL
http://www.beatcc.org
Description
Beat Childhood Cancer Consortium website
Learn more about this trial
Preventative Trial of Difluoromethylornithine (DFMO) in High Risk Patients With Neuroblastoma That is in Remission
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