search
Back to results

Therapy Optimization Trial for the Treatment of Relapsed or Refractory Brain Tumors in Children (HIT-REZ-2005)

Primary Purpose

Recurrent Brain Tumors, Supratentorial PNETs, Medulloblastomas

Status
Completed
Phase
Phase 2
Locations
Germany
Study Type
Interventional
Intervention
carboplatin
etoposide
temozolomide
thiotepa, carboplatin, etoposide
temozolomide, thiotepa
autologous stem cell transplantation
intraventricular etoposide
trofosfamide, etoposide
Sponsored by
University Hospital, Bonn
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Recurrent Brain Tumors focused on measuring brain tumor, relapse, children, etoposide, intraventricular, temozolomide

Eligibility Criteria

3 Months - 30 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Disease Characteristics

  • Histologically confirmed Medulloblastoma, cerebral PNET or Ependymoma
  • Refractory or relapsed disease
  • Measurable disease by MRI or detection of tumor cells in cerebrospinal fluid Patients characteristics
  • Performance status ECOG ≥ 3 or Karnofsky Status ≥ 40%
  • Life expectancy ≥ 8 weeks

Hematological:

  • Absolute leukocyte count ≥ 2.0 x 10^9 /l
  • Hemoglobin ≥ 10g/dl
  • Platelet count ≥ 70 x 10^9/l

Renal:

  • Creatinine no greater than 1.5 times UNL
  • No overt renal disease

Hepatic:

  • Bilirubin less than 2.5 times UNL
  • AST and ALT less than 5 times UNL
  • No overt hepatic disease

Pulmonary:

  • No overt pulmonary disease

Cardiovascular:

  • No overt cardiovascular disease

Other:

  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • No uncontrolled infection Prior concurrent therapy
  • More than 2 weeks since prior systemic chemotherapy
  • More than 4 weeks since prior radiotherapy
  • No other concurrent anticancer or experimental drugs Examinations required
  • Examination of lumbar CSF
  • Cranial and spinal MRI within 14 days prior to start of treatment

Sites / Locations

  • Universitätskinderklinik Aachen
  • Klinikum Augsburg, Klinik für Kinder- und Jugendmedizin
  • Helios Klinikum Berlin-Buch, Klinik für Kinderheilkunde und Jugendmedizin
  • Charité Klinikum Campus Virchow, Kinderklinik
  • Klinik ür Kinder- und Jugendmedizin in Bethel
  • Universitätskinderklinik Bonn
  • Städtisches Klinikum Braunschweig, Kinderklinik
  • Klinikum Bremen-Mitte
  • Carl-Thiele-Klinikum Cottbus, Zentrum für Kinderheilkunde
  • Vestische Kinder- und Jugendklinik Datteln
  • Klinikum Dortmund, Klinik für Kinder- und Jugendmedizin
  • Universitätsklinikum Dresden, Kinderklinik
  • Klinikum Duisburg, Klinik für Kinder-und Jugendmedizin
  • Universitätskinderklinik Düsseldorf
  • Helios Klinikum Erfurt, Zentrum für Kinderheilkunde
  • Universitätskinderklinik Erlangen
  • Universitätskinderklinik Essen
  • Klinikum der Wolfgang Goethe Universität, Klinik für Kinderheilkunde
  • Universitätskinderklinik Freiburg
  • Universitätsklinikum Gießen und Marburg, Zentrum für Kinderheilkunde
  • Universitätskinderklinik Greifswald
  • Universitätskinderklinik Göttingen
  • Martin-Luther-Universität Halle Wittenberg
  • Universitätskinderklinik Hamburg-Eppendorf
  • Medizinische Hochschule, Zentrum für Kinderheilkunde
  • Universitätskinderklinik Heidelberg
  • SLK Kinderklinik Heilbronn
  • Gemeinschaftskrankenhaus Herdecke, Kinderklinik
  • Universitätskinderklinik
  • Friedrich Schiller Universität, Klinik für Kinder-und Jugendmedizin
  • Städtisches Krankenhaus, Klinik für Kinder- und Jugendmedizin
  • Klinikum Kassel, Kinderklinik
  • UKSH, Campus Kiel, Klinik für Allg. Pädiatrie
  • Städtisches Klinikum Kemperhof, Klinik für Kinder- und Jugendmedizin
  • Universitätskinderklinik Köln
  • Universitätskinderklinik Leipzig
  • Universitätskinderklinik Lübeck
  • Otto-von-Guericke-Universität, Zentrum für Kinderheilkunde
  • Universitätskinderklinik Mainz
  • Universitätskinderklinik Mannheim
  • Universitätskinderklinik Marburg
  • Klinikum Minden III, Klinik für Kinder-und Jugendheilkunde
  • Dr. von Haunersches Kinderspital
  • Städtisches Krankenhaus München-Schwabing, Kinderklinik der TU München
  • Universitätskinderklinik Münster
  • Cnopf'sche Kinderklinik
  • Klinikum Oldenburg, Zentrum für Kinder-und Jugendmedizin
  • Universitäts-Kinderklinik
  • Universitätskinderklinik Rostock
  • Asklepios Klinik Sankt Augustin GmbH
  • Olgahospital-Pädiatrisches Zentrum
  • Universitätskinderklinik Tübingen
  • Univeritätsklinikum Ulm, Abteilung Kinder-und Jugendmedizin
  • Universitätskinderklinik Würzburg

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Experimental

Arm Label

1: P-HIT-REZ 2005

2: P-HIT-REZ 2005

3: E-HIT-REZ 2005

Intraventricular Etoposide

Arm Description

intravenous chemotherapy with carboplatin/etoposide,followed by high dose chemotherapy with thiotepa, carboplatin, etoposide and autologous stem cell transplantation if patient have achieved a complete remission or maintenance therapy with oral trofosfamide, etoposide

oral chemotherapy with temozolomide, followed by high dose chemotherapy with temozolomide, thiotepa and autologous stem cell transplantation if patient have achieved a complete remission maintenance therapy with oral temozolomide or in case of progression with oral trofosfamide, etoposide

Phase II: oral chemotherapy with temozolomide after progression oral trofosfamide, etoposide

Phase II, intraventricular chemotherapy with etoposide

Outcomes

Primary Outcome Measures

P-HIT-REZ 2005 study: two Chemotherapy-arms: response evaluation after the fourth therapy course
determination of objective repsonse rate (CR+PR)
E-HIT-REZ 2005 study (Phase II Study "Oral chemotherapy with temozolomide"): Evaluation of response rate to the 60-days oral chemotherapy with temozolomide
determination of objective repsonse rate (CR+PR/all patients)
Phase II study "Intraventricular therapy with etoposide": Evaluation of response rate to the 5-week intraventricular therapy with etoposide
disease stabilization rate (CR+PR+SD/all patients)

Secondary Outcome Measures

P-HIT-REZ 2005 study: two Chemotherapy-arms: PFS and OS from start of therapy
progression free and overall survival from start of therapy until PD, last follow up or death, respectively
P-HIT-REZ 2005 study: two Chemotherapy-arms: toxicity rate (CTC) in both arms
rate of adverse events of CTC°3 or CTC°4 according to CTCAE v3.0
E-HIT-REZ 2005 study: Chemotherapy-arm: PFS and OS from start of therapy
progression free and overall survival from start of therapy until PD, last follow up or death, respectively
E-HIT-REZ 2005 study: Chemotherapy-arm: toxicity rate (CTC)
progression free and overall survival from start of therapy until PD, last follow up or death, respectively
Phase II study "Intraventricular therapy with etoposide": toxicity rate (CTC)
rate of adverse events of CTC°1-4 according to CTCAE v3.0

Full Information

First Posted
September 5, 2008
Last Updated
July 18, 2018
Sponsor
University Hospital, Bonn
search

1. Study Identification

Unique Protocol Identification Number
NCT00749723
Brief Title
Therapy Optimization Trial for the Treatment of Relapsed or Refractory Brain Tumors in Children
Acronym
HIT-REZ-2005
Official Title
Therapy-Optimization Trial and Phase II Study for the Treatment of Relapsed or Refractory of Primitive Neuroectodermal Brain Tumors and Ependymomas in Children and Adolescents
Study Type
Interventional

2. Study Status

Record Verification Date
July 2018
Overall Recruitment Status
Completed
Study Start Date
February 1, 2006 (undefined)
Primary Completion Date
January 31, 2015 (Actual)
Study Completion Date
January 31, 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University Hospital, Bonn

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to improve overall survival while maintaining a good quality of life in pediatric patients with refractory or recurrent brain tumors (medulloblastomas, supratentorial PNETs, ependymomas WHO grade II and III). Response to different chemotherapy options (intravenous versus oral chemotherapy, intraventricular chemotherapy) as part of a multimodal therapy will be assessed. Progression-free, overall survival and toxicity will be evaluated additionally.
Detailed Description
Parts of the study: P-HIT-REZ-2005: a trial for the treatment of relapsed PNETs (medulloblastomas,supratentorial PNETs) E-HIT-REZ-2005: a trial for the treatment of relapsed ependymomas (Phase II-Study with temozolomide) Phase II-Study: intraventricular therapy with etoposide in neoplastic meningitis in relapsed PNETs and ependymomas with subarachnoid tumor manifestation (window study)

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Recurrent Brain Tumors, Supratentorial PNETs, Medulloblastomas, Ependymomas
Keywords
brain tumor, relapse, children, etoposide, intraventricular, temozolomide

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
174 (Actual)

8. Arms, Groups, and Interventions

Arm Title
1: P-HIT-REZ 2005
Arm Type
Experimental
Arm Description
intravenous chemotherapy with carboplatin/etoposide,followed by high dose chemotherapy with thiotepa, carboplatin, etoposide and autologous stem cell transplantation if patient have achieved a complete remission or maintenance therapy with oral trofosfamide, etoposide
Arm Title
2: P-HIT-REZ 2005
Arm Type
Experimental
Arm Description
oral chemotherapy with temozolomide, followed by high dose chemotherapy with temozolomide, thiotepa and autologous stem cell transplantation if patient have achieved a complete remission maintenance therapy with oral temozolomide or in case of progression with oral trofosfamide, etoposide
Arm Title
3: E-HIT-REZ 2005
Arm Type
Experimental
Arm Description
Phase II: oral chemotherapy with temozolomide after progression oral trofosfamide, etoposide
Arm Title
Intraventricular Etoposide
Arm Type
Experimental
Arm Description
Phase II, intraventricular chemotherapy with etoposide
Intervention Type
Drug
Intervention Name(s)
carboplatin
Other Intervention Name(s)
Carboplatin IV
Intervention Description
200 mg/m²/d continuously IV on day 1-4 of each 21-28-day-cycle. Number of cycles: until disease progression, maximum 4 cycles
Intervention Type
Drug
Intervention Name(s)
etoposide
Other Intervention Name(s)
etoposide IV
Intervention Description
100mg/m²/d continuously IV on day 1-4 of each 21-28 day cycle. Number of cycles: until disease progression, maximum 4 cycles
Intervention Type
Drug
Intervention Name(s)
temozolomide
Other Intervention Name(s)
temozolomide orally
Intervention Description
150mg/m²/d p.o. on day 1-5 of a 21-28-day-cycle. Number of cycles: until progression or maximum up to 2 years
Intervention Type
Drug
Intervention Name(s)
thiotepa, carboplatin, etoposide
Other Intervention Name(s)
thiotepa, carboplatin, etoposide IV, high dose
Intervention Description
high dose chemotherapy followed by to autologous stem cell transplantation
Intervention Type
Drug
Intervention Name(s)
temozolomide, thiotepa
Other Intervention Name(s)
temozolomide, thiotepa IV
Intervention Description
high dose chemotherapy followed by autologous stem cell transplantation
Intervention Type
Procedure
Intervention Name(s)
autologous stem cell transplantation
Other Intervention Name(s)
ASCT
Intervention Description
autologous stem cell transplantation following HD-chemotherapy
Intervention Type
Drug
Intervention Name(s)
intraventricular etoposide
Other Intervention Name(s)
etoposide intra-CSF
Intervention Description
prior to systemic chemotherapy as single agent in patients with neoplastic meningitis, in addition to systemic chemotherapy if proven effective in phase II study, intraventricularly age-dependent daily dose (>3m to <3y 0.7 mg; >3y 1.0 mg) for 5 days every 2 two 4 weeks. Number of cycles: at least 3 courses, maximum up to 2 years
Intervention Type
Drug
Intervention Name(s)
trofosfamide, etoposide
Other Intervention Name(s)
trofosfamide, etoposide orally
Intervention Description
maintenance therapy: trofosfamide and etoposide: 100 mg/m²/d and 25 mg/m²/d, respectively, for 21 days every 4 weeks. Number of cycles: until progression or maximum up to 2 years
Primary Outcome Measure Information:
Title
P-HIT-REZ 2005 study: two Chemotherapy-arms: response evaluation after the fourth therapy course
Description
determination of objective repsonse rate (CR+PR)
Time Frame
4 months for each patient (8 years for the whole study population)
Title
E-HIT-REZ 2005 study (Phase II Study "Oral chemotherapy with temozolomide"): Evaluation of response rate to the 60-days oral chemotherapy with temozolomide
Description
determination of objective repsonse rate (CR+PR/all patients)
Time Frame
2 months for each patient (8 years for the whole study population)
Title
Phase II study "Intraventricular therapy with etoposide": Evaluation of response rate to the 5-week intraventricular therapy with etoposide
Description
disease stabilization rate (CR+PR+SD/all patients)
Time Frame
6 weeks for each patient (8 years for the whole study population)
Secondary Outcome Measure Information:
Title
P-HIT-REZ 2005 study: two Chemotherapy-arms: PFS and OS from start of therapy
Description
progression free and overall survival from start of therapy until PD, last follow up or death, respectively
Time Frame
10 years
Title
P-HIT-REZ 2005 study: two Chemotherapy-arms: toxicity rate (CTC) in both arms
Description
rate of adverse events of CTC°3 or CTC°4 according to CTCAE v3.0
Time Frame
8 years
Title
E-HIT-REZ 2005 study: Chemotherapy-arm: PFS and OS from start of therapy
Description
progression free and overall survival from start of therapy until PD, last follow up or death, respectively
Time Frame
10 years
Title
E-HIT-REZ 2005 study: Chemotherapy-arm: toxicity rate (CTC)
Description
progression free and overall survival from start of therapy until PD, last follow up or death, respectively
Time Frame
10 years
Title
Phase II study "Intraventricular therapy with etoposide": toxicity rate (CTC)
Description
rate of adverse events of CTC°1-4 according to CTCAE v3.0
Time Frame
8 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
3 Months
Maximum Age & Unit of Time
30 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Disease Characteristics Histologically confirmed Medulloblastoma, cerebral PNET or Ependymoma Refractory or relapsed disease Measurable disease by MRI or detection of tumor cells in cerebrospinal fluid Patients characteristics Performance status ECOG ≥ 3 or Karnofsky Status ≥ 40% Life expectancy ≥ 8 weeks Hematological: Absolute leukocyte count ≥ 2.0 x 10^9 /l Hemoglobin ≥ 10g/dl Platelet count ≥ 70 x 10^9/l Renal: Creatinine no greater than 1.5 times UNL No overt renal disease Hepatic: Bilirubin less than 2.5 times UNL AST and ALT less than 5 times UNL No overt hepatic disease Pulmonary: No overt pulmonary disease Cardiovascular: No overt cardiovascular disease Other: Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No uncontrolled infection Prior concurrent therapy More than 2 weeks since prior systemic chemotherapy More than 4 weeks since prior radiotherapy No other concurrent anticancer or experimental drugs Examinations required Examination of lumbar CSF Cranial and spinal MRI within 14 days prior to start of treatment
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gudrun Fleischhack, MD
Organizational Affiliation
Department of Pediatric Hematology & Oncology, Pediatrics III, University Children's Hospital Essen
Official's Role
Principal Investigator
Facility Information:
Facility Name
Universitätskinderklinik Aachen
City
Aachen
ZIP/Postal Code
52074
Country
Germany
Facility Name
Klinikum Augsburg, Klinik für Kinder- und Jugendmedizin
City
Augsburg
ZIP/Postal Code
86156
Country
Germany
Facility Name
Helios Klinikum Berlin-Buch, Klinik für Kinderheilkunde und Jugendmedizin
City
Berlin
ZIP/Postal Code
13125
Country
Germany
Facility Name
Charité Klinikum Campus Virchow, Kinderklinik
City
Berlin
ZIP/Postal Code
13353
Country
Germany
Facility Name
Klinik ür Kinder- und Jugendmedizin in Bethel
City
Bielefeld
ZIP/Postal Code
33617
Country
Germany
Facility Name
Universitätskinderklinik Bonn
City
Bonn
ZIP/Postal Code
53113
Country
Germany
Facility Name
Städtisches Klinikum Braunschweig, Kinderklinik
City
Braunschweig
ZIP/Postal Code
38118
Country
Germany
Facility Name
Klinikum Bremen-Mitte
City
Bremen
ZIP/Postal Code
28177
Country
Germany
Facility Name
Carl-Thiele-Klinikum Cottbus, Zentrum für Kinderheilkunde
City
Cottbus
ZIP/Postal Code
03048
Country
Germany
Facility Name
Vestische Kinder- und Jugendklinik Datteln
City
Datteln
ZIP/Postal Code
45711
Country
Germany
Facility Name
Klinikum Dortmund, Klinik für Kinder- und Jugendmedizin
City
Dortmund
ZIP/Postal Code
44137
Country
Germany
Facility Name
Universitätsklinikum Dresden, Kinderklinik
City
Dresden
ZIP/Postal Code
01307
Country
Germany
Facility Name
Klinikum Duisburg, Klinik für Kinder-und Jugendmedizin
City
Duisburg
ZIP/Postal Code
47055
Country
Germany
Facility Name
Universitätskinderklinik Düsseldorf
City
Düsseldorf
ZIP/Postal Code
40225
Country
Germany
Facility Name
Helios Klinikum Erfurt, Zentrum für Kinderheilkunde
City
Erfurt
ZIP/Postal Code
99089
Country
Germany
Facility Name
Universitätskinderklinik Erlangen
City
Erlangen
ZIP/Postal Code
91054
Country
Germany
Facility Name
Universitätskinderklinik Essen
City
Essen
ZIP/Postal Code
45122
Country
Germany
Facility Name
Klinikum der Wolfgang Goethe Universität, Klinik für Kinderheilkunde
City
Frankfurt/Main
ZIP/Postal Code
60590
Country
Germany
Facility Name
Universitätskinderklinik Freiburg
City
Freiburg
ZIP/Postal Code
79106
Country
Germany
Facility Name
Universitätsklinikum Gießen und Marburg, Zentrum für Kinderheilkunde
City
Gießen
ZIP/Postal Code
35385
Country
Germany
Facility Name
Universitätskinderklinik Greifswald
City
Greifswald
ZIP/Postal Code
17475
Country
Germany
Facility Name
Universitätskinderklinik Göttingen
City
Göttingen
ZIP/Postal Code
37075
Country
Germany
Facility Name
Martin-Luther-Universität Halle Wittenberg
City
Halle/Saale
ZIP/Postal Code
06120
Country
Germany
Facility Name
Universitätskinderklinik Hamburg-Eppendorf
City
Hamburg
ZIP/Postal Code
20246
Country
Germany
Facility Name
Medizinische Hochschule, Zentrum für Kinderheilkunde
City
Hannover
ZIP/Postal Code
30625
Country
Germany
Facility Name
Universitätskinderklinik Heidelberg
City
Heidelberg
ZIP/Postal Code
69120
Country
Germany
Facility Name
SLK Kinderklinik Heilbronn
City
Heilbronn
ZIP/Postal Code
74078
Country
Germany
Facility Name
Gemeinschaftskrankenhaus Herdecke, Kinderklinik
City
Herdecke
ZIP/Postal Code
58313
Country
Germany
Facility Name
Universitätskinderklinik
City
Homburg/Saar
ZIP/Postal Code
66421
Country
Germany
Facility Name
Friedrich Schiller Universität, Klinik für Kinder-und Jugendmedizin
City
Jena
ZIP/Postal Code
07745
Country
Germany
Facility Name
Städtisches Krankenhaus, Klinik für Kinder- und Jugendmedizin
City
Karlsruhe
ZIP/Postal Code
76133
Country
Germany
Facility Name
Klinikum Kassel, Kinderklinik
City
Kassel
ZIP/Postal Code
34125
Country
Germany
Facility Name
UKSH, Campus Kiel, Klinik für Allg. Pädiatrie
City
Kiel
ZIP/Postal Code
24105
Country
Germany
Facility Name
Städtisches Klinikum Kemperhof, Klinik für Kinder- und Jugendmedizin
City
Koblenz
ZIP/Postal Code
56073
Country
Germany
Facility Name
Universitätskinderklinik Köln
City
Köln
ZIP/Postal Code
50924
Country
Germany
Facility Name
Universitätskinderklinik Leipzig
City
Leipzig
ZIP/Postal Code
04317
Country
Germany
Facility Name
Universitätskinderklinik Lübeck
City
Lübeck
ZIP/Postal Code
23538
Country
Germany
Facility Name
Otto-von-Guericke-Universität, Zentrum für Kinderheilkunde
City
Magdeburg
ZIP/Postal Code
39120
Country
Germany
Facility Name
Universitätskinderklinik Mainz
City
Mainz
ZIP/Postal Code
55131
Country
Germany
Facility Name
Universitätskinderklinik Mannheim
City
Mannheim
ZIP/Postal Code
68167
Country
Germany
Facility Name
Universitätskinderklinik Marburg
City
Marburg
ZIP/Postal Code
35043
Country
Germany
Facility Name
Klinikum Minden III, Klinik für Kinder-und Jugendheilkunde
City
Minden
ZIP/Postal Code
32432
Country
Germany
Facility Name
Dr. von Haunersches Kinderspital
City
München
ZIP/Postal Code
80337
Country
Germany
Facility Name
Städtisches Krankenhaus München-Schwabing, Kinderklinik der TU München
City
München
ZIP/Postal Code
80804
Country
Germany
Facility Name
Universitätskinderklinik Münster
City
Münster
ZIP/Postal Code
48129
Country
Germany
Facility Name
Cnopf'sche Kinderklinik
City
Nürnberg
ZIP/Postal Code
90419
Country
Germany
Facility Name
Klinikum Oldenburg, Zentrum für Kinder-und Jugendmedizin
City
Oldenburg
ZIP/Postal Code
26131
Country
Germany
Facility Name
Universitäts-Kinderklinik
City
Regensburg
ZIP/Postal Code
93042
Country
Germany
Facility Name
Universitätskinderklinik Rostock
City
Rostock
ZIP/Postal Code
18057
Country
Germany
Facility Name
Asklepios Klinik Sankt Augustin GmbH
City
Sankt Augustin
ZIP/Postal Code
53757
Country
Germany
Facility Name
Olgahospital-Pädiatrisches Zentrum
City
Stuttgart
ZIP/Postal Code
70176
Country
Germany
Facility Name
Universitätskinderklinik Tübingen
City
Tübingen
ZIP/Postal Code
72076
Country
Germany
Facility Name
Univeritätsklinikum Ulm, Abteilung Kinder-und Jugendmedizin
City
Ulm
ZIP/Postal Code
89075
Country
Germany
Facility Name
Universitätskinderklinik Würzburg
City
Würzburg
ZIP/Postal Code
97080
Country
Germany

12. IPD Sharing Statement

Links:
URL
http://www.kinderkrebsinfo.de/
Description
German Society of Pediatric Hematology and Oncology
URL
http://www.kinderkrebsstiftung.de/
Description
German Children's Cancer Foundation

Learn more about this trial

Therapy Optimization Trial for the Treatment of Relapsed or Refractory Brain Tumors in Children

We'll reach out to this number within 24 hrs