- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01850888
MIBG for Refractory Neuroblastoma and Pheochromocytoma
131I-Metaiodobenzylguanidine (131I-MIBG) Therapy for Refractory Neuroblastoma and Pheochromocytoma
Study Overview
Status
Detailed Description
Primary Objective is to provide access to therapy with 131I-MIBG for patients with relapsed/refractory neuroblastoma or metastatic pheochromocytoma.
Secondary Objective is to assess disease response to 131I-MIBG therapy for patients with relapsed/refractory neuroblastoma or metastatic pheochromocytoma.
Tertiary Objectives are to 1) gain more information about the toxicities of 131I-MIBG therapy; 2) assess improvement of symptoms, including pain and fatigue, for patients with relapsed/refractory neuroblastoma or metastatic pheochromocytoma who are receiving 131I-MIBG therapy.
The therapeutic dose of 131I-MIBG will be based on the following:
- Minimum dose of 10 mCi/kg for patients without a stem cell source whose renal function is above the upper limit of normal but still meets eligibility criteria.
- Dose of 12 mCi/kg for patients without a stem cell source with normal renal function and meets other eligibility criteria.
- Dose of > 12 mCi/kg to 18 mCi/kg maximum at investigator's discretion for patients meeting eligibility criteria with stem cells available.
- A urinary catheter and intravenous fluids will be used for bladder protection, and potassium iodide solution for thyroid Protection.
- G-CSF is recommended for patients with ANC less than 750 after MIBG infusion.
- hematopoietic stem cell infusion is recommended for patients with grade 4 hematologic toxicity following 131I-MIBG therapy that continues to have an ANC <200 on G-CSF without signs of recovery for >2 weeks and any patient requiring platelet transfusion more than two times weekly for 4 consecutive weeks.
- Follow-up will be done until disease progression, death or other therapies are initiated.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Emily Greengard, MD
- Phone Number: 612-626-2378
- Email: emilyg@umn.edu
Study Locations
-
-
Minnesota
-
Minneapolis, Minnesota, United States, 55455
- University of Minnesota Masonic Cancer Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Diagnosis:
- Relapsed/refractory neuroblastoma with original diagnosis based on tumor histopathology or elevated urine catecholamines with typical neuroblastoma cells in the bone marrow
- Metastatic pheochromocytoma
- Age >1 year and able to cooperate with radiation safety restrictions during therapy period
- Karnofsky or Lansky performance status of ≥ 50%
- Life expectancy: ≥ at least 8 weeks
- Disease status: Failure to respond to standard therapy or development of progressive disease at any time.
- Disease must be evaluable by MIBG scan. A positive MIBG scan must be present within 8 weeks prior to study entry and subsequent to any intervening therapy. If the patient has only one MIBG positive lesion and that lesion was radiated, a biopsy must be done at least 4 weeks after radiation was completed and must show viable neuroblastoma.
- Stem Cells: Patients must have a hematopoietic stem cell product available for reinfusion after MIBG treatment at doses of > 12 mCi/kg.
Have acceptable organ function as defined below within 7 days of enrollment:
- Bone Marrow: ANC ≥750 X 109 /L and platelets ≥50,000 X 109 /L without transfusion if stem cells are not available (any ANC or platelet allowed if stem cells available)
- Renal: Creatinine ≤3x upper limit of normal
- Hepatic: Bilirubin ≤2x upper limit of normal; AST/ALT ≤10x upper limit of normal
- Cardiac: Ejection fraction ≥45% on echocardiogram
- Pulmonary: normal lung function as manifested by no dyspnea and/or oxygen saturation ≥ 88% on room air.
Prior Therapy: Patients must have recovered from all acute toxicities (defined as CTCAE 4.0 ≤ grade 1) associated with any prior therapy, and:
- Myelosuppressive chemotherapy: At least 2 weeks should have elapsed since any chemotherapy causing myelosuppression
- Biologic (anti-neoplastic agent): At least 7 days should have elapsed since the completion of therapy with a biologic agent.
- Monoclonal antibodies: At least 3 half-lives should have elapsed since therapy with a monoclonal antibody
- Radiation therapy: Three-months should have elapsed in the case of completing radiation to any of the following fields: craniospinal, total abdominal, whole lung, total body irradiation). For all other sites of radiation, at least 2 weeks should have relapsed.
- Cytokine therapy (e.g. G-CSF, GM-CSF, IL-6, IL-2): must be discontinued a minimum of 24 hours prior to MIBG therapy.
- Voluntary written informed consent
Exclusion Criteria:
- Patients with disease of any major organ system that would compromise their ability to withstand therapy.
- Because of the teratogenic potential of the study medication, no patients who are pregnant or lactating will be allowed. Patients of childbearing potential must practice an effective method of birth control while participating on this study, to avoid possible damage to the fetus.
- Known allergy to any of the agents or their ingredients used in this study.
- Patients who are on hemodialysis
- Patients with untreated positive blood cultures or progressive infections as assessed by radiographic studies
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: 131 I-MIBG Treatment Arm
Therapeutic 131 I-Metaiodobenzylguanidine (131I-MIBG) will be infused intravenously, intravenous fluids will be administered to help maintain urine flow and isotope excretion.
Potassium iodide solution will be administered to protect thyroid function.
G-CSF will be used if necessary for neutrophil recovery.
Hematopoietic stem cell infusion if meets the criteria.
|
Minimum dose of 10 mCi/kg and up to 18 mCi/kg maximum will be diluted in 25 ml of normal saline, and will be infused intravenously over 90-120 minutes.
Other Names:
For the therapeutic MIBG administration, potassium iodide solution will be administered in a loading dose of 6mg/kg orally at least 8 hours prior to the MIBG injection, and then will be given at 1mg/kg/dose every 4 hours on days 0-6, then 1 mg/kg/day through day 45 post injection.
The minimum dose of potassium iodide to be given is one drop, which equals 50 mg.
Other Names:
It is recommended that patients with ANC less than 750 after MIBG infusion begin G-CSF 5 mcg/kg/day subcutaneously (or receive equivalent single dose of Neulasta every 14 days while neutropenic) until neutrophil recovery (generally >5000).
Other Names:
The majority of patients on this protocol will have autologous PBSCs available.
Allogeneic stem cells may be utilized in patients who has received a prior allogeneic transplant.
The minimum quantity for peripheral blood stem cells is 1.5 x 106 CD34+ cells/kg (optimum > 2 x 106 CD34+ cells/kg).
The minimum dose for bone marrow is 1.0 x 108 mononuclear cells/kg (optimum >2.0 x 108 mononuclear cells/kg).
Infusion will be performed according to institutional guidelines.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of patients who receive 131 I-MIBG.
Time Frame: 2 hours
|
The number of patients with relapsed/refractory neuroblastoma or metastatic pheochromocytoma who receive access to 131 I-MIBG.
|
2 hours
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Disease response
Time Frame: 1 year
|
Disease response to 131 I-MIBG therapy in patients with relapsed/refractory neuroblastoma or metastatic pheochromocytoma.
Disease response will be measured by Curie Score for patients with MIBG avid disease only or by both Currie Score and RECIST criteria for patients who have measureable disease in addition to MIBG avid disease.
Disease response will be assessed at day 56 (+/- 14 days) and then every 3 months until 1-year post treatment, then every 6 months until progression, death or other therapy.
|
1 year
|
Incidence of hematologic toxicities
Time Frame: 1 year
|
Evaluation of hematologic toxicities of 131I MIBG therapy.
CBC with differential and platelet count will be obtained prior to study enrollment, on day 0 and then twice weekly until ANC>500/mm3 and platelet count >20,000 x 3 days without transfusion.
Once that is achieved CBC will be then obtained on day 56 and then every 3 months until 1 year post treatment, then every 6 months until progression, death or other therapy.
In addition, we will be looking at the percent of patient that require infusion of stem cell product for cytopenias.
|
1 year
|
Incidence of hepatic toxicities
Time Frame: 1 year
|
ALT, AST, bilirubin will be obtained prior to study enrollment and then weekly until day 42, again on day 56 and then every 3 months until 1 year post treatment, then every 6 months until progression, death or other therapy
|
1 year
|
Incidence of Thyroid Toxicity
Time Frame: 1 year
|
T4 and TSH will be obtained prior to study enrollment and again on day 56 and then every 3 months until 1 year post treatment, then every 6 months until progression, death or other therapy.
|
1 year
|
Improvement of pain symptoms
Time Frame: 56 days
|
Assessment of pain will occur on day 0 of therapy, on the day of discharge and then weekly until day 42 and then again on day 56.
The PedsQL Pediatric Pain Questionnaire will be used for assessment of pain in all patients.
These questionnaires include both patient report and parent report, when appropriate.
|
56 days
|
Improvement of fatigue
Time Frame: 56 days
|
Assessment of fatigue will occur on day 0 of therapy, on the day of discharge and then weekly until day 42 and then again on day 56.
The PedsQL Multidimensional Fatigue Scale will be used for assessment of fatigue in all patients.
These scales include both patient report and parent report, when appropriate.
|
56 days
|
Collaborators and Investigators
Investigators
- Principal Investigator: Emily Greengard, MD, University of Minnesota Department of Pediatrics
Study record dates
Study Major Dates
Study Start
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Neoplasms by Histologic Type
- Neoplasms
- Neoplasms, Glandular and Epithelial
- Neoplasms, Neuroepithelial
- Neuroectodermal Tumors
- Neoplasms, Germ Cell and Embryonal
- Neoplasms, Nerve Tissue
- Neuroendocrine Tumors
- Neuroectodermal Tumors, Primitive
- Neuroectodermal Tumors, Primitive, Peripheral
- Paraganglioma
- Neuroblastoma
- Pheochromocytoma
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Antineoplastic Agents
- Radiopharmaceuticals
- Pharmaceutical Solutions
- 3-Iodobenzylguanidine
Other Study ID Numbers
- 2012LS107
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Relapsed Neuroblastoma
-
Stephan Grupp MD PhDChildren's Hospital of Philadelphia; University of Pennsylvania; Tmunity TherapeuticsRecruitingRefractory Neuroblastoma | High-risk Neuroblastoma | Relapsed NeuroblastomaUnited States
-
Emory UniversityRecruitingNeuroblastoma | Refractory Neuroblastoma | Relapsed NeuroblastomaUnited States
-
Clarity Pharmaceuticals LtdRecruitingNeuroblastoma | Refractory Neuroblastoma | Relapsed NeuroblastomaUnited States
-
Nationwide Children's HospitalRecruitingRefractory Neuroblastoma | Relapsed NeuroblastomaUnited States
-
Giselle ShollerVan Andel Research InstituteCompletedRefractory Neuroblastoma | Relapsed NeuroblastomaUnited States
-
Baylor College of MedicineCancer Prevention Research Institute of Texas; The Methodist Hospital Research... and other collaboratorsActive, not recruitingRefractory Neuroblastoma | Uveal Melanoma | Relapsed Ewing Sarcoma | Relapsed Osteosarcoma | Relapsed Neuroblastoma | Relapsed Rhabdomyosarcoma | Phyllodes Breast TumorUnited States
-
Belarusian Research Center for Pediatric Oncology...Recruiting
-
Sinobioway Cell Therapy Co., Ltd.Children's Hospital of Fudan University; Nanjing Children's HospitalUnknownRelapsed or Refractory NeuroblastomaChina
-
Dana-Farber Cancer InstitutePatient-Centered Outcomes Research InstituteActive, not recruitingRelapsed NeuroblastomaUnited States
-
PersonGen BioTherapeutics (Suzhou) Co., Ltd.Tianjin Medical University Cancer Institute and Hospital; Shandong Cancer Hospital...RecruitingB7-H3-positive Relapsed/ Refractory NeuroblastomaChina
Clinical Trials on 131 I-Metaiodobenzylguanidine (131I-MIBG)
-
University of California, San FranciscoApproved for marketingPheochromocytoma | ParagangliomaUnited States
-
John MarisAvailableNeuroblastoma | Childhood Metastatic PheochromocytomaUnited States
-
Jubilant DraxImage Inc.RecruitingNeoplasms | Neuroectodermal Tumors | NeuroblastomaUnited States
-
M.D. Anderson Cancer CenterCompletedMetastases, Neoplasm | Neuroendocrine TumorsUnited States
-
University of Texas Southwestern Medical CenterNo longer availableRelapsed Neuroblastoma | Metastatic PheochromocytomaUnited States
-
Kieuhoa VoCannonball Kids Cancer Foundation, IncAvailableNeuroblastomaUnited States
-
Nationwide Children's HospitalActive, not recruiting
-
University of California, San FranciscoThrasher Research FundCompleted
-
Northwell HealthCohen Children's Medical CenterAvailableNeuroblastoma | PheochromocytomaUnited States
-
Jubilant DraxImage Inc.AvailableNeuroblastoma | Pheochromocytoma | ParagangliomaUnited States