- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02360930
Vincristine PK and PD in the AYA Population Compared to Younger Children
The Pharmacokinetics and Pharmacodynamics of Vincristine in the Adolescent and Young Adult Population Compared to Younger Children
Study Overview
Status
Conditions
Detailed Description
The purpose of the study is to refine the PK model for planning a future definitive study. This is a pilot study to obtain preliminary data on the pharmacokinetics of VCR and the way it differs in the AYA population compared to the younger children as defined by Tanner staging. Additionally, we want to determine if Calpain levels correlate with vincristine and its PK and to determine if it can be used as biomarker for VRNT.
Specific Aim 1: Develop a non-parametric population model of vincristine and M1 PK in children and adolescents.
Hypothesis: The PK of vincristine and its metabolite M1 will differ between young children and AYA as defined by Tanner stage
Specific Aim 2: Measure repeated serum calpain with initiation of vincristine and again after four weeks of therapy.
Hypothesis: Compared to baseline, serum calpain will increase after administration of vincristine.
For the first time, patients will be classified based on their physiologic maturity-rather than age-to determine whether having a more adult phenotype is associated with prolonged vincristine exposure. This will increase our likelihood of detecting a developmentally-driven difference in vincristine metabolism and, if successful, provide evidence that Tanner staging is a more reliable method for classifying adolescents for purposes of chemotherapy dosing. Further, we will not only characterize vincristine PK differences between the two groups, but will for the first time examine differences in the PK of M1.We are analyzing calpain levels as a separate entity from Tanner staging. We are trying to establish if there is an association between calpain and vincristine administration, as well as vincristine induced peripheral neuropathy. However, in evaluating the association between vincristine dose, PK and calpain levels, we will be adjusting for age and Tanner stage in the analysis.
To account for enzyme polymorphism in the metabolism of vincristine, we will analyze each patient for CYP3A5 genotype, which has been associated with increase in clearance of vincristine and less peripheral neuropathy and decrease severity of vincristine induced peripheral neuropathy. Additionally, we will determine the vincristine's PK which will allow us to probe the impact of polymorphism with regards to VCR disposition.
For all of the following aims, we will enroll a total of 30 patients with a unified diagnosis of acute lymphoblastic leukemia (ALL),6 months to 21 in Induction phase or in Maintenance phase of therapy. Patients will be stratified by phase of treatment, and they will be classified into Tanner stage ≤ 2 or ≥ 4, based on physical examination. We plan to have 15 patients in Tanner staging ≤ 2 and 15 patients in Tanner staging ≥ 45. Each patient will receive vincristine weekly x 4 (Induction) or monthly (Maintenance), at a standard dose specified by the treatment protocol. Since PK measurements will be obtained around a single VCR dose; it is appropriate to include patients with ALL from two phases of treatment. The study will be conducted at a single institution, Children's Hospital Los Angeles (CHLA). From the newly diagnosed patients in Induction phase, we will collect optimally timed blood samples prior to and 10 minutes, 30 minutes, 1 hour, 12 hours and 24 hours following the first dose of vincristine. We will also measure serum calpain, a candidate biomarker for nerve injury, before and after the first dose of vincristine, and again after the 4th weekly dose. For the ALL patients in the Maintenance phase, we will collect optimally timed blood samples prior to and 10 minutes, 30 minutes, 1 hours and 24 hours following the dose of vincristine. In ALL patients in Maintenance, a 12 hour blood sample will not be feasible since these patients are treated in the outpatient setting. We will also measure serum calpain levels prior to vincristine dose, 24 hours after and 4 weeks after the measured vincristine level. The study period for ALL patients in Maintenance phase will be completed 4 weeks after initial measured VCR PK level.
Study Type
Enrollment (Anticipated)
Contacts and Locations
Study Locations
-
-
California
-
Los Angeles, California, United States, 90027
- Children's Hospital Los Angeles
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
30 patients with ALL. Our study will enroll patients ages 1-24 years with ALL at start of Induction or in Maintenance therapy. Patients will be classified into Tanner stage ≤ 2 or ≥ 4. We plan to have 15 patients in Tanner staging ≤ 2 and 15 patients in Tanner staging ≥ 4. Each patient will receive vincristine weekly x 4 (Induction) or monthly (Maintenance), at a standard dose specified by the treatment protocol.
The study will be conducted at Children's Hospital Los Angeles.
Tanner staging will take place after the patient is consented to the study using standard Tanner stage diagrams.
Description
Inclusion Criteria:
- Patients ages 1-24 years of age with Acute Lymphoblastic Leukemia
- Patient diagnosed with Acute Lymphoblastic Leukemia (ALL) in Induction phase of therapy
- Patient diagnosed with Acute Lymphoblastic Leukemia (ALL) in first remission in Maintenance phase of therapy Treatment plan for induction therapy includes vincristine given at weekly intervals.
- Treatment plan for Maintenance therapy includes vincristine given at monthly intervals.
Exclusion Criteria:
- Patients without a central line in induction phase of therapy
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
---|
Tanner Stage </=2
Patients will be stratified by phase of treatment, and they will be classified into Tanner stage ≤ 2 or ≥ 4, based on physical examination.
We plan to have 15 patients in Tanner staging ≤ 2 and 15 patients in Tanner staging ≥ 4.
|
Tanner Stage >/= 4
Patients will be stratified by phase of treatment, and they will be classified into Tanner stage ≤ 2 or ≥ 4, based on physical examination.
We plan to have 15 patients in Tanner staging ≤ 2 and 15 patients in Tanner staging ≥ 4.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Vincristine (concentration of vincristine)
Time Frame: 4 weeks
|
We will evaluate the concentration of vincristine in relations to the production of primary metabolite M1 over time.
Vincristine is primary metabolized using CYP3A family of enzymes is responsible.
|
4 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Calpain level
Time Frame: 4 weeks
|
Serum calpain enzyme activity will be measured at three time points: 1) just prior to the first dose of vincristine to establish baseline levels; 2) 24 hours after the first dose of vincristine to measure acute effects of vincristine on enzyme activity; 3) after the 4th weekly vincristine (Induction) or after 4 weeks since last VCR dose (Maintenance) to assess chronic effects
|
4 weeks
|
Cytochrome P450 3A5 genotype
Time Frame: One time
|
One whole blood sample will be collected for DNA extraction and genotyping from each subject enrolled in this study.
|
One time
|
Development of Vincristine Induced Neuropathy
Time Frame: 4 weeks
|
To screen for development of VRNT, we will employ two validated measures, the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0 (CTCAE 4.0)24 and the Pediatric-Modified Total Neuropathy Score.
|
4 weeks
|
Collaborators and Investigators
Sponsor
Investigators
- Study Director: Lakshmi Damerla, Children's Hospital Los Angeles
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- CHLA CCI-14-00092
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 Leukemia
-
Stanford UniversityTerminatedLeukemia | Leukemia, Lymphocytic, Acute | Leukemia Acute Promyelocytic Leukemia (APL) | Leukemia Acute Lymphoid Leukemia (ALL) | Leukemia Chronic Myelogenous Leukemia (CML) | Leukemia Acute Myeloid Leukemia (AML) | Leukemia Chronic Lymphocytic Leukemia (CLL)United States
-
Massachusetts General HospitalCelgene CorporationTerminatedAcute Myelogenous Leukemia | Acute Myeloid Leukemia (AML) | Acute Myelocytic Leukemia | Acute Granulocytic Leukemia | Acute Non-Lymphocytic LeukemiaUnited States
-
Institute of Hematology & Blood Diseases HospitalBejing Institute for Stem Cell and Regenerative Medicine; Institute for Stem...RecruitingRefractory Leukemia | Relapsed Leukemia | Acute Myeloid Leukemia, ChildhoodChina
-
Betta Pharmaceuticals Co., Ltd.Not yet recruitingAcute Myeloid Leukemia LeukemiaChina
-
Children's Oncology GroupNational Cancer Institute (NCI)CompletedChildhood Acute Monoblastic Leukemia (M5a) | Childhood Acute Monocytic Leukemia (M5b) | Childhood Acute Myeloblastic Leukemia Without Maturation (M1) | Childhood Acute Myelomonocytic Leukemia (M4) | Childhood Acute Myeloid Leukemia/Other Myeloid MalignanciesUnited States
-
Hybrigenics CorporationUnknownAcute Myelogenous LeukemiaUnited States, France
-
Center for International Blood and Marrow Transplant...National Marrow Donor Program; St. Baldrick's FoundationActive, not recruitingAcute Myelogenous LeukemiaUnited States
-
Massachusetts General HospitalCompleted
-
Beijing Boren HospitalRecruitingAcute Myeloid Leukemia | Refractory Acute Myeloid Leukemia | Relapse LeukemiaChina
-
Kinex Pharmaceuticals Inc.CompletedAcute Myelogenous LeukemiaUnited States