- ICH GCP
- Amerikanska kliniska prövningsregistret
- Klinisk prövning NCT01204450
Temsirolimus and Valproic Acid in Treating Young Patients With Relapsed Neuroblastoma, Bone Sarcoma, or Soft Tissue Sarcoma
A Multi-center Phase I Trial of Temsirolimus in Combination With Valproic Acid in Children and Adolescents With Multiply Relapsed Pediatric Solid Tumors
RATIONALE: Drugs such as temsirolimus and valproic acid may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Valproic acid may also stop the growth of solid tumors by blocking blood flow to the tumor.
PURPOSE: This phase I trial is studying the side effects and the best dose of temsirolimus when given together with valproic acid in treating young patients with relapsed neuroblastoma, bone sarcoma, or soft tissue sarcoma.
Studieöversikt
Status
Betingelser
Intervention / Behandling
Detaljerad beskrivning
OBJECTIVES:
Primary
- To identify the maximum-tolerated dose of temsirolimus in combination with valproic acid in highly pretreated pediatric patients with refractory solid tumors.
Secondary
- To estimate the objective response rate in patients treated with this regimen.
- To estimate the progression-free survival of patients treated with this regimen.
- To explore the association between tumor IGF-IR, mTOR expression, HDAC, autophagy biomarkers, and sera levels of temsirolimus, valproate, and VEGF-A with toxicity and disease response.
- To evaluate the ability of selected member divisions of a newly developed North Carolina-based pediatric oncology consortium to cooperate in clinical trials.
OUTLINE: This a multicenter, dose-escalation study of temsirolimus.
Patients receive temsirolimus IV over 30-60 minutes on days 1, 8, 15, and 22 and oral valproic acid* 3 times daily on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.
Blood samples are collected at baseline and periodically during study for pharmacokinetic and VEGF-A studies. Tumor tissue samples from archived biopsy are also analyzed for IGF-IR, mTOR expression, HDAC, and autophagy biomarkers.
After completion of study therapy, patients are followed every 3 months for 1 year, every 4 months for 2 years, and then every 6 months for 2 years.
NOTE: * Doses of valproic acid are titrated beginning 3-7 days prior to starting temsirolimus to achieve plasma levels of 75-100 µg/mL.
Studietyp
Inskrivning (Faktisk)
Fas
- Fas 1
Kontakter och platser
Studieorter
-
-
North Carolina
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Chapel Hill, North Carolina, Förenta staterna, 27599-7295
- Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill
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Charlotte, North Carolina, Förenta staterna
- Carolina Healthcare System
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-
Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Beskrivning
DISEASE CHARACTERISTICS:
Histologically confirmed malignant solid tumor at original diagnosis, including the following:
- Neuroblastoma
- Bone sarcomas (primary neuroectodermal tumors/ Ewing sarcoma (PNET/ES), osteosarcoma)
- Soft tissue sarcomas (rhabdosarcoma and related tumors)
- Histologically confirmed of relapsed disease is highly recommended but not mandatory
- Measurable disease according to RECIST
Refractory or progressive disease after ≥ 1 and ≤ 4 prior chemotherapy regimens
- Patients with neuroblastoma, PNET/ES, or rhabdosarcoma must have failed a cyclophosphamide/topotecan-containing regimen
- Stem cell transplantation, including preparative regimen and post-transplant immunotherapy, is considered to be 1 regimen
PATIENT CHARACTERISTICS:
- Karnofsky performance status (PS) 50-100% (or Lansky PS 50-100%)
- Life expectancy ≥ 8 weeks
- ANC ≥ 750/mm^3
- Platelet count ≥ 75,000/mm^3 (transfusion independent)
Hemoglobin 8.0 g/dL (may receive RBC transfusions)
- Patients with tumor metastatic to bone marrow are allowed to receive transfusions to maintain hemoglobin and platelet counts
- Serum creatinine normal
- Total bilirubin ≤ 1.5 times upper limit of normal (ULN) OR direct bilirubin < 1.0 mg/dL (if total bilirubin > 2.0 mg/dL)
- ALT < 5 times ULN
- Negative pregnancy test
- Not pregnant or nursing
- Fertile patients must use effective contraception
- Families must be able to give consent in English or Spanish
- No allergy to H1 antihistamines
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- More than 2 weeks since prior chemotherapy, immunotherapy, or radiotherapy and recovered
- No concurrent anticonvulsants, including valproic acid
- No concurrent strong inducers or inhibitors of CYP3A4, including grapefruit juice
Studieplan
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Behandling
- Tilldelning: N/A
- Interventionsmodell: Enskild gruppuppgift
- Maskning: Ingen (Open Label)
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
---|---|
Övrig: Single Arm Temsirolimus + Valproic Acid
Drug: temsirolimus 60-230mg/m2 weekly during each 28 day course, for up to 12 courses Drug: valproic acid (VPA) All patients will be given oral VPA (5 mg/kg, 3 times a day for each 28 day course, up to 12 courses |
60-230mg/m2 weekly during each 28 day course, for up to 12 courses
Andra namn:
All patients will be given oral VPA (5 mg/kg, 3 times a day for each 28 day course, up to 12 courses
Andra namn:
|
Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
---|---|---|
Maximum tolerated dose (MTD) of temsirolimus in combination with valproic acid
Tidsram: 4 weeks
|
The planned starting dose of Temsirolimus is 60mg/M2.
The traditional 3+3 design will be used, where the MTD is defined as the dose with the probability of a DLT of 0.20
|
4 weeks
|
Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
---|---|---|
Objective response rate
Tidsram: every 12 weeks
|
Each patient will be classified according to their "best response".
Best response is determined from the sequence of the objective statuses as described in RECIST 1.1
|
every 12 weeks
|
Progression-free survival
Tidsram: 3 years
|
If the patient's disease has not progressed at the time protocol-directed therapy is complete, any tumor assessments available during the follow-up period (up to 3 years) will be evaluated using RECSIT 1.1
|
3 years
|
Temsirolimus pharmakokinetic parameters (Maximum plasma concentration)
Tidsram: doses 1 and 5
|
Blood will be drawn prior to, 30 minutes, 1hr, 2hr, 5hr, 24hr after completion of doses 1 and 5. Levels of Temsirolimus will be measured using validated liquid chromatography and tandem mass spectroscopic methods
|
doses 1 and 5
|
Samarbetspartners och utredare
Samarbetspartners
Utredare
- Huvudutredare: Julie Blatt, MD, UNC Lineberger Comprehensive Cancer Center
Studieavstämningsdatum
Studera stora datum
Studiestart
Primärt slutförande (Faktisk)
Avslutad studie (Faktisk)
Studieregistreringsdatum
Först inskickad
Först inskickad som uppfyllde QC-kriterierna
Första postat (Uppskatta)
Uppdateringar av studier
Senaste uppdatering publicerad (Uppskatta)
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
Senast verifierad
Mer information
Termer relaterade till denna studie
Nyckelord
- ospecificerad solid tumör i barndomen, protokollspecifik
- återkommande barndomsrabdomyosarkom
- återkommande neuroblastom
- återkommande Ewing-sarkom/perifer primitiv neuroektodermal tumör
- återkommande osteosarkom
- återkommande supratentoriell primitiv neuroektodermal tumör i barndomen
- återkommande hjärntumör i barndomen
- återkommande mjukdelssarkom från barndomen
Ytterligare relevanta MeSH-villkor
- Sjukdomar i nervsystemet
- Neoplasmer, bindväv och mjukvävnad
- Neoplasmer efter histologisk typ
- Neoplasmer efter plats
- Neoplasmer, körtel och epitel
- Neoplasmer, neuroepitelial
- Neuroektodermala tumörer
- Neoplasmer, könsceller och embryonala
- Neoplasmer, nervvävnad
- Neuroektodermala tumörer, primitiva
- Neuroektodermala tumörer, primitiva, perifera
- Neoplasmer
- Sarkom
- Neoplasmer i nervsystemet
- Neoplasmer i centrala nervsystemet
- Neuroblastom
- Läkemedels fysiologiska effekter
- Neurotransmittormedel
- Molekylära mekanismer för farmakologisk verkan
- Anti-infektionsmedel
- Depressiva medel i centrala nervsystemet
- Enzyminhibitorer
- Antineoplastiska medel
- Immunsuppressiva medel
- Immunologiska faktorer
- Antibakteriella medel
- Lugnande medel
- Psykotropa droger
- GABA-agenter
- Antikonvulsiva medel
- Antimaniska medel
- Antibiotika, antineoplastiska
- Antifungala medel
- Valproinsyra
- Sirolimus
Andra studie-ID-nummer
- LCCC 0901
- P30CA016086 (U.S.S. NIH-anslag/kontrakt)
- CDR0000665319 (Annan identifierare: PDQ)
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