Study of Irinotecan and Bortezomib in Children With Recurrent/Refractory Neuroblastoma

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborator:
Millennium Pharmaceuticals, Inc.
Information provided by (Responsible Party):
University of Michigan Cancer Center
ClinicalTrials.gov Identifier:
NCT00644696
First received: March 24, 2008
Last updated: August 8, 2013
Last verified: August 2013
  Purpose

This Phase One pediatric trial seeks to take advantage of the susceptibility of neuroblastoma to proteasome inhibitors, proven in vitro, along with the proven in vitro synergy of bortezomib with irinotecan and the successful Phase One pediatric trials of bortezomib to create a treatment using these two drugs in combination to treat refractory/recurrent neuroblastoma in children and young adults 25 and under.


Condition Intervention Phase
Neuroblastoma
Drug: Irinotecan and Bortezomib
Phase 1

Study Type: Interventional
Study Design: Endpoint Classification: Safety Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase One Study of Intravenous Irinotecan and Bortezomib in Children With Recurrent/Refractory High-Risk Neuroblastoma

Resource links provided by NLM:


Further study details as provided by University of Michigan Cancer Center:

Primary Outcome Measures:
  • Determine highest dose of IV irinotecan administered in conjunction with bortezomib without causing severe side effects. [ Time Frame: 3 years ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Measure the neuroblastoma tumors after treatment with irinotecan and bortezomib to determine whether there was a change in size. [ Time Frame: 24 months ] [ Designated as safety issue: No ]

Enrollment: 18
Study Start Date: April 2008
Estimated Study Completion Date: August 2016
Estimated Primary Completion Date: December 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Irinotecan and Bortezomib
Irinotecan and Bortezomib will both be administered
Drug: Irinotecan and Bortezomib
Dose level-1a: IV Irinotecan 30 mg/m2/day, IV bortezomib 1.2mg/m2/day Dose level-1: IV Irinotecan 35 mg/m2/day, IV bortezomib 1.2mg/m2/day Dose level-2: IV Irinotecan 40 mg/m2/day, IV bortezomib 1.2mg/m2/day Dose level-3: IV Irinotecan 45 mg/m2/day, IV bortezomib 1.2mg/m2/day Dose level-4: IV Irinotecan 50 mg/m2/day, IV bortezomib 1.2mg/m2/day
Other Names:
  • Velcade
  • Cefpodoxime
  • Cefixime

Detailed Description:

In spite of intensive treatment including high-dose chemotherapy with autologous peripheral stem cell transplantation and radiation therapy, the long-term survival of patients with high-risk neuroblastoma remains poor. Patients who experience a relapse of their disease or fail to achieve complete remission fare even worse. More intense chemotherapy is not the answer. The development of new drugs with different mechanisms of action are required.

Inhibitors of the proteasome have created a considerable interest in their use in cancer chemotherapy, either as a single agent or in combination with other chemotherapeutic agents. The precise mechanism of action for these class of drugs is unclear, however, inhibition of I-kB degradation by VELCADE® (bortezomib) decreases NF-kB activity in neuroblastoma cell lines as well as other systems.

Previous studies have reported the activity of Irinotecan, a strong Topoisomerase-I inhibitor, against murine xenografts including those with high-risk features such as MYCN gene amplification (MYCN is also called V-Myc Myelocytomatosis Viral Related Oncogene, Neuroblastoma Derived). Irinotecan has also been shown to be active against neuroblastoma xenografts resistant to vincristine, melphalan, and topotecan, suggesting an alternative mechanism of resistance to Irinotecan. In vitro synergy between bortezomib and irinotecan has been documented in pancreatic cancer by others and in neuroblastoma by our group.

  Eligibility

Ages Eligible for Study:   1 Year to 25 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • No greater than 25 years of age when originally diagnosed.
  • Histologic verification of condition.
  • Has recurrent/progressive; or resistant/refractory neuroblastoma with at least ONE of the following:

    1. Measurable tumor on MRI or CT scan or X-ray (at least 20 mm in at least one dimension) or
    2. MIBG scan with positive uptake at minimum of one site, or
    3. Bone marrow with tumor cells seen on routine morphology (not by NSE staining only) of bilateral aspirate and/or biopsy on one bone marrow sample.
  • Has Lansky or Karnofsky score of 60%, and a life expectancy of > 2 months.
  • Has fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy.
  • Has not received treatment with myelosuppressive agents within 3 weeks and with any biological therapy within 2 weeks of study entry.
  • Has not received radiation for a minimum of four weeks prior to study entry at the site of any lesion that was biopsied to document study eligibility.
  • Patient is 2 months post myeloablative therapy and autologous stem cell transplant.
  • At least six weeks must have elapsed since treatment with therapeutic doses of MIBG.
  • Patients who have previously received combination bortezomib and irinotecan are ineligible but can have received one of the drugs.
  • Must not have received hematopoietic growth factors within 2 days of study entry.
  • Cannot be receiving enzyme-inducing anticonvulsants (phenobarbital, phenytoin, carbamazepine).
  • Concomitant radiotherapy to painful bone lesions will be allowed (excluding intestinal tract, spine or pelvis) but other non-radiated sites of measurable disease must be available to assess response to chemotherapy.
  • Patient has adequate bone marrow function (defined).
  • Patient has adequate renal function (defined).
  • Patient has adequate liver function (defined).
  • Post-menarchal females must have a negative pregnancy test measuring beta-human chorionic gonadotropin(HCG). All males and females must use effective contraception during study.

Exclusion Criteria:

  • Patient is status post-allogenic stem cell transplant.
  • Patient has uncontrolled infection or active diarrhea defined as 2 or more stools per day greater than baseline.
  • Presence of HIV, active hepatitis B, or active hepatitis C infection.
  • Pregnancy, as determined by Beta-human chorionic gonadotropin(HCG)measurement.
  • Grade 2 peripheral neuropathy within 14 days before enrollment.
  • Myocardial infarction within 6 months prior to enrollment or various other indications of heart disease. (defined)
  • Hypersensitivity to bortezomib, irinotecan, cefixime, boron or mannitol.
  • Female subject is breast-feeding.
  • Serious medical or psychiatric illness likely to interfere with participation.
  • Patient has received other investigational drugs within 14 days before enrollment.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00644696

Locations
United States, Michigan
The University of Michigan Comprehensive Cancer Center
Ann Arbor, Michigan, United States, 48109
Sponsors and Collaborators
University of Michigan Cancer Center
Millennium Pharmaceuticals, Inc.
Investigators
Principal Investigator: Rajen Mody, MD University of Michigan Cancer Center
  More Information

No publications provided

Responsible Party: University of Michigan Cancer Center
ClinicalTrials.gov Identifier: NCT00644696     History of Changes
Other Study ID Numbers: UMCC 2006.084, HUM 7859
Study First Received: March 24, 2008
Last Updated: August 8, 2013
Health Authority: United States: Food and Drug Administration

Keywords provided by University of Michigan Cancer Center:
Neuroblastoma
Irinotecan
Bortezomib

Additional relevant MeSH terms:
Neuroblastoma
Neuroectodermal Tumors, Primitive, Peripheral
Neuroectodermal Tumors, Primitive
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Cefpodoxime
Irinotecan
Bortezomib
Anti-Bacterial Agents
Anti-Infective Agents
Therapeutic Uses
Pharmacologic Actions
Antineoplastic Agents, Phytogenic
Antineoplastic Agents
Radiation-Sensitizing Agents
Physiological Effects of Drugs
Topoisomerase I Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Protease Inhibitors

ClinicalTrials.gov processed this record on April 17, 2014