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Isotretinoin With or Without Monoclonal Antibody, Interleukin-2, and Sargramostim Following Stem Cell Transplantation in Treating Patients With Neuroblastoma
This study is currently recruiting participants.
Verified February 2012 by National Cancer Institute (NCI)

First Received on November 9, 2001.   Last Updated on February 5, 2012   History of Changes
Sponsor: Children's Oncology Group
Collaborator: National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00026312
  Purpose

RATIONALE: Drugs used in chemotherapy work in different ways to stop tumor cells from dividing so they stop growing or die. Monoclonal antibodies can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Interleukin-2 and sargramostim may stimulate a person's white blood cells to kill cancer cells. It is not yet known if chemotherapy is more effective with or without monoclonal antibody therapy, interleukin-2, and sargramostim following stem cell transplantation in treating neuroblastoma.

PURPOSE: Randomized phase III trial to compare the effectiveness of chemotherapy with or without monoclonal antibody, interleukin-2, and sargramostim following stem cell transplantation in treating patients who have neuroblastoma.


Condition Intervention Phase
Neuroblastoma
Biological: aldesleukin
Biological: monoclonal antibody Ch14.18
Biological: sargramostim
Drug: isotretinoin
Phase III

Study Type: Interventional
Study Design: Allocation: Randomized
Primary Purpose: Treatment
Official Title: Phase III Randomized Study Of Chimeric Antibody 14.18 (CH14.18) In High Risk Neuroblastoma Following Myeloablative Therapy And Autologous Stem Cell Rescue

Resource links provided by NLM:


Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Event-free survival (EFS) [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Overall survival (OS) [ Designated as safety issue: No ]
  • Reduction of minimal residual disease (MRD) [ Designated as safety issue: No ]
  • Association between change from baseline MRD and EFS and OS [ Designated as safety issue: No ]
  • Correlation of tumor biology at diagnosis with EFS and OS [ Designated as safety issue: No ]
  • Toxic effects [ Designated as safety issue: Yes ]
  • Correlation of antibody-dependent cellular cytotoxicity with event-free survival [ Designated as safety issue: Yes ]
  • Comparison of outcome of patients with persistent disease with historical data [ Designated as safety issue: No ]
  • Correlation of pharmacokinetic and pharmacogenomic parameters with EFS or systemic toxicity [ Designated as safety issue: Yes ]

Estimated Enrollment: 1150
Study Start Date: October 2001
Estimated Primary Completion Date: June 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Arm I (closed to accrual as of 4/16/2009)
Patients receive oral isotretinoin twice daily for 14 days. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity.
Drug: isotretinoin
Given orally
Experimental: Arm II
Patients receive immunotherapy comprising sargramostim (GM-CSF) subcutaneously (SC) or IV over 2 hours on days 0-13 during courses 1, 3, and 5 and monoclonal antibody Ch14.18 IV over 10-20 hours on days 3-6 of courses 1-5. Patients also receive interleukin-2 IV continuously on days 0-3 and 7-10 during courses 2 and 4. Immunotherapy repeats every 28 days for 5 courses in the absence of disease progression or unacceptable toxicity. Patients also receive oral isotretinoin as in arm I beginning on day 11 of immunotherapy.
Biological: aldesleukin
Given IV
Biological: monoclonal antibody Ch14.18
Given IV
Biological: sargramostim
Given subcutaneously or IV
Drug: isotretinoin
Given orally

  Show Detailed Description

  Eligibility

Ages Eligible for Study:   up to 30 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Diagnosis of neuroblastoma

    • Categorized as high risk at diagnosis
    • Exception: patients who are initially diagnosed as non-high-risk neuroblastoma, but later converted (and/or relapsed) to high-risk neuroblastoma, are also eligible
  • Meets all of the following criteria:

    • Patients must have completed therapy including intensive induction followed by autologous stem cell transplantation (ASCT) and radiotherapy

      • Radiotherapy may be waived for patients who either have small adrenal masses which are completely resected up front, or who never have an identifiable primary tumor
    • Completed frontline therapies, examples of such therapy includes:

      • Following treatment per COG-A3973 protocol
      • Following treatment per POG-9340-42
      • Following treatment per CCG-3891
      • Following treatment on NANT-2001-02
      • Enrollment on or following treatment per COG-ANBL02P1 protocol
      • Enrollment on or following treatment per ANBL07P1
      • Tandem transplant patients are eligible

        • Following enrollment and treatment on or per COG-ANBL0532
        • Following treatment per POG-9640 protocol
        • Following treatment per COG-ANBL00P1 protocol
        • Following treatment per CHP 594 or DFCI 34-DAT
      • Other frontline therapy with permission from study chairs
    • Patients with biopsy-confirmed residual disease after ASCT are eligible
  • Must meet the International Neuroblastoma Response Criteria (INRC) for CR, VGPR, or PR for primary site, soft tissue metastases, and bone metastases AND must also meet the protocol specified criteria for bone marrow response as follows:

    • No more than 10% tumor (of total nucleated cellular content) seen on any specimen from a bilateral bone marrow aspirate/biopsy
    • Patient who have no tumor seen on the prior bone marrow, and then have ≤ 10% tumor on any of the bilateral marrow aspirate/biopsy specimens done at pre-ASCT and/or pre-enrollment evaluation will also be eligible
  • No more than 12 months from starting the first induction chemotherapy after diagnosis to the date of ASCT *

    • For patients who became high-risk neuroblastoma after initial non-high risk disease, the 12 months period should start from the date of induction therapy for high-risk neuroblastoma to the date of ASCT
  • No progressive disease at time of registration except for protocol-specified bone marrow response NOTE: * For tandem ASCT patients this is the date of the first stem cell infusion.

PATIENT CHARACTERISTICS:

Age:

  • 30 and under at diagnosis

Performance status:

  • Lansky 50-100% OR
  • Karnofsky 50-100%

Life expectancy:

  • At least 2 months

Hematopoietic:

  • Total absolute phagocyte count (neutrophils and monocytes) ≥ 1,000/mm^3

Hepatic:

  • Bilirubin ≤ 1.5 times normal
  • SGPT ≤ 5 times normal
  • Veno-occlusive disease (if present) stable or improving

Renal:

  • Creatinine adjusted according to age as follows:

    • No greater than 0.4 mg/dL (≤ 5 months)
    • No greater than 0.5 mg/dL (6 months -11 months)
    • No greater than 0.6 mg/dL (1 year-23 months)
    • No greater than 0.8 mg/dL (2 years-5 years)
    • No greater than 1.0 mg/dL (6 years-9 years)
    • No greater than 1.2 mg/dL (10 years-12 years)
    • No greater than 1.4 mg/dL (13 years and over [female])
    • No greater than 1.5 mg/dL (13 years to 15 years [male])
    • No greater than 1.7 mg/dL (16 years and over [male]) OR
  • Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min

Cardiovascular:

  • Shortening fraction ≥ 30% by echocardiogram OR
  • Ejection fraction ≥ 55% by MUGA or echocardiogram

Pulmonary:

  • FEV_1 and FVC > 60% predicted by pulmonary function test OR
  • No evidence of dyspnea at rest, no exercise intolerance

Other:

  • Not pregnant
  • Fertile patients must use effective contraception
  • Seizure disorder allowed if well-controlled and on anticonvulsants
  • CNS toxicity < grade 2

PRIOR CONCURRENT THERAPY:

Biologic therapy:

  • See Disease Characteristics
  • No more than 1 prior stem cell transplantation
  • No other concurrent cytokines or growth factors (e.g., filgrastim [G-CSF] or interferon)
  • No IV immunoglobulin G within 2 weeks before, during, and for 1 week after monoclonal antibody Ch14.18 (arm II patients)
  • No prior anti-GD2 antibody therapy

Chemotherapy:

  • No more than 1 prior myeloablative consolidation regimen
  • No concurrent myelosuppressive chemotherapy (arm II patients)

Endocrine therapy:

  • No concurrent corticosteroids unless for life-threatening conditions (e.g., increased intracranial pressure from CNS tumors or life-threatening allergic reactions)

Radiotherapy:

  • See Disease Characteristics
  • At least 7 days since prior radiotherapy

Surgery:

  • Not specified

Other:

  • No other concurrent anticancer therapy
  • No concurrent immunosuppressive drugs (e.g., cyclosporine)
  • No concurrent pentoxifylline
  • No radiographic contrast materials during and for at least 1 week after interleukin-2 (arm II)
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00026312

  Show 183 Study Locations
Sponsors and Collaborators
Children's Oncology Group
Investigators
Study Chair: Alice L. Yu, MD, PhD University of California, San Diego
  More Information

Additional Information:
Publications:
Yu AL, Gilman AL, Ozkaynak MF, London WB, Kreissman SG, Chen HX, Smith M, Anderson B, Villablanca JG, Matthay KK, Shimada H, Grupp SA, Seeger R, Reynolds CP, Buxton A, Reisfeld RA, Gillies SD, Cohn SL, Maris JM, Sondel PM; Children's Oncology Group. Anti-GD2 antibody with GM-CSF, interleukin-2, and isotretinoin for neuroblastoma. N Engl J Med. 2010 Sep 30;363(14):1324-34.
Yu AL, Gilman AL, Ozkaynak MF, et al.: A phase III randomized trial of the chimeric anti-GD2antibody ch14.18 with GM-CSF and IL2 as immunotherapy following dose intensive chemotherapy for high-risk neuroblastoma: Children's Oncology Group (COG) study ANBL0032. [Abstract] J Clin Oncol 27 (Suppl 15): A-10067z, 2009.

Responsible Party: Gregory H. Reaman, Children's Oncology Group - Group Chair Office
ClinicalTrials.gov Identifier: NCT00026312     History of Changes
Other Study ID Numbers: CDR0000069018, COG-ANBL0032, COG-P9842
Study First Received: November 9, 2001
Last Updated: February 5, 2012
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
regional neuroblastoma
disseminated neuroblastoma
stage 4S neuroblastoma
localized resectable neuroblastoma
localized unresectable neuroblastoma

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
Antibodies
Immunoglobulins
Antibodies, Monoclonal
Aldesleukin
Interleukin-2
Isotretinoin
Immunologic Factors
Physiological Effects of Drugs
Pharmacologic Actions
Antineoplastic Agents
Therapeutic Uses
Analgesics, Non-Narcotic
Analgesics
Sensory System Agents
Peripheral Nervous System Agents
Central Nervous System Agents
Dermatologic Agents
Anti-HIV Agents
Anti-Retroviral Agents
Antiviral Agents

ClinicalTrials.gov processed this record on February 13, 2012