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Trial record 1 of 1 for:    2012-000072-42
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Activity Study of Bevacizumab With Temozolomide ± Irinotecan for Neuroblastoma in Children (BEACON)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02308527
Recruitment Status : Recruiting
First Posted : December 4, 2014
Last Update Posted : March 26, 2020
Sponsor:
Collaborators:
Cancer Research UK
Roche Pharma AG
Imagine for Margo
EUSA Pharma
Information provided by (Responsible Party):
University of Birmingham

Brief Summary:

The purpose of this study is to investigate whether Bevacizumab (an anti-VEGF monoclonal antibody) added to a backbone chemotherapy regimen (Temozolomide, Irinotecan-Temozolomide or Topotecan-Temozolomide) demonstrates activity in children with relapsed or refractory neuroblastoma. Also, to investigate whether the addition of Irinotecan or Topotecan to Temozolomide increases the activity of chemotherapy.The primary objective of the study is the best response (Complete Response or Partial Response) while trial treatment, within 18 or 24 weeks depending on the arm of the trial the participant is randomised to. Secondary endpoints are assessing the side effects, the length of time before progression (Progression Free Survival) and overall survival (OS).

This trial will address two important questions:

  • does targeting blood vessel development using bevacizumab, (a monoclonal antibody against the Vascular Endothelial Growth Factor (VEGF)), add to the effect on a tumour when used with existing chemotherapy, compared to the effect of the existing chemotherapy alone (temozolomide)? NOTE- This question has been completed.
  • does the addition of a second chemotherapy drug (irinotecan or topotecan) increase the effect on a tumour compared to the effect of one alone (temozolomide) NOTE - This question has been completed.
  • does the addition of dinutuximab beta added to a backbone chemotherapy (temozolomide or temozolomide + topotecan) increase the effect of backbone alone.

Patients aged 1-21 years of age with relapsed or refractory high-risk neuroblastoma are randomised to one of two treatment arms: temozolomide-topotecan (TTo) or dinutuximab beta-temozolomide-topotecan (dBTTo). Temozolomide (T), irinotecan-temozolomide (IT), bevacizumab-T (BT), BIT (bevacizumab-IT), bevacizumab-temozolomide-topotecan (BTTo) and dinutuximab beta-temozolomide (dBT) are now closed to recruitment.


Condition or disease Intervention/treatment Phase
Neuroblastoma Drug: Bevacizumab Drug: Temozolomide Drug: Irinotecan Drug: Topotecan Drug: Dinutuximab Beta Drug: Cyclophosphamide Phase 2

Detailed Description:

This is an international open-label, randomised, multicentre phase II trial of temozolomide ± irinotecan, with or without bevacizumab, for the treatment of patients with relapsed or refractory neuroblastoma. The study will evaluate the safety and activity of these combinations.

Patients will be registered into the trial and randomised at the same time to one of the following two arms (approximately 30 patients per arm):

TTo: Temozolomide + Topotecan dBTTo: Dinuximab beta + Temozolomide + Topotecan

Arms which have now closed to recruitment:

dBT: Dinutuximab beat + Temozolomide Closed 28 ]Jan 2020 T: Temozolomide - Closed 28 Jan 2020 BT: Bevacizumab + Temozolomide - Closed 7 Feb 2019 IT: Irinotecan + Temozolomide - Closed 21 June 2018 BIT: Bevacizumab + Irinotecan + Temozolomide - Closed 21 June 2018 BTTo: Bevacizumab + Temozolomide + Topotecan - Closed 7 Feb 2019

Randomisation will be via a secure on-line computer-based system at the Cancer Research Clinical Trial Unit (CRCTU), University of Birmingham, United Kingdom (UK) and patients will be allocated in a 2:1 ratio. Minimisation will be used to ensure balance across the arms for the important prognostic factors as described by London et al. [10]: a) relapsed, refractory disease, b) early (< 18 months), late relapse (≥18 months) and c) measurable versus evaluable disease (i.e. disease evaluated according to RECIST versus disease detectable only by MIBG scanning with or without bone marrow involvement as detected by local morphology) Patients will receive treatment for 6 courses, lasting 24 weeks.

Patients with a response (CR, PR) or stable disease (SD) while on the BEACON-Neuroblastoma trial will receive 6 cycles of trial treatment. If the patient has achieved a satisfactory response (i.e. CR, PR or SD) with acceptable toxicity, treatment may be extended beyond 6 cycles (up to 12 cycles) after discussion with the Sponsor and the Chief Investigator (CI).

In addition, patients randomised to TTo may recieve an optional regimen of dinutuximab beta + topotecan + cyclophosphamide (up to 6 cycles).

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 224 participants
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Randomised Phase IIb Trial of Bevacizumab Added to Temozolomide ± Irinotecan for Children With Refractory/Relapsed Neuroblastoma - BEACON-Neuroblastoma Trial
Actual Study Start Date : July 2013
Estimated Primary Completion Date : July 2021
Estimated Study Completion Date : July 2026


Arm Intervention/treatment
Active Comparator: Temozolomide
Temozolomide Days 1-5 every 4 weeks
Drug: Temozolomide
200mg/m2/d PO (capsule taken orally) on Days 1 to 5 of a 4 week cycle, for 6 cycles or until progression
Other Name: Temodal

Experimental: Bevacizumab + Temozolomide
Bevacizumab Day 1 and 15 + Temozolomide Days 1-5 every 4 weeks
Drug: Bevacizumab
10mg/kg IV (in the vein) on Days 1 and 15 of a 4 week cycle, for 6 cycles or until progression
Other Name: Avastin

Drug: Temozolomide
200mg/m2/d PO (capsule taken orally) on Days 1 to 5 of a 4 week cycle, for 6 cycles or until progression
Other Name: Temodal

Experimental: Irinotecan + Temozolomide
Irinotecan Days 1-5 + Temozolomide Days 1-5 every 3 weeks
Drug: Temozolomide
100mg/m2/d PO (capsule taken orally) on Days 1 to 5 of a 3 week cycle, for 6 cycles or until progression
Other Name: Temodal

Drug: Irinotecan
50mg/m2/d IV (in the vein) on Days 1 to 5 of a 3 week cycle, for 6 cycles or until progression
Other Name: Campto

Experimental: Bevacizumab + Irinotecan + Temozolomide
Bevacizumab Day 1 + Irinotecan Days 1-5 + Temozolomide Days 1-5 every 3 weeks
Drug: Temozolomide
100mg/m2/d PO (capsule taken orally) on Days 1 to 5 of a 3 week cycle, for 6 cycles or until progression
Other Name: Temodal

Drug: Irinotecan
50mg/m2/d IV (in the vein) on Days 1 to 5 of a 3 week cycle, for 6 cycles or until progression
Other Name: Campto

Drug: Bevacizumab
15mg/kg IV (in the vein) on Day 1 of a 3 week cycle, for 6 cycles or until progression
Other Name: Avastin

Experimental: Temozolomide + Topotecan
Temozolomide Days 1-5+ Topotecan Days 1-5 every 4 weeks
Drug: Topotecan
0.75mg/m2/d IV (in the vein) on Days 1-5 of a 4 week cycle, for 6 cycles or until progression

Drug: Temozolomide
150mg/m2/d PO (capsule taken orally) on Days 1 to 5 of a 4 week cycle, for 6 cycles or until progression
Other Name: Temodal

Experimental: Bevacizumab + Temozolomide + Topotecan
Bevacizumab Day 1 and 15 + Temozolomide Days 1-5 + Topotecan Days 1-5 every 4 weeks
Drug: Bevacizumab
10mg/kg IV (in the vein) on Days 1 and 15 of a 4 week cycle, for 6 cycles or until progression
Other Name: Avastin

Drug: Topotecan
0.75mg/m2/d IV (in the vein) on Days 1-5 of a 4 week cycle, for 6 cycles or until progression

Drug: Temozolomide
150mg/m2/d PO (capsule taken orally) on Days 1 to 5 of a 4 week cycle, for 6 cycles or until progression
Other Name: Temodal

Experimental: Dinutuximab beta + Temozolomide
Dinutuximab beta Days 1-7 + Temozolomide Days 1-5 every 4 weeks
Drug: Temozolomide
200mg/m2/d PO (capsule taken orally) on Days 1 to 5 of a 4 week cycle, for 6 cycles or until progression
Other Name: Temodal

Drug: Dinutuximab Beta
10mg/m2/d IV (in the vein) on Days 1 to 7 of a 4 week cycle, for 6 cycles or until progression
Other Name: Qarziba

Experimental: Dinutuximab beta + Temozolomide + Topotecan
Dinutuximab beta Days 1-7 + Temozolomide Days 1-5 + Topotecan Days 1-5 every 4 weeks
Drug: Temozolomide
200mg/m2/d PO (capsule taken orally) on Days 1 to 5 of a 4 week cycle, for 6 cycles or until progression
Other Name: Temodal

Drug: Topotecan
0.75mg/m2/d IV (in the vein) on Days 1-5 of a 4 week cycle, for 6 cycles or until progression

Drug: Dinutuximab Beta
10mg/m2/d IV (in the vein) on Days 1 to 7 of a 4 week cycle, for 6 cycles or until progression
Other Name: Qarziba

Dinutuximab beta + Topotecan + Cyclophosphamide
Dinutuximab beta Days 1-7 + Topotecan Days 1-5 + Cyclophosphamide Days 1-5 every 4 weeks
Drug: Topotecan
0.75mg/m2/d IV (in the vein) on Days 1-5 of a 4 week cycle, for 6 cycles or until progression

Drug: Dinutuximab Beta
10mg/m2/d IV (in the vein) on Days 1 to 7 of a 4 week cycle, for 6 cycles or until progression
Other Name: Qarziba

Drug: Cyclophosphamide
250mg/m2/d IV (in the vein) on Days 1 to 5 of a 4 week cycle, for 6 cycles or until progression




Primary Outcome Measures :
  1. Best response (Complete Response or Partial Response) while on trial treatment, within 18 or 24 weeks depending on the arm of the trial participant is randomised to. [ Time Frame: Within 18 or 24 weeks depending on the arm of the trial the participant is randomised to. ]
    To test whether bevacizumab added to a backbone chemotherapy regimen (temozolomide, irinotecan-temozolomide or topotecan-temozolomide) demonstrates activity in children with relapsed or refractory neuroblastoma To test whether the addition of irinotecan to temozolomide increases the activity of chemotherapy in children with relapsed or refractory neuroblastoma

  2. For the bevacizumab part 2 only; Progression-free survival (PFS) [ Time Frame: Assessment will be after 30 days after treatment or end of trial ]
    Progression-free survival (PFS)


Secondary Outcome Measures :
  1. To evaluate the toxicity of the regimens [ Time Frame: Assessment will be after 30 days after treatment or end of trial ]
    Safety of the regimens: Incidence and severity of Adverse Events (AE)s

  2. To evaluate the safety of the regimens [ Time Frame: Assessment will be after 30 days after treatment or end of trial ]
    Safety of the regimens: Progression-free survival (PFS)

  3. To evaluate the overall safety of the regimens [ Time Frame: Assessment will be after 30 days after treatment or end of trial ]
    Safety of the regimens: Overall survival (OS)

  4. To evaluate the safety of the regimens [ Time Frame: Assessment will be after 30 days after treatment or end of trial ]
    Safety of the regimens: Event-free survival (EFS)



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   1 Year to 21 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria

  • Histologically proven neuroblastoma as per International Neuroblastoma Staging System (INSS) definition
  • Relapsed: any relapsed or progressed high-risk neuroblastoma
  • Refractory high risk disease: Lack of adequate response to frontline therapy that precludes the patient from proceeding to consolidation therapies
  • Measurable disease by cross sectional imaging (RECIST) or evaluable disease
  • Age ≥1 to ≤21 years
  • Informed consent from patient, parent or guardian
  • Performance Status:Lansky ≥ 50%, Karnofsky ≥ 50% or Eastern Cooperative Oncology Group ≤3 (Patients who are unable to walk because of paralysis, but who are able to sit upright unassisted in a wheelchair, will be considered ambulatory for the purpose of assessing performance score)
  • Life expectancy of ≥12 weeks
  • No bone marrow disease: Platelets ≥75 x 10^9/L (unsupported for 72 hours), absolute neutrophil count ≥0.75 x10^9/L (no G-cerebrospinal fluid support for 72 hours), Haemoglobin ≥8 g/dL (transfusions allowed) Bone marrow disease: Platelets ≥50 x10^9/L (unsupported for 72 hours), absolute neutrophil count (ANC) ≥0.5 x 10^9/L (no granulocyte colony stimulating factor (G-CSF) for 72 hours), Haemoglobin ≥8 g/dL (transfusions allowed)
  • Renal function (within 72 hours of eligibility assessment): Absence of clinically significant proteinuria (early morning urine dipstick <2+). When the dipstick urinalysis shows a proteinuria ≥2+, a protein:creatinine (Pr/Cr) ratio must be <0.5 or a 24 hour protein excretion must be <0.5g
  • Serum creatinine ≤ 1.5 upper limit of normal for age, if higher, a calculated glomerular filtration rate (radioisotope) must be ≥60 ml/min/1.73 m2
  • Liver function (within 72 hours of eligibility assessment): aspartate aminotransferase (AST) or Alanine Aminotransferase (ALT) ≤2.5 ULN and Total bilirubin ≤1.5 upper limit of normal (ULN). In case of liver metastases, AST or ALT ≤5 ULN and Total bilirubin ≤2.5 ULN
  • Cardiac function, shortening fraction ≥29% on echocardiogram
  • Coagulation, patients not on anticoagulation must have an international normalized ratio (INR) ≤1.5 and activated partial thromboplastin time (APTT) ≤1.5 ULN for age. Anti-coagulation is permitted as long as the INR or APTT is within therapeutic limits (according to the medical standard of the institution) and the patient has been on a stable dose of anticoagulants for at least two weeks at the time of study enrolment
  • Blood pressure below 95th centile for age and sex. Use of antihypertensive medication is permitted
  • Males or females of reproductive potential may not participate unless they agree to use an effective contraceptive method, for the duration of study therapy and for up to 6 months after the last dose of trial drugs. A negative urine pregnancy test must be obtained within 72 hours prior to dosing in females who are post-menarche
  • No dyspnoea at rest and pulse oximetry > 94% in room air
  • Availability and willingness to place a double central venous access if needed for trial treatment and supportive care in case of treatment with chemo-immunotherapy

Exclusion Criteria:

  • Previous treatment with bevacizumab, temozolomide, irinotecan or any combination of these drugs
  • Known hypersensitivity to: Any study drug or component of the formulation, Chinese hamster ovary products or other recombinant human or humanised antibodies, Dacarbazine
  • Prior severe arterial thrombo-embolic events (e.g. cardiac ischemia, cerebral vascular accident, peripheral arterial thrombosis)
  • Any ongoing arterial thrombo-embolic events
  • Patient less than (at point of planned date of randomisation): 48 hours post bone marrow aspirate/trephine, 48 hours post central line insertion, Four weeks post major surgery, One week post core biopsy, Two weeks from prior chemotherapy, Six weeks from prior craniospinal radiotherapy or MIBG therapy and two weeks from radiotherapy to the tumour bed, Eight weeks from prior myeloablative therapy with haematopoietic stem cell rescue (autologous stem cell transplant), Three months from prior allogeneic stem cell transplant, 14 days or 5 half-lives (whichever occurs later) from last administration of an IMP in an IMP-trial, 6 months from presentation of lung haemorrhage/haemoptysis
  • Bleeding metastases (patients with CNS metastases can be enrolled as long as the metastases are not bleeding)
  • Invasion of major blood vessels
  • Use of enzyme inducing anticonvulsants within 72 hours of randomisation
  • History or evidence of inherited bleeding diathesis or significant coagulopathy at risk of bleeding (i.e. in the absence of therapeutic anticoagulation)
  • History of abdominal fistula, gastrointestinal perforation, intra-abdominal abscess or active gastrointestinal bleeding within 6 months prior to study enrolment
  • Current chronic intestinal inflammatory disease/bowel obstruction
  • Intolerance to galactose and fructose, lactase deficiency, and/or defect of absorption of galactose and fructose
  • Pregnant or lactating patient
  • Any uncontrolled medical condition that poses an additional risk to the patient (i.e. haemoptysis, non-healing, bone fracture, wound/ulcer)
  • Low probability of treatment compliance
  • Any uncontrolled medical condition that poses an additional risk to the patient
  • Planned immunisation with live vaccine

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02308527


Contacts
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Contact: Lucas Moreno, MD 0121 4143788 lucas.moreno@vhebron.net
Contact: Keith Wheatley, PhD 0121 4143845 K.Wheatley@bham.ac.uk

Locations
Layout table for location information
Austria
St Anna Children's Hospital and CCRI/Studies and Statistics Recruiting
Vienna, Austria, A-1090
Contact: Ruth Ladenstein, MD    43 1 40470 4750    ruth.ladenstein@ccri.at   
Principal Investigator: Ruth Ladenstein, MD         
Belgium
University Hospital Recruiting
Gent, Belgium
Contact: Genevieve Laureys, MD       genevieve.laureys@uzgent.be   
Principal Investigator: Genevieve Laureys, MD         
Denmark
University Hospital Rigshospitalet Recruiting
Copenhagen, Denmark, DK-2100
Contact: Karsten Nysom, MD    45 35 45 08 09    Karsten.Nysom@regionh.dk   
Principal Investigator: Karsten Nysom, MD         
France
Hopital des Enfants Recruiting
Toulouse, France, 31059
Contact: Marion Gambart, MD    33 534 55 86 11    gambart.m@chu-toulouse.fr   
Principal Investigator: Marion Gambart, MD         
Ireland
Our Ladys Children's Hospital Dublin Recruiting
Dublin, Ireland, Dublin 12
Contact: Cormac Owens, MD    35 31 409 6659    cormac.owens@olchc.ie   
Principal Investigator: Cormac Owens, MD         
Italy
Ospedale Pediatrico Bambino Gseu Recruiting
Rome, Italy, 00165
Contact: Aurora Castellano, MD       aurora.castellano@opbg.net   
Principal Investigator: Aurora Castellano, MD         
Netherlands
Princess Maxima Centre Recruiting
Utrecht, Netherlands
Contact: Michel Zwaan, MD       c.m.zwaan@prinsesmaximacentrum.nl   
Principal Investigator: Michel Zwaan, MD         
Spain
Instituto de Investigacion Sanitaria Recruiting
Valencia, Spain, 46026
Contact: Victoria Castel, MD    34 963 862 758    castel_vic@gva.es   
Principal Investigator: Victoria Castel, MD         
Switzerland
Swiss Paediatric Oncology Group Recruiting
Bern, Switzerland, 3008
Contact: Nicolas Gerber    +41 (0)31 508 42 38    'nicolas.gerber@kispi.uzh.ch'   
Principal Investigator: Nicolas Gerber`         
United Kingdom
The Royal Marsden NHS Foundation Trust and Institute of Cancer Research Recruiting
Sutton, Surrey, United Kingdom, SM2 5PT
Contact: Sucheta Vaidya, MD       sucheta.vaidya@icr.ac.uk   
Contact: Lucas Moreno, MD         
Principal Investigator: Sucheta Vaidya, MD         
Sponsors and Collaborators
University of Birmingham
Cancer Research UK
Roche Pharma AG
Imagine for Margo
EUSA Pharma
Investigators
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Principal Investigator: Lucas Moreno, MD University of Birmingham
Layout table for additonal information
Responsible Party: University of Birmingham
ClinicalTrials.gov Identifier: NCT02308527    
Other Study ID Numbers: RG_11-087
2012-000072-42 ( EudraCT Number )
First Posted: December 4, 2014    Key Record Dates
Last Update Posted: March 26, 2020
Last Verified: March 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by University of Birmingham:
Children
Young adults
Additional relevant MeSH terms:
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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
Cyclophosphamide
Temozolomide
Bevacizumab
Irinotecan
Topotecan
Ch14.18 monoclonal antibody
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists
Antineoplastic Agents, Immunological
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Growth Inhibitors