Recurrent Neuroblastoma
Conditions
Brief summary
Phase I trial to compare the effectiveness of interleukin-12 with or without interleukin-2 in treating young patients who have refractory or recurrent neuroblastoma. Biological therapies use different ways to stimulate the immune system and stop cancer cells from growing. Combining interleukin-2 with interleukin-12 may kill more tumor cells.
Detailed description
OBJECTIVES: I. Define the maximum tolerated dose and dose-limiting toxicity of interleukin-12 with or without interleukin-2 in patients with refractory or recurrent neuroblastoma. II. Determine, preliminarily, the antitumor effect of interleukin-12 with or without interleukin-2 in these patients. III. Evaluate the immunoregulatory activity of interleukin-12 with or without interleukin-2 in these patients. IV. Evaluate the antiangiogenic activity of interleukin-12 with or without interleukin-2 in these patients. OUTLINE: This is a dose-escalation, multicenter study. Patients are assigned to 1 of 2 treatment cohorts. COHORT A: Patients receive interleukin-12 (IL-12) IV over 5-15 seconds on days 1, 3, 5, 8, 10, and 12. COHORT B: Patients receive interleukin-2 (IL-2) IV over 15 minutes twice daily on days 1 and 8 and IL-12 IV as in cohort A. Treatment in both cohorts repeats every 28 days for up to 4 courses in the absence of disease progression or unacceptable toxicity. Some patients may receive additional courses at the discretion of the principal investigator. Cohorts of 3-6 patients in both cohorts receive escalating doses of IL-2 and IL-12 until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Once the MTD is determined, an additional cohort of 8 patients receives IL-12 and IL-2 at the MTD. Patients are followed at 3 weeks.
Interventions
Given IV
Given IV
Sponsors
Study design
Eligibility
Inclusion criteria
* Diagnosis of neuroblastoma * Histologically confirmed disease AND/OR disease defined by tumor cells in the bone marrow and elevated urinary catecholamine metabolites * Persistent and/or refractory disease, with at least 1 of the following: * Biopsy-proven residual disease at least 12 weeks after myeloablative therapy * Progressive disease after nonmyeloablative or myeloablative therapy * Recurrent disease, evidenced by any of the following: * Biopsy-proven recurrent soft tissue disease * Metaiodobenzylguanidine (MIBG)-positive lesions visible on any other imaging modality or repeat MIBG obtained 2-4 weeks or more apart * Histologically confirmed bone marrow disease * Progressive or stable disease after at least 1 prior standard salvage regime * No clinically significant pleural effusion * ECOG 0-1 * Life expectancy \>= 12 weeks * Hepatitis A antibody negative * Hepatitis B surface antigen negative * Positive hepatitis B titer allowed if patient has been immunized and has no history of disease * Hepatitis C virus negative * No history of congenital or acquired coagulation disorder * Cardiac function normal by ECG * No dyspnea at rest * No exercise intolerance * Oxygen saturation at least 94% by pulse oximetry * DLCO greater than 60% of predicted * FEV1 greater than 70% of predicted * Negative pregnancy test * Skull-based bony lesions without space-occupying intracranial extension are allowed * No prior or concurrent intracranial metastatic disease to the brain parenchyma * Not pregnant or nursing * Fertile patients must use effective barrier contraception during and for at least 2 months after study * No prior hematologic malignancy (including leukemia or lymphoma) * No history of malignant hyperthermia * No prior or concurrent autoimmune disease * No positive direct Coombs testing * No history of ongoing or intermittent bowel obstruction * No active infection or other significant systemic illness * More than 2 weeks since prior fenretinide * More than 2 weeks since prior 13-cis-retinoic acid * More than 2 weeks since prior filgrastim (G-CSF) or sargramostim (GM-CSF) * More than 2 weeks since prior interferons or interleukins * More than 2 weeks since prior cytokine-fusion proteins * More than 2 weeks since prior IV immunoglobulin (IVIG) * No prior interleukin-12 * No concurrent cytokines * No concurrent fenretinide * No concurrent 13-cis-retinoic acid * No other concurrent immunomodulators, including: * G-CSF and GM-CSF * Interferons * Other interleukins * IVIG * More than 4 weeks since prior chemotherapy * No other unstable medical condition or critical illness that would preclude study participation * More than 12 weeks since prior myeloablative chemotherapy followed by autologous stem cell transplantation: No prior myeloablative chemotherapy followed by allogeneic bone marrow transplantation * More than 2 weeks since prior growth hormones * More than 4 weeks since prior systemic corticosteroids * More than 2 weeks since prior non-corticosteroid hormonal therapy (including oral birth control pills) * No concurrent hormonal therapy (including oral birth control pills) * No concurrent growth hormones * No concurrent systemic corticosteroids, except for use in life-threatening complications * More than 4 weeks since prior radiotherapy * No prior solid organ transplantation * More than 4 weeks since prior investigational agents * No other concurrent investigational agents * No prior enrollment on COG-A3973, unless disease has progressed * No history of hemolytic anemia * Absolute neutrophil count at least 1,500/mm\^3 \[Note: Independent of growth factor or transfusion support\] * Platelet count at least 75,000/mm\^3 \[Note: Independent of growth factor or transfusion support\] * AST and ALT less than 2.5 times upper limit of normal * Bilirubin less than 2.0 mg/dL * Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min OR creatinine normal * HIV negative * Ejection fraction at least 50% by echocardiogram or MUGA OR Fractional shortening at least 30% by echocardiogram * No congestive heart failure * No uncontrolled cardiac arrhythmia
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Maximum tolerated dose (MTD) assessed by Common Toxicity Criteria (CTC) | 28 days |
Secondary
| Measure | Time frame |
|---|---|
| Overall response assessed by Response Evaluation Criteria for Solid Tumors (RECIST) | Up to 3 weeks |
Countries
United States