Neuroblastoma
Conditions
Keywords
recurrent neuroblastoma
Brief summary
RATIONALE: Biological therapies such as hu14.18-interleukin-2 fusion protein work in different ways to stimulate the immune system and stop tumor cells from growing. PURPOSE: This phase II trial is studying how well hu14.18-interleukin-2 fusion protein works in treating young patients with recurrent or refractory neuroblastoma.
Detailed description
OBJECTIVES: * Determine the response rate in children with recurrent or refractory neuroblastoma treated with hu14.18-interleukin-2 (hu14.18-IL2) fusion protein. * Determine the adverse events of this drug in these patients. * Determine the immunologic activation in patients treated with this drug. * Determine the induction of anti-hu14.18-IL2 antibody in patients treated with this drug. * Correlate antitumor response with measurements of toxicity, immune activation, and anti-hu14.18-IL2 antibody activity in patients treated with this drug. OUTLINE: This is a multicenter study. Patients are stratified according to measurable/evaluable disease (measurable by standard radiographic criteria vs evaluable by MIBG (meta-iodobenzylguanidine) scanning and/or bone marrow histology vs disease identified and quantified by bone marrow immunohistochemistry). For standard radiographic criteria this study will use the definitions of measurable disease from the Response Evaluation Criteria In Solid Tumors (RECIST) from the National Cancer Institute. Complete Response (CR) - Disappearance of all target lesions. No evidence of tumor at any site (chest, abdomen, liver, bone, bone marrow, nodes, etc). Very Good Partial Response (VGPR) - Greater than 90% decrease of the disease measurement for CT/MRI target lesions, taking as reference the disease measurement done to confirm measurable disease in target lesions at study entry; all pre-existing bone lesions with CR by MIBG; MIBG scan can be SD or CR in soft tissue lesions corresponding to lesions on CT/MRI. Partial Response (PR) - At least a 30% decrease in the disease measurement for CT/MRI target lesions, taking as reference the disease measurement done to confirm measurable disease in target lesions at study entry. Progressive Disease (PD) - Any one of the following: a) At least a 20% increase in the disease measurement for CT/MRI target lesions, taking as reference the smallest disease measurement recorded since the start of treatment. b) Appearance of one or more new lesions or new sites of tumor. c) PD as defined above for either bone marrow or MIBG lesions. Stable disease (SD) - The patient will be classified as stable disease for overall response if there is stable disease by either CT/MRI lesion, bone marrow, or MIBG criteria. No new lesions; no new sites of disease. Patients will be enrolled in 3 strata, and evaluated for antitumor response following 2 monthly courses (treatment on Days 1-3, followed by 25 days of observation,). Patients with progressive disease will be taken off protocol therapy. Patients with stabilization or regression of disease will be eligible to receive 2 more monthly courses of treatment. Additional treatment following course 4 will be allowed for patients showing a continued clinical response, up to a maximum of 10 courses of treatment. Patients are followed for survival. PROJECTED ACCRUAL: A total of 40-60 patients (20 for strata 1 and 2 and 0-20 for stratum 3) will be accrued for this study within 2 years.
Interventions
Given IV
Sponsors
Study design
Eligibility
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically confirmed neuroblastoma * Relapsed or refractory to conventional therapy * Measurable or evaluable disease documented by 1 of the following criteria: * Clinical * Radiographic * Histologic * MIBG (meta-iodobenzylguanidine) scanning * Immunocytochemistry * No symptomatic pleural effusions or ascites requiring constant or intermittent drainage * No clinical or radiological evidence of central nervous system (CNS) disease PATIENT CHARACTERISTICS: Age * 21 and under Performance status * Karnofsky 50-100% (\> 16 years of age) * Lansky 50-100% (≤ 16 years of age) Life expectancy * At least 8 weeks Hematopoietic * Absolute neutrophil count \> 1,000/mm\^3 * Platelet count ≥ 75,000/mm\^3\* * Must not be refractory to platelet transfusions * Hemoglobin ≥ 9.0 g/dL\* NOTE: \*Transfusion allowed if patient is known to have a history of bone marrow involvement with tumor Hepatic * Alanine transaminase (ALT) \< 2.5 times upper limit of normal (ULN) * Bilirubin ≤ 1.5 times ULN * Hepatitis B surface antigen negative 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 ≥ 27% by echocardiogram OR * Ejection fraction ≥ 50% by Multi Gated Acquisition Scan (MUGA) * No symptomatic congestive heart failure * No uncontrolled cardiac rhythm disturbance Pulmonary * Pulse oximetry \> 94% on room air * Forced vital capacity (FVC) \> 80% * Forced expiratory volume (FEV\_1) \> 80% * No abnormal respiratory function * No dyspnea at rest * No exercise intolerance * No prior history of ventilator support related to lung injury (e.g., pneumonia, hemorrhagic pneumonitis, or capillary leakage) Other * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception * HIV negative * No active uncontrolled infection * No active uncontrolled peptic ulcer * No objective peripheral neuropathy ≥ grade 2 * No significant psychiatric disabilities * No seizure disorders requiring antiseizure medications * No other concurrent significant illness PRIOR CONCURRENT THERAPY: Biologic therapy * Recovered from prior immunotherapy * Prior in vivo monoclonal antibodies for biologic therapy or tumor imaging allowed provided there is documented absence of detectable antibody to hu14.18 by serology * More than 28 days since prior autologous stem cell transplantation * Prior autologous marrow or stem cell infusion using monoclonal antibody-purged specimens allowed * More than 1 week since prior growth factors * At least 7 days since prior nonmyelosuppressive biologic agents * No prior allogeneic bone marrow or stem cell transplantation * No concurrent immunomodulating agents * No concurrent growth factors Chemotherapy * More than 3 weeks since prior myelosuppressive chemotherapy (4 weeks for nitrosoureas) and recovered * No concurrent anticancer chemotherapy Endocrine therapy * No concurrent corticosteroids except 100 mg or less of hydrocortisone (or equivalent) as premedication for blood transfusion or treatment for transfusion reaction * No other use of systemic steroids Radiotherapy * Recovered from prior radiotherapy * At least 2 weeks since prior local palliative radiotherapy (small port) * At least 6 months since prior craniospinal radiotherapy * At least 6 months since prior total body irradiation * At least 6 months since prior radiotherapy to ≥ 50% of the pelvis * At least 6 weeks since other prior substantial bone marrow radiotherapy * Concurrent radiotherapy to localized painful lesions allowed provided at least 1 measurable or evaluable lesion is not irradiated Surgery * More than 2 weeks since prior major surgery (e.g., laparotomy or thoracotomy) * No prior organ allografts Other * No concurrent immunosuppressive drugs * No other concurrent myelosuppressive antineoplastic drugs
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Responders (Response Rate) | Up to 30 weeks | Response rate to hu14.18-Interleukin-2 in 3 separate strata of patients with recurrent or refractory neuroblastoma. Patients will have radiologic (CT/MRI) tumor and urine homovanillic acid (HVA)/vanillylmandelic acid (VMA) measurements. Patients with prior marrow involvement will have marrow assessments. Patients with MIBG+ (iodine-131-meta-iodobenzylguanidine) prior disease will have MIBG scans performed. For CT/MRI lesions, measureable disease is measured by the Response Evaluation Criteria In Solid Tumors (RECIST) from the National Cancer Institute. RECIST (v1.0) for target lesions: Complete Response (CR): Disappearance of all target lesions, Partial Response (PR): At least a 30% decrease in the sum of the longest diameter (LD) of target lesions, Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, Progressive Disease (PD): At least a 20% increase in the sum of the LD of target lesions. |
Countries
Canada, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Disease Measurable by Standard Criteria(hu14.18-interleukin-2) Patients with residual/refractory neuroblastoma and readily measurable residual/refractory disease using standard radiographic criteria. Standard radiographic criteria for CT/MRI Lesions will use the definitions of measurable disease from the Response Evaluation Criteria In Solid Tumors (RECIST) from the National Cancer Institute.
hu14.18-Interleukin-2 fusion protein : Given IV | 15 |
| Disease Eval by MIBG or BM Histology (hu14.18-interleukin-2) Patients with residual/refractory neuroblastoma with disease that is not measurable by standard radiographic criteria, but is evaluable by MIBG (iodine-131-meta-iodobenzylguanidine) scanning and/or by bone marrow histology.
hu14.18-Interleukin-2 fusion protein : Given IV | 24 |
| Disease Identified by BM Immunohistochemistry Only Patients with residual/refractory neuroblastoma that do not have disease that is measurable by standard radiographic techniques or evaluable by MIBG (iodine-131-meta-iodobenzylguanidine) scanning or BM histology, however, disease is identified and quantified by BM immunohistochemistry (\>5 neuroblastoma cells per 1,000,000 nucleated marrow cells).
hu14.18-Interleukin-2 fusion protein : Given IV | 0 |
| Total | 39 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Adverse Event | 0 | 2 | 0 |
| Overall Study | Lack of Efficacy | 12 | 13 | 0 |
| Overall Study | Physician Decision | 0 | 1 | 0 |
| Overall Study | Protocol Violation | 0 | 1 | 0 |
| Overall Study | Withdrawal by Subject | 3 | 0 | 0 |
Baseline characteristics
| Characteristic | Disease Measurable by Standard Criteria(hu14.18-interleukin-2) | Disease Eval by MIBG or BM Histology (hu14.18-interleukin-2) | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 15 participants | 23 participants | 38 participants |
| Age, Categorical >=65 years | 0 participants | 0 participants | 0 participants |
| Age, Categorical Between 18 and 65 years | 0 participants | 1 participants | 1 participants |
| Age, Continuous | 5.98 years | 6.28 years | 6.16 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 participants | 2 participants | 2 participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 15 participants | 21 participants | 36 participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 participants | 1 participants | 1 participants |
| Gender Female | 7 participants | 10 participants | 17 participants |
| Gender Male | 8 participants | 14 participants | 22 participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 participants | 1 participants | 1 participants |
| Race (NIH/OMB) Asian | 0 participants | 1 participants | 1 participants |
| Race (NIH/OMB) Black or African American | 5 participants | 3 participants | 8 participants |
| Race (NIH/OMB) More than one race | 0 participants | 0 participants | 0 participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 participants | 0 participants | 0 participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 participants | 1 participants | 2 participants |
| Race (NIH/OMB) White | 9 participants | 18 participants | 27 participants |
| Region of Enrollment Canada | 1 participants | 2 participants | 3 participants |
| Region of Enrollment United States | 14 participants | 22 participants | 36 participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 13 / 15 | 18 / 24 | 0 / — |
| serious Total, serious adverse events | 13 / 15 | 21 / 24 | 0 / 0 |
Outcome results
Number of Responders (Response Rate)
Response rate to hu14.18-Interleukin-2 in 3 separate strata of patients with recurrent or refractory neuroblastoma. Patients will have radiologic (CT/MRI) tumor and urine homovanillic acid (HVA)/vanillylmandelic acid (VMA) measurements. Patients with prior marrow involvement will have marrow assessments. Patients with MIBG+ (iodine-131-meta-iodobenzylguanidine) prior disease will have MIBG scans performed. For CT/MRI lesions, measureable disease is measured by the Response Evaluation Criteria In Solid Tumors (RECIST) from the National Cancer Institute. RECIST (v1.0) for target lesions: Complete Response (CR): Disappearance of all target lesions, Partial Response (PR): At least a 30% decrease in the sum of the longest diameter (LD) of target lesions, Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, Progressive Disease (PD): At least a 20% increase in the sum of the LD of target lesions.
Time frame: Up to 30 weeks
Population: Patients were evaluable for inclusion in the analysis of response if eligible, had an event (relapse, PD, death or secondary malignancy) any time after enrollment, or completed at least 2 courses of Irinotecan/Temozolomide therapy. Patients off therapy before completion of 2 courses by choice or toxicity were not evaluable for response analysis.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Disease Measurable by Standard Criteria(hu14.18-interleukin-2) | Number of Responders (Response Rate) | Responder | 0 participants |
| Disease Measurable by Standard Criteria(hu14.18-interleukin-2) | Number of Responders (Response Rate) | Non-responder | 13 participants |
| Disease Eval by MIBG or BM Histology (hu14.18-interleukin-2) | Number of Responders (Response Rate) | Responder | 5 participants |
| Disease Eval by MIBG or BM Histology (hu14.18-interleukin-2) | Number of Responders (Response Rate) | Non-responder | 18 participants |