Aflac ST0901 CHOANOME - Sirolimus in Solid Tumors
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Purpose
The best treatment for recurrent cancers or those that do not respond to therapies is not known. Typically, patients with these cancers receive a combination of cancer drugs (chemotherapy), surgery, or radiation therapy. These treatments can prolong their life but may not offer a long-term cure.
This study proposes using a drug called Sirolimus in combination with common chemotherapy drugs to treat patients with recurrent and refractory solid tumors. Sirolimus has been found to inhibit cell growth and to have anti-tumor activity in pediatric solid tumors in previous studies and, therefore, has the potential to increase the effectiveness of the chemotherapy drugs when given together.
This study wil investigate the highest dose of Sirolimus that can be given orally with other oral chemotherapy drugs. Cohorts of 2 subjects will be started at the minimum dose. The dose will be increased in the next 2 subjects as long as there were no major reactions in the previous groups. This study will also seek to learn more about the side effects of sirolimus when used in this combination and what effects the drug has on the white cells and the immune system. Successful use of this drug will impact the cancer population greatly by providing an increased chance of survival to those with resistant or recurrent cancers.
| Condition | Intervention | Phase |
|---|---|---|
|
Ewing's Sarcoma Osteosarcoma Astrocytoma Atypical Teratoid/Rhabdoid Tumor Ependymoma Germ Cell Tumor Glioma Medulloblastoma Rhabdoid Tumor Retinoblastoma Clear Cell Sarcoma Renal Cell Carcinoma Wilms Tumor Hepatoblastoma Neuroblastoma Rhabdomyosarcoma |
Drug: sirolimus |
Phase 1 |
| Study Type: | Interventional |
| Study Design: | Endpoint Classification: Safety/Efficacy Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | Sirolimus in Combination With Metronomic Therapy in Children With Recurrent and Refractory Solid Tumors: A Phase I Study |
- Maximum tolerated dose (MTD) [ Time Frame: 2 years after treatment starts ] [ Designated as safety issue: Yes ]estimate the maximum tolerated dose (MTD) and recommended Phase II dose of sirolimus administered orally once daily for 42 days in combination with metronomic chemotherapy in children with recurrent or refractory solid tumors.
- define and describe toxicities of sirolimus [ Time Frame: 2 years post treatment ] [ Designated as safety issue: Yes ]To define and describe the toxicities of sirolimus administered in combination with metronomic chemotherapy administered according to this schedule.
- anti-tumor activity of sirolimus [ Time Frame: 2 years post treatment ] [ Designated as safety issue: No ]To assess the antitumor activity of sirolimus administered in combination with metronomic chemotherapy to children with recurrent and refractory solid tumors within the confines of a Phase I study.
- evaluate correlation of p70S6 kinase activity [ Time Frame: 2 years post treatment ] [ Designated as safety issue: No ]To evaluate the correlation of p70S6 kinase activity inhibition with tumor response.
- evaluate risk of infection [ Time Frame: 2 years post treatment ] [ Designated as safety issue: Yes ]To evaluate the effect of this combination therapy on lymphocyte subsets and memory T-cells, and to correlate that with risk of infection.
| Estimated Enrollment: | 24 |
| Study Start Date: | April 2011 |
| Estimated Study Completion Date: | April 2021 |
| Estimated Primary Completion Date: | April 2014 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: sirolimus treatment
Dose escalation of sirolimus with starting dose at 1 mg/m2 and increasing to a possible 3 mg/m2.
|
Drug: sirolimus
daily administration of sirolimus in oral form starting at a dose of 1 mg/m2 and increasing to a possible 3 mg/m2.
Other Names:
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Detailed Description:
Sirolimus, is a potent immunosuppressive drug that is approved for use in prevention against allograft rejection following solid organ transplant. It has anti-tumor effects mainly by blocking signals which drive cells from G1 to S phase during cell cycle through inhibition of mTOR, thus inhibiting cell growth. Sirolimus, as well as other mTOR inhibitors, has shown anti-tumor activity in pediatric solid tumor xenografts. Children with relapsed and/or refractory solid tumors are in need of novel therapeutic approaches. One option for these patients is the use of prolonged exposure to low dose antiangiogenic chemotherapy, with agents such as etoposide and cyclophosphamide. In this phase I trial the feasibility and optimal dosing for daily sirolimus, in combination with daily celecoxib, and low dose etoposide alternating with cyclophosphamide, will be determined in children with relapsed and refractory solid tumors. p70S6 kinase inhibition will be used as a surrogate for mTOR inhibition. The potential immunosuppressive effect of sirolimus administered on this schedule will be assessed by serial lymphocyte subsets and assessment of memory T cell number.
Eligibility| Ages Eligible for Study: | up to 30 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- must be <=30 years of age at time of study enrollment
- histologic verification of malignancy at original diagnosis or relapsis except in patients with intrinsic brain stem tumors, optic pathway gliomas or patients wtih pineal tumors and evaluations of serum or CSF alpha-fetoprotein or beta-HCG
- measurable or evaluable disease
- disease state must be one for which there is no known curative therapy
- Performance level >=50%
- Patients must have fully recovered from acute toxic effects of all prior chemotherapy, immunotherapy or radiotherapy
- no evidence of acute graft vs. host disease and >=3 months since transplant
- organ function as defined in eligibility section of protocol
Exclusion Criteria:
- patients cannot be pregnant or breast-feeding
- patients must agree to use of an effective contraceptive method
- no growth factors that support platelet or white cell number or function for at least 7 days prior to enrollment
- patients receiving corticosteroids who have not been on a stable or decreasing dose of corticosteroid for the prior 7 days are not eligible
- patients receiving any other investigational drugs
- patients receiving any other anti-cancer drugs
- patients who have an uncontrolled infection
Contacts and Locations| Contact: Sindy Midoro | 404-785-1441 | sindy.midoro@choa.org |
| Contact: Jaclyn Smith, MBA | 404-785-0692 | jaclyn.smith@choa.org |
| United States, Georgia | |
| Children's Healthcare of Atlanta | Recruiting |
| Atlanta, Georgia, United States, 30322 | |
| Contact: Sindy Midoro 404-785-1441 sindy.midoro@choa.org | |
| Contact: Jaclyn Smith, MBA 404-785-0692 jaclyn.smith@choa.org | |
| Principal Investigator: Howard Katzenstein, MD | |
| Principal Investigator: | Howard Katzenstein, MD | Children's Healthcare of Atlanta |
More Information
Additional Information:
No publications provided
| Responsible Party: | Howard Katzenstein, Associate Professor, Emory University |
| ClinicalTrials.gov Identifier: | NCT01331135 History of Changes |
| Other Study ID Numbers: | Aflac ST0901 CHOANOME |
| Study First Received: | April 6, 2011 |
| Last Updated: | February 26, 2013 |
| Health Authority: | United States: Institutional Review Board |
Keywords provided by Emory University:
|
pediatrics sirolimus relapse |
Additional relevant MeSH terms:
|
Wilms Tumor Astrocytoma Carcinoma Carcinoma, Renal Cell Ependymoma Glioma Medulloblastoma Neuroblastoma Osteosarcoma Retinoblastoma Rhabdomyosarcoma Neoplasms, Germ Cell and Embryonal Hepatoblastoma Sarcoma, Clear Cell Rhabdoid Tumor |
Sarcoma, Ewing's Neuroectodermal Tumors, Primitive, Peripheral Sarcoma Neoplasms, Neuroepithelial Neuroectodermal Tumors Neoplasms by Histologic Type Neoplasms Neoplasms, Glandular and Epithelial Neoplasms, Nerve Tissue Adenocarcinoma Kidney Neoplasms Urologic Neoplasms Urogenital Neoplasms Neoplasms by Site Kidney Diseases |
ClinicalTrials.gov processed this record on May 19, 2013