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Decitabine, Doxorubicin, and Cyclophosphamide in Treating Children With Relapsed or Refractory Solid Tumors or Neuroblastoma
This study has been completed.
First Received: January 9, 2004   Last Updated: February 6, 2009   History of Changes
Sponsors and Collaborators: Children's Oncology Group
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00075634
  Purpose

RATIONALE: Drugs used in chemotherapy, such as decitabine, doxorubicin, and cyclophosphamide, work in different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells.

PURPOSE: This phase I trial is studying the side effects and best dose of decitabine when given together with doxorubicin and cyclophosphamide in treating children with relapsed or refractory solid tumors or neuroblastoma.


Condition Intervention Phase
Neuroblastoma
Unspecified Childhood Solid Tumor, Protocol Specific
Biological: filgrastim
Biological: pegfilgrastim
Drug: cyclophosphamide
Drug: decitabine
Drug: doxorubicin hydrochloride
Phase I

Study Type: Interventional
Study Design: Treatment
Official Title: Phase I Study of Decitabine (NSC #127716, IND #50733) in Combination With Doxorubicin and Cyclophosphamide in the Treatment of Relapsed or Refractory Solid Tumors

Resource links provided by NLM:


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

Primary Outcome Measures:
  • Toxicity [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Caspase-8 expression [ Designated as safety issue: No ]

Estimated Enrollment: 21
Study Start Date: December 2003
Detailed Description:

OBJECTIVES:

Primary

  • Determine the maximum tolerated dose of decitabine in combination with doxorubicin and cyclophosphamide in children with relapsed or refractory solid tumors or neuroblastoma.
  • Determine the toxic effects of this regimen in these patients.
  • Determine whether decitabine induces tumor caspase-8 demethylation and expression in these patients.

Secondary

  • Determine the pharmacokinetics of low-dose decitabine in these patients.
  • Determine the biological and clinical response in patients treated with this regimen.
  • Compare patterns of peripheral blood gene expression, using gene expression profiling, in patients before and after treatment with decitabine.

OUTLINE: This is a multicenter, dose-escalation study of decitabine.

  • Part A (solid tumor patients): Patients receive decitabine IV over 1 hour on days 0-6 and doxorubicin IV over 15 minutes and cyclophosphamide IV over 1 hour on day 7. Patients then receive filgrastim (G-CSF) subcutaneously (SC) beginning on day 8 and continuing until blood counts recover OR pegfilgrastim SC once on day 8 or 9*. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of decitabine 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.

NOTE: *For patients > 45 kg

  • Part B (neuroblastoma patients): Once the MTD is determined for part A, patients are treated as in part A at the MTD .

Patients are followed at 30 days.

PROJECTED ACCRUAL: A total of 15-21 patients will be accrued for this study within 1-2 years.

  Eligibility

Ages Eligible for Study:   1 Year to 21 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically confirmed diagnosis of either of the following:

    • Solid tumor (part A)

      • No lymphoma
    • Neuroblastoma (part B)

      • Original diagnosis may be based on elevated urine vanillylmandelic acid (VMA) and homovanillic acid (HVA) and bone marrow examination
      • Accessible disease by bone marrow aspirate or tumor biopsy

        • No laparotomy, thoracotomy, endoscopy, or craniotomy for biopsy
  • No known curative therapy OR therapy proven to prolong survival with an acceptable quality of life available
  • No known brain or spinal cord metastases
  • No CNS tumors

PATIENT CHARACTERISTICS:

Age

  • Over 12 months to 21 years

Performance status

  • Karnofsky 50-100% (patients 11 to 21 years of age)
  • Lansky 50-100% (patients ≤ 10 years of age)

Life expectancy

  • Not specified

Hematopoietic

  • Parts A and B without bone marrow infiltration:

    • Absolute neutrophil count ≥ 1,000/mm^3
    • Platelet count ≥ 100,000/mm^3 (transfusion independent)
  • Part B with bone marrow infiltration (i.e., tumor metastatic to bone marrow with granulocytopenia, anemia, and/or thrombocytopenia):

    • Absolute neutrophil count ≥ 750/mm^3
    • Platelet count ≥ 50,000/mm^3 (transfusion independent)
  • Hemoglobin ≥ 8.0 g/dL (transfusion allowed)
  • No sickle cell anemia

Hepatic

  • Bilirubin ≤ 1.5 mg/dL
  • ALT ≤ 5 times upper limit of normal
  • No significant hepatic dysfunction that would compromise the tolerability of decitabine or interfere with study procedures or results

Renal

  • Creatinine based on age as follows:

    • ≤ 0.8 mg/dL (5 years of age and under)
    • ≤ 1.0 mg/dL (6 to 10 years of age)
    • ≤ 1.2 mg/dL (11 to 15 years of age)
    • ≤ 1.5 mg/dL (16 to 21 years of age) OR
  • Creatinine clearance or radioisotope glomerular filtration rate ≥ 70 mL/min
  • No significant renal dysfunction that would compromise the tolerability of decitabine or interfere with study procedures or results

Cardiovascular

  • Shortening fraction ≥ 28% by echocardiogram OR
  • Ejection fraction of ≥ 45% by MUGA

Pulmonary

  • No significant pulmonary dysfunction that would compromise the tolerability of decitabine or interfere with study procedures or results

Other

  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • No prior allergic reaction attributed to compounds of similar chemical or biological composition to agents used in this study
  • No uncontrolled serious infection
  • No significant end-organ dysfunction that would compromise the tolerability of decitabine or interfere with study procedures or results

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • Recovered from prior immunotherapy
  • At least 7 days since prior biologic therapy
  • More than 1 week since prior growth factor therapy (2 weeks for pegfilgrastim)
  • More than 2 weeks since prior epoetin alfa
  • At least 6 months since prior autologous stem cell transplantation
  • At least 6 months since prior allogeneic bone marrow transplantation

    • Patients must have full organ recovery and no evidence of graft-versus-host disease
  • No concurrent immunomodulating agents
  • No concurrent immunotherapy
  • No concurrent biologic therapy
  • No concurrent epoetin alfa

Chemotherapy

  • Recovered from prior chemotherapy
  • More than 2 weeks since prior myelosuppressive chemotherapy (6 weeks for nitrosoureas)
  • Prior total lifetime cumulative anthracycline dose ≤ 450 mg/m^2 of doxorubicin or equivalent
  • No other concurrent chemotherapy
  • No concurrent hydroxyurea

Endocrine therapy

  • Not specified

Radiotherapy

  • Recovered from prior radiotherapy
  • More than 2 weeks since prior local palliative small port radiotherapy
  • More than 6 months since prior substantial bone marrow irradiation (e.g., cranio-spinal irradiation, total body irradiation, or hemi-pelvic irradiation)
  • No concurrent radiotherapy

Surgery

  • Not specified

Other

  • No other concurrent anticancer therapy
  • No other concurrent investigational agents
  • Concurrent oral iron supplementation for patients with a known iron deficiency or a microcytic hypochromic anemia allowed
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00075634

Locations
United States, California
Stanford Comprehensive Cancer Center at Stanford University Medical Center
Stanford, California, United States, 94305
United States, District of Columbia
Children's National Medical Center
Washington, District of Columbia, United States, 20010-2970
United States, Indiana
Indiana University Cancer Center
Indianapolis, Indiana, United States, 46202-5289
United States, Massachusetts
Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute
Boston, Massachusetts, United States, 02115
United States, Minnesota
Mayo Clinic Cancer Center
Rochester, Minnesota, United States, 55905
University of Minnesota Medical Center - Fairview
Minneapolis, Minnesota, United States, 55455
United States, Mississippi
University of Mississippi Medical Center
Jackson, Mississippi, United States, 39216-4505
United States, New York
Herbert Irving Comprehensive Cancer Center at Columbia University
New York, New York, United States, 10032
SUNY Upstate Medical University Hospital
Syracuse, New York, United States, 13210
United States, Ohio
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States, 45229-3039
United States, Oregon
Oregon Health & Science University Cancer Institute
Portland, Oregon, United States, 97239-3098
United States, Pennsylvania
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States, 19104-9786
Children's Hospital of Pittsburgh
Pittsburgh, Pennsylvania, United States, 15213
United States, Tennessee
St. Jude Children's Research Hospital
Memphis, Tennessee, United States, 38105
United States, Texas
Baylor University Medical Center - Houston
Houston, Texas, United States, 77030-2399
Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas
Dallas, Texas, United States, 75390
United States, Washington
Children's Hospital and Regional Medical Center - Seattle
Seattle, Washington, United States, 98105
Canada, Ontario
Hospital for Sick Children
Toronto, Ontario, Canada, M5G 1X8
Canada, Quebec
Hopital Sainte Justine
Montreal, Quebec, Canada, H3T 1C5
Sponsors and Collaborators
Children's Oncology Group
Investigators
Study Chair: Rani E. George, MD, PhD Dana-Farber Cancer Institute
Investigator: Lisa Diller, MD Dana-Farber Cancer Institute
  More Information

Additional Information:
Publications:
George R, Lahti J, Ingle M, et al.: Decitabine (DAC) in combination with doxorubicin (DOX) and cyclophosphamide (CTX) in relapsed neuroblastoma (NBL): a Children's Oncology Group study. [Abstract] J Clin Oncol 25 (Suppl 18): A-9565, 542s, 2007.
George RE, Medeiros-Nancarrow C, Adamson PC, et al.: A phase I study of decitabine (DCT) in combination with doxorubicin (DOX) and cyclophosphamide (CTX) in the treatment of relapsed or refractory solid tumors - a Children's Oncology Group study. [Abstract] J Clin Oncol 23 (Suppl 16): A-8530, 807s, 2005.

Study ID Numbers: CDR0000347393, COG-ADVL0215
Study First Received: January 9, 2004
Last Updated: February 6, 2009
ClinicalTrials.gov Identifier: NCT00075634     History of Changes
Health Authority: United States: Federal Government

Keywords provided by National Cancer Institute (NCI):
unspecified childhood solid tumor, protocol specific
recurrent neuroblastoma

Study placed in the following topic categories:
Antimetabolites
Neuroectodermal Tumors, Primitive
Immunologic Factors
Cyclophosphamide
Decitabine
Immunosuppressive Agents
Neuroblastoma
Recurrence
Doxorubicin
Anti-Bacterial Agents
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neuroepithelioma
Antineoplastic Agents, Alkylating
Antirheumatic Agents
Alkylating Agents
Neuroectodermal Tumors, Primitive, Peripheral
Neoplasms, Glandular and Epithelial

Additional relevant MeSH terms:
Antimetabolites
Antimetabolites, Antineoplastic
Neuroectodermal Tumors, Primitive
Immunologic Factors
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Neoplasms, Nerve Tissue
Physiological Effects of Drugs
Cyclophosphamide
Antibiotics, Antineoplastic
Neuroblastoma
Neoplasms, Germ Cell and Embryonal
Therapeutic Uses
Alkylating Agents
Neoplasms by Histologic Type
Enzyme Inhibitors
Decitabine
Immunosuppressive Agents
Doxorubicin
Pharmacologic Actions
Neuroectodermal Tumors
Neoplasms
Myeloablative Agonists
Antineoplastic Agents, Alkylating
Neoplasms, Neuroepithelial
Antirheumatic Agents
Neuroectodermal Tumors, Primitive, Peripheral
Neoplasms, Glandular and Epithelial

ClinicalTrials.gov processed this record on July 02, 2009