High-Dose Iodine I 131 Metaiodobenzylguanidine, Topotecan, and Peripheral Stem Cell Transplant in Treating Young Patients With Relapsed Stage 4 Neuroblastoma or Primary Resistant High-Risk Neuroblastoma - Full Text View

Purpose

RATIONALE: Radioisotope therapy, such as iodine I 131 metaiodobenzylguanidine (MIBG), releases radiation that kills tumor cells. Drugs used in chemotherapy, such as topotecan, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Topotecan may also make tumor cells more sensitive to iodine I 131 MIBG. A peripheral stem cell transplant may be able to replace blood-forming cells that were destroyed by iodine I 131 MIBG and topotecan. This may allow more iodine I 131 MIBG and topotecan to be given so that more tumor cells are killed.

PURPOSE: This phase II trial is studying how well giving high-dose iodine I 131 MIBG together with topotecan and peripheral stem cell transplant works in treating young patients with relapsed stage 4 neuroblastoma or primary resistant high-risk neuroblastoma.

Condition	Intervention	Phase
Neuroblastoma	Drug: iodine I 131 metaiodobenzylguanidine Drug: topotecan hydrochloride Procedure: chemotherapy Procedure: peripheral blood stem cell transplantation Procedure: radioisotope therapy Procedure: radionuclide imaging Procedure: radiosensitization Procedure: total-body irradiation	Phase 2


Study Type:	Interventional
Study Design:	Masking: Open Label Primary Purpose: Treatment
Official Title:	International Phase II Studies of I-mIBG in Combination With Topotecan and Peripheral Blood Stem Cell Rescue for (A) Primary Resistant High Risk Neuroblastoma and (B) Relapsed Stage 4 Neuroblastoma

Resource links provided by NLM:

Genetics Home Reference related topics: neuroblastoma

MedlinePlus related topics: Neuroblastoma

Drug Information available for: Iodine Sodium iodide I 131 Topotecan hydrochloride Topotecan

Genetic and Rare Diseases Information Center resources: Neuroblastoma Neuroepithelioma

U.S. FDA Resources

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

Primary Outcome Measures:

Proportion of patients who respond to treatment (partial response and complete response at metastatic sites) as measured by metaiodobenzylguanidine scintigraphy and positron emission tomography and CT imaging [ Designated as safety issue: No ]
Proportion of patients who are able to progress to potentially curative treatment with surgery and further systemic treatment [ Designated as safety issue: No ]
Correlation of tumor dosimetry with response [ Designated as safety issue: No ]
Time to tumor progression [ Designated as safety issue: No ]


Enrollment:	0
Study Start Date:	July 2008
Estimated Primary Completion Date:	July 2008 (Final data collection date for primary outcome measure)

Detailed Description:

OBJECTIVES:

Determine response (partial and complete response at metastatic sites) in children with relapsed stage 4 neuroblastoma or primary resistant high-risk neuroblastoma treated with high-dose iodine I 131 metaiodobenzylguanidine, topotecan hydrochloride, and peripheral blood stem cell transplantation.
Determine the proportion of patients who, as a result of this treatment, are able to progress to potentially curative surgery and further systemic treatment.
Correlate tumor dosimetry (to determine whether the tumor absorbed the radiation dose) with response in patients treated with this regimen.
Determine the time to tumor progression.

OUTLINE: This is an open-label, multicenter study. Patients are stratified according to disease type (relapsed stage 4 vs primary resistant high-risk neuroblastoma).

Patients receive topotecan hydrochloride IV over 30 minutes on days 1-5 and 15-19 and high-dose iodine I 131 metaiodobenzylguanidine (^131I-MIBG) IV over 30 minutes on days 1 and 15. Patients receive autologous CD 34+ peripheral blood stem cells when ^131I-MIBG dosimetry levels reach an acceptable low on days 25-29.

Total whole-body absorbed dose is measured periodically after the first ^131I-MIBG dose is administered and periodically thereafter.

After completion of study treatment, patients are followed periodically for up to 10 years.

PROJECTED ACCRUAL: A total of 67 patients will be accrued for this study.

Eligibility


Ages Eligible for Study:	1 Year to 17 Years (Child)
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

DISEASE CHARACTERISTICS:

Confirmed diagnosis of neuroblastoma meeting the 1 of the following criteria:
- Primary resistant high-risk disease meeting the following criteria:
  - International neuroblastoma staging system (INSS) stage 4, or stage 2 or 3 with myelocytomatosis viral-related oncogene (MycN) amplification
  - Failed to achieve satisfactory remission with induction chemotherapy, defined as one of the following:
    - Less than 50% reduction or > 3 positive sites on iodine I 131 metaiodobenzylguanidine (^131I-MIBG) scintigraphy
    - Persistent cytomorphological positive disease in bone marrow aspirates or trephine biopsies
    - Progressive disease necessitating a change of treatment
- Relapsed stage 4 disease meeting the following criteria:
  - High-risk neuroblastoma (INSS stage 4, or stage 2 or 3 with MycN amplification)
  - Relapsed after intensive treatment including high-dose chemotherapy and hematopoietic progenitor cell support
    - Patients may be entered at the time of relapse, or at any point subsequently after other treatments
^131I-MIBG-positive disease on diagnostic scintigraphy
Peripheral blood stem cell harvest ≥ 300,000/mm³ CD 34+ cells
Enrolled in or has been treated on protocol SIOP-NB-2009 or a similar protocol

PATIENT CHARACTERISTICS:

Glomerular filtration rate ≥ 50 mL/min
Considered fit enough to undergo proposed study treatment

PRIOR CONCURRENT THERAPY:

See Disease Characteristics

Contacts and Locations

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, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00389766

Sponsors and Collaborators

Children's Cancer and Leukaemia Group

Investigators


Study Chair:	Mark N. Gaze, MD	University College London Hospitals

More Information


ClinicalTrials.gov Identifier:	NCT00389766 History of Changes
Other Study ID Numbers:	CCLG-NB-2006-08 CDR0000508611 EU-20644 EUDRACT-2005-002089-13
Study First Received:	October 18, 2006
Last Updated:	July 9, 2013
Health Authority:	Unspecified

Keywords provided by National Cancer Institute (NCI):


localized unresectable neuroblastoma recurrent neuroblastoma regional neuroblastoma localized resectable neuroblastoma disseminated neuroblastoma

Additional relevant MeSH terms:


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 Iodine Topotecan 3-Iodobenzylguanidine	Anti-Infective Agents, Local Anti-Infective Agents Trace Elements Micronutrients Growth Substances Physiological Effects of Drugs Topoisomerase I Inhibitors Topoisomerase Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Antineoplastic Agents Radiopharmaceuticals

ClinicalTrials.gov processed this record on September 27, 2016