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Aflac ST0901 CHOANOME - Sirolimus in Solid Tumors (Aflac ST0901)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT01331135
Recruitment Status : Completed
First Posted : April 7, 2011
Last Update Posted : May 29, 2020
Sponsor:
Collaborator:
Children's Healthcare of Atlanta
Information provided by (Responsible Party):
Muna Qayed, Emory University

Study Description
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Brief Summary:

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 or disease Intervention/treatment 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

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.
Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 18 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (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
Actual Study Start Date : April 2011
Actual Primary Completion Date : August 9, 2017
Actual Study Completion Date : August 9, 2017

Resource links provided by the National Library of Medicine

Drug Information available for: Sirolimus

Arms and Interventions
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Arm Intervention/treatment
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:
  • rapamune
  • cypher
  • renacept


Outcome Measures
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Primary Outcome Measures :
  1. Maximum tolerated dose (MTD) [ Time Frame: 2 years after treatment starts ]
    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.


Secondary Outcome Measures :
  1. define and describe toxicities of sirolimus [ Time Frame: 2 years post treatment ]
    To define and describe the toxicities of sirolimus administered in combination with metronomic chemotherapy administered according to this schedule.

  2. anti-tumor activity of sirolimus [ Time Frame: 2 years post treatment ]
    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.

  3. evaluate correlation of p70S6 kinase activity [ Time Frame: 2 years post treatment ]
    To evaluate the correlation of p70S6 kinase activity inhibition with tumor response.

  4. evaluate risk of infection [ Time Frame: 2 years post treatment ]
    To evaluate the effect of this combination therapy on lymphocyte subsets and memory T-cells, and to correlate that with risk of infection.


Eligibility Criteria
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Information from the National Library of Medicine

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Ages Eligible for Study:   up to 30 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

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
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01331135


Locations
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United States, Georgia
Children's Healthcare of Atlanta
Atlanta, Georgia, United States, 30322
Sponsors and Collaborators
Emory University
Children's Healthcare of Atlanta
Investigators
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Principal Investigator: Muna Qayed, MD Children's Healthcare of Atlanta
More Information
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Additional Information:

Publications of Results:

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Responsible Party: Muna Qayed, Principal Investigator, Emory University
ClinicalTrials.gov Identifier: NCT01331135    
Other Study ID Numbers: IRB00047016
Aflac ST0901 CHOANOME ( Other Identifier: Other )
First Posted: April 7, 2011    Key Record Dates
Last Update Posted: May 29, 2020
Last Verified: May 2020
Keywords provided by Muna Qayed, Emory University:
pediatrics
sirolimus
relapse
Additional relevant MeSH terms:
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Neoplasms
Sarcoma
Neuroblastoma
Astrocytoma
Osteosarcoma
Rhabdomyosarcoma
Ependymoma
Sarcoma, Ewing
Medulloblastoma
Wilms Tumor
Retinoblastoma
Rhabdoid Tumor
Hepatoblastoma
Sarcoma, Clear Cell
Neoplasms, Connective and Soft Tissue
 Neoplasms by Histologic Type
Neoplasms, Glandular and Epithelial
Kidney Neoplasms
Urologic Neoplasms
Urogenital Neoplasms
Neoplasms by Site
Female Urogenital Diseases
Female Urogenital Diseases and Pregnancy Complications
Urogenital Diseases
Kidney Diseases
Urologic Diseases
Male Urogenital Diseases
Neuroectodermal Tumors, Primitive, Peripheral
Neuroectodermal Tumors, Primitive
Neoplasms, Neuroepithelial