We're building a better ClinicalTrials.gov. Check it out and tell us what you think!
ClinicalTrials.gov Menu
Trial record 1 of 1 for:    3+3 Trial of PO Sorafenib and Topotecan in
Previous Study | Return to List | Next Study

Sorafenib and Topotecan in Refractory/Recurrent Pediatric Malignancies

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: NCT01683149
Recruitment Status : Completed
First Posted : September 11, 2012
Last Update Posted : March 4, 2016
Pediatric Cancer Foundation
Information provided by (Responsible Party):
H. Lee Moffitt Cancer Center and Research Institute

Brief Summary:

H. Lee Moffitt Cancer Center and Research Institute will be the Sunshine Project Coordinator, but will not be recruiting locally.

The purpose of this research study is to establish a dose of the combination of drugs, Topotecan and Sorafenib in children. This will be called the maximum tolerated dose. The chemotherapy in this study is a combination of Topotecan and Sorafenib. The investigators are trying to find the highest dose of Topotecan and Sorafenib that can be given safely to children with Refractory or Recurrent Pediatric Solid Malignancies. The investigators will do this by testing different doses of these drugs in different groups of children. The investigators will also study how the body processes these drugs.

Condition or disease Intervention/treatment Phase
Solid Tumor Drug: Topotecan Drug: Sorafenib Phase 1

Layout table for study information
Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 13 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase I, Traditional 3+3, Trial of PO Sorafenib and Topotecan in Refractory or Recurrent Pediatric Solid Malignancies
Study Start Date : January 2013
Actual Primary Completion Date : January 2016
Actual Study Completion Date : January 2016

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Combination Chemotherapy

Combination Chemotherapy: Topotecan and Sorafenib. Participants will receive the treatment in cycles. Every cycle is 28 days long. For the first cycle participants will get the chemotherapy drugs:

  • Topotecan PO (by mouth) once daily on days 1-5 and days 8-12
  • Sorafenib PO (by mouth) twice daily (BID), continuously on days 2-28 of cycle one and days 1-28 on each additional cycle.
  • Level -1: Topotecan 1.0 mg/m^2: Sorafenib 100 mg/m^2 BID
  • Level -2: Topotecan 0.8 mg/m^2: Sorafenib 100 mg/m^2 BID
  • Level 1: Topotecan 1.0 mg/m^2: Sorafenib 150 mg/m^2 BID
  • Level 2: Topotecan 1.4 mg/m^2: Sorafenib 150 mg/m^2 BID
  • Level 3: Topotecan 1.4 mg/m^2: Sorafenib 200 mg/m^2 BID
  • Level 4: Topotecan 1.8 mg/m^2: Sorafenib 200 mg/m^2 BID
Drug: Topotecan
Topotecan will be given by mouth as outlined in treatment arm.
Other Name: Topoisomerase-I inhibitor

Drug: Sorafenib
Sorafenib will be given by mouth as outlined in treatment arm.
Other Name: BAY 43-9006

Primary Outcome Measures :
  1. Maximum Tolerated Dose (MTD) [ Time Frame: 24 months ]
    Establish the recommended phase II dose of the combination of topotecan and sorafenib in children. This will be the maximum tolerated dose.

Secondary Outcome Measures :
  1. Time to Progression (TTP) [ Time Frame: 24 months ]
    Determine Time to Progression (TTP) for all patients, comparing TTP on study to TTP on previous regimen. This study will use the (RECIST 1.1) Response Evaluation Criteria in Solid Tumors from the NCI for assessment of radiographic response in patients with solid tumors and in order to determine if patients have met off study criteria, i.e. disease progression. Progressive Disease (PD): At least a 20% increase in the disease measurement, taking as reference the smallest disease measurement recorded since the start of treatment, or the appearance of one or more new lesions, or evidence of laboratory or clinical progression.

  2. The Number of Participants with Adverse Events as a Measure of Safety and Feasibility [ Time Frame: 24 months ]
    Describe the toxicity as per NCI Common Toxicity Criteria, version 4.0 (CTCAE 4.0).

Information from the National Library of Medicine

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, Learn About Clinical Studies.

Layout table for eligibility information
Ages Eligible for Study:   3 Years to 18 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Life expectancy of at least 12 weeks (3 months)
  • Must have had relapsed or refractory solid tumor malignancy, or a relapsed or refractory central nervous system malignancy AND must have received at least one prior course of therapy for their malignancy.
  • Patients with a solid tumor must have radiographic evidence of disease. Bone only disease is acceptable if biopsy proven but will not be eligible for response criteria by RECIST 1.1. Ideally patients will have disease evaluable by RECIST 1.1.
  • Patient's current disease state must be one for which there is no known curative therapy or therapy proven to prolong survival with an acceptable quality of life.
  • Karnofsky ≥ 50 for patients > 16 years of age, and Lansky ≥ 50 for patients ≤ 16 years of age.
  • Prior Therapy: Patients with solid tumors must have fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study.

    1. Previous Sorafenib or Topotecan: Patients may not have previously been treated with sorafenib. Patients may have been previously treated with topotecan provided it was in combination with other agents and the most recent dose was more than 6 months from study entry. Patients in whom disease has progressed on single agent topotecan will not be eligible for this study.
    2. Myelosuppressive Chemotherapy: Patients with solid tumors must not have received myelosuppressive chemotherapy within 3 weeks or nitrosourea within 6 weeks of entry onto this study.
    3. Hematopoietic Growth Factors: At least 7 days since the completion of therapy with a growth factor and at least 14 days since pegfilgrastim (Neulasta®) administration.
    4. Biologic (anti-neoplastic agent): At least 21 days or 5 half lives (whichever is greater duration) since the completion of therapy with a biologic agent. For agents that have known adverse events occurring beyond 7 days after administration, this period must be extended beyond the time during which adverse events are known to occur. The duration of this interval must be discussed with the study chair.
    5. Radiation Therapy (XRT): ≥ 4 wks for local palliative XRT (small port); ≥ 3 months must have elapsed if prior TBI, or craniospinal XRT or if ≥ 50% radiation of pelvis; ≥ 6 weeks must have elapsed if other substantial bone marrow (BM) radiation.
    6. Stem Cell Transplant or Rescue without total body irradiation (TBI): For allograft: no evidence of active graft vs. host disease and ≥ 3 months must have elapsed since stem cell transplantation (SCT). Autologous transplant recipients must be transfusion independent and not require growth factors for >4 weeks.
  • All patients and/or their parents or legal guardians must sign a written informed consent. Assent, when appropriate will be obtained according to local Institutional Review Board (IRB) guidelines. A signed informed consent form must be appropriately obtained prior to the conduct of any trial-specific procedure.
  • Organ Function Requirements - Adequate Bone Marrow Function Defined As:

    1. Peripheral absolute neutrophil count (ANC) ≥ 1500/μL.
    2. Platelet count ≥ 100,000/μL (transfusion independent, defined as not receiving platelet transfusions within a 7 day period prior to enrollment)
    3. Hemoglobin ≥ 10.0 gm/dL (may receive red blood cell transfusions)
    4. Patients with known bone marrow metastatic disease will be eligible for study. These patients must not be known to be refractory to red cell or platelet transfusion. If dose limiting hematologic toxicity is observed, all subsequent patients enrolled at the dose level must not have bone marrow metastatic disease.
  • Adequate Renal Function Defined As: Creatinine clearance or radioisotope glomerular filtration rate (GFR) ≥ 60ml/min/1.73 m^2, or serum creatinine based on age/gender as defined in the Schwartz formula for estimating GFR (Schwartz et al. J. Peds, 106:522, 1985) utilizing child length and stature data published by the Centers for Disease Control and Prevention (CDC).
  • Adequate Liver Function Defined As:

    1. Bilirubin (sum of conjugated + unconjugated) ≤ upper limit of normal (ULN) for age
    2. Alanine transaminase (ALT) ≤ upper limit of normal for age
    3. All clinically significant chemistries excluding alkaline phosphatase, uric acid, aspartic transaminase (AST) and lactate dehydrogenase (LDH) must be grade 1 or less
  • Adequate Cardiac Function Defined As:

    1. Normal 12 lead EKG with corrected QT interval (QTc) < 450 msec, and either:
    2. Shortening fraction ≥ 28% or left ventricular ejection fraction ≥ 50%.
    3. Systolic Blood Pressure and Diastolic Blood Pressure ≤ 95th percentile for age and gender
  • Adequate Pulmonary Function Defined As: No evidence of dyspnea at rest, and a resting pulse oximetry > 92%.
  • All acute toxic effects of any prior treatment have resolved to NCI-CTCAE v4.0 Grade 1 or less at the time of enrollment, signing the Informed Consent Form (ICF).
  • Women of childbearing potential must have a negative serum pregnancy test performed within 7 days prior to the start of treatment.
  • Prothrombin time-international normalized ratio (PT-INR) ≤ 1.5 X ULN and partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT) ≤ 1.5 X ULN.
  • Participants (men and women) of childbearing potential must agree to use adequate contraception beginning at the signing of the ICF until at least 30 days after the last dose of study drug.
  • Must be able to swallow and retain oral medication

Exclusion Criteria:

  • Previous assignment to treatment during this study
  • Uncontrolled hypertension (systolic pressure >140 mm Hg or diastolic pressure > 90 mm Hg [NCI-CTCAE v4.0] on repeated measurement) despite optimal medical management
  • Evidence or history of bleeding diathesis or coagulopathy
  • Any pulmonary hemorrhage/bleeding event of NCI-CTCAE v4.0 Grade 2 or higher within 4 weeks of treatment; any other hemorrhage/bleeding event of NCI-CTCAE v4.0 Grade 3 or higher within 4 weeks of treatment
  • Have used strong cytochrome P450 3A4 (CYP3A4) inducers (eg, phenytoin, carbamazepine, phenobarbital, St. John's Wort [Hypericum perforatum], dexamethasone at a dose of greater than 16 mg daily, or rifampin [rifampicin], and/or rifabutin) within 28 days before treatment
  • Any previously untreated or concurrent cancer that is distinct in primary site or histology from the primary. Patients surviving a cancer that was curatively treated and without evidence of disease for more than 3 years before randomization are allowed. All cancer treatments must be completed at least 3 years prior to study entry (i.e., signature date of the informed consent form)
  • Presence of a non-healing wound, non-healing ulcer, or bone fracture
  • History of organ allograft. (Including corneal transplant)
  • Known or suspected allergy or hypersensitivity to any of the study drugs, study drug classes, or excipients of the formulations given during the course of this trial
  • Women who are pregnant or breast-feeding
  • Inability to comply with the protocol and/or not willing or not available for follow-up assessments
  • Any condition which, in the investigator's opinion, makes the patient unsuitable for trial participation

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): NCT01683149

Layout table for location information
United States, California
Childrens Hospital Los Angeles
Los Angeles, California, United States, 90027
United States, Connecticut
Connecticut Childrens Medical Center
Hartford, Connecticut, United States, 06106
United States, Delaware
Nemours/Alfred I. duPont Hospital for Children, Delaware
Wilmington, Delaware, United States, 19803
United States, Florida
University of Florida, Gainesville
Gainesville, Florida, United States, 32610
Nemours Children's Clinic, Jacksonville
Jacksonville, Florida, United States, 32207
University of Miami, Sylvester Comprehensive Cancer Center
Miami, Florida, United States, 33136
All Children's Hospital, St. Petersburg
St. Petersburg, Florida, United States, 33701
United States, New York
Montefiore Medical Center, Children's Hospital at Montefiore
Bronx, New York, United States, 10467
United States, Utah
Primary Children's Medical Center/Utah
Salt Lake City, Utah, United States, 84113
Sponsors and Collaborators
H. Lee Moffitt Cancer Center and Research Institute
Pediatric Cancer Foundation
Layout table for investigator information
Principal Investigator: Damon Reed, M.D. H. Lee Moffitt Cancer Center and Research Institute
Principal Investigator: G. Douglas Letson, M.D. H. Lee Moffitt Cancer Center and Research Institute
Layout table for additonal information
Responsible Party: H. Lee Moffitt Cancer Center and Research Institute
ClinicalTrials.gov Identifier: NCT01683149    
Other Study ID Numbers: MCC-16963
ONC-2011-49 ( Other Identifier: Bayer HealthCare )
Sunshine Project 002 ( Other Grant/Funding Number: Pediatric Cancer Foundation )
First Posted: September 11, 2012    Key Record Dates
Last Update Posted: March 4, 2016
Last Verified: March 2016
Keywords provided by H. Lee Moffitt Cancer Center and Research Institute:
Additional relevant MeSH terms:
Layout table for MeSH terms
Topoisomerase I Inhibitors
Antineoplastic Agents
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Topoisomerase Inhibitors