Crizotinib in Treating Young Patients With Relapsed or Refractory Solid Tumors or Anaplastic Large Cell Lymphoma

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Children's Oncology Group
ClinicalTrials.gov Identifier:
NCT00939770
First received: July 14, 2009
Last updated: January 14, 2016
Last verified: January 2016
  Purpose

RATIONALE: Crizotinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.

PURPOSE: This phase I/II trial is studying the side effects and best dose of crizotinib and to see how well it works in treating young patients with relapsed or refractory solid tumors or anaplastic large cell lymphoma.


Condition Intervention Phase
Brain and Central Nervous System Tumors
Lymphoma
Neuroblastoma
Unspecified Childhood Solid Tumor, Protocol Specific
Drug: crizotinib
Other: pharmacogenomic studies
Other: pharmacological study
Phase 1
Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase I/II Study of PF-02341066, an Oral Small Molecule Inhibitor of Anaplastic Lymphoma Kinase (ALK) and c-Met, in Children With Relapsed/Refractory Solid Tumors, Primary CNS Tumors, and Anaplastic Large Cell Lymphoma

Resource links provided by NLM:


Further study details as provided by Children's Oncology Group:

Primary Outcome Measures:
  • Maximum-tolerated dose and recommended phase II dose of crizotinib in children with relapsed or refractory solid tumors or anaplastic large cell lymphoma (ALCL) [ Time Frame: 28 Days ] [ Designated as safety issue: Yes ]
  • Toxicities of crizotinib [ Time Frame: Up to 30 days post-treatment ] [ Designated as safety issue: Yes ]
  • Pharmacokinetics of crizotinib [ Time Frame: Day 1 ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Antitumor activity of crizotinib in children with relapsed or refractory solid tumors or ALCL [ Time Frame: Up to 30 days post treatment ] [ Designated as safety issue: No ]
  • Antitumor activity of crizotinib in children with relapsed or refractory neuroblastoma or ALCL [ Time Frame: Up to 30 days post treatment ] [ Designated as safety issue: No ]
  • Relationship between response to treatment and anaplastic lymphoma kinase gene status in children with relapsed or refractory neuroblastoma or ALCL [ Time Frame: Up to 30 days post treatment ] [ Designated as safety issue: No ]
  • Relationship between minimal residual disease status and clinical response to treatment in children with ALCL [ Time Frame: Up to 30 days post treatment ] [ Designated as safety issue: No ]

Enrollment: 122
Study Start Date: September 2009
Estimated Primary Completion Date: May 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Treatment (Crizotinib) Drug: crizotinib Other: pharmacogenomic studies Other: pharmacological study

Detailed Description:

OBJECTIVES:

Primary

  • To estimate the maximum-tolerated dose and recommended phase II dose of crizotinib administered orally twice daily to children with relapsed or refractory solid tumors or anaplastic large cell lymphoma (ALCL).
  • To define and describe the toxicities of this drug when administered on this schedule.
  • To characterize the pharmacokinetics of this drug in these patients.

Secondary

  • To preliminarily define the antitumor activity of this drug within the confines of a phase I study.
  • To obtain initial phase II data on the antitumor activity of this drug in children with relapsed or refractory neuroblastoma or ALCL.
  • To preliminarily examine the relationship between response to treatment and anaplastic lymphoma kinase gene status (e.g., the presence of a mutation, duplication, amplification, and/or translocation) in children with relapsed or refractory neuroblastoma or ALCL.
  • To preliminarily examine the relationship between minimal residual disease status and clinical response to treatment in children with ALCL.

OUTLINE: This is a multicenter, phase I dose-escalation study followed by a phase II study.

Patients receive oral crizotinib twice daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.

Plasma and whole blood samples are collected for pharmacokinetic and pharmacogenomic analysis. Tumor tissue (from patients with neuroblastoma) and bone marrow and/or peripheral blood (from patients with anaplastic large cell lymphoma) samples are collected for further correlative laboratory studies.

After completion of study treatment, patients are followed up periodically.

  Eligibility

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

DISEASE CHARACTERISTICS:

  • Histologically confirmed* malignancy at original diagnosis or relapse, including the following:

    • Solid tumors (phase I)
    • CNS tumors (phase I)

      • Neurologic deficits must have been relatively stable for ≥ 1 week before study enrollment
    • Anaplastic large cell lymphoma (ALCL) (phase I or II)

      • No primary cutaneous ALCL
    • Confirmed anaplastic lymphoma kinase (ALK) fusion proteins, ALK mutations, or ALK amplification (defined as > 4-fold increase in the ALK signal number as compared to reference signal number on chromosome 2q arm) (phase I)
    • Neuroblastoma (phase I or II) NOTE: *Histologic confirmation is not required for patients with diffuse intrinsic brain stem tumors, optic pathway tumors, or pineal region tumors with elevations of serum or CSF tumor markers (e.g., alpha-fetoprotein or beta-HCG).
  • Relapsed or refractory disease
  • Measurable and/or evaluable disease

    • Patients with neuroblastoma must have measurable tumor on MRI, CT scan, or x-ray obtained within the past 2 weeks and/or evaluable tumor by MIBG scan and/or bone marrow involvement with tumor cells seen on routine morphology
    • Patients with ALCL enrolled in the phase II portion of the trial must have measurable disease
  • No known curative therapy or therapy proven to prolong survival with an acceptable quality of life exists

PATIENT CHARACTERISTICS:

  • Karnofsky performance status (PS) 50-100% (for patients > 16 years of age) or Lansky PS 50-100% (for patients ≤ 16 years of age)

    • Patients who are up in a wheelchair and are unable to walk due to paralysis will be considered ambulatory for the purpose of assessing PS
  • ANC ≥ 1,000/mm^3 (≥ 750/mm^3 in patients with metastatic bone marrow disease)
  • Platelet count ≥ 75,000/mm^3 (transfusion independent, defined as no platelet transfusions within the past 7 days) in patients without bone marrow involvement OR ≥ 25,000/mm^3 (platelet transfusions allowed) in patients with metastatic bone marrow disease
  • Hemoglobin ≥ 8.0 g/dL (RBC transfusions allowed)
  • Creatinine clearance or radioisotope GFR ≥ 70 mL/min OR serum creatinine based on age/gender as follows:

    • ≤ 0.6 mg/dL (for patients 1 year of age)
    • ≤ 0.8 mg/dL (for patients 2 to 5 years of age)
    • ≤ 1.0 mg/dL (for patients 6 to 9 years of age)
    • ≤ 1.2 mg/dL (for patients 10 to 12 years of age)
    • ≤ 1.4 mg/dL (for female patients ≥ 13 years of age)
    • ≤ 1.5 mg/dL (for male patients 13 to 15 years of age)
    • ≤ 1.7 mg/dL (for male patients ≥ 16 years of age)
  • Bilirubin (sum of conjugated and unconjugated) ≤ 1.5 times upper limit of normal for age
  • SGPT ≤ 110 U/L
  • Serum albumin ≥ 2 g/dL
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • Body surface area ≥ 0.4 mm² (for patients enrolled at dose levels 0 and 1 only)
  • Able to swallow capsules or a liquid suspension/solution
  • Able to comply with the safety monitoring requirements of the study, in the opinion of the investigator
  • No uncontrolled infection
  • No evidence of active graft vs host disease
  • Not refractory to red cell or platelet transfusion (in patients with metastatic bone marrow disease)

PRIOR CONCURRENT THERAPY:

  • Recovered from prior chemotherapy, immunotherapy, or radiotherapy
  • No prior crizotinib
  • At least 6 months since prior total-body radiotherapy (TBI), craniospinal radiotherapy, or radiotherapy to ≥ 50% of the pelvis
  • At least 3 months since prior bone marrow or stem cell transplant (without TBI) (≥ 6 weeks for patients with neuroblastoma or patients with confirmed ALK fusion proteins, ALK mutations, or ALK amplification)

    • No evidence of active graft-vs-host disease
  • At least 6 weeks since prior therapeutic doses of MIBG
  • At least 6 weeks since other prior substantial bone marrow radiotherapy
  • At least 2 weeks since prior local palliative radiotherapy (small port)
  • More than 3 weeks since prior myelosuppressive chemotherapy (6 weeks for nitrosoureas) for patients with solid tumors
  • At least 14 days since prior cytotoxic therapy for patients with ALCL who relapse while receiving cytotoxic therapy

    • Patients with lymphoma who relapse during standard maintenance therapy are eligible at time of relapse
    • Cytoreduction with hydroxyurea may be initiated and continued for up to 24 hours before the start of study treatment
  • At least 7 days since prior growth factor therapy
  • At least 7 days since prior biological agents
  • At least 7 days or 3 half-lives (whichever is longer) since prior monoclonal antibody
  • More than 12 days since prior and no concurrent potent CYP3A4 inducers including, but not limited to carbamazepine, phenobarbital, phenytoin, rifabutin, rifampin, tipranavir, ritonavir, or St. John wort
  • More than 7 days since prior and no concurrent potent CYP3A4 inhibitors including, but not limited to ketoconazole, itraconazole, miconazole, clarithromycin, erythromycin, ritonavir, indinavir, nelfinavir, saquinavir, amprenavir, delavirdine, nefazodone, diltiazem, verapamil, or grapefruit juice
  • No concurrent medications known to be metabolized by CYP3A4 with narrow therapeutic indices, including pimozide, aripiprazole, triazolam, ergotamine, and halofantrine
  • No other concurrent anticancer therapy (including chemotherapy, radiotherapy, immunotherapy, or biologic therapy), except for hydroxyurea for patients with ALCL or decadron for patients with CNS tumors
  • No other concurrent investigational drugs
  • Concurrent corticosteroids for CNS tumors allowed provided the dose has been stable or decreasing for the past 7 days
  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: NCT00939770

  Hide Study Locations
Locations
United States, Alabama
UAB Comprehensive Cancer Center
Birmingham, Alabama, United States, 35294
United States, California
Children's Hospital of Orange County
Orange, California, United States, 92868
UCSF Helen Diller Family Comprehensive Cancer Center
San Francisco, California, United States, 94115
United States, Colorado
Children's Hospital Colorado Center for Cancer and Blood Disorders
Aurora, Colorado, United States, 80045
United States, District of Columbia
Children's National Medical Center
Washington, District of Columbia, United States, 20010-2970
United States, Georgia
AFLAC Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta - Egleston Campus
Atlanta, Georgia, United States, 30322
United States, Illinois
Children's Memorial Hospital - Chicago
Chicago, Illinois, United States, 60611
United States, Indiana
Riley's Children Cancer Center at Riley Hospital for Children
Indianapolis, Indiana, United States, 46202
United States, Maryland
Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office
Bethesda, Maryland, United States, 20892-1182
United States, Massachusetts
Dana-Farber/Harvard Cancer Center at Dana-Farber Cancer Institute
Boston, Massachusetts, United States, 2115
United States, Michigan
C.S. Mott Children's Hospital at University of Michigan Medical Center
Ann Arbor, Michigan, United States, 48109-0286
United States, Minnesota
Masonic Cancer Center at University of Minnesota
Minneapolis, Minnesota, United States, 55455
United States, Missouri
Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis
St. Louis, Missouri, United States, 63110
United States, New York
Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center
New York, New York, United States, 10032
United States, Ohio
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States, 45229-3039
Nationwide Children's Hospital
Columbus, Ohio, United States, 43205-2696
United States, Oregon
Knight Cancer Institute at Oregon Health and Science University
Portland, Oregon, United States, 97239-3098
United States, Pennsylvania
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States, 19104
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania, United States, 15213
United States, Tennessee
St. Jude Children's Research Hospital
Memphis, Tennessee, United States, 38105
Vanderbilt-Ingram Cancer Center
Nashville, Tennessee, United States, 37232-6838
United States, Texas
Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas
Dallas, Texas, United States, 75390
Baylor University Medical Center - Houston
Houston, Texas, United States, 77030-2399
United States, Washington
Children's Hospital and Regional Medical Center - Seattle
Seattle, Washington, United States, 98105
United States, Wisconsin
Midwest Children's Cancer Center at Children's Hospital of Wisconsin
Milwaukee, Wisconsin, United States, 53226
Canada, Ontario
Hospital for Sick Children
Toronto, Ontario, Canada, M5G 1X8
Sponsors and Collaborators
Children's Oncology Group
National Cancer Institute (NCI)
Investigators
Study Chair: Yael P. Mosse, MD Children's Hospital of Philadelphia
  More Information

Publications:
Mosse YP, Balis FM, Lim MS, et al.: Efficacy of crizotinib in children with relapsed/refractory ALK-driven tumors including anaplastic large cell lymphoma and neuroblastoma: a Children's Oncology Group phase I consortium study. [Abstract] J Clin Oncol 30 (Suppl 15): A-9500, 2012.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Children's Oncology Group
ClinicalTrials.gov Identifier: NCT00939770     History of Changes
Obsolete Identifiers: NCT01182896
Other Study ID Numbers: ADVL0912  COG-ADVL0912  CDR0000647587 
Study First Received: July 14, 2009
Last Updated: January 14, 2016
Health Authority: United States: Food and Drug Administration

Keywords provided by Children's Oncology Group:
unspecified childhood solid tumor, protocol specific
recurrent neuroblastoma
recurrent childhood anaplastic large cell lymphoma
recurrent childhood brain stem glioma
recurrent childhood cerebellar astrocytoma
recurrent childhood cerebral astrocytoma
recurrent childhood anaplastic astrocytoma
recurrent childhood anaplastic oligoastrocytoma
recurrent childhood anaplastic oligodendroglioma
recurrent childhood fibrillary astrocytoma
recurrent childhood gemistocytic astrocytoma
recurrent childhood giant cell glioblastoma
recurrent childhood glioblastoma
recurrent childhood gliomatosis cerebri
recurrent childhood gliosarcoma
recurrent childhood oligoastrocytoma
recurrent childhood oligodendroglioma
recurrent childhood pilocytic astrocytoma
recurrent childhood pilomyxoid astrocytoma
recurrent childhood pleomorphic xanthoastrocytoma
recurrent childhood protoplasmic astrocytoma
recurrent childhood subependymal giant cell astrocytoma
recurrent childhood visual pathway and hypothalamic glioma
recurrent childhood visual pathway glioma
recurrent childhood medulloblastoma
recurrent childhood ependymoma
recurrent childhood pineoblastoma
recurrent childhood supratentorial primitive neuroectodermal tumor
childhood choroid plexus tumor
childhood craniopharyngioma

Additional relevant MeSH terms:
Central Nervous System Neoplasms
Lymphoma
Lymphoma, Large-Cell, Anaplastic
Lymphoma, Non-Hodgkin
Neoplasms
Nervous System Neoplasms
Neuroblastoma
Immune System Diseases
Immunoproliferative Disorders
Lymphatic Diseases
Lymphoma, T-Cell
Lymphoproliferative Disorders
Neoplasms by Histologic Type
Neoplasms by Site
Neoplasms, Germ Cell and Embryonal
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Neoplasms, Neuroepithelial
Nervous System Diseases
Neuroectodermal Tumors
Neuroectodermal Tumors, Primitive
Neuroectodermal Tumors, Primitive, Peripheral
Crizotinib
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Protein Kinase Inhibitors

ClinicalTrials.gov processed this record on April 27, 2016