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HeadStart4: Newly Diagnosed Children (<10 y/o) With Medulloblastoma and Other CNS Embryonal Tumors

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ClinicalTrials.gov Identifier: NCT02875314
Recruitment Status : Recruiting
First Posted : August 23, 2016
Last Update Posted : March 12, 2018
Sponsor:
Collaborator:
Children's Hospital Los Angeles
Information provided by (Responsible Party):
Jonathan Finlay, Nationwide Children's Hospital

Brief Summary:
This is a prospective randomized clinical trial, to determine whether dose-intensive tandem Consolidation, in a randomized comparison with single cycle Consolidation, provides an event-free survival (EFS) and overall survival (OS). The study population will be high-risk patients (non-Wnt and non-Shh sub-groups) with medulloblastoma, and for all patients with central nervous system (CNS) embryonal tumors completing "Head Start 4" Induction. This study will further determine whether the additional labor intensity (duration of hospitalizations and short-term and long-term morbidities) associated with the tandem treatment is justified by the improvement in outcome. It is expected that the tandem (3 cycles) Consolidation regimen will produce a superior outcome compared to the single cycle Consolidation, given the substantially higher dose intensity of the tandem regimen, without significant addition of either short-term or long-term morbidities.

Condition or disease Intervention/treatment Phase
Medulloblastoma Central Nervous System Embryonal Tumors Drug: Induction Drug: Single Cycle Intensive Chemotherapy Drug: Tandem 3 Cycle Intensive Chemotherapy Phase 4

Detailed Description:

Due to the inferior response and event-free survival data of Regimens D and D2 on "Head Start III" for all children with supratentorial embryonal tumors, in comparison with the published data from "Head Start II" with Regimen A2 for metastatic patients, all such patients will receive the "Head Start II" Induction Regimen A2, on "Head Start 4", for either three or five cycles, depending upon whether or not they achieve complete remission by the end of Induction cycle #3. They will then undergo randomization to either single cycle or three tandem cycles of Consolidation marrow-ablative chemotherapy with AuHPCR.

Because of the unsatisfactory event-free survival for young children with non-desmoplastic/extensive nodular medulloblastoma (predominantly non-Shh and non-Wnt medulloblastoma subgroups) on Regimens D and D2 of "Head Start III", all these patients will receive the "Head Start II" Induction Regimen A2 on ""Head Start 4"", for either three or five cycles, depending upon whether or not they achieve complete remission by the end of Induction cycle #3. They will then undergo randomization to either single cycle or three tandem cycles of Consolidation marrow-ablative chemotherapy with AuHPCR.

Because of the excellent event-free and overall survival for young children with good risk medullo-blastoma (Shh or Wnt subgroups) treated with up-front "Head Start" chemotherapy strategies, such patients will undergo risk-tailored reduction of duration of Induction therapy from five cycles to three cycles of the "Head Start II" Induction Regimen A2 on "Head Start 4" for patients achieving a complete response to 3 cycles, followed, provided they are also without evidence of residual tumor following recovery from Induction cycle #3. They will NOT then undergo randomization, but will follow with a single cycle of Consolidation marrow-ablative chemotherapy as in "Head Start" studies.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 250 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: HeadStart4: Newly Diagnosed Children (<10 y/o) With Medulloblastoma and Other CNS Embryonal Tumors Clinical and Molecular Risk-Tailored Intensive and Compressed Induction Chemotherapy Followed by Consolidation With Randomization to Either Single Cycle or to Three Tandem Cycles of Marrow-Ablative Chemotherapy With Autologous Hematopoietic Progenitor Cell Rescue
Study Start Date : September 2015
Estimated Primary Completion Date : September 2020
Estimated Study Completion Date : September 2020

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Induction

The 5 chemotherapy drugs used in the Induction part of treatment are vincristine, cisplatin, cyclophosphamide, etoposide and high-dose methotrexate.

Three medications are also given to help reduce the side effects of the chemotherapy drugs. Filgrastim will be given through a vein or through a tiny needle into the tissue just under the skin to help blood counts recover after the chemotherapy. Mesna will be given through a vein with cyclophosphamide to help prevent bleeding in the bladder. Leucovorin will be given through a vein after the methotrexate to protect the body from the side effects of the methotrexate.

Drug: Induction
vincristine, cisplatin, cyclophosphamide, etoposide, high-dose methotrexate
Other Name: vincristine, cisplatin, cyclophosphamide, etoposide, high-dose methotrexate

Experimental: Single Cycle Intensive Chemotherapy

The three drugs to be used in this research study are thiotepa, etoposide and carboplatin. These drugs will be given over 6 days to help kill the cancer cells. After 72 hours from getting these drugs, previously collected and frozen blood cells will be thawed and returned through the venous catheter.

Carboplatin is given by vein over 4 hours. Thiotepa is given by vein over 3 hours. Etoposide is given by vein over 3 hours. The schedule for these drugs is as follows:

Day -8: Carboplatin Day -7: Carboplatin Day -6: Carboplatin Day -5: Thiotepa, Etoposide Day -4: Thiotepa, Etoposide Day -3: Thiotepa, Etoposide Day -2: Rest Day -1: Rest Day 0: Re-infusion of blood cells

Drug: Single Cycle Intensive Chemotherapy
Carboplatin, thiotepa, etoposide
Other Name: Carboplatin, thiotepa, etoposide

Experimental: Tandem 3 Cycle Intensive Chemotherapy

The 2 drugs to be used in this treatment are thiotepa and carboplatin. These drugs will be given over 2 days to help kill the cancer cells. After 72 hours from getting these drugs, previously collected and frozen blood cells will be thawed and returned through the venous catheter.

Day -4: Thiotepa, Carboplatin Day -3: Thiotepa, Carboplatin Day -2: Rest Day -1: Rest Day 0: Re-infusion of blood cells.

Following recovery from the first cycle of this chemotherapy, about 28 days following the Day 0 reinfusion of blood cells, the same cycle will be repeated again. A total of 3 cycles of this therapy will be administered, over the course of 12 weeks.

Drug: Tandem 3 Cycle Intensive Chemotherapy
Carboplatin, thiotepa
Other Name: Carboplatin, thiotepa




Primary Outcome Measures :
  1. Compare tandem consolidation vs. single cycle consolidation A [ Time Frame: 5 years ]
    Dose-intensive tandem Consolidation will be compared with single cycle consolidation via randomization. The randomized consolidations will provide an event-free survival (EFS) analysis after completing "Head Start 4" Induction.

  2. Compare tandem consolidation vs. single cycle consolidation B [ Time Frame: 5 years ]
    Dose-intensive tandem Consolidation will be compared with single cycle consolidation via randomization. The randomized consolidations will provide an overall survival (OS) analysis after completing "Head Start 4" Induction.


Secondary Outcome Measures :
  1. Induction Cycle Reduction [ Time Frame: 5 years ]
    Induction chemotherapy cycles will be reduced in number from five to three for molecularly high-risk medulloblastoma (non-Shh/non-Wnt) and CNS embryonal tumors who achieve a complete response (CR) after three cycles of Induction therapy results in equivalent 3-year EFS. Outcome will be analyzed irrespective of Consolidation assignment (Primary Aim) and compared to historical controls.

  2. Uniform Treatment Regimen [ Time Frame: 5 years ]
    Assess the rate of response of sequential dose-intensive and dose-compressed Induction chemotherapy followed by marrow-ablative chemotherapy and autologous hematopoietic progenitor cell rescue (AuHPCR) for children with medulloblastoma and other CNS embryonal tumors enrolled on the "Head Start 4" study utilizing a uniform treatment regimen.

  3. Therapy-Related Hearing Loss Evaluation A [ Time Frame: 5 years ]
    The prevalence and severity of therapy-related hearing loss as a function of cumulative dosing of cisplatin (three versus five cycles during Induction) will be evaluated. Distortion-Product Oto-acoustic Emissions (DPOAE) will be used as an early predictor of hearing loss to identify at-risk patients.

  4. Therapy-Related Hearing Loss Evaluation B [ Time Frame: 5 years ]
    The prevalence and severity of therapy-related hearing loss as a function of AuHPCR (one versus three tandem transplants in Consolidation) will be evaluated. Distortion-Product Oto-acoustic Emissions (DPOAE) will be used as an early predictor of hearing loss to identify at-risk patients.

  5. Neuropsychological effects will be evaluated using age based tests and questionnaires. [ Time Frame: 5 years ]
    The long-term neuropsychological effects will be evaluated.

  6. Endocrine studies will be conducted using Serum-free T4, TSH, Cortisol, IGF and IGFBP3 laboratory tests. [ Time Frame: 5 years ]
    The long-term endocrine functions effect will be evaluated.

  7. Physical growth will be evaluated by collecting patient's height, weight and BSA. [ Time Frame: 5 years ]
    The long-term physical growth effect will be evaluated.

  8. The development of second neoplasms will be monitored. [ Time Frame: 5 years ]
    The long-term development of second neoplasms will be evaluated.

  9. Neuropathology Biorepository and Clinical Database [ Time Frame: 5 years ]
    The study will establish a "Head Start 4" repository of clinical, radiographic and biologic specimens, including nucleic acids derived from these specimens, for future genomic, biologic and pharmacologic research.



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.


Ages Eligible for Study:   up to 10 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients 10 years of age at the time of definitive confirmatory eligible histologic or cytologic diagnosis of eligible CNS tumor (brain or spinal cord)
  • Patients may not have received irradiation or chemotherapy (except corticosteroids)
  • Have histologically proven diagnosis of medulloblastoma or CNS embryonal tumors of the brain or spinal cord
  • Medulloblastoma

    • Posterior fossa classic, desmoplastic or extensive nodular or anaplastic/large cell medulloblastoma with appropriate and sufficient tumor material (FFPE or snap frozen) for proposed assays: all stages, age less than 6 years at diagnosis
    • Posterior fossa classic or anaplastic/large cell medulloblastoma with sufficient tumor material (FFPE or snap frozen) for proposed assays: clinically high-stage (neuraxis or extra-neural dissemination, M1-4), age greater than 6 years to less than 10 years at diagnosis
    • Posterior fossa medulloblastoma, those 6 years of age and above at diagnosis, will only be eligible if they have evidence of neuraxis or extraneural dissemination. Patients 6 years of age and above with low-stage (standard-risk, M0) medulloblastoma will NOT be eligible for this study, irrespective of molecular subgroup and extend of local resection
  • CNS Embryonal Tumors:

    - Pineoblastoma, CNS neuroblastoma, CNS ganglioneuroblastoma, embryonal tumor with multi-layered rosettes (ETMR, including embryonal tumor with abundant neuropil and true rosettes (ETANTR), ependymoblastoma and ETMR not otherwise specified), medulloepithelioma, CNS embryonal tumor with rhabdoid features (INI1 intact) and CNS embryonal tumor, not otherwise specified.

  • Must commence Induction chemotherapy within 28 days of the most recent definitive surgical procedure and within 21 days of the most recent neuro-imaging studies (MRI of brain, performed with and without gadolinium contrast, and MRI of total spine, performed with gadolinium contrast) and lumbar CSF cytological examination
  • Patients must have adequate organ functions at the time of registration:

    • Liver: bilirubin less than 1.5 mg/dL (except for patients with Gilbert's Syndrome of indirect hyperbilirubinemia) and transaminases [SGPT or ALT, and SGOT or AST] less than 2.5 (two and a half) times the upper limits of institutional normal.
    • Renal: Creatinine clearance and/or glomerular filtration rate (GFR) greater than or equal to 60 mL/min/1.73m² within 21 days of protocol therapy.
    • Bone Marrow Function:

      1. Peripheral absolute phagocyte count (APC) > 1000/ µL. APC = numbers of banded neutrophils + segmented neutrophils + metamyelocytes + monocytes + eosinophils Please note, if institution reports differential as a percentage, then APC = [percentage of banded neutrophils + segmented neutrophils+ metamyelocytes+monocytes+eosinophils] x total white cell count.
      2. Platelet Count > 100,000/µL (transfusion independent)
      3. Hemoglobin > 8 gm/dL (may have received RBC transfusions).

Exclusion Criteria:

  • Patients older than 10 years of age at time of diagnosis
  • Following diagnoses are not eligible for study enrollment: CNS atypical teratoid/rhabdoid tumor (AT/RT); all ependymomas including anaplastic ependymomas of the brain or spinal cord; all choroid plexus carcinomas; all high-grade glial and glio-neuronal tumors; all primary CNS germ cell tumors; all primary CNS sarcomas; all primary or metastatic CNS lymphomas and solid leukemic lesions (i.e., chloromas, granulocytic sarcomas).
  • Patients with unbiopsied diffuse intrinsic pontine tumors will NOT be eligible for this study.

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): NCT02875314


Contacts
Contact: Megan Jaeger 614-722-3686 megan.jaeger@nationwidechildrens.org
Contact: Melinda Triplet, RN 614-722-6039 melinda.triplet@nationwidechildrens.org

  Hide Study Locations
Locations
United States, Alabama
Children's of Alabama Recruiting
Birmingham, Alabama, United States, 35233
Contact: Alyssa Reddy, MD    205-638-9100    areddy@peds.uab.edu   
United States, Arizona
Phoenix Children's Hospital Recruiting
Phoenix, Arizona, United States, 85016
Contact: Michael Etzl Jr, MD    602-933-0920    metzl@phoenixchildrens.com   
United States, California
Children's Hospital Los Angeles Recruiting
Los Angeles, California, United States, 90027
Contact: Kelley Haley    323-361-2840    KHaley@chla.usc.edu   
Principal Investigator: Girish Dhall, MD         
UCSF Oakland Benioff Recruiting
Oakland, California, United States, 94609
Contact: Joseph Torkildson, MD    510-428-3272    jtorklidson@mail.cho.org   
Children's Hospital Orange County Recruiting
Orange, California, United States, 91868
Contact: Ashley Plant, MD    714-509-4348    APlant@choc.org   
United States, Colorado
Children's Hospital Colorado Recruiting
Aurora, Colorado, United States, 80045
Contact: Kathleen Dorris, MD    720-777-8314    Kathleen.Dorris@childrenscolorado.org   
United States, Delaware
Nemours Center for Cancer and Blood Disorders Recruiting
Wilmington, Delaware, United States, 19803
Contact: Andrew Walter, MD    302-651-5500    andrew.walter@nemours.org   
United States, District of Columbia
Children's National Medical Center Recruiting
Washington, District of Columbia, United States, 20010
Contact: Eugene Hwang, MD    202-476-2800    ehwang@childrensnational.org   
United States, Florida
Shands Children's Hospital/ University of FL Recruiting
Gainesville, Florida, United States, 32610
Contact: Sridharan Gururangan, MD    312-294-8347    Sridharan.Gururangan@neurosurgery.ufl.edu   
Nemours Center for Cancer and Blood Disorders Recruiting
Jacksonville, Florida, United States, 19803
Contact: Michael J Joyce, MD, PhD    904-697-3793    michael.joyce@nemours.org   
Miami Children's Hospital/Nicklaus Recruiting
Miami, Florida, United States, 33155
Contact: Ziad Khatib, MD    305-662-8360    ziad.khatib@mch.com   
John's Hopkins All Children's Hospital Recruiting
Saint Petersburg, Florida, United States, 33701
Contact: Stacie Stapleton, MD    727-767-4176    stacie.stapleton@jhmi.edu   
United States, Georgia
Children's Healthcare of Atlanta Recruiting
Atlanta, Georgia, United States, 30342
Contact: Claire Mazewski, MD    404-213-7777    Claire.Mazewski@choa.org   
United States, Indiana
Riley Children's Hospital/University of Indiana Recruiting
Indianapolis, Indiana, United States, 46202
Contact: Chie Schin Shih, MD    317-944-8784    cshih2@iuhealth.org   
United States, Kentucky
University of Louisville School of Medicine Recruiting
Louisville, Kentucky, United States, 40202
Contact: Michael Huang, MD    502-852-8450    mchuan01@exchange.louisville.edu   
United States, Maryland
John's Hopkins University School of Medicine Recruiting
Baltimore, Maryland, United States, 21287
Contact: Kenneth Cohen, MD    410-614-5055    kcohen@jhmi.edu   
United States, Michigan
University of Michigan Recruiting
Ann Arbor, Michigan, United States, 48109
Contact: Carl Koschmann, MD    734-615-2736    ckoschma@med.umich.edu   
Helen DeVos Recruiting
Grand Rapids, Michigan, United States, 49503
Contact: Albert Cornelius, MD    616-267-1925    albert.cornelius@spectrumhealth.org   
United States, Minnesota
Masonic Children's Hospital/University of Minnesota Recruiting
Minneapolis, Minnesota, United States, 55454
Contact: Christopher Moertel, MD    614-625-3229    moert001@umn.edu   
United States, New Jersey
Joseph Sanzari Children's Hospital/ Hackensack University Recruiting
Hackensack, New Jersey, United States, 07601
Contact: Derek Hanson, MD    551-996-5437    Derek.hanson@hackensackmeridian.org   
United States, New York
Northwell Health Recruiting
Hempstead, New York, United States, 11549
Contact: Julie Krystal, MD, MPH    718-470-3460    Jkrystal12@northwell.edu   
NYU Langone Medical Center Recruiting
New York, New York, United States, 10016
Contact: Sharon Gardner, MD    212-263-9913    sharon.gardner@nyumc.org   
Columbus Presbyterian Children's Hospital Recruiting
New York, New York, United States, 10032
Contact: James Garvin, MD    212-305-5808    jhg1@columbia.edu   
Memorial Sloan Kettering Cancer Center Recruiting
New York, New York, United States, 10065
Contact: Kim Kramer, MD    212-639-6410    kramerk@mskcc.org   
SUNY Recruiting
Syracuse, New York, United States, 13210
Contact: Melanie Comito, MD    315-464-5294    comitom@upstate.edu   
United States, North Carolina
Carolina's HealthCare System/Levine Cancer Institute Recruiting
Charlotte, North Carolina, United States, 28204
Contact: Chad Jacobsen, MD    704-381-9900    chad.jacobsen@carolinashealthcare.org   
United States, Ohio
Akron Children's Hospital Recruiting
Akron, Ohio, United States, 44308
Contact: Sarah Rush, MD    330-543-8730    SRush@chmca.org   
Cleveland Clinic Recruiting
Cleveland, Ohio, United States, 44195
Contact: Tanya Tekautz, MD    216-444-9532    tekautt@ccf.org   
Nationwide Children's Hospital Recruiting
Columbus, Ohio, United States, 43205
Contact: Megan Jaeger    614-722-3686    megan.jaeger@nationwidechildrens.org   
Contact: Caitlin Trentman, RN    614-722-6575    caitlin.trentman@nationwidechildrens.org   
Principal Investigator: Jonathan Finlay, MD         
United States, Pennsylvania
Penn State Hershey Children's Hospital Recruiting
Hershey, Pennsylvania, United States, 17033
Contact: Robert Greiner, MD    717-531-6012    rgreiner1@hmc.psu.edu   
Children's Hospital of Philadelphia Recruiting
Philadelphia, Pennsylvania, United States, 19104
Contact: Kristina Cole, MD    267-426-2285    colek@email.chop.edu   
United States, Wisconsin
American Family Children's Hospital/University of Wisconsin Recruiting
Madison, Wisconsin, United States, 53792
Contact: Neha Patel, MD    608-263-6200    npatel@pediatrics.wisc.edu   
Medical College of Wisconsin Recruiting
Milwaukee, Wisconsin, United States, 58226
Contact: Jeffrey Knipstein, MD    414-955-4170    jknipstein@mcw.edu   
Canada, British Columbia
B.C. Children's Hospital Recruiting
Vancouver, British Columbia, Canada, V6H 3V4
Contact: Sylvia Cheng, MD, FRCPC    604-875-2345 ext 2406    Sylvia.Cheng@cw.bc.ca   
Sponsors and Collaborators
Nationwide Children's Hospital
Children's Hospital Los Angeles
Investigators
Principal Investigator: Jonathan Finlay, MD Nationwide Children's Hospital

Responsible Party: Jonathan Finlay, Prinicipal Investigator, Nationwide Children's Hospital
ClinicalTrials.gov Identifier: NCT02875314     History of Changes
Other Study ID Numbers: IRB15-00399
First Posted: August 23, 2016    Key Record Dates
Last Update Posted: March 12, 2018
Last Verified: March 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Additional relevant MeSH terms:
Medulloblastoma
Methotrexate
Neoplasms, Germ Cell and Embryonal
Glioma
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms by Histologic Type
Neoplasms
Neuroectodermal Tumors, Primitive
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Etoposide phosphate
Cisplatin
Cyclophosphamide
Carboplatin
Etoposide
Vincristine
Thiotepa
Antineoplastic Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Myeloablative Agonists
Abortifacient Agents, Nonsteroidal
Abortifacient Agents
Reproductive Control Agents