A Phase I Study of Oxaliplatin (NSC# 266046, IND #57004) and Irinotecan in Pediatric Patients With Refractory Solid Tumors and Lymphomas
Inclusion Criteria:
- Histologically confirmed refractory malignant solid tumor or lymphoma
- Intrinsic brain stem tumors and optic pathway tumors do not require histologic
verification
- No known curative therapy or therapy proven to prolong survival with an acceptable
quality of life exists
- Measurable or evaluable disease
- Evaluable disease is defined as a tumor that cannot be measured using a ruler or
calipers, but can be assessed to determine disease progression or complete
response, such as any of the following:
- Positive lesions on metaiodobenzylguanidine (MIBG) or bone scan
- Metastatic bone marrow disease
- Elevated tumor markers
- Presence of a malignant pleural effusion
- No leukemia
- Performance status - Karnofsky 50-100% (for patients > 10 years of age)
- Performance status - Lansky 50-100% (for patients ≤ 10 years of age)
- Not specified
- Absolute neutrophil count ≥ 1,000/mm^3
- Platelet count ≥ 100,000/mm^3 (transfusion independent)
- Hemoglobin ≥ 8.0 g/dL (transfusion allowed)
- Bilirubin ≤ 1.5 times upper limit of normal (ULN)
- ALT ≤ 5 times ULN
- Albumin ≥ 2 g/dL
- Creatinine clearance or radioisotope glomerular filtration rate ≥ 70 mL/min
- Creatinine based on age as follows:
- No greater than 0.8 mg/dL (for patients age 5 and under)
- No greater than 1.0 mg/dL (for patients age 6 to 10)
- No greater than 1.2 mg/dL (for patients age 11 to 15)
- No greater than 1.5 mg/dL (for patients age 16 and over)
- No arrhythmia on EKG
- No evidence of dyspnea at rest
- No exercise intolerance
- Pulse oximetry > 94% on room air and no evidence of pulmonary fibrosis by chest
radiograph* or CT scan
- Not pregnant
- Negative pregnancy test
- Fertile patients must use effective contraception
- Weight ≥ 10 kg
- Neurologic deficits relatively stable for ≥ 1 week before study entry (patients with
CNS tumors only)
- No electrolyte (e.g., sodium, potassium, bicarbonate, calcium, magnesium, and
phosphate) abnormality ≥ grade 2 (electrolyte supplementation allowed)
- No uncontrolled infection
- No history of life-threatening allergy to camptothecin derivatives or platinum agents
- No sensory or motor peripheral neuropathy ≥ grade 2
- No elevation of amylase or lipase ≥ grade 2
- Able to tolerate enteral medications (e.g., cefixime, cefpodoxime, or loperamide)
- Recovered from all prior immunotherapy
- At least 7 days since prior hematopoietic growth factors
- At least 7 days since prior antineoplastic biologic therapy
- Prior stem cell transplantation or rescue without total-body irradiation (TBI)
allowed provided ≥ 3 months have elapsed and there is no evidence of active
graft-versus-host disease
- No concurrent immunotherapy
- No concurrent biologic therapy
- More than 3 weeks since prior myelosuppressive chemotherapy (6 weeks for
nitrosoureas) and recovered
- No prior oxaliplatin
- No other concurrent chemotherapy
- Concurrent steroids allowed provided dose has been stable for ≥ 7 days before study
entry
- See Biologic therapy
- Recovered from all prior radiotherapy
- At least 2 weeks since prior local palliative small port radiotherapy
- At least 6 months since prior TBI
- At least 6 months since prior craniospinal, whole spinal, or whole lung/abdominal
radiotherapy
- At least 6 months since prior radiotherapy to ≥ 50 % of the pelvis
- At least 6 weeks since other prior substantial radiotherapy to the bone marrow
- No concurrent radiotherapy
- No other concurrent investigational drugs
- No other concurrent anticancer therapy
- No concurrent cephalosporin antibiotics
- No concurrent use of any of the following:
- Phenytoin
- Carbamazepine
- Oxcarbazepine
- Barbiturates
- Rifampin
- Phenobarbital
- Azole antifungal agents
- Aprepitant
- Hypericum perforatum (St. John's wort)