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A Phase I Study of Vorinostat and Bortezomib in Children With Refractory or Recurrent Solid Tumors, Including CNS Tumors and Lymphomas


Phase 1
1 Year
21 Years
Open (Enrolling)
Both
Childhood Burkitt Lymphoma, Childhood Central Nervous System Choriocarcinoma, Childhood Central Nervous System Germ Cell Tumor, Childhood Central Nervous System Germinoma, Childhood Central Nervous System Mixed Germ Cell Tumor, Childhood Central Nervous System Teratoma, Childhood Central Nervous System Yolk Sac Tumor, Childhood Choroid Plexus Tumor, Childhood Craniopharyngioma, Childhood Diffuse Large Cell Lymphoma, Childhood Immunoblastic Large Cell Lymphoma, Childhood Medulloepithelioma, Childhood Meningioma, Childhood Mixed Glioma, Childhood Nasal Type Extranodal NK/T-cell Lymphoma, Childhood Oligodendroglioma, Recurrent Childhood Anaplastic Large Cell Lymphoma, Recurrent Childhood Brain Stem Glioma, Recurrent Childhood Central Nervous System Embryonal Tumor, Recurrent Childhood Cerebellar Astrocytoma, Recurrent Childhood Cerebral Astrocytoma, Recurrent Childhood Ependymoma, Recurrent Childhood Grade III Lymphomatoid Granulomatosis, Recurrent Childhood Large Cell Lymphoma, Recurrent Childhood Lymphoblastic Lymphoma, Recurrent Childhood Malignant Germ Cell Tumor, Recurrent Childhood Medulloblastoma, Recurrent Childhood Pineoblastoma, Recurrent Childhood Small Noncleaved Cell Lymphoma, Recurrent Childhood Subependymal Giant Cell Astrocytoma, Recurrent Childhood Supratentorial Primitive Neuroectodermal Tumor, Recurrent Childhood Visual Pathway and Hypothalamic Glioma, Recurrent Childhood Visual Pathway Glioma, Recurrent/Refractory Childhood Hodgkin Lymphoma, Unspecified Childhood Solid Tumor, Protocol Specific

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Trial Information

A Phase I Study of Vorinostat and Bortezomib in Children With Refractory or Recurrent Solid Tumors, Including CNS Tumors and Lymphomas


PRIMARY OBJECTIVES:

I. To determine the maximum-tolerated dose and/or recommended phase II dose of vorinostat in
combination with bortezomib in pediatric patients with refractory or recurrent solid tumors,
including central nervous system tumors and lymphoma.

II. To define and describe the toxicities of this regimen in these patients. III. To
characterize the pharmacokinetics of this regimen in these patients.

SECONDARY OBJECTIVES:

I. To preliminarily define the antitumor activity of this regimen within the confines of a
phase I study.

II. To assess the biologic activity of bortezomib by measuring NF-κB activity in peripheral
blood mononuclear cells (PBMC).

III. To assess the biologic activity of bortezomib by measuring endoplasmic reticulum stress
response using the GRP78 molecular chaperone marker in PBMC.

OUTLINE: This is a multicenter, dose-escalation study of vorinostat.

Patients receive oral vorinostat once daily on days 1-5 and 8-12 and bortezomib IV over 3-5
seconds on days 1, 4, 8, and 11. Courses repeat every 21 days for up to 2 years in the
absence of disease progression or unacceptable toxicity. Blood samples are collected at
baseline and during course 1 of study for further analysis.

After completion of study therapy, patients are followed up within 30 days.


Inclusion Criteria:



- Histologically confirmed solid tumors, including CNS tumors or lymphoma

- Histological confirmation not required for the following diagnoses

- Intrinsic brain stem tumors

- Optic pathway gliomas

- Pineal tumors and elevations of cerebral spinal fluid or serum tumor
markers, including alpha-fetoprotein or beta-human chorionic gonadotropin,
allowed

- Relapsed or refractory disease

- Must have measurable or evaluable tumor

- No known curative therapy or therapy proven to prolong survival with an acceptable
quality of life

- Karnofsky performance status (PS) 60-100% for patients > 16 years of age OR Lansky
PS60-100% for patients ≤ 16 years of age

- Neurologic deficits inpatients with CNS tumors must have been relatively stable
for a minimum of 1week

- Patients who are unable to walk because ofparalysis, but who are up in a
wheelchair, will be considered ambulatory for thepurpose of assessing the
performance score

- ANC ≥ 1,000/μL

- Platelet count ≥ 100,000/μL (transfusion independent, defined as not receiving
platelet transfusions within the past 7 days)

- Patients with known bone marrow metastatic disease allowed provided they meet
the blood count criteria and are not known to be refractory to platelet
transfusion

- Hemoglobin ≥ 8.0 g/dL (may receive RBC transfusions)

- Patients with known bone marrow metastatic disease allowed provided they meet
the blood count criteria and are not know to be refractory to RBC or platelet
transfusion

- Creatinine clearance or radioisotope GFR ≥ 70 mL/min OR serum creatinine based on age
and/or gender as follows:

- 0.6 mg/dL (1 to < 2 years of age)

- 0.8 mg/dL (2 to < 6 years of age)

- 1.0 mg/dL (6 to < 10 years of age)

- 1.2 mg/dL (10 to < 13 years of age)

- 1.5 (male) or 1.4 (female) (13 to < 16 years of age)

- 1.7 (male) or 1.4 (female) ( ≥ 16 years of age)

- Bilirubin (sum of conjugated + unconjugated) ≤ 1.5 times upper limit ofnormal

- ALT ≤ 110 U/L

- Serum albumin ≥ 2 g/dL

- QTc interval ≤ 450 milliseconds

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- Must be able to swallow capsules or liquids

- Able to comply withthe safety-monitoring requirements of the study, in the opinion of
the investigator

- No peripheral neuropathy ≥ grade 2 within the past 14 days

- No known hypersensitivity to vorinostat or bortezomib

- No uncontrolled infection

- No concurrent enzyme-inducing anticonvulsants

- Must be recovered from the acute toxic effects of all prior chemotherapy,
immunotherapy, or radiotherapy

- More than 3 weeks since prior myelosuppressive chemotherapy (6 weeks for nitrosourea)

- At least 7 days since prior therapy with any of the following:

- Hematopoietic growth factors

- Biologic (anti-neoplastic) 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

- Corticosteroids unless on a stable or decreasing dose

- At least 7 days or 3 half-lives, whichever is longer, since prior monoclonal
antibodies

- At least 2 weeks since prior local palliative radiotherapy (small port)

- At least 6 months since prior total-body irradiation therapy, craniospinal
radiotherapy, or ≥ 50% of pelvis irradiated

- At least 6 weeks since prior substantial bone marrow radiotherapy

- At least 3 months since prior stem cell transplantation or rescue and no evidence of
active graft-vs-host disease

- At least 2 weeks since prior and no concurrent valproic acid

- At least 6 weeks since priorimmunotherapy (e.g., tumor vaccines)

- No prior vorinostat

- No other concurrent investigational drugs or other anticancer agents, including
chemotherapy, radiotherapy, immunotherapy, or biologic therapy

Type of Study:

Interventional

Study Design:

Endpoint Classification: Safety Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Maximum-tolerated dose defined as the maximum dose at which fewer than one-third of patients experience DLT according to NCI CTCAE version 3.0

Outcome Description:

In addition to determination of the MTD, a descriptive summary of all toxicities will be reported.

Outcome Time Frame:

21 days

Safety Issue:

Yes

Principal Investigator

Jodi Muscal

Investigator Role:

Principal Investigator

Investigator Affiliation:

Children's Oncology Group

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2011-01980

NCT ID:

NCT00994500

Start Date:

August 2009

Completion Date:

Related Keywords:

  • Childhood Burkitt Lymphoma
  • Childhood Central Nervous System Choriocarcinoma
  • Childhood Central Nervous System Germ Cell Tumor
  • Childhood Central Nervous System Germinoma
  • Childhood Central Nervous System Mixed Germ Cell Tumor
  • Childhood Central Nervous System Teratoma
  • Childhood Central Nervous System Yolk Sac Tumor
  • Childhood Choroid Plexus Tumor
  • Childhood Craniopharyngioma
  • Childhood Diffuse Large Cell Lymphoma
  • Childhood Immunoblastic Large Cell Lymphoma
  • Childhood Medulloepithelioma
  • Childhood Meningioma
  • Childhood Mixed Glioma
  • Childhood Nasal Type Extranodal NK/T-cell Lymphoma
  • Childhood Oligodendroglioma
  • Recurrent Childhood Anaplastic Large Cell Lymphoma
  • Recurrent Childhood Brain Stem Glioma
  • Recurrent Childhood Central Nervous System Embryonal Tumor
  • Recurrent Childhood Cerebellar Astrocytoma
  • Recurrent Childhood Cerebral Astrocytoma
  • Recurrent Childhood Ependymoma
  • Recurrent Childhood Grade III Lymphomatoid Granulomatosis
  • Recurrent Childhood Large Cell Lymphoma
  • Recurrent Childhood Lymphoblastic Lymphoma
  • Recurrent Childhood Malignant Germ Cell Tumor
  • Recurrent Childhood Medulloblastoma
  • Recurrent Childhood Pineoblastoma
  • Recurrent Childhood Small Noncleaved Cell Lymphoma
  • Recurrent Childhood Subependymal Giant Cell Astrocytoma
  • Recurrent Childhood Supratentorial Primitive Neuroectodermal Tumor
  • Recurrent Childhood Visual Pathway and Hypothalamic Glioma
  • Recurrent Childhood Visual Pathway Glioma
  • Recurrent/Refractory Childhood Hodgkin Lymphoma
  • Unspecified Childhood Solid Tumor, Protocol Specific
  • Astrocytoma
  • Burkitt Lymphoma
  • Choriocarcinoma
  • Craniopharyngioma
  • Adamantinoma
  • Endodermal Sinus Tumor
  • Ependymoma
  • Glioma
  • Hodgkin Disease
  • Lymphoma
  • Lymphoma, Large B-Cell, Diffuse
  • Lymphoma, Non-Hodgkin
  • Lymphomatoid Granulomatosis
  • Medulloblastoma
  • Meningioma
  • Carcinoma, Embryonal
  • Neoplasms, Germ Cell and Embryonal
  • Neurologic Manifestations
  • Nervous System Neoplasms
  • Oligodendroglioma
  • Teratoma
  • Lymphoma, Large-Cell, Immunoblastic
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Lymphoma, T-Cell
  • Central Nervous System Neoplasms
  • Choroid Plexus Neoplasms
  • Pinealoma
  • Neuroectodermal Tumors
  • Neuroectodermal Tumors, Primitive
  • Lymphoma, Large-Cell, Anaplastic
  • Germinoma
  • Optic Nerve Glioma
  • Lymphoma, Extranodal NK-T-Cell
  • Neoplasms

Name

Location

Baylor College of Medicine Houston, Texas  77030
Dana-Farber Cancer Institute Boston, Massachusetts  02115
St. Jude Children's Research Hospital Memphis, Tennessee  38105-2794
Children's Hospital of Pittsburgh of UPMC Pittsburgh, Pennsylvania  15213
Childrens Memorial Hospital Chicago, Illinois  60614
Columbia University Medical Center New York, New York  10032