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Phase III Randomized Study Of Chimeric Antibody 14.18 (CH14.18) In High Risk Neuroblastoma Following Myeloablative Therapy And Autologous Stem Cell Rescue

NCT No.: NCT00026312

Study Type: INTERVENTIONAL

Phase: Phase III

Region: California - Northern

Acronym: 

Official Title

Phase III Randomized Study Of Chimeric Antibody 14.18 (CH14.18) In High Risk Neuroblastoma Following Myeloablative Therapy And Autologous Stem Cell Rescue

Purpose

Randomized phase III trial to compare the effectiveness of chemotherapy with or without monoclonal antibody, interleukin-2, and sargramostim following stem cell transplantation in treating patients who have neuroblastoma. Drugs used in chemotherapy work in different ways to stop tumor cells from dividing so they stop growing or die. Monoclonal antibodies can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Interleukin-2 and sargramostim may stimulate a person's white blood cells to kill cancer cells. It is not yet known if chemotherapy is more effective with or without monoclonal antibody therapy, interleukin-2, and sargramostim following stem cell transplantation in treating neuroblastoma.

Detailed Description

This is a randomized, multicenter study. Patients are stratified according to pre-autologous stem cell transplantation (ASCT) response (complete vs very good partial vs partial), stem cells received (purged vs unpurged), and frontline chemotherapy (COG-A3973 vs POG 9341/9342 vs COG-ANGL02P1 vs other therapy). A further stratum consists of patients with biopsy-confirmed post-ASCT persistent disease who are also enrolled on COG-A3973 or COG-ANBL0532. These patients are not randomized but assigned to treatment arm II. Patients in the first set of strata are randomized to 1 of 2 treatment arms. Patients may undergo an ECG monitoring study. Blood samples may be collected for immunologic and genotype assays, and isotretinoin pharmacokinetics and pharmacogenomics. Patients are followed up periodically for 10 years.

Sex

Male & Female

Age Limit

0 - 30 years

Eligibility Criteria

Inclusion Criteria

• All patients must be diagnosed with neuroblastoma, and categorized as high risk at the time of diagnosis; exception: patients who are initially diagnosed as non-high-risk neuroblastoma, but later converted (and/or relapsed) to high risk neuroblastoma are also eligible

• All patients must have completed therapy including intensive induction followed by ASCT and radiotherapy to be eligible for ANBL0032; radiotherapy may be waived for patients who either have small adrenal masses which are completely resected up front, or who never have an identifiable primary tumor; examples of such therapies include:
  • Following treatment per A3973 protocol
  • Following treatment per Pediatric Oncology Group (POG)-9341/9342 protocol
  • Following treatment per CCG3891
  • Following treatment on New Approaches to Neuroblastoma Therapy (NANT) 2001-02
  • Enrollment on or following treatment per ANBL02P1
  • Enrollment on or following treatment per ANBL07P1
  • Tandem transplant patients are eligible:
    • Following treatment on or per ANBL0532
    • Following treatment per POG 9640
    • Following treatment per COG ANBL00P1
    • Following treatment per CHP 594/Dana-Farber Cancer Institute (DFCI) 34-DAT

• No more than 12 months from the date of starting the first induction chemotherapy after diagnosis to the date of ASCT except for the rare occasions as noted below; for tandem ASCT patients, this will be the date of the FIRST stem cell infusion; exception: for those who are initially diagnosed as non-high risk neuroblastoma, but later converted (and/or relapsed) to high risk neuroblastoma, the 12 months restriction should start from the date of induction therapy for high risk neuroblastoma (not from the initial induction therapy for non-high risk disease), to the date of ASCT

• At pre-ASCT evaluation patients must meet the International Neuroblastoma Response Criteria (INRC) for CR, VGPR, or PR for primary site, soft tissue metastases and bone metastases; patients who meet those criteria must also meet the protocol specified criteria for bone marrow response as outlined below:
  • =< 10% tumor (of total nucleated cellular content) seen on any specimen from a
  bilateral bone marrow aspirate/biopsy
  • Patient who have no tumor seen on the prior bone marrow, and then have =< 10%        
  • tumor on any of the bilateral marrow aspirate/biopsy specimens done at pre-ASCT
  and/or pre-enrollment evaluation will also be eligible (note that per INRC this would
  have been defined as "overall" response of progressive disease [PD])

• Prior to enrollment on ANBL0032, a determination of mandatory disease staging must be performed (tumor imaging studies including computed tomography [CT] or magnetic resonance imaging [MRI], MIBG scan, and vanillylmandelic acid [VMA]/homovanillic acid [HVA]; bone marrow aspirates are required but biopsy may be omitted if negative prior to ASCT); this disease assessment is required for eligibility and should be done preferably within 2 weeks, but must be done within a maximum of 4 weeks before enrollment
  • For those with residual disease before radiotherapy, re-evaluation of irradiated
  residual tumors is preferably performed at the earliest 5 days after completing
  radiotherapy; patients with residual disease are eligible; biopsy is not required; patients
  who have biopsy proven residual disease after ASCT will be enrolled on Stratum 07
    • Patients must not have progressive disease at the time of study enrollment
    except for protocol specified bone marrow response and except for elevations of
    catecholamines as the only sign of disease in a patient who had normal
    catecholamines at pre-ASCT evaluation

• Patients must be enrolled before treatment begins; the date protocol therapy is projected to start must be no later than ten (10) calendar days after the date of study enrollment; patients should be enrolled preferably between day 56 and day 85 after peripheral blood stem cell (PBSC) infusion (day from 2nd stem cell infusion for tandem transplant); patients must be enrolled no later than day 200 after PBSC infusion; enrollment must occur after completion of radiotherapy, and after completion of tumor assessment post-ASCT and radiotherapy; informed consent should be obtained within 3 weeks pre-ASCT up to the time of registration

• Patients must not have received prior anti-disialoganglioside (GD2) antibody therapy

• Patients must have a Lansky or Karnofsky performance scale score of >= 50% and patients must have a life expectancy of >= 2 months

• Total absolute phagocyte count (APC = %neutrophils + %monocytes) X white blood cell (WBC) is at least 1000/uL

• Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 mL/min/1.73 m^2 or a serum creatinine based on age/gender as follows:
  • No greater than 0.4 mg/dL (1 month to < 6 months)
  • No greater than 0.5 mg/dL (6 months to < 1 year)
  • No greater than 0.6 mg/dL (1 to < 2 years)
  • No greater than 0.8 mg/dL (2 to < 6 years)
  • No greater than 1.0 mg/dL (6 to < 10 years)
  • No greater than 1.2 mg/dL (10 to < 13 years)
  • No greater than 1.4 mg/dL (>= 13 years [female])
  • No greater than 1.5 mg/dL (13 to < 16 years [male])
  • No greater than 1.7 mg/dL (>= 16 years [male])

• Total bilirubin =< 1.5 x normal

•Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 5 x normal

• Veno-occlusive disease, if present, should be stable or improving

• Shortening fraction of >= 27% by echocardiogram, or if shortening fraction abnormal, ejection fraction of >= 55% by gated radionuclide study or echocardiogram; note: the echocardiogram or gated radionuclide study must be performed within 4 weeks prior to enrollment

• Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) > 60% predicted by pulmonary function test; for children who are unable to do pulmonary function tests (PFTs), no evidence of dyspnea at rest and no exercise intolerance should be documented; note: the pulmonary function test must be performed within 4 weeks prior to enrollment

• Patients with seizure disorder may be enrolled if on anticonvulsants and well-controlled; central nervous system (CNS) toxicity < grade 2

• Written informed consent in accordance with institutional and Food and Drug Administration (FDA) guidelines must be obtained from parent or legal guardian

• Females of childbearing potential must have a negative pregnancy test; patients of childbearing potential must agree to use an effective birth control method; female patients who are lactating must agree to stop breast-feeding

Exclusion Criteria


• Please contact study team for additional exclusion criteria.

Keywords and/or Specific Medical Conditions

  • antibodies
  • analgesics
  • aldesleukin
  • Cancer
  • COG
  • COG-ANBL0032
  • immunoglobulins
  • interleukin-2
  • isotretinoin
  • monoclonal antibody Ch14.18
  • neuroblastoma
  • sargramostim
  • Oncology (Pediatrics)

Sponsors

  • Children's Oncology Group
  • National Cancer Institute (NCI)

Principal Investigator

Aarati V Rao , MD 

Contact Information

 - CTP Collaborate Team
- 916-474-2306
- CTPCollaborate@kp.org
- Roseville Medical Center

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