A Phase II Trial of All-Trans-Retinoic Acid in Combination With Interferon-Alpha 2a in Children With Recurrent Neuroblastoma or Wilms' Tumor
Information source: National Institutes of Health Clinical Center (CC)
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Nephroblastoma; Neuroblastoma
Intervention: IFN-alpha with retinoic acid (Drug)
Phase: Phase 2
Status: Completed
Sponsored by: National Cancer Institute (NCI)
Summary
A body of preclinical data has provided a strong rationale for evaluating the combination of
IFN-alpha with retinoic acid. The two drugs have different mechanisms of action and, when
used in combination, show enhanced activity in both adult and pediatric tumor cell lines.
The combination of the antiproliferative and differentiation inducing effect of retinoids
together with the antiproliferative, immunostimulatory and differentiation-potentiating
effects of IFN-alpha warrant clinical investigation of this combination for the treatment of
refractory pediatric malignancies.
Clinical Details
Official title: A Phase II Trial of All-Trans-Retinoic Acid in Combination With Interferon-Alpha 2a in Children With Recurrent Neuroblastoma or Wilms' Tumor
Study design: Endpoint Classification: Safety/Efficacy Study, Primary Purpose: Treatment
Detailed description:
A body of preclinical data has provided a strong rationale for evaluating the combination of
IFN-alpha with retinoic acid. The two drugs have different mechanisms of action and, when
used in combination, show enhanced activity in both adult and pediatric tumor cell lines.
In the pediatric phase I trial which administered ATRA for 3 consecutive days/week repeated
weekly, the AUC of ATRA decreased on day 1 to day 3 of drug administration but returned to
day 1 levels at the beginning of subsequent weeks. This intermittent schedule of ATRA
administration allowed for exposure to relatively high plasma concentrations of ATRA on a
repetitive basis. The combination of ATRA/IFN-alpha 2a has demonstrated clinical activity
in the pediatric phase I trial in neuroblastoma and Wilms' tumor. The combination of the
antiproliferative and differentiation inducing effect of retinoids together with the
antiproliferative, immunostimulatory and differentiation-potentiating effects of IFN-alpha
warrant clinical investigation of this combination for the treatment of refractory pediatric
malignancies.
Eligibility
Minimum age: N/A.
Maximum age: N/A.
Gender(s): Both.
Criteria:
AGE:
All patients must be less than or equal to 21 years of age.
PERFORMANCE STATUS:
Patients should have an ECOG performance status of 0, 1, or 2, and a life expectancy of at
least 8 weeks.
HISTOLOGIC DIAGNOSIS:
Patients with the following diagnosis, confirmed by appropriate histologic examination,
will be eligible for this study: neuroblastoma and Wilms' tumor.
MEASURABLE DISEASE:
Patients must have measurable disease. Patients with evaluable disease only (i. e.,
limited to positive bone scan or bone marrow) are eligible only if the bone involvement is
measurable by alternative imaging modalities (MRI, CT, or plain film).
PROGRESSIVE DISEASE:
Patients must have evidence of progressive disease following or during prior therapy.
HEMATOLOGIC FUNCTION:
Patients do not have to be evaluable for hematologic toxicity to be enrolled onto the
study. Patients without bone marrow involvement by tumor, with no history of BMT, and
with no prior cranio-spinal or pelvic radiation, will be considered evaluable for
hematologic toxicity.
Patients evaluable for hematologic toxicity must have adequate bone marrow function
(defined as peripheral absolute granulocyte count of greater than 1500/mm(3), hemoglobin
greater than 8. 0 gm% and platelet count greater than 100,000/mm(3)).
HEPATIC FUNCTION:
Patients must have adequate liver function (bilirubin less than 2. 0 mg%; SGPT less than 2
times normal).
RENAL FUNCTION:
Patients must have adequate renal function defined as a creatinine clearance greater than
or equal to 70 ml/min/1. 732 or a serum creatinine based on age as follows:
equal to or less than 5 years old: maximum serum creatinine 0. 8;
older than 5 but equal to or less than 10: 1. 0;
older than 10 but equal to or less than 15: 1. 2;
older than 15: 1. 5.
RECOVERY FROM PRIOR THERAPY:
Patients must have recovered from the toxic effects of prior therapy, and must be off of
all chemotherapy for a minimum of two weeks prior to entry onto the protocol (a minimum of
six weeks for prior nitrosoureas).
INFORMED CONSENT:
All patients or their legal guardians must sign a document of informed consent indicating
their awareness of the investigational nature and the risks of this study.
No history of CNS malignant disease, hydro-cephalus, or pseudotumor cerebri.
No history of treatment with 13-cis retinoic acid within the prior three months.
Women of childbearing potential must not be pregnant or lactating.
Locations and Contacts
National Cancer Institute (NCI), Bethesda, Maryland 20892, United States
Additional Information
Related publications: Smith MA, Adamson PC, Balis FM, Feusner J, Aronson L, Murphy RF, Horowitz ME, Reaman G, Hammond GD, Fenton RM, et al. Phase I and pharmacokinetic evaluation of all-trans-retinoic acid in pediatric patients with cancer. J Clin Oncol. 1992 Nov;10(11):1666-73. Smith MA, Parkinson DR, Cheson BD, Friedman MA. Retinoids in cancer therapy. J Clin Oncol. 1992 May;10(5):839-64. Review. Adamson PC, Bailey J, Pluda J, Poplack DG, Bauza S, Murphy RF, Yarchoan R, Balis FM. Pharmacokinetics of all-trans-retinoic acid administered on an intermittent schedule. J Clin Oncol. 1995 May;13(5):1238-41.
Starting date: July 1996
Last updated: March 3, 2008
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