Melanoma Clinical Trial
Biological Therapy in Treating Children With Refractory or Recurrent Neuroblastoma or Other Tumors
Summary
RATIONALE: Biological therapies such as hu14.18-interleukin-2 fusion protein use different ways to stimulate the immune system and stop cancer cells from growing.
PURPOSE: Phase I trial to study the effectiveness of hu14.18-interleukin-2 fusion protein in treating children who have refractory or recurrent neuroblastoma or other tumors.
Full Description
OBJECTIVES:
Determine the maximum tolerated dose of hu14.18-interleukin-2 fusion protein in children with refractory or recurrent neuroblastoma or other GD2-positive tumors.
Determine the toxicity and pharmacokinetics of the fusion protein in these patients.
Determine the effect of the fusion protein on systemic immune modulation in these patients.
Quantitate the antifusion protein antibodies in patients treated with fusion protein.
Evaluate antitumor responses resulting from this fusion protein regimen in these patients.
OUTLINE: This is a dose-escalation study.
Patients receive hu14.18-interleukin-2 (hu14.18-IL2) fusion protein IV over 4 hours once daily on days 1-3. Treatment repeats every 28 days for up to 4 courses in the absence of disease progression or unacceptable toxicity.
Cohorts of 3-6 patients receive escalating doses of hu14.18-IL2 fusion protein until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which at least 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.
Patients are followed every 2 months for 1 year, every 6 months for 3 years, and then annually for 5 years.
PROJECTED ACCRUAL: A total of 18-24 patients will be accrued for this study within 1 year.
Eligibility Criteria
DISEASE CHARACTERISTICS:
Histologically confirmed neuroblastoma or melanoma at original diagnosis
Refractory to chemotherapy or recurrence after prior multiagent chemotherapy
Measurable or evaluable (detectable by bone scan) metastatic disease OR
No evidence of disease if complete response to prior surgical resection, radiotherapy, and/or chemotherapy OR
Histologically confirmed tumor expressing GD2 antigen at original diagnosis or relapse
Refractory to standard treatment
Measurable or evaluable disease by clinical assessments or laboratory markers OR
No evidence of disease after prior surgical resection of metastatic, recurrent disease
Histologically confirmed recurrent osteogenic sarcoma after prior chemotherapy allowed
Soft tissue sarcoma allowed
No primary CNS tumors
Prior CNS metastases allowed, provided:
Disease previously treated
Disease clinically stable for 4 weeks before study
At least 4 weeks since prior steroids for CNS metastases
No clinically detectable pleural effusions or ascites
PATIENT CHARACTERISTICS:
Age:
21 and under
Performance status:
Karnofsky 60-100% for children over age 10
Lansky 60-100% for children age 10 and under
Life expectancy:
At least 12 weeks
Hematopoietic:
Absolute neutrophil count greater than 1,000/mm^3
Platelet count at least 75,000/mm^3 (transfusion allowed)
Hemoglobin at least 9.0 g/dL (transfusion allowed)
Hepatic:
Bilirubin less than 1.5 mg/dL
ALT or AST no greater than 2.5 times normal
Hepatitis B surface antigen negative
Renal:
Creatinine no greater than 1.5 mg/dL OR
Creatinine clearance or radioisotope glomerular filtration rate at least 60 mL/min
Cardiovascular:
Shortening fraction at least 27% by echocardiogram OR
Ejection fraction more than 50% by MUGA scan
No congestive heart failure
No uncontrolled cardiac rhythm disturbance
Pulmonary:
FEV_1 and FVC more than 60% of predicted OR
No dyspnea at rest
No exercise intolerance
Oxygen saturation more than 94% by pulse oximetry on room air
Neurologic:
No seizure disorders requiring antiseizure medications
No significant neurologic deficit or grade 2 or greater objective peripheral neuropathy
Other:
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
HIV negative
No significant concurrent illnesses unrelated to cancer or its treatment
No significant psychiatric disabilities
No uncontrolled active infections
No uncontrolled active peptic ulcer
PRIOR CONCURRENT THERAPY:
Biologic therapy:
At least 1 week since prior growth factors
At least 1 week since prior immunomodulatory therapy
Prior monoclonal antibodies allowed if no detectable antibody to hu14.18
Prior autologous bone marrow transplantation (BMT) or stem cell transplantation (SCT) allowed
Prior autologous BMT or SCT with monoclonal antibody-purged specimens allowed
No concurrent growth factors
No concurrent interferon
Chemotherapy:
See Disease Characteristics
At least 3 weeks since prior chemotherapy (6 weeks for nitrosoureas, mitomycin, or melphalan)
No concurrent palliative chemotherapy
Endocrine therapy:
See Disease Characteristics
At least 2 weeks since prior glucocorticoids, except for life-threatening symptoms
No concurrent corticosteroids
No concurrent glucocorticoids, except for life-threatening symptoms
Radiotherapy:
See Disease Characteristics
At least 3 weeks since prior radiotherapy
No concurrent palliative radiotherapy
Surgery:
See Disease Characteristics
At least 2 weeks since prior major surgery (e.g., laparotomy or thoracotomy)
No prior organ allografts
No concurrent palliative surgery
Other:
Recovered from prior therapy
At least 1 week since prior tretinoin
At least 3 weeks since prior immunosuppressive therapy
No other concurrent immunosuppressive drugs
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There are 58 Locations for this study
Little Rock Arkansas, 72202, United States
Little Rock Arkansas, 72205, United States
Duarte California, 91010, United States
La Jolla California, 92093, United States
Los Angeles California, 90027, United States
Los Angeles California, 90095, United States
Orange California, 92868, United States
San Francisco California, 94115, United States
Stanford California, 94305, United States
Washington District of Columbia, 20010, United States
Gainesville Florida, 32610, United States
Atlanta Georgia, 30342, United States
Chicago Illinois, 60614, United States
Indianapolis Indiana, 46202, United States
Kansas City Kansas, 66160, United States
New Orleans Louisiana, 70112, United States
Baltimore Maryland, 21231, United States
Boston Massachusetts, 02111, United States
Boston Massachusetts, 02115, United States
Ann Arbor Michigan, 48109, United States
Detroit Michigan, 48201, United States
Minneapolis Minnesota, 55455, United States
Rochester Minnesota, 55905, United States
Jackson Mississippi, 39216, United States
Kansas City Missouri, 64108, United States
Saint Louis Missouri, 63104, United States
Saint Louis Missouri, 63105, United States
Hackensack New Jersey, 07601, United States
New Brunswick New Jersey, 08901, United States
New York New York, 10016, United States
New York New York, 10021, United States
New York New York, 10032, United States
Syracuse New York, 13210, United States
Durham North Carolina, 27710, United States
Cincinnati Ohio, 45229, United States
Columbus Ohio, 43205, United States
Oklahoma City Oklahoma, 73126, United States
Portland Oregon, 97225, United States
Philadelphia Pennsylvania, 19104, United States
Pittsburgh Pennsylvania, 15213, United States
Charleston South Carolina, 29425, United States
Memphis Tennessee, 38105, United States
Nashville Tennessee, 37232, United States
Dallas Texas, 75390, United States
Fort Worth Texas, 76104, United States
Houston Texas, 77030, United States
Houston Texas, 77030, United States
San Antonio Texas, 78207, United States
Temple Texas, 76508, United States
Salt Lake City Utah, 84112, United States
Seattle Washington, 98105, United States
Madison Wisconsin, 53792, United States
Marshfield Wisconsin, 54449, United States
Milwaukee Wisconsin, 53226, United States
Parkville Victoria, 3052, Australia
Perth Western Australia, 6001, Australia
Toronto Ontario, M5G 1, Canada
Montreal Quebec, H3G 1, Canada
Montreal Quebec, H3T 1, Canada
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