Melanoma Clinical Trial
Colony-Stimulating Factors in Treating Children With Recurrent or Refractory Solid Tumors
Summary
RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Colony-stimulating factors such as thrombopoietin and G-CSF may increase the number of immune cells found in bone marrow or peripheral blood and may help a person's immune system recover from the side effects of chemotherapy.
PURPOSE: Phase I trial to study the effectiveness of colony-stimulating factors in treating children who have recurrent or refractory solid tumors and who are receiving chemotherapy.
Full Description
OBJECTIVES:
Determine the pharmacokinetics and toxicities associated with the administration of recombinant human thrombopoietin in children with solid tumors receiving myelosuppressive chemotherapy with ifosfamide, carboplatin, and etoposide (ICE).
Determine a safe dose of recombinant human thrombopoietin with filgrastim (G-CSF) in this patient population.
Evaluate the time to platelet count recovery following chemotherapy in this patient population.
Evaluate the depth and duration of neutropenia and thrombocytopenia and the number of platelet transfusion events in this patient population.
OUTLINE: This is a dose escalation study of recombinant human thrombopoietin.
All patients receive chemotherapy consisting of carboplatin IV over 60 minutes on days 0 and 1 and etoposide and ifosfamide IV over 60 minutes on days 0-4. Chemotherapy is continued in the absence of disease progression or unacceptable toxicity for a maximum of 6 courses every 21 days.
Cohorts of 3-6 patients each receive escalating doses of recombinant human thrombopoietin IV on days 4, 6, 8, 10, and 12 until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose at which fewer than 2 patients experience dose limiting toxicity. After the MTD is determined an additional cohort of patients are treated at this dose level every other day on days 4-20. Patients receive filgrastim (G-CSF) subcutaneously beginning on day 5 and continuing until absolute neutrophil count is greater than 1000/mm3 for 2 consecutive days or day 33.
PROJECTED ACCRUAL: A total of 24 evaluable patients will be accrued for this study.
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically proven (except for brain stem tumors) malignancy that has
failed or relapsed after standard first-line antineoplastic therapy
Sarcoma (soft tissue and bone)
Kidney tumors
Brain tumors
Other solid tumors (gonadal and germ cell tumors, malignant melanoma,
retinoblastoma, liver tumors, and miscellaneous tumors) Must have had recurrence within the past 4 weeks
No bone marrow involvement
No prior or concurrent myelogenous leukemia
PATIENT CHARACTERISTICS:
Age:
1 to 21
Performance status:
Lansky or Karnofsky 60-100%
Life expectancy:
At least 12 weeks
Hematopoietic:
Absolute neutrophil count greater than 1000/mm3
Platelet count greater than 100,000/mm3
No grade III or IV thrombosis
Hepatic:
Bilirubin less than 1.5 times upper limit of normal (ULN)
SGOT or SGPT less than 2.5 times ULN
Renal:
Creatinine clearance or glomerular filtration rate at least 70 mL/min
Cardiovascular:
Ejection fraction normal
No evidence of arrhythmias requiring therapy
Fractional shortening greater than 28%
Other:
Not pregnant or nursing
PRIOR CONCURRENT THERAPY:
Biologic therapy:
At least 10 days since prior colony-stimulating factor therapy and recovered
At least 30 days since prior epoetin alfa
No other concurrent cytokines, including epoetin alfa
Chemotherapy:
At least 3 weeks since prior chemotherapy (6 weeks for nitrosoureas) and
recovered
At least 3 months since therapy with etoposide, carboplatin, or ifosfamide
that is identical to study treatment
Endocrine therapy:
Not specified
Radiotherapy:
Concurrent radiotherapy allowed after third course of therapy
No prior cranial/spinal radiotherapy
No prior radiotherapy to greater than 50% of bone marrow
Surgery:
Concurrent surgery allowed after the second course of therapy
Other:
No concurrent investigational agents
No concurrent lithium, aspirin, coumadin, or heparin
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There are 24 Locations for this study
Long Beach California, 90806, United States
Los Angeles California, 90027, United States
Los Angeles California, 90095, United States
Los Angeles California, 91010, United States
Orange California, 92668, United States
San Francisco California, 94115, United States
Washington District of Columbia, 20010, United States
Indianapolis Indiana, 46202, United States
Ann Arbor Michigan, 48109, United States
Minneapolis Minnesota, 55455, United States
Rochester Minnesota, 55905, United States
Kansas City Missouri, 64108, United States
New York New York, 10016, United States
New York New York, 10021, United States
New York New York, 10032, United States
Cincinnati Ohio, 45229, United States
Philadelphia Pennsylvania, 19104, United States
Pittsburgh Pennsylvania, 15213, United States
Nashville Tennessee, 37232, United States
Houston Texas, 77030, United States
Salt Lake City Utah, 84132, United States
Seattle Washington, 98105, United States
Madison Wisconsin, 53792, United States
Perth Western Australia, 6001, Australia
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