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Vorinostat Combined With Isotretinoin and Chemotherapy in Treating Younger Patients With Embryonal Tumors of the Central Nervous System

Basic Trial Information
Trial Description
     Summary
     Further Trial Information
     Eligibility Criteria
Trial Contact Information

Basic Trial Information

PhaseTypeStatusAgeSponsorProtocol IDs
No phase specifiedBiomarker/Laboratory analysis, TreatmentActive2 months to 3 yearsNCINCI-2012-03167
PBTC-026, U01CA081457, NCT00867178

Trial Description

Summary

This pilot clinical trial studies the side effects and the best way to give vorinostat with isotretinoin and combination chemotherapy and to see how well it works in treating younger patients with embryonal tumors of the central nervous system. Vorinostat may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as isotretinoin, vincristine sulfate, cisplatin, cyclophosphamide, and etoposide phosphate, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving vorinostat with isotretinoin and combination chemotherapy may be and effective treatment for embryonal tumors of the central nervous system. A peripheral blood stem cell transplant may be able to replace blood-forming cells that were destroyed by chemotherapy. This may allow more chemotherapy to be given so that more tumor cells are killed.

Further Study Information

PRIMARY OBJECTIVES:

I. To investigate the feasibility of administering vorinostat (SAHA) and isotretinoin for three days prior and concomitant with cisplatin based chemotherapy over three courses of induction chemotherapy.

II. To describe the toxicity of administering vorinostat (SAHA) and isotretinoin for three days prior and concomitant with cisplatin based chemotherapy over three courses of induction chemotherapy.

III. To investigate prognostic values of histopathological classification and biological markers in the context of a feasibility study.

SECONDARY OBJECTIVES:

I. To estimate the preliminary response rate of this approach in patients with measurable residual disease (primary site and/or metastatic sites).

II. To estimate disease specific progression-free and overall survival, in the context of a feasibility study.

III. To explore the predictive values of biological markers in cerebrospinal fluid (CSF), plasma, urine tumor material in the context of a feasibility study.

OUTLINE: This is a multicenter study.

INDUCTION THERAPY: Patients receive vorinostat orally (PO) once daily (QD) and isotretinoin PO twice daily (BID) on days 1-4; vincristine sulfate intravenously (IV) on days 4, 11, and 18; cisplatin IV over 6 hours on day 4; cyclophosphamide IV over 1 hour on days 5-6; and etoposide phosphate IV over 1 hour on days 4-6. Treatment repeats every 21 days for 3 courses in the absence of disease progression or unacceptable toxicity. Patients also undergo peripheral blood stem cell (PBSC) harvesting after each course.

CONSOLIDATION THERAPY: Within 6 weeks (10 weeks if patient is re-staged) after completion of induction therapy, patients receive carboplatin IV over 2 hours and thiotepa IV over 2 hours on days 1-2. Patients also receive autologous PBSC rescue infusion over 6 hours on day 4. Treatment repeats every 28 days for 3 courses in the absence of disease progression or unacceptable toxicity. Beginning 3 weeks later, patients with M0 non-desmoplastic medulloblastoma also undergo conformal radiotherapy* to the tumor bed.

NOTE: *Patients with supratentorial primary tumors or metastatic disease undergo radiotherapy at the discretion of treating physician.

MAINTENANCE THERAPY: Beginning 4 weeks after completion of radiotherapy or immediately after completion of consolidation therapy, patients receive vorinostat PO QD on days 1, 3, 5, 6, 8, 10, 12, and 13 and isotretinoin PO BID on days 1-14. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed every 3 months for 2 years and then every 6 months for 3 years.

Eligibility Criteria

Inclusion Criteria:

  • Patients must have a histologically confirmed, newly-diagnosed medulloblastoma (except for patients with the histology of localized (M0) desmoplastic medulloblastoma or atypical teratoid/rhabdoid tumor [ATRT]) or supratentorial primitive neuroectodermal tumor (PNET) including pineoblastomas
  • Patients must have not received any prior therapy other than surgery and/or steroids
  • Patient must have adequate pre-trial formalin-fixed, paraffin-embedded (FFPE) tumor material available for use in the biology studies and central pathology review; if snap frozen tissue is not available, the study chair must be contacted to discuss eligibility
  • Patient must be a suitable candidate, by institutional standards for stem cell apheresis
  • Lansky performance score (LPS for =< 16 years of age) >= 30 assessed within two weeks prior to registration
  • No prior therapy except surgery and/or corticosteroids alone
  • Absolute neutrophil count (ANC) >= 1000/ul (unsupported)
  • Platelets >= 100,000/ul (unsupported)
  • Hemoglobin >= 8 g/dL (may be supported)
  • Bilirubin < 1.5 times upper limit of normal for age
  • Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 1.5 times institutional upper limit of normal for age
  • Serum creatinine =< 1.5 times upper limit of institutional normal for age or glomerular filtration rate (GFR) >= 70 ml/min/1.73m^2 or estimated GFR (Schwartz bedside) that is > 99ml/min/1.73m^2
  • Parents/legal guardians must have the ability to understand and the willingness to sign a written informed consent document according to institutional guidelines

Exclusion Criteria:

  • Patients with diagnosis of atypical teratoid/rhabdoid tumor (ATRT by histology, immunohistochemistry and/or molecular analysis) and desmoplastic M0 medulloblastoma will be excluded from the study
  • Patients with any clinically significant unrelated systemic illness (serious infections or significant cardiac, pulmonary, hepatic or other organ dysfunction), that would compromise the patient's ability to tolerate protocol therapy or would likely interfere with the study procedures or results
  • Patients receiving any other anticancer or investigational drug therapy are excluded; patients having taken valproic acid within 2 weeks prior to initiation of treatment are excluded
  • Patients with inability to return for follow-up visits or obtain follow-up studies required to assess toxicity to therapy
  • Patients with a parabens allergy

Trial Contact Information

Trial Lead Organizations/Sponsors

National Cancer Institute

Sarah LearyPrincipal Investigator

Trial Sites

U.S.A.
California
  Los Angeles
 Children's Hospital Los Angeles
 Girish Dhall Ph: 323-361-4629
  Email: gdhall@chla.usc.edu
 Girish DhallPrincipal Investigator
  Palo Alto
 Lucile Packard Children's Hospital at Stanford University Medical Center
 Paul G. Fisher Ph: 650-721-5889
  Email: pfisher@stanford.edu
 Paul Graham FisherPrincipal Investigator
District of Columbia
  Washington
 Children's National Medical Center
 Lindsay B. Kilburn Ph: 202-476-3854
  Email: lkilburn@cnmc.org
 Lindsay B. KilburnPrincipal Investigator
Illinois
  Chicago
 Ann and Robert H. Lurie Children's Hospital of Chicago
 Stewart Goldman Ph: 312-227-4844
  Email: sgoldman@luriechildrens.org
 Stewart GoldmanPrincipal Investigator
Maryland
  Bethesda
 NCI - Pediatric Oncology Branch
 Katherine E. Warren Ph: 301-435-4683
  Email: warrenk@mail.nih.gov
 Katherine WarrenPrincipal Investigator
New York
  New York
 Memorial Sloan-Kettering Cancer Center
 Ira J. Dunkel Ph: 212-639-2153
  Email: dunkeli@mskcc.org
 Ira J. DunkelPrincipal Investigator
North Carolina
  Durham
 Duke Cancer Institute
 Sridharan Gururangan Ph: 919-684-3506
  Email: gurur002@mc.duke.edu
 Sri GururanganPrincipal Investigator
Ohio
  Cincinnati
 Cincinnati Children's Hospital Medical Center
 Maryam Fouladi Ph: 513-803-0721
  Email: maryam.fouladi@cchmc.org
 Maryam FouladiPrincipal Investigator
Pennsylvania
  Philadelphia
 Children's Hospital of Philadelphia
 Peter C. Phillips Ph: 215-590-2107
  Email: phillipsp@email.chop.edu
 Peter C. PhillipsPrincipal Investigator
  Pittsburgh
 Children's Hospital of Pittsburgh of UPMC
 Ian F. Pollack Ph: 412-692-5881
  Email: ian.pollack@chp.edu
 Ian F. PollackPrincipal Investigator
Tennessee
  Memphis
 St. Jude Children's Research Hospital
 Alberto Broniscer Ph: 901-595-4925
  Email: alberto.broniscer@stjude.org
 Alberto BroniscerPrincipal Investigator
Texas
  Houston
 M. D. Anderson Cancer Center at University of Texas
 Anita Mahajan Ph: 713-563-2350
  Email: amahajan@mdanderson.org
 Anita MahajanPrincipal Investigator
 Texas Children's Hospital
 Murali M. Chintagumpala Ph: 832-822-4266
  Email: mxchinta@txch.org
 Murali M. ChintagumpalaPrincipal Investigator
Washington
  Seattle
 Children's Hospital and Regional Medical Center - Seattle
 Sarah E. Leary Ph: 206-987-2106
  Email: sarah.leary@seattlechildrens.org
 Sarah E. LearyPrincipal Investigator

Link to the current ClinicalTrials.gov record.
NLM Identifer NCT00867178
ClinicalTrials.gov processed this data on January 21, 2014

Note: Information about this trial is from the ClinicalTrials.gov database. The versions designated for health professionals and patients contain the same text. Minor changes may be made to the ClinicalTrials.gov record to standardize the names of study sponsors, sites, and contacts. Cancer.gov only lists sites that are recruiting patients for active trials, whereas ClinicalTrials.gov lists all sites for all trials. Questions and comments regarding the presented information should be directed to ClinicalTrials.gov.

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