Pilot Study of Zoledronic Acid and Interleukin-2 for Refractory Pediatric Neuroblastoma
| Status: | Completed |
|---|---|
| Conditions: | Brain Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 2 - 21 |
| Updated: | 2/7/2015 |
| Start Date: | August 2011 |
| End Date: | September 2014 |
| Contact: | Joseph Pressey, MD |
| Email: | jpressey@uab.edu |
| Phone: | 205-638-9285 |
Pilot Study of Zoledronic Acid and Interleukin-2 for Refractory Pediatric Neuroblastoma: Assessment of Tolerability and In Vivo Expansion γδ T-Cells
Neuroblastoma (NB) is the most common extracranial solid tumor in children, with an annual
incidence of 10.5 per million children less than 15 years of age. NB accounts for 15% of
childhood cancer deaths. High risk (HR) patients carry a poor prognosis despite treatment
with intensive chemotherapy, surgery and/or radiation, autologous bone marrow transplant,
and treatment with cis-retinoic acid. New therapies are desperately needed for such
patients. Recently, it has been demonstrated that HR NB patients benefit from anti-GD2
antibody therapy which directs the immune system against NB cells. To further explore means
of harnessing the immune system to attack NB, the investigators are studying the combination
of zoledronic acid (ZOL) and interleukin-2 (IL-2). ZOL has been demonstrated to have direct
anti-neuroblastoma effects in laboratory studies. ZOL also augments the production of tumor
killing white blood cells called gamma-delta T cells. When used in combination with IL-2,
ZOL is capable of eliciting potent anti-cancer effects in patients, in part, via the
expansion of gamma-delta T cells. In this present trial the investigators aim to study the
tolerability of the combination of ZOL and IL-2 in pediatric NB patients. Patients will also
be monitored radiologically for tumor response to therapy. Correlative biological studies
will study the ability of this drug combination to elicit the production of NB killing
gamma-delta T cells in children.
incidence of 10.5 per million children less than 15 years of age. NB accounts for 15% of
childhood cancer deaths. High risk (HR) patients carry a poor prognosis despite treatment
with intensive chemotherapy, surgery and/or radiation, autologous bone marrow transplant,
and treatment with cis-retinoic acid. New therapies are desperately needed for such
patients. Recently, it has been demonstrated that HR NB patients benefit from anti-GD2
antibody therapy which directs the immune system against NB cells. To further explore means
of harnessing the immune system to attack NB, the investigators are studying the combination
of zoledronic acid (ZOL) and interleukin-2 (IL-2). ZOL has been demonstrated to have direct
anti-neuroblastoma effects in laboratory studies. ZOL also augments the production of tumor
killing white blood cells called gamma-delta T cells. When used in combination with IL-2,
ZOL is capable of eliciting potent anti-cancer effects in patients, in part, via the
expansion of gamma-delta T cells. In this present trial the investigators aim to study the
tolerability of the combination of ZOL and IL-2 in pediatric NB patients. Patients will also
be monitored radiologically for tumor response to therapy. Correlative biological studies
will study the ability of this drug combination to elicit the production of NB killing
gamma-delta T cells in children.
Inclusion Criteria:
- All patients must be diagnosed with treatment-refractory neuroblastoma with no known
curative treatment options. Tumor histology should be verified at diagnosis or
relapse.
- Prior to enrollment, a determination of residual disease must be performed
- Patients must have a Lansky or Karnofsky performance scale score of ≥ 50%.
- Patients must have a life expectancy of ≥ 2 months (8 weeks).
- Total absolute neutrophil count (ANC) is at least 750, Hgb≥8 grams/dl, and plts ≥
75K. PRBC transfusions are allowed.
- Patients with bone marrow disease will not evaluable for hematologic toxicity. These
patients must have a peripheral absolute neutrophil count
- 750, platelet count ≥ 50K and Hgb ≥8 grams/dl. Transfusions are permitted to
meet both the platelet and hemoglobin criteria.
- Creatinine clearance or radioisotope GFR > 70mL/min/1.73 m2 or a serum creatinine
based on age/gender as follows:
- ≤ 0.8 mg/dL (for patients 2 to 5 years of age)
- ≤ 1.0 mg/dL (for patients 6 to 9 years of age)
- ≤ 1.2 mg/dL (for patients 10 to 12 years of age)
- ≤ 1.4 mg/dL (for female patients ≥ 13 years of age)
- ≤ 1.5 mg/dL (for male patients 13 to 15 years of age)
- ≤ 1.6 mg/dL (for male patients ≥ 16 years of age)
- Total bilirubin ≤ 2.5 x upper limit of normal (ULN) for age, and
- SGPT (ALT) < 2.5 x upper limit of normal (ULN) for age.
- SOS (sinusoidal obstruction syndrome, formerly known as veno-occlusive disease
[VOD]), if present, should be stable or improving.
- Shortening fraction of > 27% by echocardiogram, or ejection fraction of > 55% by
radionuclide angiography.
- No evidence of dyspnea at rest. If PFTs are performed, FEV1/FVC > 60% by pulmonary
function test.
- Patients with seizure disorder may be enrolled if on anticonvulsants and well
controlled.
- CNS toxicity < Grade 2.
Exclusion Criteria:
- 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.
- All patients and/or their parents or legal guardians must sign a written informed
consent.
- All institutional requirements for human studies must be met.
- Previous treatment with anti-GD2 and interleukin2 therapy
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