Molecular-Guided Therapy for Childhood Cancer

Inclusion Criteria:

1. Subjects must have proven pediatric cancer with confirmation at diagnosis or at the
time of recurrence/progression and clinical determination of disease for which there
is no known effective curative therapy or disease that is refractory to established
proven therapies fitting into one of the following categories:

- Neuroblastoma- Patients that have relapsed following standard of care therapy
(such as high risk patients, patient presenting after age 15 months or MYCN
amplified, and only following (for eligible patients) high-dose chemotherapy
followed by hematopoietic stem cell transplantation and maintenance therapy with
retinoic acid and antibody therapy) or having progressed during standard of care
therapy and non-responsive/progressive to accepted curative chemotherapy.

- Brain Tumors

- Medulloblastomas (At relapse after standard of care therapy [surgery,
chemotherapy and/or radiation] and/or non-responsive/progressive on accepted
curative therapy)

- Gliomas (At relapse after standard of care therapy [surgery and/or radiation
and/or chemotherapy] and/or non-responsive/progressive on accepted curative
therapy)

- Ependymomas (At relapse after standard of care therapy [surgery with or without
radiation] and/or non-responsive/progressive on accepted curative therapy)

- Choroid plexus tumors (At relapse after standard of care therapy [surgery] and/or
non-responsive/progressive on accepted curative therapy)

- Craniopharyngiomas (At relapse after standard of care therapy [surgery or
suppressive therapy] and/or non-responsive/progressive on accepted curative
therapy)

- Dysembryoplastic neuroepithelial tumors (DNETs) (At relapse after standard of
care therapy [surgery] and/or non-responsive/progressive on accepted curative
therapy)

- Meningiomas (At relapse after standard of care therapy [surgery] and/or
non-responsive/progressive on accepted curative therapy)

- Primitive Neuroectodermal Tumors (PNETs) (At relapse after standard of care
therapy [surgery, chemotherapy, and/or radiation] and/or
non-responsive/progressive on accepted curative therapy)

- Germ cell tumors (At relapse after standard of care therapy [surgery, and/or
radiation and/or chemotherapy] and/or non-responsive/progressive on accepted
curative therapy)

- Rare Tumors:

- Soft tissue sarcoma Rhabdomyosarcoma (At relapse after standard of care therapy
[surgery, and/or radiation, chemotherapy] and/or non-responsive/progressive to
accepted curative chemotherapy) Non-rhabdomyosarcoma (At relapse after standard
of care therapy [surgery, and/or radiation, chemotherapy] and/or
non-responsive/progressive to accepted curative chemotherapy)

- Bone Ewings sarcoma (At relapse after standard of care therapy [surgery, and/or
radiation, chemotherapy] and/or non- responsive/progressive to accepted curative
chemotherapy) Osteosarcoma (At relapse after standard of care therapy [surgery,
chemotherapy] and/or non- responsive/progressive to accepted curative
chemotherapy)

- Renal Wilms tumor (At relapse after standard of care therapy [surgery, and/or
radiation, chemotherapy] and/or non- responsive/progressive to accepted
chemotherapy) Renal cell carcinoma (At relapse after standard of care therapy
[surgery, chemotherapy] and/or non- responsive/progressive to accepted curative
chemotherapy) Malignant rhabdoid tumor (At diagnosis, as there is no known
curative therapy) Clear Cell Sarcoma- (At relapse after standard of care therapy
[radiation, chemotherapy] and/or non- responsive/progressive to accepted curative
chemotherapy) Germ Cell tumors (At relapse after standard of care therapy
[surgery, chemotherapy] and/or non-responsive/progressive to accepted curative
chemotherapy)

- Liver Tumors (At relapse after standard of care therapy [surgery, chemotherapy]
and/or non- responsive/progressive to accepted curative chemotherapy)

2. Subjects must be age >12 months at enrollment

3. Subjects must be age ≤ 21 years at initial diagnosis

4. Subjects must have measurable disease as demonstrated by residual abnormal tissue at a
primary or metastatic site (measurable on CT or MRI) at the time of biopsy; tumor must
be accessible for biopsy. In addition, subjects with bone or bone marrow only disease
expected to be >75% tumor are eligible to enroll.

5. Current disease state must be one for which there is currently no known effective
therapy

6. Specimens will be obtained only in a non-significant risk manner and not solely for
the purpose of investigational testing.

7. Lansky or Karnofsky Score must be ≥ 50

8. Subjects without bone marrow metastases must have an ANC > 750/μl to begin treatment.

9. Subjects with CNS disease must have been on a stable dose of steroids for 2 weeks
prior to their biopsy and must not have progressive hydrocephalus at enrollment.

10. Adequate liver function must be demonstrated, defined as:

- Total bilirubin ≤ 1.5 x upper limit of normal (ULN) for age AND

- ALT (SGPT) < 10 x upper limit of normal (ULN) for age

11. A negative serum pregnancy test is required for female participants of child bearing
potential (≥13 years of age or after onset of menses)

12. Both male and female post-pubertal study subjects need to agree to use one of the more
effective birth control methods during treatment and for six months after treatment is
stopped. These methods include total abstinence (no sex), oral contraceptives ("the
pill"), an intrauterine device (IUD), levonorgestrol implants (Norplant), or
medroxyprogesterone acetate injections (Depo-provera shots). If one of these cannot be
used, contraceptive foam with a condom is recommended.

13. Informed Consent: All subjects and/or legal guardians must sign informed written
consent. Assent, when appropriate, will be obtained according to institutional
guidelines

Exclusion Criteria:

1. Subjects who have received any cytotoxic chemotherapy within the last 7 days prior to
biopsy

2. Subjects who have received any radiotherapy to the primary sample site within the last
14 days (radiation may be included in treatment decision after biopsy).

3. Subjects receiving any investigational drug concurrently.

4. Subjects with uncontrolled serious infections or a life-threatening illness (unrelated
to tumor)

5. Subjects with any other medical condition, including malabsorption syndromes, mental
illness or substance abuse, deemed by the Investigator to be likely to interfere with
the interpretation of the results or which would interfere with a subject's ability to
sign or the legal guardian's ability to sign the informed consent, and subject's
ability to cooperate and participate in the study