MIBG With Dinutuximab

131I-Metaiodobenzylguanidine (131I-MIBG) is one of the most effective therapies utilized for
neuroblastoma patients with refractory or relapsed disease. Data from pre-clinical and adult
studies suggest that radiation can enhance the efficacy of immunotherapy and targeted
therapies such as dinutuximab. This first pediatric phase 1 trial of 131I-MIBG in combination
with dinutuximab aims to determine the recommended phase 2 pediatric dose of these two
therapies in combination.

Inclusion Criteria:

- Patients must have a diagnosis of neuroblastoma either by histologic verification of
neuroblastoma and/or demonstration of tumor cells in the bone marrow with increased
urinary catecholamines

- Patients must have high risk neuroblastoma according to COG risk classification at the
time of study registration. Patients who were initially considered low or intermediate
risk, but then reclassified as high risk are also eligible.

- Patients must have at least ONE of the following: 1) Recurrent/progressive disease at
any time prior to study enrollment, 2) Refractory disease, 3) Persistent disease

- Patients must have at least ONE of the following: 1) Bone disease, 2) Any amount of
neuroblastoma tumor cells in the bone marrow, 3) At least one soft tissue lesion that
meets criteria for a TARGET lesion, 4) At least one non-target soft tissue lesion that
is not measurable, but had a biopsy positive for neuroblastoma and/or
ganglioneuroblastoma at any time prior to enrollment or is MIBG avid

- Patients must have a Lansky (≤16 years) or Karnofsky (> 16 years) score of at least 50

- Patients must have fully recovered from the acute toxic effects of all prior
chemotherapy, immunotherapy, or radiotherapy prior to entering this study.

- Patients must not have received any of the specified therapies as stated in the
protocol in the time period prior to registration

- Patients must not be receiving any other anti-cancer agents or radiotherapy at the
time of study entry or while on study.

- Patients must not be receiving other investigational medications (covered under
another IND) within 30 days of study entry or while on study.

- Patients must not be receiving chronic systemic corticosteroids at doses greater than
physiologic dosing (inhaled corticosteroids acceptable).

- Patient must meet the organ function and system function requirements as stated in the
protocol

Exclusion Criteria:

- Pregnancy, breast feeding, or unwillingness to use effective contraception during the
study.

- Patients who, in the opinion of the investigator, may not be able to comply with the
safety monitoring requirements of the study.

- Patients with disease of any major organ system that would compromise their ability to
withstand therapy.

- Patients who have received prior allogeneic stem cell transplant

- Patients who are on hemodialysis.

- Patients with an active or uncontrolled infection.

- Known history of human immunodeficiency virus (HIV) infection, hepatitis B, or
hepatitis C.

- Patients and/or families who are physically and psychologically unable to cooperate
with the radiation safety isolation.

- Patients with a history of having to discontinue anti-GD2 antibody therapy due to
toxicity are not eligible.

- Prior anti-GD2 therapy is not otherwise an exclusionary criteria unless it was given
in combination with therapeutic 131I-MIBG.

- Patient declines participation in NANT 2004-05, the NANT Biology Study