Patient case: 4-year-old female with neuroblastoma; genetic feature: ALK

Clinical trial: N2007-03: Vorinostat and 131-I MIBG in Treating Patients With Resistant or Relapsed Neuroblastoma

Summary: RATIONALE: Vorinostat may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Radioactive drugs, such as iobenguane I 131, may carry radiation directly to tumor cells and not harm normal cells. Giving vorinostat together with iobenguane I 131 may kill more tumor cells.
  PURPOSE: This phase I trial is studying the side effects and best dose of giving vorinostat together with iobenguane I 131 in treating patients with resistant or relapsed neuroblastoma.

Detailed description: OBJECTIVES:
  Primary
  -  To determine the maximum tolerated dose of vorinostat in combination with iobenguane I 131 in patients with resistant or relapsed neuroblastoma.
  -  To define the toxicities of vorinostat in combination with therapeutic doses of iobenguane I 131 in these patients.
  Secondary
  -  To describe, within the context of a phase I study, the response rate in patients treated with vorinostat and iobenguane I 131.
  -  To describe histone acetylation levels and norepinephrine transporter mRNA levels in peripheral blood mononuclear cells after treatment with different doses of vorinostat.
  OUTLINE: This is a multicenter study.
  Patients receive oral vorinostat once daily on days 1-14 and iobenguane I 131 IV over 1½-2 hours on day 3. Patients undergo autologous peripheral blood stem cell transplantation on day 17.
  Blood samples may be collected periodically for correlative biological studies.
  After completion of study treatment, patients are followed up periodically.

Eligibility: Inclusion Criteria:
  -  Patients must be at least 24 months and no older than 30 years of age when registered on study.
  -  Patients must have relapsed neuroblastoma, refractory neuroblastoma that had less than a partial response to standard treatment or persistent neuroblastoma that had at least a partial response to standard treatment.
  -  Patients who have at least a partial response to standard treatment who still have neuroblastoma that can be seen on CT/MRI or MIBG scans must have a surgical biopsy done of the tumor to confirm that it is neuroblastoma. Patients with relapsed or refractory neuroblastoma do not need to have a biopsy done to enter on study.
  -  Patients must have evidence of MIBG uptake into tumor at one site within 4 weeks prior to entry on study and subsequent to any intervening therapy.
  -  Patients must have a stem cell product available that meets study criteria. If they don't already have stem cells frozen away then they must be able to have a stem cell collection done to collect the necessary amount of stem cells for study entry and these stem cells must meet study criteria.
  -  Patients must have adequate heart, kidney, liver and bone marrow function. Patients who have bone marrow disease must meet the bone marrow function criteria to enter the study.
  Exclusion Criteria:
  -  They have had treatment with 131I-MIBG before.
  -  They have had prior treatment with vorinostat or other HDAC inhibitor.
  -  They have had a stem cell transplant using another person as the stem cell donor. (You can still be in the study if a previous transplant used your own stem cells)
  -  They have other medical problems that could get much worse if they had this treatment.
  -  They are on dialysis for bad kidney function.
  -  They have a history of unexplained blood clot, pulmonary embolus, thrombotic stroke, or arterial clot.
  -  They are pregnant or breast feeding.
  -  They have active infections such as hepatitis or fungal infections.
  -  They had total body radiation or radiation to the entire belly or a large amount of radiation to the liver or kidney (some radiation to the liver or kidneys is ok).
  -  They can't cooperate with the special precautions that are needed during MIBG treatment.

Relevance to patient case: not relevant