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

Clinical trial: ABT-751 in Treating Young Patients With Refractory Solid Tumors

Summary: RATIONALE: Drugs used in chemotherapy, such as ABT-751, work in different ways to stop tumor cells from dividing so they stop growing or die.
  PURPOSE: This phase I trial is studying the side effects of ABT-751 in treating young patients with refractory solid tumors.

Detailed description: OBJECTIVES:
  Primary
  -  Determine the maximum tolerated dose and dose-limiting toxic effects of ABT-751 administered daily for 7 days every 21 days or daily for 21 days every 28 days in children with refractory solid tumors.
  -  Determine the toxicity spectrum of these regimens in these patients.
  -  Determine the pharmacokinetics of these regimens in these patients.
  -  Evaluate the pharmacodynamics of this drug by measuring the fraction of tubulin that is polymerized in the peripheral blood mononuclear cells of these patients before and after receiving this drug.
  Secondary
  -  Quantify responses in patients treated with these regimens.
  -  Assess the effect of this drug on tumor vascularity and tumor blood flow using dynamic enhanced MRI in these patients.
  OUTLINE: This is an open-label, multicenter, dose-escalation study of 2 different schedules of ABT-751. Patients are assigned to 1 of 2 dosing schedules.
  -  Schedule 1 (closed to accrual as of 5/25/2009): Patients receive oral ABT-751 once daily on days 1-7. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
  -  Schedule 2 (closed to accrual as of 5/25/2009): Patients receive oral ABT-751 once daily on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
  On each schedule, cohorts of 3-6 patients receive escalating doses of ABT-751 until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which at least 2 of 6 patients experience dose-limiting toxicity. Once the MTD is determined, up to 9 patients (a minimum of 3 patients age 11 and under and 3 patients age 12 to 18) are treated at the MTD.
  PROJECTED ACCRUAL: A maximum of 90 patients will be accrued for this study within 8 months.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically confirmed solid tumor*, including, but not limited to, the following:
  -  Rhabdomyosarcoma
  -  Other soft tissue sarcomas
  -  Ewing's sarcoma family of tumors
  -  Osteosarcoma
  -  Neuroblastoma
  -  Wilms' tumor
  -  Hepatic tumors
  -  Germ cell tumors
  -  Primary brain tumors
  -  Brain stem or optic gliomas (histological confirmation may be waived if a biopsy has not been performed) NOTE: *Closed to accrual for all diagnoses except neuroblastoma as of 4/16/05
  -  Relapsed after or failed to respond to frontline standard therapy and no other standard treatment options (e.g., surgery, radiotherapy, chemotherapy, or any combination of these modalities) exist
  -  Measurable or evaluable disease* NOTE: *Not required for patients with neuroblastoma
  -  No CNS tumor with motor or sensory deficits that would obscure the study assessment of sensory neuropathy
  PATIENT CHARACTERISTICS:
  Age:
  -  18 and under
  Performance status:
  -  Lansky 60-100% (age 10 and under)
  -  Karnofsky 60-100% (age 11 to 18)
  Life expectancy:
  -  Not specified
  Hematopoietic:
  -  Absolute neutrophil count at least 1,500/mm^3
  -  Platelet count at least 100,000/mm^3
  Hepatic:
  -  Bilirubin no greater than 1.5 times upper limit of normal (ULN)
  -  ALT and AST no greater than 2.5 times ULN (5 times ULN for patients treated after the maximum tolerated dose is determined)
  -  No clinically significant hepatic dysfunction
  Renal:
  -  Creatinine normal for age OR
  -  Creatinine clearance at least 60 mL/min
  -  No clinically significant renal dysfunction
  Cardiovascular:
  -  LVEF normal by echocardiogram
  Other:
  -  Not pregnant or nursing
  -  Negative pregnancy test
  -  Fertile patients must use effective contraception
  -  No allergy to sulfa-containing medications
  -  No clinically significant unrelated systemic illness (e.g., other organ dysfunction) that would preclude study participation
  -  No serious infection
  -  No preexisting grade 2 or greater sensory or motor neuropathy
  -  HIV negative
  PRIOR CONCURRENT THERAPY:
  Biologic therapy:
  -  At least 4 months since prior bone marrow transplantation
  -  At least 72 hours since prior interleukin-11
  -  At least 72 hours since prior colony-stimulating factors (e.g., filgrastim [G-CSF] or sargramostim [GM-CSF]) except epoetin alfa
  -  No concurrent growth factors (e.g., GM-CSF) except epoetin alfa
  -  Concurrent G-CSF allowed if neutropenia lasts longer than 5 days OR if the patient experiences confirmed septicemia associated with neutropenia
  -  No concurrent immunotherapy
  -  No concurrent interleukin-11
  Chemotherapy:
  -  See Disease Characteristics
  -  At least 30 days since prior chemotherapy (42 days for nitrosoureas)
  -  No other concurrent anticancer chemotherapy
  Endocrine therapy:
  -  Patients with brain tumors:
  -  Must be on a stable or tapering dose of corticosteroids for 7 days before baseline scan performed for the purpose of assessing response to study therapy
  -  Concurrent corticosteroids allowed for control of symptoms of tumor-associated edema
  Radiotherapy:
  -  See Disease Characteristics
  -  At least 4 weeks since prior radiotherapy
  -  At least 4 months since prior extensive radiotherapy (craniospinal radiotherapy, total body irradiation, or radiotherapy to more than 50% of the pelvis)
  -  No concurrent radiotherapy
  Surgery:
  -  See Disease Characteristics
  Other:
  -  Recovered from prior therapy
  -  At least 30 days since prior investigational anticancer therapy
  -  No other concurrent investigational agents

Relevance to patient case: not relevant