N99-01: Combination Chemotherapy, Radiation Therapy, and Stem Cell Transplantation in Treating Patients With Neuroblastoma
Condition: Neuroblastoma
MeSH terms: Neuroblastoma
Study type: Interventional
Phase: Phase 1

Summary: 
      RATIONALE: Drugs used in chemotherapy work in different ways to stop tumor cells from
      dividing so they stop growing or die. Giving the drugs in different ways may kill more tumor
      cells. Radiation therapy uses high-energy x-rays to damage tumor cells. Peripheral stem cell
      or bone marrow transplantation may be able to replace immune cells that were destroyed by
      chemotherapy or radiation therapy.

      PURPOSE: This phase I trial is studying the side effects and best dose of combination
      chemotherapy when given before stem cell transplant and radiation therapy in treating
      patients with neuroblastoma that has not responded to previous treatments.
    

Detailed description: 
      OBJECTIVES:

        -  Determine the maximum tolerated dose and toxic effects of iodine I 131
           metaiodobenzylguanidine (131 I-MIBG) plus ablative doses of carboplatin and etoposide
           administered with fixed-dose melphalan followed by autologous hematopoietic stem cell
           transplantation in patients with refractory or residual high-risk neuroblastoma.

        -  Determine the number of days until blood counts recover in these patients after
           receiving this treatment regimen.

        -  Determine the response rate to this treatment regimen in these patients.

        -  Determine the tumor dosimetry of 131 I-MIBG in patients with measurable soft tissue
           lesions.

      OUTLINE: This is a dose-escalation study of iodine I 131 metaiodobenzylguanidine (131
      I-MIBG), carboplatin, and etoposide. Patients are stratified according to glomerular
      filtration rate (at least 100 mL/min vs 60-99 mL/min).

      Patients undergo peripheral blood stem cell harvest or bone marrow harvest at least 2 weeks
      prior to treatment with 131 I-MIBG.

      Patients receive 131 I-MIBG IV over 120 minutes on day -21; melphalan IV on days -7 to -5;
      carboplatin and etoposide IV continuously over 96 hours on days -7 to -4; autologous
      hematopoietic stem cell transplantation IV over 15-30 minutes on day 0; and filgrastim
      (G-CSF) subcutaneously or IV starting on day 0 and continuing until blood counts recover.
      Radiotherapy is administered to the primary tumor site and metastatic sites twice daily for 7
      consecutive days within 6 weeks of transplantation or once blood counts have recovered.

      Cohorts of 3-6 patients receive escalating doses of 131 I-MIBG, carboplatin, and etoposide
      until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose
      preceding that at which 2 of 6 patients experience dose-limiting toxicity.

      Patients are followed at day 84, and then 2 months later if there is a complete response
      and/or partial response. Patients who continue therapy on other protocols are followed before
      starting the new therapy. All patients are followed for life for any delayed toxic effects
      related to study therapy, secondary malignancies, disease status, and survival.

      PROJECTED ACCRUAL: A total of 30-60 patients (15-30 per stratum) will be accrued for this
      study within 2-3 years.
    

Intervention name(s): filgrastim; carboplatin; etoposide; melphalan; autologous bone marrow transplantation; peripheral blood stem cell transplantation; iobenguane I 131; radiation therapy
Intervention type(s): Biological; Drug; Drug; Drug; Procedure; Procedure; Radiation; Radiation
Intervention MeSH terms: Carboplatin; Etoposide; Melphalan; 3-Iodobenzylguanidine
Primary purpose: Treatment
Keywords: localized resectable neuroblastoma; regional neuroblastoma; disseminated neuroblastoma; stage 4S neuroblastoma; recurrent neuroblastoma; localized unresectable neuroblastoma