Sorafenib in Treating Young Patients With Relapsed or Refractory Solid Tumors or Leukemia
Condition: Blastic Phase; Childhood Acute Promyelocytic Leukemia With PML-RARA; Childhood Chronic Myelogenous Leukemia, BCR-ABL1 Positive; Childhood Solid Neoplasm; Chronic Myelogenous Leukemia, BCR-ABL1 Positive; Juvenile Myelomonocytic Leukemia; Philadelphia Chromosome Negative, BCR-ABL1 Positive Chronic Myelogenous Leukemia; Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Recurrent Disease
MeSH terms: Leukemia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Leukemia, Myeloid; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukemia, Promyelocytic, Acute; Leukemia, Myelomonocytic, Juvenile; Recurrence; Philadelphia Chromosome
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      This phase I/II trial is studying the side effects and best dose of sorafenib in treating
      young patients with relapsed or refractory solid tumors or leukemia. Sorafenib may stop the
      growth of cancer cells by blocking some of the enzymes needed for cell growth and by blocking
      blood flow to the cancer.
    

Detailed description: 
      PRIMARY OBJECTIVES:

      I. Determine the maximum-tolerated dose (MTD) and recommended phase II dose of sorafenib in
      pediatric patients with relapsed or refractory solid tumors.

      II. Determine whether pediatric patients with relapsed or refractory leukemia can tolerate
      the MTD of sorafenib for solid tumors.

      III. Determine the tolerability, active N-oxide metabolite, pharmacodynamics, and activity of
      sorafenib a the MTD in a subset of patients with acute myeloid leukemia (AML) and FLT3-ITD
      mutation.

      IV. Determine the toxicities of this drug in these patients. V. Determine the
      pharmacokinetics of this drug in these patients.

      SECONDARY OBJECTIVES:

      I. Determine, preliminarily, the antitumor activity of this drug within the confines of a
      phase I trial.

      II. Assess the biologic effect of sorafenib on circulating endothelial cells (CEC),
      circulating CEC precursors (CECP), VEGF, and VEGF-2 in peripheral blood.

      III. Assess the gene expression, proteomic profile, and ERK phosphorylation in blasts of
      patients with refractory leukemia treated with this regimen.

      IV. Assess the effect of sorafenib on solid tumor vascularity and tumor blood flow using
      dynamic contrast-enhanced MRI (DEMRI) in patients with measurable soft tissue tumors.

      V. Analyze tumor samples and leukemic blasts for the presence of ras, raf, or FLT3
      (leukemias) mutations.

      VI. Analyze the plasma inhibitory activity for FLT3 phosphorylation in peripheral blood of
      patients with AML and FLT3-ITD mutation.

      VII. Determine the tolerability, pharmacokinetics of sorafenib and sorafenib?s active N-oxide
      metabolite, pharmacodynamics, and activity of sorafenib administered at the MTD for
      refractory leukemias in a subset of patients with AML and FLT3-ITD mutation.

      VIII. Analyze the plasma inhibitory activity for FLT3 phosphorylation in peripheral blood
      samples obtained at the time of PK studies in patients with FLT3-ITD mutation AML.

      OUTLINE: This is a dose-escalation, multicenter study. Patients are stratified according to
      diagnosis (malignant solid tumor vs leukemia).

      STRATUM I(REFRACTORY SOLID TUMOR PATIENTS): Patients receive oral sorafenib twice daily on
      days 1-28. Treatment repeats every 28 days for up to 24 courses in the absence of disease
      progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of
      sorafenib until the maximum-tolerated dose (MTD) is determined. The MTD is defined as the
      dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity
      (DLT). Once the MTD is determined, up to 6 additional patients under 12 years of age may be
      treated at the MTD. The MTD dose level is also expanded to enroll up to 6 patients with
      refractory leukemia.

      STRATUM II (REFRACTORY LEUKEMIA PATIENTS): A cohort of 3-6 patients with leukemia receives
      treatment as in stratum 1 at the MTD determined in stratum 1. If 2 of 3 or 2 of 6 patients
      experience a DLT at the solid tumor MTD, sorafenib is reduced by one dose level. The leukemia
      MTD is defined as the dose at which < 1/3 of patients experience DLT during course 1 of
      treatment.

      STRATUM III (ACUTE MYELOID LEUKEMIA AND FLT3-ITD MUTATION PATIENTS): Patients receive
      sorafenib as in stratum 1 at the MTD determined in stratum 2. Patients undergo blood sample
      collection for pharmacokinetics, pharmacodynamics (in leukemia blasts only), circulating
      endothelial cells (CEC), circulating CEC precursors (CECP), VEGF and VEGF-2 , gene
      expression, proteomic profile, ERK phosphorylation, and FLT3 phosphorylation activity. Tumor
      tissue samples may also be analyzed for the presence of ras, raf, or FLT3.

      After completion of study treatment, patients are followed periodically.
    

Intervention name(s): Laboratory Biomarker Analysis; Pharmacological Study; Sorafenib Tosylate
Intervention type(s): Other; Other; Drug
Intervention description(s): Correlative studies; Correlative studies; Given orally
Other intervention name(s): BAY 43-9006 Tosylate; BAY 54-9085; Nexavar; sorafenib
Intervention MeSH terms: Sorafenib
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment