N2007-01: Ultratrace™ Iobenguane I 131 in Patients With Relapsed/Refractory High-Risk Neuroblastoma
Condition: Neuroblastoma
MeSH terms: Neuroblastoma
Study type: Interventional
Phase: Phase 2

Summary: 
      RATIONALE: Radioactive drugs, such as iodine I 131 metaiodobenzylguanidine (MIBG), may carry
      radiation directly to tumor cells and not harm normal cells. A bone marrow or peripheral stem
      cell transplant using stem cells from the patient may be able to replace blood-forming cells
      that were destroyed by I 131 MIBG.

      PURPOSE: This phase II trial is studying the side effects and best dose of iodine I 131 MIBG
      followed by a stem cell transplant in treating young patients with relapsed or refractory
      high-risk neuroblastoma.
    

Detailed description: 
      OBJECTIVES:

      Primary

        -  To establish the maximum tolerated dose of iodine I 131 metaiodobenzylguanidine
           (^131I-MIBG) in patients with relapsed/refractory high-risk neuroblastoma.

      Secondary

        -  To describe toxicity following treatment with ^131I-MIBG in patients with
           relapsed/refractory high-risk neuroblastoma.

        -  To estimate radiation absorbed doses to measurable lesions and to a standard set of
           normal organs following a 0.1 mCi/kg [3.7 MBq/kg] (minimum dose of 1.0 mCi [37 MBq] but
           not to exceed 5.0 mCi [185 MBq]) intravenous administration of ^131I-MIBG in patients
           with relapsed/refractory high-risk neuroblastoma.

        -  To describe, within the confines of a phase IIa trial, objective tumor response
           following treatment with ^131I-MIBG in patients with relapsed/refractory high-risk
           neuroblastoma.

        -  To explore dose-response following treatment with ^131I-MIBG in patients with
           relapsed/refractory high-risk neuroblastoma.

        -  To explore quality of life assessment following treatment with ^131I-MIBG in patients
           with relapsed/refractory high-risk neuroblastoma.

      OUTLINE:

        -  Dosimetry: Patients receive a dosimetric dose of iodine I 131 metaiodobenzylguanidine
           (^131I-MIBG) IV over 1-3 minutes. Patients then undergo 2 or 3 MIBG scans within 5 days
           of the dosimetry dose to assess biodistribution and tumor uptake. Patients with normal
           tumor uptake and biodistribution proceed to treatment.

        -  Treatment: Within 1-4 weeks of the dosimetric dose, patients with normal tumor uptake
           and biodistribution receive a therapeutic dose of ^131I-MIBG IV over 1 hour on day 0 and
           undergo MIBG scan on day 7. Patients then proceed to autologous stem cell infusion.

        -  Autologous stem cell infusion: Patients receive an infusion of autologous stem cells
           from peripheral blood or bone marrow on day 14. Patients with an ANC of < 500/µl at any
           point after autologous stem cell infusion receive filgrastim (G-CSF) IV or
           subcutaneously once daily until ANC is > 2,000/µl.

      Patients complete a quality of life questionnaire at baseline and then at day 60.

      After completion of study treatment, patients are followed at day 60 and periodically
      thereafter.
    

Intervention name(s): UltratraceTM Iobenguane I 131 Imaging; UltratraceTM Iobenguane I 131 Therapy
Intervention type(s): Drug; Drug
Intervention description(s): 0.1 mCi/kg [3.7 MBq/kg] (minimum dose 1mCi [37MBq] but not to exceed 5 mCi [185 MBq]) of UltratraceTM Iobenguane I 131 given 7 -28 days before therapeutic dose administration on day 0. Thyroid protection will be administered per institutional protocol for I-131-MIBG however, thyroid blocking must be started prior to the Ultratrace imaging dose. Anterior and posterior whole body images will be taken to assess organ distribution, tumor uptake and dosimetry calculations.; Therapeutic dose will be given on Day 0 if dosimetry scans showed that the prescribed or adjusted dose will not exceed > 23 Gy to the kidneys, > 30 Gy to the liver, or > 15 Gy to the lungs. and tumor uptake confirmed with UltratraceTM imaging dose. Only one treatment course of therapeutic UltratraceTM will be given in this study.
Other intervention name(s): Azedra; Azedra
Intervention MeSH terms: 3-Iodobenzylguanidine
Intervention model: Single Group Assignment
Intervention model description: Ultratrace™ Iobenguane I 131
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: recurrent neuroblastoma