Alisertib in Treating Young Patients With Recurrent or Refractory Solid Tumors or Leukemia
Condition: Hepatoblastoma; Previously Treated Childhood Rhabdomyosarcoma; Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Recurrent Childhood Kidney Neoplasm; Recurrent Childhood Malignant Germ Cell Tumor; Recurrent Childhood Rhabdomyosarcoma; Recurrent Childhood Soft Tissue Sarcoma; Recurrent Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor; Recurrent Neuroblastoma; Recurrent Osteosarcoma
MeSH terms: Neoplasms; Leukemia; Sarcoma; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Neuroblastoma; Osteosarcoma; Rhabdomyosarcoma; Sarcoma, Ewing; Neuroectodermal Tumors; Neuroectodermal Tumors, Primitive; Rhabdomyosarcoma, Embryonal; Neuroectodermal Tumors, Primitive, Peripheral; Hepatoblastoma; Kidney Neoplasms; Recurrence
Intervention: Alisertib; Laboratory Biomarker Analysis; Pharmacological Study
Intervention description: Given orally; Correlative studies; Correlative studies
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 118.0
Sex: All
Minimum age: 1 Year
Maximum age: 21 Years
Healthy volunteers: No

Summary:

      This phase II trial is studying the side effects of and how well alisertib works in treating
      young patients with relapsed or refractory solid tumors or leukemia. Alisertib may stop the
      growth of cancer cells by blocking some of the enzymes needed for cell growth.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients must have had histologic verification of malignancy at original diagnosis or
             at relapse, to include any of the following malignancies (no other histology is
             eligible):

               -  Neuroblastoma- measurable

               -  Neuroblastoma- MIBG evaluable

               -  Rhabdomyosarcoma

               -  Osteosarcoma

               -  Ewing sarcoma/Peripheral PNET

               -  Non-RMS soft tissue sarcoma

               -  Hepatoblastoma

               -  Malignant germ cell tumor

               -  Wilms tumor

               -  Acute lymphoblastic leukemia

               -  Acute myelogenous leukemia

               -  Rhabdoid malignancy

          -  Disease status for solid tumor patients:

               -  Patients must have radiographically measurable disease (with the exception of
                  neuroblastoma)

               -  Measurable disease is defined as the presence of at least one lesion on magnetic
                  resonance imaging (MRI) or computed tomography (CT) scan that can be accurately
                  measured with the longest diameter a minimum of 20 mm in at least one dimension;
                  for spiral CT, measurable disease is defined as a minimum diameter of 10 mm in at
                  least one dimension

               -  Note: The following do not qualify as measurable disease:

                    -  Malignant fluid collections (e.g., ascites, pleural effusions)

                    -  Bone marrow infiltration

                    -  Lesions detected by nuclear medicine studies (e.g., bone, gallium or
                       positron emission tomography [PET] scans)

                    -  Elevated tumor markers in plasma or cerebrospinal fluid (CSF)

                    -  Previously irradiated lesions that have not demonstrated clear progression
                       post radiation

               -  Patients with neuroblastoma who do not have measurable disease but have MIBG+
                  evaluable disease are eligible

          -  Disease status for leukemia patients:

               -  Patients with leukemia must be recurrent or refractory to at least two prior
                  induction or treatment regimens, in addition to the following criteria:

               -  Acute lymphoid leukemia:

                    -  25% blasts in the bone marrow (M3 bone marrow), excluding patients with
                       known central nervous system (CNS) disease

               -  Acute myeloid leukemia according to FAB classification

                    -  ≥ 5 % blasts in the bone marrow (M2/M3 bone marrow); excluding patients with
                       known CNS disease

          -  Rhabdoid tumors:

               -  To be eligible for enrollment in the rhabdoid tumors stratum, the patient must
                  have a solid tumor where the institutional pathological evaluation of the tumor
                  at initial diagnosis or relapse has confirmed:

                    -  Morphology and immunophenotypic panel consistent with rhabdoid tumor
                       (required)

                    -  Loss of SWI/SNF related, matrix associated, actin dependent regulator of
                       chromatin, subfamily b, member 1 (INI1) confirmed by immunohistochemistry,
                       or

                    -  Molecular confirmation of tumor-specific bi-allelic INI1 loss/mutation if
                       INI1 immunohistochemistry is not available; note that molecular confirmation
                       of tumor-specific bi-allelic INI1 loss/mutation is encouraged in cases where
                       INI1 immunohistochemistry is equivocal

          -  Patients must have a Lansky or Karnofsky performance status score of ≥ 50,
             corresponding to Eastern Cooperative Oncology Group (ECOG) categories 0, 1 or 2; use
             Karnofsky for patients > 16 years of age and Lansky for patients ≤ 16 years of age;
             Note: Patients who are unable to walk because of paralysis, but who are up in a
             wheelchair, will be considered ambulatory for the purpose of assessing the performance
             score

          -  Patients must have fully recovered from the acute toxic effects of all prior
             chemotherapy, immunotherapy, or radiotherapy prior to study enrollment

          -  Myelosuppressive chemotherapy:

               -  Solid tumors:

                    -  Patients with solid tumors must not have received myelosuppressive
                       chemotherapy within 3 weeks of enrollment onto this study (6 weeks if prior
                       nitrosourea)

               -  Leukemia:

                    -  Patients with leukemia who relapse while receiving standard maintenance
                       therapy will not be required to have a waiting period before enrollment onto
                       this study

                    -  Patients who relapse while they are not receiving standard maintenance
                       therapy must have completely recovered from all acute toxic effects of
                       chemotherapy, immunotherapy or radiotherapy prior to study enrollment; at
                       least 14 days must have elapsed since the completion of cytotoxic therapy,
                       with the exception of hydroxyurea

                    -  Note: cytoreduction with hydroxyurea can be initiated and continued for up
                       to 24 hours prior to the start of MLN8237

          -  At least 7 days must have elapsed since the completion of therapy with a growth
             factor; at least 14 days must have elapsed after receiving pegfilgrastim

          -  At least 7 days must have elapsed since completion of therapy with a biologic agent;
             for agents that have known adverse events occurring beyond 7 days after
             administration, this period prior to enrollment must be extended beyond the time
             during which adverse events are known to occur

          -  At least 3 half-lives must have elapsed since prior therapy that included a monoclonal
             antibody

          -  ≥ 2 weeks must have elapsed since local palliative radiation therapy (XRT) (small
             port); ≥ 6 weeks must have elapsed since treatment with therapeutic doses of MIBG; ≥ 6
             months must have elapsed if prior craniospinal XRT was received, if ≥ 50% of the
             pelvis was irradiated, or if total body irradiation (TBI) was received; ≥ 6 weeks must
             have elapsed if other substantial bone marrow irradiation was given

          -  No evidence of active graft vs. host disease and ≥ 3 months must have elapsed since
             transplant

          -  For patients with solid tumors without bone marrow involvement:

               -  Peripheral absolute neutrophil count (ANC) >= 1000/mm^3

               -  Platelet count >= 100,000/mm^3 (transfusion independent, defined as not receiving
                  platelet transfusions within a 7 day period prior to enrollment)

               -  Hemoglobin > 8.0 g/dL (may receive red blood cell [RBC] transfusions)

          -  For patients with solid tumors and known bone marrow metastatic disease:

               -  Peripheral absolute neutrophil count (ANC) ≥ 750/mm^3

               -  Platelet count ≥ 50,000/mm^3

               -  Hemoglobin ≥ 8.0 g/dL

               -  Transfusions are permitted to meet both the platelet and hemoglobin criteria;
                  patients must not be known to be refractory to red blood cell or platelet
                  transfusions

          -  Patients with leukemia must not be known to be refractory to red blood cell or
             platelet transfusions

          -  Creatinine clearance or radioisotope glomerular filtration rate (GFR) 70 mL/min/1.73
             m^2 or a serum creatinine based on age/gender as follows:

               -  1 to < 2 years: 0.6

               -  2 to < 6 years: 0.8

               -  6 to < 10 years: 1

               -  10 to < 13 years: 1.2

               -  13 to < 16 years: 1.5 (male), 1.4 (female)

               -  >= 16 years: 1.7 (male), 1.4 (female)

          -  Total bilirubin =< 1.5 x upper limit of normal (ULN) for age

          -  Serum glutamic pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) ≤ 5.0 x
             ULN for age (≤ 225 U/L); for the purpose of this study, the ULN for SGPT is 45 U/L

          -  Serum albumin ≥ 2 g/dL

          -  All patients and/or their parents or legal guardians must sign a written informed
             consent

        Exclusion Criteria:

          -  Patients who are pregnant or breast-feeding are not eligible for this study; negative
             pregnancy tests must be obtained in girls who are post-menarchal; males or females of
             reproductive potential may not participate unless they have agreed to use an effective
             contraceptive method for the duration of study therapy; breastfeeding women are
             excluded

          -  Growth factors that support platelet or white cell number or function must not have
             been administered within the 7 days prior to enrollment (14 days if pegfilgrastim)

          -  Patients requiring corticosteroids who have not been on a stable or decreasing dose of
             corticosteroid for the 7 days prior to enrollment are not eligible

          -  Patients who are currently receiving another investigational drug are not eligible

          -  Patients who are currently receiving other anti-cancer agents are not eligible

          -  Use of daily benzodiazepine therapy excludes a patient from being eligible because of
             the potential benzodiazepine-like effects of MLN8237

          -  Patients who are currently receiving digoxin, cyclosporine, tacrolimus, or sirolimus
             are not eligible

          -  Patients who are unable to swallow tablets are not eligible

          -  Patients who have an uncontrolled infection are not eligible

          -  Leukemia patients with CNS disease are not eligible

          -  Patients who in the opinion of the investigator may not be able to comply with the
             safety monitoring requirements of the study are not eligible