Study of Treatment for Patients With Cancer of the Eye -Retinoblastoma
Condition: Retinoblastoma; Retinal Neoplasm
MeSH terms: Retinoblastoma; Retinal Neoplasms
Intervention: Enucleation; Vincristine, Carboplatin; Focal Therapies; External Beam Radiation; Vincristine and Topotecan; Vincristine + Carboplatin + Etoposide; vincristine, cyclophosphamide, and doxorubicin; Vincristine, Carboplatin and Etoposide; Periocular carboplatin; G-CSF
Intervention description: Enucleation (possibly associated with all treatment strata/arms. For Stratum A, patients with bilateral disease will have surgery to remove the advanced eye before chemotherapy, or patients that have disease progression after chemotherapy may have surgery to remove the affected eye.
For Stratum B, Surgical removal of the affected eye may be required in cases of disease progression For Stratum C, first intervention is removal of the affected eye.; (Stratum A subjects receive 8 courses every 3-4 weeks, Stratum B subjects receive this combination for Courses 3, 4, 6, 7, 9, and 10 after the window, if they respond to window therapy) Vincristine dosage< 12 months of age: 0.05 mg/kg i.v. day 1, ≥ 12 months of age: 1.5 mg/m2 i.v. day 1 (max. dose 2 mg) Carboplatin will be administered i.v. to achieve an AUC of 6.5 mg/ml/min, day 1.; Method will be at the discretion of the treating team, used after second course of chemotherapy. Cryotherapy- freezing of affected tissue, Laser photocoagulation- using lasers to destroy affected tissue, Thermotherapy and thermochemotherapy- using heat or heat/chemotherapy combination to destroy diseased tissue, and Episcleral plaque brachytherapy- radiation insertions in the diseased area to destroy affected tissue.; 44-46 Gy administered using standard practices , limiting dose to normal tissues to subjects with recurrent or progressive disease not considered controllable with focal treatments, Stratum B subjects with suspected active disease after completing therapy, or patients considered to have high-risk disease.; (Stratum B subjects receive two up-front courses of vincristine and topotecan, given in 21-day intervals, then those who respond receive 3 additional courses (courses 5, 8, and 11) after the window. Dosages are the same for both window and subsequent courses: Vincristine: < 12 months of age: 0.05 mg/kg i.v. day 1, ≥ 12 months of age: 1.5 mg/m2 i.v. day 1 (max. dose 2 mg) Topotecan: TSE of 140 ± 20 ng/ml*hr, daily for 5 consecutive days, infused over 30 minutes.; Stratum B patients that do not respond to window receive 6 courses of this combination.
Vincristine: < 12 months of age: 0.05 mg/kg i.v. day 1, ≥ 12 months of age: 1.5 mg/m2 i.v. day 1 (max. dose 2 mg) Carboplatin will be administered i.v. to achieve an AUC of 6.5 mg/ml/min, day 1 Etoposide, < 12 months of age: 3.3 mg/kg/d i.v. days 1 - 3, ≥ 12 months of age: 100 mg/m2/d i.v. days 1 - 3; (High risk Stratum C patients in courses 2, 4, and 6 after enucleation, intermediate risk stratum C patients for four consecutive courses after enucleation) Vincristine: < 12 months of age: 0.05 mg/kg i.v. day 1, ≥ 12 months of age: 1.5 mg/m2 i.v. day 1 (max. dose 2 mg) Cyclophosphamide: < 12 months of age: 40 mg/kg i.v. day 1, ≥ 12 months of age: 1,200 mg/m2 i.v. day 1, MESNA 200 mg/m2 at 0, 3, 6, and 9 hours Doxorubicin < 12 months of age: 1.5 mg/kg i.v. day 1, ≥ 12 months of age: 45 mg/m2 i.v. day 1; High risk Stratum C patients in courses 1, 3, and 5 after enucleation: Vincristine: < 12 months of age: 0.05 mg/kg i.v. day 1, ≥ 12 months of age: 1.5 mg/m2 i.v. day 1 (max. dose 2 mg) Carboplatin will be administered i.v. to achieve an AUC of 6.5 mg/ml/min, day 1 Etoposide, < 12 months of age: 3.3 mg/kg/d i.v. days 1 - 3, ≥ 12 months of age: 100 mg/m2/d i.v. days 1 - 3; Periocular (subtenon) carboplatin 20 mg, one injection, in courses 5, 8, and 11 in patients responding to the VT window, and in courses 1, 3, and 6 of VCE in patients not responding to the VT window, when active vitreous disease is present. Carboplatin 20 mg will be diluted in 2 mL of NS or D5W and given by subtenon administration while the patient is under general anesthesia.; G-CSF (5 mcg/kg/day), will be administered starting 24-36 hours after the completion of each course of chemotherapy, for 7 to 10 days, until ANC is > 2,000/mL in one occasion after the expected nadir.
Intervention MeSH terms: Cyclophosphamide; Carboplatin; Doxorubicin; Etoposide; Etoposide phosphate; Vincristine; Topotecan
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 107.0
Sex: All
Healthy volunteers: No
Keywords: Cancer of the Eye; Eye Enucleation

Summary:

      Retinoblastoma is a childhood cancer which affects the retina of the eye. The retina is the
      light sensitive layer of tissue that lines the back of the eyeball; sends visual messages
      through the optic nerve to the brain. When only one eye is affected, this is known as
      unilateral retinoblastoma and when both eyes are affected, it is called bilateral
      retinoblastoma. Treatment for retinoblastoma is individualized for each patient and is based
      on the form and the stage of the disease (inside the eye or has moved outside). The main goal
      is always to cure the cancer, and save the life of the child. Treatments are also designed
      with the hope of saving the vision, while completely destroying the tumor. Therapies may
      involve surgery, chemotherapy, radiation, and other treatments called focal treatments. Focal
      treatments may be laser therapy, freezing, or heat treatments meant to shrink and kill the
      tumor.

      In this study, researchers want to investigate how different participants respond to
      different therapies that are individualized specifically for them. Participants will be
      divided into three main groups, depending on whether the disease is unilateral or bilateral,
      and the stage of the disease. One of the main objectives of the study is to investigate how
      advanced tumors in children with bilateral disease respond to a new combination of
      chemotherapy with topotecan and vincristine, with G-CSF support. In order to improve results,
      some children with very advanced disease may receive carboplatin chemotherapy given around
      the eye at the same time that they receive topotecan by vein. Also, because children with
      retinoblastoma are diagnosed so early in life and the vision may be significantly impaired,
      this study will investigate how children develop and how the brain adjusts and compensates
      for the visual deficits. Finally, this study also investigates the biology of retinoblastoma,
      in order to understand better how this cancer develops.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Must have newly diagnosed intraocular retinoblastoma, previously untreated. Patients
             previously diagnosed with unilateral retinoblastoma treated surgically (or with focal
             therapies), who develop asynchronous involvement of the contralateral eye, will be
             eligible for study.

          -  Must have a life expectancy of at least 8 weeks.

          -  Must have Performance Status (ECOG) of 0-2.

          -  Patients must have an adequate liver function, as defined by bilirubin less than or
             equal to 3 x normal, and SGOT and SGPT less than or equal to 3x normal.

          -  Patients must have adequate renal function as defined by serum creatinine less than or
             equal to 3x normal for age.

          -  Legal guardians must sign an informed consent indicating that they are aware of this
             study, its possible benefits, and toxic side effects. Legal guardians will be given a
             copy of the consent form.

        Exclusion Criteria:

          -  Previously treated patients

          -  Presence of metastatic disease or orbital involvement

          -  Patients must not have an invasive infection at time of protocol entry.