Clinical trial NCT04671901: A Study of Romiplostim to Prevent Low Platelet Counts in Children and Young Adults Receiving Chemotherapy for Solid Tumors
Official title: A Single Arm Open-Label Pilot Study of Prophylactic Romiplostim Use Compared to Benchmark Rate in the Prevention of Chemotherapy Induced Thrombocytopenia in Pediatric Solid Tumors Patients Undergoing Myelosuppressive Chemotherapy
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: PHASE2
Conditions: Solid Tumor
Solid Tumor, Childhood
Solid Carcinoma
Keywords: romiplostim
primary solid tumor
Solid tumor
Solid tumor, childhood
Childhood solid tumor
Pediatric Solid Tumors
20-467
Memorial Sloan Kettering Cancer Center
Lead sponsor: Memorial Sloan Kettering Cancer Center
Sponsor class: OTHER
First posted: 2020-12-17
Enrollment: 2
Sex: ALL
Minimum age (years): 1
Maximum age (years): 21
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to find out whether romiplostim can help prevent low platelet counts caused by N8 or EFT chemotherapy, reduce the number of platelet transfusions required during chemotherapy, and prevent treatment delays due to low platelet counts.


Eligibility criteria: Inclusion Criteria:

* Documented diagnosis of a primary solid tumor. Patients must have histological verification of malignancy at MSKCC.
* Male and female patients aged 1-21 years with a primary solid tumor undergoing treatment with the pre-defined chemotherapy regimens of EFT, MAP, D9803. Prior to enrollment patient could have been undergoing induction therapy with a similarly myelosuppressive regimen as long as they will be continuing with EFT, MAP, D9803 at the time of study enrollment.
* Patients undergoing treatment with MAP chemotherapy w ho have had ≥ 1 platelet transfusion during induction stage of treatment.
* Total Bilirubin (sum of conjugated + unconjugated) ≤ 3 times institutional upper limit of normal (ULN) for age and ALT/AST ≤ 3 times institutional ULN for age.
* Normal cardiac function:

  * Shortening fraction greater than or equal to 28% by echocardiogram OR Left ventricular ejection fraction (LVEF) greater than or equal to 50% on technetium- 99m pertechnetate radionuclide cineangiography (MUGA) or echocardiogram.
  * Screening ECG with corrected QT (QTc) interval of \< 470 msec.
  * Timing of cardiac assessment: We will utilize the most recent EKG/ECHO when assessing cardiac function. See section 9.0 for additional details.
* Adequate renal function, defined as an estimated Creatinine Clearance or GFR \>40ml/min or an normal creatine for age (see below)

Serum Creatinine by age:

Age (years) \<6: Maximum Serum Creatinine (mg/dL), Male 0.8, Female 0.8 Age (years) 6 to \<10: Maximum Serum Creatinine (mg/dL), Male 1, Female 1 Age (years) 10 to \<13: Maximum Serum Creatinine (mg/dL), Male 1.2, Female 1.2 Age (years) 13 to \<16: Maximum Serum Creatinine (mg/dL), Male 1.5, Female 1.4 Age (years) \>16: Maximum Serum Creatinine (mg/dL), Male 1.7, Female 1.4

These threshold creatine values were derived from the Scwartz formula estimating GFR, utilizing child length and statured published by the CDC.

Exclusion Criteria:

* Patients with history of hematologic malignancies or allogenic/autogenic stem cell transplant.
* Patients with a currently known predisposition to a myeloid stem cell disorder, myeloid leukemia, and/or bone marrow failure syndrome including, but not limited to:

  * Aplastic anemia
  * Ataxia telangiectasia
  * Bloom syndrome
  * Congenital amegakaryocytic thrombocytopenia
  * Cyclic neutropenia
  * Diamond Blackfan anemia
  * Dyskeratosis congenita
  * Familial AML/MDS syndromes (including ANKRD26, CEBPA, DDX41, ETV6, GATA2, RUNX1, SRP72)
  * Fanconi anemia
  * Kostmann disease
  * Li-Fraumeni syndrome
  * Neurofibromatosis
  * Nijmegen breakage syndrome
  * Noonan syndrome
  * Paroxysmal nocturnal hemoglobinuria
  * Pearson syndrome
  * Poland syndrome
  * Rothmund-Thomson syndrome
  * Severe congenital neutropenia
  * Thrombocytopenia absent radii syndrome
  * Trisomy 8
  * Trisomy 21
  * WHIM syndrome
  * Wiskott Aldrich syndrome
  * Xeroderma pigmentosa
* Secondary malignancy in the past 5 years.
* Patients who have previously undergone up-front chemotherapy and have relapsed or progressed through therapy.
* Patients who have received 4 or more cycles of induction chemotherapy for their current malignancy prior to time of enrollment.
* Previous use of romiplostim, eltrombopag, recombinant human TPO, or any other TPO receptor agonist, or any investigational platelet producing agent.
* Patients receiving other investigational agents are not eligible for study entry.

History of uncontrolled arrhythmias, clinically significant electrocardiogram (ECG) abnormalities, active heart failure or pericardial disease.

* Patients with current or prior venous thrombotic event or arterial thrombotic event at time of enrollment will be ineligible for this study.
* Pregnant women/lactating mothers.
* Patients unwilling to use effective contraception method, which includes abstinence.
* Patients with an inability to return for follow-up visits or obtain follow-up studies required to assess toxicity to therapy.

Primary outcomes:
measure: Total Number of Platelet Transfusions During the Studied Portions of the EFT or D9803 Cycles
timeFrame: up to 6 months
Secondary outcomes:
Other outcomes:
Locations:
city: Basking Ridge
country: United States
facility: Memorial Sloan Kettering Basking Ridge (Limited Protocol Activities)
state: New Jersey
city: Middletown
country: United States
facility: Memorial Sloan Kettering Monmouth (Limited Protocol Activities)
state: New Jersey
city: Montvale
country: United States
facility: Memorial Sloan Kettering Bergen (Limited Protocol Activities)
state: New Jersey
city: Commack
country: United States
facility: Memorial Sloan Kettering Cancer Center @ Suffolk - Commack (Limited Protocol Activities)
state: New York
city: Harrison
country: United States
facility: Memorial Sloan Kettering Westchester (Limited Protocol Activities)
state: New York
city: New York
country: United States
facility: Memorial Sloan Kettering Cancer Center
state: New York
city: Uniondale
country: United States
facility: Memorial Sloan Kettering Nassau (Limited Protocol Activities)
state: New York
Study officials:
affiliation: Memorial Sloan Kettering Cancer Center
name: Michael Ortiz, MD
role: PRINCIPAL_INVESTIGATOR
References: