Clinical trial NCT00072384: Systemic Chemotherapy and Subtenon Carboplatin, and Local Ophthalmic Therapy in Children With Intraocular Retinoblastoma
Official title: A Single Arm Trial of Systemic And Subtenon Chemotherapy For Groups C And D Intraocular Retinoblastoma
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Intraocular Retinoblastoma
Lead sponsor: Children's Oncology Group
Sponsor class: NETWORK
Collaborators: name: National Cancer Institute (NCI)
First posted: 2003-11-06
Enrollment: 30
Sex: ALL
Maximum age (years): 17
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: Phase III trial to determine the effectiveness of combining systemic chemotherapy and subtenon carboplatin with ophthalmic therapy in treating children who have intraocular retinoblastoma. Drugs used in chemotherapy, such as vincristine, carboplatin, and etoposide, work in different ways to stop tumor cells from dividing so they stop growing or die. It is not yet known whether systemic chemotherapy and subtenon (under the conjunctiva of the eye) carboplatin combined with ophthalmic therapy is effective in treating intraocular (within the eyeball) retinoblastoma.

Detailed description: PRIMARY OBJECTIVES:

I. Determine the event-free survival at 12 months of pediatric patients' eyes with group D intraocular retinoblastoma treated with systemic chemotherapy comprising vincristine, carboplatin, and etoposide, subtenon carboplatin, and local ophthalmic therapy. (Event defined for each eye individually as needed for nonprotocol therapy including nonprotocol chemotherapy, enucleation or any external-beam radiation)

SECONDARY OBJECTIVES:

I. Determine the event-free survival at 12 months of pediatric patients' eyes with group C retinoblastoma treated with systemic chemotherapy comprising carboplatin, etoposide, vincristine, subtenon carboplatin, and local ophthalmic therapy.

II. Determine the acute and long-term toxic effects of these regimens in these patients, including visual outcome and incidence of secondary malignancies.

III. Determine the patterns of failure in patients treated with these regimens, in terms of vitreous vs retinal vs both as sites of recurrence.

IV. Determine predictors of failure including findings at the on study examination under anesthesia and response status after six courses of chemotherapy.

V. Determine the percentage of group C and D eyes separately that can be preserved without enucleation after failing protocol therapy.

OUTLINE: This is a multicenter study.

Patients receive vincristine IV over 1 minute on day 1 and carboplatin IV over 1 hour and etoposide IV over 1 hour on days 1 and 2. Patients also receive filgrastim (G-CSF) subcutaneously daily beginning on day 3 and continuing until blood counts recover. Patients receive subtenon carboplatin to each group C or D eye on day 0 or 1 prior of courses 2-4 only. Treatment repeats every 28 days for 6 courses in the absence of occurrence of extraocular retinoblastoma or a second malignancy. Beginning with course 3 of systemic chemotherapy, patients undergo local ophthalmic therapy comprising local laser and/or cryotherapy on day 1.

Patients are followed with ophthalmology exams every 4-12 weeks until 3 years of age, every 6 months until 5 years of age, and then annually for up to 10 years.

Eligibility criteria: Inclusion Criteria:

* Diagnosis of bilateral retinoblastoma with at least 1 eye group C or D intraocular retinoblastoma by ophthalmologic examination, defined by the International Classification System for Intraocular Retinoblastoma as the following:

  * Group C: Discrete localized disease with minimal subretinal and/or vitreous seeding

    * Subretinal fluid, without prior or concurrent seeding, involving ≤ one quarter of the retina
    * Local fine vitreous seeding may be present close to discrete tumor
    * Local subretinal seeding \< 3 mm from tumor
  * Group D: Diffuse disease with significant vitreous and/or subretinal seeding

    * Tumor(s) may be massive or diffuse
    * Subretinal fluid, without prior or concurrent seeding, involving up to total retinal detachment
    * Diffuse or massive vitreous disease may include "greasy" seeds or avascular tumor masses
    * Diffuse subretinal seeding may include subretinal plaques or tumor nodules
* Prior enucleation of 1 eye allowed provided the remaining eye is group C or D
* No tumor present on histologic examination at the cut end of the optic nerve on any eye enucleated prior to study entry

  * Evidence of choroidal and/or optic nerve invasion past the lumina cribrosa is allowed
* No extraocular retinoblastoma clinically or by MRI of brain and orbits with and without gadolinium or CT scan with and without contrast of brain and orbits
* No evidence of systemic metastases by bone marrow, lumbar puncture, bone scan, and/or any other additional test
* Performance status - Karnofsky 50-100% (over 16 years of age)
* Performance status - Lansky 50-100% (16 and under)
* Bilirubin ≤ 1.5 times upper limit of normal (ULN) for age
* AST and ALT \< 2.5 times ULN for age
* Creatinine adjusted according to age as follows:

  * No greater than 0.4 mg/dL (≤ 5 months)
  * No greater than 0.5 mg/dL (6 months -11 months)
  * No greater than 0.6 mg/dL (1 year-23 months)
  * No greater than 0.8 mg/dL (2 years-5 years)
  * No greater than 1.0 mg/dL (6 years-9 years)
  * No greater than 1.2 mg/dL (10 years-12 years)
  * No greater than 1.4 mg/dL (13 years and over \[female\])
  * No greater than 1.5 mg/dL (13 years to 15 years \[male\])
  * No greater than 1.7 mg/dL (16 years and over \[male\])
* Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min/1.73m\^2
* Not pregnant or nursing
* Fertile patients must use effective contraception
* Negative pregnancy test in postmenarchal females
* No prior chemotherapy
* No other concurrent chemotherapy
* No prior radiotherapy
* No other concurrent radiotherapy

Primary outcomes:
measure: Group D Eyes - Treatment Failure Within One Year
timeFrame: One year
measure: Group C Eyes - Treatment Failure Within One Year
timeFrame: One year
Secondary outcomes:
measure: Event-free Survival (EFS)
timeFrame: One year after study enrollment
measure: Toxicity Associated With Chemotherapy
timeFrame: From date of enrollment until termination of protocol therapy assessed up to 72 weeks
measure: Patterns of Failure for Group C and Group D in Terms of Vitreous vs Patterns of Failure for Group C and Group D in Terms of Vitreous vs Retinal vs Both as Sites of Recurrence
timeFrame: From the date of enrollment assessed up to 36 months
measure: Patterns of Treatment Failure vs. no Treatment Failure for Group C Eyes and Group D Eyes According to Initial Sites of Involvement
timeFrame: From the date of enrollment assessed up to 12 months
Other outcomes:
Locations:
city: Arcadia
country: United States
facility: Children's Oncology Group
state: California
city: Downey
country: United States
facility: Southern California Permanente Medical Group
state: California
city: Los Angeles
country: United States
facility: Children's Hospital Los Angeles
state: California
city: New Haven
country: United States
facility: Yale University
state: Connecticut
city: Washington
country: United States
facility: Lombardi Comprehensive Cancer Center at Georgetown University
state: District of Columbia
city: Atlanta
country: United States
facility: Children's Healthcare of Atlanta - Egleston
state: Georgia
city: Chicago
country: United States
facility: University of Illinois
state: Illinois
city: Durham
country: United States
facility: Duke University Medical Center
state: North Carolina
city: Cincinnati
country: United States
facility: Cincinnati Children's Hospital Medical Center
state: Ohio
city: Houston
country: United States
facility: Baylor College of Medicine
state: Texas
city: Houston
country: United States
facility: M D Anderson Cancer Center
state: Texas
Study officials:
affiliation: Children's Oncology Group
name: Rima Jubran
role: PRINCIPAL_INVESTIGATOR
References: