Vinorelbine for Children With Progressive or Recurrent Low-grade Gliomas

Phase 2

Completed

Brief Summary: The purpose of this study is to investigate whether weekly Vinorelbine treatment can shrink or slow the growth of pediatric low-grade gliomas that have either returned or are continuing to grow.

Vinorelbine is a semi-synthetic vinca alkaloid that has recently generated interest in patients with pediatric low-grade glioma. It has been specifically synthesized to broaden its therapeutic spectrum and decrease the neurotoxicity associated with related agents.

Detailed Description: Different treatments exist for children with progressive or recurrent low-grade glioma. Each has variable efficacy at slowing or reversing growth, and exploration continues into finding better-tolerated, more effective treatments.

Vinorelbine has recently generated interest in stabilizing some pediatric low-grade gliomas. It has been fairly well tolerated in both adult and pediatric studies that have examined its use in other tumors.

Objective: To test the efficacy of Vinorelbine in children with pediatric low-grade glioma that has returned or continues to grow.

In this trial, Vinorelbine will be given intravenously once a week for 6 weeks followed by a 2 week rest (6 of every 8 weeks) for one year. The patients will then be followed for 60 months. Progression free survival is the primary outcome and defined as the none of the following: greater a 20% increase in the sun of the longest diameter of the target lesion, or a measurable increase in a non-target lesion, or the appearance of new lesions.

Recruitment & Eligibility

Inclusion Criteria

Age: < 18 years
Tumor: Progressive or recurrent low grade glioma, WHO grade 1 or 2 who have failed at least one form of 'conventional' non-surgical therapy
Histologic confirmation is required with the exception of optic pathway and brain stem gliomas. Patients are not required to have a re-operation at time of recurrence.
Patients with disseminated disease are eligible.
Children with neuro-fibromatosis and optic pathway or brainstem tumors are eligible but must have definitive radiologic or clinical evidence of progression
Patients must have evidence of measureable disease
Performance status: Karnofsky or Lansky performance status of >50%
Organ Function:
Adequate bone marrow function (ANC>1000/mm3, platelet count of >75,000/mm3, and hemoglobin > 8gm/dL) prior to starting therapy. Hemoglobin may be supported by transfusion
Adequate liver function (SGPT/ALT<2.5 times ULN and bilirubin < 1.5 times ULN) prior to starting therapy
Prior therapy:
May have had treatment including surgery, chemotherapy, or radiotherapy for any number of relapses prior to enrollment
Patients must have received their last fraction of radiotherapy >12 weeks prior to starting therapy
Previous Vincristine or Vinblastine exposure is allowable.

Exclusion Criteria

No other significant medical illness that in the investigators' opinion cannot be adequately controlled with appropriate therapy or would compromise the patient's ability to tolerate this therapy
Any other cancer (except non-melanoma skin cancer), unless in complete remission and off of all therapy for that disease for a minimum of 3 years.
Patients of childbearing potential must not be pregnant or breast-feeding (vinorelbine is a pregnancy category D, no data on excretion in breastmilk)
Patients of childbearing or fathering potential must practice adequate contraception

Arm && Interventions

Group	Intervention	Description
Vinorelbine	Vinorelbine	IV Vinorelbine (6mg/m2) provided once a week for 6 weeks followed by a 2 week rest (6 of every 8 weeks) for one year. Progression free survival will be monitored for 60 months.

Primary Outcome Measures

Name	Time	Method
Progression-free Survival	Assessed throughout the study from the first dose of the study drug to the date of progressive disease, death, or 60m.	IV Vinorelbine (6mg/m2) provided once a week for 6 weeks followed by a 2 week rest (6 of every 8 weeks) for one year. Progression free survival will be monitored for 60 months.

Secondary Outcome Measures

Name	Time	Method

Locations (2): Children's National Medical Center
🇺🇸
Washington, District of Columbia, United States
Mayo Clinic
🇺🇸
Rochester, Minnesota, United States