A Study of Romiplostim to Prevent Low Platelet Counts in Children and Young Adults Receiving Chemotherapy for Solid Tumors

Phase 2

Terminated

Conditions: Solid Carcinoma
Solid Tumor
Solid Tumor, Childhood

Interventions: Drug: Romiplostim

Registration Number: NCT04671901

Lead Sponsor: Memorial Sloan Kettering Cancer Center

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.

Detailed Description: Not available

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 2

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.

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Pediatric Participants	Romiplostim	Male and female patients aged 1-21 years with a primary solid tumor undergoing treatment with the pre-defined chemotherapy regimens of EFT, MAP or D9803.

Primary Outcome Measures

Name	Time	Method
Total Number of Platelet Transfusions During the Studied Portions of the EFT or D9803 Cycles	up to 6 months	The primary purpose of this study is to evaluate whether romiplostim administration can decrease the total number of platelet transfusions required during the treatment courses of EFT or D9803 when compared to the benchmark rate.

Secondary Outcome Measures

Name	Time	Method

Trial Locations

Locations (7): Memorial Sloan Kettering Cancer Center @ Suffolk - Commack (Limited Protocol Activities)
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Commack, New York, United States
Memorial Sloan Kettering Bergen (Limited Protocol Activities)
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Montvale, New Jersey, United States
Memorial Sloan Kettering Monmouth (Limited Protocol Activities)
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Middletown, New Jersey, United States
Memorial Sloan Kettering Nassau (Limited Protocol Activities)
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Uniondale, New York, United States
Memorial Sloan Kettering Basking Ridge (Limited Protocol Activities)
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Basking Ridge, New Jersey, United States
Memorial Sloan Kettering Cancer Center
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New York, New York, United States
Memorial Sloan Kettering Westchester (Limited Protocol Activities)
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Harrison, New York, United States