A Study Of Panobinostat In Children With Refractory Hematologic Malignancies

Phase 1

Completed

• Conditions: Myelogenous Leukemia, Acute, Childhood; Hodgkin's Disease; Non-Hodgkin's Lymphoma; Lymphoblastic Leukemia, Acute, Childhood
• Interventions: Drug: Panobinostat; Drug: Cytarabine

• Registration Number: NCT01321346
• Lead Sponsor: Therapeutic Advances in Childhood Leukemia Consortium

Brief Summary

This study is for patients with relapsed or refractory Acute Lymphoblastic Leukemia (ALL), Acute Myelogenous Leukemia (AML), Hodgkin's Disease (HD) or Non-Hodgkin's Lymphoma (NHL). Panobinostat is a new drug that is considered investigational because it has not been approved in the United States by the Food and Drug Administration (FDA), or in any other country. Panobinostat is a histone deacetylase inhibitor (HDACi) and interferes with gene expression found in cells causing them to stop growing or die. Panobinostat has been used in several hundred adults who had leukemia, HD, NHL and other solid tumors. Panobinostat has not been given to children.

This is a phase I study. In a phase I study, drugs are tested to the highest dose that can be safely given. Drugs are given at gradually increasing dosages until there are unacceptable side effects. The goal of the Phase I study is to find out the dose of panobinostat that can be safely given to children with relapsed ALL, AML, HD and NHL.

Detailed Description

Not available

Study Timeline

• Study Start: 2011-03
• Study First Submitted: 2011-03-21
• Study First Submitted QC: 2011-03-22
• Study First Posted: 2011-03-23
• Primary Completion: 2015-10
• Status Verified: 2015-11
• Last Update Submitted: 2015-11-20
• Last Update Posted: 2015-11-24

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 30

Inclusion Criteria

• Patients must be ≤ 21 years of age at the time of enrollment.

• Patients must have one of the following:

  1. Patient must have relapsed/refractory acute myelogenous leukemia (AML) with ≥ 5% blast in the bone marrow or biopsy confirmed chloroma. Patient may have CNS 1, 2 or 3 disease. Isolated CNS relapse is not eligible.
  2. Patient must have relapsed/refractory acute lymphoblastic leukemia (ALL) with ≥ 5 blasts in the bone marrow or biopsy confirmed extramedullary disease. Patient may have CNS 1, 2 or 3 disease. Isolated CNS relapse is not eligible.
  3. Patient must have relapsed or refractory non-Hodgkin's lymphoma (NHL) or Hodgkin's disease. Patients must have CNS 1 disease. Patient must have histologic verification of disease at original diagnosis. Patient must have measurable disease documented by clinical or radiographic criteria or bone marrow disease present at study entry.

• Karnofsky > 50% for patients > 16 years of age and Lansky > 50% for patients less than or equal to 16 years of age. (See Appendix I for Performance Scales).

• Patient must have a life expectancy of 8 weeks.

• PRIOR THERAPY Patients must have fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study.

  1. Patients with AML must have had at least 2 prior therapeutic attempts including frontline induction.

  2. Patients with ALL must have had at least 3 prior therapeutic attempts including frontline induction.

  3. Radiotherapy: At least 28 days must have elapsed since and radiation therapy.

  4. Hematopoietic Stem Cell Transplant:

     Patients who have had previous allogeneic HSCT must have grade I or less of Graft-versus-Host Disease (GVHD) and have not received immunosuppressive medication for at least 90 days.

  5. Hematopoietic grow factors: It must have been at least 7 days since the completion of therapy with GCSF or other growth factors at the time of enrollment. It must have been at least 14 days since the completion of therapy with pegfilgrastim (Neulasta®).

  6. Biologic/Immunologic (anti-neoplastic) therapy: It must be at least 28 days since the completion of therapy with a biologic/immunologic agent such as a monoclonal antibody prior to study enrollment and at least 28 days since non-study chemotherapy has been administered, excluding CNS directed therapy as described in Section 4.1.

  7. Prior HSCT for Hodgkin's Lymphoma: Patients with Hodgkin's lymphoma must have had prior attempt at autologous HSCT.

• Renal and Hepatic Function

  1. Patient's serum creatinine must be ≤ 1.5 x institutional upper limit of normal (ULN) according to age. If the serum creatinine is greater than 1.5 times normal, the patient must have a calculated creatinine clearance or radioisotope GRF ≥ 70mL/min/1.73m2.

     • Pediatric Population (age <18): Calculated creatinine clearance ≥ 90 ml/min/1.73m2 as calculated by the Schwartz formula for estimated glomerular filtration rate (GFR)
     • Adult Population (age >18): Serum creatinine <1.0 mg/dL; if serum creatinine >1.0 mg/dL, then the estimated glomerular filtration rate (GFR) must be >60 mL/min/1.73 m2

  2. Patient's ALT must be < 5 x institutional upper limit of norm ULN.

  3. Patient's total bilirubin must be ≤ 1.5 x ULN.

• Cardiac Function

  a. Patient must have a shortening fraction ≥ 29% or an ejection fraction ≥ 40% by ECHO/MUGA.

• Reproductive Function

  1. Female patients of childbearing potential must have a negative urine or serum pregnancy test confirmed prior to enrollment.
  2. Female patients with infants must agree not to breastfeed their infants while on this study.
  3. Male and female patients of child-bearing potential must agree to use an effective method of contraception approved by the investigator during the study.

Exclusion Criteria

• Patients will be excluded if they are unable to swallow capsules whole.

• Patients will be excluded if they have received previous therapy with HDAC, DAC, HSP90 inhibitors or valproic acid anticancer therapy. Valproic acid therapy is not allowed for any reason while on this study.

• AML patients who are candidates for allogeneic stem cell transplant are excluded.

• Patients will be excluded if they have a systemic fungal, bacterial, viral or other infection that is exhibiting ongoing signs/symptoms related to the infection without improvement despite appropriate antibiotics or other treatment.

• Gastrointestinal Function

  1. Impairment of GI function or GI disease that may significantly alter the absorption of panobinostat.
  2. Patients with diarrhea > CTCAE grade 2.

• Patients will be excluded if there is a plan to administer non-protocol chemotherapy, radiation therapy, or immunotherapy during the study period, excluding CNS directed therapy upfront for AML patients and continuing for CNS positive patients as described in Section 4.1. Cyto-reduction with hydroxyurea can be initiated and continued for up to 24 hours prior to the start or protocol therapy.

• Patients will be excluded if they have significant concurrent disease, illness, psychiatric disorder or social issue that would compromise patient safety or compliance, interfere with consent, study participation, follow up, or interpretation of study results.

• Patients with known positivity for human immunodeficiency virus (HIV) or hepatitis C; baseline testing for HIV and hepatitis C is not required.

• Cardiac Exclusion Criteria:

Patients will be excluded if these meet any of the following:

1. History or presence of sustained ventricular tachyarrhythmia. (Patients with a history of atrial arrhythmia are eligible but should be discussed with the study chair prior to enrollment).
2. Any history of ventricular fibrillation or torsade de pointes.
3. Bradycardia defined as HR< 50 bpm. Patients with pacemakers are eligible if HR ≥ 50 bpm.
4. Screening ECG with a QTc > 450 msec.
5. Patients using medications that have a relative risk of prolonging the QT interval or inducing torsade de pointes if treatment cannot be discontinued or switched to a different medication prior to starting study drug.
6. Right bundle branch block + left anterior hemiblock (bifascicular block).
7. Patients with myocardial infarction or unstable angina ≤ 6 months prior to starting study drug.
8. Other clinically significant heart disease (e.g., CHF NY Heart Association class III or IV, uncontrolled hypertension, history of labile hypertension, or history of poor compliance with an antihypertensive regimen).
9. Patients with leukemia must not be known to be refractory to red blood cell or platelet transfusions.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Lymphoma Patients	Panobinostat	Patients with NHL or HD will be treated in one arm of the study.
Leukemia Patients	Panobinostat	Patients with ALL and AML will be treated in one arm of the study.
Leukemia Patients	Cytarabine	Patients with ALL and AML will be treated in one arm of the study.

Primary Outcome Measures

Name	Time	Method
To find the highest dose of oral panobinostat that can be given to patients with relapsed AML, HD or NHL without causing severe side effects.	8 weeks
To learn what kind of side effects panobinostat can cause when taken by children with relapsed ALL, AML, HD or NHL.	8 weeks

Secondary Outcome Measures

Name	Time	Method
To test the amount of panobinostat in the patient's blood and spinal fluid after taking panobinostat.	3 years
To test samples of cancer cells to see if they have chemicals that affect the way panobinostat works.	3 years
To determine whether panobinostat is a beneficial treatment for ALL, AML, HD or NHL.	8 weeks

Trial Locations

Locations (20)

UCSF School of Medicine; 🇺🇸 San Francisco, California, United States

Childrens Hospital Los Angeles; 🇺🇸 Los Angeles, California, United States

University of Miami Cancer Center; 🇺🇸 Miami, Florida, United States

Children's Healthcare of Atlanta, Emory University; 🇺🇸 Atlanta, Georgia, United States

Lurie Children's Hospital; 🇺🇸 Chicago, Illinois, United States

Levine Children's Hospital at Carolinas Medical Center; 🇺🇸 Charlotte, North Carolina, United States

New York University Medical Center; 🇺🇸 New York, New York, United States

Rainbow Babies; 🇺🇸 Cleveland, Ohio, United States

Seattle Children's Hospital; 🇺🇸 Seattle, Washington, United States

St. Jude; 🇺🇸 Memphis, Tennessee, United States

Vanderbilt Children's Hospital; 🇺🇸 Nashville, Tennessee, United States

Medical College of Wisconsin; 🇺🇸 Milwaukee, Wisconsin, United States

Dana Farber; 🇺🇸 Boston, Massachusetts, United States

Oregon Health and Science University; 🇺🇸 Portland, Oregon, United States

C.S. Mott Children's Hospital; 🇺🇸 Ann Arbor, Michigan, United States

Primary Children's; 🇺🇸 Salt Lake City, Utah, United States

Children's National Medical Center; 🇺🇸 Washington, District of Columbia, United States

Children's Hospital New York-Presbyterian; 🇺🇸 New York, New York, United States

Childrens Hospital & Clinics of Minnesota; 🇺🇸 Minneapolis, Minnesota, United States

Nationwide Childrens Hospital; 🇺🇸 Columbus, Ohio, United States