A trial of BEvACizumab added to temozolomide +/- irinOtecan for children with refractory/relapsed Neuroblastoma

• Register: ISRCTN
• Last refreshed on: 18 March 2024
• Main ID: ISRCTN40708286
• Date of registration: 24/04/2013
• Prospective Registration: No
• Primary sponsor: University of Birmingham
• Public title: A trial of BEvACizumab added to temozolomide +/- irinOtecan for children with refractory/relapsed Neuroblastoma
• Scientific title: A randomised phase IIb trial of BEvACizumab added to temozolomide +/- irinOtecan for children with refractory/relapsed Neuroblastoma
• Date of first enrolment: 01/04/2013
• Target sample size: 224
• Recruitment status: Ongoing
• URL: https://www.isrctn.com/ISRCTN40708286
• Study type: Interventional
• Study design: Interventional phase II randomised open label international multicentre 2x2 factorial trial (Treatment)
• Phase: Phase II

Countries of recruitment

Austria, Belgium, Denmark, England, France, Germany, Ireland, Italy, Netherlands, Spain, Switzerland, United Kingdom

Contacts

• Name: Lucas Moreno

Key inclusion & exclusion criteria

Inclusion criteria: Disease specific
1. Histologically proven neuroblastoma as per International Neuroblastoma Staging System (INSS) [1] definition
2. Relapsed or refractory neuroblastoma
2.1. Relapsed: any relapsed or progressed high-risk neuroblastoma
2.2. Refractory high risk disease: Lack of adequate response to frontline therapy that precludes the patient from proceeding to consolidation therapies (e.g myeloablative chemotherapy)
3. Measurable disease by cross sectional imaging (RECIST) or evaluable disease (uptake on MIBG scan with or without bone marrow histology). Patients with only bone marrow detectable disease (bone marrow aspirate or trephine) are NOT eligible for the study

General
1. Age =1 to =21 years
2. Informed consent from patient, parent or guardian

Performance and organ function
1. Performance Status:
1.1. Lansky = 50%, Karnofsky = 50% or ECOG =3
(Patients who are unable to walk because of paralysis, but who are able to sit upright unassisted in a wheelchair, will be considered ambulatory for the purpose of assessing performance score)
2. Life expectancy of =12 weeks
3. Bone marrow function (within 72 hours of eligibility assessment):
No bone marrow disease:
1. Platelets = 75 x 109/L (unsupported for 72 hours)
2. ANC = 0.75 x 109/L (no G-CSF support for 72 hours)
3. Haemoglobin > 7.5 g/dL (transfusions allowed)
Bone marrow disease:
1. Platelets = 50 x109/L (unsupported for 72 hours)
2. ANC =0.5 x 109/L (no G-CSF for 72 hours)
3. Haemoglobin > 7.5 g/dL (transfusions allowed)
4. Renal function (within 72 hours of eligibility assessment):
4.1. Absence of clinically significant proteinuria (early morning urine dipstick =2+). When the dipstick urinalysis shows a proteinuria > 2+, a protein:creatinine (Pr/Cr) ratio must be < 0.5 or a 24 hour protein excretion must be < 0.5g
4.2. Serum creatinine =1.5 ULN for age, if higher, a calculated GFR (radioisotope) must be = 60 ml/min/1.73 m2
5. Liver function (within 72 hours of eligibility assessment): AST and ALT =2.5 ULN and total bilirubin =1.5 ULN. In case of liver metastases, AST and ALT =5 ULN and total bilirubin =2.5 ULN
6. Cardiac function, shortening fraction =29% on echocardiogram
7. Coagulation, patients not on anticoagulation must have an INR =1.5 and APTT =1.5 ULN for age. Anticoagulation is permitted as long as the INR or APTT is within therapeutic limits (according to the medical standard of the institution) and the patient has been on a stable dose of anticoagulants for at least two weeks at the time of study enrolment. Blood pressure below 95th centile for age and sex. Use of antihypertensive medication is permitted
8. Males or females of reproductive potential may not participate unless they agree to use an effective contraceptive method, for the duration of study therapy and for up to 6 months after the last dose of trial drugs. A negative urine pregnancy test must be obtained within 72 hours prior to dosing in females who are post-menarche
Exclusion criteria: 1. Previous treatment with bevacizumab, temozolomide, irinotecan or any combination of these drugs
2. Known hypersensitivity to:
2.1. Any study drug or component of the formulation
2.2. Chinese hamster ovary products or other recombinant human or humanised antibodies
3. Prior severe arterial thrombo-embolic events (e.g. cardiac ischemia, cerebral vascular accident, peripheral arterial thrombosis)
4. Any ongoing arterial thrombo-embolic events
5. Patient less than (at point of eligibility assessment):
5.1. 48 hours post bone marrow aspirate/trephine
5.2. 48 hours post central line insertion
5.3. Four weeks post major surgery
5.4. One week post core biopsy
5.5. Two weeks from prior chemotherapy
5.6. Six weeks from prior craniospinal or MIBG therapy and two weeks from radiotherapy to the tumour bed
5.7. Eight weeks from prior myeloablative therapy with haematopoeitic stem cell rescue (autologous stem cell transplant)
5.8. Three months from prior allogeneic stem cell transplant
5.9. Two weeks from last administration of an IMP in an IMP-trial
6. Bleeding metastases (patients with CNS metastases can be enrolled as long as the metastases are not bleeding)
7. Invasion of major blood vessels
8. Use of enzyme inducing anticonvulsants within 72 hours of eligibility assessment
9. History or evidence of inherited bleeding diathesis or significant coagulopathy at risk of bleeding (i.e. in the absence of therapeutic anticoagulation)
10. History of abdominal fistula, gastrointestinal perforation, intra-abdominal abscess or active gastrointestinal bleeding within 6 months prior to study enrolment
11. Pregnant or lactating patient
12. Any uncontrolled medical condition that poses an additional risk to the patient (i.e. haemoptysis, non-healing, bone fracture, wound/ulcer)
13. Low probability of treatment compliance
14. Planned immunisation with live vaccine

Age minimum:
Age maximum:
Gender: Both

Health Condition(s) or Problem(s) studied

Neuroblastoma in children aged =1 to =21 years
Cancer
Malignant neoplasm of adrenal gland

Intervention(s)

Current intervention as of 25/03/2019:
Investigational medicinal products: bevacizumab, irinotecan, temozolomide, topotecan, dinutuximab beta, cyclophosphamide

Arm T:
Temozolomide 200 mg/m2 per day oral on days 1-5 every 4 weeks
Duration of intervention: 24 weeks

Arm BT:
Temozolomide 200 mg/m2 per day oral on days 1-5 every 4 weeks
Bevacizumab 10mg/kg intravenous on days 1 and 15 every 4 weeks
Duration of intervention: 24 weeks

Arm IT:
Temozolomide 100 mg/m2 per day oral on days 1-5 every 3 weeks
Irinotecan 50 mg/m2 per day intravenous on days 1-5 every 3 weeks
Duration of intervention: 18 weeks

Arm BIT:
Temozolomide 100 mg/m2 per day oral on days 1-5 every 3 weeks
Irinotecan 50 mg/m2 per day intravenous on days 1-5 every 3 weeks
Bevacizumab 15 mg/kg intravenous on day 1 every 3 weeks
Duration of intervention: 18 weeks

Arm TTo:
Topotecan 0.75 mg/m2/day intravenous on days 1-5 every 4 weeks
Temozolomide 200 mg/m2 per day oral on days 1-5 every 4 weeks
Duration of intervention: 24 weeks

Arm BTTo:
Topotecan 0.75 mg/m2/day intravenous on days 1-5 every 4 weeks
Temozolomide 200 mg/m2 per day oral on days 1-5 every 4 weeks
Bevacizumab 10mg/kg intravenous on days 1 and 15 every 4 weeks
Duration of intervention: 24 weeks

Arm dBT
Dinutuximab beta 10 mg/m2/day 24-h infusion on days 1-7 every 4 weeks
Temozolomide 200 mg/m2/day oral on days 1-5 every 4 weeks
Duration of intervention: 24 weeks

Arm dBTTo
Dinutuximab beta 10 mg/m2/day 24-h infusion on days 1-7 every 4 weeks
Temozolomide 200 mg/m2/day oral on days 1-5 every 4 weeks
Topotecan 0.75mg/m2/day intravenous on days 1-5 every 4 weeks
Duration of intervention: 24 weeks


Previous intervention:
Investigational Medicinal Products: Bevacizumab, Irinotecan, Temozolomide

Arm T:
Temozolomide 200 mg/m2 per day ora

Primary Outcome(s)

Best response (Complete Response [CR], or Partial Response [PR][1] at any time during the first 6 cycles of trial treatment

Secondary Outcome(s)

1. Safety of the regimens: Incidence and severity of Adverse Events (AEs)
2. Progression-free survival (PFS)
3. Overall survival (OS)

Secondary ID(s)

RG_11-087

NCT02308527

2012-000072-42

Source(s) of Monetary Support

Cancer Research UK (UK) - Clinical Trials Awards & Advisory Committee: C1536/A14426

Ethics review

Status:
Approval date:
Contact:

Old ethics approval format; The NRES Commitee West Midlands - Coventry & Warwickshire, 06/02/2013, ref: 13/WM/0023

Results

• Results available: Yes
• Date Completed: 30/06/2026