Combination Chemotherapy, Autologous Stem Cell Transplant, and/or Radiation Therapy in Treating Young Patients With Extraocular Retinoblastoma



Status:Active, not recruiting
Conditions:Brain Cancer
Therapuetic Areas:Oncology
Healthy:No
Age Range:Any - 10
Updated:2/10/2019
Start Date:February 4, 2008

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A Trial of Intensive Multi-Modality Therapy for Extra-Ocular Retinoblastoma

This phase III trial is studying the side effects and how well giving combination
chemotherapy together with autologous stem cell transplant and/or radiation therapy works in
treating young patients with extraocular retinoblastoma. Giving chemotherapy before an
autologous stem cell transplant stops the growth of tumor cells by stopping them from
dividing or killing them. After treatment, stem cells are collected from the patient?s blood
and/or bone marrow and stored. More chemotherapy is given to prepare the bone marrow for the
stem cell transplant. The stem cells are then returned to the patient to replace the
blood-forming cells that were destroyed by the chemotherapy. Radiation therapy uses high
energy x-rays to kill tumor cells. Giving radiation therapy after combination chemotherapy
and/or autologous stem cell transplant may kill any remaining tumor cells.

OBJECTIVES:

I. To estimate the proportion of 3 groups of patients with extraocular retinoblastoma (stage
2 and 3: regional extra-ocular disease;, stage 4a: disseminated metastatic disease not
involving the central nervous system [CNS]; or stage 4b: patients with CNS disease) who
achieve long-term event-free survival after treatment with aggressive multimodality therapy
compared to historical controls.

II. To estimate the response rate to the induction phase of the regimen. III. To evaluate the
toxicities associated with this regimen.

OUTLINE:

INDUCTION CHEMOTHERAPY: Patients receive vincristine intravenously (IV) on days 0, 7, and 14,
cisplatin IV over 6 hours on day 0, cyclophosphamide IV over 1 hour and etoposide IV over 1
hour on days 1 and 2, and filgrastim (G-CSF) subcutaneously (SC) beginning on day 3 and
continuing until blood counts recover.

Treatment repeats every 21 days for up to 4 courses in the absence of disease progression or
unacceptable toxicity.

After completion of induction chemotherapy, patients with stage 2 or 3 disease who have at
least a partial response proceed to radiotherapy. Patients with stage 4a or 4b disease who
have at least a partial response proceed to high-dose consolidation chemotherapy and
autologous stem cell infusion.

STEM CELL HARVESTING (stage 4a or 4b disease only): Peripheral blood stem cells (preferred)
or bone marrow cells are collected after at least 1 course of induction chemotherapy.

HIGH-DOSE CONSOLIDATION CHEMOTHERAPY (stage 4a or 4b disease only): Patients receive
carboplatin IV over 4 hours on days -8 to -6 and thiotepa IV over 3 hours and etoposide IV
over 3 hours on days -5 to -3.

AUTOLOGOUS STEM CELL INFUSION (stage 4a or 4b disease only): Patients undergo autologous stem
cell infusion on day 0. Patients then receive filgrastim subcutaneously (SC) beginning on day
1 and continuing until blood counts recover.

RADIOTHERAPY: Patients with stage 2 or 3 disease (orbital and/or regional involvement)
undergo radiotherapy to sites that were initially involved beginning within 42 days after the
start of course 4 of induction chemotherapy. Patients with stage 4a or 4b disease undergo
radiotherapy to sites initially involved based on response beginning approximately 42 days
after autologous stem cell infusion. Patients with stage 4a disease who achieve a complete
response to induction chemotherapy or with less than 5 mm of residual tumor at the time of
planned irradiation, or patients with stage 4b disease who achieve a complete response to
induction chemotherapy do not undergo radiotherapy.

After completion of study therapy, patients are followed every 3 months for 1 year and then
annually thereafter for 9 years.

Inclusion Criteria:

- Patients must have histologic or cytologic verification of extra-ocular
retinoblastoma; extra-ocular disease includes orbital disease, optic nerve involvement
at the surgical margin, regional nodal disease, and/or overt distant metastatic
disease (at sites such as bone, bone marrow, liver and/or the central nervous system);
patients with trilateral retinoblastoma will also be included in this protocol

- Patients with a CNS lesion consistent with trilateral or stage 4b disease may be
enrolled without tissue confirmation if (1) unequivocal leptomeningeal disease is
present on brain or spine magnetic resonance imaging (MRI) scan and/or (2) the
primary tumor is at least 2 cm in diameter, predominantly solid, and demonstrates
enhancement on the post-gadolinium images; however, even in such cases surgery
should be given serious consideration

- Patients must have a performance status corresponding to Eastern Cooperative Oncology
Group (ECOG) scores of 0, 1, or 2; use Karnofsky for patients > 16 years of age and
Lansky for patients =< 16 years of age

- No prior chemotherapy or radiotherapy for the extra-ocular retinoblastoma may have
been administered prior to entering this study; prior treatment (chemotherapy and/or
radiation therapy) for intra-ocular retinoblastoma is permissible

- Peripheral absolute neutrophil count (ANC) >= 750/uL

- If the ANC and/or platelet count are not adequate, but due to bone marrow
metastatic disease, these criteria will be waived

- Platelet count >= 75,000/uL (transfusion independent)

- If the ANC and/or platelet count are not adequate, but due to bone marrow
metastatic disease, these criteria will be waived

- Creatinine clearance OR radioisotope glomerular filtration rate >= 70 mL/min/1.73 m^2
or a serum creatinine based on age/gender as follows:

- 0.4 mg/dL (1 month to < 6 months of age)

- 0.5 mg/dL (6 months to < 1 year of age)

- 0.6 mg/dL (1 years to < 2 years of age)

- 0.8 mg/dL (2 years to < 6 years of age)

- 1.0 mg/dL (6 years to < 10 years of age)

- 1.2 mg/dL (10 years to < 13 years of age)

- 1.5 mg/dL (male) or 1.4 mg/dL (female) (13 years to < 16 years of age)

- 1.7 mg/dL (male) or 1.4 mg/dL (female) (>= 16 years of age)

- Total bilirubin =< 1.5 times upper limit of normal (ULN)

- Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) or
serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) < 2.5 x
upper limit of normal (ULN)

- All patients and/or their parents or legal guardians must sign a written informed
consent

- All institutional, Food and Drug Administration (FDA), and National Cancer Institute
(NCI) for human studies must be met
We found this trial at
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1717 South Orange Avenue # 100
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1600 7th Avenue
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3333 Burnet Avenue # Mlc3008
Cincinnati, Ohio 45229
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11100 Euclid Avenue
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7777 Forest Ln # C840
Dallas, Texas 75230
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Medical City Dallas Hospital If you have concerns for your health, that of a family...
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282 Washington St
Hartford, Connecticut 06106
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Connecticut Children's Medical Center Connecticut Children’s Medical Center is a nationally recognized, 187-bed not-for-profit children’s...
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2500 N State St
Jackson, Mississippi 39216
(601) 984-1000
University of Mississippi Medical Center The University of Mississippi Medical Center, located in Jackson, is...
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2401 Gillham Rd
Kansas City, Missouri 64108
(816) 234-3000
Children's Mercy Hospital Children's Mercy Hospitals and Clinics continues redefining pediatric medicine throughout the Midwest...
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529 West Markham Street
Little Rock, Arkansas 72205
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4650 Sunset Blvd
Los Angeles, California 90027
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Childrens Hospital Los Angeles Children's Hospital Los Angeles is a 501(c)(3) nonprofit hospital for pediatric...
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262 Danny Thomas Pl
Memphis, Tennessee 38105
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5153 North 9th Avenue
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South 34th Street
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4401 Penn Avenue
Pittsburgh, Pennsylvania 15224
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401 College Street
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7700 Floyd Curl Dr
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Methodist Children's Hospital of South Texas Methodist Children
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4502 Medical Drive
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40 Sunshine Cottage Road
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(914) 594-4000
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1600 Rockland Road
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13123 E 16th Ave
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8901 Rockville Pike
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450 Brookline Ave
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55 Fruit St
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Charlotte, North Carolina 28204
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1200 West Harrison Stree
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2301 Erwin Rd
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801 7th Avenue
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835 S Van Buren St
Green Bay, Wisconsin 54301
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705 Riley Hospital Dr
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Jacksonville, Florida 32207
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601 South Rancho Drive Suite C-26
Las Vegas, Nevada 89106
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1 Children's Way
Little Rock, Arkansas 72202
(501) 364-1100
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9000 W Wisconsin Ave #270
Milwaukee, Wisconsin 53226
(414) 266-2000
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Morristown, New Jersey 07962
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1275 York Ave
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940 NE 13th St
Oklahoma City, Oklahoma 73190
(405) 271-6458
University of Oklahoma Health Sciences Center The OU Health Sciences Center is composed of seven...
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13535 Nemours Parkway
Orlando, Florida 32827
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725 Welch Rd
Palo Alto, California 94304
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Philadelphia, Pennsylvania 19104
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1919 E Thomas Rd
Phoenix, Arizona 85006
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660 S Euclid Ave
Saint Louis, Missouri 63110
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111 Michigan Ave NW
Washington, District of Columbia
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