20140106-CFZ008: Study of Carfilzomib in Combination With Induction Chemotherapy in Children With Relapsed or Refractory Acute Lymphoblastic Leukemia

Why are we doing this research?

PURPOSE:

The purpose of the study is to determine the maximum tolerated dose and assess the safety, tolerability and activity of carfilzomib, alone and in combination with induction chemotherapy, in children with relapsed or refractory acute lymphoblastic leukemia (ALL).

ARM INFORMATION:

EXPERIMENTAL: DOSE ESCALATION 1

  • Subjects will receive carfilzomib in combination with induction chemotherapy, comprising either an R3 backbone of dexamethasone, mitoxantrone, PEG asparaginase, and vincristine (Dose Escalation 1) or a VXLD backbone of vincristine, dexamethasone, PEG asparaginase, and daunorubicin (Dose Escalation 2).
  • Subjects participating in the Dose Escalation 1 (R3) portion of the study will have a 1 week carfilzomib single agent Lead in Window prior to the Induction Cycle. Subjects in both dose escalation portions of the study will receive a 4 week cycle of induction chemotherapy and have the option to receive a 4 week cycle of consolidation chemotherapy (Children's Oncology Group (COG) modified Berlin Frankfurt Münster (BFM) chemotherapy backbone (6 mercaptopurine, cyclophosphamide, cytarabine, PEG asparaginase, vincristine), if stable disease or better response is achieved at the end of the Induction Cycle.

Study Type: Interventional
Allocation: Non-Randomized
Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment

AGES ELIGIBLE FOR STUDY: Child, Adult, Senior

Who can participate?

ELIGIBILITY CRITERIA

Inclusion Criteria:

  • Age 21 years or younger at the time of initial ALL diagnosis and age > 1 year at the time of study treatment initiation.
  • Subjects must have a diagnosis of relapsed or refractory ALL with ≥ 5% blasts in the bone marrow (M2 or M3 disease), with or without extramedullary disease. -To be eligible, subjects must have had 1 or more prior therapeutic attempts, defined as:
    • Early first relapse (< 36 months from original diagnosis) after achieving a CR (B-ALL) or first relapse any time following the original diagnosis after achieving a CR (T-ALL)
    • Relapse after achieving a CR following the first or subsequent relapse (i.e., ≥ 2 relapses) OR
    • Failing to achieve a CR from original diagnosis after at least 1 induction attempt
  • Subjects must have fully recovered from the acute toxic effects of all previous chemotherapy, immunotherapy, or radiotherapy treatment before enrollment.
  • Subjects must have a serum creatinine level that is ≤ 1.5 × institutional upper limit of normal (ULN) according to age. If serum creatinine level is > 1.5 × ULN, the subject must have a calculated creatinine clearance or radioisotope glomerular filtration rate (GFR) ≥ 70 mL/min/1.73 m2.
  • Adequate liver function, defined as both of the following:
    • Total bilirubin ≤ 1.5 × institutional ULN except in the presence of Gilbert Syndrome
    • Alanine aminotransferase (ALT) ≤ 5 × institutional ULN
  • Performance status: Karnofsky or Lansky scores ≥ 50 for subjects > 16 years old or ≤ 16 years old, respectively.

Exclusion Criteria:

  • Known allergy to any of the drugs used in the study. (Subjects who have had a previous allergy to PEG-asparaginase but can receive Erwinia are eligible.)
  • Known allergy to Captisol (a cyclodextrin derivative used to solubilize carfilzomib)
  • Left ventricular fractional shortening < 30%
  • History of ≥ Grade 2 pancreatitis
  • Active graft-versus-host disease requiring systemic treatment
  • Positive culture for or other clinical evidence of infection with bacteria or fungus within 14 days of the initiation of study treatment
  • Down Syndrome
  • Prior therapy restrictions:
  • Subjects must have completed therapy with granulocyte-colony stimulating factor (G-CSF) or other myeloid growth factors at least 7 days before study treatment initiation, or at least 14 days before study treatment initiation, if pegylated myeloid growth factors were administered.
  • Subjects must have completed any type of active immunotherapy (e.g., tumor vaccines) at least 42 days before study treatment initiation.
  • At least 3 antibody half-lives must have elapsed since the last dose of monoclonal antibody (e.g., 66 days for rituximab and 69 days for epratuzumab) before subjects may initiate study treatment.
  • Subjects must have completed any type of active immunotherapy (e.g., tumor vaccines) at least 42 days before study treatment initiation.
  • Subjects must not have received other antineoplastic agents with therapeutic intent, excluding hydroxyurea and antimetabolites administered as part of maintenance chemotherapy, within 7 days prior to study treatment initiation.

Conditions

  • Leukemia ALL Relapse - Refractory
  • Adult - Leukemia ALL Relapse - Refractory

Find More

    For more information contact:
    Cincinnati Children’s Hospital Medical Center
    Division of Hematology/Oncology
    3333 Burnet Ave., Cincinnati OH 45229-3039
    Phone: 513-636-2799
    cancer@cchmc.org