Resumen

Este ensayo clínico se llevará a cabo en niños diagnosticados con neuroblastoma de alto riesgo que hayan alcanzado una respuesta completa o muy buena respuesta parcial después de la terapia estándar. Una cohorte adicional de niños que no hayan podido alcanzar estos criterios de respuesta o que hayan recaído después de la terapia estándar pero no presenten enfermedad progresiva recibirá Racotumomab junto con quimioterapia metronómica. Los objetivos principales de este estudio son determinar la respuesta inmunitaria después de un año de inmunización con Racotumomab, describir la respuesta de la terapia con Racotumomab en la enfermedad mínima residual (EMR) en médula ósea y describir el perfil de toxicidad de Racotumomab.

Descripción detallada

El neuroblastoma es el tumor extracraneal más frecuente en la infancia, pero el pronóstico sigue siendo desfavorable, incluso con los avances en su tratamiento. Se han examinado nuevas estrategias terapéuticas y actualmente se están evaluando diversos enfoques inmunoterapéuticos, incluyendo terapia combinada con anticuerpos monoclonales (anti-GD2), interleucina-2 (IL-2) intravenosa y factor estimulante de colonias de granulocitos y macrófagos (GM-CSF) intravenoso, así como vacunas anti-idiotípicas. Racotumomab es un anticuerpo anti-idiotípico capaz de inducir anticuerpos anti-N-glicolil GM3 en pacientes con neuroblastoma. Se demostró la expresión del gangliósido N-glicolil GM3 en el neuroblastoma y esta expresión podría ser útil como diana específica para la inmunoterapia. Racotumomab se administrará una vez que se haya completado la terapia estándar para el neuroblastoma.

Elegibilidad

Edad mínima: 1 YearEdad máxima: 12 YearsSexo: ALL

Criterios de inclusión

Informed Consent or written child assent, if applicable, prior to any specific procedure of the study.
Aged ≥ 1 year old and ≤ 12 years old at the time of diagnose.
High-risk neuroblastoma diagnose according to the International Neuroblastoma Risk Group Staging System (INRGSS) (Annex I).
Patients who have received complete chemotherapy, radiotherapy (if applicable) and autologous hematopoietic stem cell transplantation (if applicable) not earlier than 30 days prior to being included in the study, and patients of Group I who have completed therapy with cis retinoic acid or other maintenance onco-specific therapy using the standard dose for neuroblastoma treatment. .
Use of concomitant metronomic chemotherapy by patients of Group II is considered acceptable.
For patients belonging to other risk group who have relapsed or progressed, the period between the beginning of chemotherapy for the treatment of high-risk neuroblastoma and the inclusion of patients must not exceed 12 months.
Partial or complete remission status, very good partial remission or stable disease (pursuant to the International Neuroblastoma Response Criteria) at the time of inclusion (Annex IV).
Assessment of the disease must be conducted within 30 days prior to inclusion.
Additional studies supporting the response to treatment at the time of inclusion are required.
Normal organ functions according to the following parameters:
Adequate cardiac function as defined below:
Electrocardiogram (ECG) 30 days prior to inclusion without substantial anomalies.
Electrocardiogram (ECG) 30 days prior to inclusion with fractional shortening ≥27%
Adequate bone marrow functions defined as follows:
Neutrophil ≥1000/mm3 with no use of stimulating factor for at least 2 weeks prior to inclusion.
Lymphocytes ≥500/mm3
Platelets ≥ 50000/mm3.
Adequate hepatic functions defined as follows:
Direct bilirubin ≤1.5 x upper limit of normal (ULN)
AST/ALT ≤ 5 x ULN
Adequate renal function defined as follows:
Creatinine Clearance ≥70 ml/min/1.73m2 or serum Creatinine (Cr) as per age/gender.
Known history of Hepatitis B or C seropositivity with studies showing hepatic function results within acceptable limits may be eligible.
Negative HIV serology.
Pregnancy test-negative for women of childbearing potential.
No previous Racotumomab therapy.
No previous intravenous immunoglobulin therapy for at least one month prior to the beginning of treatment.
Lansky Scale ≥ 50 (Annex II)
Patients with extended bone metastasis in cranial vault or cranial base due to proximity may be considered eligible.

Criterios de exclusión

In order to be included, patients must not meet the following criteria:
Neuroblastoma as progressive disease at the time of the beginning of the study.
Patients with known hypersensitivity to any of the components of the investigational drug.
Pregnant or breastfeeding patients.
Patients who have received other investigational drugs or Racotumomab within 30 days prior to their inclusion in the protocol.
History of autoimmune diseases, congenital immunodeficiencies or uncontrolled chronic diseases.
Acute allergy disorders or history of severe allergy reactions.
History of demyelinating disease or inflammatory disease of the central nervous system or the peripheral nervous system.
Patients with any of the following uncontrolled intercurrent disease:
Active infectious diseases
Uncontrolled cardiac disease: symptomatic congestive heart failure, serious cardiac arrhythmia.
Known hepatic disease: cirrhosis, chronic active hepatitis or chronic persistent hepatitis.
Convulsions not controlled with any anticonvulsant medication.
Other malignancies after adequate therapy showing a disease-free period for more than 5 years.
Patients receiving chronic therapy with systemic steroids and other immunosuppressive agents. Topical steroids and inhaled corticosteroids are permitted.
History of positive HIV serology.
Clinically symptomatic metastasis in central nervous system.

Estudio de inmunoterapia de fase II, abierto, multicéntrico, con Racotumomab en pacientes con neuroblastoma de alto riesgo.

Resumen

Descripción detallada

Elegibilidad

Criterios de inclusión

Criterios de exclusión

Intervenciones

Racotumomab

Ubicaciones

Hospital Universitario Austral

Prof. Dr. J. P. Garrahan National Children's Hospital

Patrocinadores