Dinutuximab, Sargramostim, and Combination Chemotherapy in Treating Patients With Newly Diagnosed High-Risk Neuroblastoma Undergoing Stem Cell Transplant

Status: Recruiting
DFCI Protocol ID: 19-710

This phase II trial studies the side effects and how well dinutuximab and sargramostim work with combination chemotherapy in patients with high-risk neuroblastoma undergoing stem cell transplant. Immunotherapy with monoclonal antibodies, such as dinutuximab, may induce changes in the body's immune system and may interfere with the ability of tumor cells to grow and spread. Sargramostim helps the body produce normal infection-fighting white blood cells. Giving chemotherapy before a stem cell transplant, with drugs such as cisplatin, etoposide, vincristine, doxorubicin, cyclophosphamide, thiotepa, melphalan, etoposide, carboplatin, topotecan, and isotretinoin, helps kill any cancer cells that are in the body and helps make room in a patient's bone marrow for new blood-forming cells (stem cells). Giving dinutuximab and sargramostim with combination chemotherapy may work better in treating patients with high-risk neuroblastoma undergoing stem cell transplant.

Conducting Institutions:

Brigham and Women's Hospital, Children's Hospital Boston, Dana-Farber Cancer Institute

Overall PI:

Suzanne Shusterman, MD, Dana-Farber Cancer Institute

Site-responsible Investigators:


Dana-Farber Cancer Institute: Childrens Hospital Pediatric Clinical Translation Investigation Program CTIP, ctip@partners.org

Eligibility Criteria

Inclusion Criteria:

  -  Patients must be enrolled on ANBL00B1 or APEC14B1 prior to enrollment on ANBL17P1.

  -  Patients must have a diagnosis of neuroblastoma or ganglioneuroblastoma (nodular)
     verified by tumor pathology analysis or demonstration of clumps of tumor cells in bone
     marrow with elevated urinary catecholamine metabolites. The following disease groups
     are eligible:

       -  Patients with International Neuroblastoma Risk Group (INRG) stage M disease are
  eligible if found to have either of the following features:

    -  MYCN amplification (> 4-fold increase in MYCN signals as compared to
       reference signals), regardless of age or additional biologic features; OR

    -  Age > 547 days regardless of biologic features;

       -  Patients with INRG stage MS disease with MYCN amplification

       -  Patients with INRG stage L2 disease with MYCN amplification

       -  Patients > 547 days of age initially diagnosed with INRG stage L1, L2 or MS
  disease who progress to stage M without prior chemotherapy may enroll within 4
  weeks of progression to stage M.

       -  Patients >= 365 days of age initially diagnosed with MYCN amplified INRG stage L1
  disease who progress to stage M without systemic therapy may enroll within 4
  weeks of progression to stage M.

  -  Patients initially recognized to have high-risk disease must have had no prior
     systemic therapy (other than topotecan/cyclophosphamide initiated on an emergent basis
     and within allowed timing as described).

  -  Patients observed or treated with a single cycle of chemotherapy per a low or
     intermediate risk neuroblastoma regimen (e.g., as per ANBL0531, ANBL1232 or similar)
     for what initially appeared to be non-high risk disease but subsequently found to meet
     the criteria will also be eligible.

  -  Patients who receive localized emergency radiation to sites of life-threatening or
     function-threatening disease prior to or immediately after establishment of the
     definitive diagnosis will be eligible.

  -  Creatinine clearance (CrCl) or radioisotope glomerular filtration rate (GFR) >= 70
     mL/min/1.73 m^2 or a serum creatinine based on age/sex as follows:

       -  Age 1 month to < 6 months (male 0.4 mg/dL, female 0.4 mg/dL)

       -  Age 6 months to < 1 year (male 0.5 mg/dL, female 0.5 mg/dL)

       -  Age 1 to < 2 years (male 0.6 mg/dL, female 0.6 mg/dL)

       -  Age 2 to < 6 years (male 0.8 mg/dL, female 0.8 mg/dL)

       -  Age 6 to < 10 years (male 1 mg/dL, female 1 mg/dL)

       -  Age 10 to < 13 years (male 1.2 mg/dL, female 1.2 mg/dL)

       -  13 to < 16 years (male 1.5 mg/dL, female 1.4 mg/dL)

       -  >= 16 years (male 1.7 mg/dL, female 1.4 mg/dL) (within 7 days prior to

  -  Total bilirubin =< 1.5 x upper limit of normal (ULN) for age (within 7 days prior to

  -  Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) < 10 x
     ULN. For the purposes of this study, ULN for ALT is 45 IU/L (within 7 days prior to

  -  Shortening fraction of >= 27% by echocardiogram (within 7 days prior to enrollment).

  -  Ejection fraction of >= 50% by echocardiogram or radionuclide angiogram (within 7 days
     prior to enrollment).

  -  No known contraindication to peripheral blood stem cell (PBSC) collection. Examples of
     contraindications might be a weight or size less than the collecting institution finds
     feasible, or a physical condition that would limit the ability of the child to undergo
     apheresis catheter placement (if necessary) and/or the apheresis procedure.

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

  -  All institutional, Food and Drug Administration (FDA), and National Cancer Institute
     (NCI) requirements for human studies must be met.

Exclusion Criteria:

  -  Patients >18 months of age with INRG stage L2, MYCN non-amplified, regardless of
     additional biologic features.

  -  Patients with bone marrow failure syndromes.

  -  Patients that are >= 12 and =< 18 months of age with INRG stage M and all 3 favorable
     biologic features (i.e., non-amplified MYCN, favorable pathology, and deoxyribonucleic
     acid [DNA] index > 1) are not eligible.

  -  Patients on immunosuppressive medications (e.g. tacrolimus, cyclosporine,
     corticosteroids for reasons other than prevention/treatment of allergic reactions,
     adrenal replacement therapy, etc.) are not eligible.

  -  Female patients who are pregnant are ineligible since fetal toxicities and teratogenic
     effects have been noted for several of the study drugs. A pregnancy test is required
     for female patients of childbearing potential.

  -  Lactating females who plan to breastfeed their infants.

  -  Sexually active patients of reproductive potential who have not agreed to use an
     effective contraceptive method during study therapy and for two months after the last
     dose of ch14.18 (dinutuximab) are not eligible.

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