This study evaluates the use of carfilzomib in combination with cyclophosphamide and etoposide for children with relapsed/refractory solid tumors or leukemia. The medications cyclophosphamide and etoposide are standard drugs often used together for the treatment of cancer in children with solid tumors or leukemia. Carfilzomib is FDA (Food and Drug Administration) approved in the United States for adults with multiple myeloma (a type of cancer). However, this drug is not approved to treat children with relapsed/refractory solid tumors or leukemia. With this research, we plan to determine the DLTs and MTD of Carfilzomib given in combination with cyclophosphamide and etoposide in pediatric patients with relapsed/refractory leukemias and solid tumors.
Part 1 of the study will include a dose escalation based on Dose limiting toxicities (DLTs) until the MTD or highest dose level is reached, whichever comes first. At the MTD or highest dose level (if no MTD is reached), an additional 6 patients will be enrolled to further evaluate safety of the regimen (Part 2). Part 2 of this study will enroll additional patients at the highest tolerable dose found in Part 1 in order to get more information on side effects and make sure the dose is tolerable Once an MTD is determined for Strata A or B, if the Study Principal Investigator determines that the study treatment should not be further pursued due to safety or enrollment barriers, the expansion Part or the study will be discontinued.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
4
Carfilzomib in combination with cyclophosphamide and etoposide for children with relapsed and refractory solid tumors and leukemias
Phoenix Children's Hospital
Phoenix, Arizona, United States
Arkansas Children's Hospital
Little Rock, Arkansas, United States
Stanford University School of Medicine and Stanford Cancer Institute
Palo Alto, California, United States
Dana Farber Cancer Institute
Boston, Massachusetts, United States
Memorial Sloan-Kettering Cancer Center
New York, New York, United States
Penn State Hershey Children's Hospital
Hershey, Pennsylvania, United States
University of Texas Health Science Center at San Antonio
San Antonio, Texas, United States
Alberta Children's Hospital
Calgary, Alberta, Canada
To determine the DLTs and MTD of carfilzomib given in combination with cyclophosphamide and etoposide in pediatric patients with relapsed/refractory leukemias and solid tumors
Time frame: 30 Days post treatment initiation
To evaluate toxicities of carfilzomib in the pediatric population when combined with conventional chemotherapy.
Record AEs and SAEs
Time frame: Treatment initiation through 30 days post treatment
Determine patient response rate (CR, PR, SD, PD) with this regimen
Time frame: Treatment initiation through 30 days post treatment
To measure if circulating plasma proteosome (cProt) levels post treatment correlate with response to therapy and overall survival.
Time frame: Treatment initiation through 30 days post treatment
To measure if the levels of proteasome activity and resistance to carfilzomib correlates with toxicity and/or response to treatment
Time frame: Treatment initiation through 30 days post treatment
To measure if inhibition of proteasome activity by carfilzomib results in alteration in a number of autophagy and apoptosis related proteins, providing means to evaluate correlates of activity of carfilzomib
Time frame: Treatment initiation through 30 days post treatment
To measure the level of proteosome inhibition in patient PBMCs before and during treatment by determination of the level of protein ubiquitination
Time frame: Treatment initiation through 30 days post treatment
To determine in vitro sensitivity of patient leukemias and solid tumors to carfilzomib alone and in combination with study chemotherapeutic agents in order to generate a predictive model of drug sensitivity
Time frame: Treatment initiation through 30 days post treatment
To perform whole exome sequencing (WES) and RNA seq on patient leukemia and solid tumor samples and WES on germ line DNA in order to determine potential mechanisms of drug sensitivity or resistance
Time frame: Treatment initiation through 30 days post treatment
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