RECRUITING

NK Cells Infusions With Irinotecan, Temozolomide, and Dinutuximab

Conditions

Relapsed Neuroblastoma Refractory Neuroblastoma

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Study Overview

This clinical trial focuses on testing the efficacy of different digital interventions to promote re-engagement in cancer-related long-term follow-up care for adolescent and young adult (AYA) survivors of childhood cancer.

Description

This is a Phase 1 study with Phase 2 expansion cohort. Phase 1 will assess the safety and tolerability of universal donor TGFβi NK Cell in combination with irinotecan, temozolomide, and dinituximab. The phase 2 of the study will estimate the response to treatment.

Official Title

A Phase I/II Safety Lead in Study of Ex-Vivo Expanded Allogeneic Universal Donor TGFβi NK Cell Infusions in Combination With Irinotecan, Temozolomide, and Dinutuximab in Patients With Relapsed or Refractory Neuroblastoma: The Allo - STING Trial

Quick Facts

Study Start:2022-09-01

Study Completion:2025-12

Study Type:Not specified

Phase:Not Applicable

Enrollment:Not specified

Status:RECRUITING

Study ID

NCT04211675

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Ages Eligible for Study:Not specified to 29 Years

Sexes Eligible for Study:ALL

Accepts Healthy Volunteers:No

Standard Ages:CHILD, ADULT

Inclusion Criteria	Exclusion Criteria
* Less than 30 years of age when registered on the study. * Patients must have a histologic verification of neuroblastoma (NBL) or ganglioneuroblastoma or NBL cells in bone marrow with or without elevated urine catecholamines. * Life expectancy \>2 months, AND one of the following: * Recurrent disease; or * First episode of progressive disease (new lesion, increase in size, previous negative bone marrow) during initial multi-drug, induction myelosuppressive therapy; or * Primary resistant/refractory disease (partial, mixed, stable response criteria met) after completing at least 4 cycles of induction multi-drug induction chemotherapy * One of the following: * Patients must have measurable or evaluable tumor defined as: a) Measurable tumor on MRI or CT obtained within 4 weeks prior to study entry; Measurable is defined as ≥ 10mm in at least one dimension AND that has positive uptake on I-123 MIBG scan ("MIBG avid") or demonstrates increased FDG uptake on 18F-FDG PET-CT or PET-MRI ("PET-avid"); OR b) Evaluable tumor by I-123 MIBG scan within 4 weeks prior to study entry, defined as positive uptake at a minimum of one site; * Measurable or evaluable disease must represent recurrent disease after therapy completion or progressive disease on therapy or refractory disease during induction; * Patients with refractory disease that are not avid on MIBG scan and do not have increased FDG uptake on PET must have biopsy proven viable NBL; * New soft tissue sites that are MIBG avid or PET avid do not require biopsy as long as initial histologically-confirmed NBL diagnosis prior to current therapy * Patients must have progressed during or following completion of frontline therapy. Agents considered to be a part of frontline therapy would include chemotherapy, radiation therapy, autologous stem cell transplantation, retinoids, immunotherapy with anti GD2 agents, cellular therapies, or I-131 MIBG, and frontline therapy is defined as any combination of these agents defined in published regimens or current cooperative group clinical trials for the successful treatment of that cancer. Therapy may not have been received more recently than the timeframes defined below: * Myelosuppressive chemotherapy: At least 14 days since completion of myelosuppressive therapy * Biologic: At least 7 days since completion of therapy with non-myelosuppressive biologic or retinoid * Radiation: At least 4 weeks since completion of radiation to any site identified as a target lesion. Palliative radiation is allowed to sites not used to measure response * Stem Cell Transplant (SCT): At least 6 weeks after autologous stem cell transplant or stem cell infusions as long as hematologic criteria have been met * 131I-MIBG Therapy: At least 6 weeks after therapeutic MIBG treatment * Cellular therapies: At least 6 weeks after any cellular therapy treatment (e.g., prior NK, CAR-T therapy) * Adequate bone marrow function, defined as: * Peripheral absolute neutrophil count (ANC) ≥500/microL. Patients must not have received long-acting myeloid growth factors (e.g., Neulasta) within 14 days or short-acting myeloid growth factors (e.g., Neupogen) within 7 days of study entry. * Platelet count ≥50,000/microL (transfusion independent for at least 1 week) * Adequate renal function defined as: * Creatinine clearance or estimated radioisotope GFR ≥70 ml/min/1.73m2 or * Serum creatinine \< 2x upper limit of normal (ULN) based on age/gender * Adequate liver function defined as: * Total bilirubin \<1.5x ULN for age AND * SGPT (ALT) ≤5x ULN for age (or ≤225 U/L). For purpose of this study, the ULN for SGPT (ALT) is 45 U/L. * Adequate central nervous system function defined as: * Patients with seizure disorders may be enrolled if seizures are well controlled on anti-convulsants * CNS toxicity ≤ Grade 2 * Adequate cardiac function defined as: * Shortening fraction of ≥ 27% by ECHO OR * Ejection fraction ≥ 50% by ECHO or gated radionuclide study * Adequate pulmonary function defined as: * No evidence of dyspnea at rest, no exercise intolerance, no chronic oxygen requirement, and room air pulse oximetry \> 94% if there is a clinical indication for pulse oximetry	* Patients who are pregnant or breastfeeding * Patients with elevated catecholamines (\>2x ULN) only. * Patients must not have received 0.5 mg/ kg/ day (prednisone equivalent) doses of systemic steroids for at least 7 days prior to enrollment. * Patients must not have received CYP3A4 inducer or inhibitor for at least 7 days prior to study enrollment. * Patients must not have been diagnosed with any other malignancy. * Patients must not have \> Grade 2 diarrhea. * Patients must not have uncontrolled infection. * Patients with history of Grade 4 allergic reactions to anti-GD2 antibodies or reactions that required discontinuation of anti-GD2 therapy. * Patients with a significant illness that is not covered by the exclusion criteria or that is expected to interfere with the action of study agents or to increase the severity of the toxicities experienced from the study treatment.

Inclusion Criteria

Exclusion Criteria

* Less than 30 years of age when registered on the study.
* Patients must have a histologic verification of neuroblastoma (NBL) or ganglioneuroblastoma or NBL cells in bone marrow with or without elevated urine catecholamines.
* Life expectancy \>2 months, AND one of the following:
* Recurrent disease; or
* First episode of progressive disease (new lesion, increase in size, previous negative bone marrow) during initial multi-drug, induction myelosuppressive therapy; or
* Primary resistant/refractory disease (partial, mixed, stable response criteria met) after completing at least 4 cycles of induction multi-drug induction chemotherapy
* One of the following:
* Patients must have measurable or evaluable tumor defined as: a) Measurable tumor on MRI or CT obtained within 4 weeks prior to study entry; Measurable is defined as ≥ 10mm in at least one dimension AND that has positive uptake on I-123 MIBG scan ("MIBG avid") or demonstrates increased FDG uptake on 18F-FDG PET-CT or PET-MRI ("PET-avid"); OR b) Evaluable tumor by I-123 MIBG scan within 4 weeks prior to study entry, defined as positive uptake at a minimum of one site;
* Measurable or evaluable disease must represent recurrent disease after therapy completion or progressive disease on therapy or refractory disease during induction;
* Patients with refractory disease that are not avid on MIBG scan and do not have increased FDG uptake on PET must have biopsy proven viable NBL;
* New soft tissue sites that are MIBG avid or PET avid do not require biopsy as long as initial histologically-confirmed NBL diagnosis prior to current therapy
* Patients must have progressed during or following completion of frontline therapy. Agents considered to be a part of frontline therapy would include chemotherapy, radiation therapy, autologous stem cell transplantation, retinoids, immunotherapy with anti GD2 agents, cellular therapies, or I-131 MIBG, and frontline therapy is defined as any combination of these agents defined in published regimens or current cooperative group clinical trials for the successful treatment of that cancer. Therapy may not have been received more recently than the timeframes defined below:
* Myelosuppressive chemotherapy: At least 14 days since completion of myelosuppressive therapy
* Biologic: At least 7 days since completion of therapy with non-myelosuppressive biologic or retinoid
* Radiation: At least 4 weeks since completion of radiation to any site identified as a target lesion. Palliative radiation is allowed to sites not used to measure response
* Stem Cell Transplant (SCT): At least 6 weeks after autologous stem cell transplant or stem cell infusions as long as hematologic criteria have been met
* 131I-MIBG Therapy: At least 6 weeks after therapeutic MIBG treatment
* Cellular therapies: At least 6 weeks after any cellular therapy treatment (e.g., prior NK, CAR-T therapy)
* Adequate bone marrow function, defined as:
* Peripheral absolute neutrophil count (ANC) ≥500/microL. Patients must not have received long-acting myeloid growth factors (e.g., Neulasta) within 14 days or short-acting myeloid growth factors (e.g., Neupogen) within 7 days of study entry.
* Platelet count ≥50,000/microL (transfusion independent for at least 1 week)
* Adequate renal function defined as:
* Creatinine clearance or estimated radioisotope GFR ≥70 ml/min/1.73m2 or
* Serum creatinine \< 2x upper limit of normal (ULN) based on age/gender
* Adequate liver function defined as:
* Total bilirubin \<1.5x ULN for age AND
* SGPT (ALT) ≤5x ULN for age (or ≤225 U/L). For purpose of this study, the ULN for SGPT (ALT) is 45 U/L.
* Adequate central nervous system function defined as:
* Patients with seizure disorders may be enrolled if seizures are well controlled on anti-convulsants
* CNS toxicity ≤ Grade 2
* Adequate cardiac function defined as:
* Shortening fraction of ≥ 27% by ECHO OR
* Ejection fraction ≥ 50% by ECHO or gated radionuclide study
* Adequate pulmonary function defined as:
* No evidence of dyspnea at rest, no exercise intolerance, no chronic oxygen requirement, and room air pulse oximetry \> 94% if there is a clinical indication for pulse oximetry

* Patients who are pregnant or breastfeeding
* Patients with elevated catecholamines (\>2x ULN) only.
* Patients must not have received 0.5 mg/ kg/ day (prednisone equivalent) doses of systemic steroids for at least 7 days prior to enrollment.
* Patients must not have received CYP3A4 inducer or inhibitor for at least 7 days prior to study enrollment.
* Patients must not have been diagnosed with any other malignancy.
* Patients must not have \> Grade 2 diarrhea.
* Patients must not have uncontrolled infection.
* Patients with history of Grade 4 allergic reactions to anti-GD2 antibodies or reactions that required discontinuation of anti-GD2 therapy.
* Patients with a significant illness that is not covered by the exclusion criteria or that is expected to interfere with the action of study agents or to increase the severity of the toxicities experienced from the study treatment.

Contacts and Locations

Study Contact

Melinda Triplet, RN

CONTACT

614-722-6039

Melinda.Triplet@nationwidechildrens.org

Principal Investigator

Mark Ranalli, MD

PRINCIPAL_INVESTIGATOR

Nationwide Children's Hospital

Study Locations (Sites)

Nationwide Children's Hospital

Columbus, Ohio, 43205

United States

Collaborators and Investigators

Sponsor: Nationwide Children's Hospital

Mark Ranalli, MD, PRINCIPAL_INVESTIGATOR, Nationwide Children's Hospital

Study Record Dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Registration Dates

Study Start Date2022-09-01

Study Completion Date2025-12

Study Record Updates

Study Start Date2022-09-01

Study Completion Date2025-12

Terms related to this study

Additional Relevant MeSH Terms

Relapsed Neuroblastoma
Refractory Neuroblastoma