Donor Natural Killer Cells, Cyclophosphamide, and Etoposide in Treating Children and Young Adults With Relapsed or Refractory Solid Tumors

  • STATUS
    Recruiting
  • End date
    Dec 1, 2022
  • participants needed
    38
  • sponsor
    M.D. Anderson Cancer Center
Updated on 14 February 2022
cancer
white blood cell count
measurable disease
gilbert's syndrome
glomerular filtration rate
metastasis
tumor cells
pulse oximetry
solid tumor
alopecia

Summary

This phase I trial studies the side effects and best dose of cord blood-derived expanded allogeneic natural killer cells (donor natural killer [NK] cells) and how well they work when given together with cyclophosphamide and etoposide in treating children and young adults with solid tumors that have come back (relapsed) or that do not respond to treatment (refractory). NK cells, white blood cells important to the immune system, are donated/collected from cord blood collected at birth from healthy babies and grown in the lab. Drugs used in chemotherapy, such as cyclophosphamide and etoposide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving NK cells together with cyclophosphamide and etoposide may work better in treating children and young adults with solid tumors.

Description

PRIMARY OBJECTIVE:

I. Determine the safety, maximum tolerated dose and/or recommended phase II dose of cord blood-derived expanded allogeneic natural killer cells (expanded allogeneic cord donor natural killer [NK] cells) following chemotherapy.

SECONDARY OBJECTIVES:

I. Determine the persistence of adoptively-transferred cord NK cells after solid tumor directed chemotherapy.

II. Preliminarily define the antitumor activity to adoptively transferred NK cells following the study preparative regimen in the confines of a phase I study.

III. Determine the immunophenotype and function of the infused NK cell product. IV. Preliminarily evaluate for any correlate of phenotype, killer cell immunoglobulin-like receptor (kir) haplotype, and function with overall response.

OUTLINE: This is a dose escalation study of cord blood derived allogeneic NK cells.

Patients receive cyclophosphamide intravenously (IV) once daily (QD) over 30 minutes and etoposide IV QD over 60 minutes on days 1-5 in the absence of unacceptable toxicity. Patients then receive cord blood derived allogeneic NK cells IV on day 8.

After completion of study treatment, patients are followed up at 3-4 days, and then every week for 30 days.

Details
Condition Recurrent Cutaneous Melanoma, Recurrent Lip and Oral Cavity Carcinoma, Recurrent Malignant Endocrine Neoplasm, Recurrent Malignant Female Reproductive System Neoplasm, Recurrent Malignant Male Reproductive System Neoplasm, Recurrent Malignant Mesothelioma, Recurrent Malignant Neoplasm of Multiple Primary Sites, Recurrent Malignant Oral Neoplasm, Recurrent Malignant Pharyngeal Neoplasm, Recurrent Malignant Skin Neoplasm, Recurrent Malignant Soft Tissue Neoplasm, Recurrent Malignant Solid Neoplasm, Recurrent Malignant Thyroid Gland Neoplasm, Recurrent Malignant Urinary System Neoplasm, Refractory Cutaneous Melanoma, Refractory Malignant Bone Neoplasm, Refractory Malignant Endocrine Neoplasm, Refractory Malignant Female Reproductive System Neoplasm, Refractory Malignant Male Reproductive System Neoplasm, Refractory Malignant Mesothelioma, Refractory Malignant Neoplasm of Multiple Primary Sites, Refractory Malignant Oral Neoplasm, Refractory Malignant Pharyngeal Neoplasm, Refractory Malignant Skin Neoplasm, Refractory Malignant Soft Tissue Neoplasm, Refractory Malignant Solid Neoplasm, Refractory Malignant Thyroid Gland Neoplasm, Refractory Malignant Urinary System Neoplasm
Treatment cyclophosphamide, etoposide, MESNA, NK Cell Infusion, Cord Blood-derived Expanded Allogeneic Natural Killer Cells
Clinical Study IdentifierNCT03420963
SponsorM.D. Anderson Cancer Center
Last Modified on14 February 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

SCREENING: Patients with relapsed or refractory solid tumors and without known curative therapy or therapy proven to proven to prolong survival with acceptable quality of life
SCREENING: Patients older than 21 years must have a solid tumor considered by study doctor to be of the childhood cancer type
SCREENING: Performance level as measured by Karnofsky >= 60% for patients > 16 years of age or Lansky >= 60% for patients =< 16 years of age
SCREENING: Documentation of measurable or evaluable non-measurable disease
SCREENING: At least one documented histological verification of solid tumor diagnosis. Can be from original diagnosis or more recent
ENROLLMENT: Patient must have fully recovered (i.e. returned to baseline) from the clinically significant acute treatment-related toxicities of all prior treatments prior to beginning treatment on this protocol with exceptions of cytopenias resulting from persistent disease, hearing loss and alopecia
ENROLLMENT: Performance level as measured by Karnofsky >= 60% for patients > 16 years of age or Lansky >= 60% for patients =< 16 years of age
ENROLLMENT: Creatinine clearance >= 60 mL/min/1.73m^2 (calculated by 24 hour [h] urine collection or nuclear glomerular filtration rate [GFR] scan if 24 h collection is not possible) or a serum creatinine based on age and gender as follows
Age, maximum serum creatinine (mg/dL)
month to < 6 months, male 0.4, female 0.4
months to < 1 year, male 0.5, female 0.5
to < 2 years, male 0.6, female 0.6
to < 6 years, male 0.8, female 0.8
to < 10 years, male 1, female 1
to < 13 years, male 1.2, female 1.2
to < 16 years, male 1.5, female 1.4
>= 16 years, male 1.7, female 1.4
ENROLLMENT: Adequate liver function, defined as: total bilirubin =< 2 mg/dl
ENROLLMENT: Adequate liver function, as defined as serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 2.5 x upper limit of normal (ULN) for age (unless Gilbert's disease or abnormal liver function due to primary disease)
ENROLLMENT: Evidence of adequate bone marrow function (defined by absolute neutrophil count >= 750), unless patient has documented tumor metastasis to the bone marrow or other condition that results in cytopenia without abnormal marrow function
ENROLLMENT: Evidence of adequate bone marrow function (defined by platelets >= 50,000), unless patient has documented tumor metastasis to the bone marrow or other condition that results in cytopenia without abnormal marrow function
ENROLLMENT: Pulmonary symptoms controlled by medication and pulse oximetry >= 92% on room air
ENROLLMENT: Sexually active males and females of childbearing potential must agree to use a form of contraception considered effective and medically acceptable by the investigator. (Non-childbearing potential defined as pre-menarche, greater than one year post-menopausal or surgically sterilized)
ENROLLMENT: Confirmation that a cord blood donor which is matched with the recipient at a 4, 5, or 6/6 human leukocyte antigen (HLA) class I (serological) and HLA class II (molecular) antigens
ENROLLMENT: Signed informed consent and if applicable pediatric assent

Exclusion Criteria

SCREENING: Primary tumors of the central nervous system
SCREENING: Chronic corticosteroid dependence that is unable to be weaned to discontinue
SCREENING: Determined by study doctor that patient is unlikely to meet inclusion criteria after screening
ENROLLMENT: Uncontrolled arrhythmias or uncontrolled symptoms of cardiac disease noted by screening history and physical. Patients with known cardiac dysfunction should have an ejection fraction (EF) > 40% documented by echocardiogram (ECHO)
ENROLLMENT: Patients where the burden of pulmonary metastasis, location, or bulkiness of disease may cause high morbidity if localized swelling such as causing uncontrolled symptoms, oxygen dependence, or location near a major bronchi as determined by investigator
ENROLLMENT: Pregnant females
ENROLLMENT: Any uncontrolled systemic infection
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