Dasatinib With Ifosfamide, Carboplatin, Etoposide: A Pediatric Phase I/II Trial
Dasatinib With Ifosfamide, Carboplatin, Etoposide: A Pediatric Phase I/II Trial
RATIONALE: Dasatinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs in chemotherapy, such as ifosfamide, carboplatin, and etoposide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving dasatinib together with ifosfamide, carboplatin, and etoposide may kill more tumor cells.
PURPOSE: This phase I/II trial is studying the side effects and best dose of dasatinib when given together with ifosfamide, carboplatin, and etoposide and to see how well they work in treating young patients with metastatic or recurrent malignant solid tumors.
OBJECTIVES:
Primary
Secondary
OUTLINE: This is a multicenter, phase I, dose-escalation study of dasatinib followed by a phase II study. Patients enrolled in phase II are stratified according to disease.
Patients receive D-ICE comprising oral dasatinib twice daily on days 5-21, ifosfamide IV over 1 hour and etoposide phosphate IV over 1 hour on days 1-5, and carboplatin IV over 1 hour on days 1 and 2. Treatment repeats every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Patients then undergo radiotherapy and/or surgery (consolidation therapy) after 2, 4, or 6 courses of D-ICE. After completion of consolidation therapy, patients receive oral dasatinib twice daily for up to 6 months in the absence of disease progression or unacceptable toxicity.
Tumor tissue and peripheral blood mononuclear cell (PBMC) samples are collected periodically for correlative laboratory studies. PBMCs are analyzed by western blotting for total and phospho-SRC, phospho-FAK, and other relevant biomarkers. Tumor tissue samples are analyzed by IHC for total and phospho-SRC, phospho-FAK, phospho-STAT3, phospho-KIT, and phospho-PDGFR, EPHA2, and VEGF. Tumor tissue samples are also analyzed by microarray gene expression profiling to define a potential molecular signature or gene expression pattern that may predict response to dasatinib.
After completion of study treatment, patients are followed periodically.
DISEASE CHARACTERISTICS:
Histologically confirmed malignant solid tumor that did not respond to or relapsed after standard first-line chemotherapy or other antineoplastic therapy (if the standard therapy for the tumor is generally recognized to be beneficial)
Meets one of the following criteria:
Phase I: Relapsed/refractory malignant solid tumor (excluding CNS tumors)
Phase II: Patients are stratified according to one of the following diagnoses:
Stratum A: Relapsed sarcoma (rhabdomyosarcoma, osteosarcoma, or Ewing sarcoma)
Stratum B: Other relapsed solid tumors, including any of the following:
Stratum C: Newly diagnosed, poor-risk metastatic sarcoma consisting of unresectable pulmonary metastases (≥ 6 nodules) and/or disease involving multiple bones or other organs NOTE: *Patients with recurrent primary CNS tumors are eligible for the phase II portion of this study provided there are no significant intratumoral bleeding toxicities seen in either COG pediatric phase I studies of dasatinib or the phase I portion of this study
Radiographically measurable disease (Phase II)
No bone marrow involvement (Phase I)
PATIENT CHARACTERISTICS:
Lansky performance status (PS) 50-100% (patients 1-16 years of age) or Karnofsky PS 50-100% (patients > 16 years of age)
Life expectancy ≥ 8 weeks
ANC > 1,000/μL
Platelet count > 75,000/μL
Creatinine clearance or GFR ≥ 70 mL/min OR creatinine < 1.5 times upper limit of normal (ULN)
Bilirubin < 1.5 times ULN for age
SGOT or SGPT < 2.5 times ULN for age (< 5 times ULN if liver involvement by tumor)
Ejection fraction normal by MUGA OR shortening fraction > 28%
No evidence of cardiac arrhythmias requiring therapy
Corrected QTc interval < 450 msecs
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
Able to comply with the safety monitoring requirements of this study
No uncontrolled infection
No swallowing dysfunction that would preclude oral medication intake
No history of significant bleeding disorder unrelated to cancer, including the following:
PRIOR CONCURRENT THERAPY:
See Disease Characteristics
Recovered from all prior therapy
At least 7 days since prior and no concurrent drugs known to cause Torsades de Pointes, including the following:
At least 3 weeks since prior chemotherapy (6 weeks for nitrosourea-containing therapy)
At least 3 months since prior ifosfamide, carboplatin, and/or etoposide phosphate in the exact combination and dosage as administered in this study
More than 7 days since prior filgrastim (G-CSF), sargramostim (GM-CSF), or interleukin-11
More than 14 days since prior pegfilgrastim
More than 30 days since prior epoetin alfa
No prior cranial-spinal irradiation at doses > 2,400 cGy
No prior radiotherapy, including total-body irradiation, to > 50% of the bone marrow space
No other concurrent investigational drugs or anticancer agents
No concurrent enzyme-inducing anticonvulsants (e.g., phenytoin, phenobarbital, felbamate, primdone, oxcarbazepine, or carbamazepine)
No concurrent anti-thrombotic or anti-platelet agents (e.g., warfarin, heparin, low molecular weight heparin, aspirin, ibuprofen, or other NSAIDs)
No concurrent CYP3A4 inhibitors (e.g., itraconazole, ketoconazole, or voriconazole)
No concurrent highly active antiretroviral therapy for HIV-positive patients
No concurrent St. John's wort
No IV bisphosphonates during the first 8 weeks of dasatinib therapy