Recurrent or Refractory Solid TumorsPhase 1NCT00756340
A Trial of Everolimus and Bevacizumab in Children With Recurrent Solid Tumors
A Phase 1 study testing Bevacizumab and Everolimus in people with Recurrent or Refractory Solid Tumors and CNS Malignancies, run by St. Jude Children's Research Hospital at 1 site in United States.
Trial summary
The main goals of this Phase I study are to learn about the side effects that may occur when everolimus and bevacizumab are given to children and young adults and to find the highest doses of these drugs that can be given together without causing severe side effects. Read more about this study
- Who is it for?
- Ages Up to 21 years
- Conditions the study is for
- Recurrent or Refractory Solid Tumors, CNS Malignancies
- What is being tested?
- Bevacizumab and Everolimus
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 16 participants
- Where
- 1 siteUnited States
- Study dates
- Jul 2008to Sep 2015
- Phase
- Phase 1
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Up to 21 years
- All sexes
- No healthy volunteers
- Child, Adult
Who may be able to join
- Diagnosis: Solid tumor, including central nervous tumors, that is recurrent or refractory to standard therapy or for which standard therapy is not available. All research participants must have a pathologic diagnosis either from their initial presentation, or at the time of recurrence or progression. The requirement for histologic verification may be waived for patients with brainstem glioma and optic pathway glioma.
- Performance Status: Karnofsky > 50% for > 10 years of age; Lansky > 50% for children < 10 years of age. Patients who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered ambulatory for the purposes of assessing performance score.
- Neurologic deficits. Patients with CNS tumors must have stable neurological deficits for a minimum of 1 week prior to study entry.
- Life Expectancy: Must be greater than 8 weeks.
- Prior/Concurrent Therapy: Research participants must have recovered from the acute effects of prior treatment and:
- Chemotherapy: Must not have received myelosuppressive chemotherapy within 3 weeks prior to study entry (6 weeks if prior nitrosurea,).
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- Stem Cell Transplant or Rescue: No evidence of active graft vs. host disease and greater than or equal to 2 months must have elapsed.
- Steroids: Dose should be stable or decreasing for at least one week prior to starting therapy. Corticosteroid therapy is permissible only for the treatment of increased intracranial pressure in patients with malignancies in the CNS or for spinal cord compression. Corticosteroid should be used at the lowest dose to control symptoms and discontinued if possible.
- Must not be receiving tacrolimus or cyclosporine
- Biologic (anti-neoplastic) agent: At least 7 days since the completion of therapy with a biologic agent.
- XRT: Must not have received XRT within 3 months prior to study entry for craniospinal irradiation (>24 Gy) or total body irradiation or if greater than or equal to 50% radiation of pelvis; > 8 weeks for local irradiation to primary tumor; > 2 weeks for focal irradiation for symptomatic metastatic sites.
- Growth factors: Must be off growth factor(s) > 1 week prior to study entry (GCSF, GM CSF, erythropoietin).
- Age: ≤ 21 years.
- Organ Function: Must have adequate organ function and marrow function as defined by the following parameters:
- Bone marrow: peripheral ANC > 1,000/µl, hemoglobin > 8 g/dl (may be transfusion dependent), platelets > 100,000/µ (transfusion independent). (Patients with bone marrow involvement are eligible provided they meet these criteria).
- Hepatic: Bilirubin < 1.5 x institutional upper limit of normal (IULN), SGPT < 3 x IULN.
- Renal: Normal creatinine for age or GFR > 70/ml/min/1.73m2.
- Cardiac: Must have normal EKG and Echocardiogram with shortening fraction > 27% or ejection fraction > 50%.
- Pulmonary: No evidence of dyspnea at rest, no exercise intolerance, and a pulse oximetry > 94% in room air, if there is clinical indication for determination
- Central Nervous System: Patients without seizure disorder OR patients with well-controlled seizure disorder receiving anticonvulsants may be enrolled on this protocol. Anticonvulsants must not be enzyme-inducing (i.e., no barbiturates, phenytoin, carbamazepine, etc, please see Appendix II for a list of drugs that are inducers and inhibitors of CYP3A)
- Informed consent explained to and signed by parent/legal guardian or patient if the patient is ≥ 18 years.
- Patient must begin therapy within 7 calendar days of registration.
- Patient must be able to swallow whole tablets
Who cannot join
- Concurrently receiving any other concomitant anticancer or experimental drug therapy.
- Have ≥ Grade 2 uncontrolled hypertension
- History of a stroke, myocardial infarction, or unstable angina in the previous 6 months
- Evidence of a bleeding diathesis or PT INR>1.5
- Pre-existing Coagulopathy
- Major surgical procedure(s) within previous 4 weeks prior to study enrollment
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- Minor surgical procedures within 7 days prior to study enrollment
- History of an abdominal fistula, GI perforation, or intra-abdominal abscess within previous 6 months.
- A serious, non-healing wound, ulcer, or bone fracture
- In patients with CNS tumors or known CNS metastases, evidence of intracranial or intratumoral hemorrhage on baseline MRI obtained within 14 days prior to study registration.
- If there is proteinuria present on dipstick, patients are excluded if they have >500 mg protein on 24 hour urine collection.
- Require treatment with any of the medications listed in Appendix II (Excluding dexamethasone: Corticosteroid therapy is permissible only for the treatment of increased intracranial pressure in patients with malignancies in the CNS or for spinal cord compression. Corticosteroid should be used at the lowest dose to control symptoms and discontinued if possible).
- Use of H2 antagonists such as ranitidine, cimetidine and proton pump blockers such as omeprazole are permissible only in conjunction with corticosteroids in the setting of increased intracranial pressure or for spinal cord compression, as these drugs interfere with CYP3A4. If patients are given such drugs, they must be taken at least 4 hours after intake of everolimus.
- Have an uncontrolled infection.
- History of infection with the hepatitis B and/or C viruses or positive hepatitis B virus surface antigen and hepatitis C virus antibody.
- Pregnant. Females of childbearing potential must have negative serum or urine pregnancy test within 7 days prior to study entry. The effects of everolimus on the developing human fetus are unknown. However, bevacizumab is known to be teratogenic and detrimental to fetal development in animal models. In addition, bevacizumab may alter corpus luteum development and endometrial proliferation, thereby having a negative effect on fertility. For these reasons, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately and will be removed from the study.
- Breastfeeding. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with everolimus or bevacizumab, breastfeeding should be discontinued if the mother is treated on this study.
- Inability or unwillingness of research participant or legal guardian/representative to give written informed consent.
Trial locations and contacts
1 site in 1 country.
United States1 site
St. Jude Children's Research Hospital
Memphis, Tennessee, 38105
About this study
Official title: A Phase I Trial of RAD001 (Everolimus) and Avastin(R) (Bevacizumab) in Children With Recurrent Solid Tumors
The main goals of this Phase I study are to learn about the side effects that may occur when everolimus and bevacizumab are given to children and young adults and to find the highest doses of these drugs that can be given together without causing severe side effects. Bevacizumab will be given into the vein (IV) over 30-90 minutes every two weeks and everolimus tablets will be given daily by mouth. A cycle of therapy will be four weeks.
Read the detailed description
This is a traditional phase I dose finding study to estimate the maximum tolerated dose (MTD) and describe the dose limiting toxicities (DLT) of the combination of bevacizumab, administered every 2 weeks IV and everolimus administered orally daily to children with recurrent or refractory solid tumors including CNS malignancies. Patients will receive bevacizumab every two weeks IV, and everolimus orally daily. Four consecutive weeks will constitute one course and subsequent courses will immediately follow with no break in the administration of either drug. In the absence of disease progression or unacceptable toxicity, treatment can continue for 2 years. The bevacizumab dose will start at 10 mg/kg. Everolimus will start at 4 mg/m2, 80% of the MTD established in our current phase I trial. A traditional 3+3 dose escalation/de-escalation design will be used to determine the joint MTD for these two agents. Doses to be studied are detailed in the table below. Consistent with the traditional design, we will enroll cohorts of 3 patients at each dose level starting with dose level 1 and will escalate to the next higher dose, if none of these 3 experiences a DLT. If one of 3 patients experiences a DLT at a dose level then 3 more patients will be studied at this level. If none of these 3 experiences a DLT then escalation to the next level will occur. Otherwise the current dose will be considered too toxic and de-escalation will occur. Under this setting, MTD will be the dose level at which 0/3 or 1/6 patient would have experienced DLT and the next dose level is determined to be too toxic.
Exploratory objectives:
- To preliminarily define the antitumor activity of the combination of everolimus and bevacizumab within the confines of a phase I study
- To assess the incidence of PTEN and PI3Kinase pathway activation in recurrent or refractory solid tumors of childhood
- To assess everolimus pharmacokinetics in children, including the effect of concomitant drug therapy (e.g., dexamethasone).
- To explore changes in correlative magnetic resonance imaging in children receiving everolimus and bevacizumab
- To identify additional genes both within and outside of the mTOR pathway that may act as determinants of response to everolimus
- To explore the pharmacogenetic polymorphisms responsible for everolimus disposition (e.g., metabolism and elimination)
- To test the ability of everolimus to inhibit mTOR pathway signaling in patients with recurrent solid tumors including CNS malignancies in peripheral blood mononuclear cells
- To estimate blood levels of VEGF, BFGF, TSP-1, I-CAM, v-CAM and circulating endothelial cells prior to, during therapy and after therapy
- Being tested
- Bevacizumab, Everolimus
- Medical subject headings
- Recurrence, Central Nervous System Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
BevacizumabDrug
Also called Avastin(R)
- Bevacizumab IV every 2 weeks
- Dose Level 0- 8 mg/kg
- Dose Level 1 (starting dose)- 10 mg/kg
- Dose Level 2- 10 mg/kg
EverolimusDrug
Also called RAD001, Afinitor(R)
- Everolimus
- Dose Level 0- 4 mg/m2
- Dose level 1 (starting dose)- 4 mg/m2
- Dose Level 2- 5 mg/m2
| Study group | Role | What they receive |
|---|---|---|
| 1 | Experimental | * Dose Level 0, Bevacizumab IV every 2 weeks 8 mg/kg, Everolimus 4 mg/m^2
* Dose Level 1 (starting dose), Bevacizumab IV every 2 weeks 10 mg/kg, Everolimus 4 mg/m^2
* Dose Level 2, Bevacizumab IV every 2 weeks 10 mg/kg, Everolimus 5 mg/m^2 Receives: Drug: Bevacizumab; Drug: Everolimus |
What is being measured
The primary outcome is the main question the study is designed to answer.
To estimate the MTD and describe the DLT of the combination of bevacizumab, administered every 2 weeks IV and everolimus administered orally daily to children with recurrent or refractory solid tumors including CNS malignancies
Measured: Within 30 days per subject
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted22 Sep 2008 (estimated)
- Study startJul 2008
- Primary completionSep 2015
- Study completionSep 2015
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Recurrent or Refractory Solid TumorsStudies of the same condition, open and under way.
- More trials run by St. Jude Children's Research HospitalThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 1
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 16 participants (actual)
Sponsor and investigators
- Lead sponsor
- St. Jude Children's Research Hospital
- Sponsor type
- University, hospital or other
- Collaborators
- Novartis Pharmaceuticals
- Responsible party
- Sponsor
- Investigators
- Victor Santana, MD, Principal investigator, St. Jude Children's Research Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00756340
- Sponsor's protocol ID
- RADBEV
- Other IDs
- NCI-2011-01149
- Status last verified
- Oct 2015
- First submitted
- 18 Sep 2008
- Last updated
- 14 Oct 2015
- Results posted
- No
- Data monitoring committee
- No
Publications
Santana VM, Sahr N, Tatevossian RG, Jia S, Campagne O, Sykes A, Stewart CF, Furman WL, McGregor LM. A phase 1 trial of everolimus and bevacizumab in children with recurrent solid tumors. Cancer. 2020 Apr 15;126(8):1749-1757. doi: 10.1002/cncr.32722. Epub 2020 Jan 22.
PubMed 31967673
Study at a glance
From the registry record, last updated by the sponsor on 14 Oct 2015. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Phase I Trial of RAD001 (Everolimus) and Avastin(R) (Bevacizumab) in Children With Recurrent Solid Tumors
- ClinicalTrials.gov ID
- NCT00756340
- Acronym / sponsor ID
- RADBEV
- Phase
- Phase 1
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 16 participants (actual)
- Lead sponsor
- St. Jude Children's Research HospitalUniversity, hospital or other
- Collaborators
- Novartis Pharmaceuticals
- Study start
- Jul 2008
- Primary completion
- Sep 2015 (actual)
- Study completion
- Sep 2015 (actual)
- First posted
- 22 Sep 2008 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The main goals of this Phase I study are to learn about the side effects that may occur when everolimus and bevacizumab are given to children and young adults and to find the highest doses of these drugs that can be given together without causing severe side effects. Bevacizumab will be given into the vein (IV) over 30-90 minutes every two weeks and everolimus tablets will be given daily by mouth. A cycle of therapy will be four weeks.
Detailed description
This is a traditional phase I dose finding study to estimate the maximum tolerated dose (MTD) and describe the dose limiting toxicities (DLT) of the combination of bevacizumab, administered every 2 weeks IV and everolimus administered orally daily to children with recurrent or refractory solid tumors including CNS malignancies. Patients will receive bevacizumab every two weeks IV, and everolimus orally daily. Four consecutive weeks will constitute one course and subsequent courses will immediately follow with no break in the administration of either drug. In the absence of disease progression or unacceptable toxicity, treatment can continue for 2 years. The bevacizumab dose will start at 10 mg/kg. Everolimus will start at 4 mg/m2, 80% of the MTD established in our current phase I trial. A traditional 3+3 dose escalation/de-escalation design will be used to determine the joint MTD for these two agents. Doses to be studied are detailed in the table below. Consistent with the traditional design, we will enroll cohorts of 3 patients at each dose level starting with dose level 1 and will escalate to the next higher dose, if none of these 3 experiences a DLT. If one of 3 patients experiences a DLT at a dose level then 3 more patients will be studied at this level. If none of these 3 experiences a DLT then escalation to the next level will occur. Otherwise the current dose will be considered too toxic and de-escalation will occur. Under this setting, MTD will be the dose level at which 0/3 or 1/6 patient would have experienced DLT and the next dose level is determined to be too toxic.
Exploratory objectives:
- To preliminarily define the antitumor activity of the combination of everolimus and bevacizumab within the confines of a phase I study
- To assess the incidence of PTEN and PI3Kinase pathway activation in recurrent or refractory solid tumors of childhood
- To assess everolimus pharmacokinetics in children, including the effect of concomitant drug therapy (e.g., dexamethasone).
- To explore changes in correlative magnetic resonance imaging in children receiving everolimus and bevacizumab
- To identify additional genes both within and outside of the mTOR pathway that may act as determinants of response to everolimus
- To explore the pharmacogenetic polymorphisms responsible for everolimus disposition (e.g., metabolism and elimination)
- To test the ability of everolimus to inhibit mTOR pathway signaling in patients with recurrent solid tumors including CNS malignancies in peripheral blood mononuclear cells
- To estimate blood levels of VEGF, BFGF, TSP-1, I-CAM, v-CAM and circulating endothelial cells prior to, during therapy and after therapy
Study design
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| 1 | Experimental | Drug: Bevacizumab, Drug: Everolimus* Dose Level 0, Bevacizumab IV every 2 weeks 8 mg/kg, Everolimus 4 mg/m^2 * Dose Level 1 (starting dose), Bevacizumab IV every 2 weeks 10 mg/kg, Everolimus 4 mg/m^2 * Dose Level 2, Bevacizumab IV every 2 weeks 10 mg/kg, Everolimus 5 mg/m^2 |
Who may qualify
- Ages
- Up to 21 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult
Key inclusion criteria (23 listed)
- Diagnosis: Solid tumor, including central nervous tumors, that is recurrent or refractory to standard therapy or for which standard therapy is not available. All research participants must have a pathologic diagnosis either from their initial presentation, or at the time of recurrence or progression. The requirement for histologic verification may be waived for patients with brainstem glioma and optic pathway glioma.
- Performance Status: Karnofsky > 50% for > 10 years of age; Lansky > 50% for children < 10 years of age. Patients who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered ambulatory for the purposes of assessing performance score.
- Neurologic deficits. Patients with CNS tumors must have stable neurological deficits for a minimum of 1 week prior to study entry.
- Life Expectancy: Must be greater than 8 weeks.
- Prior/Concurrent Therapy: Research participants must have recovered from the acute effects of prior treatment and:
Key exclusion criteria (18 listed)
- Concurrently receiving any other concomitant anticancer or experimental drug therapy.
- Have ≥ Grade 2 uncontrolled hypertension
- History of a stroke, myocardial infarction, or unstable angina in the previous 6 months
- Evidence of a bleeding diathesis or PT INR>1.5
- Pre-existing Coagulopathy
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| BevacizumabAlso: Avastin(R)* Bevacizumab IV every 2 weeks * Dose Level 0- 8 mg/kg * Dose Level 1 (starting dose)- 10 mg/kg * Dose Level 2- 10 mg/kg | Drug | 1 |
| EverolimusAlso: RAD001, Afinitor(R)* Everolimus * Dose Level 0- 4 mg/m2 * Dose level 1 (starting dose)- 4 mg/m2 * Dose Level 2- 5 mg/m2 | Drug | 1 |
Primary outcome
To estimate the MTD and describe the DLT of the combination of bevacizumab, administered every 2 weeks IV and everolimus administered orally daily to children with recurrent or refractory solid tumors including CNS malignancies
Time frame: Within 30 days per subject
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 14 Oct 2015.
- Derived from this study: PubMed 31967673Santana VM, Sahr N, Tatevossian RG, Jia S, Campagne O, Sykes A, Stewart CF, Furman WL, McGregor LM. A phase 1 trial of everolimus and bevacizumab in children with recurrent solid tumors. Cancer. 2020 Apr 15;126(8):1749-1757. doi: 10.1002/cncr.32722. Epub 2020 Jan 22.
- St. Jude Children's Research HospitalLink provided by the sponsor.
- Clinical Trials Open at St. JudeLink provided by the sponsor.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Victor Santana, MD principal investigator
St. Jude Children's Research Hospital
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 1 study testing Bevacizumab and Everolimus in people with Recurrent or Refractory Solid Tumors and CNS Malignancies, run by St. Jude Children's Research Hospital at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 23 inclusion and 18 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 14 Oct 2015. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
To estimate the MTD and describe the DLT of the combination of bevacizumab, administered every 2 weeks IV and everolimus administered orally daily to children with recurrent or refractory solid tumors including CNS malignancies (time frame: Within 30 days per subject). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT00756340, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Oct 2015.