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RATIONALE: Drugs used in chemotherapy, such as decitabine, doxorubicin, and cyclophosphamide, work in different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells.
PURPOSE: This phase I trial is studying the side effects and best dose of decitabine when given together with doxorubicin and cyclophosphamide in treating children with relapsed or refractory solid tumors or neuroblastoma.
- Determine the maximum tolerated dose of decitabine in combination with doxorubicin and cyclophosphamide in children with relapsed or refractory solid tumors or neuroblastoma.
- Determine the toxic effects of this regimen in these patients.
- Determine whether decitabine induces tumor caspase-8 demethylation and expression in these patients.
- Determine the pharmacokinetics of low-dose decitabine in these patients.
- Determine the biological and clinical response in patients treated with this regimen.
- Compare patterns of peripheral blood gene expression, using gene expression profiling, in patients before and after treatment with decitabine.
OUTLINE: This is a multicenter, dose-escalation study of decitabine.
- Part A (solid tumor patients): Patients receive decitabine IV over 1 hour on days 0-6 and doxorubicin IV over 15 minutes and cyclophosphamide IV over 1 hour on day 7. Patients then receive filgrastim (G-CSF) subcutaneously (SC) beginning on day 8 and continuing until blood counts recover OR pegfilgrastim SC once on day 8 or 9*. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.
Cohorts of 3-6 patients receive escalating doses of decitabine until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.
NOTE: *For patients > 45 kg
- Part B (neuroblastoma patients): Once the MTD is determined for part A, patients are treated as in part A at the MTD .
Patients are followed at 30 days.
PROJECTED ACCRUAL: A total of 15-21 patients will be accrued for this study within 1-2 years.
Primary Purpose: Treatment
filgrastim, pegfilgrastim, cyclophosphamide, decitabine, doxorubicin hydrochloride
Stanford Comprehensive Cancer Center at Stanford University Medical Center
National Cancer Institute (NCI)
Published on BioPortfolio: 2014-07-24T14:33:29-0400
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