Irinotecan Hydrochloride, Temozolomide, and Dinutuximab With or Without Eflornithine in Treating Patients With Relapsed or Refractory Neuroblastoma
Study Details
Study Description
Brief Summary
This phase II trial studies how well irinotecan hydrochloride, temozolomide, and dinutuximab work with or without eflornithine in treating patients with neuroblastoma that has come back (relapsed) or that isn't responding to treatment (refractory). Drugs used in chemotherapy, such as irinotecan hydrochloride and temozolomide, 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. Immunotherapy with monoclonal antibodies, such as dinutuximab, may induce changes in the body's immune system and may interfere with the ability of tumor cells to grow and spread. Eflornithine blocks the production of chemicals called polyamines that are important in the growth of cancer cells. Giving eflornithine with irinotecan hydrochloride, temozolomide, and dinutuximab, may work better in treating patients with relapsed or refractory neuroblastoma.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 2 |
Detailed Description
PRIMARY OBJECTIVE:
- To determine whether administration of eflornithine hydrochloride (eflornithine [DFMO]) in combination with dinutuximab, irinotecan hydrochloride (irinotecan) and temozolomide results in an improved response rate compared to dinutuximab, irinotecan and temozolomide in patients with relapsed or refractory neuroblastoma and therefore is a therapeutic regimen worthy of further testing in patients with newly-diagnosed high-risk neuroblastoma.
SECONDARY OBJECTIVES:
-
To compare progression-free survival and overall survival between patients receiving dinutuximab, irinotecan and temozolomide with and without the addition of DFMO.
-
To define the toxicity profile of DFMO administered with dinutuximab, irinotecan and temozolomide.
EXPLORATORY OBJECTIVES:
-
To characterize the immune and cytokine profiles of patients treated with DFMO/chemotherapy/dinutuximab combination and correlate with response to therapy.
-
To evaluate GD2 levels in tumor cells from patient bone marrow samples and correlate with response to therapy.
-
To explore whether the addition of DFMO to the dinutuximab and chemotherapy backbone affects pain as determined by patient report and opiate usage.
OUTLINE: Patients are randomized to 1 of 2 regimens.
REGIMEN A: Patients receive temozolomide orally (PO), via nasogastric (NG), or gastric (G) tube on days 1-5, irinotecan hydrochloride intravenously (IV) over 90 minutes on days 1-5, dinutuximab IV over 10-20 hours on days 2-5, and sargramostim subcutaneously (SC) or IV over 2 hours on days 6-12 of a 21-day cycle. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.
REGIMEN B: Patients receive eflornithine PO, via NG, or G tube on days -6 to 7 and days 15-21 of cycle 1 and days 1-7 and 15-21 of subsequent cycles, temozolomide PO, via NG, or G tube on days 1-5, irinotecan hydrochloride intravenously (IV) over 90 minutes on days 1-5, dinutuximab IV over 10-20 hours on days 2-5, and sargramostim SC or IV over 2 hours on days 6-12. Treatment lasts 28 days for cycle 1 and then every 21 days for subsequent cycles up to 6 cycles in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 30 days and periodically for 5 years.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: Regimen A (chemotherapy, dinutuximab, sargramostim) Patients receive temozolomide PO, via NG, or G tube on days 1-5, irinotecan hydrochloride IV over 90 minutes on days 1-5, dinutuximab IV over 10-20 hours on days 2-5, and sargramostim SC or IV over 2 hours on days 6-12 of a 21-day cycle. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. |
Biological: Dinutuximab
Given IV
Other Names:
Drug: Irinotecan Hydrochloride
Given IV
Other Names:
Biological: Sargramostim
Given SC or IV
Other Names:
Drug: Temozolomide
Given PO or via NG or G tube
Other Names:
|
| Experimental: Regimen B (eflornithine, chemotherapy, dinutuximab) Patients receive eflornithine PO, via NG, or G tube on days -6 to 7 and days 15-21 of cycle 1 and days 1-7 and 15-21 of subsequent cycles, temozolomide PO, via NG, or G tube on days 1-5, irinotecan hydrochloride IV over 90 minutes on days 1-5, dinutuximab IV over 10-20 hours on days 2-5, and sargramostim SC or IV over 2 hours on days 6-12. Treatment duration is 28 days for cycle 1 and then every 21 days in subsequent cycles for up to 6 cycles in the absence of disease progression or unacceptable toxicity. |
Biological: Dinutuximab
Given IV
Other Names:
Drug: Eflornithine Hydrochloride
Given PO or via NG or G tube
Other Names:
Drug: Irinotecan Hydrochloride
Given IV
Other Names:
Biological: Sargramostim
Given SC or IV
Other Names:
Drug: Temozolomide
Given PO or via NG or G tube
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Response rate [After every 2 cycles, for a maximum of 6 cycles of treatment]
Responders are defined as patients who achieve a >= minor response (MR) per the International Neuroblastoma Response Criteria (INRC) as their best overall response by the end of 6 cycles. The response rate to treatment will be calculated among all eligible patients, including placement of a 95% confidence interval on the response rate.
Secondary Outcome Measures
- Progression-free survival (PFS) [Up to 5 years]
Kaplan-Meier method will be used to estimate progression-free survival (PFS). PFS time will be calculated from the time of randomization to the occurrence of relapse, progressive disease, or death. Patients without a PFS event will be censored at the time of last follow-up.
- Overall survival (OS) [Up to 5 years]
Kaplan-Meier method will be used to estimate overall survival (OS). OS time will be calculated from the time of randomization to the occurrence of death. Patients still alive will be censored at the time of last follow-up.
- Incidence of adverse events >= Grade 3 (Regimen B) [Up to 5 years]
The percentage of patients on Regimen B with at least one Grade 3 or higher toxicity will be calculated, assessed with Common Terminology Criteria for Adverse Events version 5.0.
Other Outcome Measures
- Immune and cytokine profiles [Up to 6 cycles]
Will be assessed by exploring the relationship between response (responder versus [vs.] non-responder) after 6 cycles on Regimen B with serum cytokine levels (IL1, IL6, tumor necrosis factor [TNF]-alpha, IFN-gamma, etc.), tumor resident immune cells (natural killer [NK] cells, tumor-associated macrophages [TAMS], tumor infiltrating lymphocyte [TILS]), and critical immune cell suppressing proteins (B7H3, PDL-1) using Fisher's exact test for categorical and Wilcoxon rank-sum test for continuous factors.
- GD2 levels in tumor cells from bone marrow samples [Up to 5 years]
Will be correlated with response (responder vs. non-responder) after 6 cycles using Fisher's exact test for categorical and the Wilcoxon rank-sum test for continuous factors.
- Patient reported pain and opiate usage [Up to 5 years]
The occurrence of pain on each regimen as reported by patient report and opiate use will be descriptively summarized. Descriptive and summary statistics will be used to describe the scores from the Faces Pain Scale-Revised during the dinutuximab infusion and on day 1 with irinotecan and temozolomide alone for each arm separately. Confidence intervals will be constructed for the mean and frequency estimates. The day 1 patient reported outcome data are expected to be similar between the 2 regimens, while differences during or after completion of treatment may be observed.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Patients must have had histologic verification of neuroblastoma or ganglioneuroblastoma or demonstration of neuroblastoma cells in the bone marrow with elevated urinary catecholamines (i.e. > 2 x upper limit of normal [ULN]), at the time of initial diagnosis.
-
For the purposes of this study, aggressive multidrug chemotherapy is defined as chemotherapy including 2 or more agents that must include an alkylating agent and a platinum-containing compound as intended to treat high-risk disease. The doses of chemotherapy must be comparable to those used in frontline high-risk neuroblastoma therapies (examples include A3973, ANBL0532, ANBL09P1, ANBL12P1, and ANBL1531).
Patients must have ONE of the following:
-
First episode of recurrent high-risk disease following completion of aggressive multi-drug frontline high-risk therapy.
-
First episode of progressive high-risk disease during aggressive multi-drug frontline therapy.
-
Primary resistant/refractory disease (less than partial response by International Neuroblastoma Response Criteria [INRC]) detected at the conclusion of at least 4 cycles of aggressive multidrug induction chemotherapy on or according to a high-risk neuroblastoma protocol (examples include A3973, ANBL0532, ANBL09P1, ANBL12P1, ANBL1531, etc.).
-
Patients must have at least ONE of the following at the time of enrollment:
-
Measurable tumor on magnetic resonance imaging (MRI) or computed tomography (CT) scan. Measurable is defined as >= 10 mm in at least one dimension on spiral/helical CT that is metaiodobenzylguanidine (MIBG) avid or demonstrates increased fludeoxyglucose F-18 (FDG) uptake on positron emission tomography (PET) scan.
-
MIBG-avid lesion detected on MIBG scan with positive uptake at a minimum of one site. This site must represent disease recurrence after completion of therapy, progressive disease on therapy, or refractory disease during induction.
-
Patients with resistant/refractory soft tissue disease that is not MIBG avid or does not demonstrate increased FDG uptake on PET scan must undergo biopsy to document the presence of viable neuroblastoma. Biopsy is not required for patients who have a new site of soft tissue disease (radiographic evidence of disease progression) regardless of whether progression occurs while receiving therapy or after completion of therapy.
-
Patients with bone marrow disease only will be eligible if they have more than 5% disease involvement (documented neuroblastoma cells) in at least one sample from bilateral bone marrow biopsies.
-
Note: Patients with elevated catecholamines (i.e. > 2 x ULN) only are NOT eligible for this study.
-
Patients must have a performance status corresponding to Eastern Cooperative Oncology Group (ECOG) scores of 0, 1 or 2. Use Karnofsky for patients > 16 years of age and Lansky for patients =< 16 years of age.
-
Primary refractory/resistant patients must have received at least 4 cycles of frontline high-risk chemotherapy. Frontline therapy may also have included surgery, chemotherapy, autologous stem cell transplantation (SCT) +/- MIBG, immunotherapy, radiotherapy, and retinoids but must NOT have received second line therapy for resistant/refractory, relapsed, or progressive disease. Patients who received intensified therapy for poor induction response or refractory disease (e.g. MIBG) will be considered to have received second line therapy and will not be eligible.
-
At least 14 days must have elapsed since completion of myelosuppressive therapy.
-
Anti-cancer agents not known to be myelosuppressive (e.g. not associated with reduced platelet or absolute neutrophil count [ANC] counts): >= 7 days after the last dose of agent.
-
Antibodies: >= 21 days must have elapsed from infusion of last dose of antibody, and toxicity related to prior antibody therapy must be recovered to grade =< 1.
-
No interim time prior to study entry is required following prior radiation therapy (RT) for non-target lesions. However, patients must not have received radiation for a minimum of 4 weeks prior to study entry at the site of any lesion that will be identified as a target lesion to measure tumor response. Lesions that have been previously radiated cannot be used as target lesions unless there is radiographic evidence of progression at the site following radiation or a biopsy done following radiation shows viable neuroblastoma. Palliative radiation while on study is not permitted.
-
Patients are eligible >= 6 weeks after autologous stem cell transplants or stem cell infusions (including stem cell infusions given as supportive care following 131 I-MIBG therapy) as long as hematologic and other eligibility criteria have been met.
-
Patients are eligible >= 6 weeks after therapeutic 131 I-MIBG provided that all other eligibility criteria are met.
-
Subjects who have previously received anti-GD2 monoclonal antibodies with or without retinoids for biologic therapy are eligible unless they have had progressive disease while receiving prior anti-GD2 therapy or progressed/relapsed within 3 months of receiving anti-GD2 therapy. However, eligible patients may NOT have received anti-GD2 monoclonal antibodies in combination with chemotherapy.
-
Subjects who have received autologous marrow infusions or autologous stem cell infusions that were purged using monoclonal antibody linked to beads are eligible.
-
Subjects who have previously received DFMO are eligible for this study provided they have not had progressive disease while receiving DFMO or progressed/relapsed within 3 months of completing DFMO.
-
Patients must not have received long-acting myeloid growth factors (e.g. pegfilgrastim) within 14 days of entry on this study. Seven days must have elapsed since administration of a short-acting myeloid growth factor.
-
For patients with solid tumors (without marrow involvement) including status post SCT: peripheral absolute neutrophil count (ANC) >= 750/uL (within 7 days prior to enrollment).
-
For patients with solid tumors (without marrow involvement) including status post SCT: platelet count >= 75,000/uL (transfusion independent) (within 7 days prior to enrollment).
-
Patients known to have bone marrow involvement with neuroblastoma are eligible provided that minimum ANC and transfusion independent platelet count criteria are met (as above). However, these patients are not evaluable for hematological toxicity.
-
Creatinine clearance or radioisotope GFR >= 70 mL/min/1.73 m^2 or a serum creatinine based on age/gender as follows:
-
1 to < 2 years (male 0.6 mg/dL, female 0.6 mg/dL)
-
2 to < 6 years (male 0.8 mg/dL, female 0.8 mg/dL)
-
6 to < 10 years (male 1 mg/dL, female 1 mg/dL)
-
10 to < 13 years (male 1.2 mg/dL, female 1.2 mg/dL)
-
13 to < 16 years (male 1.5 mg/dL, female 1.4 mg/dL)
-
= 16 years (male 1.7 mg/dL, female 1.4 mg/dL) (within 7 days prior to enrollment).
-
Total bilirubin =< 1.5 x ULN for age (within 7 days prior to enrollment).
-
Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 5.0 x ULN for age (=< 225 U/L). For the purpose of this study, the ULN for SGPT is 45 U/L (within 7 days prior to enrollment).
-
Shortening fraction of >= 27% by echocardiography (ECHO) (within 7 days prior to enrollment).
-
Ejection fraction of >= 50% by ECHO or gated radionuclide study (within 7 days prior to enrollment).
-
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. Normal pulmonary function tests in patients who are capable of cooperating with testing (including diffusion capacity of the lung for carbon monoxide [DLCO)] are required if there is a clinical indication for determination. For patients who do not have respiratory symptoms, full pulmonary function tests (PFTs) are NOT required.
-
Patients with a history of central nervous system (CNS) disease must have no clinical or radiological evidence of active CNS disease at the time of study enrollment.
-
Patients with seizure disorders may be enrolled if seizures are well controlled on anti-convulsants.
-
CNS toxicity =< grade 2.
Exclusion Criteria:
-
Men and women of childbearing potential and their partners must agree to use adequate contraception while enrolled on this study. Based on the established teratogenic potential of alkylating agents, pregnant women will be excluded from this study. Because of potential risks to breastfed infants due to drug metabolites that could be excreted in breast milk, female patients who are lactating must agree to stop breastfeeding or will otherwise be excluded from this study. Females of childbearing potential must have a negative pregnancy test to be eligible for this study.
-
Patients with only elevated catecholamines (i.e. > 2 x ULN) are NOT eligible for this study.
-
Patients must have been off pharmacologic doses of systemic steroids for at least 7 days prior to enrollment. Patients who require or are likely to require pharmacologic doses of systemic corticosteroids while receiving treatment on this study are ineligible. The only exception is for patients known to require 2 mg/kg or less of hydrocortisone (or an equivalent dose of an alternative corticosteroid) as premedication for blood product administration in order to avoid allergic transfusion reactions. The use of conventional doses of inhaled steroids for the treatment of asthma is permitted, as is the use of physiologic doses of steroids for patients with known adrenal insufficiency.
Patients on any other immunosuppressive medications (e.g. cyclosporine, tacrolimus) are not eligible.
-
Patients must not have received prior treatment with irinotecan and temozolomide.
-
Patients must not have received enzyme-inducing anticonvulsants including phenytoin, phenobarbital, or carbamazepine for at least 7 days prior to study enrollment. Patients receiving non-enzyme inducing anticonvulsants such as gabapentin, valproic acid, or levetiracetam will be eligible.
-
Patients who have received drugs that are strong inducers or inhibitors of CYP3A4 within 7 days prior to study enrollment are not eligible.
-
Patients must not have been diagnosed with myelodysplastic syndrome or with any malignancy other than neuroblastoma.
-
Patients with symptoms of congestive heart failure are not eligible.
-
Patients must not have >= grade 2 diarrhea.
-
Patients who are unable to tolerate oral/nasogastric/gastrostomy medications will not be eligible for this trial. Additionally, patients with significant malabsorption will not be eligible for this trial.
-
Patients must not have uncontrolled infection.
-
Patients with a history of grade 4 allergic reactions to anti-GD2 antibodies or reactions that required permanent discontinuation of the anti-GD2 therapy are not eligible.
-
Patients with a significant intercurrent illness (any ongoing serious medical problem unrelated to cancer or its treatment) that is not covered by the detailed exclusion criteria and that is expected to interfere with the action of study agents or to significantly increase the severity of the toxicities experienced from study treatment are not eligible.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Children's Hospital of Alabama | Birmingham | Alabama | United States | 35233 |
| 2 | Arkansas Children's Hospital | Little Rock | Arkansas | United States | 72202-3591 |
| 3 | Kaiser Permanente Downey Medical Center | Downey | California | United States | 90242 |
| 4 | Children's Hospital Los Angeles | Los Angeles | California | United States | 90027 |
| 5 | Cedars Sinai Medical Center | Los Angeles | California | United States | 90048 |
| 6 | Valley Children's Hospital | Madera | California | United States | 93636 |
| 7 | Kaiser Permanente-Oakland | Oakland | California | United States | 94611 |
| 8 | Children's Hospital of Orange County | Orange | California | United States | 92868 |
| 9 | Lucile Packard Children's Hospital Stanford University | Palo Alto | California | United States | 94304 |
| 10 | University of California Davis Comprehensive Cancer Center | Sacramento | California | United States | 95817 |
| 11 | Rady Children's Hospital - San Diego | San Diego | California | United States | 92123 |
| 12 | UCSF Medical Center-Mission Bay | San Francisco | California | United States | 94158 |
| 13 | Children's Hospital Colorado | Aurora | Colorado | United States | 80045 |
| 14 | Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center | Denver | Colorado | United States | 80218 |
| 15 | Connecticut Children's Medical Center | Hartford | Connecticut | United States | 06106 |
| 16 | Yale University | New Haven | Connecticut | United States | 06520 |
| 17 | Alfred I duPont Hospital for Children | Wilmington | Delaware | United States | 19803 |
| 18 | MedStar Georgetown University Hospital | Washington | District of Columbia | United States | 20007 |
| 19 | Golisano Children's Hospital of Southwest Florida | Fort Myers | Florida | United States | 33908 |
| 20 | University of Florida Health Science Center - Gainesville | Gainesville | Florida | United States | 32610 |
| 21 | Memorial Regional Hospital/Joe DiMaggio Children's Hospital | Hollywood | Florida | United States | 33021 |
| 22 | Nemours Children's Clinic-Jacksonville | Jacksonville | Florida | United States | 32207 |
| 23 | University of Miami Miller School of Medicine-Sylvester Cancer Center | Miami | Florida | United States | 33136 |
| 24 | Nicklaus Children's Hospital | Miami | Florida | United States | 33155 |
| 25 | Arnold Palmer Hospital for Children | Orlando | Florida | United States | 32806 |
| 26 | Nemours Children's Hospital | Orlando | Florida | United States | 32827 |
| 27 | Johns Hopkins All Children's Hospital | Saint Petersburg | Florida | United States | 33701 |
| 28 | Saint Mary's Hospital | West Palm Beach | Florida | United States | 33407 |
| 29 | Children's Healthcare of Atlanta - Egleston | Atlanta | Georgia | United States | 30322 |
| 30 | Memorial Health University Medical Center | Savannah | Georgia | United States | 31404 |
| 31 | Kapiolani Medical Center for Women and Children | Honolulu | Hawaii | United States | 96826 |
| 32 | Saint Luke's Cancer Institute - Boise | Boise | Idaho | United States | 83712 |
| 33 | Lurie Children's Hospital-Chicago | Chicago | Illinois | United States | 60611 |
| 34 | University of Illinois | Chicago | Illinois | United States | 60612 |
| 35 | University of Chicago Comprehensive Cancer Center | Chicago | Illinois | United States | 60637 |
| 36 | Loyola University Medical Center | Maywood | Illinois | United States | 60153 |
| 37 | Saint Jude Midwest Affiliate | Peoria | Illinois | United States | 61637 |
| 38 | Riley Hospital for Children | Indianapolis | Indiana | United States | 46202 |
| 39 | Saint Vincent Hospital and Health Care Center | Indianapolis | Indiana | United States | 46260 |
| 40 | Blank Children's Hospital | Des Moines | Iowa | United States | 50309 |
| 41 | University of Iowa/Holden Comprehensive Cancer Center | Iowa City | Iowa | United States | 52242 |
| 42 | University of Kentucky/Markey Cancer Center | Lexington | Kentucky | United States | 40536 |
| 43 | Norton Children's Hospital | Louisville | Kentucky | United States | 40202 |
| 44 | Children's Hospital New Orleans | New Orleans | Louisiana | United States | 70118 |
| 45 | Ochsner Medical Center Jefferson | New Orleans | Louisiana | United States | 70121 |
| 46 | Eastern Maine Medical Center | Bangor | Maine | United States | 04401 |
| 47 | Maine Children's Cancer Program | Scarborough | Maine | United States | 04074 |
| 48 | University of Maryland/Greenebaum Cancer Center | Baltimore | Maryland | United States | 21201 |
| 49 | Sinai Hospital of Baltimore | Baltimore | Maryland | United States | 21215 |
| 50 | Johns Hopkins University/Sidney Kimmel Cancer Center | Baltimore | Maryland | United States | 21287 |
| 51 | Dana-Farber Cancer Institute | Boston | Massachusetts | United States | 02215 |
| 52 | C S Mott Children's Hospital | Ann Arbor | Michigan | United States | 48109 |
| 53 | Children's Hospital of Michigan | Detroit | Michigan | United States | 48201 |
| 54 | Wayne State University/Karmanos Cancer Institute | Detroit | Michigan | United States | 48201 |
| 55 | Michigan State University Clinical Center | East Lansing | Michigan | United States | 48824-7016 |
| 56 | Helen DeVos Children's Hospital at Spectrum Health | Grand Rapids | Michigan | United States | 49503 |
| 57 | Bronson Methodist Hospital | Kalamazoo | Michigan | United States | 49007 |
| 58 | Children's Hospitals and Clinics of Minnesota - Minneapolis | Minneapolis | Minnesota | United States | 55404 |
| 59 | University of Minnesota/Masonic Cancer Center | Minneapolis | Minnesota | United States | 55455 |
| 60 | University of Mississippi Medical Center | Jackson | Mississippi | United States | 39216 |
| 61 | Children's Mercy Hospitals and Clinics | Kansas City | Missouri | United States | 64108 |
| 62 | Washington University School of Medicine | Saint Louis | Missouri | United States | 63110 |
| 63 | Mercy Hospital Saint Louis | Saint Louis | Missouri | United States | 63141 |
| 64 | Children's Hospital and Medical Center of Omaha | Omaha | Nebraska | United States | 68114 |
| 65 | University of Nebraska Medical Center | Omaha | Nebraska | United States | 68198 |
| 66 | University Medical Center of Southern Nevada | Las Vegas | Nevada | United States | 89102 |
| 67 | Sunrise Hospital and Medical Center | Las Vegas | Nevada | United States | 89109 |
| 68 | Alliance for Childhood Diseases/Cure 4 the Kids Foundation | Las Vegas | Nevada | United States | 89135 |
| 69 | Summerlin Hospital Medical Center | Las Vegas | Nevada | United States | 89144 |
| 70 | Renown Regional Medical Center | Reno | Nevada | United States | 89502 |
| 71 | Hackensack University Medical Center | Hackensack | New Jersey | United States | 07601 |
| 72 | Morristown Medical Center | Morristown | New Jersey | United States | 07960 |
| 73 | Albany Medical Center | Albany | New York | United States | 12208 |
| 74 | Montefiore Medical Center - Moses Campus | Bronx | New York | United States | 10467 |
| 75 | Roswell Park Cancer Institute | Buffalo | New York | United States | 14263 |
| 76 | NYU Winthrop Hospital | Mineola | New York | United States | 11501 |
| 77 | The Steven and Alexandra Cohen Children's Medical Center of New York | New Hyde Park | New York | United States | 11040 |
| 78 | NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center | New York | New York | United States | 10032 |
| 79 | University of Rochester | Rochester | New York | United States | 14642 |
| 80 | State University of New York Upstate Medical University | Syracuse | New York | United States | 13210 |
| 81 | Carolinas Medical Center/Levine Cancer Institute | Charlotte | North Carolina | United States | 28203 |
| 82 | Duke University Medical Center | Durham | North Carolina | United States | 27710 |
| 83 | Wake Forest University Health Sciences | Winston-Salem | North Carolina | United States | 27157 |
| 84 | Children's Hospital Medical Center of Akron | Akron | Ohio | United States | 44308 |
| 85 | Cincinnati Children's Hospital Medical Center | Cincinnati | Ohio | United States | 45229 |
| 86 | Rainbow Babies and Childrens Hospital | Cleveland | Ohio | United States | 44106 |
| 87 | Cleveland Clinic Foundation | Cleveland | Ohio | United States | 44195 |
| 88 | Nationwide Children's Hospital | Columbus | Ohio | United States | 43205 |
| 89 | Dayton Children's Hospital | Dayton | Ohio | United States | 45404 |
| 90 | ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital | Toledo | Ohio | United States | 43606 |
| 91 | University of Oklahoma Health Sciences Center | Oklahoma City | Oklahoma | United States | 73104 |
| 92 | Oregon Health and Science University | Portland | Oregon | United States | 97239 |
| 93 | Lehigh Valley Hospital-Cedar Crest | Allentown | Pennsylvania | United States | 18103 |
| 94 | Penn State Children's Hospital | Hershey | Pennsylvania | United States | 17033 |
| 95 | Children's Hospital of Philadelphia | Philadelphia | Pennsylvania | United States | 19104 |
| 96 | Children's Hospital of Pittsburgh of UPMC | Pittsburgh | Pennsylvania | United States | 15224 |
| 97 | Rhode Island Hospital | Providence | Rhode Island | United States | 02903 |
| 98 | Prisma Health Richland Hospital | Columbia | South Carolina | United States | 29203 |
| 99 | BI-LO Charities Children's Cancer Center | Greenville | South Carolina | United States | 29605 |
| 100 | Sanford USD Medical Center - Sioux Falls | Sioux Falls | South Dakota | United States | 57117-5134 |
| 101 | East Tennessee Childrens Hospital | Knoxville | Tennessee | United States | 37916 |
| 102 | Saint Jude Children's Research Hospital | Memphis | Tennessee | United States | 38105 |
| 103 | The Children's Hospital at TriStar Centennial | Nashville | Tennessee | United States | 37203 |
| 104 | Vanderbilt University/Ingram Cancer Center | Nashville | Tennessee | United States | 37232 |
| 105 | Dell Children's Medical Center of Central Texas | Austin | Texas | United States | 78723 |
| 106 | Driscoll Children's Hospital | Corpus Christi | Texas | United States | 78411 |
| 107 | Medical City Dallas Hospital | Dallas | Texas | United States | 75230 |
| 108 | UT Southwestern/Simmons Cancer Center-Dallas | Dallas | Texas | United States | 75390 |
| 109 | Cook Children's Medical Center | Fort Worth | Texas | United States | 76104 |
| 110 | Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center | Houston | Texas | United States | 77030 |
| 111 | Children's Hospital of San Antonio | San Antonio | Texas | United States | 78207 |
| 112 | University of Texas Health Science Center at San Antonio | San Antonio | Texas | United States | 78229 |
| 113 | Primary Children's Hospital | Salt Lake City | Utah | United States | 84113 |
| 114 | University of Vermont and State Agricultural College | Burlington | Vermont | United States | 05405 |
| 115 | Children's Hospital of The King's Daughters | Norfolk | Virginia | United States | 23507 |
| 116 | Seattle Children's Hospital | Seattle | Washington | United States | 98105 |
| 117 | Providence Sacred Heart Medical Center and Children's Hospital | Spokane | Washington | United States | 99204 |
| 118 | Mary Bridge Children's Hospital and Health Center | Tacoma | Washington | United States | 98405 |
| 119 | Madigan Army Medical Center | Tacoma | Washington | United States | 98431 |
| 120 | West Virginia University Healthcare | Morgantown | West Virginia | United States | 26506 |
| 121 | University of Wisconsin Carbone Cancer Center | Madison | Wisconsin | United States | 53792 |
| 122 | Children's Hospital of Wisconsin | Milwaukee | Wisconsin | United States | 53226 |
| 123 | John Hunter Children's Hospital | Hunter Regional Mail Centre | New South Wales | Australia | 2310 |
| 124 | Sydney Children's Hospital | Randwick | New South Wales | Australia | 2031 |
| 125 | The Children's Hospital at Westmead | Westmead | New South Wales | Australia | 2145 |
| 126 | Queensland Children's Hospital | South Brisbane | Queensland | Australia | 4101 |
| 127 | Women's and Children's Hospital-Adelaide | North Adelaide | South Australia | Australia | 5006 |
| 128 | Royal Children's Hospital | Parkville | Victoria | Australia | 3052 |
| 129 | Perth Children's Hospital | Perth | Western Australia | Australia | 6009 |
| 130 | CancerCare Manitoba | Winnipeg | Manitoba | Canada | R3E 0V9 |
| 131 | IWK Health Centre | Halifax | Nova Scotia | Canada | B3K 6R8 |
| 132 | McMaster Children's Hospital at Hamilton Health Sciences | Hamilton | Ontario | Canada | L8N 3Z5 |
| 133 | Kingston Health Sciences Centre | Kingston | Ontario | Canada | K7L 2V7 |
| 134 | Children's Hospital | London | Ontario | Canada | N6A 5W9 |
| 135 | Hospital for Sick Children | Toronto | Ontario | Canada | M5G 1X8 |
| 136 | The Montreal Children's Hospital of the MUHC | Montreal | Quebec | Canada | H3H 1P3 |
| 137 | Centre Hospitalier Universitaire Sainte-Justine | Montreal | Quebec | Canada | H3T 1C5 |
| 138 | Centre Hospitalier Universitaire de Quebec | Quebec | Canada | G1V 4G2 | |
| 139 | Starship Children's Hospital | Grafton | Auckland | New Zealand | 1145 |
| 140 | Christchurch Hospital | Christchurch | New Zealand | 8011 | |
| 141 | HIMA San Pablo Oncologic Hospital | Caguas | Puerto Rico | 00726 |
Sponsors and Collaborators
- Children's Oncology Group
- National Cancer Institute (NCI)
Investigators
- Principal Investigator: Margaret E Macy, Children's Oncology Group
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- ANBL1821
- NCI-2018-03377
- ANBL1821
- ANBL1821
- U10CA180886