Clinical characteristics and outcomes of pediatric oncology patients with aggressive biology enrolled in phase I clinical trials designed for adults: The university of Texas MD Anderson cancer center experience

Fernando Corrales-Medina, Cynthia Herzog, Kenneth Hess, Daniela Egas-Bejar, David S. Hong, Gerald Falchook, Pete Anderson, Cesar Nunez, Winston W. Huh, Aung Naing, Apostolia M. Tsimberidou, Jennifer Wheler, Sarina Piha Paul, Filip Janku, Eugenie S. Kleinerman, Razelle Kurzrock, Vivek Subbiah

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Children (patients ≤ 18 years of age) are not usually included on pharmaceutical industry sponsored Phase I trials. Methods: We reviewed the medical records of 40 patients ≤ 18 years treated in ≥ 1 phase I trial at MD Anderson. Results: The median OS was 8.5 months (95% CI, 5.5-13.2 months). In the multivariate analysis, age ≥15 only predicted increased OS (P = 0.0065), and >3 prior therapies (P = 0.053) predicted decreased OS. The median PFS was 2.8 months (95% CI, 2.3-4.1 months). In the multivariate analysis, independent factors that predicted increased PFS were age ≥15 years (P <0.001) and prior radiation therapy (P = 0.049); performance status >1 (P <0.001) and >3 prior therapies (P = 0.002) predicted decreased PFS. RMH score ≥ 2 and MDACC score ≥ 3 were associated with decreased median OS (P = 0.029 and P = 0.031 respectively). Conclusions: It is feasible to conduct phase I studies in pediatric patients based on adult protocols. In the era of targeted therapy more trials should allow pediatric patients earlier in the drug development especially if deemed safe in adults in early phase trials. Translational Relevance: Most pharmaceutical industry sponsored trials exclude patients less than 18 years in phase I clinical trials. Even in the era of targeted therapy pediatric patients usually have to wait for most phases of trials to be completed in adults before being allowed to enroll in clinical trials of new therapies, even in the advanced metastatic and relapsed setting. Some investigator initiated phase 1 trials of combinations of US FDA approved agents allow patients less than 18 years. We report the preliminary analyses of the outcomes of pediatric patients enrolled in phase I studies initially designed for adults, but allowing for enrollment of patients under 18.

Original languageEnglish (US)
Pages (from-to)522-530
Number of pages9
JournalOncoscience
Volume1
Issue number7
DOIs
StatePublished - 2014
Externally publishedYes

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Clinical Trials, Phase I
Pediatrics
Neoplasms
Drug Industry
Multivariate Analysis
Therapeutics
Proxy
Medical Records
Research Personnel
Clinical Trials

Keywords

  • Children
  • Phase I trials
  • Prognostic scores
  • Targeted therapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Clinical characteristics and outcomes of pediatric oncology patients with aggressive biology enrolled in phase I clinical trials designed for adults : The university of Texas MD Anderson cancer center experience. / Corrales-Medina, Fernando; Herzog, Cynthia; Hess, Kenneth; Egas-Bejar, Daniela; Hong, David S.; Falchook, Gerald; Anderson, Pete; Nunez, Cesar; Huh, Winston W.; Naing, Aung; Tsimberidou, Apostolia M.; Wheler, Jennifer; Paul, Sarina Piha; Janku, Filip; Kleinerman, Eugenie S.; Kurzrock, Razelle; Subbiah, Vivek.

In: Oncoscience, Vol. 1, No. 7, 2014, p. 522-530.

Research output: Contribution to journalArticle

Corrales-Medina, F, Herzog, C, Hess, K, Egas-Bejar, D, Hong, DS, Falchook, G, Anderson, P, Nunez, C, Huh, WW, Naing, A, Tsimberidou, AM, Wheler, J, Paul, SP, Janku, F, Kleinerman, ES, Kurzrock, R & Subbiah, V 2014, 'Clinical characteristics and outcomes of pediatric oncology patients with aggressive biology enrolled in phase I clinical trials designed for adults: The university of Texas MD Anderson cancer center experience', Oncoscience, vol. 1, no. 7, pp. 522-530. https://doi.org/10.18632/oncoscience.68
Corrales-Medina, Fernando ; Herzog, Cynthia ; Hess, Kenneth ; Egas-Bejar, Daniela ; Hong, David S. ; Falchook, Gerald ; Anderson, Pete ; Nunez, Cesar ; Huh, Winston W. ; Naing, Aung ; Tsimberidou, Apostolia M. ; Wheler, Jennifer ; Paul, Sarina Piha ; Janku, Filip ; Kleinerman, Eugenie S. ; Kurzrock, Razelle ; Subbiah, Vivek. / Clinical characteristics and outcomes of pediatric oncology patients with aggressive biology enrolled in phase I clinical trials designed for adults : The university of Texas MD Anderson cancer center experience. In: Oncoscience. 2014 ; Vol. 1, No. 7. pp. 522-530.
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abstract = "Background: Children (patients ≤ 18 years of age) are not usually included on pharmaceutical industry sponsored Phase I trials. Methods: We reviewed the medical records of 40 patients ≤ 18 years treated in ≥ 1 phase I trial at MD Anderson. Results: The median OS was 8.5 months (95{\%} CI, 5.5-13.2 months). In the multivariate analysis, age ≥15 only predicted increased OS (P = 0.0065), and >3 prior therapies (P = 0.053) predicted decreased OS. The median PFS was 2.8 months (95{\%} CI, 2.3-4.1 months). In the multivariate analysis, independent factors that predicted increased PFS were age ≥15 years (P <0.001) and prior radiation therapy (P = 0.049); performance status >1 (P <0.001) and >3 prior therapies (P = 0.002) predicted decreased PFS. RMH score ≥ 2 and MDACC score ≥ 3 were associated with decreased median OS (P = 0.029 and P = 0.031 respectively). Conclusions: It is feasible to conduct phase I studies in pediatric patients based on adult protocols. In the era of targeted therapy more trials should allow pediatric patients earlier in the drug development especially if deemed safe in adults in early phase trials. Translational Relevance: Most pharmaceutical industry sponsored trials exclude patients less than 18 years in phase I clinical trials. Even in the era of targeted therapy pediatric patients usually have to wait for most phases of trials to be completed in adults before being allowed to enroll in clinical trials of new therapies, even in the advanced metastatic and relapsed setting. Some investigator initiated phase 1 trials of combinations of US FDA approved agents allow patients less than 18 years. We report the preliminary analyses of the outcomes of pediatric patients enrolled in phase I studies initially designed for adults, but allowing for enrollment of patients under 18.",
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AU - Hess, Kenneth

AU - Egas-Bejar, Daniela

AU - Hong, David S.

AU - Falchook, Gerald

AU - Anderson, Pete

AU - Nunez, Cesar

AU - Huh, Winston W.

AU - Naing, Aung

AU - Tsimberidou, Apostolia M.

AU - Wheler, Jennifer

AU - Paul, Sarina Piha

AU - Janku, Filip

AU - Kleinerman, Eugenie S.

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AU - Subbiah, Vivek

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N2 - Background: Children (patients ≤ 18 years of age) are not usually included on pharmaceutical industry sponsored Phase I trials. Methods: We reviewed the medical records of 40 patients ≤ 18 years treated in ≥ 1 phase I trial at MD Anderson. Results: The median OS was 8.5 months (95% CI, 5.5-13.2 months). In the multivariate analysis, age ≥15 only predicted increased OS (P = 0.0065), and >3 prior therapies (P = 0.053) predicted decreased OS. The median PFS was 2.8 months (95% CI, 2.3-4.1 months). In the multivariate analysis, independent factors that predicted increased PFS were age ≥15 years (P <0.001) and prior radiation therapy (P = 0.049); performance status >1 (P <0.001) and >3 prior therapies (P = 0.002) predicted decreased PFS. RMH score ≥ 2 and MDACC score ≥ 3 were associated with decreased median OS (P = 0.029 and P = 0.031 respectively). Conclusions: It is feasible to conduct phase I studies in pediatric patients based on adult protocols. In the era of targeted therapy more trials should allow pediatric patients earlier in the drug development especially if deemed safe in adults in early phase trials. Translational Relevance: Most pharmaceutical industry sponsored trials exclude patients less than 18 years in phase I clinical trials. Even in the era of targeted therapy pediatric patients usually have to wait for most phases of trials to be completed in adults before being allowed to enroll in clinical trials of new therapies, even in the advanced metastatic and relapsed setting. Some investigator initiated phase 1 trials of combinations of US FDA approved agents allow patients less than 18 years. We report the preliminary analyses of the outcomes of pediatric patients enrolled in phase I studies initially designed for adults, but allowing for enrollment of patients under 18.

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