Alisertib in Treating Young Patients With Recurrent or Refractory Solid Tumors or Leukemia

This phase II trial is studying the side effects of and how well alisertib works in treatingyoung patients with relapsed or refractory solid tumors or leukemia. Alisertib may stop thegrowth of cancer cells by blocking some of the enzymes needed for cell growth.

Stanford is currently not accepting patients for this trial. For more information, please contact Nadeem Mukhtar at 650497881 .

Lead Sponsor:

Children's Oncology Group

Collaborator: National Cancer Institute (NCI)

Stanford Investigator(s):

• Neyssa Marina

Intervention(s):

• Drug: alisertib
• Other: pharmacological study
• Other: laboratory biomarker analysis

Phase:

Phase 2

Eligibility

Inclusion Criteria:

   - Patients must have had histologic verification of malignancy at original diagnosis or
   at relapse, to include any of the following malignancies (no other histology is
   eligible):

      - Neuroblastoma- measurable

      - Neuroblastoma- MIBG evaluable

      - Rhabdomyosarcoma

      - Osteosarcoma

      - Ewing sarcoma/Peripheral PNET

      - Non-RMS soft tissue sarcoma

      - Hepatoblastoma

      - Malignant germ cell tumor

      - Wilms tumor

      - Acute lymphoblastic leukemia

      - Acute myelogenous leukemia

      - Rhabdoid malignancy

   - Disease status for solid tumor patients:

      - Patients must have radiographically measurable disease (with the exception of
      neuroblastoma)

      - Measurable disease is defined as the presence of at least one lesion on magnetic
      resonance imaging (MRI) or computed tomography (CT) scan that can be accurately
      measured with the longest diameter a minimum of 20 mm in at least one dimension;
      for spiral CT, measurable disease is defined as a minimum diameter of 10 mm in
      at least one dimension

      - Note: The following do not qualify as measurable disease:

         - Malignant fluid collections (e.g., ascites, pleural effusions)

         - Bone marrow infiltration

         - Lesions detected by nuclear medicine studies (e.g., bone, gallium or
         positron emission tomography [PET] scans)

         - Elevated tumor markers in plasma or cerebrospinal fluid (CSF)

         - Previously irradiated lesions that have not demonstrated clear progression
         post radiation

      - Patients with neuroblastoma who do not have measurable disease but have MIBG+
      evaluable disease are eligible

   - Disease status for leukemia patients:

      - Patients with leukemia must be recurrent or refractory to at least two prior
      induction or treatment regimens, in addition to the following criteria:

      - Acute lymphoid leukemia:

         - 25% blasts in the bone marrow (M3 bone marrow), excluding patients with
         known central nervous system (CNS) disease

      - Acute myeloid leukemia according to FAB classification

         - ≥ 5 % blasts in the bone marrow (M2/M3 bone marrow); excluding patients
         with known CNS disease

   - Rhabdoid tumors:

      - To be eligible for enrollment in the rhabdoid tumors stratum, the patient must
      have a solid tumor where the institutional pathological evaluation of the tumor
      at initial diagnosis or relapse has confirmed:

         - Morphology and immunophenotypic panel consistent with rhabdoid tumor
         (required)

         - Loss of SWI/SNF related, matrix associated, actin dependent regulator of
         chromatin, subfamily b, member 1 (INI1) confirmed by immunohistochemistry,
         or

         - Molecular confirmation of tumor-specific bi-allelic INI1 loss/mutation if
         INI1 immunohistochemistry is not available; note that molecular
         confirmation of tumor-specific bi-allelic INI1 loss/mutation is encouraged
         in cases where INI1 immunohistochemistry is equivocal

   - Patients must have a Lansky or Karnofsky performance status score of ≥ 50,
   corresponding to Eastern Cooperative Oncology Group (ECOG) categories 0, 1 or 2; use
   Karnofsky for patients > 16 years of age and Lansky for patients ≤ 16 years of age;
   Note: Patients who are unable to walk because of paralysis, but who are up in a
   wheelchair, will be considered ambulatory for the purpose of assessing the
   performance score

   - Patients must have fully recovered from the acute toxic effects of all prior
   chemotherapy, immunotherapy, or radiotherapy prior to study enrollment

   - Myelosuppressive chemotherapy:

      - Solid tumors:

         - Patients with solid tumors must not have received myelosuppressive
         chemotherapy within 3 weeks of enrollment onto this study (6 weeks if prior
         nitrosourea)

      - Leukemia:

         - Patients with leukemia who relapse while receiving standard maintenance
         therapy will not be required to have a waiting period before enrollment
         onto this study

         - Patients who relapse while they are not receiving standard maintenance
         therapy must have completely recovered from all acute toxic effects of
         chemotherapy, immunotherapy or radiotherapy prior to study enrollment; at
         least 14 days must have elapsed since the completion of cytotoxic therapy,
         with the exception of hydroxyurea

         - Note: cytoreduction with hydroxyurea can be initiated and continued for up
         to 24 hours prior to the start of MLN8237

   - At least 7 days must have elapsed since the completion of therapy with a growth
   factor; at least 14 days must have elapsed after receiving pegfilgrastim

   - At least 7 days must have elapsed since completion of therapy with a biologic agent;
   for agents that have known adverse events occurring beyond 7 days after
   administration, this period prior to enrollment must be extended beyond the time
   during which adverse events are known to occur

   - At least 3 half-lives must have elapsed since prior therapy that included a
   monoclonal antibody

   - ≥ 2 weeks must have elapsed since local palliative radiation therapy (XRT) (small
   port); ≥ 6 weeks must have elapsed since treatment with therapeutic doses of MIBG; ≥
   6 months must have elapsed if prior craniospinal XRT was received, if ≥ 50% of the
   pelvis was irradiated, or if total body irradiation (TBI) was received; ≥ 6 weeks
   must have elapsed if other substantial bone marrow irradiation was given

   - No evidence of active graft vs. host disease and ≥ 3 months must have elapsed since
   transplant

   - For patients with solid tumors without bone marrow involvement:

      - Peripheral absolute neutrophil count (ANC) >= 1000/mm^3

      - Platelet count >= 100,000/mm^3 (transfusion independent, defined as not
      receiving platelet transfusions within a 7 day period prior to enrollment)

      - Hemoglobin > 8.0 g/dL (may receive red blood cell [RBC] transfusions)

   - For patients with solid tumors and known bone marrow metastatic disease:

      - Peripheral absolute neutrophil count (ANC) ≥ 750/mm^3

      - Platelet count ≥ 50,000/mm^3

      - Hemoglobin ≥ 8.0 g/dL

      - Transfusions are permitted to meet both the platelet and hemoglobin criteria;
      patients must not be known to be refractory to red blood cell or platelet
      transfusions

   - Patients with leukemia must not be known to be refractory to red blood cell or
   platelet transfusions

   - Creatinine clearance or radioisotope glomerular filtration rate (GFR) 70 mL/min/1.73
   m^2 or a serum creatinine based on age/gender as follows:

      - 1 to < 2 years: 0.6

      - 2 to < 6 years: 0.8

      - 6 to < 10 years: 1

      - 10 to < 13 years: 1.2

      - 13 to < 16 years: 1.5 (male), 1.4 (female)

      - >= 16 years: 1.7 (male), 1.4 (female)

   - Total bilirubin =< 1.5 x upper limit of normal (ULN) for age

   - Serum glutamic 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

   - Serum albumin ≥ 2 g/dL

   - All patients and/or their parents or legal guardians must sign a written informed
   consent

Exclusion Criteria:

   - Patients who are pregnant or breast-feeding are not eligible for this study; negative
   pregnancy tests must be obtained in girls who are post-menarchal; males or females of
   reproductive potential may not participate unless they have agreed to use an
   effective contraceptive method for the duration of study therapy; breastfeeding women
   are excluded

   - Growth factors that support platelet or white cell number or function must not have
   been administered within the 7 days prior to enrollment (14 days if pegfilgrastim)

   - Patients requiring corticosteroids who have not been on a stable or decreasing dose
   of corticosteroid for the 7 days prior to enrollment are not eligible

   - Patients who are currently receiving another investigational drug are not eligible

   - Patients who are currently receiving other anti-cancer agents are not eligible

   - Use of daily benzodiazepine therapy excludes a patient from being eligible because of
   the potential benzodiazepine-like effects of MLN8237

   - Patients who are currently receiving digoxin, cyclosporine, tacrolimus, or sirolimus
   are not eligible

   - Patients who are unable to swallow tablets are not eligible

   - Patients who have an uncontrolled infection are not eligible

   - Leukemia patients with CNS disease are not eligible

   - Patients who in the opinion of the investigator may not be able to comply with the
   safety monitoring requirements of the study are not eligible

Ages Eligible for Study

1 Year - 21 Years

Genders Eligible for Study

Both