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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
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 mont...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Impact Journals LLC
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4278323/ https://www.ncbi.nlm.nih.gov/pubmed/25587555 |
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author | Corrales-Medina, Fernando F. 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 |
author_facet | Corrales-Medina, Fernando F. 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 |
author_sort | Corrales-Medina, Fernando F. |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-4278323 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Impact Journals LLC |
record_format | MEDLINE/PubMed |
spelling | pubmed-42783232015-01-15 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 F. 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 Oncoscience Research Paper 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. Impact Journals LLC 2014-07-27 /pmc/articles/PMC4278323/ /pubmed/25587555 Text en © 2014 Corrales-Medina et al. http://creativecommons.org/licenses/by/2.5/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Paper Corrales-Medina, Fernando F. 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 |
title | 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 |
title_full | 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 |
title_fullStr | 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 |
title_full_unstemmed | 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 |
title_short | 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 |
title_sort | 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 |
topic | Research Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4278323/ https://www.ncbi.nlm.nih.gov/pubmed/25587555 |
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