Sean J Hipp1, Stewart Goldman2, Aradhana Kaushal3, Andra Krauze4, Deborah Citrin5, John Glod6, Kim Walker6, Joanna H Shih7, Hema Sethumadhavan6, Keith O'Neill6, James H Garvin8, Julia Glade-Bender8,9, Matthias A Karajannis9,10, Mark P Atlas11, Arman Odabas6, Louis T Rodgers6, Cody J Peer12, Jason Savage5, Kevin A Camphausen5, Roger J Packer13, W Douglas Figg6, Katherine E Warren6,14. 1. Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX, 78234, USA. sean.j.hipp.mil@mail.mil. 2. Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA. 3. Department of Radiation Medicine, University of Kentucky College of Medicine, Lexington, KY, USA. 4. Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, BC, Canada. 5. Radiation Oncology Branch, National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA. 6. National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA. 7. Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA. 8. Columbia University Med Center, New York, NY, USA. 9. Memorial Sloan Kettering Cancer Center, New York, NY, USA. 10. New York University Langone Medical Center, New York, NY, USA. 11. The Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, NY, USA. 12. Clinical Pharmacology Program, National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA. 13. Children's National Hospital, Washington, DC, USA. 14. Dana Farber Cancer Institute, Boston, MA, USA.
Abstract
PURPOSE: This study was performed to determine the maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D) of the immunomodulatory agent, lenalidomide, when administered daily during 6 weeks of radiation therapy to children with newly diagnosed diffuse intrinsic pontine glioma (DIPG) or high-grade glioma (HGG) PATIENTS & METHODS: Children and young adults < 22 years of age with newly diagnosed disease and no prior chemotherapy or radiation therapy were eligible. Children with HGG were required to have an inoperable or incompletely resected tumor. Eligible patients received standard radiation therapy to a prescription dose of 54-59.4 Gy, with concurrent administration of lenalidomide daily during radiation therapy in a standard 3 + 3 Phase I dose escalation design. Following completion of radiation therapy, patients had a 2-week break followed by maintenance lenalidomide at 116 mg/m2/day × 21 days of a 28-day cycle. RESULTS: Twenty-nine patients (age range 4-19 years) were enrolled; 24 were evaluable for dose finding (DIPG, n = 13; HGG, n = 11). The MTD was not reached at doses of lenalidomide up to 116 mg/m2/day. Exceptional responses were noted in DIPG and malignant glioma (gliomatosis cerebri) notably at higher dose levels and at higher steady state plasma concentrations. The primary toxicity was myelosuppression. CONCLUSION: The RP2D of lenalidomide administered daily during radiation therapy is 116 mg/m2/day. Children with malignant gliomas tolerate much higher doses of lenalidomide during radiation therapy compared to adults. This finding is critical as activity was observed primarily at higher dose levels suggesting a dose response.
PURPOSE: This study was performed to determine the maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D) of the immunomodulatory agent, lenalidomide, when administered daily during 6 weeks of radiation therapy to children with newly diagnosed diffuse intrinsic pontine glioma (DIPG) or high-grade glioma (HGG) PATIENTS & METHODS:Children and young adults < 22 years of age with newly diagnosed disease and no prior chemotherapy or radiation therapy were eligible. Children with HGG were required to have an inoperable or incompletely resected tumor. Eligible patients received standard radiation therapy to a prescription dose of 54-59.4 Gy, with concurrent administration of lenalidomide daily during radiation therapy in a standard 3 + 3 Phase I dose escalation design. Following completion of radiation therapy, patients had a 2-week break followed by maintenance lenalidomide at 116 mg/m2/day × 21 days of a 28-day cycle. RESULTS: Twenty-nine patients (age range 4-19 years) were enrolled; 24 were evaluable for dose finding (DIPG, n = 13; HGG, n = 11). The MTD was not reached at doses of lenalidomide up to 116 mg/m2/day. Exceptional responses were noted in DIPG and malignant glioma (gliomatosis cerebri) notably at higher dose levels and at higher steady state plasma concentrations. The primary toxicity was myelosuppression. CONCLUSION: The RP2D of lenalidomide administered daily during radiation therapy is 116 mg/m2/day. Children with malignant gliomas tolerate much higher doses of lenalidomide during radiation therapy compared to adults. This finding is critical as activity was observed primarily at higher dose levels suggesting a dose response.
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Authors: Howard A Fine; Lyndon Kim; Paul S Albert; J Paul Duic; Hilary Ma; Wei Zhang; Tanyifor Tohnya; William D Figg; Cheryl Royce Journal: Clin Cancer Res Date: 2007-12-01 Impact factor: 12.531