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Hipp SJ, Goldman S, Kaushal A, Krauze A, Citrin D, Glod J, Walker K, Shih JH, Sethumadhavan H, O'Neill K, Garvin JH, Glade-Bender J, Karajannis MA, Atlas MP, Odabas A, Rodgers LT, Peer CJ, Savage J, Camphausen KA, Packer RJ, Figg WD, Warren KE. A phase I trial of lenalidomide and radiotherapy in children with diffuse intrinsic pontine gliomas or high-grade gliomas. J Neurooncol 2020; 149:437-445. [PMID: 33040274 DOI: 10.1007/s11060-020-03627-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/18/2020] [Indexed: 11/25/2022]
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.
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Affiliation(s)
- Sean J Hipp
- Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX, 78234, USA.
| | - Stewart Goldman
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Aradhana Kaushal
- Department of Radiation Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Andra Krauze
- Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Deborah Citrin
- Radiation Oncology Branch, National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | - John Glod
- National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | - Kim Walker
- National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | - Joanna H Shih
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Hema Sethumadhavan
- National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | - Keith O'Neill
- National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | | | - Julia Glade-Bender
- Columbia University Med Center, New York, NY, USA.,Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthias A Karajannis
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,New York University Langone Medical Center, New York, NY, USA
| | - Mark P Atlas
- The Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | - Arman Odabas
- National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | - Louis T Rodgers
- National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | - Cody J Peer
- Clinical Pharmacology Program, National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | - Jason Savage
- Radiation Oncology Branch, National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | - Kevin A Camphausen
- Radiation Oncology Branch, National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | | | - W Douglas Figg
- National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | - Katherine E Warren
- National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA.,Dana Farber Cancer Institute, Boston, MA, USA
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