A Phase 2 interventional study of Nifurtimox and Cyclophosphamide in Neuroblastoma and Medulloblastoma, sponsored by Giselle Sholler. Completed at 15 sites in United States. Open to participants aged Up to 21 Years. Per ClinicalTrials.gov, last updated 2024-08-06.
Sponsored by Giselle Sholler · Phase 2, Interventional, and Treatment
The purpose of this study is to determine whether nifurtimox in combination with cyclophosphamide and topotecan are effective in the treatment of relapsed or refractory neuroblastoma and medulloblastoma.
This study is being done to test the effect of a drug, nifurtimox, against neuroblastoma and medulloblastoma in children. Nifurtimox is a drug that has been used in South America for many years to treat a parasitic disease known as Chagas Disease. It is not approved by the Food and Drug Administration for routine use in neuroblastoma or medulloblastoma in the United States, but limited early observations suggest that nifurtimox may have anti tumor activity for neuroblastoma and medulloblastoma.
From the preliminary trials of nifurtimox we have determined a safely tolerated dose of nifurtimox to use in neuroblastoma patients (30mg/kg/day). The dose determined in the Phase I study to be safe, will be the dose used for this study. From clinical experience in South America, we know that children can tolerate nifurtimox when given by mouth, and it appears to have no long-term side effects when used to treat Chagas Disease. Based on our laboratory and animal studies, we believe that drug levels similar to those used to treat Chagas Disease may shrink/kill neuroblastoma cells, especially when combined with other chemotherapy drugs. We do not know whether nifurtimox will shrink/kill tumor cells effectively in children. Therefore, the major goal of the study is to learn if nifurtimox in combination with other chemotherapy drugs is effective in shrinking/killing neuroblastoma and medulloblastoma cells.
625 studies on the registry are indexed under Neuroblastoma; 122 are open to participants now.
This study's enrollment of 112 is above the median of 32 across 475 interventional studies indexed under Neuroblastoma.
Browse Neuroblastoma studies →Giselle Sholler is the lead sponsor of 22 studies on the registry; 6 are open to participants now.
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Measurable disease, including at least one of the following:
Exclusion Criteria:
Compensation for travel related expenses may be available
Drug: Nifurtimox · Drug: Cyclophosphamide · Drug: Topotecan
30mg/kg/day PO divided into TID dosing q day
Also known as: Lampit
250 mg/m2/dose in normal saline, IV, infused over 30 minutes on days 1-5 of each cycle.
Also known as: Cytoxan
0.75mg/m2/dose, in normal saline, IV, infused over 30 minutes on days 1-5 of each cycle.
Also known as: Hycamptin
Number of Participants With Related Adverse Events as a Measure of Safety and Tolerability
Test the safety of nifurtimox in children with relapsed or refractory neuroblastoma or medulloblastoma in combination with cyclophosphamide/topotecan
Time frame: 2 years
Best Radiological Response in Participants Using the RECIST Criteria
Test the efficacy of nifurtimox in children with relapsed or refractory neuroblastoma or medulloblastoma in combination with cyclophosphamide/topotecan Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions, Overall Best Response assessed by CT or MRI, MIBG, and Bone Marrow: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions, bone marrow with CR, and MIBG with CR/PR. Overall Response (OR) = CR + PR.
Time frame: 2 years
| Milestone | Nifurtimox |
|---|---|
| Started | 112 |
| Completed | 76 |
| Not completed | 36 |
Test the safety of nifurtimox in children with relapsed or refractory neuroblastoma or medulloblastoma in combination with cyclophosphamide/topotecan
| Participants | Nifurtimox |
|---|---|
| Number of Participants With Related Adverse Events as a Measure of Safety and Tolerability | 45 |
Test the efficacy of nifurtimox in children with relapsed or refractory neuroblastoma or medulloblastoma in combination with cyclophosphamide/topotecan Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions, Overall Best Response assessed by CT or MRI, MIBG, and Bone Marrow: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions, bone marrow with CR, and MIBG with CR/PR. Overall Response (OR) = CR + PR.
| Participants | Nifurtimox |
|---|---|
| Complete Response | 7 |
| Partial Response | 11 |
| Stable Disease | 35 |
| Progressive Disease | 23 |
Collected over From first dose of Nifurtimox through to 30 days after last dose, an average of 8 months. Additionally all events deemed related to Nifurtimox were followed past the 30 days to resolution or baseline.. Non-serious events are listed at a 2% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Nifurtimox | 19/110 (17.3%) | 25/110 (22.7%) | 45/110 (40.9%) |
| Event | Nifurtimox |
|---|---|
| Other (Progressive Disease)Neoplasms benign, malignant and unspecified (incl cysts and polyps) | 17/110 |
| SeizureNervous system disorders | 3/110 |
| SepsisInfections and infestations | 2/110 |
| Febrile neutropeniaBlood and lymphatic system disorders | 2/110 |
| AnorexiaGastrointestinal disorders | 1/110 |
| Nausea and vomitingGastrointestinal disorders | 1/110 |
| Bladder ThrombosisRenal and urinary disorders | 1/110 |
| Tooth PainGeneral disorders | 1/110 |
| Respiratory DistressRespiratory, thoracic and mediastinal disorders | 1/110 |
| Aspiration pneumoniaRespiratory, thoracic and mediastinal disorders | 1/110 |
| Event | Nifurtimox |
|---|---|
| AtaxiaNervous system disorders | 10/110 |
| AnemiaBlood and lymphatic system disorders | 9/110 |
| LeukopeniaBlood and lymphatic system disorders | 7/110 |
| NeutropeniaBlood and lymphatic system disorders | 7/110 |
| ThrombocytopeniaBlood and lymphatic system disorders | 7/110 |
| Motor Neuropathy/WeaknessNervous system disorders | 7/110 |
| AnorexiaGastrointestinal disorders | 7/110 |
| ConfusionNervous system disorders | 6/110 |
| NauseaGastrointestinal disorders | 6/110 |
| VomitingGastrointestinal disorders | 6/110 |
Number of subjects that signed consent and had baseline information collected
| Age, Continuous(years) | Nifurtimox |
|---|---|
| Mean | 5.5 (1.1 to 21.5) |
| Sex: Female, Male(Participants) | Nifurtimox |
|---|---|
| Female | 39 |
| Male | 73 |
| Ethnicity (NIH/OMB)(Participants) | Nifurtimox |
|---|---|
| Hispanic or Latino | 16 |
| Not Hispanic or Latino | 93 |
| Unknown or Not Reported | 3 |
| Race (NIH/OMB)(Participants) | Nifurtimox |
|---|---|
| American Indian or Alaska Native | 1 |
| Asian | 4 |
| Native Hawaiian or Other Pacific Islander | 2 |
| Black or African American | 11 |
| White | 89 |
| More than one race | 2 |
| Unknown or Not Reported | 3 |
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Giselle Sholler