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Active, not recruitingNCT02574728AflacST1502Updated Mar 2, 2026

Sirolimus in Combination With Metronomic Chemotherapy in Children With Recurrent and/or Refractory Solid and CNS Tumors

A Phase 2 interventional study of Sirolimus and Celecoxib in Cancer, sponsored by Emory University. Active, not recruiting at 6 sites in United States. Open to participants aged 12 Months to 30 Years. Per ClinicalTrials.gov, last updated 2026-03-02.

Sponsored by Emory University · Phase 2, Interventional, and Treatment

From the registry’s dates

  • Primary completion was expected by Jun 2026, 5 months ago, but the record still lists the study as active, not recruiting.
Phase
Phase 2
Study type
Interventional
Enrollment
46
Allocation
Not applicable
Ages
12 Months to 30 Years
Sex
All
01

Study summary

This study aims to determine the efficacy of daily sirolimus and celecoxib, with low dose etoposide alternating with cyclophosphamide for pediatric participants with relapsed or refractory tumors.

Read the detailed description

This study aims to learn if the combination of oral sirolimus once daily with celecoxib, and with oral etoposide alternating every 21 days with oral cyclophosphamide (metronomic chemotherapy) is effective in shrinking relapsed or refractory tumors in pediatric participants. In addition, this study seeks to learn the length of time this combination can keep the tumor from growing, learn more about the side effects of sirolimus when used in this combination, and to learn if the sirolimus is working by evaluating blood and tumor tissue.

02

Conditions studied

  • Cancer

Keywords

  • Pediatrics
  • Brain Tumors
  • Medulloblastoma
  • Ependymoma
  • Atypical teratoid rhabdoid tumor (ATRT)
  • Pineoblastoma
  • Germ cell tumors (CNS and non-CNS)
  • Neuroblastoma
  • Osteosarcoma
  • Ewing's Sarcoma
  • Rhabdomyosarcoma
  • Wilms Tumors
  • Soft Tissue Sarcomas
  • Langerhans cell histiocytosis (LCH)
  • Histiocytic disorders
  • Rare pediatric solid tumors
  • Carcinomas
03

In context

Neoplasms

10,818 studies on the registry are indexed under Neoplasms; 2,324 are open to participants now.

This study's enrollment of 46 is below the median of 60 across 7,703 interventional studies indexed under Neoplasms.

Browse Neoplasms studies →

Lead sponsor

Emory University is the lead sponsor of 1,405 studies on the registry; 225 are open to participants now.

Of its 237 completed or terminated interventional studies of FDA-regulated products, 178 (75%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
12 Months to 30 Years
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Participants with any of the following tumors who have experienced relapse following front-line therapy, or who are to front-line therapy, and participants with tumors that carry a poor prognosis and have no known standard curative therapy

    • Brain tumors of all World Health Organization (WHO) grades, except diffuse intrinsic pontine glioma (DIPG) - enrollment in the brain tumor stratum is closed
    • Extracranial solid tumors including histiocytoses
  • Participants must have had a histologic verification of at original diagnosis or relapse, except in participants with optic pathway gliomas, or participants with pineal tumors and elevations of serum or cerebrospinal fluid (CSF) alpha-fetoprotein (AFP) or beta-human chorionic gonadotropin (beta-HCG)
  • Tissue blocks or slides must be sent
  • Participants must have radiographically at the time of study enrollment to be eligible. Patients with neuroblastoma who do not have measurable disease but have metaiodobenzylguanidine (MIBG+) evaluable disease are eligible. Measurable disease in patients with CNS involvement is defined as tumor that is measurable (≥ 10 mm) in two perpendicular diameters on MRI and visible on more than one slice. For all patients, tumors that are located in a previously irradiated area may be considered measurable if the lesion has shown tumor growth after radiation or has been biopsied and proven to have active disease.
  • Participant's current disease state must be one for which there is no known curative therapy
  • performance level of greater than or equal to 50 percent for participants who are greater than 16 years of age at the time of screening
  • Lansky performance level of greater than or equal to 50 percent for participants who are less than or equal to 16 years of age at the time of screening
  • Fully recovered from acute toxic effects of all prior anti-cancer therapy
  • Adequate bone marrow function as deemed by the protocol at the time of screening
  • Adequate renal function as deemed by the study protocol at the time of screening
  • Adequate liver function as deemed by the study protocol at the time of screening
  • Serum triglyceride level ≤300 mg/dL and serum cholesterol ≤ 300 mg/dL
  • Random or fasting blood glucose within the upper normal limits for age
  • Adequate pulmonary function as deemed by the study protocol at the time of screening

Exclusion criteria

Exclusion Criteria:

  • Women who are currently pregnant or breastfeeding
  • Receiving who have not been on a stable dose for at least 7 days
  • Currently receiving enzyme inducing anticonvulsants
  • Currently receiving receiving potent (enzyme) inducers or inhibitors
  • Currently receiving another drug
  • Currently receiving any other anti-cancer agents
  • The use of cannabis oil is prohibited during the first 2 cycles of this protocol. Patients must be off of cannabis oil for 3 days prior to enrollment.
  • Uncontrolled infection
  • Participants who in the opinion of the investigator may not be able to comply with the safety monitoring requirements
Terms in these criteria, in plain language(7)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Relapsed and refractory

Relapsed: the illness came back after treatment had worked. Refractory: it did not respond to treatment, or stopped responding while still on it.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

Measurable disease

The amount of disease can be tracked with a defined measurement, so the study can see whether it shrinks or grows. It might be a tumour measured on a scan or, in some blood cancers such as myeloma, a marker measured in blood or urine.

The criteria or the study team say which measurement counts — having no tumour visible on a scan does not by itself rule you out.

Karnofsky performance status (KPS)

A 0–100 scale of how well someone can carry out everyday activities. 100 is no complaints and no signs of illness; 70 is able to look after yourself but not to work or keep up normal activity; 50 is needing considerable help and frequent medical care.

Studies often ask for 60 or 70 and above. Your doctor gives the score.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

CYP3A (CYP3A4) inhibitors and inducers

CYP3A is a group of enzymes, mainly CYP3A4, in the liver and gut that break down many medicines. Some medicines, supplements and foods (grapefruit, St John’s wort) slow them down or speed them up, which changes how much of a study drug stays in the body.

Studies list them so they can be avoided or switched; bring a list of everything you take, including supplements.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
46 participants (actual)

Study arms

  • Experimental
    Oral sirolimus, celecoxib, etoposide, and cyclophosphamide

    Participants in this group will receive oral sirolimus and celecoxib in addition to cycles of oral etoposide and cyclophosphamide for up to two years.

    Drug: Sirolimus · Drug: Celecoxib · Drug: Etoposide · Drug: Cyclophosphamide

Interventions

  • The starting dose for sirolimus is 2 mg/m2 once daily. The dose of sirolimus will be individually adjusted to achieve a target serum trough concentration in the range of 10-15 ng/ml. Sirolimus will be given by mouth every day for six weeks (every six weeks is called one cycle) for up to two years or 16 cycles.

    Also known as: Rapamune, rapamycin

  • Celecoxib 100 mg will be given by mouth twice a day for six weeks (every six weeks is called one cycle) for up to two years or 16 cycles.

  • Etoposide 50 mg/m2 (maximum dose 100 mg) will be given daily by mouth for the first 3 weeks of a 6 week cycle. Six week cycles will be repeated for up to two years or 16 cycles.

    Also known as: Etopophos, Toposar

  • Cyclophosphamide 2.5 mg/Kg (maximum dose 100 mg) will be given daily by mouth for the second 3 weeks of a 6 week cycle. Six week cycles will be repeated for up to two years or 16 cycles.

    Also known as: Cytoxan

06

What researchers measure

Primary outcomes

  1. Radiographic response to treatment for solid tumors

    Radiographic response to treatment will be assessed by Response Evaluation Criteria in Solid Tumors (RECIST) for participants with solid tumors via CT or MRI scan. A complete response (CR) is a disappearance of all target and non-target lesions. Partial response (PR) is at least a 30% decrease in the disease measurement compared to the baseline measurement. Stable disease (SD) is neither sufficient shrinkage to qualify for partial response (PR) nor sufficient increase to qualify for progressive disease (PD) taking as reference the smallest disease measurement since baseline. Progressive disease (PD) is at least a 20% increase in the disease measurement compared to baseline, or the appearance of one or more new lesions, or evidence of laboratory or clinical progression.

    Time frame: Baseline, End of Treatment (Up to 2 years)

  2. Radiographic response to treatment for central nervous system (CNS) tumors

    Radiographic response to treatment will be assessed for participants with CNS tumors via CT or MRI scan. Response criteria are assessed based on the lesion of the longest diameter and its longest perpendicular diameter. Development of new disease or progression in any established lesions is considered progressive disease, regardless of response in other lesions. Complete response (CR) is the the disappearance of all target lesions. Partial response (PR) is greater than or equal to 50% decrease decrease in the sum of the products of the two perpendicular diameters of all target lesions, taking into reference the baseline measurement. Stable disease (SD) is neither a sufficient decrease in the sum of the products of the two perpendicular diameters of all target lesions to qualify for PR, nor sufficient increase in a single target lesion to qualify for progressive disease (PD).

    Time frame: Baseline, End of Treatment (Up to 2 years)

Secondary outcomes

  1. Number of adverse events

    The adverse events associated with sirolimus in combination with metronomic chemotherapy administered on this schedule will be defined and evaluated throughout the treatment period.

    Time frame: Baseline, End of Treatment (Up to 2 years)

07

Study locations

6 sites
08

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Mar 2, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
09

Registry details

Key details

Study ID
NCT02574728
Lead sponsor
Emory University
Collaborators
Cannonball Kids' Cancer Foundation, Hyundai Hope On Wheels
Responsible party
William T Cash (Associate Professor, Emory University) — Principal investigator
First posted
Oct 14, 2015
Start date
Jun 2015
Primary completion
Jun 2026 (estimated)
Completion
Jun 2026 (estimated)
Last update
Mar 2, 2026

Study contacts

Thomas Cash, MD
principal investigator · Emory University

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is active, not recruiting, as verified in Feb 2026. You cannot join it, but the record below documents what was studied.

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Discussion

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Studies of the drug tested here: Sirolimus

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