A Phase II Trial of Chidamide Combined With Dinutuximab Beta, Irinotecan, and Temozolomide for Refractory or Relapsed Neuroblastoma in Children
This is a Phase II clinical trial investigating the effectiveness and safety of a four-drug combination-Chidamide, Dinutuximab Beta, Irinotecan, and Temozolomide-for children with relapsed or refractory neuroblastoma. The primary goal is to evaluate how well this regimen works to control the cancer, while the secondary goal is to closely monitor its safety and side effects in these young patients.
• Age 0-18 years at enrolment.
• Histologically diagnosed neuroblastoma defined as high-risk according to the International Neuroblastoma Risk Group classification or Chinese consensus/guideline risk classification.
• Relapsed or refractory neuroblastoma. Relapse is defined as any recurrence of neuroblastoma. Refractory disease is defined as inadequate response to prior therapy, including partial response, minor response or stable disease, followed by progression.
• Prior exposure to histone deacetylase inhibitors, DNA methylation inhibitors or GD2 monoclonal antibodies does not preclude eligibility.
• Presence of evaluable disease.
• Performance status of Lansky score \>=50%, Karnofsky score \>=50% or ECOG performance status \<=3.
• Life expectancy \>=12 weeks.
• Adequate bone marrow function: for patients without bone marrow disease, platelet count \>=75 x 10\^9/L, absolute neutrophil count \>=0.75 x 10\^9/L and haemoglobin \>=8 g/dL with transfusion permitted; for patients with bone marrow disease, platelet count \>=50 x 10\^9/L, absolute neutrophil count \>=0.5 x 10\^9/L and haemoglobin \>=8 g/dL with transfusion permitted.
• Renal function without clinically significant proteinuria. If urine dipstick protein is \>=2+, protein:creatinine ratio must be \<0.5 or 24-hour protein excretion must be \<0.5 g.
⁃ Serum creatinine \<=1.5 x upper limit of normal or calculated glomerular filtration rate \>=60 mL/min/1.73 m2 if serum creatinine is higher.
⁃ Adequate liver function: AST or ALT \<=2.5 x upper limit of normal and total bilirubin \<=1.5 x upper limit of normal; in the presence of hepatic metastases, AST or ALT \<=5 x upper limit of normal and total bilirubin \<=2.5 x upper limit of normal.
⁃ Cardiac shortening fraction \>=29% on echocardiography.
⁃ Coagulation function with INR \<=1.5 and APTT \<=1.5 x upper limit of normal for age if not receiving anticoagulation; anticoagulation is permitted if INR or APTT is within the therapeutic range and the dose has been stable for at least 2 weeks before registration.
⁃ Oxygen saturation \>94% without supplemental oxygen. Ability to comply with the visit schedule and other protocol requirements.