Etanercept (Enbrel) for Juvenile Myelomonocytic Leukemia

Condition(s) targeted: Leukemia

Intervention: Etanercept (Drug)

Phase: Phase 2

Status: Recruiting

Sponsored by: M.D. Anderson Cancer Center

Official(s) and/or principal investigator(s):
Seth J. Corey, MD, Principal Investigator, Affiliation: U.T.M.D. Anderson Cancer Center

Overall contact:
Seth J. Corey, MD, Phone: 713-745-0774

Primary Objectives:

- Estimate rate of response and define acute toxicity to etanercept used in an up-front

phase II window in newly diagnosed or relapsed JMML.

- Determine if response to TNF blockade correlates with genetic basis of JMML (mutations

in NF1, Ras, SHP2) or levels of TNFa.

- Determine if TNF blockade by etanercept results in inhibition of free levels of TNFa and

other cytokines by ELISA and bioassay and improves blood counts.

- Estimate the two year event free survival and overall survival in JMML patients

following etanercept and allogeneic hematopoietic stem cell transplantation.

Official title: Phase IIA Window Study of Etanercept (Enbrel) for Juvenile Myelomonocytic Leukemia

Study design: Treatment, Non-Randomized, Open Label, Uncontrolled, Single Group Assignment, Safety/Efficacy Study

Primary outcome: To learn if Enbrel (Etanercept) can help to control JMML.

Secondary outcome: To study the safety of this treatment.

Detailed description: Etanercept blocks a hormone called Tumor Necrosis Factor (TNF), which has been shown to play a role in helping the growth of leukemic cells in JMML.

Before participants can start treatment on this study, they will have what are called "screening tests". These tests will help the doctor decide if patients are eligible to take part in the study. You will have a complete medical history and physical exam. About two tablespoons of blood and urine will be collected for routine tests as well as to test for the liver and kidney function. You will have a bone marrow biopsy performed to monitor disease activity. To collect a bone marrow biopsy, an area of the hip or chest bone is numbed with anesthetic and a small amount of bone marrow and bone is withdrawn through a large needle. You will have cells from inside of the mouth tested for genetic changes by swabbing the side of the cheeks.

If you are found to be eligible, etanercept will be given as an injection under the skin once a week for up to 90 days.

During the study, you will have weekly follow-up tests that will include physical exam and lab tests. About 2 tablespoons of blood will be collected each time. Urine will also be collected for testing at least every 3 weeks while on the study.

If the disease gets worse or intolerable side effects occur, you will be taken off study and alternative treatment options will be discussed.

This is an investigational study. The FDA has approved etanercept for use in adults and children with rheumatoid arthritis and juvenile rheumatoid arthritis. Its use in this study is experimental. A total of up to 30 patients will take part in this study. All will be enrolled at M. D. Anderson.

Minimum age: 6 Months. Maximum age: 18 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

1. All children greater than 6 months of age and less than 18 years of age with newly-diagnosed previously untreated or previously diagnosed JMML, which has reoccurred after treatment with chemotherapy, stem cell transplantation, and/or cis-retinoic acid.

2. A diagnosis of JMML is confirmed only if the following criteria for JMML are met: a) ALL of the following: Absence of t(9;22) or BCR-ABL by PCR or FISH; Absolute monocyte count >1000 (1 X 109/µL); <20% bone marrow blasts; b) At least 2 of the following: Elevated Hb F hemoglobin; Myeloid precursors in peripheral blood; WBC >10,000 (10 X 109/µL); GM-CSF hypersensitivity in methylcellulose culture of bone marrow progenitors cells.

3. Adequate hepatic function (bilirubin equal or less than 2. 0 mg/dl; ALT equal or less than 3x normal)

4. Adequate renal function (serum creatinine equal or less than 2 x normal)

5. Performance Status: Have a Karnofsky score >50.

6. Written, informed consent according to institution guidelines.

Exclusion Criteria:

1. Pregnant or lactating.

2. Receiving any other chemotherapy. Patients must have been off chemotherapy for at least 2 weeks and must have recovered from acute toxicity of all previous therapy prior to enrollment.

3. Febrile neutropenia at study entry.

Seth J. Corey, MD, Phone: 713-745-0774

U.T.M.D. Anderson Cancer Center, Houston, Texas 77030, United States; Recruiting
Seth J. Corey, MD, Principal Investigator

UT MD Anderson Cancer Center website

Starting date: September 2004
Last updated: October 21, 2008