Treatment for advanced retinoblastoma using a chemoplaque

Retinoblastoma Phase II Expanded Access Clinical Trial

This study is testing a new treatment using a special chemotherapy patch for young children with advanced retinoblastoma to see if it helps fight the cancer while keeping their vision safe.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 30 (estimated)
• Ages: N/A to 8 Years
• Sex: All
• Sponsor: Targeted Therapy Technologies, LLC (Industry-sponsored)
• Drugs / interventions: chemotherapy
• Locations: 2 sites (New York, New York and 1 other locations)
• Trial ID: NCT06679634 on ClinicalTrials.gov

What this trial studies

This clinical trial aims to evaluate the safety and efficacy of a chemoplaque containing chemotherapy for children with advanced or recurrent retinoblastoma. The chemoplaque will be surgically placed under the conjunctiva of the affected eye during an examination under anesthesia. Participants will be monitored through a series of eye exams and blood tests over an 84-day period to assess the treatment's effectiveness and any potential side effects. The study focuses on children under 8 years of age who have specific stages of retinoblastoma and vision potential in the affected eye.

Who should consider this trial

Good fit: Ideal candidates are children under 8 years old with advanced or recurrent intraocular retinoblastoma who have not responded to conventional treatments.

Not a fit: Patients with retinoblastoma that is not amenable to treatment or those who are older than 8 years may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could help preserve vision in children with advanced retinoblastoma and reduce the need for eye removal.

How similar studies have performed: While this approach is innovative, similar studies have shown promise in using localized chemotherapy for retinoblastoma treatment.

Eligibility criteria

Inclusion Criteria:

* Age: Participants must be \< 8 years of age.
* Diagnosis and Treatment. Participants must have: Group D or earlier-stage intraocular retinoblastoma in which enucleation is a recommended therapy, OR Active residual or recurrent intraocular retinoblastoma in at least one eye following completion of first- line therapy (focal therapy for IIRC Group A eyes, or systemic or intra-arterial chemotherapy).

If both eyes require treatment, there will receive independent and individual treatment. Non-study eye will be treated by standard of care, with only focal therapy during the Study Period, if required.

* Must have demonstrated intraocular calcium in the tumor-containing eye by ophthalmic ultrasound or by neuroimaging as part of standard retinoblastoma diagnosis.
* Study eye must have vision potential, at least light perception vision in the tumor-bearing eye either with pupil response testing or demonstration of avoidance behavior to light presentation in the affected eye, and no clinical features suggestive of high risk of extraocular extension.
* Performance Level: Lansky ≥ 50 (\<16 years of age); Karnofsky performance scale of ≥50 (≥16 years of age).
* Organ Function Requirements:

  1. Adequate Bone Marrow Function defined as:

     * Peripheral absolute neutrophil count (ANC) ≥ 1000/mm3
     * Platelet count ≥ 100,000/mm3 (transfusion independent, defined as not receiving platelet transfusions for at least 7 Days prior to enrollment)
     * Hemoglobin ≥ 8.0 g/dL at baseline (may receive RBC transfusions)
  2. Adequate Renal Function defined as:

     * Creatinine clearance or radioisotope GFR ≥70ml/min/1.73 m2 or
     * A serum creatinine based on age/gender as follows:

     Age Maximum Serum Creatinine (mg/dL) Male Female

     1 month to \< 6 months 0.4 0.4 6 months to \< 1 year 0.5 0.5
     1. to \< 2 years 0.6 0.6
     2. to \< 6 years 0.8 0.8

     6 to \< 7 years 1 1

     The threshold creatinine values in this Table were derived from the Schwartz formula for estimating GFR utilizing child length and stature data published by the CDC.
  3. Adequate Liver Function defined as:

     * Bilirubin (sum of conjugated + unconjugated) ≤ 1.5 x upper limit of normal (ULN) for age.
     * SGPT (ALT) ≤ 110 U/L. For the purpose of this study, the ULN for SGPT is 45 U/L.
     * Serum albumin ≥ 2 g/dL.
  4. Pregnancy prevention. Females of reproductive potential must agree to the use of highly effective contraception during study participation and for an additional 40 days after the end of Episcleral Topotecan administration.
  5. Informed consent. All participants and/or their parents or legally authorized representatives must have the ability to understand and the willingness to sign a written informed consent. Assent, where appropriate, will also be obtained.

Exclusion Criteria:

* Disease status. Participants known to have any of the following are excluded:

  1. tumor involving the optic nerve rim
  2. clinical or EUA evidence of extraocular extension
  3. evidence of metastatic retinoblastoma
  4. existing neuroimaging showing suspicion of, or definitive, optic nerve invasion, trilateral retinoblastoma or extra-ocular extension.
* Allergy. Participants with reported allergy to topotecan, camptothecin or derivatives thereof are excluded.
* Concomitant treatment. Participants who have received chemotherapy, other focal retinoblastoma therapy or any other investigational agent within 3 weeks of Episcleral Topotecan placement are not eligible.
* Uncontrolled intercurrent illness. Participants with known uncontrolled intercurrent illness that, in the investigator's opinion, would put the participant at undue risk or limit compliance with the study requirements, are not eligible.
* Febrile illness. Participants with clinically significant febrile illness (as determined by the investigator) within one week prior to initiation of protocol therapy are excluded.
* Pregnancy and lactation. Females of reproductive potential must have a negative serum pregnancy test within 72 hours prior to initiation of protocol therapy. Due to the unknown but potential risk for adverse events (AEs) in nursing infants secondary to treatment of the mother with the study agents, breastfeeding must be discontinued if the mother is treated on study.
* Compliance. Any condition of diagnosis that could in the opinion of the Principal Investigator or delegate interfere with the participant's ability to comply with the study instruction, might confound the interpretation of the study results, or put the participant at risk.

Where this trial is running

New York, New York and 1 other locations

• NewYork Presbyterian Morgan Stanley Children's Hospital — New York, New York, United States (Recruiting)
• Children's Wisconsin — Milwaukee, Wisconsin, United States (Recruiting)

Study contacts

• Study coordinator: Brian Marr, MD

Conditions Retinoblastoma