
“I think it’s really important that people keep signing up to these type of trials to push research forward.”
This trial is comparing high dose chemotherapy with molecular radiotherapy and chemotherapy. It is for children and young people with neuroblastoma that has spread.
Cancer Research UK supports this trial.
This trial is for children and young people with neuroblastoma that has:
We use the term 'you' in this summary, but if you are a parent, we are referring to your child.
The first treatment (induction treatment) for neuroblastoma that has spread is chemotherapy. This is to either get rid of, or reduce, the cancer spread. But this does not work so well in a small number of children and young people. Their neuroblastoma does not respond well enough to this chemotherapy. We know from research that this means their neuroblastoma is more difficult to treat.
There is no for children and young people in this situation. Possible treatments include one or more of the following:
Doctors would like to know which treatment, or treatment combinations, are best.
The researchers are comparing two different types of intensive treatment. These are:
Molecular radiotherapy is when a substance called metaiodobenzylguanidine (mIBG) is added to radioactive iodine (131-I). It’s used to deliver targeted radiation therapy. The mIBG is picked up by the cancer cells. The dose of radioactive iodine attached to the mIBG is high enough to kill the neuroblastoma cells. But generally, the treatment does not cause serious side effects to surrounding tissues.
The aims of this trial are to find out:
The following bullet points are a summary of the entry conditions for this trial. Talk to your doctor or the trial team if you are unsure about any of these. They will be able to advise you.
Who can take part
You may be able to join this trial if all of the following apply. You:
Who can’t take part
You cannot join this trial if any of these apply. You:
This is a phase 2 trial. The researchers hope 150 children and young people will take part in the UK and Europe. It has 4 stages. Apart from stage 3, everyone taking part has the same treatment.
Stage 1 - Chemotherapy stage (initial chemotherapy)
Everyone has irinotecan and temozolomide. You have treatment in cycles and each 21 day period is a cycle of treatment. You:
You have treatment every day for the first 5 days of each cycle. And you have 3 cycles in total.
You have chemotherapy into the bloodstream through a long flexible plastic tube called a central line. This can stay in while you are taking part in the trial and is used for:
Stage 2 - Collecting your stem cells
Everyone taking part has their stem cells collected from your bloodstream through a drip. This usually takes a few hours. Collecting your stem cells means doctors can then use your own stem cells to replace blood cells destroyed by high doses of chemotherapy and other treatments.
After the chemotherapy stage, you have injections of a growth factor every day. Growth factors are natural substances that make the bone marrow produce more stem and blood cells.
Once you have enough stem cells, these are collected from your bloodstream through a drip. They are then frozen and stored.
Stage 3 – First intensive consolidation treatment and stem cells back
This part of the trial is randomised. You are put into a group by a computer. Neither you nor your doctor will be able to decide which group you are in. There are 2 treatment groups. For both treatments you might need to travel to a different hospital depending on where you live. Your team will discuss this with you.
The two treatment groups are:
Group A
You have both molecular radiotherapy with 131-I-mIBG and topotecan for one cycle over 19 days. You have both of these through a drip into your bloodstream. You have:
Group B
You have the chemotherapy drug thiotepa at a high dose for one cycle. You have it once a day for 3 days.
Both groups
You then have some of your defrosted stem cells back. You have these through a drip into your bloodstream.
Stage 4 – Second intensive consolidation chemotherapy and stem cells back
You have this at the same hospital where you had your first intensive consolidation treatment.
Everyone has one cycle of chemotherapy with the drugs busulfan and melphalan.
This cycle takes 8 days. You have busulfan and melphalan via a drip into your bloodstream. You have this on days 1 to 5, and day 7.
You have more of your defrosted stem cells through a drip into your bloodstream.
You might then have other treatments for your neuroblastoma. This might include surgery and radiotherapy. Your doctor will let you know if these are suitable treatments for you.
You see a doctor and have some tests before you can take part. These include:
You might need to travel to a specialist hospital for certain parts of this trial, such as for molecular radiotherapy or stem cell collection and return.
The trial team can let you know how long each treatment stage lasts. And how long you will be in hospital at different points during the trial. You will stay in hospital for about 3 or 4 weeks during your intensive treatment (stage 3).
Tests and scans during treatment
While having chemotherapy, you have the same routine tests that you would have if not taking part in the trial. These include scans and blood tests. This is to check you are well enough to have chemotherapy and how well the treatments are working.
You have extra tests at certain points during the trial. These include:
Follow up
After treatment has finished, the trial team will monitor you for at least 3 years.
You will only need to attend routine clinic appointments for them to check how you are getting on. These are usually every 3 months for the first 3 years.
The trial team monitor you during treatment and afterwards. Contact your advice line or tell your doctor or nurse if any side effects are bad or not getting better.
Chemotherapy
Some common side effects of chemotherapy include:
We have information about:
131-I- mIBG treatment
Children and young people having 131-I- mIBG treatment need to be cared for on their own because of the radioactive iodine. It’s normal to feel a bit nervous about this at first. The specialist team let you know what to expect and how best you and your family might cope. Non pregnant family members can consent to staying with a younger child. The team minimise risk of radiation to other people.
The trial team will explain more about the side effects of this type of intensive treatment. Possible side effects include:
Stem cell collection and transplant
Your team will explain more about the possible side effects of having your stem cells collected and returned.
Generally, the main side effects of intensive treatment with a stem cell transplant include:
There are longer term side effects of having intensive chemotherapy. Your team will talk these through with you. You have time to ask any questions you might have.
Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.
Dr Guy Makin
Cancer Research UK
Cancer Research UK Clinical Trials Unit
Gustave Roussy
University of Birmingham
SIOPEN
This is Cancer Research UK trial number CRUKE/17/017.
Freephone 0808 800 4040
“I think it’s really important that people keep signing up to these type of trials to push research forward.”