Phase II trial of temsirolimus in children with high-grade glioma, neuroblastoma and rhabdomyosarcoma

Abstract

PurposeA phase II study of temsirolimus was conducted in children and adolescents with high-grade glioma, neuroblastoma or rhabdomyosarcoma. Patients and methodsTemsirolimus 75mg/m2 was administered once weekly until disease progression or intolerance. Using the Simon 2-stage design, further enrolment in each disease cohort required ⩾2 objective responses within the first 12weeks for the first 12 evaluable patients (those who received ⩾3 temsirolimus doses). ResultsFifty-two heavily pretreated patients with relapsed (12%) or refractory (88%) disease, median age 8years (range 1–21years), were enroled and treated. One patient with neuroblastoma achieved confirmed partial response within the first 12weeks; thus, none of the 3 cohorts met the criterion for continued enrolment. Disease stabilisation at week 12 was observed in 7 of 17 patients (41%) with high-grade glioma (5 diffuse pontine gliomas, 1 glioblastoma multiforme and 1 anaplastic astrocytoma), 6 of 19 (32%) with neuroblastoma and 1 of 16 (6%) with rhabdomyosarcoma (partial response confirmed at week 18). In the three cohorts, median duration of stable disease or better was 128, 663 and 75d, respectively. The most common treatment-related adverse events were thrombocytopaenia, hyperlipidaemia and aesthenia. Pharmacokinetic findings were similar to those observed in adults. ConclusionsTemsirolimus administered weekly at the dose of 75mg/m2 did not meet the primary objective efficacy threshold in children with high-grade glioma, neuroblastoma or rhabdomyosarcoma; however, meaningful prolonged stable disease merits further evaluation in combination therapy.