Single-agent erlotinib versus oral etoposide in patients with recurrent or refractory pediatric ependymoma: a randomized open-label study

Regina I. Jakacki, Margaret A. Foley, Julie Horan, Jiuzhou Wang, Mark W. Kieran, Daniel C. Bowers, Eric Bouffet, Stergios Zacharoulis, Stan C. Gill

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Overexpression of human epidermal growth factor receptor (HER/EGFR) is associated with various tumors, including ependymomas. To investigate whether EGFR inhibition was of benefit in pediatric patients with recurrent ependymoma, a multi-center, randomized, open-label, phase 2 study of oral erlotinib versus oral etoposide was undertaken. Twenty-five patients were randomized to receive erlotinib 85 mg/m2 daily or etoposide 50 mg/m2/day for 21 consecutive days followed by a 7-day rest period. Courses were repeated every 28 days. In the erlotinib arm, no patient achieved a complete, partial, or minor response, and only 2 (15.4 %) patients showed stable disease as their best response. In the etoposide arm, 2 patients (16.7 %) demonstrated partial responses, 1 (8.3 %) patient demonstrated a minor response, and 2 (16.7 %) showed prolonged stable disease, for a prolonged disease control rate of 41.7 %. Three patients received at least nine cycles of etoposide (range 9–24 cycles) before discontinuing at the request of the physician and/or family. Four patients who failed etoposide in this study received erlotinib in a companion single arm study; none had a response. The futility criteria were met at the second interim analysis, and both studies were discontinued. Pharmacokinetics of erlotinib were similar to previous observations in pediatric patients. Overall, erlotinib was well tolerated and safety was consistent with its established profile in adults. The overall risk–benefit profile does not support the use of erlotinib in pediatric patients with recurrent ependymoma, whereas single-agent etoposide appears to have efficacy in a subset of patients.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalJournal of Neuro-Oncology
DOIs
StateAccepted/In press - Jun 10 2016

Fingerprint

Ependymoma
Etoposide
Pediatrics
Erlotinib Hydrochloride
Medical Futility
Family Physicians
Epidermal Growth Factor Receptor
Pharmacokinetics

Keywords

  • EGFR
  • Ependymoma
  • Epidermal growth factor receptor
  • Erlotinib
  • Etoposide
  • Pediatrics

ASJC Scopus subject areas

  • Clinical Neurology
  • Cancer Research
  • Oncology
  • Neurology

Cite this

Single-agent erlotinib versus oral etoposide in patients with recurrent or refractory pediatric ependymoma : a randomized open-label study. / Jakacki, Regina I.; Foley, Margaret A.; Horan, Julie; Wang, Jiuzhou; Kieran, Mark W.; Bowers, Daniel C.; Bouffet, Eric; Zacharoulis, Stergios; Gill, Stan C.

In: Journal of Neuro-Oncology, 10.06.2016, p. 1-8.

Research output: Contribution to journalArticle

Jakacki, Regina I. ; Foley, Margaret A. ; Horan, Julie ; Wang, Jiuzhou ; Kieran, Mark W. ; Bowers, Daniel C. ; Bouffet, Eric ; Zacharoulis, Stergios ; Gill, Stan C. / Single-agent erlotinib versus oral etoposide in patients with recurrent or refractory pediatric ependymoma : a randomized open-label study. In: Journal of Neuro-Oncology. 2016 ; pp. 1-8.
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AB - Overexpression of human epidermal growth factor receptor (HER/EGFR) is associated with various tumors, including ependymomas. To investigate whether EGFR inhibition was of benefit in pediatric patients with recurrent ependymoma, a multi-center, randomized, open-label, phase 2 study of oral erlotinib versus oral etoposide was undertaken. Twenty-five patients were randomized to receive erlotinib 85 mg/m2 daily or etoposide 50 mg/m2/day for 21 consecutive days followed by a 7-day rest period. Courses were repeated every 28 days. In the erlotinib arm, no patient achieved a complete, partial, or minor response, and only 2 (15.4 %) patients showed stable disease as their best response. In the etoposide arm, 2 patients (16.7 %) demonstrated partial responses, 1 (8.3 %) patient demonstrated a minor response, and 2 (16.7 %) showed prolonged stable disease, for a prolonged disease control rate of 41.7 %. Three patients received at least nine cycles of etoposide (range 9–24 cycles) before discontinuing at the request of the physician and/or family. Four patients who failed etoposide in this study received erlotinib in a companion single arm study; none had a response. The futility criteria were met at the second interim analysis, and both studies were discontinued. Pharmacokinetics of erlotinib were similar to previous observations in pediatric patients. Overall, erlotinib was well tolerated and safety was consistent with its established profile in adults. The overall risk–benefit profile does not support the use of erlotinib in pediatric patients with recurrent ependymoma, whereas single-agent etoposide appears to have efficacy in a subset of patients.

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