title: Clinical characteristics and outcomes of pediatric oncology patients with aggressive biology enrolled in phase I clinical trials designed for adults: the university of Texas MD anderson cancer center experience.
abstract: BACKGROUND
  Children (patients ≤ 18 years of age) are not usually included on pharmaceutical industry sponsored Phase I trials.
  
  
  METHODS
  We reviewed the medical records of 40 patients ≤ 18 years treated in ≥ 1 phase I trial at MD Anderson.
  
  
  RESULTS
  The median OS was 8.5 months (95% CI, 5.5-13.2 months). In the multivariate analysis, age ≥15 only predicted increased OS (P = 0.0065), and >3 prior therapies (P = 0.053) predicted decreased OS. The median PFS was 2.8 months (95% CI, 2.3-4.1 months). In the multivariate analysis, independent factors that predicted increased PFS were age ≥15 years (P < 0.001) and prior radiation therapy (P = 0.049); performance status >1 (P < 0.001) and >3 prior therapies (P = 0.002) predicted decreased PFS. RMH score ≥ 2 and MDACC score ≥ 3 were associated with decreased median OS (P = 0.029 and P = 0.031 respectively).
  
  
  CONCLUSIONS
  It is feasible to conduct phase I studies in pediatric patients based on adult protocols. In the era of targeted therapy more trials should allow pediatric patients earlier in the drug development especially if deemed safe in adults in early phase trials.
  
  
  CONCLUSIONS
  Most pharmaceutical industry sponsored trials exclude patients less than 18 years in phase I clinical trials. Even in the era of targeted therapy pediatric patients usually have to wait for most phases of trials to be completed in adults before being allowed to enroll in clinical trials of new therapies, even in the advanced metastatic and relapsed setting. Some investigator initiated phase 1 trials of combinations of US FDA approved agents allow patients less than 18 years. We report the preliminary analyses of the outcomes of pediatric patients enrolled in phase I studies initially designed for adults, but allowing for enrollment of patients under 18.
authors.affiliation: Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Fernando F
authors.initials: FF
authors.lastname: Corrales-Medina
authors.affiliation: Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Herzog
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Hess
authors.affiliation: Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Daniela
authors.initials: D
authors.lastname: Egas-Bejar
authors.affiliation: Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Hong
authors.affiliation: Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Falchook
authors.affiliation: Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.|Pediatric Hematology/Oncology/BMT, Levine Children's Hospital/Levine Cancer Institute, Charlotte, North Carolina, USA.
authors.forename: Pete
authors.initials: P
authors.lastname: Anderson
authors.affiliation: Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Cesar
authors.initials: C
authors.lastname: Nunez
authors.affiliation: Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Winston W
authors.initials: WW
authors.lastname: Huh
authors.affiliation: Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Aung
authors.initials: A
authors.lastname: Naing
authors.affiliation: Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Apostolia M
authors.initials: AM
authors.lastname: Tsimberidou
authors.affiliation: Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wheler
authors.affiliation: Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Sarina Piha
authors.initials: SP
authors.lastname: Paul
authors.affiliation: Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Filip
authors.initials: F
authors.lastname: Janku
authors.affiliation: Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Eugenie S
authors.initials: ES
authors.lastname: Kleinerman
authors.affiliation: Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Razelle
authors.initials: R
authors.lastname: Kurzrock
authors.affiliation: Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.|Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Subbiah
keywords: children; phase I trials; prognostic scores; targeted therapy