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These results may in part be explained by data from preclinical models showing significant activity only at higher concentrations compared to those achieved with current dosing regimens. In the current pediatric trial, we applied an intra-patient dose escalation design.<\/jats:p>\n                <jats:p>The purpose of this trial was to determine a safe dose recommendation (SDR) of single-agent vorinostat for intra-patient dose escalation, pharmacokinetic analyses (PK), and activity evaluation in children (3\u201318\u00a0years) with relapsed or therapy-refractory malignancies.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A phase I intra-patient dose (de)escalation was performed until individual maximum tolerated dose (MTD). The starting dose was 180\u00a0mg\/m<jats:sup>2<\/jats:sup>\/day with weekly dose escalations of 50\u00a0mg\/m<jats:sup>2<\/jats:sup> until DLT\/maximum dose. After MTD determination, patients seamlessly continued in phase II with disease assessments every 3\u00a0months. PK and plasma cytokine profiles were determined. Fifty of 52 patients received treatment. <jats:italic>n<\/jats:italic>\u00a0=\u200927\/50 (54%) completed the intra-patient (de)escalation and entered phase II. An SDR of 130\u00a0mg\/m<jats:sup>2<\/jats:sup>\/day was determined (maximum, 580\u00a0mg\/m<jats:sup>2<\/jats:sup>\/day). <jats:italic>n<\/jats:italic>\u00a0=\u200946\/50 (92%) patients experienced treatment-related AEs which were mostly reversible and included thrombocytopenia, fatigue, nausea, diarrhea, anemia, and vomiting. <jats:italic>n<\/jats:italic>\u00a0=\u20096\/50 (12%) had treatment-related SAEs. No treatment-related deaths occurred. Higher dose levels resulted in higher C<jats:sub>max<\/jats:sub>. Five patients achieved prolonged disease control (&gt;\u200912\u00a0months) and showed a higher C<jats:sub>max<\/jats:sub> (&gt;\u2009270\u00a0ng\/mL) and MTDs. Best overall response (combining PR and SD, no CR observed) rate in phase II was 6\/27 (22%) with a median PFS and OS of 5.3 and 22.4\u00a0months. Low levels of baseline cytokine expression were significantly correlated with favorable outcome.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>An SDR of 130\u00a0mg\/m<jats:sup>2<\/jats:sup>\/day for individual dose escalation was determined. Higher drug exposure was associated with responses and long-term disease stabilization with manageable toxicity. Patients with low expression of plasma cytokine levels at baseline were able to tolerate higher doses of vorinostat and benefited from treatment. Baseline cytokine profile is a promising potential predictive biomarker.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>ClinicalTrials.gov, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/results?cond=&amp;term=NCT01422499&amp;cntry=&amp;state=&amp;city=&amp;dist=\">NCT01422499<\/jats:ext-link>. Registered 24 August 2011, <\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13148-019-0775-1","type":"journal-article","created":{"date-parts":[[2019,12,10]],"date-time":"2019-12-10T12:04:28Z","timestamp":1575979468000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Phase I\/II intra-patient dose escalation study of vorinostat in children with relapsed solid tumor, lymphoma, or leukemia"],"prefix":"10.1186","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5274-910X","authenticated-orcid":false,"given":"Cornelis M.","family":"van Tilburg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Till","family":"Milde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Witt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Ecker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Hielscher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelika","family":"Seitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens-Peter","family":"Schenk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliane L.","family":"Buhl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Riehl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Fr\u00fchwald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnulf","family":"Pekrun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Rossig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina","family":"Wieland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Flotho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Kordes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Gruhn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorsten","family":"Simon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christin","family":"Linderkamp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Sahm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenka","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelika","family":"Freitag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Burhenne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathrin I.","family":"Foerster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas D.","family":"Meid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan M.","family":"Pfister","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irini","family":"Karapanagiotou-Schenkel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olaf","family":"Witt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,12,10]]},"reference":[{"issue":"2","key":"775_CR1","doi-asserted-by":"publisher","first-page":"e102","DOI":"10.1097\/MPH.0000000000000237","volume":"37","author":"F Bautista","year":"2015","unstructured":"Bautista F, Di Giannatale A, Dias-Gastellier N, Fahd M, Valteau-Couanet D, Couanet D, Grill J, Brugieres L, Dufour C, Gaspar N, et al. 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