Fenretinide in Treating Children With Recurrent or Resistant Neuroblastoma

Inclusion Criteria:

* Diagnosis of recurrent or resistant/refractory high-risk neuroblastoma by one or both of the following:

  * Histological confirmation
  * Demonstration of tumor cells in bone marrow with increased urinary catecholamines
* Stratum I:

  * At least 1 unidimensionally measurable lesion\*

    * At least 20 mm by MRI and/or CT scan OR at least 10 mm by spiral CT scan
* Stratum II: Meets one or both of the following criteria:

  * At least 1 site with positive uptake on meta-iodobenzylguanidine (MIBG) I 123 scan
  * Tumor in bilateral bone marrow aspirate/biopsy by routine morphology (no NSE staining only)
* Stratum III:

  * At least 5 tumor cells/10\^6 mononuclear cells in the bone marrow by immunocytology only (on 2 successive bone marrows performed from 1 day to 4 weeks apart)
* Patients in first response (i.e., patients with persistent tumor at end of frontline therapy, but who have never had disease relapse or progression) must have histological\* or morphological (by bone marrow) confirmation\*\* of viable tumor on CT scan, MRI, or MIBG scan after completion of myeloablative therapy (for strata I and II)
* No catecholamine elevation only
* Performance status - 0-2
* At least 2 months
* Hemoglobin greater than 7.5 g/dL (transfusion allowed)
* Bilirubin no greater than 1.5 times normal
* SGPT and SGOT less than 2.5 times normal
* Creatinine normal for age
* No hematuria or proteinuria greater than 1+ on urinalysis
* Calcium less than 11.6 mg/dL
* Triglycerides less than 300 mg/dL
* Not pregnant
* Negative pregnancy test
* Fertile patients must use effective contraception
* No seizure disorders unless on anticonvulsants and well controlled
* No skin toxicity greater than grade 1
* Must be able to consume entire intact study capsule in the dosage prescribed for body surface area
* Recovered from prior immunotherapy
* At least 7 days since prior anticancer biologic therapy
* At least 2 days since prior growth factors
* Prior autologous stem cell transplantation allowed
* No prior allogeneic stem cell transplantation
* No concurrent immunomodulating agents
* At least 2 weeks since prior myelosuppressive chemotherapy (4 weeks for nitrosoureas) and recovered
* No concurrent anticancer chemotherapy
* No concurrent steroids
* Recovered from prior radiotherapy
* At least 4 weeks since prior radiotherapy to target lesion
* Prior radiotherapy to non target lesions allowed
* No concurrent radiotherapy to sole measurable lesion for symptom relief
* Concurrent palliative radiotherapy to non target or localized painful lesions allowed
* Prior tretinoin or isotretinoin allowed
* At least 2 weeks since other prior retinoids
* No prior fenretinide
* No concurrent supplemental oral or IV vitamin A, ascorbic acid, or vitamin E (except if contained in routine total parenteral nutrition \[TPN\] vitamin supplements)
* No concurrent drugs suspected of causing pseudotumor cerebri (e.g., tetracycline, nalidixic acid, nitrofurantoin, phenytoin, sulfonamides, lithium, amiodarone, or vitamin A \[except as part of routine TPN supplements\])
* No other concurrent anticancer agents