Combination Chemotherapy Plus Radiation Therapy in Treating Patients With Metastatic Rhabdomyosarcoma or Sarcoma
Recruitment status was Active, not recruiting
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Purpose
RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Combining more than one chemotherapy drug with radiation therapy may kill more tumor cells.
PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy combined with radiation therapy in treating patients who have metastatic rhabdomyosarcoma or sarcoma.
| Condition | Intervention | Phase |
|---|---|---|
|
Sarcoma |
Biological: dactinomycin Biological: filgrastim Biological: pegfilgrastim Biological: sargramostim Drug: cyclophosphamide Drug: irinotecan hydrochloride Drug: vincristine sulfate Radiation: radiation therapy |
Phase 2 |
| Study Type: | Interventional |
| Study Design: | Masking: Open Label Primary Purpose: Treatment |
| Official Title: | A Phase II "Up-Front Window Study" of Irinotecan (CPT-11) Followed by Multimodal, Multiagent, Therapy for Selected Children and Adolescents With Newly Diagnosed Stage 4/Clinical Group IV Rhabdomyosarcoma: An IRS-V Study |
| Estimated Enrollment: | 46 |
| Study Start Date: | March 2001 |
OBJECTIVES:
- Determine the response rate of patients with newly diagnosed high-risk metastatic stage IV/clinical group IV rhabdomyosarcoma treated with upfront window therapy comprising irinotecan and vincristine.
- Determine the toxic effects of this regimen in these patients.
- Determine the toxic effects of this regimen when given in alternating courses with vincristine, dactinomycin, and cyclophosphamide (VAC) as continuation therapy in patients with partial or complete response.
- Determine the overall and failure-free survival of patients treated with irinotecan and vincristine followed by VAC alone or VAC alternating with vincristine and irinotecan plus radiotherapy.
- Determine the pharmacokinetics of irinotecan and vincristine in these patients.
OUTLINE:
Upfront window therapy: Patients receive vincristine IV on days 1 and 8 and irinotecan IV over 60 minutes on days 1-5 and 8-12. Treatment repeats every 21 days for a total of 2 courses. Patients experiencing partial or complete response proceed to regimen A. Patients experiencing stable or progressive disease proceed to regimen B.
- Regimen A: Patients receive vincristine IV over 1 minute weekly on weeks 6-13, 15-19, 23-27, 29, 32-35, 38-39, and 41; dactinomycin IV over 1 minute weekly on weeks 6, 12, 23, 29, 35, and 41; and cyclophosphamide IV over 30-60 minutes weekly on weeks 6, 12, 16, 19, 23, 29, 35, and 41. Patients also receive irinotecan IV over 1 hour daily, 5 days a week, on weeks 9, 10, 26, 27, 32, 33, 38, and 39 and undergo radiotherapy daily, 5 days a week, on weeks 15-22.
- Regimen B: Patients receive vincristine as in regimen A; dactinomycin IV over 1 minute weekly on weeks 6, 9, 12, 23, 26, 29, 32, 35, 38, and 41 and cyclophosphamide IV over 30-60 minutes weekly on weeks 6, 9, 12, 16, 19, 23, 26, 29, 32, 35, 38, and 41. Patients receive radiotherapy as in regimen A.
Patients who do not receive upfront window irinotecan/vincristine therapy are treated with standard therapy.
- Standard therapy: Patients receive vincristine IV over 1 minute weekly on weeks 0-13, 15-19, 23-27, 29, 32-35, 38, and 41; dactinomycin IV over 1 minute weekly on weeks 0, 6, 9, 12, 23, 26, 29, 32, 35, 38, and 41; and cyclophosphamide IV over 30-60 minutes weekly on weeks 0, 3, 6, 9, 12, 16, 19, 23, 26, 29, 32, 35, 38, and 41. Patients without evidence of intracranial extension receive radiotherapy once daily, 5 days a week, during weeks 15-22. Patients with evidence of intracranial extension, or who require emergency radiotherapy, receive radiotherapy during weeks 0-6. Dactinomycin is withheld during radiotherapy.
All patients receive filgrastim (G-CSF) or sargramostim (GM-CSF) subcutaneously (SC) beginning 24 hours after completion of each course of chemotherapy and continuing until blood counts recover. Alternatively, patients may receive pegfilgrastim SC beginning 24-36 hours after completion of each course of chemotherapy and continuing until blood counts recover.
Patients are followed every 2 months for 1 year, every 4 months for 2 years, and then annually thereafter.
PROJECTED ACCRUAL: A total of 18-46 patients will be accrued for this study within 9-24 months.
Eligibility| Ages Eligible for Study: | up to 49 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
DISEASE CHARACTERISTICS:
Histologically confirmed metastatic stage IV/clinical group IV rhabdomyosarcoma, undifferentiated sarcoma, or ectomesenchymoma
- No metastatic embryonal tumors in patients under 10 years of age, regardless of primary site
- Metastatic tumors of parameningeal sites eligible
- Bidimensionally measurable disease
- No positive cerebrospinal fluid cytology or multiple intracranial metastases
Patients presenting with the following are only eligible for continuation therapy and may not receive irinotecan/vincristine upfront window therapy:
- Evidence of base of skull erosion or skull metastatic disease that displaces or indents the dura, compresses the brain parenchyma, or causes evidence of cranial nerve palsy
- Tumor that touches or displaces the spinal cord
- Evidence of intracranial primary tumor extension
- Tumors that could cause potentially life-threatening complications (e.g., renal, airway) with progression due to location and/or growth rate
- Requires emergency radiotherapy
- Lab values are consistent with disseminated intravascular coagulation
PATIENT CHARACTERISTICS:
Age:
- Under 50 (alveolar rhabdomyosarcoma, undifferentiated sarcoma, and ectomesenchymoma patients)
- 10 to 49 (embryonal histology patients)
Performance status:
- Not specified
Life expectancy:
- Not specified
Hematopoietic:
- See Disease Characteristics
- Absolute neutrophil count greater than 1,000/mm^3*
- Platelet count greater than 150,000/mm^3* NOTE: *Unless there is tumor involvement of bone marrow
Hepatic:
- Bilirubin less than 1.5 mg/dL
- PT, PTT, and fibrinogen less than 1.5 times upper limit of normal
Renal:
- Creatinine less than 1.2 mg/dL
Other:
- Not pregnant or nursing
- Fertile patients must use effective contraception
PRIOR CONCURRENT THERAPY:
Biologic therapy:
- Not specified
Chemotherapy:
- No prior chemotherapy
Endocrine therapy:
- Prior steroids allowed
Radiotherapy:
- See Disease Characteristics
- No prior radiotherapy
Surgery:
- No more than 42 days since prior initial surgical procedure, including biopsy for diagnosis
Contacts and Locations
Show 237 Study Locations| Study Chair: | Alberto S. Pappo, MD | Texas Children's Cancer Center |
More Information
Additional Information:
Publications:
| ClinicalTrials.gov Identifier: | NCT00003955 History of Changes |
| Other Study ID Numbers: | CDR0000067154, COG-D9802, IRS-D9802, CCG-D9802, POG-D9802 |
| Study First Received: | November 1, 1999 |
| Last Updated: | February 6, 2009 |
| Health Authority: | United States: Federal Government |
Keywords provided by National Cancer Institute (NCI):
|
embryonal childhood rhabdomyosarcoma alveolar childhood rhabdomyosarcoma metastatic childhood soft tissue sarcoma childhood malignant mesenchymoma |
previously untreated childhood rhabdomyosarcoma adult rhabdomyosarcoma adult malignant mesenchymoma stage IV adult soft tissue sarcoma |
Additional relevant MeSH terms:
|
Rhabdomyosarcoma Sarcoma Myosarcoma Neoplasms, Muscle Tissue Neoplasms, Connective and Soft Tissue Neoplasms by Histologic Type Neoplasms Dactinomycin Irinotecan Cyclophosphamide Vincristine Camptothecin Lenograstim Antibiotics, Antineoplastic Antineoplastic Agents |
Therapeutic Uses Pharmacologic Actions Protein Synthesis Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Nucleic Acid Synthesis Inhibitors Anti-Bacterial Agents Anti-Infective Agents Immunosuppressive Agents Immunologic Factors Physiological Effects of Drugs Antirheumatic Agents Antineoplastic Agents, Alkylating Alkylating Agents Myeloablative Agonists |
ClinicalTrials.gov processed this record on May 21, 2013