Cisplatin With or Without Sodium Thiosulfate in Treating Young Patients With Stage I, Stage II, or Stage III Childhood Liver Cancer

• Rate of Brock grade ≥ 1 hearing loss determined after end of trial treatment or at an age of at least 3.5 years [ Designated as safety issue: Yes ]
  

• Response to preoperative chemotherapy [ Designated as safety issue: No ]
  
• Complete resection [ Designated as safety issue: No ]
  
• Complete remission [ Designated as safety issue: No ]
  
• Event-free survival (EFS) [ Designated as safety issue: No ]
  
• Overall survival (OS) [ Designated as safety issue: No ]
  
• Toxicity as graded by CTCAE v 3.0 [ Designated as safety issue: Yes ]
  
• Long-term renal clearance [ Designated as safety issue: Yes ]
  
• Feasibility of central audiology review [ Designated as safety issue: No ]
  

OBJECTIVES:

Primary

• To assess the efficacy of sodium thiosulfate (STS) to reduce the hearing impairment caused by cisplatin chemotherapy.

Secondary

• To carefully monitor any potential impact of STS on response to cisplatin and survival.
• To assess the short- and long-term tolerability of the combination of STS and cisplatin
• To prospectively evaluate and validate biological, radiological and pathological features of standard-risk hepatoblastoma for future risk adapted management
• To investigate the effect of STS on the formation of cisplatin-DNA adducts.
• To prospectively collect patient DNA specifically for the analysis of possible genetic factors that may contribute to the development of treatment-related ototoxicity and nephrotoxicity

OUTLINE: This is a multicenter study. Patients are stratified according to country, median age (< 15 months vs ≥ 15 months), and PRETEXT tumor classification (I vs II vs III). Patients are randomized to 1 of 2 treatment arms.

• Arm I (Neoadjuvant and adjuvant cisplatin): Patients receive cisplatin IV over 6 hours on day 1. Treatment repeats every 2 weeks for 4 courses. Patients with progressive disease after course 4 are taken off study. Patients without evidence of disease progression proceed to surgery. Beginning within 3 weeks after surgery, patients receive cisplatin IV over 6 hours on day 1. Treatment repeats every 2 weeks for 2 courses in the absence of disease progression or unacceptable toxicity.
• Arm II (Neoadjuvant and adjuvant cisplatin and sodium thiosulphate): Patients receive cisplatin IV over 6 hours and sodium thiosulphate IV over 15 minutes (beginning 6 hours after completion of cisplatin) on day 1. Treatment repeats every 2 weeks for 4 courses. Patients with progressive disease after course 4 are taken off study. Patients without evidence of disease progression proceed to surgery. Beginning within 3 weeks after surgery, patients receive cisplatin IV over 6 hours and sodium thiosulphate IV over 15 minutes (as in neoadjuvant therapy) on day 1. Treatment repeats every 2 weeks for 2 courses in the absence of disease progression or unacceptable toxicity.

Patients undergo blood collection and tumor biopsies periodically for biological and pharmacological studies consisting of biomarker analysis, gene expression profiling, IHC, proteomic analysis, and gene rearrangement analysis. Patients undergo auditory evaluations at baseline, and at the completion of study treatment or at an age of at least 3.5 years to measure ototoxicity and hearing impairment.

After completion of study treatment, patients are followed periodically for at least 5 years.