A Study of Bevacizumab in Combination With Chemotherapy for Treatment of Osteosarcoma

• Feasibility [ Time Frame: 5 years ] [ Designated as safety issue: Yes ]
  To study the feasibility of combining bevacizumab (Avastin®), a humanized monoclonal antibody against vascular endothelial growth factor (VEGF), with cisplatin, doxorubicin, and high-dose methotrexate (HDMTX) in patients with localized resectable osteosarcoma, and bevacizumab with cisplatin, doxorubicin, HDMTX, ifosfamide, and etoposide in patients with unresectable or metastatic osteosarcoma.
• Event Free Survival compared to historical controls on the Intergroup Study 0133 [ Time Frame: 7 years ] [ Designated as safety issue: No ]
  To study the effect of adding bevacizumab to chemotherapy comprised of cisplatin, doxorubicin, and HDMTX on the event-free survival (EFS) in patients with localized resectable osteosarcoma compared to historical controls treated with cisplatin, doxorubicin, and HDMTX without bevacizumab on the Intergroup Study 0133.

• Event Free Survival [ Time Frame: 7 years ] [ Designated as safety issue: No ]
• Feasibility [ Time Frame: 5 years ] [ Designated as safety issue: Yes ]

• Histologic response in patients with localized resectable osteosarcoma compared to Intergroup Study 0133 patients [ Time Frame: 5 years plus 6 cycles of chemotherapy ] [ Designated as safety issue: No ]
  To study the effect of adding bevacizumab to preoperative chemotherapy comprised of cisplatin, doxorubicin, and HDMTX on the histologic response in patients with localized resectable osteosarcoma compared to historical controls treated with preoperative cisplatin, doxorubicin, and HDMTX without bevacizumab on the Intergroup Study 0133.
• Event free survival of patients with osteosarcoma [ Time Frame: 6 years ] [ Designated as safety issue: No ]
  To estimate the EFS and overall survival of patients with osteosarcoma treated with chemotherapy and bevacizumab.
• Overall survival of patients with osteosarcoma [ Time Frame: 6 years ] [ Designated as safety issue: No ]
  To estimate the EFS and overall survival of patients with osteosarcoma treated with chemotherapy and bevacizumab.
• Event free survival in patients with localized resectable disease compared to OS99 protocol. [ Time Frame: 6 years ] [ Designated as safety issue: No ]
  To compare outcomes (EFS and survival) of patients with localized resectable disease treated on this protocol vs. those treated on the OS99 protocol.
• Overall survival in patients with localized resectable disease compared to OS99 protocol. [ Time Frame: 6 years ] [ Designated as safety issue: No ]
  To compare outcomes (EFS and survival) of patients with localized resectable disease treated on this protocol vs. those treated on the OS99 protocol.

This study adopts a novel strategy for first-line treatment of osteosarcoma by combining chemotherapy with anti-angiogenic therapy using bevacizumab (Avastin®), a humanized monoclonal antibody against vascular endothelial growth factor (VEGF). Chemotherapy for localized disease comprises a 3-drug regimen (cisplatin, doxorubicin, and high-dose methotrexate). Chemotherapy for metastatic or unresectable disease comprises a cisplatin-based regimen that includes high-dose methotrexate, doxorubicin, ifosfamide, and etoposide.

This is a comprehensive study that uses a novel agent that targets angiogenesis (bevacizumab) in combination with conventional chemotherapy for the treatment of osteosarcoma. Bevacizumab, a monoclonal antibody against the vascular endothelial growth factor (VEGF), has been shown to stop the growth of new blood vessels of tumors, both in the laboratory and in patients with other types of cancers. Bevacizumab has improved the effect of chemotherapy in adult patients with different types of cancer by increasing tumor response and increasing the chances of survival. This study has two main goals:

• To find out if bevacizumab can be combined safely with chemotherapy for osteosarcoma
• To find out if adding bevacizumab to chemotherapy will be beneficial in treating osteosarcoma.

The chemotherapy drugs used in this study are commonly used to treat osteosarcoma. Patients with non-metastatic and resectable tumors receive bevacizumab and chemotherapy comprised of cisplatin, doxorubicin and high-dose methotrexate. Patients with metastatic tumors or tumors that cannot be removed by surgery receive bevacizumab and chemotherapy comprised of cisplatin, doxorubicin and high-dose methotrexate, ifosfamide and etoposide. If the tumor can be removed by surgery, surgery will be performed after 10 weeks of chemotherapy and will be followed by additional chemotherapy. After completion of active therapy, patient's response to therapy will be followed for approximately 5 years.

• Osteosarcoma
• Malignant Fibrous Histiocytoma (MFH) of Bone

• Biological: Bevacizumab
  Monoclonal Antibody against VEGF
• Drug: Chemotherapy (Cisplatin, Doxorubicin, Methotrexate, Ifosfamide, Etoposide)

  Cisplatin, Doxorubicin, Methotrexate, Ifosfamide, Etoposide.

  Participants with resectable localized disease (Stratum A) only receive cisplatin, methotrexate and doxorubicin.

Inclusion Criteria:

• Patient must have newly diagnosed high-grade, biopsy proven, osteosarcoma or malignant fibrous histiocytoma (MFH) of bone with no history of prior chemotherapy or radiation;
• Participant is able to perform tasks and daily activities as defined in the study guidelines
• Patient meets established guidelines for adequate function of the kidney, liver, heart and bone marrow
• Participants meets other requirements defined in the eligibility portion of the study

Exclusion Criteria:

• recent major surgical procedure or injury
• Known bleeding diathesis, platelet disorder or coagulopathy
• Thrombosis
• Cardiac disease or hypertension
• Significant proteinuria
• Central nervous system disease
• Gastrointestinal perforation/abdominal fistula
• Osteosarcoma or MFH of bone as second malignancy