A Pilot Study of Pre-Operative Treatment of Newly-Diagnosed, Surgically-Resectable Osteosarcoma With Doxorubicin, Ifosfamide, Etoposide, and Cisplatin With Early Metabolic Assessment of Response
Overview
- Phase
- Phase 1
- Intervention
- Dexrazoxane
- Conditions
- Osteosarcoma
- Sponsor
- University of Chicago
- Enrollment
- 2
- Locations
- 1
- Primary Endpoint
- Feasibility and usefulness of measuring early changes in tumor metabolic activity.
- Status
- Terminated
- Last Updated
- 12 years ago
Overview
Brief Summary
This is a pilot study that will allow investigators to collect data related to early and potentially more accurate response assessments using a chemotherapy protocol that eliminates methotrexate to maximize the dose intensity of doxorubicin. The pilot data will be used to seek funding to more fully address the hypotheses in a multi-institutional, Phase II or Phase III trial. The primary and secondary objectives are as follows:
Primary:
- To evaluate the feasibility and potential usefulness of measuring early changes in tumor metabolic activity, assessed by Fludeoxyglucose-Positron Emission Tomography (FDG-PET) imaging and alkaline phosphatase activity, as early predictors of histological response rate at 12 weeks in osteosarcoma patients.
- To explore whether histological response can be assessed by a computer algorithm using virtual microscopic images of pathology material, and whether quantifying necrosis in this way correlates with microscope slide-based review.
Secondary:
- To gather pilot data on the histological response rate, 3-year event-free survival, and toxicity when children and young adults with resectable osteosarcoma are treated using a chemotherapy regimen of alternating courses of doxorubicin/cisplatin (DC) and doxorubicin/ifosfamide/etoposide (IDE).
All patients will receive 4 courses of preoperative chemotherapy courses. With the exception of high-dose methotrexate, which is given weekly, preoperative and postoperative chemotherapy courses are planned to begin every 21 days.
Patients with good histological response (those patients with > 90% tumor necrosis at time of definitive resection) will receive three postoperative chemotherapy courses. The 1st will consist of doxorubicin, dexrazoxane, cisplatin and Granulocyte-Colony Stimulating Factor (G-CSF)(or Polyethylene Glycol filgrastim). The 2nd course will consist of doxorubicin, dexrazoxane, ifosfamide, MESNA, etoposide, G-CSF (or PEG-filgrastim). The 3rd course will consist of ifosfamide, MESNA, etoposide, G-CSF (or PEG-filgrastrim). The total doxorubicin dose will be 450 mg/m2.
Patients with poor response (those patients with < 90% tumor necrosis found on pathology at time of definitive resection) will receive five postoperative chemotherapy courses. High Dose-Methotrexate will be administered during the 1st and 3rd postoperative chemotherapy courses as 4-weekly and 2-weekly doses, respectively. The 2nd course will consist of doxorubicin, dexrazoxane, cisplatin and G-CSF (or PEG-filgrastim). The 4th course will consist of doxorubicin, dexrazoxane, ifosfamide, Mesna, etoposide, G-CSF (or PEG-filgrastim). The 5th cycle will consist of ifosfamide, Mesna, etoposide, G-CSF (or PEG-filgrastrim). The total doxorubicin dose will be 450 mg/m2.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Must be between 2 and 35 years of age at time of diagnosis
- •Must have biopsy-proven, high-grade osteosarcoma.
- •Patients with metastases are eligible as long as the lung is the only site of metastatic disease.
- •The primary tumor and all pulmonary metastases must be deemed to be potentially resectable. There must be a commitment by the surgical team to resect the primary tumor at week 12, and pulmonary nodules at any point, unless the clinical situation indicates these interventions are not in the patient's best interest.
- •Patients must have normal laboratory values and cardiac function as defined below:
- •Creatinine clearance or radioisotope GFR of \> or equal to 70ml/min/1.73 m2 OR
- •A serum creatinine based on age/gender as follows:
- •Age Maximum Serum Creatinine (mg/dL) Male Female
- •1 month to \< 6 months 0.4 0.4 6 months to \< 1 year 0.5 0.5
- •to \< 2 years 0.6 0.6
Exclusion Criteria
- •Patients with any low-grade osteosarcoma, post-radiation osteosarcoma, and osteosarcoma associated with Paget's disease are not eligible.
- •Patients with metastases other than lung metastases are not eligible.
- •Patients may not have received prior chemotherapy.
Arms & Interventions
Pre-op treatment
Intervention: Dexrazoxane
Pre-op treatment
Intervention: Doxorubicin
Pre-op treatment
Intervention: Cisplatin
Pre-op treatment
Intervention: G-CSF
Pre-op treatment
Intervention: PEG-filgrastim
Pre-op treatment
Intervention: Etoposide
Pre-op treatment
Intervention: Ifosfamide
Pre-op treatment
Intervention: Mesna
Pre-op treatment
Intervention: Leucovorin
Outcomes
Primary Outcomes
Feasibility and usefulness of measuring early changes in tumor metabolic activity.
Time Frame: 6 months after last subject has been enrolled
The feasibility and potential usefulness of measuring early changes in tumor metabolic activity will be assessed by early Fludeoxyglucose-Positron Emission Tomography imaging and alkaline phosphatase activity.
Secondary Outcomes
- Gather pilot data on 3-year event-free survival(3 years after last subject is enrolled)
- Gather pilot data on toxicity(3 years after last subject is enrolled on the study.)
- Gather pilot data on the histological response rate(3 years after last enrolled subject has completed therapy)
- Explore whether histological response can be measured by a computer algorithm(1 year after last enrolled subject has completed therapy)