Stage IV Adult Soft Tissue Sarcoma Clinical Trial
Official title:
A Pilot Study to Evaluate Novel Agents (Temozolomide and Cixutumumab [IMC-A12, Anti-IGF-IR Monoclonal Antibody NSC # 742460]) in Combination With Intensive Multi-agent Interval Compressed Therapy for Patients With High-Risk Rhabdomyosarcoma
This randomized pilot clinical trial is studying the side effects and how well giving temozolomide and cixutumumab together with combination chemotherapy works in treating patients with metastatic rhabdomyosarcoma. Drugs used in chemotherapy, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as cixutumumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Giving temozolomide and cixutumumab together with combination chemotherapy may kill more tumor cells.
PRIMARY OBJECTIVES:
I. To determine the feasibility of administering IMC-A12 (cixutumumab) in combination with a
multi-agent intensive chemotherapy regimen for the treatment of high-risk rhabdomyosarcoma
(RMS).
II. To determine the feasibility of adding temozolomide to vincristine (vincristine
sulfate)/irinotecan (irinotecan hydrochloride) cycles in patients with high-risk RMS.
III. To assess immediate and short-term side effects of delivery of concurrent
temozolomide-vincristine-irinotecan with irradiation in patients with high-risk RMS.
SECONDARY OBJECTIVES:
I. To gain a preliminary estimate of the response rate to IMC-A12 or temozolomide plus
vincristine/irinotecan in previously untreated high-risk RMS.
II. To obtain preliminary efficacy data for IMC-A12 or temozolomide in combination with a
multi-agent interval compressed chemotherapy regimen in previously untreated high-risk RMS.
III. To determine the effectiveness of detecting metastatic disease with fludeoxyglucose F
18 positron emission tomography (FDG PET) and to compare assessment of response using
standard imaging techniques with response assessed by FDG PET.
IV. To assess changes in serum levels of insulin-like growth factor (IGF)-I, IGF-II, IGF-BP3
as biomarkers of IGF-IR inhibition.
OUTLINE: This is a dose-escalation study of cixutumumab. Patients are assigned to 1 of 2
treatment groups according to the timing of their enrollment onto the study.
GROUP 1: Patients receive vincristine sulfate intravenously (IV) over 1 minute on day 1 of
weeks 1-5, 7, 8, 11, 12, 15, 16, 20-24, 28, 29, 32, 33, 35, 38, 41-44, 47, 48, 50, and 51;
irinotecan hydrochloride IV over 90 minutes on days 1-5 of weeks 1, 4, 20, 23, 47, and 50;
ifosfamide IV over 1 hour and etoposide IV over 1-2 hours on days 1-5 of weeks 9, 13, 17,
26, and 30; doxorubicin hydrochloride IV over 1-15 minutes on days 1 and 2 of weeks 7, 11,
15, 28, and 32; cyclophosphamide IV over 30-60 minutes on day 1 of weeks 7, 11, 15, 28, 32,
35, 38, 41, and 44; dactinomycin IV over 1-5 minutes on day 1 of weeks 35, 38, 41, and 44;
and cixutumumab IV over 1 hour on day 1 of weeks 1-51. Patients also undergo radiation
therapy* on days 1-5 of weeks 20-24.
GROUP 2: Patients receive vincristine sulfate, irinotecan hydrochloride, ifosfamide,
etoposide, doxorubicin hydrochloride, cyclophosphamide, and dactinomycin and undergo
radiation therapy* as in group 1. Patients also receive temozolomide orally (PO) on days 1-5
of weeks 1, 4, 20, 23, 47, and 50.
GROUP 3: Patients receive vincristine sulfate, irinotecan hydrochloride, ifosfamide,
etoposide, doxorubicin hydrochloride, cyclophosphamide, dactinomycin, and cixutumumab and
undergo radiation therapy* as in group 1. Patients also receive temozolomide as in group 2.
(Discontinued as of January 2013)
NOTE: *Patients with parameningeal tumors and evidence of intracranial extension or those
requiring emergency radiotherapy may receive radiation therapy starting in week 1;
cixutumumab should be withheld during radiation therapy.
After completion of study therapy, patients are followed up at 3 weeks and then periodically
for up to 5 years.
;
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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