Comparison of Chemotherapy Regimens in Treating Children With Relapsed or Progressive Rhabdomyosarcoma

Recurrent Childhood Rhabdomyosarcoma Clinical Trial

Official title:

A Groupwide Randomized Phase II Window Study of Two Different Schedules of Irinotecan in Combination With Vincristine And Pilot Assessment of Safety and Efficacy of Tirapazamine Combined With Multiagent Chemotherapy for First Relapse or Progressive Disease in Rhabdomyosarcoma and Related Tumors

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00025363
• Other study ID #: NCI-2012-01864
• Secondary ID: ARST0121U10CA098
• Status: Completed
• Phase: Phase 2
• First received: October 11, 2001
• Last updated: January 16, 2013
• Start date: November 2001

Study information

• Verified date: January 2013
• Source: National Cancer Institute (NCI)
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Food and Drug Administration
• Study type: Interventional

Clinical Trial Summary

Randomized phase II trial to compare the effectiveness of different combination chemotherapy regimens in treating children who have rhabdomyosarcoma. Drugs used in chemotherapy work in different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells

Description:

OBJECTIVES:

I. Compare response rate in children with relapsed or progressive rhabdomyosarcoma, undifferentiated sarcoma, or ectomesenchymoma treated with 2 different schedules of irinotecan and vincristine in an upfront phase II window.

II. Determine the progression-free and overall survival of patients treated with multiagent chemotherapy.

III. Determine the toxic effects of tirapazamine, doxorubicin, and cyclophosphamide in these patients.

IV. Determine the toxic effects of irinotecan and vincristine in these patients.

V. Determine whether conversion of irinotecan to its active metabolite SN-38 predicts tumor response in these patients.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to risk status and window therapy eligibility (unfavorable risk and eligible vs unfavorable risk and ineligible vs favorable risk).

UNFAVORABLE-RISK PATIENTS ELIGIBLE FOR WINDOW THERAPY: Patients are stratified according to prior topotecan (yes vs no). These patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive vincristine IV on days 1 and 8 and irinotecan IV over 1 hour on days 1-5 and 8-12. Treatment repeats every 21 days for 2 courses in the absence of disease progression or unacceptable toxicity.

ARM II: Patients receive vincristine IV on days 1 and 8 and irinotecan IV over 1 hour on days 1-5. Treatment repeats every 21 days for 2 courses in the absence of disease progression or unacceptable toxicity.

Patients in both arms with partial response (PR) or complete response (CR) receive 5 additional courses of irinotecan and vincristine on the previous schedule. In addition, patients with PR or CR also receive cyclophosphamide/doxorubicin (CD) and ifosfamide/etoposide (IE) chemotherapy.

CD/IE CHEMOTHERAPY: Patients receive cyclophosphamide IV over 1 hour and doxorubicin IV over 15-30 minutes on day 1 of weeks 7, 16, 28, 37, and 40. Patients also receive ifosfamide IV over 1 hour and etoposide IV over 1 hour on days 1-5 of weeks 10, 19, 22, 31, and 43. Treatment continues in the absence of disease progression or unacceptable toxicity.

Patients with no response or progressive disease on arm I or II proceed to tirapazamine/cyclophosphamide/doxorubicin (TCD) and ifosfamide/etoposide (IE) chemotherapy.

TCD/IE CHEMOTHERAPY: Patients receive tirapazamine IV over 2 hours, cyclophosphamide IV over 1 hour, and doxorubicin IV over 15-30 minutes on day 1 of weeks 7, 10, 16, 25, and 34. Patients also receive ifosfamide IV over 1 hour and etoposide IV over 1 hour on days 1-5 of weeks 13, 19, 22, 28, 31, and 37.

PATIENTS WITH UNFAVORABLE RISK AND INELIGIBLE FOR WINDOW THERAPY: Patients receive tirapazamine IV over 2 hours, cyclophosphamide IV over 1 hour, and doxorubicin IV over 15-30 minutes on day 1 of weeks 1, 4, 10, 19, and 28. Patients also receive ifosfamide IV over 1 hour and etoposide IV over 1 hour on days 1-5 of weeks 7, 13, 16, 22, 25, and 31. Patients also receive filgrastim (G-CSF) or sargramostim (GM-CSF) subcutaneously (SC) beginning 1 day after each course of chemotherapy and continuing until blood counts recover. Treatment continues in the absence of disease progression or unacceptable toxicity.

PATIENTS WITH FAVORABLE RISK: Patients receive cyclophosphamide IV over 1 hour and doxorubicin IV over 15-30 minutes on day 1 of weeks 1, 4, 10, 19, and 28. Patients also receive ifosfamide IV over 1 hour and etoposide IV over 1 hour on days 1-5 of weeks 7, 13, 16, 22, 25, and 31. Patients also receive G-CSF or GM-CSF SC beginning 1 day after each course of chemotherapy and continuing until blood counts recover. Treatment continues in the absence of disease progression or unacceptable toxicity.

Patients are followed every 2 months for 1 year, every 4 months for 2 years, and then annually thereafter.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 150
• Est. primary completion date: October 2007
• Accepts healthy volunteers: No
• Gender: Both
• Age group: N/A to 20 Years

Eligibility

Inclusion Criteria:

• Histologically confirmed rhabdomyosarcoma, undifferentiated sarcoma, or ectomesenchymoma

• First relapse or first occurrence of disease progression

• Unfavorable-risk patients eligible for study window therapy with irinotecan and vincristine meeting the following criteria:

• Unfavorable risk defined by any of the following:

• Embryonal histology with stage I or group I at initial diagnosis with distant recurrence or with local or regional recurrence after prior cyclophosphamide

• Embryonal histology with initial stage II, III, or IV or group II, III, or IV with any relapse pattern

• Alveolar histology with any stage or group at initial diagnosis

• At least unidimensionally measurable disease

• No prior irinotecan

• Bone marrow must not be only site of relapse

• Unfavorable-risk patients ineligible for study window therapy with irinotecan meeting the following criteria:

• Either no measurable disease OR patient received prior irinotecan

• Bone marrow as only site of relapse allowed

• Favorable-risk patients meeting the following criteria:

• Initial botryoid histology (any stage, any group, or any pattern of relapse)

• Embryonal histology if either stage I or group I (with either local or regional recurrence)

• No prior cyclophosphamide

• No CNS metastases

• Performance status - ECOG 0-2

• Performance status - Zubrod 0-2

• At least 2 months

• Absolute neutrophil count at least 750/mm^3

• Platelet count at least 75,000/mm^3 (transfusion independent)

• Hemoglobin at least 10.0 g/dL (red blood cell transfusion allowed)

• Bilirubin no greater than 1.5 times normal

• SGPT less than 2.5 times normal

• Creatinine no greater than 1.5 times normal

• Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min

• Shortening fraction at least 27% by echocardiogram

• Ejection fraction at least 50% by MUGA

• No prior ischemic heart disease

• Seizure disorder allowed if well controlled by anticonvulsants

• No CNS toxicity greater than grade 2

• Not pregnant or nursing

• Negative pregnancy test

• Fertile patients must use effective contraception

• No prior myeloablative therapy with stem cell transplantation

• At least 1 week since prior antineoplastic biologic agent

• At least 1 week since prior growth factor(s)

• Recovered from prior immunotherapy

• No concurrent immunomodulating agents

• See Disease Characteristics

• See Biologic therapy

• No more than 1 prior chemotherapy regimen

• No prior doxorubicin or daunorubicin

• At least 2 weeks since prior myelosuppressive chemotherapy (4 weeks for nitrosoureas) and recovered

• No other concurrent anticancer chemotherapy

• Concurrent corticosteroid therapy allowed

• At least 2 weeks since prior small-port radiotherapy.

• At least 6 months since prior radiotherapy to 50% or more of pelvis

• At least 6 weeks since other prior substantial radiotherapy to bone marrow

• Recovered from prior radiotherapy

• Concurrent radiotherapy to localized painful lesions allowed provided at least 1 measurable lesion is not irradiated

• No concurrent intensity-modulated radiotherapy

Study Design

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Alveolar Childhood Rhabdomyosarcoma
• Embryonal Childhood Rhabdomyosarcoma
• Embryonal-botryoid Childhood Rhabdomyosarcoma
• Previously Treated Childhood Rhabdomyosarcoma
• Recurrent Childhood Rhabdomyosarcoma
• Rhabdomyosarcoma

Intervention

Drug:
• vincristine sulfate
Given IV
• irinotecan hydrochloride
Given IV
• cyclophosphamide
Given IV
• doxorubicin hydrochloride
Given IV
• ifosfamide
Given IV
• etoposide
Given IV
• tirapazamine
Given IV

Biological:
• filgrastim
Given SC
• sargramostim
Given SC

Other:
• pharmacological study
Correlative studies
• pharmacogenomic studies
Correlative studies
• laboratory biomarker analysis
Correlative studies

Locations

Country	Name	City	State
United States	Children's Oncology Group	Arcadia	California

Sponsors (1)

Lead Sponsor	Collaborator
National Cancer Institute (NCI)

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Response at week 6 of investigational window therapy (unfavorable risk patients)		At week 6	No
Primary	Incidence of DLT when tirapazamine is given in combination with cyclophosphamide and doxorubicin, graded according to the NCI CTC v 2.0		Up to 6 years	Yes
Secondary	Incidence of toxicities associated with the two administration schedules of irinotecan in combination with vincristine, graded according to the NCI CTC v 2.0 (unfavorable risk patients)		Up to 6 years	Yes
Secondary	Blood metabolite SN-38 levels (unfavorable risk patients)		Up to 6 years	No
Secondary	Progression-free survival		Up to 6 years	No
Secondary	Survival		Up to 6 years	No