Adjuvant High-Dose Thiotepa and Stem Cell Rescue Associated With Conventional Chemotherapy in Relapsed Osteosarcoma (OSII-TTP)

This study is currently recruiting participants. (see Contacts and Locations)
Verified August 2014 by Centre Leon Berard
Sponsor:
Information provided by (Responsible Party):
Centre Leon Berard
ClinicalTrials.gov Identifier:
NCT00978471
First received: September 16, 2009
Last updated: August 4, 2014
Last verified: August 2014

September 16, 2009
August 4, 2014
July 2009
December 2016   (final data collection date for primary outcome measure)
Estimate the overall survival rate [ Time Frame: 24 months ] [ Designated as safety issue: No ]
Same as current
Complete list of historical versions of study NCT00978471 on ClinicalTrials.gov Archive Site
  • Estimate overall survival after relapse diagnosis [ Time Frame: 24 months ] [ Designated as safety issue: No ]
  • Estimate the survival free progression after randomization [ Time Frame: 24 months ] [ Designated as safety issue: No ]
  • Evaluate the tolerance profile of experimental treatment (hematologic toxicity) [ Time Frame: every 3 weeks ] [ Designated as safety issue: No ]
  • Estimate the rate of tumor response to treatment as assessed by conventional CT-scan [ Time Frame: at inclusion, day 14-day 21 after the 2nd chemotherapy cycle, before randomization, day 14-day 21 after the 4th chemotherapy cycle, after thiotepa cure and 8 weeks after the end of treatment ] [ Designated as safety issue: No ]
  • Estimate histological response to treatment on surgical tumor samples [ Time Frame: If surgery is applicable, a few weeks after thiotepa cure (12 to 17 weeks after inclusion) ] [ Designated as safety issue: No ]
  • Study of biological and genomic properties and analysis of angiogenic markers correlated with relapse (optional) [ Time Frame: At inclusion,at surgery , and at the end of treatment ] [ Designated as safety issue: No ]
Same as current
Not Provided
Not Provided
 
Adjuvant High-Dose Thiotepa and Stem Cell Rescue Associated With Conventional Chemotherapy in Relapsed Osteosarcoma
Efficacy and Tolerance Adjuvant High-Dose Thiotepa With Peripheral Stem Cell Rescue Associated With Conventional Chemotherapy in Children and Adults With Relapsed Osteosarcoma

Approximately 150 new cases of osteosarcoma are reported each year in France, of which 15 to 20% are metastatic.

Further to the initial standard care, about 45% of the patients relapse within a median duration of 20 months.

Result of the OS94 study results and of the investigation performed within the CRLCC, indicate that 25 to 30 patients (children and adults) experience an osteosarcoma relapse each year in FRANCE.

According to several studies, the 5-year overall survival rate of patients in first relapse is 23-28%,with a median post relapse survival of 10 to 17 months. Multiple relapse cases are also reported in the COSS study, with a median time to second relapse of 0.8 year.

At present, there is no reference treatment for the standard care of osteosarcoma relapse in FRANCE.

Thiotepa is known for its antitumor effect in numerous malignant tumors. In 2007, a study from our institution reported that about 35% of all osteosarcoma relapses are treated with a high-dose thiotepa while the efficacy and tolerance of this therapeutic strategy have never been assessed.

These results highlight the need to the evaluate the efficacy and tolerance of this high-dose of thiotepa within a clinical trial and its inclusion in the standard care of the osteosarcoma at relapse.

Despite the absence of tumor registry, approximately 150 new cases of osteosarcoma are reported each year in France (100 cases per year in children and 50 cases in adults), of which 15 to 20% are metastatic. The standardized impact rate in the world population is estimated at 3 per million inhabitants per year.

Further to the initial standard care, about 45% of the patients relapse within a median interval of 20 months (range 3 months - 10 years).

Results of the OS94 study and of the investigation performed within the CRLCC indicate that 25 to 30 patients (children and adults) experience an osteosarcoma relapse each year in FRANCE.

Results of the five major published series indicate that the 5-year overall survival rate of patients in first relapse is between 23 and 28%, with a median post-relapse survival of 10 to 17 months. Multiple relapse cases are also reported in the COSS study, with a median time to second relapse of 0.8 year.

At present, there is no reference treatment for the standard care of osteosarcoma relapse in FRANCE.

Some recommendations have been given in the OS94 protocol, but they are generally not followed or they are implemented in a heterogeneous manner.

Thiotepa (N N' N'' triethylenethiophosphoramide), an alkylating agent of the chemical family of ethylene-imines, is known for its antitumor effect in a number of malignant tumors.

Its efficacy in osteosarcoma has been reported in the literature. A retrospective study of the SFCE (French Society for Childhood Cancer, results not yet published) in 45 patients presenting with refractory osteosarcoma or relapse has shown a radiological reaction rate of 30%.

Moreover, a preliminary investigation performed by the CLB in 2007 within the framework of the SFCE study explored all relapse cases diagnosed between the beginning of 2004 and the end of 2006. Results showed that about 35% of the patients with osteosarcoma relapses are treated with high-dose thiotepa while the efficacy and tolerance of this therapeutic strategy have never been assessed.

Altogether, these results led the SFCE osteosarcoma group to propose the evaluation of the efficacy and tolerance of this high-dose thiotepa chemotherapy within a clinical trial and to include the drug in the standard care of osteosarcoma in relapse.

Interventional
Phase 2
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Osteosarcoma
Drug: Thiotepa
Thiotepa 8-12mg/m²/day/injection Total dose for one cure:15-50mg.
Other Names:
  • N N'N'triethylenethiophosphosphoramide
  • Tepadina
  • Experimental: experimental arm thiotepa
    4 courses of conventional chemotherapy followed by high-dose Thiotepa with peripheral stem cell rescue. Surgical resection of all tumor masses will be performed as soon as possible.
    Intervention: Drug: Thiotepa
  • Reference arm
    4 courses of conventional chemotherapy. Surgical resection of all tumor masses will be performed as soon as possible.
    Intervention: Drug: Thiotepa

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
66
December 2017
December 2016   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • Age > 1 year and < 50 years
  • First osteosarcoma relapse, either local or metastatic, or second relapse after exclusive surgery NB: Whenever possible, only patients with histological evidence of relapse will be included.
  • Indication for chemotherapy confirmed by a multidisciplinary committee.
  • Surgical resection of all tumor sites must be possible, either as first-line therapy or after chemotherapy.
  • Lansky score ≥ 60%, or ECOG Performance Status ≤ 2
  • ≥ 21-day interval after first-line chemotherapy
  • Blood tests, renal and liver functions within the normal range for age with, in particular, 7 days prior to study entry, blood or serum values as follows:
  • blood: neutrophil count > 1 G/L; platelets >100 G/L
  • renal: serum creatinine ≤ 1.5 x ULN depending on age; patients with serum creatinine values > 1.5 x ULN are eligible if creatinine clearance is > 70 mL/min/1.73 m²
  • liver: total bilirubin < 2 x ULN; ASAT and ALAT ≤ 5 x ULN
  • cardiac: isotopic or echographic Left Ventricular Ejection Fraction > 50 %.
  • Signed written informed consent; for children, signed consent from the patient (depending on age) and from the parents or legal representative is mandatory
  • Documented negative serum βHCG for female patients of childbearing age
  • Affiliation with health insurance.

Exclusion Criteria:

  • Patients with multiple relapses for whom surgical resection seems impossible, even after chemotherapy.
  • Patients already treated with high-dose chemotherapy regimens
  • Patients with a contra-indication to the treatment proposed
  • Patients not eligible for leukapheresis
  • Two-year follow-up impossible due to social, family, geographic or psychological reasons
  • Patient included in another protocol of clinical research
  • Pregnant or lactating women.
Both
1 Year to 50 Years
No
Contact: Perrine MAREC-BERARD, MD 04 78 78 26 42 perrine.marec-berard@lyon.unicancer.fr
Contact: Séverine METZGER severine.metzger@lyon.unicancer.fr
France
 
NCT00978471
OSII-TTP, 2009-009899-12
Yes
Centre Leon Berard
Centre Leon Berard
Not Provided
Principal Investigator: Perrine MAREC-BÉRARD, Dr Institut d'Hématologie et d'Oncologie Pédiatrique (IHOP) - CLB
Centre Leon Berard
August 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP