Combination Chemotherapy in Treating Patients With Stage III or Stage IV Malignant Peripheral Nerve Sheath Tumors
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The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. |
| ClinicalTrials.gov Identifier: NCT00304083 |
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Recruitment Status :
Completed
First Posted : March 17, 2006
Results First Posted : May 25, 2018
Last Update Posted : September 18, 2018
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Sponsor:
Sarcoma Alliance for Research through Collaboration
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Sarcoma Alliance for Research through Collaboration
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Brief Summary:
RATIONALE: Drugs used in chemotherapy, such as doxorubicin, ifosfamide, and etoposide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving combination chemotherapy with or without radiation therapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed. Giving combination chemotherapy after surgery may kill any tumor cells that remain after surgery.
PURPOSE: This phase II trial is studying how well combination chemotherapy works in treating patients with stage III or stage IV malignant peripheral nerve sheath tumors.
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Neurofibromatosis Type 1 Sarcoma | Biological: filgrastim Drug: doxorubicin hydrochloride Drug: etoposide Drug: ifosfamide Procedure: conventional surgery Radiation: radiation therapy | Phase 2 |
OBJECTIVES:
Primary
- Determine the clinical response rate (complete and partial) in patients with sporadic or neurofibromatosis type 1 (NF1)-associated high-grade stage III or IV malignant peripheral nerve sheath tumors (MPNSTs) after treatment with 4 courses of chemotherapy comprising doxorubicin hydrochloride and ifosfamide (IA) followed by etoposide and ifosfamide (IE).
Secondary
- Evaluate the utility of fludeoxyglucose F18 positron emission tomography (^18FDG-PET) and automated MRI volumetric tumor analysis as tools to assess response to treatment.
- Correlate response evaluation by 2-dimensional WHO criteria, 1-dimensional RECIST criteria, ^18FDG-PET, and volumetric MRI with percent necrosis in tumor specimens from patients who undergo surgery for local control after chemotherapy.
- Evaluate the response of plexiform neurofibroma(s) (if present) to chemotherapy using WHO criteria and automated volumetric MRI analysis.
- Evaluate the molecular biology of sporadic and NF1-associated MPNSTs by performing a detailed pathologic analysis of tumor samples with the goal to analyze if markers can be identified that predict for response to chemotherapy or outcome.
- Construct a tissue microarray from submitted tumor samples, that will be used in the future to identify novel targets for treatment of MPNSTs.
- Assess if a serum biomarker can be identified, that predicts for the presence of a MPNST versus benign plexiform neurofibroma.
- Increase the knowledge of the epidemiology and clinical presentation of NF1-associated MPNSTs.
OUTLINE: This is a multicenter study. Patients are stratified according to type of malignant peripheral nerve sheath tumor (MPNST) (sporadic MPNST vs neurofibromatosis type 1 [NF1]-associated MPNST). Patients receive 1 of 2 treatment regimens depending on the location of the MPNST and tumor response to chemotherapy.
- Chemotherapy and local control by radiotherapy and surgery: Patients receive doxorubicin hydrochloride and ifosfamide (IA) chemotherapy comprising doxorubicin hydrochloride IV over 15 minutes on days 1 and 2 and ifosfamide IV over 1 hour on days 1-5. Treatment repeats every 21 days for 2 courses in the absence of unacceptable toxicity. Patients then receive etoposide and ifosfamide (IE) chemotherapy comprising etoposide IV over 1 hour and ifosfamide 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 also receive filgrastim (G-CSF) subcutaneously (SC) after each chemotherapy course beginning on day 6 or 7 and continuing until blood counts recover or pegfilgrastim SC once on day 6 or 7.
After recovery from chemotherapy, patients undergo radiotherapy and receive 2 more courses of IE during radiotherapy followed by 2 more courses of IA after completion of radiotherapy. Some patients may then undergo surgery.
- Chemotherapy and local control by surgery: Patients receive 2 courses of IA followed by 2 courses of IE as above. After recovery from chemotherapy, patients undergo surgery. After recovery from surgery, patients receive 2 more courses of IA followed by 2 more courses of IE in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed periodically for up to 5 years.
PROJECTED ACCRUAL: A total of 74 patients will be accrued for this study.
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 48 participants |
| Allocation: | Non-Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Treatment |
| Official Title: | Phase II Trial of Chemotherapy in Sporadic and Neurofibromatosis Type 1 Associated High Grade Malignant Peripheral Nerve Sheath Tumors |
| Study Start Date : | December 2005 |
| Actual Primary Completion Date : | June 2014 |
| Actual Study Completion Date : | June 2014 |
Resource links provided by the National Library of Medicine
MedlinePlus related topics:
Neurofibromatosis
| Arm | Intervention/treatment |
|---|---|
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Experimental: Chemotherapy and local control by radiotherapy and surgery
Patients receive doxorubicin hydrochloride and ifosfamide (IA) chemotherapy. Treatment repeats every 21 days for 2 courses in the absence of unacceptable toxicity. Patients then receive etoposide and ifosfamide (IE) chemotherapy. Treatment repeats every 21 days for 2 courses in the absence of disease progression or unacceptable toxicity. Patients also receive filgrastim (G-CSF) subcutaneously (SC) after each chemotherapy course. After recovery from chemotherapy, patients undergo radiotherapy and receive 2 more courses of IE during radiotherapy followed by 2 more courses of IA after completion of radiotherapy. Some patients may then undergo surgery.
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Biological: filgrastim
Given subcutaneously Drug: doxorubicin hydrochloride Given IV Drug: etoposide Given IV Drug: ifosfamide Given IV Procedure: conventional surgery Patients undergo surgery Radiation: radiation therapy Patients undergo radiotherapy |
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Experimental: Chemotherapy and local control by surgery
Patients receive 2 courses of IA followed by 2 courses of IE as above. After recovery from chemotherapy, patients undergo surgery. After recovery from surgery, patients receive 2 more courses of IA followed by 2 more courses of IE in the absence of disease progression or unacceptable toxicity.
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Drug: doxorubicin hydrochloride
Given IV Drug: etoposide Given IV Drug: ifosfamide Given IV Procedure: conventional surgery Patients undergo surgery |
Primary Outcome Measures :
- Number of Participants With Response Rate (Complete Response and Partial Response) [ Time Frame: After 4 Cycles (1 cycle=21 days) ]WHO criteria was used to determine responses due to the nonspherical shape of most MPNST. Complete Response (CR), Disappearance of all target lesions; Partial response (PR), >=50% decrease of target lesions.
Secondary Outcome Measures :
- Response of Plexiform Neurofibroma to Neoadjuvant Chemotherapy Using Volumetric MRI Analysis [ Time Frame: After 4 Cycles (1 cycle=21 days) ]Evaluate the response of plexiformneurofibroma (if present) to neoadjuvant chemotherapy using WHO criteria and volumetric MRI analysis as a tool for response assessment
- Utility of Fludeoxyglucose F18 Positron Emission Tomography (18FDG-PET) and Automated MRI Volumetric Tumor Analysis to Assess Response to Treatment [ Time Frame: After 4 cycles ]Evaluate the utility of fludeoxyglucose F18 positron emission tomography (18FDG-PET) and automated MRI volumetric tumor analysis as tools to assess response to treatment.
- Response Evaluation Using WHO, RECIST, 18 FDG-PET and Volumetric MRI With Percent Necrosis in Tumor Specimens [ Time Frame: After 4 cycles ]Correlate response evaluation using WHO, RECIST, 18 FDG-PET and volumetric MRI with percent necrosis in tumor specimens from patients who undergo surgery for local control after chemotherapy.
- Perform Pathologic Analysis of Tumor Samples to Analyze the Number of Participants With Markers as Predictors of Response [ Time Frame: After 4 cycles ]Evaluate the molecular biology of sporadic and NF1-associated MPNSTs by performing a detailed pathologic analysis of tumor samples with the goal to analyze if markers can be identified that predict for response to chemotherapy or outcome.
- Construct Tissue Microarray to Identify Novel Targets for Treatment for the Number of Participants With Available Tissue [ Time Frame: After 4 cycles ]Construct a tissue microarray from submitted tumor samples that will be used in the future to identify novel targets for treatment of MPNSTs. The tissue microarray looked at various gene deletions and amplifications.
- Identify the Number of Participants With a Serum Biomarker to Predict the Presence of MPNST Versus Benign Plexiform Neurofibroma [ Time Frame: After 4 cycles ]Assess if a serum biomarker can be identified that predicts for the presence of a MPNST versus benign plexiform neurofibroma.
- Provide Epidemiology and Clinical Presentation of the Number of Participants With NF1-associated MPNSTs. [ Time Frame: After 4 cycles ]Increase the knowledge of the epidemiology and clinical presentation of NF1-associated MPNSTs.
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| Ages Eligible for Study: | Child, Adult, Older Adult |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Criteria
DISEASE CHARACTERISTICS:
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Newly diagnosed sporadic or neurofibromatosis type 1 (NF1)-associated high-grade malignant peripheral nerve sheath tumors (MPNSTs)
- Stage III or stage IV (metastatic) disease
- Measurable disease, defined as at least 1 tumor that is measurable in 2 dimensions on CT scan or MRI
PATIENT CHARACTERISTICS:
- Ejection fraction normal by echocardiogram or MUGA
- Serum creatinine normal for age OR creatinine clearance > 60 mL/min
- SGPT < 5 times upper limit of normal (ULN)
- Bilirubin < 2.5 times ULN
- Absolute neutrophil count ≥ 1,500/mm^3*
- Hemoglobin ≥ 9.0 g/dL*
- Platelet count ≥ 100,000/mm^3*
- ECOG performance status 0-2
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception during and for 6 months after completion of study treatment NOTE: * Unsupported
PRIOR CONCURRENT THERAPY:
- No prior chemotherapy for MPNST
- Prior surgical resection of MPNST allowed provided residual or recurrent measurable disease is present
- Recovered from toxic effects of all prior therapy
- At least 3 weeks since prior chemotherapy or biologic therapy for treatment of a plexiform neurofibroma, optical pathway tumor, or other NF1-associated tumor (in patients with NF1)
- At least 6 weeks since prior radiotherapy for treatment of a plexiform neurofibroma, optical pathway tumor, or other NF1-associated tumor (in patients with NF1)
- At least 4 weeks since prior radiotherapy to the area involved by MPNST
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No other concurrent growth factors (e.g., sargramostim [GM-CSF] or interleukin-11)
- Concurrent epoetin alfa allowed
Information from the National Library of Medicine
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00304083
Locations
| United States, Alabama | |
| UAB Comprehensive Cancer Center | |
| Birmingham, Alabama, United States, 35294 | |
| United States, California | |
| Sarcoma Oncology Center | |
| Santa Monica, California, United States, 90403 | |
| United States, Illinois | |
| Children's Memorial Hospital - Chicago | |
| Chicago, Illinois, United States, 60614 | |
| United States, Indiana | |
| Indiana University | |
| Indianapolis, Indiana, United States, 46202-5289 | |
| United States, Iowa | |
| University of Iowa Hospitals and Clinics | |
| Iowa City, Iowa, United States, 52242 | |
| United States, Maryland | |
| Johns Hopkins | |
| Baltimore, Maryland, United States, 21231-2410 | |
| Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office | |
| Bethesda, Maryland, United States, 20892-1182 | |
| United States, Michigan | |
| University of Michigan Comprehensive Cancer Center | |
| Ann Arbor, Michigan, United States, 48109-0942 | |
| United States, Minnesota | |
| University of Minnesota | |
| Minneapolis, Minnesota, United States, 55455 | |
| United States, North Carolina | |
| Carolinas Hematology-Oncology Associates | |
| Charlotte, North Carolina, United States, 28203 | |
| United States, Ohio | |
| Cincinnati Children's Hospital Medical Center | |
| Cincinnati, Ohio, United States, 45229-3039 | |
| United States, Pennsylvania | |
| Children's Hospital of Philadelphia | |
| Philadelphia, Pennsylvania, United States, 19104 | |
| Pennsylvania Oncology Hematology Associates | |
| Philadelphia, Pennsylvania, United States, 19106 | |
| Children's Hospital of Pittsburgh | |
| Pittsburgh, Pennsylvania, United States, 15213 | |
| United States, Texas | |
| M. D. Anderson Cancer Center at University of Texas | |
| Houston, Texas, United States, 77030-4009 | |
| United States, Utah | |
| Huntsman Cancer Institute at University of Utah | |
| Salt Lake City, Utah, United States, 84112 | |
| United States, Washington | |
| Seattle Cancer Care Alliance at Washington University | |
| Seattle, Washington, United States, 98109 | |
Sponsors and Collaborators
Sarcoma Alliance for Research through Collaboration
National Cancer Institute (NCI)
Investigators
| Principal Investigator: | Brigitte C. Widemann, MD | National Cancer Institute (NCI) |
| Responsible Party: | Sarcoma Alliance for Research through Collaboration |
| ClinicalTrials.gov Identifier: | NCT00304083 History of Changes |
| Obsolete Identifiers: | NCT00266890 |
| Other Study ID Numbers: |
SARC006 SARC-006 NCI-06-C-0043 NCI-P6452 UMN-2007CG077 |
| First Posted: | March 17, 2006 Key Record Dates |
| Results First Posted: | May 25, 2018 |
| Last Update Posted: | September 18, 2018 |
| Last Verified: | May 2018 |
Keywords provided by Sarcoma Alliance for Research through Collaboration:
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adult neurofibrosarcoma childhood neurofibrosarcoma metastatic childhood soft tissue sarcoma |
nonmetastatic childhood soft tissue sarcoma stage IV adult soft tissue sarcoma neurofibromatosis type 1 |
Additional relevant MeSH terms:
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Sarcoma Neurofibromatoses Neurofibromatosis 1 Neurofibroma Nerve Sheath Neoplasms Neurofibrosarcoma Neoplasms, Connective and Soft Tissue Neoplasms by Histologic Type Neoplasms Neoplasms, Nerve Tissue Neoplastic Syndromes, Hereditary Neurocutaneous Syndromes Nervous System Diseases Heredodegenerative Disorders, Nervous System Neurodegenerative Diseases |
Genetic Diseases, Inborn Peripheral Nervous System Diseases Neuromuscular Diseases Peripheral Nervous System Neoplasms Nervous System Neoplasms Fibrosarcoma Neoplasms, Fibrous Tissue Neoplasms, Connective Tissue Doxorubicin Liposomal doxorubicin Etoposide Etoposide phosphate Ifosfamide Isophosphamide mustard Lenograstim |