Vinorelbine Tartrate and Cyclophosphamide in Combination With Bevacizumab or Temsirolimus in Treating Patients With Recurrent or Refractory Rhabdomyosarcoma
This randomized phase II trial studies how well vinorelbine tartrate and cyclophosphamide work in combination with bevacizumab or temsirolimus in treating patients with recurrent or refractory rhabdomyosarcoma. Drugs used in chemotherapy, such as vinorelbine tartrate and cyclophosphamide, 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 bevacizumab, 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. Bevacizumab may also stop the growth of rhabdomyosarcoma by blocking blood flow to the tumor. Temsirolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. It is not yet known whether combination chemotherapy is more effective when given together with bevacizumab or temsirolimus in treating rhabdomyosarcoma.
Childhood Alveolar Rhabdomyosarcoma
Childhood Anaplastic Rhabdomyosarcoma
Childhood Mixed Alveolar Rhabdomyosarcoma
Previously Treated Childhood Rhabdomyosarcoma
Recurrent Adult Soft Tissue Sarcoma
Recurrent Childhood Rhabdomyosarcoma
Other: Laboratory Biomarker Analysis
Drug: Vinorelbine Tartrate
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||A Randomized Phase II Trial of Bevacizumab (Avastin) and Temsirolimus (Torisel) in Combination With Intravenous Vinorelbine and Cyclophosphamide in Patients With Recurrent/Refractory Rhabdomyosarcoma|
- Event-free survival [ Time Frame: From enrollment to the first occurrence of disease recurrence or death from any cause, up to 5 years ] [ Designated as safety issue: No ]Estimated using Kaplan-Meier curves. EFS experience for the 2 regimens will be compared using the log-rank test.
- Feasibility, assessed by rate of grade 3+ non-hematologic toxicity, graded using Common Terminology Criteria for Adverse Events version 4.0 [ Time Frame: 42 days ] [ Designated as safety issue: Yes ]
- Response rate (CR + PR) [ Time Frame: Up to day 42 ] [ Designated as safety issue: No ]
- Biomarker levels [ Time Frame: Up to 36 weeks ] [ Designated as safety issue: No ]Biomarker data will be summarized for each response category, at each time point using either means and standard deviations or medians and ranges.
- Changes in angiogenesis-associated plasma markers between patients by treatment [ Time Frame: Baseline up to day 42 ] [ Designated as safety issue: No ]First, the distributions of these markers will be compared at 'end of 2 cycles' between treatments using a 2-independent sample non-parametric test. The mean will also be modeled for each of these markers (or a transformation of the marker to near normality) as a function of time and treatment using GEEs which are designed to take into account the internal correlation of repeated measurements taken on the same subject. Associations between progression-free survival and changes in each of the biomarkers will be investigated using univariate Cox proportional hazards regression analysis.
- Clinical predictors, including histologic and molecular subtype, age, stage, and site [ Time Frame: Up to 5 years ] [ Designated as safety issue: No ]These known risk factors will be compared to genomic features like gene and ribonucleic acid (RNA) expression values, as well as combinations of the two and splice variants of known genes, in order to identify those features most related to treatment resistance and poor outcome (overall survival and failure-free survival) using a Cox proportional hazards model of gene expression with cross validation.
- Clinical response [ Time Frame: Up to 5 years ] [ Designated as safety issue: No ]The data reported in 2 groups will be summarized using numbers and percentages of patients in each stratum and at each time point (baseline, after course 2, at the time of best response and end of therapy or progressive disease, whichever comes first). A binomial generalized estimating equation (GEE) model will be fitted to the data. The variables in the model will be time, treatment group and a biomarker. The beta coefficient of the biomarker will quantify the strength of the association between clinical response and the biomarker, beyond the association of the outcome to the other variables.
- Levels of biomarkers related to the effect of temsirolimus on the unfolded protein response [ Time Frame: Up to 36 weeks ] [ Designated as safety issue: No ]
- Progression-free survival [ Time Frame: Up to 5 years ] [ Designated as safety issue: No ]Progression-free survival data will be explored using Kaplan Meier analysis. Associations between this outcome and each of the biomarkers will be investigated using univariate Cox proportional hazards regression analysis.
|Study Start Date:||October 2010|
|Estimated Primary Completion Date:||July 2016 (Final data collection date for primary outcome measure)|
Experimental: Arm I (vinorelbine tartrate, cyclophosphamide, bevacizumab)
Patients receive vinorelbine tartrate IV over 6-10 minutes on days 1 and 8 and cyclophosphamide IV over 30-60 minutes on day 1. Patients also receive bevacizumab IV over 30-90 minutes on day 1.
Other Names:Drug: Cyclophosphamide
Other Names:Other: Laboratory Biomarker Analysis
Correlative studiesDrug: Vinorelbine Tartrate
Experimental: Arm II (vinorelbine tartrate, cyclophosphamide, temsirolimus)
Patients receive vinorelbine tartrate and cyclophosphamide as in arm I. Patients also receive temsirolimus IV over 30-60 minutes on days 1, 8, and 15.
Other Names:Other: Laboratory Biomarker Analysis
Correlative studiesDrug: Temsirolimus
Other Names:Drug: Vinorelbine Tartrate
l. To determine the feasibility of administering bevacizumab in combination with intravenous vinorelbine (vinorelbine tartrate) and cyclophosphamide (VC) in patients with recurrent rhabdomyosarcoma (RMS).
II. To determine the feasibility of administering temsirolimus in combination with VC in patients with recurrent RMS.
III. To estimate the event-free survival (EFS) of patients with recurrent/refractory RMS treated with bevacizumab and VC and compare with the EFS of those treated with temsirolimus and VC.
I. To estimate the initial (2 cycle) response rate of patients with recurrent/refractory RMS treated with bevacizumab and VC and compare with the response rate of those treated with temsirolimus and VC, and to also compare the best response rate on each regimen of protocol therapy.
II. To evaluate surrogate biological markers in patients with recurrent RMS and to estimate differences in these markers following treatment with bevacizumab and temsirolimus.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM I: Patients receive vinorelbine tartrate intravenously (IV) over 6-10 minutes on days 1 and 8 and cyclophosphamide IV over 30-60 minutes on day 1. Patients also receive bevacizumab IV over 30-90 minutes on day 1.
ARM II: Patients receive vinorelbine tartrate and cyclophosphamide as in arm I. Patients also receive temsirolimus IV over 30-60 minutes on days 1, 8, and 15.
In both arms, treatment repeats every 21 days for 12 courses in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up annually for 5 years.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01222715
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|Principal Investigator:||Leo Mascarenhas||Children's Oncology Group|