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Vincristine, Dactinomycin, and Lower Doses of Cyclophosphamide With or Without Radiation Therapy for Patients With Newly Diagnosed Low-Risk Embryonal/Botryoid/Spindle Cell Rhabdomyosarcoma


Phase 3
N/A
49 Years
Not Enrolling
Both
Adult Rhabdomyosarcoma, Embryonal Childhood Rhabdomyosarcoma, Embryonal-botryoid Childhood Rhabdomyosarcoma, Previously Untreated Childhood Rhabdomyosarcoma, Stage I Adult Soft Tissue Sarcoma, Stage II Adult Soft Tissue Sarcoma, Stage III Adult Soft Tissue Sarcoma

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Trial Information

Vincristine, Dactinomycin, and Lower Doses of Cyclophosphamide With or Without Radiation Therapy for Patients With Newly Diagnosed Low-Risk Embryonal/Botryoid/Spindle Cell Rhabdomyosarcoma


PRIMARY OBJECTIVES:

I. Determine the failure-free survival of patients with newly diagnosed low-risk
rhabdomyosarcoma treated with vincristine (V), dactinomycin (A), cyclophosphamide (C), and
radiotherapy.

SECONDARY OBJECTIVES:

I. Determine local control rates in patients treated with this regimen. II. Determine the
rate of second-look surgery in patients with bulk residual tumor at diagnosis (clinical
group III) and the proportion of second-look surgeries that render patients treated with
this regimen tumor-free or with microscopic tumor only and evaluate the pathologic
significance of that residual tumor.

III. Determine the local control rates in patients with clinical group III disease treated
with response-adjusted radiotherapy doses after second-look surgical resection.

OUTLINE: This is a nonrandomized, multicenter study. Patients are assigned to 1 of 2
treatment regimens according to disease stage and clinical group.

REGIMEN I (subset 1 patients) [closed to accrual as of 08/13/2010: Patients receive VAC
chemotherapy comprising vincristine IV over 1 minute on day 1 of weeks 1-9 and dactinomycin
IV over 1 minute and cyclophosphamide IV over 1 hour on day 1 of weeks 1, 4, 7, and 10; VA
chemotherapy comprising vincristine IV over 1 minute on day 1 of weeks 13-21 and
dactinomycin* IV over 1 minute on day 1 of weeks 13, 16, 19, and 22; and radiotherapy**, 5
days a week, beginning on week 13 and continuing for 4-7 weeks, depending on prescribed
dose.

REGIMEN II (subset 2 patients): Patients receive VAC chemotherapy and radiotherapy** as in
regimen I and VA chemotherapy comprising vincristine IV over 1 minute on day 1 of weeks
13-21, 25-33, and 37-45 and dactinomycin* IV over 1 minute on day 1 of weeks 13, 16, 19, 22,
25, 28, 31, 34, 37, 40, 43, and 46. Patients with clinical group III disease may undergo
second-look surgery at week 13 followed by response-adjusted radiotherapy, administered as
in regimen I, and continued VA* chemotherapy as in regimen I or II. In both regimens,
treatment continues in the absence of disease progression or unacceptable toxicity.

NOTE: *For both regimens, dactinomycin is omitted during radiotherapy.

NOTE: **Clinical Group I tumors and those with Clinical Group III uterine/cervix primary
disease with negative nodes who have undergone a complete resection (i.e. hysterectomy) at
Week 13 do not receive radiotherapy at Week 13

Patients are followed up every 3 months for 1 year, every 4 months for 2 years, every 6
months for 1 year, and then annually thereafter.


Inclusion Criteria:



- Histologically confirmed newly diagnosed embryonal rhabdomyosarcoma (RMS), botryoid
or spindle cell variants of embryonal RMS, or embryonal ectomesenchymoma, meeting
criteria for 1 of the following subsets:

- Subset 1, defined by meeting 1 of the following criteria (closed to accrual as
of 08/13/2010):

- Stage 1 and clinical group I (completely resected) or II (microscopic
residual disease and/or regional lymph node involvement) disease

- Stage 1 and clinical group III (gross residual disease) disease arising in
the orbit

- Stage 2 and clinical group I or II disease

- Subset 2, defined by meeting 1 of the following criteria:

- Stage 1 and clinical group III disease arising in a non-orbit site

- Stage 3 and clinical group I or II disease

- Prior staging ipsilateral retroperitoneal lymph node dissection required for all
patients age 10 and over with paratesticular tumors and patients under 10 years of
age with clinically or radiographically involved lymph nodes (except when extensive
lymph node involvement is identified by imaging studies)

- If there is extensive gross node involvement only confirmatory node biopsy is
recommended and the patient is classified as Clinical Group III

- Prior regional lymph node sampling required for patients with extremity tumors

- None of the following diagnoses:

- Intermediate-risk embryonal RMS

- Metastatic embryonal RMS

- Alveolar RMS

- Undifferentiated sarcoma

- RMS not otherwise specified (NOS)

- Other soft tissue sarcoma, including sarcoma NOS

- Prior enrollment on clinical trial COG-D9902

- Performance status - ECOG 0-2

- Performance status - Karnofsky 50-100% (≥ 16 years old)

- Performance status - Lansky 50-100% (< 16 years old)

- Absolute neutrophil count at least 750/mm^3

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

- Bilirubin no greater than 1.5 times upper limit of normal (ULN)*

- Creatinine* based on age/gender as follows:

- No greater than 0.8 mg/dL for patients age 5 and under

- No greater than 1.0 mg/dL for patients age 6 to 9

- No greater than 1.2 mg/dL for patients age 10 to 12

- No greater than 1.4 mg/dL for female patients age 13 and over

- No greater than 1.5 mg/dL for male patients age 13 to 15

- No greater than 1.7 mg/dL for male patients age 16 and over

- Creatinine clearance* or radioisotope glomerular filtration rate at least 70
mL/min/1.73 m^2

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- No uncontrolled infection

- No prior chemotherapy (except for patients treated on the related intermediate-risk
study)

- Prior steroids allowed

- No prior radiotherapy

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Failure-free survival (FFS) for patients with low-risk rhabdomyosarcoma in subset 1

Outcome Description:

An analysis plan based on the method of Woolson (1981) will be used to monitor outcome for these patients. The monitoring boundary p-values associated with the 3 interim looks using the O'Brien-Fleming spending function truncated at 3.00 will be 0.001, 0.020, and 0.052, with the final analysis being done with p=0.082. The type I error associated with this monitoring plan is about 0.10.

Outcome Time Frame:

Up to 10 years

Safety Issue:

No

Principal Investigator

David Walterhouse

Investigator Role:

Principal Investigator

Investigator Affiliation:

Children's Oncology Group

Authority:

United States: Institutional Review Board

Study ID:

ARST0331

NCT ID:

NCT00075582

Start Date:

September 2004

Completion Date:

Related Keywords:

  • Adult Rhabdomyosarcoma
  • Embryonal Childhood Rhabdomyosarcoma
  • Embryonal-botryoid Childhood Rhabdomyosarcoma
  • Previously Untreated Childhood Rhabdomyosarcoma
  • Stage I Adult Soft Tissue Sarcoma
  • Stage II Adult Soft Tissue Sarcoma
  • Stage III Adult Soft Tissue Sarcoma
  • Rhabdomyosarcoma
  • Rhabdomyosarcoma, Embryonal
  • Sarcoma

Name

Location

Baylor College of Medicine Houston, Texas  77030
Johns Hopkins University Baltimore, Maryland  21205
Memorial Sloan Kettering Cancer Center New York, New York  10021
Cleveland Clinic Foundation Cleveland, Ohio  44195
Roswell Park Cancer Institute Buffalo, New York  14263
Mayo Clinic Rochester, Minnesota  55905
Children's Hospital of Philadelphia Philadelphia, Pennsylvania  19104
University of Iowa Hospitals and Clinics Iowa City, Iowa  52242
University of Mississippi Medical Center Jackson, Mississippi  39216-4505
Washington University School of Medicine Saint Louis, Missouri  63110
Medical University of South Carolina Charleston, South Carolina  29425-0721
Tripler Army Medical Center Honolulu, Hawaii  96859-5000
Hurley Medical Center Flint, Michigan  48503
Medical City Dallas Hospital Dallas, Texas  75230
University of Texas Health Science Center at San Antonio San Antonio, Texas  78284-7811
Midwest Children's Cancer Center Milwaukee, Wisconsin  53226
Sinai Hospital of Baltimore Baltimore, Maryland  21225
Geisinger Medical Center Danville, Pennsylvania  17822-0001
Vanderbilt-Ingram Cancer Center Nashville, Tennessee  37232-6838
Massachusetts General Hospital Cancer Center Boston, Massachusetts  02114
Loma Linda University Medical Center Loma Linda, California  92354
Baptist Hospital of Miami Miami, Florida  33176-2197
Newark Beth Israel Medical Center Newark, New Jersey  07112
New York Medical College Valhalla, New York  10595
Dana-Farber Cancer Institute Boston, Massachusetts  02115
Cedars-Sinai Medical Center Los Angeles, California  90048
University of Arkansas for Medical Sciences Little Rock, Arkansas  72205
Eastern Maine Medical Center Bangor, Maine  04401
Baystate Medical Center Springfield, Massachusetts  01199
William Beaumont Hospital Royal Oak, Michigan  48073
University of Nebraska Medical Center Omaha, Nebraska  68198-3330
Hackensack University Medical Center Hackensack, New Jersey  07601
Children's Hospital Los Angeles Los Angeles, California  90027-0700
Children's National Medical Center Washington, District of Columbia  20010-2970
Miami Children's Hospital Miami, Florida  33155-4069
All Children's Hospital St. Petersburg, Florida  33701
Advocate Hope Children's Hospital Oak Lawn, Illinois  60453
Saint Jude Midwest Affiliate Peoria, Illinois  61637
Maine Children's Cancer Program Scarborough, Maine  04074-9308
Legacy Emanuel Hospital and Health Center Portland, Oregon  97227
St. Jude Children's Research Hospital Memphis, Tennessee  38105-2794
Driscoll Children's Hospital Corpus Christi, Texas  78466
Scott and White Memorial Hospital Temple, Texas  76508
Inova Fairfax Hospital Falls Church, Virginia  22042-3300
Southern California Permanente Medical Group Downey, California  90242
Children's Hospital Central California Madera, California  93638-8762
Kosair Children's Hospital Louisville, Kentucky  40202-3830
Brooklyn Hospital Center Brooklyn, New York  11201
Children's Hospital Medical Center of Akron Akron, Ohio  44308
Covenant Children's Hospital Lubbock, Texas  79410
University of Wisconsin Hospital and Clinics Madison, Wisconsin  53792-0001
Mount Sinai Medical Center New York, New York  10029
Cincinnati Children's Hospital Medical Center Cincinnati, Ohio  45229-3039
Methodist Children's Hospital of South Texas San Antonio, Texas  78229-3993
Primary Children's Medical Center Salt Lake City, Utah  84113-1100
Montefiore Medical Center Bronx, New York  10467-2490
Rady Children's Hospital - San Diego San Diego, California  92123-4282
Children's Hospitals and Clinics of Minnesota - Minneapolis Minneapolis, Minnesota  55404
University of New Mexico Cancer Center Albuquerque, New Mexico  87131-5636
Nationwide Children's Hospital Columbus, Ohio  43205-2696
Children's Hospital of Pittsburgh of UPMC Pittsburgh, Pennsylvania  15213
Children's Hospital and Research Center at Oakland Oakland, California  94609-1809
Lehigh Valley Hospital - Muhlenberg Bethlehem, Pennsylvania  18017
Presbyterian Hospital Charlotte, North Carolina  28233-3549
University of Virginia Charlottesville, Virginia  22908
University of Alabama at Birmingham Birmingham, Alabama  35294-3300
Connecticut Children's Medical Center Hartford, Connecticut  06106
University of North Carolina Chapel Hill, North Carolina  27599
University of Rochester Rochester, New York  14642
Nemours Children's Clinic - Pensacola Pensacola, Florida  32504
Helen DeVos Children's Hospital at Spectrum Health Grand Rapids, Michigan  49503
Wayne State University Detroit, Michigan  48202
University of Arizona Health Sciences Center Tucson, Arizona  85724
Dartmouth Hitchcock Medical Center Lebanon, New Hampshire  03756
Indiana University Medical Center Indianapolis, Indiana  46202
University Of Vermont Burlington,, Vermont  05403
Albany Medical Center Albany, New York  12208
University of Texas Southwestern Medical Center Dallas, Texas  
University of Kentucky Lexington, Kentucky  40536-0098
UC Davis Comprehensive Cancer Center Sacramento, California  95817
Oregon Health and Science University Portland, Oregon  97201
Tulane University Health Sciences Center New Orleans, Louisiana  70112
Virginia Commonwealth University Richmond, Virginia  
Memorial Health University Medical Center Savannah, Georgia  31404
University of Chicago Comprehensive Cancer Center Chicago, Illinois  60637-1470
M D Anderson Cancer Center Houston, Texas  77030
Seattle Children's Hospital Seattle, Washington  98105
Wake Forest University Health Sciences Winston-Salem, North Carolina  27157
Childrens Memorial Hospital Chicago, Illinois  60614
Kaiser Permanente-Oakland Oakland, California  94611
M D Anderson Cancer Center- Orlando Orlando, Florida  32806
University of Hawaii Honolulu, Hawaii  96813
Saint Luke's Mountain States Tumor Institute Boise, Idaho  83712
Michigan State University - Breslin Cancer Center East Lansing, Michigan  48824-1313
Nevada Cancer Research Foundation CCOP Las Vegas, Nevada  89106
Columbia University Medical Center New York, New York  10032
State University of New York Upstate Medical University Syracuse, New York  13210
Mission Hospitals Inc Asheville, North Carolina  28801
Saint Vincent Hospital Green Bay, Wisconsin  54301
University of Maryland Greenebaum Cancer Center Baltimore, Maryland  21201
University of Illinois Chicago, Illinois  60612
Cook Children's Medical Center Fort Worth, Texas  76104
Memorial Healthcare System - Joe DiMaggio Children's Hospital Hollywood, Florida  33021
West Virginia University Charleston Charleston, West Virginia  25304
The Children's Medical Center of Dayton Dayton, Ohio  45404
Advocate Lutheran General Hospital Park Ridge, Illinois  60068
University of Miami Miller School of Medicine-Sylvester Cancer Center Miami, Florida  33136
University of Minnesota Medical Center-Fairview Minneapolis, Minnesota  55455
Children's Oncology Group Arcadia, California  91006-3776
C S Mott Children's Hospital Ann Arbor, Michigan  48109
Southern Illinois University Springfield, Illinois  62702
Cardinal Glennon Children's Medical Center St. Louis, Missouri  63104
UMDNJ - Robert Wood Johnson University Hospital New Brunswick, New Jersey  08903
Phoenix Childrens Hospital Phoenix, Arizona  85016
Miller Children's Hospital Long Beach, California  90806
Childrens Hospital of Orange County Orange, California  92868-3874
Nemours Children's Clinic - Jacksonville Jacksonville, Florida  32207-8426
Saint Joseph Children's Hospital of Tampa Tampa, Florida  33607
Children's Healthcare of Atlanta - Egleston Atlanta, Georgia  30322
The Childrens Mercy Hospital Kansas City, Missouri  64108
Rainbow Babies and Childrens Hospital Cleveland, Ohio  44106
Penn State Hershey Children's Hospital Hershey, Pennsylvania  17033
East Tennessee Childrens Hospital Knoxville, Tennessee  37916
Saint Mary's Hospital West Palm Beach, Florida  33407
Children's Hospital and Medical Center of Omaha Omaha, Nebraska  68114
Childrens Hospital-King's Daughters Norfolk, Virginia  23507
Children's Hospital Colorado Aurora, Colorado  80045
Lucile Packard Children's Hospital Stanford University Palo Alto, California  94304
University of California San Francisco Medical Center-Parnassus San Francisco, California  94143
Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center Denver, Colorado  80218
Raymond Blank Children's Hospital Des Moines, Iowa  50309
Children's Hospital-Main Campus New Orleans, Louisiana  70118
Saint Christopher's Hospital for Children Philadelphia, Pennsylvania  19134
Greenville Cancer Treatment Center Greenville, South Carolina  29605
T C Thompson Children's Hospital Chattanooga, Tennessee  37403
Providence Sacred Heart Medical Center and Children's Hospital Spokane, Washington  99204
Broward Health Medical Center Fort Lauderdale, Florida  33316
The Steven and Alexandra Cohen Children's Medical Center of New York New Hyde Park, New York  11040