Phase II Trial of Chemotherapy in Sporadic and Neurofibromatosis Type 1 Associated High Grade Malignant Peripheral Nerve Sheath Tumors
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.
Interventional
Masking: Open Label, Primary Purpose: Treatment
Response rate (complete response and partial response)
No
Brigitte C. Widemann, MD
Principal Investigator
National Cancer Institute (NCI)
United States: Food and Drug Administration
SARC006
NCT00304083
December 2005
Name | Location |
---|---|
University of Michigan Comprehensive Cancer Center | Ann Arbor, Michigan 48109-0752 |
Children's Hospital of Philadelphia | Philadelphia, Pennsylvania 19104 |
University of Iowa Hospitals and Clinics | Iowa City, Iowa 52242 |
Children's Hospital of Pittsburgh | Pittsburgh, Pennsylvania 15213 |
Children's Memorial Hospital - Chicago | Chicago, Illinois 60614 |
Carolinas Hematology-Oncology Associates | Charlotte, North Carolina 28203 |
Cincinnati Children's Hospital Medical Center | Cincinnati, Ohio 45229-3039 |
M. D. Anderson Cancer Center at University of Texas | Houston, Texas 77030-4009 |
Huntsman Cancer Institute at University of Utah | Salt Lake City, Utah 84112 |
UAB Comprehensive Cancer Center | Birmingham, Alabama 35294 |
University of Minnesota | Minneapolis, Minnesota 55455 |
Pennsylvania Oncology Hematology Associates | Philadelphia, Pennsylvania 19107 |
Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office | Bethesda, Maryland 20892-1182 |
Indiana University | Indianapolis, Indiana 46202 |
Johns Hopkins | Baltimore, Maryland 21231 |
Sarcoma Oncology Center | Santa Monica, California 90403 |
Seattle Cancer Care Alliance at Washington University | Seattle, Washington 98109 |