Feasibility and Dose Discovery Analysis of Zoledronic Acid With Concurrent Chemotherapy in the Treatment of Newly Diagnosed Metastatic Osteosarcoma

Trial Information

Feasibility and Dose Discovery Analysis of Zoledronic Acid With Concurrent Chemotherapy in the Treatment of Newly Diagnosed Metastatic Osteosarcoma

OBJECTIVES:

Primary

- To assess the feasibility and safety of zoledronic acid when administered in
combination with standard chemotherapy in patients with newly diagnosed metastatic
osteosarcoma.

- To determine the maximum tolerated dose of zoledronic acid when administered in
combination with standard chemotherapy in these patients.

Secondary

- To compare the histologic response and event-free survival of patients treated with
this regimen versus patients treated on INT-0133 or CCG-7943.

OUTLINE: This is a multicenter, dose-escalation study of zoledronic acid.

- Induction therapy (weeks 1-11): Patients receive dexrazoxane hydrochloride IV slowly
over 5-15 minutes, doxorubicin hydrochloride IV over 15 minutes, and cisplatin IV over
1 hour on days 1 and 2 of weeks 1 and 6; zoledronic acid IV over 30 minutes on day 4 of
weeks 1 and 6; high-dose methotrexate IV over 4 hours on day 1 of weeks 4, 5, 9, and
10; leucovorin calcium IV or orally every 6 hours on day 2 of weeks 4, 5, 9, and 10;
and filgrastim (G-CSF) subcutaneously (SC) once daily beginning on day 3 of weeks 1 and
6 and continuing until blood counts recover.

- Surgery (week 12): Patients undergo definitive surgery (limb-salvage surgery or
amputation) of the primary tumor in week 12.

- Maintenance therapy course 1 (weeks 13-25): Patients receive etoposide IV over 1 hour
and ifosfamide IV over 4 hours on days 1-5 of weeks 13 and 21; zoledronic acid IV over
30 minutes on day 4 of week 17 and on day 7 of weeks 13 and 21; high-dose methotrexate
IV over 4 hours on day 1 of weeks 16, 20, and 24; leucovorin calcium IV or orally every
6 hours on day 2 of weeks 16, 20, and 24; dexrazoxane hydrochloride IV slowly over 5-15
minutes, doxorubicin hydrochloride IV over 15 minutes, and cisplatin IV over 1 hour on
days 1 and 2 of week 17; and G-CSF SC once daily beginning on day 6 of weeks 13, 17,
and 21 and continuing until blood counts recover.

- Surgery (week 26): Patients may undergo surgical resection of primary metastases in
week 26.

- Maintenance therapy course 2 (weeks 27-36): Patients receive dexrazoxane hydrochloride
IV slowly over 5-15 minutes and doxorubicin hydrochloride IV over 15 minutes on days 1
and 2 of weeks 27 and 31; cisplatin IV over 1 hour on days 1 and 2 of week 27;
zoledronic acid IV over 30 minutes on day 4 of week 27 and on day 7 of weeks 31 and 36;
high-dose methotrexate IV over 4 hours on day 1 of weeks 30, 34, and 35; leucovorin
calcium IV or orally every 6 hours on day 2 of weeks 30, 34, and 35; etoposide IV over
1 hour on days 1-5 of week 36; low-dose ifosfamide IV over 1 hour on days 1-5 of week
31; standard-dose ifosfamide IV over 4 hours on days 1-5 of week 36; and G-CSF SC once
daily beginning on day 3 of weeks 27, 31, and 36 and continuing until blood counts
recover.

After completion of study treatment, patients are followed periodically for up to 5 years.