Therapeutic Trial for Patients With Ewing Sarcoma Family of Tumor and Desmoplastic Small Round Cell Tumors

NCT ID: NCT01946529

Last Updated: 2025-09-04

Basic Information

• Recruitment Status: ACTIVE_NOT_RECRUITING
• Clinical Phase: PHASE2
• Total Enrollment: 24 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2013-12-27
• Study Completion Date: 2026-07-31

Brief Summary

This protocol will study treatment for Ewing sarcoma family of tumors (ESFT) and desmoplastic small round cell tumor (DSRCT). Participants with ESFT will be divided into two treatment groups, A or B, based on tumor characteristics.

Group A (standard risk) participants have tumor that is not in the pelvis, has not spread to other parts of the body, and are less than 14 years of age. Because previous clinical trials have shown that standard treatment is very effective for children whose tumors have these characteristics, these participants will receive standard treatment.

Group B (high risk) participants are 14 years of age or older or have tumor in the pelvis, or the tumor has spread to other parts of the body. Participants with DSRCT in the abdomen and/or pelvis or with tumor that cannot be removed by surgery alone or has spread to other parts of the body will be included in Group B. Participants in this group are considered high risk because there is a greater chance of tumor recurring following standard treatments currently in use.

All participants will be followed and evaluated for 10 years following completion of therapy.

Detailed Description

PRIMARY OBJECTIVE:

• To estimate the response rate to two initial courses of temsirolimus, temozolomide and irinotecan in previously untreated patients with high-risk Ewing sarcoma family of tumors (ESFT).

SECONDARY OBJECTIVES:

• To estimate the overall survival and progression-free survival in participants with ESFT treated with these approaches.
• To estimate the time to progression in participants with ESFT treated in Group B (high risk).
• To estimate the cumulative incidence of local failure following local control paradigm in this trial.

Group A:

Participants will receive interval compressed (every 2 weeks) alternating courses of chemotherapy with vincristine, doxorubicin, and cyclophosphamide (VDC) and with ifosfamide and etoposide (IE). Doxorubicin will be omitted following a total cumulative dose of 375 mg/m^2. Local control measures (surgery and/or radiation therapy) will be instituted after 6 courses of chemotherapy. Total duration of treatment is approximately 29 weeks.

Group B:

Participants eligible for the window therapy will receive two courses (21 days duration each) of mTOR inhibitor, temsirolimus, in combination with temozolomide and irinotecan. Irinotecan (20 mg/m^2) will be administered IV on a protracted schedule of daily for 5 days, 2 days off, repeated daily x 5 [(qdx5)x2], temozolomide (100 mg/m^2) PO daily x 5 days and temsirolimus 35 mg/m^2 IV weekly on day 1 and 8. Following window treatment (weeks 1 - 6), participants will proceed to induction chemotherapy (weeks 7 - 33) consisting of interval compressed (every 2 weeks) alternating courses of chemotherapy with vincristine, doxorubicin, and cyclophosphamide (VDC) with ifosfamide and etoposide (IE). Doxorubicin will be omitted following a total cumulative dose of 375 mg/m^2. Local control measures (surgery and/or radiation therapy) will be instituted after 6 courses of induction chemotherapy (week 19). Participants whose tumors respond to window therapy will receive temsirolimus, temozolomide and irinotecan at weeks 29 and 31 in place of ifosfamide and etoposide. Following induction therapy, participants will receive six 21-day courses of maintenance therapy consisting of bevacizumab IV on day 1 and daily oral sorafenib and low-dose cyclophosphamide day 1 through day 21.

Conditions

Desmoplastic Small Round Cell Tumor; Ewing Sarcoma of Bone or Soft Tissue; Localized Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor; Metastatic Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Group A (Standard Risk)

Participants will receive vincristine, doxorubicin, cyclophosphamide, ifosfamide and etoposide. Doxorubicin will be omitted following a total cumulative dose of 375 mg/m\^2. Depending on the size and location of the participant's tumor, they will have surgery alone, radiation alone, or surgery followed by radiation. Local control measures (surgery and/or radiation therapy) will be instituted after 6 courses of chemotherapy. Total duration of treatment is approximately 29 weeks.

Group Type: ACTIVE_COMPARATOR

vincristine

Intervention Type: DRUG

Dosage and route of administration: Infants \< 12 months of age: 0.05 mg/kg IV day 1; participants ≥ 12 months of age: 1.5 mg/m\^2 IV day 1 (max. dose 2 mg).

doxorubicin

Intervention Type: DRUG

Dosage and route of administration: Infants \< 1 year 2.5 mg/kg continuous infusion (CI) over 48 hours, days 1-2; participants \> 1 year of age 75 mg/m\^2 CI over 48 hours, days 1-2.

cyclophosphamide

Intervention Type: DRUG

Dosage and route of administration: The dose and route are different in neo-adjuvant/adjuvant chemotherapy and maintenance therapy. Please see the Detailed Description for further information.

ifosfamide

Intervention Type: DRUG

Dosage and route of administration: Infants \< 1 year of age 60 mg/kg/day IV over 60 minutes days 1-5; participants \> 12 months of age 1800 mg/m\^2 IV over 60 minutes x 5 days, days 1-5.

etoposide

Intervention Type: DRUG

Dosage and route of administration: Infants \< 1 year of age 3.3 mg/kg/day IV over 60 minutes days 1-5; children \> 1 year 100 mg/m\^2 daily IV over 60 minutes days 1-5.

surgery

Intervention Type: PROCEDURE

If participant meets the criteria, they will have surgical resection of their tumor.

radiation

Intervention Type: RADIATION

If the participant meets the criteria, participants will receive radiation therapy. Chemotherapy will continue during radiation.

Group B (High Risk)

Participants will receive vincristine, doxorubicin, cyclophosphamide, ifosfamide, etoposide, irinotecan, temozolomide, temsirolimus, bevacizumab, and sorafenib. Depending on the size and location of the participant's tumor, they will have surgery alone, radiation alone or surgery followed by radiation.

Group Type: ACTIVE_COMPARATOR

doxorubicin

Intervention Type: DRUG

Dosage and route of administration: Infants \< 1 year 2.5 mg/kg continuous infusion (CI) over 48 hours, days 1-2; participants \> 1 year of age 75 mg/m\^2 CI over 48 hours, days 1-2.

cyclophosphamide

Intervention Type: DRUG

Dosage and route of administration: The dose and route are different in neo-adjuvant/adjuvant chemotherapy and maintenance therapy. Please see the Detailed Description for further information.

ifosfamide

Intervention Type: DRUG

Dosage and route of administration: Infants \< 1 year of age 60 mg/kg/day IV over 60 minutes days 1-5; participants \> 12 months of age 1800 mg/m\^2 IV over 60 minutes x 5 days, days 1-5.

etoposide

Intervention Type: DRUG

Dosage and route of administration: Infants \< 1 year of age 3.3 mg/kg/day IV over 60 minutes days 1-5; children \> 1 year 100 mg/m\^2 daily IV over 60 minutes days 1-5.

temozolomide

Intervention Type: DRUG

Dosage and route of administration: Temozolomide 100 mg/m\^2 PO once daily, days 1-5.

temsirolimus

Intervention Type: DRUG

Dosage and route of administration: Temsirolimus 35 mg/m\^2 IV once day 1 and day 8.

bevacizumab

Intervention Type: DRUG

Dosage and route of administration: Bevacizumab 15 mg/kg IV on day 1 every 3 weeks.

sorafenib

Intervention Type: DRUG

Dosage and route of administration: 90 mg/m\^2/dose PO BID

surgery

Intervention Type: PROCEDURE

If participant meets the criteria, they will have surgical resection of their tumor.

radiation

Intervention Type: RADIATION

If the participant meets the criteria, participants will receive radiation therapy. Chemotherapy will continue during radiation.

Interventions

vincristine

Dosage and route of administration: Infants \< 12 months of age: 0.05 mg/kg IV day 1; participants ≥ 12 months of age: 1.5 mg/m\^2 IV day 1 (max. dose 2 mg).

Intervention Type: DRUG

doxorubicin

Dosage and route of administration: Infants \< 1 year 2.5 mg/kg continuous infusion (CI) over 48 hours, days 1-2; participants \> 1 year of age 75 mg/m\^2 CI over 48 hours, days 1-2.

Intervention Type: DRUG

cyclophosphamide

Dosage and route of administration: The dose and route are different in neo-adjuvant/adjuvant chemotherapy and maintenance therapy. Please see the Detailed Description for further information.

Intervention Type: DRUG

ifosfamide

Dosage and route of administration: Infants \< 1 year of age 60 mg/kg/day IV over 60 minutes days 1-5; participants \> 12 months of age 1800 mg/m\^2 IV over 60 minutes x 5 days, days 1-5.

Intervention Type: DRUG

etoposide

Dosage and route of administration: Infants \< 1 year of age 3.3 mg/kg/day IV over 60 minutes days 1-5; children \> 1 year 100 mg/m\^2 daily IV over 60 minutes days 1-5.

Intervention Type: DRUG

temozolomide

Dosage and route of administration: Temozolomide 100 mg/m\^2 PO once daily, days 1-5.

Intervention Type: DRUG

temsirolimus

Dosage and route of administration: Temsirolimus 35 mg/m\^2 IV once day 1 and day 8.

Intervention Type: DRUG

bevacizumab

Dosage and route of administration: Bevacizumab 15 mg/kg IV on day 1 every 3 weeks.

Intervention Type: DRUG

sorafenib

Dosage and route of administration: 90 mg/m\^2/dose PO BID

Intervention Type: DRUG

surgery

If participant meets the criteria, they will have surgical resection of their tumor.

Intervention Type: PROCEDURE

radiation

If the participant meets the criteria, participants will receive radiation therapy. Chemotherapy will continue during radiation.

Intervention Type: RADIATION

Other Intervention Names

Oncovin(R); Adriamycin(R); Cytoxan(R); Ifex(R); VP-16; Vepesid(R); Temodar(R); CCI-779; Torisel^TM; rhumab VEGF; Avastin(R); BAY-43-9006; Nexavar(R); therapeutic conventional surgery; proton beam radiation therapy; external beam radiation therapy; brachytherapy

Eligibility Criteria

Inclusion Criteria

• Group A participants must be <14 years of age at time of diagnosis of histologically proven non-pelvic localized Ewing sarcoma family of tumor (ESFT) involving the bone or soft tissue.
• Group B participants must have newly diagnosed of histologically proven ESFT involving the bone or soft tissue and at least one of the following: metastatic disease (must be biopsy proven), or pelvic primary, or ≥14 years of age at the time of diagnosis.
• OR Group B participants must be newly diagnosed with intra-abdominal, unresectable or metastatic desmoplastic small round cell tumor. Metastatic site must be biopsy proven.
• Age must be ≤25 years.
• Adequate bone marrow function defined as a peripheral absolute neutrophil count (ANC) ≥750/m^3 and platelet count ≥75,000/m^3 (no transfusion within 7 days of study enrollment). Patients with Ewing sarcoma metastatic to the bone marrow are not required to meet bone marrow criteria for study eligibility and are not evaluable for hematologic toxicity.
• Must have adequate renal function based on age.
• Must not have had prior chemotherapy or radiation therapy. Emergent radiotherapy to preserve vital organ function is permitted. Participants who receive emergent radiation will not be eligible for window therapy.
• Must have adequate hepatic function defined as total bilirubin ≤3.0 mg/dL.
• Must have adequate cardiac function defined as shortening fraction ≥28%.
• Females of childbearing potential and males able to father a child must be willing to practice acceptable methods of birth control to prevent pregnancy.
• Additional criteria for Group B participants who will receive upfront window therapy (does not apply to participants who opt out of window therapy):

• Cytochrome P450 CYP3A4 active agents: Must not be taking any of the following potent CYP3A4 inducers or inhibitors within 1 week prior to study entry: azole antifungals (such as fluconazole, voriconazole, itraconazole, ketoconazole), rifampin, phenytoin, phenobarbitol, carbamazepine, grapefruit juice and St. John's wort.
• Must have measurable disease.
• Must not have received emergent radiation therapy.
• Serum triglyceride level ≤ 300 mg/dL and serum cholesterol ≤ 300 mg/dL.
• Random or fasting glucose within the upper limits of normal for age. If random glucose is elevated, fasting glucose must be within normal range.
• SGOT (AST) and SGPT (ALT) ≤3.0 x upper limit of normal for age.

Exclusion Criteria

• Participant is pregnant or breastfeeding.
• Inability or unwillingness of research participant or legal guardian/representative to give written informed consent.
• Participant has a prior history of malignancy, with the exception of non-melanoma skin cancer. Participants with history of skin cancer must have 5 years elapse since that diagnosis, be in remission, and must not have received chemotherapy, immunotherapy, or radiation therapy.

• Maximum Eligible Age: 25 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Tennessee

OTHER

Sponsor Role: collaborator

University of Florida

OTHER

Sponsor Role: collaborator

Nemours Children's Clinic

OTHER

Sponsor Role: collaborator

St. Jude Children's Research Hospital

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Sara M. Federico, MD

Role: PRINCIPAL_INVESTIGATOR

St. Jude Children's Research Hospital

Locations

St. Jude Children's Research Hospital

Memphis, Tennessee, United States

Countries

United States

Related Links

http://www.stjude.org

St. Jude Children's Research Hospital

http://www.stjude.org/protocols

Clinical Trials Open at St. Jude

Other Identifiers

NCI-2013-01657

Identifier Type: REGISTRY

Identifier Source: secondary_id

ESFT13

Identifier Type: -

Identifier Source: org_study_id