A Study to Compare the Efficacy and Safety of Ifosfamide and Etoposide With or Without Lenvatinib in Children, Adolescents and Young Adults With Relapsed and Refractory Osteosarcoma

NCT ID: NCT04154189

Last Updated: 2024-07-22

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

81 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-03-23

Study Completion Date

2023-08-17

Brief Summary

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This Is a Multicenter, Randomized, Open-Label, Parallel-Group, Phase 2 Study to Compare the Efficacy and Safety of Lenvatinib in Combination with Ifosfamide and Etoposide Versus Ifosfamide and Etoposide in Children, Adolescents, and Young Adults with Relapsed or Refractory Osteosarcoma.

Detailed Description

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Conditions

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Osteosarcoma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Randomization Phase: Lenvatinib + Ifosfamide + Etoposide

Participants with relapsed or refractory osteosarcoma will receive lenvatinib in combination with ifosfamide and etoposide.

Group Type EXPERIMENTAL

Lenvatinib

Intervention Type DRUG

Lenvatinib 14 milligrams per square meter (mg/m\^2) capsules will be administered once daily on Days 1 to 21 of each 21-day cycle until disease progression (PD), development of unacceptable toxicity, participant request, withdrawal of consent, or discontinuation of study by the sponsor.

An extemporaneous suspension of lenvatinib capsules may be used for participants unable to swallow capsules.

Ifosfamide

Intervention Type DRUG

Ifosfamide 3000 milligrams per square meter per day (mg/m\^2/day) intravenous infusion will be administered on Days 1 to 3 of each 21-day cycle for a total of 5 cycles.

Etoposide

Intervention Type DRUG

Etoposide 100 mg/m\^2/day intravenous infusion will be administered on Days 1 to 3 of each 21-day cycle for a total of 5 cycles.

Randomization Phase: Ifosfamide + Etoposide

Participants with relapsed or refractory osteosarcoma will receive ifosfamide with etoposide. Participants with relapsed or refractory osteosarcoma may receive optional lenvatinib plus or minus chemotherapy (Ifosfamide and Etoposide) if disease progression is observed in study.

Group Type ACTIVE_COMPARATOR

Ifosfamide

Intervention Type DRUG

Ifosfamide 3000 milligrams per square meter per day (mg/m\^2/day) intravenous infusion will be administered on Days 1 to 3 of each 21-day cycle for a total of 5 cycles.

Etoposide

Intervention Type DRUG

Etoposide 100 mg/m\^2/day intravenous infusion will be administered on Days 1 to 3 of each 21-day cycle for a total of 5 cycles.

Lenvatinib

Intervention Type DRUG

Lenvatinib 14 mg/m\^2 capsules will be administered once daily on Days 1 to 21 of each 21-day cycle until the next PD (per response evaluation criteria in solid tumors \[RECIST\] 1.1 as assessed by investigator), development of unacceptable toxicity, participant request, or withdrawal of consent, whichever occurs first.

Interventions

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Lenvatinib

Lenvatinib 14 milligrams per square meter (mg/m\^2) capsules will be administered once daily on Days 1 to 21 of each 21-day cycle until disease progression (PD), development of unacceptable toxicity, participant request, withdrawal of consent, or discontinuation of study by the sponsor.

An extemporaneous suspension of lenvatinib capsules may be used for participants unable to swallow capsules.

Intervention Type DRUG

Ifosfamide

Ifosfamide 3000 milligrams per square meter per day (mg/m\^2/day) intravenous infusion will be administered on Days 1 to 3 of each 21-day cycle for a total of 5 cycles.

Intervention Type DRUG

Etoposide

Etoposide 100 mg/m\^2/day intravenous infusion will be administered on Days 1 to 3 of each 21-day cycle for a total of 5 cycles.

Intervention Type DRUG

Lenvatinib

Lenvatinib 14 mg/m\^2 capsules will be administered once daily on Days 1 to 21 of each 21-day cycle until the next PD (per response evaluation criteria in solid tumors \[RECIST\] 1.1 as assessed by investigator), development of unacceptable toxicity, participant request, or withdrawal of consent, whichever occurs first.

Intervention Type DRUG

Other Intervention Names

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E7080 E7080

Eligibility Criteria

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Inclusion Criteria

1. Histologically or cytologically confirmed diagnosis of high grade osteosarcoma
2. Refractory or relapsed osteosarcoma after 1 to 2 prior lines of systemic treatments
3. Measurable or evaluable disease per RECIST 1.1.
4. Life expectancy of 12 weeks or more
5. Lansky play score greater than or equal to (\>=) 50 Percent (%) or Karnofsky Performance Status score \>=50%. Use Karnofsky for participants \>=16 years of age and Lansky for participants less than (\<)16 years of age. Participants who are unable to walk because of paralysis, but who are able to perform activities of daily living while wheelchair bound, will be considered ambulatory for the purpose of assessing the performance score
6. Adequate organ function per blood work
7. Adequate cardiac function as evidenced by left ventricular ejection fraction (LVEF) \>=50% at baseline as determined by echocardiography or multigated acquisition (MUGA) scan
8. Adequately controlled blood pressure (BP) with or without antihypertensive medications, defined as:

BP \<95th percentile for sex, age, and height/length at screening (as per National Heart Lung and Blood Institute guidelines) and no change in antihypertensive medications within 1 week prior to Cycle 1 Day 1. Participants \>18 years of age should have BP less than or equal to (\<=) 150/90 millimeters of Mercury at screening and no change in antihypertensive therapy within 1 week prior to Cycle 1 Day 1
9. Washout before Cycle 1 Day 1 of 3 weeks in case of prior chemotherapy, 6 weeks if treatment included nitrosoureas; 4 weeks for definitive radiotherapy, 2 weeks for palliative radiotherapy; and 3 months from high-dose chemotherapy and stem cell rescue. For all other anti-cancer therapies, washout before Cycle 1 Day 1 of at least 5 half-lives (or at least 28 days, whichever is shorter). Participants must have recovered \[to Grade \<=1, except for alopecia, ototoxicity, and Grade \<=2 peripheral neuropathy, per common terminology criteria for adverse events (CTCAE) v5.0\] from the acute toxic effects of all prior anticancer therapy before Cycle 1 Day 1
10. Must have no prior history of lenvatinib treatment

Eligibility for optional lenvatinib crossover:

1. Disease progression per RECIST 1.1 (as confirmed by IIR for all participants who crossover prior to the study data-cut)
2. No new systemic anti-cancer medication administered after the last dose of study drugs
4. Study is ongoing

Exclusion Criteria

1. Any active infection or infectious illness unless fully recovered prior to Cycle 1 Day 1 (that is, no longer requiring systemic treatment)
2. Participants with central nervous system metastases are not eligible, unless they have completed local therapy (example, whole brain radiation therapy, surgery or radiosurgery) and have discontinued the use of corticosteroids for this indication for at least 2 weeks before Cycle 1 Day 1
3. Active second malignancy within 2 years prior to enrollment (\[in addition to osteosarcoma\], but not including definitively treated superficial melanoma, carcinoma-in-situ, basal or squamous cell carcinoma of the skin)
4. Has had major surgery within 3 weeks prior to Cycle 1 Day 1. Note: Adequate wound healing after major surgery must be assessed clinically, independent of time elapsed for eligibility
5. A clinically significant electrocardiogram (ECG) abnormality, including a marked baseline prolonged QT or corrected QT (QTc) interval (example, a repeated demonstration of a QTc interval greater than \[\>\] 480 millisecond \[msec\])
6. Has clinically significant cardiovascular disease within 6 months from first dose of study intervention, including New York Heart Association Class III or IV congestive heart failure, unstable angina, myocardial infarction, cerebral vascular accident, or cardiac arrhythmia associated with hemodynamic instability. Note: Medically controlled arrhythmia would be permitted
7. Gastrointestinal malabsorption, gastrointestinal anastomosis, or any other condition that in the opinion of the investigator might affect the absorption of lenvatinib
8. Pre-existing Grade \>=3 gastrointestinal or non-gastrointestinal fistula
9. Gastrointestinal bleeding or active hemoptysis (bright red blood of at least 1 divided \[/\] by 2 teaspoon) within 3 weeks prior to Cycle 1 Day 1
10. Radiographic evidence of intratumoral cavitation, encasement, or invasion of a major blood vessel. Additionally, the degree of proximity to major blood vessels should be considered for exclusion because of the potential risk of severe hemorrhage associated with tumor shrinkage/necrosis after lenvatinib therapy
11. History of ifosfamide-related Grade \>=3 nephrotoxicity or encephalopathy
12. Known to be human immunodeficiency virus (HIV) positive
13. Known active Hepatitis B (example, Hepatitis B surface antigen \[HBsAg\] reactive) or Hepatitis C (example, hepatitis C virus \[HCV\] ribonucleic acid \[RNA\] \[qualitative\] is detected). Note: Testing for Hepatitis B or Hepatitis C is required at screening only when mandated by local health authority
Minimum Eligible Age

2 Years

Maximum Eligible Age

25 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Merck Sharp & Dohme LLC

INDUSTRY

Sponsor Role collaborator

Eisai Inc.

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Children's of Alabama

Birmingham, Alabama, United States

Site Status

Loma Linda University Medical Center

Loma Linda, California, United States

Site Status

Children's Hospital of Orange County

Orange, California, United States

Site Status

UCSF Benioff Children's Hospitals

San Francisco, California, United States

Site Status

Childrens Hospital Colorado

Aurora, Colorado, United States

Site Status

Children's National Medical Center

Washington D.C., District of Columbia, United States

Site Status

Riley Hospital For Children

Indianapolis, Indiana, United States

Site Status

Dana Farber Cancer Institute

Boston, Massachusetts, United States

Site Status

University of Mississippi Medical Center

Jackson, Mississippi, United States

Site Status

Hackensack University Medical Center

Hackensack, New Jersey, United States

Site Status

Memorial Sloan Kettering Cancer Center

New York, New York, United States

Site Status

Cincinnati Children's Hospital Medical Center

Cincinnati, Ohio, United States

Site Status

Vanderbilt University Medical Center

Nashville, Tennessee, United States

Site Status

Children's Medical Center Dallas

Dallas, Texas, United States

Site Status

Cook Children's Health Care System

Fort Worth, Texas, United States

Site Status

Texas Children's Hospital

Houston, Texas, United States

Site Status

Chris O'Brien Lifehouse Hospital

Camperdown, , Australia

Site Status

Perth Childrens Hospital

Nedlands, , Australia

Site Status

Royal Children's Hospital Melbourne

Parkville, , Australia

Site Status

Queensland Children's Hospital

South Brisbane, , Australia

Site Status

Children's Hospital at Westmead

Westmead, , Australia

Site Status

St. Anna Kinderspital

Vienna, , Austria

Site Status

UZ Gent

Ghent, , Belgium

Site Status

Hospital For Sick Children

Toronto, , Canada

Site Status

FN Brno 2 Detska Klinika

Brno, , Czechia

Site Status

Fakultní nemocnice v Motole

Prague, , Czechia

Site Status

Tampereen yliopistollinen sairaala

Tampere, Länsi-Suomen Lääni, Finland

Site Status

Centre Hospitalier Universitaire de Bordeaux, Hopital Pellegrin

Bordeaux, , France

Site Status

Centre Oscar Lambret

Lille, , France

Site Status

Centre Léon Berard

Lyon, , France

Site Status

Hopitaux de La Timone

Marseille, , France

Site Status

Hôpital de La Mère Et de L'enfant

Nantes, , France

Site Status

CHU de Nice

Nice, , France

Site Status

Hôpital Armand Trousseau

Paris, , France

Site Status

Institut Curie

Paris, , France

Site Status

Hopital de Hautepierre

Strasbourg, , France

Site Status

Hôpital Des Enfants

Toulouse, , France

Site Status

CHRU Nancy

Vandœuvre-lès-Nancy, , France

Site Status

Institut Gustave Roussy

Villejuif, , France

Site Status

Hong Kong Children's Hospital

Hong Kong, , Hong Kong

Site Status

Prince of Wales Hospital

Hong Kong, , Hong Kong

Site Status

Children's Health Ireland at Crumlin

Dublin, , Ireland

Site Status

Schneider Children's Medical Center of Israel

Petah Tikva, , Israel

Site Status

Istituti Ortopedici Rizzoli

Bologna, , Italy

Site Status

Azienda Ospedaliera A Meyer

Florence, , Italy

Site Status

Istituto Giannina Gaslini

Genova, , Italy

Site Status

Istituto Nazionale Dei Tumori

Milan, , Italy

Site Status

IRCCS Ospedale Pediatrico Bambino Gesù

Roma, , Italy

Site Status

Princess Maxima Center for Pediatric Oncology

Utrecht, , Netherlands

Site Status

Auckland City Hospital

Auckland, , New Zealand

Site Status

Starship Children's Hospital

Auckland, , New Zealand

Site Status

KK Women's and Children's Hospital

Singapore, , Singapore

Site Status

National Cancer Centre

Singapore, , Singapore

Site Status

National University Hospital

Singapore, , Singapore

Site Status

National Cancer Center

Goyang-si, , South Korea

Site Status

Asan Medical Center

Seoul, , South Korea

Site Status

Samsung Medical Center

Seoul, , South Korea

Site Status

Seoul National University Hospital

Seoul, , South Korea

Site Status

Severance Hospital Yonsei University Health System

Seoul, , South Korea

Site Status

Hospital Universitario de Cruces

Barakaldo, , Spain

Site Status

Hospital Sant Joan de Deu

Barcelona, , Spain

Site Status

Hospital Universitario Vall d'Hebrón

Barcelona, , Spain

Site Status

Hospital Infantil Universitario Niño Jesus

Madrid, , Spain

Site Status

Hospital Universitario Fundacion Jimenez Diaz

Madrid, , Spain

Site Status

Hospital Universitario La Paz

Madrid, , Spain

Site Status

Hospital Universitario Virgen del Rocio

Seville, , Spain

Site Status

Hospital Universitari i Politecnic La Fe de Valencia

Valencia, , Spain

Site Status

Drottning Silvias Barn Och Ungdomssjukhus

Gothenburg, , Sweden

Site Status

Skanes Universitetssjukhus Lund

Lund, , Sweden

Site Status

Karolinska Universitetssjukhuset Solna

Stockholm, , Sweden

Site Status

Centre Hospitalier Universitaire Vaudois

Lausanne, , Switzerland

Site Status

Kinderspital Zürich - Eleonorenstiftung

Zurich, , Switzerland

Site Status

National Taiwan University Hospital

Taipei, , Taiwan

Site Status

Taipei Veterans General Hospital

Taipei, , Taiwan

Site Status

Birmingham Children's Hospital

Birmingham, , United Kingdom

Site Status

The Royal Hospital for Children

Bristol, , United Kingdom

Site Status

Royal Hospital for Children

Glasgow, , United Kingdom

Site Status

Leeds Children Hospital

Leeds, , United Kingdom

Site Status

Alder Hey Children's Hospital

Liverpool, , United Kingdom

Site Status

UCL Cancer Institute

London, , United Kingdom

Site Status

Royal Manchester Childrens Hospital

Manchester, , United Kingdom

Site Status

The Christie NHS Foundation Trust

Manchester, , United Kingdom

Site Status

Royal Victoria Infirmary

Newcastle, , United Kingdom

Site Status

John Radcliffe Hospital

Oxford, , United Kingdom

Site Status

Countries

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United States Australia Austria Belgium Canada Czechia Finland France Hong Kong Ireland Israel Italy Netherlands New Zealand Singapore South Korea Spain Sweden Switzerland Taiwan United Kingdom

References

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Gaspar N, Hung GY, Strauss SJ, Campbell-Hewson Q, Dela Cruz FS, Glade Bender JL, Koh KN, Whittle SB, Chan GC, Gerber NU, Palmu S, Morgenstern DA, Longhi A, Baecklund F, Lee JA, Locatelli F, Marquez Vega C, Janeway KA, McCowage G, McCabe MG, Bidadi B, Huang J, McKenzie J, Okpara CE, Bautista F; OLIE Study Investigators. Lenvatinib Plus Ifosfamide and Etoposide in Children and Young Adults With Relapsed Osteosarcoma: A Phase 2 Randomized Clinical Trial. JAMA Oncol. 2024 Dec 1;10(12):1645-1653. doi: 10.1001/jamaoncol.2024.4381.

Reference Type DERIVED
PMID: 39418029 (View on PubMed)

Gaspar N, Venkatramani R, Hecker-Nolting S, Melcon SG, Locatelli F, Bautista F, Longhi A, Lervat C, Entz-Werle N, Casanova M, Aerts I, Strauss SJ, Thebaud E, Morland B, Nieto AC, Marec-Berard P, Gambart M, Rossig C, Okpara CE, He C, Dutta L, Campbell-Hewson Q. Lenvatinib with etoposide plus ifosfamide in patients with refractory or relapsed osteosarcoma (ITCC-050): a multicentre, open-label, multicohort, phase 1/2 study. Lancet Oncol. 2021 Sep;22(9):1312-1321. doi: 10.1016/S1470-2045(21)00387-9. Epub 2021 Aug 17.

Reference Type DERIVED
PMID: 34416158 (View on PubMed)

Gaspar N, Campbell-Hewson Q, Huang J, Okpara CE, Bautista F. OLIE, ITCC-082: a Phase II trial of lenvatinib plus ifosfamide and etoposide in relapsed/refractory osteosarcoma. Future Oncol. 2021 Nov;17(32):4249-4261. doi: 10.2217/fon-2021-0743. Epub 2021 Aug 12.

Reference Type DERIVED
PMID: 34382412 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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2019-003696-19

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

E7080-G000-230

Identifier Type: -

Identifier Source: org_study_id

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