Samarium Sm 153 and Stem Cell Transplant Followed By Radiation Therapy Patients With Osteosarcoma
Information source: Sidney Kimmel Comprehensive Cancer Center
ClinicalTrials.gov processed this data on August 23, 2015 Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Sarcoma
Intervention: filgrastim (Biological); ifosfamide (Drug); peripheral blood stem cell transplantation (Procedure); Sm-EDTMP (low dose) (Radiation); sm-EDTMP (higher dose) (Radiation)
Phase: Phase 2
Status: Completed
Sponsored by: Sidney Kimmel Comprehensive Cancer Center Official(s) and/or principal investigator(s): David M. Loeb, MD, PhD, Principal Investigator, Affiliation: Sidney Kimmel Comprehensive Cancer Center
Summary
RATIONALE: Radioactive drugs, such as samarium Sm 153 lexidronam pentasodium, may carry
radiation directly to tumor cells and not harm normal cells. A peripheral stem cell
transplant may be able to replace blood-forming cells that were destroyed by chemotherapy
and samarium Sm 153 lexidronam pentasodium. Radiation therapy uses high-energy x-rays to
kill tumor cells. Giving samarium Sm 153 lexidronam pentasodium together with a peripheral
stem cell transplant and radiation therapy may kill more tumor cells.
PURPOSE: This phase II trial is studying how well giving samarium Sm 153 lexidronam
pentasodium together with autologous stem cell transplant and radiation therapy works in
treating patients with recurrent or refractory, metastatic, or unresectable osteosarcoma.
Clinical Details
Official title: High Dose Samarium-153 With Peripheral Blood Stem Cell Support in High Risk Osteogenic Sarcoma
Study design: Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Primary outcome: Tumor Response
Secondary outcome: Predictive Value of Imaging StudiesOverall and Progression-free Survival After Study Treatment Toxicity at End of Study Treatment Long Term Side Effects of Infusional Samarium-153 After Study Treatment Correlative Dose of Radiation by Low Dose and High Dose Samarium-153
Detailed description:
OBJECTIVES:
Primary
- Determine the clinical response in patients with recurrent or refractory, metastatic,
or unresectable osteosarcoma treated with high-dose samarium Sm 153 lexidronam
pentasodium (^153Sm-EDTMP) and autologous peripheral blood stem cell transplantation
followed by external-beam radiotherapy.
- Correlate the amount of radiation delivered to a tumor with low-dose ^153Sm-EDTMP with
that of high-dose ^153Sm-EDTMP in patients treated with this regimen.
Secondary
- Determine the overall and progression-free survival of patients treated with this
regimen.
- Determine the toxicity of this regimen in these patients.
- Determine the long-term effects of this regimen in these patients.
- Determine the predictive value of fludeoxyglucose F 18 positron emission tomography
(FDG-PET), diffusion-weighted MRI, and magnetic resonance spectroscopy for evaluation
of treatment response in patients treated with this regimen.
OUTLINE: Patients are stratified according to resectability of the primary tumor (recurrent,
refractory, or very high-risk disease vs unresectable primary tumor).
- Mobilization and collection of autologous peripheral blood stem cells (PBSCs)* :
Patients receive ifosfamide IV daily for 5 days followed by filgrastim (G-CSF)
subcutaneously daily. Patients then undergo leukapheresis for collection of autologous
PBSCs until ≥ 2 x 10^6 CD34-positive cells/kg are collected.
NOTE: *Patients who have undergone PBSC collection before study entry proceed to high-dose
samarium Sm 153 lexidronam pentasodium (153Sm-EDTMP) infusion without mobilization and
collection of autologous PBSCs.
- 153Sm-EDTMP infusion: Patients receive a trace dose of ^153Sm-EDTMP** IV over 1-2
minutes and undergo bone scan 4, 24, and 48-72 hours later. Six weeks later, patients
receive high-dose ^153Sm-EDTMP IV over 1-2 minutes and undergo repeat bone scans 4, 24,
and 48-72 hours later.
NOTE: **Patients may receive the trace dose on protocol JHOC-J0094.
- Autologous peripheral blood stem cell transplantation (PBSCT): Between 12-14 days after
administration of high-dose ^153Sm-EDTMP, patients undergo autologous PBSCT. Beginning
2 days later, patients receive G-CSF IV daily.
- External-beam radiotherapy: Patients then undergo external-beam radiotherapy to the
sites of bulky disease.
- Surgery: Some patients may also undergo surgical resection of residual disease. After
completion of study treatment, patients are followed periodically for up to 3 years.
PROJECTED ACCRUAL: A total of 54 patients will be accrued for this study.
Eligibility
Minimum age: 13 Years.
Maximum age: 50 Years.
Gender(s): Both.
Criteria:
Inclusion
- Diagnosis of osteosarcoma
- High-risk disease, meeting 1 of the following criteria:
- Recurrent disease
- Refractory to conventional therapy
- Newly diagnosed metastatic disease with ≥ 4 pulmonary nodules or multiple
bone lesions
- Unresectable primary tumor
- Prior intralesional resection allowed
- Measurable disease by technetium Tc 99m diphosphonate bone scan
- Refractory to all standard therapies or highly unlikely to respond to conventional
treatment
- Performance status Karnofsky 60-100%
- Life expectancy more than 8 weeks
- Absolute neutrophil count > 500/mm^3
- Platelet count > 50,000/mm^3
- Creatinine clearance > 70 mL/min OR * Radioisotope glomerular filtration rate normal
- Recovered from prior chemotherapy
Exclusion
- Pregnant or nursing
- Positive pregnancy test for females of childbearing potential
- Fertile patients do not agree to use effective contraception
- Prior radiotherapy to the site of currently active disease
- Concurrent enrollment on protocol JHOC-J0094 allowed
Locations and Contacts
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland 21231-2410, United States
Additional Information
Clinical trial summary from the National Cancer Institute's PDQ® database
Starting date: October 2004
Last updated: April 15, 2015
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