A Phase 2 interventional study of Dacarbazine and Doxorubicin Hydrochloride in Recurrent Adult Soft Tissue Sarcoma, Stage I Adult Soft Tissue Sarcoma AJCC v7 and Stage II Adult Soft Tissue Sarcoma AJCC v7, sponsored by National Cancer Institute (NCI). Terminated at 1 site in United States. Open to participants aged 16 Years and older. Per ClinicalTrials.gov, last updated 2018-04-13.
Sponsored by National Cancer Institute (NCI) · Phase 2, Interventional, and Treatment
Thalidomide may stop the growth of soft tissue sarcoma by stopping blood flow to the tumor. Radiation therapy uses high-energy x-rays to damage tumor cells. Drugs used in chemotherapy, such as doxorubicin, ifosfamide, and dacarbazine, work in different ways to stop tumor cells from dividing so they stop growing or die. Giving thalidomide together with radiation therapy and/or chemotherapy before surgery may shrink the tumor so that it can be removed. This phase II trial is studying how well giving preoperative (before surgery) thalidomide together with radiation therapy works in treating patients with low-grade primary soft tissue sarcoma, and how well giving thalidomide together with radiation therapy, doxorubicin, ifosfamide, and dacarbazine works in treating patients with high-grade or intermediate-grade primary soft tissue sarcoma of the arm, leg, chest wall, or abdominal wall.
OBJECTIVES:
I. Determine the treatment delivery and toxicity of the combination of thalidomide and radiotherapy in patients with low-grade primary soft tissue sarcoma of the extremity or body wall.
II. Determine the treatment delivery and toxicity of the combination of thalidomide and doxorubicin, ifosfamide, dacarbazine, and radiotherapy in patients with high- or intermediate-grade primary soft tissue sarcoma of the extremity or body wall and compare these results with those of patients treated on RTOG-9514.
III. Determine the feasibility of using specific tissue and circulating biomarkers of antiangiogenic response in patients treated with these regimens, in a multi-institutional setting.
IV. Determine the quantitative changes and patient variabilities of these biomarkers before, during, and after therapy with these regimens.
V. Determine the baseline data sets of biomarkers, particularly circulating endothelial cells, in patients treated with these regimens.
VI. Determine the tolerance to long-term post-operative thalidomide in these patients.
VII. Determine the clinical response to pre-operative therapy in these patients.
VIII. Correlate local control and disease-free survival with surrogate biological endpoints in patients treated with these regimens.
OUTLINE: This is a pilot, cohort study. Patients with high- or intermediate-grade tumors >= 8 cm in diameter are assigned to cohort A and patients with low-grade tumors > 5 cm in diameter are assigned to cohort B.
Cohort A: Patients receive doxorubicin, ifosfamide, and dacarbazine IV continuously on days 1-3, 22-24, and 43-45. Patients receive filgrastim (G-CSF) subcutaneously beginning on days 4, 25, and 46 and continuing until blood counts recover. Patients undergo radiotherapy once daily on days 7-11, 14-18, 21, 28-32, 35-39, and 42. Patients receive oral thalidomide once daily on days 7-21 and 26-42. Patients undergo surgical resection between days 84 and 98. Beginning 2 weeks after surgery, patients receive oral thalidomide once daily for 12 months in the absence of unacceptable toxicity.
Cohort B: Patients receive oral thalidomide once daily beginning on day 1 and continuing until 1 week before surgery. Patients undergo radiotherapy once daily, 5 days a week, on weeks 1-5. Patients undergo surgical resection between days 77 and 91. Beginning 2 weeks after surgery, patients receive oral thalidomide once daily for 6 months in the absence of unacceptable toxicity.
Patients are followed every 3 months for 2 years and then every 6 months for 4 years.
PROJECTED ACCRUAL: A total of 44 patients (22 per cohort) will be accrued for this study within 17 months.
1,667 studies on the registry are indexed under Sarcoma; 393 are open to participants now.
This study's enrollment of 23 is below the median of 40 across 1,283 interventional studies indexed under Sarcoma.
Browse Sarcoma studies →National Cancer Institute (NCI) is the lead sponsor of 3,506 studies on the registry; 334 are open to participants now.
Of its 402 completed or terminated interventional studies of FDA-regulated products, 365 (91%) have results posted.
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Inclusion Criteria:
Diagnosis of primary soft tissue sarcoma
Meets 1 of the following criteria:
No known hypercoagulable disorders, such as the following:
Cohort A only:
Patients receive doxorubicin, ifosfamide, and dacarbazine IV continuously on days 1-3, 22-24, and 43-45. Patients receive G-CSF subcutaneously beginning on days 4, 25, and 46 and continuing until blood counts recover. Patients undergo radiotherapy once daily on days 7-11, 14-18, 21, 28-32, 35-39, and 42. Patients receive oral thalidomide once daily on days 7-21 and 26-42. Patients undergo surgical resection between days 84 and 98. Beginning 2 weeks after surgery, patients receive oral thalidomide once daily for 12 months in the absence of unacceptable toxicity.
Drug: Dacarbazine · Drug: Doxorubicin Hydrochloride · Biological: Filgrastim · Drug: Ifosfamide · Other: Laboratory Biomarker Analysis · Radiation: Radiation Therapy · Drug: Thalidomide · Procedure: Therapeutic Conventional Surgery
Patients receive oral thalidomide once daily beginning on day 1 and continuing until 1 week before surgery. Patients undergo radiotherapy once daily, 5 days a week, on weeks 1-5. Patients undergo surgical resection between days 77 and 91. Beginning 2 weeks after surgery, patients receive oral thalidomide once daily for 6 months in the absence of unacceptable toxicity.
Other: Laboratory Biomarker Analysis · Radiation: Radiation Therapy · Drug: Thalidomide · Procedure: Therapeutic Conventional Surgery
Given IV
Also known as: 4-(Dimethyltriazeno)imidazole-5-carboxamide, 5-(Dimethyltriazeno)imidazole-4-carboxamide, Asercit, Biocarbazine, Dacarbazina, Dacarbazina Almirall, Dacarbazine - DTIC, Dacatic, Dakarbazin, Deticene, Detimedac, DIC, Dimethyl (triazeno) imidazolecarboxamide, Dimethyl Triazeno Imidazol Carboxamide, Dimethyl Triazeno Imidazole Carboxamide, dimethyl-triazeno-imidazole carboxamide, Dimethyl-triazeno-imidazole-carboximide, DTIC, DTIC-Dome, Fauldetic, Imidazole Carboxamide, Imidazole Carboxamide Dimethyltriazeno, WR-139007
Given IV
Also known as: 5,12-Naphthacenedione, 10-[(3-amino-2,3,6-trideoxy-alpha-L-lyxo-hexopyranosyl)oxy]-7,8, 9,10-tetrahydro-6,8,11-trihydroxy-8-(hydroxyacetyl)-1-methoxy-, hydrochloride, (8S-cis)- (9CI), ADM, Adriacin, Adriamycin, Adriamycin Hydrochloride, Adriamycin PFS, Adriamycin RDF, ADRIAMYCIN, HYDROCHLORIDE, Adriamycine, Adriblastina, Adriblastine, Adrimedac, Chloridrato de Doxorrubicina, DOX, DOXO-CELL, Doxolem, Doxorubicin.HCl, Doxorubin, Farmiblastina, FI 106, FI-106, hydroxydaunorubicin, Rubex
Given subcutaneously
Also known as: FILGRASTIM, LICENSE HOLDER UNSPECIFIED, G-CSF, Neupogen, r-metHuG-CSF, Recombinant Methionyl Human Granulocyte Colony Stimulating Factor, rG-CSF, Tevagrastim
Given IV
Also known as: Asta Z 4942, Asta Z-4942, Cyfos, Holoxan, Holoxane, Ifex, IFO, IFO-Cell, Ifolem, Ifomida, Ifomide, Ifosfamidum, Ifoxan, IFX, Iphosphamid, Iphosphamide, Iso-Endoxan, Isoendoxan, Isophosphamide, Mitoxana, MJF 9325, MJF-9325, Naxamide, Seromida, Tronoxal, Z 4942, Z-4942
Correlative studies
Undergo radiotherapy
Also known as: Cancer Radiotherapy, Irradiate, Irradiated, irradiation, RADIATION, Radiotherapeutics, radiotherapy, RT, Therapy, Radiation
Given orally
Also known as: (+)-Thalidomide, (-)-Thalidomide, .alpha.-Phthalimidoglutarimide, 2, 6-Dioxo-3-phthalimidopiperidine, Alpha-Phthalimidoglutarimide, Contergan, Distaval, Kevadon, N-(2,6-Dioxo-3-piperidyl)phthalimide, N-Phthaloylglutamimide, N-Phthalylglutamic Acid Imide, Neurosedyn, Pantosediv, Phthalimide, N-(2, 6-dioxo-3-piperidyl)-, (+)-, Phthalimide, N-(2, 6-dioxo-3-piperidyl)-, (-)-, Sedalis, Sedoval K-17, Softenon, Synovir, Talimol, Thalomid
Undergo surgical resection
Treatment Delivery With Compliance Defined as Receiving at Least 95% of the Pre-operative Protocol Dose of RT, All 3 Cycles of MAID (if Applicable), and Receive Thalidomide on 75% of the Days During Radiation
Was to be estimated using a binomial distribution and accompanied by the associated 95% confidence interval. Due to early study closure, this endpoint could not be fully evaluated per the protocol plan.
Time frame: Duration of treatment (which can continue up to approximately 15 months).
Wound Complication (Grades 2, 3, 4, and 5) as Measured by CTCAE v3.0
Will be estimated using a binomial distribution and accompanied by the associated 95% confidence interval.
Time frame: From start of treatment to time of surgery
Response to Pre-operative Therapy Assessed Using RECIST Criteria
Time frame: From start of treatment to time of surgery.
| Milestone | Cohort A (Chemotherapy, Radiation, Thalidomide, Surgery) | Cohort B (Thalidomide, Radiation, Surgery) |
|---|---|---|
| Started | 16 | 7 |
| Completed | 15 | 7 |
| Not completed | 1 | 0 |
| Withdrew: Ineligible | 1 | 0 |
Was to be estimated using a binomial distribution and accompanied by the associated 95% confidence interval. Due to early study closure, this endpoint could not be fully evaluated per the protocol plan.
| participants | Cohort A (Chemotherapy, Radiation, Thalidomide, Surgery) | Cohort B (Thalidomide, Radiation, Surgery) |
|---|---|---|
| Not Compliant | 5 | 2 |
| Compliant | 10 | 5 |
Will be estimated using a binomial distribution and accompanied by the associated 95% confidence interval.
No measurements were reported for this outcome.
No measurements were reported for this outcome.
Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Cohort A (Chemotherapy, Radiation, Thalidomide, Surgery) | — | 9/15 (60%) | 15/15 (100%) |
| Cohort B (Thalidomide, Radiation, Surgery) | — | 3/7 (42.9%) | 7/7 (100%) |
| Event | Cohort A (Chemotherapy, Radiation, Thalidomide, Surgery) | Cohort B (Thalidomide, Radiation, Surgery) |
|---|---|---|
| White blood cell decreasedInvestigations | 5/15 | 0/7 |
| Thromboembolic eventVascular disorders | 5/15 | 0/7 |
| Wound dehiscenceInjury, poisoning and procedural complications | 0/15 | 2/7 |
| Neutrophil count decreasedInvestigations | 4/15 | 0/7 |
| Platelet count decreasedInvestigations | 3/15 | 0/7 |
| Pain in extremityMusculoskeletal and connective tissue disorders | 3/15 | 0/7 |
| Infections and infestations - OtherInfections and infestations | 1/15 | 1/7 |
| Skin infectionInfections and infestations | 1/15 | 1/7 |
| ArthritisMusculoskeletal and connective tissue disorders | 0/15 | 1/7 |
| HypotensionVascular disorders | 0/15 | 1/7 |
| Event | Cohort A (Chemotherapy, Radiation, Thalidomide, Surgery) | Cohort B (Thalidomide, Radiation, Surgery) |
|---|---|---|
| FatigueGeneral disorders | 14/15 | 4/7 |
| AnemiaBlood and lymphatic system disorders | 13/15 | 2/7 |
| NauseaGastrointestinal disorders | 13/15 | 1/7 |
| ConstipationGastrointestinal disorders | 11/15 | 3/7 |
| VomitingGastrointestinal disorders | 10/15 | 0/7 |
| Pain in extremityMusculoskeletal and connective tissue disorders | 9/15 | 0/7 |
| White blood cell decreasedInvestigations | 8/15 | 0/7 |
| AnorexiaMetabolism and nutrition disorders | 8/15 | 1/7 |
| HypoalbuminemiaMetabolism and nutrition disorders | 8/15 | 1/7 |
| HyperglycemiaMetabolism and nutrition disorders | 7/15 | 1/7 |
All eligible patients who started treatment.
| Age, Continuous(years) | Cohort A (Chemotherapy, Radiation, Thalidomide, Surgery) | Cohort B (Thalidomide, Radiation, Surgery) | Total |
|---|---|---|---|
| Median | 49.0 (20.0 to 75.0) | 47.0 (39.0 to 81.0) | 48 (20 to 81) |
| Sex: Female, Male(Participants) | Cohort A (Chemotherapy, Radiation, Thalidomide, Surgery) | Cohort B (Thalidomide, Radiation, Surgery) | Total |
|---|---|---|---|
| Female | 7 | 2 | 9 |
| Male | 8 | 5 | 13 |
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