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TerminatedNCT00089544Updated Apr 13, 2018Results posted

Preoperative Thalidomide With Radiation Therapy For Patients With Low-Grade Primary Soft Tissue Sarcoma or Thalidomide With Radiation Therapy and Chemotherapy For Patients With High-Grade or Intermediate-Grade Primary Soft Tissue Sarcoma of the Arm, Leg, or Body Wall

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

Phase
Phase 2
Study type
Interventional
Enrollment
23
Allocation
Non-randomized
Ages
16 Years and older
Sex
All
01

Study summary

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.

Read the detailed description

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.

02

Conditions studied

  • Recurrent Adult Soft Tissue Sarcoma
  • Stage I Adult Soft Tissue Sarcoma AJCC v7
  • Stage II Adult Soft Tissue Sarcoma AJCC v7
  • Stage III Adult Soft Tissue Sarcoma AJCC v7

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03

In context

Sarcoma

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.

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Lead sponsor

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.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
16 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Eligibility criteria

Inclusion Criteria:

  • Diagnosis of primary soft tissue sarcoma

    • T2a or T2b disease
    • Superficial or deep tumor
    • Grade 1, 2, 3, or 4
    • Tumor located on the upper extremity (including shoulder), lower extremity (including hip), or trunk
  • Meets 1 of the following criteria:

    • Tumor ? 8 cm in maximal diameter and grade 3 or 4 (intermediate or high grade) (cohort A)
    • Tumor > 5 cm in maximal diameter and grade 1 or 2 (low grade) (cohort B)
  • Locally recurrent disease allowed provided there has been no prior radiotherapy to the primary tumor
  • No histologically confirmed rhabdomyosarcoma, extraosseous Ewing's primitive neuroectodermal tumors, osteosarcoma or chondrosarcoma, Kaposi's sarcoma, angiosarcoma, desmoid tumors, or dermatofibrosarcoma protuberans
  • No overt evidence of lung metastases (CT scan evidence of small incidental lesions without histologic diagnosis allowed)
  • No evidence of other metastases
  • No sarcoma of the head, neck, intra-abdominal, or retroperitoneal region
  • Performance status - Zubrod 0-1
  • At least 2 years
  • Absolute neutrophil count ? 1,500/mm\^3
  • Platelet count ? 120,000/mm\^3
  • Hemoglobin ? 8.0 g/dL (cohort A)
  • No known hypercoagulable disorders, such as the following:

    • APC resistance (factor V Leiden)
    • Protein S deficiency
    • Protein C deficiency
    • Antithrombin III deficiency
    • Hyperhomocystinemia
    • Dysplasminogenemia
    • High plasminogen activator inhibitor
    • Dysfibrinogenemia
    • Antiphospholipid syndrome
    • Thrombocythemia
    • Dysproteinemia
  • Fibrin split products \< 2 times upper limit of normal (ULN)
  • Fibrinogen > 200 mg/dL
  • Bilirubin ? 1.5 mg/dL (1.0 mg/dL for patients with Gilbert's syndrome)
  • AST and ALT ? 2.0 times ULN
  • PT and PTT \< 1.25 times ULN (except in patients treated with anticoagulants for unrelated medical conditions [e.g., atrial fibrillation])
  • No history of hepatic cirrhosis
  • Creatinine ? 1.5 mg/dL
  • Creatinine clearance > 60 mL/min
  • No atherosclerotic coronary artery disease that required bypass surgery within the past year
  • No uncompensated coronary artery disease by ECG or physical examination
  • No myocardial infarction within the past 6 months
  • No severe or unstable angina within the past 6 months
  • No uncompensated congestive heart failure
  • No New York Heart Association class II-IV heart disease
  • No symptomatic peripheral vascular disease
  • No history of deep vein thrombosis
  • Cohort A only:

    • EF ? 50% within the past 6 months
    • LVEF > 50%
  • No pulmonary embolus except if caused directly by foreign body implants (e.g., central venous catheters or portacaths)
  • No global neurocognitive symptomatology
  • No fatigue ? grade 2
  • No history of uncontrolled seizures or uncontrolled seizure disorder
  • No sensory neuropathy ? grade 2 except for localized neuropathy due to mechanical cause or trauma
  • No other malignancies within the past 3 years except non-invasive malignancies (e.g., carcinoma in situ of the cervix, breast, or oral cavity) or squamous or basal cell skin cancer
  • No history of uncontrolled myxedema
  • No hypothyroidism ? grade 3
  • No active uncontrolled bacterial, viral, or fungal infection
  • No other significant illness that would preclude surgery
  • No other major illness or psychiatric impairment that would preclude study therapy
  • No known AIDS
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use 2 effective barrier methods of contraception for 4 weeks before, during, and for at least 4 weeks after study treatment
  • No prior thalidomide
  • No prior biologic therapy for this tumor
  • No prior chemotherapy for this tumor
  • See Disease Characteristics
  • No prior radiotherapy for this tumor
  • See Cardiovascular
  • No other concurrent investigational drugs
  • No concurrent sedating drugs
  • No concurrent illegal sedating "recreational" drugs
  • No concurrent alcohol intake of more than 1 drink per day
05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Non-randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
23 participants (actual)

Study arms

  • Experimental
    Cohort A (chemotherapy, radiation, thalidomide, surgery)

    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

  • Experimental
    Cohort B (thalidomide, radiation, 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

Interventions

  • DrugDacarbazine

    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

  • DrugDoxorubicin Hydrochloride

    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

  • BiologicalFilgrastim

    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

  • DrugIfosfamide

    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

  • OtherLaboratory Biomarker Analysis

    Correlative studies

  • RadiationRadiation Therapy

    Undergo radiotherapy

    Also known as: Cancer Radiotherapy, Irradiate, Irradiated, irradiation, RADIATION, Radiotherapeutics, radiotherapy, RT, Therapy, Radiation

  • DrugThalidomide

    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

  • ProcedureTherapeutic Conventional Surgery

    Undergo surgical resection

06

What researchers measure

Primary outcomes

  1. 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).

Secondary outcomes

  1. 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

  2. Response to Pre-operative Therapy Assessed Using RECIST Criteria

    Time frame: From start of treatment to time of surgery.

07

Results

Posted Jul 10, 2013
Limitations and caveats
This study closed early due to unacceptably high rate of thromboembolic events in Cohort A and due to low accrual in Cohort B. For this reason efficacy endpoints other than response to pre-operative therapy were not reported.

Participant flow

Participant flow — Overall Study
MilestoneCohort A (Chemotherapy, Radiation, Thalidomide, Surgery)Cohort B (Thalidomide, Radiation, Surgery)
Started167
Completed157
Not completed10
Withdrew: Ineligible10

Outcome measures

PrimaryTreatment 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).
Reported as:
Number · participants
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
participantsCohort A (Chemotherapy, Radiation, Thalidomide, Surgery)Cohort B (Thalidomide, Radiation, Surgery)
Not Compliant52
Compliant105
SecondaryWound 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

No measurements were reported for this outcome.

SecondaryResponse to Pre-operative Therapy Assessed Using RECIST Criteria
Time frame:
From start of treatment to time of surgery.

No measurements were reported for this outcome.

Adverse events

Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Cohort A (Chemotherapy, Radiation, Thalidomide, Surgery)—9/15 (60%)15/15 (100%)
Cohort B (Thalidomide, Radiation, Surgery)—3/7 (42.9%)7/7 (100%)
Most frequent serious events
Showing 10 of 28
Most frequent serious events
EventCohort A (Chemotherapy, Radiation, Thalidomide, Surgery)Cohort B (Thalidomide, Radiation, Surgery)
White blood cell decreasedInvestigations5/150/7
Thromboembolic eventVascular disorders5/150/7
Wound dehiscenceInjury, poisoning and procedural complications0/152/7
Neutrophil count decreasedInvestigations4/150/7
Platelet count decreasedInvestigations3/150/7
Pain in extremityMusculoskeletal and connective tissue disorders3/150/7
Infections and infestations - OtherInfections and infestations1/151/7
Skin infectionInfections and infestations1/151/7
ArthritisMusculoskeletal and connective tissue disorders0/151/7
HypotensionVascular disorders0/151/7
Most frequent other events
Showing 10 of 119
Most frequent other events
EventCohort A (Chemotherapy, Radiation, Thalidomide, Surgery)Cohort B (Thalidomide, Radiation, Surgery)
FatigueGeneral disorders14/154/7
AnemiaBlood and lymphatic system disorders13/152/7
NauseaGastrointestinal disorders13/151/7
ConstipationGastrointestinal disorders11/153/7
VomitingGastrointestinal disorders10/150/7
Pain in extremityMusculoskeletal and connective tissue disorders9/150/7
White blood cell decreasedInvestigations8/150/7
AnorexiaMetabolism and nutrition disorders8/151/7
HypoalbuminemiaMetabolism and nutrition disorders8/151/7
HyperglycemiaMetabolism and nutrition disorders7/151/7

Baseline characteristics

All eligible patients who started treatment.

Age, Continuous
Age, Continuous(years)Cohort A (Chemotherapy, Radiation, Thalidomide, Surgery)Cohort B (Thalidomide, Radiation, Surgery)Total
Median49.0 (20.0 to 75.0)47.0 (39.0 to 81.0)48 (20 to 81)
Sex: Female, Male
Sex: Female, Male(Participants)Cohort A (Chemotherapy, Radiation, Thalidomide, Surgery)Cohort B (Thalidomide, Radiation, Surgery)Total
Female729
Male8513
08

Study locations

1 site
  • Radiation Therapy Oncology Group
    Philadelphia, Pennsylvania 19103, United States
09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Apr 13, 2018, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT00089544
Lead sponsor
National Cancer Institute (NCI)
Collaborators
Radiation Therapy Oncology Group
Responsible party
Sponsor
First posted
Aug 9, 2004
Start date
Jun 17, 2004
Primary completion
Sep 27, 2011
Completion
Nov 5, 2013
Results posted
Jul 10, 2013
Last update
Apr 13, 2018

Study contacts

Burton Eisenberg
principal investigator · Radiation Therapy Oncology Group
View the source record on ClinicalTrials.gov ↗

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