Comparison of Combination Chemotherapy Regimens in Treating Patients With Ewing's Sarcoma or Neuroectodermal Tumor
Basic Trial Information
|Phase III||Treatment||Completed||50 and under at diagnosis||NCI, Other||AEWS0031|
COG-AEWS0031, CDR0000068323, A7983, CCG-A7983, SWOG-COG-AEWS0031, NCT00006734
RATIONALE: Drugs used in chemotherapy work in different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. It is not yet known which chemotherapy regimen combined with radiation therapy and/or surgery is more effective in treating Ewing's sarcoma or primitive neuroectodermal tumor.
PURPOSE: Randomized phase III trial to compare the effectiveness of different chemotherapy regimens combined with radiation therapy and/or surgery in treating patients who have Ewing's sarcoma or primitive neuroectodermal tumor.
Further Study Information
- Compare the effect of interval-compressed vs standard chemotherapy in terms of event-free survival and overall survival in patients with newly diagnosed, localized Ewing's sarcoma or peripheral primitive neuroectodermal tumor.
OUTLINE: This is a randomized, multicenter study. Patients are stratified according to age (under 18 years vs 18 years and over) and location of primary disease (pelvic vs nonpelvic). Patients are randomized to 1 of 2 treatment arms for induction and continuation therapy.
- Induction therapy (weeks 1-12):
- Arm I: Patients receive alternating courses of chemotherapy consisting of vincristine IV on day 1, doxorubicin IV continuously over 48 hours on days 1 and 2, and cyclophosphamide IV over 1 hour on day 1 for courses 1 and 3 and ifosfamide IV over 1 hour and etoposide IV over 1-2 hours on days 1-5 for courses 2 and 4. Beginning 24 hours after the last dose of chemotherapy for each course, patients receive filgrastim (G-CSF) subcutaneously (SC) daily until blood counts recover. Treatment continues every 3 weeks for 4 courses.
- Arm II: Patients receive alternating courses of chemotherapy consisting of vincristine, doxorubicin, and cyclophosphamide as in arm I for courses 1, 3, and 5 and ifosfamide and etoposide as in arm I for courses 2, 4, and 6. Patients also receive G-CSF as in arm I. Treatment continues every 2 weeks for 6 courses.
After completion of induction therapy, patients in both arms receive local control treatment to the primary tumor. Patients receive continuation chemotherapy after surgery or concurrently with radiotherapy.
- Continuation therapy:
- Arm I (weeks 13-42): Patients receive additional alternating courses of chemotherapy as in arm I of induction therapy with the exception of vincristine and cyclophosphamide alone for courses 7 and/or 11 and/or 13. Patients also receive G-CSF as in induction therapy. Treatment continues every 3 weeks for 10 courses.
- Arm II (weeks 13-29): Patients receive additional alternating courses of chemotherapy as in arm II of induction therapy with the exception of vincristine and cyclophosphamide alone for courses 9 and/or 11 and/or 13. Patients also receive G-CSF as in induction therapy. Treatment continues every 2 weeks for 8 courses.
Patients are followed every 3 months for 4 years and then every 6 months for 1 year.
PROJECTED ACCRUAL: Approximately 528 patients will be accrued for this study within 4-5 years.
- Histologically confirmed localized Ewing's sarcoma or peripheral primitive neuroectodermal tumor (PNET) of the bone or soft tissues
- Diagnostic biopsy of primary tumor within 30 days of study
- Paraspinal or bony skull tumors of extradural origin allowed
- No intradural soft tissue tumors
- Askin's tumor of the chest wall allowed
- Chest wall tumors with ipsilateral pleural effusions or ipsilateral pleural-based secondary tumor nodules allowed
- No contralateral pleural effusions
- No metastatic disease or distant node involvement
- One pulmonary or pleural nodule greater than 1 cm in diameter OR more than 1 nodule greater than 0.5 cm in diameter are considered pulmonary metastasis
- Solitary lung nodules of 0.5-1 cm OR multiple nodules of 0.3-0.5 cm allowed unless biopsy positive for tumor
- Light microscopic appearance (hematoxylin and eosin stained) consistent with Ewing's sarcoma or peripheral PNET
- No immunohistochemical or ultrastructural evidence of rhabdomyosarcoma
- No esthesioneuroblastoma
- Clinically or pathologically involved regional lymph nodes allowed
- No CNS involvement
- 50 and under at diagnosis
- Not specified
- Not specified
- Not specified
- Bilirubin no greater than 1.5 mg/dL
- Creatinine normal for age
- Creatinine clearance or isotope glomerular filtration rate at least 75 mL/min
- Shortening fraction at least 28% by echocardiography OR
- Ejection fraction at least 55% by radionuclide angiogram
- Not pregnant or nursing
- Fertile patients must use effective contraception
- No other prior malignancy except skin cancer diagnosed at least 5 years ago and currently in remission
PRIOR CONCURRENT THERAPY:
- No prior immunotherapy for skin cancer
- No concurrent sargramostim (GM-CSF)
- No concurrent pegfilgrastim
- No prior chemotherapy
- Not specified
- No prior radiotherapy
- Prior complete or partial excision of primary tumor allowed
Trial Contact Information
Trial Lead Organizations/Sponsors
Children's Oncology Group
- National Cancer Institute
- Southwest Oncology Group
Link to the current ClinicalTrials.gov record.
NLM Identifier NCT00006734
ClinicalTrials.gov processed this data on April 21, 2015
Note: Information about this trial is from the ClinicalTrials.gov database. The versions designated for health professionals and patients contain the same text. Minor changes may be made to the ClinicalTrials.gov record to standardize the names of study sponsors, sites, and contacts. Cancer.gov only lists sites that are recruiting patients for active trials, whereas ClinicalTrials.gov lists all sites for all trials. Questions and comments regarding the presented information should be directed to ClinicalTrials.gov.