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NCT00085202 · CITED IN SOURCE DOCUMENTS

Treatment of Patients With Newly Diagnosed Medulloblastoma, Supratentorial Primitive Neuroectodermal Tumor, or Atypical Teratoid Rhabdoid Tumor

An NCI or FDA source cites this study. A citation does not establish that it applies to an individual diagnosis.

Phase
PHASE3
Status at capture
COMPLETED
Registry last update
2024-02-08

Drugs used in chemotherapy, such as vincristine, cisplatin, and cyclophosphamide, 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. Combining radiation therapy with chemotherapy may kill more tumor cells. Autologous stem cell transplant may be able to replace blood-forming cells that were destroyed by chemotherapy or radiation therapy. It is not yet known which radiation therapy regimen combined with chemotherapy and donor stem cell transplant is more effective in treating medulloblastoma, supratentorial primitive neuroectodermal tumor, or atypical teratoid rhabdoid tumor. This phase III trial is studying two different regimens of radiation therapy when given together with chemotherapy and autologous stem cell transplant to see how well they work in treating patients with newly diagnosed medulloblastoma, supratentorial primitive neuroectodermal tumor, or atypical teratoid rhabdoid tumor. PRIMARY OBJECTIVE: * To assess the relationship between ERBB2 protein expression in tumors and progression-free survival probability for patients with medulloblastoma. * To estimate the frequency of mutations associated with SHH and WNT tumors (as defined by gene expression profiling) via targeted sequencing performed in an independent cohort of WNT and SHH tumors (also defined by gene expression profiling).

Open the original ClinicalTrials.gov record → · Download preserved record

What did the study report?

Outcomes, safety and baseline populations are separate source sections. Quality-of-life measures appear under their original outcome titles.

flow

Participant flow

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baseline

Baseline characteristics

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outcome · POSTED

Progression-Free Survival (PFS) in ERBB2-Negative Tumors Compared to ERBB2-Positive Tumors

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outcome · POSTED

Progression-Free Survival (PFS) Compared Between ERBB2 Assessment and Risk Group.

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outcome · POSTED

Frequency of Mutations Associated With SHH and WNT Tumors

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outcome · POSTED

Reading Decoding Composite Scores in the Intervention and Standard of Care Groups

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outcome · POSTED

Number of Average Risk Patients Whose Treatment Failure Included the Posterior Fossa

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outcome · POSTED

Associative Memory for Two Risk Group at Enrollment

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outcome · POSTED

Associative Memory for Two Risk Group at 5 Years After Enrollment

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outcome · POSTED

Processing Speed for Two Risk Group at Enrollment

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outcome · POSTED

Processing Speed for Two Risk Group at 5 Years After Enrollment

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outcome · POSTED

Perceptual Speed for Two Risk Group at Enrollment

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outcome · POSTED

Perceptual Speed for Two Risk Group at 5 Years After Enrollment

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adverse events

Adverse events

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more info

Limitations, agreements, and source contact

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Who could take part
eligibility Criteria
DISEASE CHARACTERISTICS: * Histologically confirmed diagnosis of 1 of the following: * Medulloblastoma * Supratentorial primitive neuroectodermal tumor (PNET) * PNET variants (ependymoblastoma, pineoblastoma, CNS neuroblastoma) * Atypical teratoid rhabdoid tumor (ATRT) * Definitive surgery for CNS tumor within the past 31 days * Meets one of the following risk criteria: * Average-risk disease * Localized disease with no overt evidence of invasion beyond the posterior fossa (or supratentorial compartment for PNET or ATRT) by intraoperative observations of the neurosurgeon AND postoperative CT scan or MRI * T4 disease eligible if all of the following are true: * Gross total resection determined by intraoperative observations of the neurosurgeon AND postoperative CT scan or MRI * Residual tumor or imaging abnormality whose size is \< 1.5 cm\^2 * No evidence of CNS or extraneural metastasis by MRI of the spine (with and without contrast agent) or CT-based myelogram AND by cytologic examination of the lumbar cerebral spinal fluid (CSF) 14-28 days after surgery * Brain stem invasion allowed in the absence of residual tumor (tumor \< 1.5 cm\^2 by imaging) * High-risk disease meeting one of the following criteria: * Metastatic disease within the neuraxis (i.e., evidence of subarachnoid dissemination by imaging and/or cytologic examination of CSF) * Presence of residual disease \> 1.5 cm\^2 at the primary site after surgery PATIENT CHARACTERISTICS: Age * 3 to 21 at diagnosis Performance status * Lansky 30-100% (\< 10 years old) * Karnofsky 30-100% (≥ 10 years old) (except for posterior fossa syndrome) Life expectancy * Not specified Hematopoietic * Hemoglobin \> 8 g/dL * WBC \> 2,000/mm\^3 * Absolute neutrophil count \> 500/mm\^3 * Platelet count \> 50,000/mm\^3 Hepatic * ALT \< 5 times normal * Bilirubin \< 3.0 mg/dL Renal * Creatinine \< 2.0 mg/dL OR * Creatinine clearance \> 70 mL/min Other * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception PRIOR CONCURRENT THERAPY: Biologic therapy * Not specified Chemotherapy * No prior chemotherapy Endocrine therapy * Prior corticosteroid therapy allowed Radiotherapy * No prior radiotherapy Surgery * See Disease Characteristics
healthy Volunteers
false
maximum Age
21 Years
minimum Age
3 Years
sex
ALL
std Ages
  1. CHILD
  2. ADULT
Treatment arms and interventions
arm Groups
  1. description
    Patients undergo craniospinal radiotherapy once daily 5 days a week for 6 weeks. Six weeks after the completion of radiotherapy, patients receive high-dose chemotherapy followed by autologous stem cell transplantation (SCT) and filgrastim (G-CSF) with post-transplantation vincristine. High-dose chemotherapy and autologous SCT repeat every 4 weeks for 3 additional courses in the absence of unacceptable toxicity. Interventions: vincristine, cisplatin, cyclophosphamide, autologous hematopoietic stem cell transplantation, filgrastim, radiation therapy
    intervention Names
    1. Biological: filgrastim
    2. Drug: cisplatin
    3. Drug: cyclophosphamide
    4. Drug: vincristine
    5. Procedure: autologous hematopoietic stem cell transplantation
    6. Radiation: radiation therapy
    label
    Stratum 1 (high-risk group)
    type
    EXPERIMENTAL
  2. description
    Patients undergo craniospinal radiotherapy as in stratum 1, but at a lower dose. Patients receive high-dose chemotherapy, autologous SCT, G-CSF, and post-transplantation vincristine as in stratum 1. Interventions: vincristine, cisplatin, cyclophosphamide, autologous hematopoietic stem cell transplantation, filgrastim, radiation therapy
    intervention Names
    1. Biological: filgrastim
    2. Drug: cisplatin
    3. Drug: cyclophosphamide
    4. Drug: vincristine
    5. Procedure: autologous hematopoietic stem cell transplantation
    6. Radiation: radiation therapy
    label
    Stratum 2 (average-risk group)
    type
    EXPERIMENTAL
interventions
  1. arm Group Labels
    1. Stratum 1 (high-risk group)
    2. Stratum 2 (average-risk group)
    description
    Given subcutaneously
    name
    filgrastim
    other Names
    1. Neupogen(R)
    2. G-CSF
    type
    BIOLOGICAL
  2. arm Group Labels
    1. Stratum 1 (high-risk group)
    2. Stratum 2 (average-risk group)
    description
    Given IV
    name
    cisplatin
    other Names
    1. Platinol-AQ(R)
    type
    DRUG
  3. arm Group Labels
    1. Stratum 1 (high-risk group)
    2. Stratum 2 (average-risk group)
    description
    Given IV
    name
    cyclophosphamide
    other Names
    1. Cytoxan(R)
    type
    DRUG
  4. arm Group Labels
    1. Stratum 1 (high-risk group)
    2. Stratum 2 (average-risk group)
    description
    Given IV
    name
    vincristine
    other Names
    1. Oncovin(R)
    type
    DRUG
  5. arm Group Labels
    1. Stratum 1 (high-risk group)
    2. Stratum 2 (average-risk group)
    description
    Patients undergo autologous stem cell transplantation
    name
    autologous hematopoietic stem cell transplantation
    other Names
    1. autologous HSCT
    type
    PROCEDURE
  6. arm Group Labels
    1. Stratum 1 (high-risk group)
    2. Stratum 2 (average-risk group)
    description
    Patients undergo craniospinal radiotherapy once daily 5 days a week for 6 weeks.
    name
    radiation therapy
    other Names
    1. RT
    2. Craniospinal radiotherapy
    type
    RADIATION
Study design
allocation
NON_RANDOMIZED
intervention Model
PARALLEL
masking Info
masking
NONE
primary Purpose
TREATMENT
Enrollment
count
416
type
ACTUAL
Registered outcome plans (not posted results)
primary Outcomes
  1. description
    The relationship between ERBB2 protein expression in tumors and progression-free survival was assessed in 122 participants with a diagnosis of medulloblastoma and with ERBB2 protein assessments. If the ERBB2 value was greater than zero, the ERBB2 was defined as positive for the participant. If the ERBB2 value was zero, the ERBB2 was defined as negative. Progression-free survival was calculated from the date of diagnosis to the date of disease progression/relapse, the date of death, or the date of last contact. The log-rank test was used to compare the PFS distributions of ERBB2 groups.
    measure
    Progression-Free Survival (PFS) in ERBB2-Negative Tumors Compared to ERBB2-Positive Tumors
    time Frame
    2 years after tumor cell analysis in 122 participants
  2. description
    122 participants with a diagnosis of medulloblastoma were grouped by ERBB2 positive/negative assessment and risk group into 4 groups. Progression-free survival was calculated from the date of diagnosis to the date of disease progression/relapse, the date of death, or the date of last contact. The log-rank test was used to compare the PFS distributions of ERBB2 groups.
    measure
    Progression-Free Survival (PFS) Compared Between ERBB2 Assessment and Risk Group.
    time Frame
    2 years after tumor cell analysis in 122 participants
  3. description
    The frequency of mutations for the main genes associated with SHH and WNT tumors identified via targeted sequencing based on formalin fixed paraffin embedded material is provided.
    measure
    Frequency of Mutations Associated With SHH and WNT Tumors
    time Frame
    within 3.5 years following completion of accrual
secondary Outcomes
  1. description
    SOC is standard-of-Care control group. Patients randomly assigned to the control group received the current standard of care. RI is Reading Intervention Group. Patients randomly assigned to Reading Intervention Group which is with The Fast ForWord program. Assessment of reading decoding was completed using the Woodcock Johnson, Third Edition (WJIII) Tests of Achievement (Woodcock, McGraw, \& Mather, 2001), with particular attention given to the reading and reading-related abilities. Two subtests were completed: (1) Letter-Word Identification, and (2) Word Attack, a test requiring the patient to read phonologically regular nonwords. The combination of these two subtests provided a standardized composite score of overall reading decoding ability with a population mean of 100 and a standard deviation of 15. Scores of 90-110 are considered to be in the average range, while those 80-89 are considered low-average (refer: Journal of Pediatric Psychology 39(4) pp. 450-458, 2014).
    measure
    Reading Decoding Composite Scores in the Intervention and Standard of Care Groups
    time Frame
    5 years postdiagnosis
  2. description
    To monitor for treatment failure in the posterior fossa of patients whose tumor bed receives a reduced volume of radiation.
    measure
    Number of Average Risk Patients Whose Treatment Failure Included the Posterior Fossa
    time Frame
    Annually for 6 years post irradiation
  3. description
    Assessment of associative memory at enrollment. Associate memory score is a representative measurement of learning and recalling pictograph representations of words. It measures associative memory (Long-Term Retrieval). Mean=100, SD=15, Average Range 85-115. Higher is better.
    measure
    Associative Memory for Two Risk Group at Enrollment
    time Frame
    At enrollment
  4. description
    Assessment of associative memory at 5 years after enrollment. Assessment of associative memory score at enrollment. Associate memory score is a representative measurement of learning and recalling pictograph representations of words. It measures associative memory (Long-Term Retrieval). Mean=100, SD=15, Average Range 85-115. Higher is better.
    measure
    Associative Memory for Two Risk Group at 5 Years After Enrollment
    time Frame
    At 5 years after enrollment
  5. description
    Assessment of Processing Speed at enrollment. This score measure of Processing Speed based on Visual Matching and Decision Speed tests. Mean=100, SD=15, Average Range 85-115. Higher is better.
    measure
    Processing Speed for Two Risk Group at Enrollment
    time Frame
    At enrollment
  6. description
    Assessment of Processing Speed at 5 years after enrollment. This score measure of Processing Speed based on Visual Matching and Decision Speed tests. Mean=100, SD=15, Average Range 85-115. Higher is better.
    measure
    Processing Speed for Two Risk Group at 5 Years After Enrollment
    time Frame
    At 5 years after enrollment
  7. description
    Assessment of Perceptual Speed at enrollment. It measures rapidly locating and circling identical numbers from a set of numbers which reflects perceptual speed. Mean=100, SD=15, Average Range 85-115. Higher is better.
    measure
    Perceptual Speed for Two Risk Group at Enrollment
    time Frame
    At enrollment
  8. description
    Assessment of Perceptual Speed at 5 years after enrollment. It measures rapidly locating and circling identical numbers from a set of numbers which reflects perceptual speed. Mean=100, SD=15, Average Range 85-115. Higher is better.
    measure
    Perceptual Speed for Two Risk Group at 5 Years After Enrollment
    time Frame
    At 5 years after enrollment
Full study description
brief Summary
Drugs used in chemotherapy, such as vincristine, cisplatin, and cyclophosphamide, 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. Combining radiation therapy with chemotherapy may kill more tumor cells. Autologous stem cell transplant may be able to replace blood-forming cells that were destroyed by chemotherapy or radiation therapy. It is not yet known which radiation therapy regimen combined with chemotherapy and donor stem cell transplant is more effective in treating medulloblastoma, supratentorial primitive neuroectodermal tumor, or atypical teratoid rhabdoid tumor. This phase III trial is studying two different regimens of radiation therapy when given together with chemotherapy and autologous stem cell transplant to see how well they work in treating patients with newly diagnosed medulloblastoma, supratentorial primitive neuroectodermal tumor, or atypical teratoid rhabdoid tumor. PRIMARY OBJECTIVE: * To assess the relationship between ERBB2 protein expression in tumors and progression-free survival probability for patients with medulloblastoma. * To estimate the frequency of mutations associated with SHH and WNT tumors (as defined by gene expression profiling) via targeted sequencing performed in an independent cohort of WNT and SHH tumors (also defined by gene expression profiling).
detailed Description
SECONDARY OBJECTIVES: * To compare the effects of a computer-based training system specifically targeting language, reading, and learning skills (Fast ForWord, Scientific Learning Corporation) with the current standard of care on reading decoding skills as measured by individual academic testing. * To monitor for treatment failure in the posterior fossa of patients whose tumor bed receives a reduced volume of radiation. * To correlate radiation dosimetry of target and normal tissues with rate and patterns of failure and longitudinal measures of audiometric, endocrine and cognitive effects. EXPLORATORY OBJECTIVES: * To estimate the change in neuropsychological performance from the neuropsychology assessment battery (intellect, academic achievement and cognitive ability) and examine the relationship of these changes to risk group, age at diagnosis, and parent measures. * To evaluate the differences between neurotoxicity in the average-risk patient group with that in the high-risk group through qMRI, and fMRI. * To develop or refine novel models relating impact of medulloblastoma therapy on neurocognitive performance to quantitative and functional neuroimaging measures. OUTLINE: This is a multicenter study. Patients are stratified according to disease risk (high-risk disease vs average-risk disease). Patients in both strata undergo peripheral blood stem cell or bone marrow harvest. * Stratum 1 (high-risk group): * Radiotherapy: Patients undergo craniospinal radiotherapy once daily 5 days a week for 6 weeks. * High-dose chemotherapy and autologous stem cell transplantation (SCT): Six weeks after the completion of radiotherapy, patients receive high-dose chemotherapy comprising vincristine IV followed by cisplatin IV over 6 hours on day -4 and cyclophosphamide IV over 1 hour on days -3 and -2. Patients undergo autologous SCT on day 0. Patients receive filgrastim (G-CSF) subcutaneously beginning on day 1 and continuing until blood counts recover. Patients receive vincristine IV on day 6. High-dose chemotherapy and autologous SCT repeat every 4 weeks for 3 additional courses in the absence of unacceptable toxicity. * Stratum 2 (average-risk group): * Radiotherapy: Patients undergo craniospinal radiotherapy as in stratum 1, but at a lower dose. * High-dose chemotherapy and autologous SCT: Patients receive high-dose chemotherapy, autologous SCT, G-CSF, and post-transplantation vincristine as in stratum 1. Some patients undergo a neuropsychology assessment at baseline, before chemotherapy, and then annually for 5 years. After completion of study therapy, patients are followed every 3 months until month 30 (2.5 years) after diagnosis and then every 6 months until month 72 (6 years) after diagnosis.
Source references
references
  1. citation
    Acharya S, Guo Y, Patni T, Li Y, Wang C, Gargone M, Ashford JM, Wilson L, Faught A, Reddick WE, Patay Z, Gajjar A, Conklin HM, Merchant TE. Association Between Brain Substructure Dose and Cognitive Outcomes in Children With Medulloblastoma Treated on SJMB03: A Step Toward Substructure-Informed Planning. J Clin Oncol. 2022 Jan 1;40(1):83-95. doi: 10.1200/JCO.21.01480. Epub 2021 Oct 29.
    pmid
    34714708
    type
    DERIVED
  2. citation
    Partanen M, Anghelescu DL, Hall L, Schreiber JE, Rossi M, Gajjar A, Jacola LM. Longitudinal associations between exposure to anesthesia and neurocognitive functioning in pediatric medulloblastoma. Eur J Cancer. 2021 May;148:103-111. doi: 10.1016/j.ejca.2021.02.010. Epub 2021 Mar 17.
    pmid
    33743477
    type
    DERIVED
  3. citation
    Kumar R, Smith KS, Deng M, Terhune C, Robinson GW, Orr BA, Liu APY, Lin T, Billups CA, Chintagumpala M, Bowers DC, Hassall TE, Hansford JR, Khuong-Quang DA, Crawford JR, Bendel AE, Gururangan S, Schroeder K, Bouffet E, Bartels U, Fisher MJ, Cohn R, Partap S, Kellie SJ, McCowage G, Paulino AC, Rutkowski S, Fleischhack G, Dhall G, Klesse LJ, Leary S, Nazarian J, Kool M, Wesseling P, Ryzhova M, Zheludkova O, Golanov AV, McLendon RE, Packer RJ, Dunham C, Hukin J, Fouladi M, Faria CC, Pimentel J, Walter AW, Jabado N, Cho YJ, Perreault S, Croul SE, Zapotocky M, Hawkins C, Tabori U, Taylor MD, Pfister SM, Klimo P Jr, Boop FA, Ellison DW, Merchant TE, Onar-Thomas A, Korshunov A, Jones DTW, Gajjar A, Ramaswamy V, Northcott PA. Clinical Outcomes and Patient-Matched Molecular Composition of Relapsed Medulloblastoma. J Clin Oncol. 2021 Mar 1;39(7):807-821. doi: 10.1200/JCO.20.01359. Epub 2021 Jan 27.
    pmid
    33502920
    type
    DERIVED
  4. citation
    Gajjar A, Robinson GW, Smith KS, Lin T, Merchant TE, Chintagumpala M, Mahajan A, Su J, Bouffet E, Bartels U, Schechter T, Hassall T, Robertson T, Nicholls W, Gururangan S, Schroeder K, Sullivan M, Wheeler G, Hansford JR, Kellie SJ, McCowage G, Cohn R, Fisher MJ, Krasin MJ, Stewart CF, Broniscer A, Buchhalter I, Tatevossian RG, Orr BA, Neale G, Klimo P Jr, Boop F, Srinivasan A, Pfister SM, Gilbertson RJ, Onar-Thomas A, Ellison DW, Northcott PA. Outcomes by Clinical and Molecular Features in Children With Medulloblastoma Treated With Risk-Adapted Therapy: Results of an International Phase III Trial (SJMB03). J Clin Oncol. 2021 Mar 1;39(7):822-835. doi: 10.1200/JCO.20.01372. Epub 2021 Jan 6.
    pmid
    33405951
    type
    DERIVED
  5. citation
    Xu H, Robinson GW, Huang J, Lim JY, Zhang H, Bass JK, Broniscer A, Chintagumpala M, Bartels U, Gururangan S, Hassall T, Fisher M, Cohn R, Yamashita T, Teitz T, Zuo J, Onar-Thomas A, Gajjar A, Stewart CF, Yang JJ. Common variants in ACYP2 influence susceptibility to cisplatin-induced hearing loss. Nat Genet. 2015 Mar;47(3):263-6. doi: 10.1038/ng.3217. Epub 2015 Feb 9.
    pmid
    25665007
    type
    DERIVED
see Also Links
  1. label
    St. Jude Children's Research Hospital
  2. label
    Clinical Trials Open at St. Jude
Source notices and limitations
    Discovery and provenance
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        ed over time.</li><li>Studies of working memory and academic achievement in patients enrolled on the same medulloblastoma trial (SJCRH <a href="/clinicaltrials/NCT00085202">SJMB03 [NCT00085202]</a>) indicated that performance was largely within the age-expected range up to 5 years postdiagnosis,[<a href="#cit/section_4.36">36</a
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        >Studies of working memory and academic achievement in patients enrolled on the same medulloblastoma trial (SJCRH <a href="/clinicaltrials/NCT00085202">SJMB03 [NCT00085202]</a>) indicated that performance was largely within the age-expected range up to 5 years postdiagnosis,[<a href="#cit/section_4.36">36</a>,<a href="#cit/secti
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      Late Effects of Treatment for Childhood Cancer (PDQ®)–Health Professional Version
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      1. context
        Updated: April 14, 2025
        datetime
        2025-04-14T12:00:00Z
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        April 14, 2025

    Preserved source evidence · Not medical advice