NCT00667342 · REGISTRY CONDITION SEARCH

A Study of Bevacizumab in Combination With Chemotherapy for Treatment of Osteosarcoma

Found through the registry condition index, not selected as a treatment recommendation. This discovery collection was restricted to studies with posted results.

Phase: PHASE2
Status at capture: COMPLETED
Registry last update: 2023-08-07

This study adopts a novel strategy for first-line treatment of osteosarcoma by combining chemotherapy with anti-angiogenic therapy using bevacizumab (Avastin®), a humanized monoclonal antibody against vascular endothelial growth factor (VEGF). Chemotherapy for localized disease comprises a 3-drug regimen (cisplatin, doxorubicin, and high-dose methotrexate). Chemotherapy for metastatic or unresectable disease comprises a cisplatin-based regimen that includes high-dose methotrexate, doxorubicin, ifosfamide, and etoposide.

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

Number of Participants With Unacceptable Toxicity

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outcome · POSTED

3-Year Event Free Survival

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outcome · POSTED

Histologic Response by Stratum

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outcome · POSTED

2-Year Event Free Survival (EFS) of Patients With Osteosarcoma

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outcome · POSTED

2-Year Overall Survival (OS) of Patients With Osteosarcoma

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outcome · POSTED

2-Year Event Free Survival (EFS) in Patients With Localized Resectable Disease Compared to St. Jude OS99 Protocol.

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outcome · POSTED

2-Year Overall Survival (OS) in Patients With Localized Resectable Disease Compared to OS99 Protocol.

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outcome · POSTED

Mean Ktrans

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outcome · POSTED

Mean Vp

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outcome · POSTED

Mean Ve

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outcome · POSTED

Histologic Response by Number of Participants

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outcome · POSTED

Ktrans by Good and Poor Response

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outcome · POSTED

P95 of Ktrans by Good and Poor Response

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outcome · POSTED

Difference Between Good and Poor Response by SUVmax

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outcome · POSTED

Number of Participants With Neuropathic Pain (NP) Following Surgery

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outcome · POSTED

Median Duration of Neuropathic Pain

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outcome · POSTED

Mean Duration of Neuropathic Pain

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outcome · POSTED

Median Duration of Neuropathic Pain Medication

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outcome · POSTED

Mean Duration of Neuropathic Pain Medication

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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: Inclusion Criteria: * Patient must have newly diagnosed high-grade, biopsy proven, osteosarcoma or malignant fibrous histiocytoma (MFH) of bone with no history of prior chemotherapy or radiation; * Participant is able to perform tasks and daily activities as defined in the study guidelines * Patient meets established guidelines for adequate function of the kidney, liver, heart and bone marrow * Participants meets other requirements defined in the eligibility portion of the study Exclusion Criteria: * recent major surgical procedure or injury * Known bleeding diathesis, platelet disorder or coagulopathy * Thrombosis * Cardiac disease or hypertension * Significant proteinuria * Central nervous system disease * Gastrointestinal perforation/abdominal fistula * Osteosarcoma or MFH of bone as second malignancy
healthy Volunteers: false
maximum Age: 30 Years
sex: ALL
std Ages: CHILD
ADULT

Treatment arms and interventions

arm Groups

description
Participants with localized resectable disease receive Cycle 1 of bevacizumab 3 days before chemotherapy with cisplatin and doxorubicin. Subsequent cycles consist of bevacizumab on the first day of chemotherapy, then cisplatin, and doxorubicin, or methotrexate. If applicable, definitive surgery and assessment of histologic response will occur at week 10 followed by bevacizumab on the first day of chemotherapy with cisplatin and doxorubicin, or methotrexate.
intervention Names
Biological: Bevacizumab
Drug: Cisplatin
Drug: Doxorubicin
Drug: Methotrexate
Procedure: Surgery
label
Localized Resectable Disease (Stratum A)
type
EXPERIMENTAL
description
Participants with metastatic disease (Stratum B) receive Cycle 1 of bevacizumab 3 days before chemotherapy with cisplatin and doxorubicin. Subsequent cycles consist of bevacizumab on the first day of chemotherapy, then cisplatin and doxorubicin, methotrexate or ifosfamide, and etoposide. If applicable, definitive surgery and assessment of histologic response will occur at week 10 followed by bevacizumab on the first day of chemotherapy with cisplatin and doxorubicin, methotrexate, or ifosfamide, and etoposide. Radiotherapy will be given post-operatively.
intervention Names
Biological: Bevacizumab
Drug: Cisplatin
Drug: Doxorubicin
Drug: Methotrexate
Drug: Ifosfamide
Drug: etoposide
Procedure: Surgery
Radiation: Radiotherapy
label
Metastatic Disease (Stratum B)
type
EXPERIMENTAL
description
Participants with unresectable disease (Stratum C) receive treatment identical to Stratum B: Cycle 1 of bevacizumab 3 days before chemotherapy with cisplatin and doxorubicin. Subsequent cycles consist of bevacizumab on the first day of chemotherapy, then cisplatin and doxorubicin, methotrexate or ifosfamide, and etoposide. If applicable, definitive surgery and assessment of histologic response will occur at week 10 followed by bevacizumab on the first day of chemotherapy with cisplatin and doxorubicin, methotrexate, or ifosfamide, and etoposide. Radiotherapy will be given post-operatively.
intervention Names
Biological: Bevacizumab
Drug: Cisplatin
Drug: Doxorubicin
Drug: Methotrexate
Drug: Ifosfamide
Drug: etoposide
Procedure: Surgery
Radiation: Radiotherapy
label
Unresectable Disease (Stratum C)
type
EXPERIMENTAL

interventions

arm Group Labels
Localized Resectable Disease (Stratum A)
Metastatic Disease (Stratum B)
Unresectable Disease (Stratum C)
description
Monoclonal Antibody against vascular endothelial growth factor (VEGF). Given intravenously (IV).
name
Bevacizumab
other Names
rhuMAb VEGF
Avastin®
type
BIOLOGICAL
arm Group Labels
Localized Resectable Disease (Stratum A)
Metastatic Disease (Stratum B)
Unresectable Disease (Stratum C)
description
Given IV.
name
Cisplatin
other Names
Platinol-AQ®
type
DRUG
arm Group Labels
Localized Resectable Disease (Stratum A)
Metastatic Disease (Stratum B)
Unresectable Disease (Stratum C)
description
Given IV.
name
Doxorubicin
other Names
Adriamycin®
type
DRUG
arm Group Labels
Localized Resectable Disease (Stratum A)
Metastatic Disease (Stratum B)
Unresectable Disease (Stratum C)
description
Given IV.
name
Methotrexate
other Names
MTX
type
DRUG
arm Group Labels
Metastatic Disease (Stratum B)
Unresectable Disease (Stratum C)
description
Given IV.
name
Ifosfamide
other Names
Ifex®
type
DRUG
arm Group Labels
Metastatic Disease (Stratum B)
Unresectable Disease (Stratum C)
description
Given IV.
name
etoposide
other Names
VP-16
Vepesid®
type
DRUG
arm Group Labels
Localized Resectable Disease (Stratum A)
Metastatic Disease (Stratum B)
Unresectable Disease (Stratum C)
description
Participants undergo definitive surgery and assessment of histologic response at week 10.
name
Surgery
type
PROCEDURE
arm Group Labels
Metastatic Disease (Stratum B)
Unresectable Disease (Stratum C)
description
Radiation therapy delivered for positive margins or intralesional resections.
name
Radiotherapy
type
RADIATION

Study design

allocation

NON_RANDOMIZED

intervention Model

PARALLEL

masking Info

masking: NONE

primary Purpose

TREATMENT

Enrollment

count: 43
type: ACTUAL

Registered outcome plans (not posted results)

other Outcomes

description
Of the 43 participants enrolled on this trial, 37 met criteria for evaluation of neuropathic pain (NP) following definitive surgery. The 37 participants underwent 38 surgeries: one participant had a limb-sparing surgery followed by an amputation surgery. Six of 43 participants were excluded from evaluation for NP: 1 due to deep vein thrombosis, 2 removed from study prior to surgery, 1 removed immediately after surgery to receive radiation therapy, 1 had non-extremity osteosarcoma, and 1 patient had a fibula resection. Patients were followed for neuropathic pain daily for the first week postoperatively and weekly for up to 6 months postoperatively.
measure
Number of Participants With Neuropathic Pain (NP) Following Surgery
time Frame
Up to 6 months postoperatively
description
Thirty participants who underwent surgery (31 surgeries) were determined to have neuropathic pain. Four participants received only opioids for NP and 26 participants (for 27 surgeries) were treated with NP specific medications including gabapentin, tricyclic antidepressant, methadone. One participant had 2 different surgical procedures and was analyzed both in the limb sparing group and in the amputation group.
measure
Median Duration of Neuropathic Pain
time Frame
From surgery until resolution of NP symptoms, up to 6 months
description
Thirty participants who underwent surgery (31 surgeries) were determined to have neuropathic pain (NP). Four participants received only opioids for NP and 26 participants (for 27 surgeries) were treated with NP specific medications including gabapentin, tricyclic antidepressant, methadone. One participant had 2 different surgical procedures and was analyzed both in the limb sparing group and in the amputation group.
measure
Mean Duration of Neuropathic Pain
time Frame
From surgery until resolution of NP symptoms, up to 6 months
description
Thirty participants who underwent surgery (31 surgeries) were determined to have neuropathic pain (NP). Four participants received only opioids for NP and 26 participants (for 27 surgeries) were treated with NP specific medications including gabapentin, tricyclic antidepressant, methadone. One participant had 2 different surgical procedures and was analyzed both in the limb sparing group and in the amputation group.
measure
Median Duration of Neuropathic Pain Medication
time Frame
From surgery until resolution of NP symptoms, up to 6 months
description
Thirty participants who underwent surgery (31 surgeries) were determined to have neuropathic pain. Four participants received only opioids for NP and 26 participants (for 27 surgeries) were treated with NP specific medications including gabapentin, tricyclic antidepressant, methadone. One participant had 2 different surgical procedures and was analyzed both in the limb sparing group and in the amputation group.
measure
Mean Duration of Neuropathic Pain Medication
time Frame
From surgery until resolution of NP symptoms, up to 6 months

primary Outcomes

description
Objective: To study the feasibility of combining: 1) bevacizumab with cisplatin, doxorubicin, and high-dose methotrexate (MAP) in patients with localized resectable osteosarcoma; and 2) bevacizumab with MAP and ifosfamide, and etoposide in patients with unresectable or metastatic osteosarcoma. The target unacceptable toxicity is defined as grade 4 hypertension, proteinuria, or bleeding excluding petechiae/purpura, grade 3/4 thrombosis/embolism excluding catheter-related thrombosis. The unacceptable toxicity for major wound complication is defined as grade 2, 3, or 4 major wound complications. A six-stage group sequential stopping rule was developed for monitoring unacceptable toxicity.
measure
Number of Participants With Unacceptable Toxicity
time Frame
After all patients have completed therapy, up to 1 year after last patient is enrolled
description
To study the effect of adding bevacizumab to chemotherapy comprised of cisplatin, doxorubicin, and high-dose methotrexate (HDMTX) on the event-free survival (EFS) in patients with localized resectable osteosarcoma. The Kaplan-Meier (K-M) method was used to estimate survival rate.
measure
3-Year Event Free Survival
time Frame
After all patients have completed therapy, up to 4 years after last patient is enrolled

secondary Outcomes

description
The effect of adding bevacizumab to preoperative chemotherapy comprised of cisplatin, doxorubicin, and HDMTX on the histologic response in patients with localized resectable osteosarcoma compared to historical controls treated with preoperative cisplatin, doxorubicin, and HDMTX without bevacizumab on the Intergroup Study 0133. Histologic response at week 10 of therapy was evaluated by Huvos grading systems as grade I: tumor not responding to therapy, no effect identified; grade IIA: more than 50% viable tumor left; grade IIB: 5-50% viable tumor remaining; grade III: only scattered foci of viable tumor seen (less than 5% of tumor); grade IV: no viable tumor seen in extensive sampling (at least a full cross-section of the tumor). The study did not enroll an adequate number of participants, therefore, the comparison to Intergroup Study 0133 participants was not done.
measure
Histologic Response by Stratum
time Frame
After 6 cycles of chemotherapy, up to 1 year after the start of therapy
description
Kaplan-Meier method was used to estimate the EFS of patients with osteosarcoma treated with chemotherapy and Bevacizumab.
measure
2-Year Event Free Survival (EFS) of Patients With Osteosarcoma
time Frame
After all patients have completed therapy, up to 2 years after last patient is enrolled
description
Kaplan-Meier method was used to estimate the OS of patients with osteosarcoma treated with chemotherapy and Bevacizumab.
measure
2-Year Overall Survival (OS) of Patients With Osteosarcoma
time Frame
After all patients have completed therapy, up to 2 years after last patient is enrolled
description
The current protocol OS2008 (NCT00667342) was closed early due to slow accrual. Thus, with the limited number of patients, the comparison of EFS of OS20008 to that of OS99 (NCT00145639) participants was not done. The 2-year EFS of OS2008 participants is reported here.
measure
2-Year Event Free Survival (EFS) in Patients With Localized Resectable Disease Compared to St. Jude OS99 Protocol.
time Frame
After all patients have completed therapy, up to 2 years after last patient is enrolled
description
The current protocol OS2008 (NCT00667342) was closed early due to slow accrual. Thus, with the limited number of patients, the comparison of EFS of OS2008 to that of OS99 (NCT00145639) participants was not done. The 2-year OS of OS2008 participants is reported here.
measure
2-Year Overall Survival (OS) in Patients With Localized Resectable Disease Compared to OS99 Protocol.
time Frame
After all patients have completed therapy, up to 2 years after last patient is enrolled
description
The volume transfer constant (Ktrans) was used to evaluate clinical outcomes. The average for the distribution across the whole region of interest (ROI) was calculated as a summary measure for each data set.
measure
Mean Ktrans
time Frame
Baseline through Week 10
description
The fractional blood plasma volume (Vp) was used to evaluate clinical outcomes. The average for the distribution across the whole region of interest (ROI) was calculated as a summary measure for each data set.
measure
Mean Vp
time Frame
Baseline through Week 10
description
The fractional volume of extravascular extracellular space (Ve) was used to evaluate clinical outcomes. The average for the distribution across the whole region of interest (ROI) was calculated as a summary measure for each data set.
measure
Mean Ve
time Frame
Baseline through Week 10
description
The association of interested variables with response was checked with the Wilcoxon rank-sum test. The response is based on the Huvos grade of histologic response for DCE-MRI comparisons and is defined as good for ≥90% necrosis and poor for less than 90%.
measure
Histologic Response by Number of Participants
time Frame
at week 10 after start of therapy
description
The response is based on the Huvos grade of histologic response for DCE-MRI comparisons and is defined as good for ≥90% necrosis and poor for less than 90%.
measure
Ktrans by Good and Poor Response
time Frame
at week 10 after start of therapy
description
The response is based on the Huvos grade of histologic response for DCE-MRI comparisons and is defined as good for ≥90% necrosis and poor for less than 90%. P95 denotes the level of each kinetic parameter exceeding 95% of its values in each tumor.
measure
P95 of Ktrans by Good and Poor Response
time Frame
at week 10 after start of therapy
description
The response is based on the Huvos grade of histologic response for DCE-MRI comparisons and is defined as good for ≥90% necrosis and poor for less than 90%.
measure
Difference Between Good and Poor Response by SUVmax
time Frame
at week 10 after start of therapy

Full study description

brief Summary: This study adopts a novel strategy for first-line treatment of osteosarcoma by combining chemotherapy with anti-angiogenic therapy using bevacizumab (Avastin®), a humanized monoclonal antibody against vascular endothelial growth factor (VEGF). Chemotherapy for localized disease comprises a 3-drug regimen (cisplatin, doxorubicin, and high-dose methotrexate). Chemotherapy for metastatic or unresectable disease comprises a cisplatin-based regimen that includes high-dose methotrexate, doxorubicin, ifosfamide, and etoposide.
detailed Description: This is a comprehensive study that uses a novel agent that targets angiogenesis (bevacizumab) in combination with conventional chemotherapy for the treatment of osteosarcoma. Bevacizumab, a monoclonal antibody against the vascular endothelial growth factor (VEGF), has been shown to stop the growth of new blood vessels of tumors, both in the laboratory and in patients with other types of cancers. Bevacizumab has improved the effect of chemotherapy in adult patients with different types of cancer by increasing tumor response and increasing the chances of survival. This study has two main goals: * To find out if bevacizumab can be combined safely with chemotherapy for osteosarcoma * To find out if adding bevacizumab to chemotherapy will be beneficial in treating osteosarcoma. The chemotherapy drugs used in this study are commonly used to treat osteosarcoma. Patients with non-metastatic and resectable tumors receive bevacizumab and chemotherapy comprised of cisplatin, doxorubicin and high-dose methotrexate. Patients with metastatic tumors or tumors that cannot be removed by surgery receive bevacizumab and chemotherapy comprised of cisplatin, doxorubicin and high-dose methotrexate, ifosfamide and etoposide. If the tumor can be removed by surgery, surgery will be performed after 10 weeks of chemotherapy and will be followed by additional chemotherapy. After completion of active therapy, patient's response to therapy will be followed for approximately 5 years.

Source references

references

citation
Turner DC, Navid F, Daw NC, Mao S, Wu J, Santana VM, Neel M, Rao B, Willert JR, Loeb DM, Harstead KE, Throm SL, Freeman BB 3rd, Stewart CF. Population pharmacokinetics of bevacizumab in children with osteosarcoma: implications for dosing. Clin Cancer Res. 2014 May 15;20(10):2783-92. doi: 10.1158/1078-0432.CCR-13-2364. Epub 2014 Mar 17.
pmid
24637635
type
DERIVED