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NCT01055314 · CITED IN SOURCE DOCUMENTS

Temozolomide, Cixutumumab, and Combination Chemotherapy in Treating Patients With Metastatic Rhabdomyosarcoma

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

Phase
PHASE2
Status at capture
COMPLETED
Registry last update
2017-08-29

This randomized pilot clinical trial is studying the side effects and how well giving temozolomide and cixutumumab together with combination chemotherapy works in treating patients with metastatic rhabdomyosarcoma. Drugs used in chemotherapy, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as cixutumumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Giving temozolomide and cixutumumab together with combination chemotherapy may kill more tumor cells.

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

Feasibility of the Addition of Cixutumumab to Chemotherapy Determined by Patient Enrollment

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outcome · POSTED

Feasibility of the Addition of Temozolomide to Chemotherapy Determined by Patient Enrollment

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outcome · POSTED

Incidence of Adverse Events Assessed by Common Terminology Criteria for Adverse Events Version 4.0

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outcome · POSTED

Event-Free Survival

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outcome · POSTED

Response Rate (CR + PR)

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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: * Patients must be eligible for, and enrolled on D9902 prior to enrollment on ARST08P1 * Patients with newly diagnosed, biopsy-proven metastatic rhabdomyosarcoma or ectomesenchymoma (stage IV, clinical group IV) are eligible for this study; patients with stage IV, clinical group IV RMS with parameningeal and paraspinal primary tumors, including those with intracranial extension (ICE) are eligible for ARST08P1; ICE is defined by contrast magnetic resonance imaging (MRI) showing that the primary tumor touches, displaces, invades, distorts, or otherwise causes signal abnormality of the dura in brain or spinal cord in contiguity to the primary site; ICE is also presumed to exist if the cerebrospinal fluid (CSF) cytopathology is positive for tumor at diagnosis * Patients must have a performance status corresponding to Eastern Cooperative Oncology Group (ECOG) scores of 0, 1, or 2; use Karnofsky for patients \> 16 years of age and Lansky for patients =\< 16 years of age * No prior chemotherapy or radiotherapy except for use of corticosteroids or emergent radiation therapy; patients requiring emergency radiation are eligible * Creatinine clearance or radioisotope glomerular filtration rate (GFR) \>= 70 mL/min/1.73m\^2 OR maximum serum creatinine based on age/gender as follows: * 0.4 mg/dL (for patients 1 to 5 months of age) * 0.5 mg/dL (for patients 6 to 11 months of age) * 0.6 mg/dL (for patients 1 year of age) * 0.8 mg/dL (for patients 2 to 5 years of age) * 1.0 mg/dL (for patients 6 to 9 years of age) * 1.2 mg/dL (for patients 10 to 12 years of age) * 1.5 mg/dL (males) or 1.4 mg/dL (females) (for patients 13 to 15 years of age) * 1.7 mg/dL (males) or 1.4 mg/dL (females) (for patients \>= 16 years of age) * Patients with urinary tract obstruction by tumor must meet the renal function criteria listed above AND must have unimpeded urinary flow established via decompression of the obstructed portion of the urinary tract * Total bilirubin =\< 1.5 x upper limit of normal (ULN) for age, unless there is evidence of biliary obstruction by the tumor * Shortening fraction \>= 27% by echocardiogram (ECHO) OR ejection fraction \>= 50% by radionuclide angiogram * Absolute neutrophil count (ANC) \>= 750/uL; abnormal blood counts are permissible if there is bone marrow biopsy or aspirate proven bone marrow involvement by rhabdomyosarcoma * Platelet count \>= 75,000/uL; abnormal blood counts are permissible if there is bone marrow biopsy or aspirate proven bone marrow involvement by rhabdomyosarcoma * Sexually active patients of childbearing potential must agree to use effective contraception during therapy (Pilots 1 and 2) and for at least 3 months after the last dose of IMC-A12 (Pilots 1) Exclusion Criteria: * Female patients who are pregnant are not eligible * Female patients who are breastfeeding are not eligible; female patients who are lactating must agree to stop breastfeeding to participate in this study * Patients receiving growth hormone therapy are not eligible * Patients with known type I or type II diabetes mellitus are not eligible for enrollment on Pilot 1 * Patients with evidence of uncontrolled infection are not eligible * All patients and/or their parents or legal guardians must sign a written informed consent * All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met
healthy Volunteers
false
maximum Age
49 Years
sex
ALL
std Ages
  1. CHILD
  2. ADULT
Treatment arms and interventions
arm Groups
  1. description
    Patients receive vincristine sulfate IV over 1 minute on day 1 of weeks 1-5, 7, 8, 11, 12, 15, 16, 20-24, 28, 29, 32, 33, 35, 38, 41-44, 47, 48, 50, and 51; irinotecan hydrochloride IV over 90 minutes on days 1-5 of weeks 1, 4, 20, 23, 47, and 50; ifosfamide IV over 1 hour and etoposide IV over 1-2 hours on days 1-5 of weeks 9, 13, 17, 26, and 30; doxorubicin hydrochloride IV over 1-15 minutes on days 1 and 2 of weeks 7, 11, 15, 28, and 32; cyclophosphamide IV over 30-60 minutes on day 1 of weeks 7, 11, 15, 28, 32, 35, 38, 41, and 44; dactinomycin IV over 1-5 minutes on day 1 of weeks 35, 38, 41, and 44; and cixutumumab IV over 1 hour on day 1 of weeks 1-51. Patients also undergo radiation therapy on days 1-5 of weeks 20-24.
    intervention Names
    1. Biological: Cixutumumab
    2. Drug: Cyclophosphamide
    3. Biological: Dactinomycin
    4. Drug: Doxorubicin Hydrochloride
    5. Drug: Etoposide
    6. Drug: Ifosfamide
    7. Drug: Irinotecan Hydrochloride
    8. Other: Laboratory Biomarker Analysis
    9. Drug: Vincristine Sulfate Liposome
    label
    Group 1 (chemotherapy, radiation therapy, cixutumumab)
    type
    EXPERIMENTAL
  2. description
    Patients receive vincristine sulfate, irinotecan hydrochloride, ifosfamide, etoposide, doxorubicin hydrochloride, cyclophosphamide, and dactinomycin and undergo radiation therapy as in group 1. Patients also receive temozolomide PO on days 1-5 of weeks 1, 4, 20, 23, 47, and 50.
    intervention Names
    1. Drug: Cyclophosphamide
    2. Biological: Dactinomycin
    3. Drug: Doxorubicin Hydrochloride
    4. Drug: Etoposide
    5. Drug: Ifosfamide
    6. Drug: Irinotecan Hydrochloride
    7. Other: Laboratory Biomarker Analysis
    8. Drug: Temozolomide
    9. Drug: Vincristine Sulfate Liposome
    label
    Group 2 (chemotherapy, radiation therapy, temozolomide)
    type
    EXPERIMENTAL
interventions
  1. arm Group Labels
    1. Group 1 (chemotherapy, radiation therapy, cixutumumab)
    description
    Given IV
    name
    Cixutumumab
    other Names
    1. Anti-IGF-1R Recombinant Monoclonal Antibody IMC-A12
    2. IMC-A12
    type
    BIOLOGICAL
  2. arm Group Labels
    1. Group 1 (chemotherapy, radiation therapy, cixutumumab)
    2. Group 2 (chemotherapy, radiation therapy, temozolomide)
    description
    Given IV
    name
    Cyclophosphamide
    other Names
    1. (-)-Cyclophosphamide
    2. 2H-1,3,2-Oxazaphosphorine, 2-[bis(2-chloroethyl)amino]tetrahydro-, 2-oxide, monohydrate
    3. Carloxan
    4. Ciclofosfamida
    5. Ciclofosfamide
    6. Cicloxal
    7. Clafen
    8. Claphene
    9. CP monohydrate
    10. CTX
    11. CYCLO-cell
    12. Cycloblastin
    type
    DRUG
  3. arm Group Labels
    1. Group 1 (chemotherapy, radiation therapy, cixutumumab)
    2. Group 2 (chemotherapy, radiation therapy, temozolomide)
    description
    Given IV
    name
    Dactinomycin
    other Names
    1. Actinomycin A IV
    2. Actinomycin C1
    3. ACTINOMYCIN D
    4. Actinomycin I1
    5. Actinomycin IV
    6. Actinomycin X 1
    7. Actinomycin-[thr-val-pro-sar-meval]
    8. Cosmegen
    9. DACT
    10. Dactinomycine
    11. Lyovac Cosmegen
    12. Meractinomycin
    type
    BIOLOGICAL
  4. arm Group Labels
    1. Group 1 (chemotherapy, radiation therapy, cixutumumab)
    2. Group 2 (chemotherapy, radiation therapy, temozolomide)
    description
    Given IV
    name
    Doxorubicin Hydrochloride
    other Names
    1. 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)
    2. ADM
    3. Adriacin
    4. Adriamycin
    5. Adriamycin Hydrochloride
    6. Adriamycin PFS
    7. Adriamycin RDF
    8. ADRIAMYCIN, HYDROCHLORIDE
    9. Adriamycine
    10. Adriblastina
    11. Adriblastine
    12. Adrimedac
    type
    DRUG
  5. arm Group Labels
    1. Group 1 (chemotherapy, radiation therapy, cixutumumab)
    2. Group 2 (chemotherapy, radiation therapy, temozolomide)
    description
    Given IV
    name
    Etoposide
    other Names
    1. Demethyl Epipodophyllotoxin Ethylidine Glucoside
    2. EPEG
    3. Lastet
    4. Toposar
    5. Vepesid
    6. VP 16-213
    7. VP-16
    8. VP-16-213
    type
    DRUG
  6. arm Group Labels
    1. Group 1 (chemotherapy, radiation therapy, cixutumumab)
    2. Group 2 (chemotherapy, radiation therapy, temozolomide)
    description
    Given IV
    name
    Ifosfamide
    other Names
    1. Asta Z 4942
    2. Asta Z-4942
    3. Cyfos
    4. Holoxan
    5. Holoxane
    6. Ifex
    7. IFO
    8. IFO-Cell
    9. Ifolem
    10. Ifomida
    11. Ifomide
    12. Ifosfamidum
    type
    DRUG
  7. arm Group Labels
    1. Group 1 (chemotherapy, radiation therapy, cixutumumab)
    2. Group 2 (chemotherapy, radiation therapy, temozolomide)
    description
    Given IV
    name
    Irinotecan Hydrochloride
    other Names
    1. Campto
    2. Camptosar
    3. Camptothecin 11
    4. Camptothecin-11
    5. CPT 11
    6. CPT-11
    7. U-101440E
    type
    DRUG
  8. arm Group Labels
    1. Group 1 (chemotherapy, radiation therapy, cixutumumab)
    2. Group 2 (chemotherapy, radiation therapy, temozolomide)
    description
    Correlative studies
    name
    Laboratory Biomarker Analysis
    type
    OTHER
  9. arm Group Labels
    1. Group 2 (chemotherapy, radiation therapy, temozolomide)
    description
    Given PO
    name
    Temozolomide
    other Names
    1. CCRG-81045
    2. Imidazo[5,1-d]-1,2,3,5-tetrazine-8-carboxamide, 3, 4-dihydro-3-methyl-4-oxo-
    3. M & B 39831
    4. M and B 39831
    5. Methazolastone
    6. RP-46161
    7. SCH 52365
    8. Temodal
    9. Temodar
    type
    DRUG
  10. arm Group Labels
    1. Group 1 (chemotherapy, radiation therapy, cixutumumab)
    2. Group 2 (chemotherapy, radiation therapy, temozolomide)
    description
    Given IV
    name
    Vincristine Sulfate Liposome
    other Names
    1. Marqibo
    type
    DRUG
Study design
allocation
RANDOMIZED
intervention Model
PARALLEL
masking Info
masking
NONE
primary Purpose
TREATMENT
Enrollment
count
175
type
ACTUAL
Registered outcome plans (not posted results)
primary Outcomes
  1. description
    Proportion of no Grade 3+ cardiac toxicity.
    measure
    Feasibility of the Addition of Cixutumumab to Chemotherapy Determined by Patient Enrollment
    time Frame
    From start to week 26 of therapy
  2. description
    Proportion of no Grade 4+ non-hematologic toxicity.
    measure
    Feasibility of the Addition of Temozolomide to Chemotherapy Determined by Patient Enrollment
    time Frame
    From start to week 26 of therapy
  3. description
    Number of patients with grade 3+ adverse events (AE) during therapy. (Grade 3+) = (Grade 3 + Grade 4 + Grade 5) . Grade 3: Severe and undesirable AE; Grade 4: Life threatening or disabling AE; Grade 5: Death related to AE.
    measure
    Incidence of Adverse Events Assessed by Common Terminology Criteria for Adverse Events Version 4.0
    time Frame
    Up to 54 weeks
  4. description
    Probability of no relapse, secondary malignancy, or death after 3 years in the study.
    measure
    Event-Free Survival
    time Frame
    3 years
secondary Outcomes
  1. description
    Proportion of patients with complete or partial response. Complete Response (CR): Complete disappearance of the tumor confirmed at \> 4 weeks. Partial Response (PR): At least 64% decrease in volume compared to the measurement obtained at study enrollment; Overall Response (OR) = CR + PR.
    measure
    Response Rate (CR + PR)
    time Frame
    From the start of treatment until a maximum of 2 cycles (21 days per cycle) of treatment in the absence of disease progression or unacceptable toxicities
Full study description
brief Summary
This randomized pilot clinical trial is studying the side effects and how well giving temozolomide and cixutumumab together with combination chemotherapy works in treating patients with metastatic rhabdomyosarcoma. Drugs used in chemotherapy, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as cixutumumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Giving temozolomide and cixutumumab together with combination chemotherapy may kill more tumor cells.
detailed Description
PRIMARY OBJECTIVES: I. To determine the feasibility of administering IMC-A12 (cixutumumab) in combination with a multi-agent intensive chemotherapy regimen for the treatment of high-risk rhabdomyosarcoma (RMS). II. To determine the feasibility of adding temozolomide to vincristine (vincristine sulfate)/irinotecan (irinotecan hydrochloride) cycles in patients with high-risk RMS. III. To assess immediate and short-term side effects of delivery of concurrent temozolomide-vincristine-irinotecan with irradiation in patients with high-risk RMS. SECONDARY OBJECTIVES: I. To gain a preliminary estimate of the response rate to IMC-A12 or temozolomide plus vincristine/irinotecan in previously untreated high-risk RMS. II. To obtain preliminary efficacy data for IMC-A12 or temozolomide in combination with a multi-agent interval compressed chemotherapy regimen in previously untreated high-risk RMS. III. To determine the effectiveness of detecting metastatic disease with fludeoxyglucose F 18 positron emission tomography (FDG PET) and to compare assessment of response using standard imaging techniques with response assessed by FDG PET. IV. To assess changes in serum levels of insulin-like growth factor (IGF)-I, IGF-II, IGF-BP3 as biomarkers of IGF-IR inhibition. OUTLINE: This is a dose-escalation study of cixutumumab. Patients are assigned to 1 of 2 treatment groups according to the timing of their enrollment onto the study. GROUP 1: Patients receive vincristine sulfate intravenously (IV) over 1 minute on day 1 of weeks 1-5, 7, 8, 11, 12, 15, 16, 20-24, 28, 29, 32, 33, 35, 38, 41-44, 47, 48, 50, and 51; irinotecan hydrochloride IV over 90 minutes on days 1-5 of weeks 1, 4, 20, 23, 47, and 50; ifosfamide IV over 1 hour and etoposide IV over 1-2 hours on days 1-5 of weeks 9, 13, 17, 26, and 30; doxorubicin hydrochloride IV over 1-15 minutes on days 1 and 2 of weeks 7, 11, 15, 28, and 32; cyclophosphamide IV over 30-60 minutes on day 1 of weeks 7, 11, 15, 28, 32, 35, 38, 41, and 44; dactinomycin IV over 1-5 minutes on day 1 of weeks 35, 38, 41, and 44; and cixutumumab IV over 1 hour on day 1 of weeks 1-51. Patients also undergo radiation therapy\* on days 1-5 of weeks 20-24. GROUP 2: Patients receive vincristine sulfate, irinotecan hydrochloride, ifosfamide, etoposide, doxorubicin hydrochloride, cyclophosphamide, and dactinomycin and undergo radiation therapy\* as in group 1. Patients also receive temozolomide orally (PO) on days 1-5 of weeks 1, 4, 20, 23, 47, and 50. GROUP 3: Patients receive vincristine sulfate, irinotecan hydrochloride, ifosfamide, etoposide, doxorubicin hydrochloride, cyclophosphamide, dactinomycin, and cixutumumab and undergo radiation therapy\* as in group 1. Patients also receive temozolomide as in group 2. (Discontinued as of January 2013) NOTE: \*Patients with parameningeal tumors and evidence of intracranial extension or those requiring emergency radiotherapy may receive radiation therapy starting in week 1; cixutumumab should be withheld during radiation therapy. After completion of study therapy, patients are followed up at 3 weeks and then periodically for up to 5 years.
Source references
Source notices and limitations
    Discovery and provenance
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        rials/NCT00003955">D9802</a>, <a href="/clinicaltrials/NCT00003958">D9803</a>, <a href="/clinicaltrials/NCT00354744">ARST0431</a>, and <a href="/clinicaltrials/NCT01055314">ARST08P1</a>) between 1997 and 2013.[<a href="#cit/section_1.81">81</a>] Patients were a median age of 14.8 years and 58% were male. Alveolar histology was
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        o were enrolled in four COG studies (<a href="/clinicaltrials/NCT00003955">D9802</a>, <a href="/clinicaltrials/NCT00003958">D9803</a>, <a href="/clinicaltrials/NCT01055314">ARST08P1</a>, and <a href="/clinicaltrials/NCT00354744">ARST0431</a>) were retrospectively analyzed. All four protocols required whole-lung irradiation therap
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      Childhood Rhabdomyosarcoma Treatment (PDQ®)–Health Professional Version
      source update dates
      1. context
        Updated: April 11, 2025
        datetime
        2025-04-11T12:00:00Z
        display
        April 11, 2025

    Preserved source evidence · Not medical advice