Transcript Slide 1
Children’s Oncology Group
Sarcoma Plans
Holcombe E. Grier MD
For the Children’s Oncology Group
Lots of Folks Involved
Bone Sarcoma Committee
Neyssa Marina- chair
Rich Gorlick- vice chair
Mark Bernstein- previous chair of bone sarcoma
committee
Mark Krailo- biostatistician
Soft Tissue Sarcoma Committee
William Meyer- chair
Doug Hawkins- vice chair
James Anderson- biostatistician
Plan: Present Upfront and Relapsed
Trials for Following Diseases
Bone tumors
Osteosarcoma
Ewing Sarcoma
Soft Tissue Sarcomas
Rhabdomyosarcoma
Non-Rhabo STS
Infantile fibrosarcoma
Desmoid tumor
Osteosarcoma: Up front trials
Patients without metastases: Euramos
(Neyssa Marina USA chair)
Metastatic:
Recently completed trial of feasibility of adding
transtuzumab (herceptan) to MAP (David Ebb)
Plan to incorporate bisphosfonates
(zolendronic acid) into MAP background
Osteosarcoma-Treatment at First Pulmonary
Relapse: Inhaled GM-CSF (Arndt PI)
For patients with
bilateral mets
Resect one side
2 cycles GM-CSF
Resect other sidemeasure Fas/FasL in
tumor
Also using for patients
with unilateral disease
Disease free interval
will be measured
Ewing Sarcoma: Upfront treatment
Patients without metastases
Still analyzing dose compression trial (Rick
Womer)
Next trial will incorporate
topotecan/cyclophosphamide pair (Mason
Bond)
Patients with metastases
EuroEwings: pulmonary mets (Doug Hawkins)
Metranomic therapy (Judy Felgenhauer)
Schema: AEWS0031
(Mason Bond)
R
A
N
D
O
M
I
Z
E
VAdCA
alt with
I/E
Duration 48 weeks
VAdCA
alt with
I/E
alt with
V/T/C
Duration 48 weeks
Metronomic Therapy for Patients Presenting
with Extensive Metastases
PI Felgenhauer
Standard therapy backbone (Vcr, Dox, Cyclophos
alt with ifosfamide/etoposide)
Overlay of
Celecoxib 250 mg/m2 per day
Vinblastine 1 mg/m2 three times weekly
Objective is feasibility of regimen, estimation of
EFS, assessment of surrogate angiogen. markers
Will reach accrual soon
Concept for Next Trial for Patients
with Extensive Metastases
Pilot to look at addition of
irinotecan/temozolomide to standard
therapy
Goal will be feasibility
Also considering bevacizumab
randomization
Rhabdomyosarcoma-Up Front
Patients Without Metastases
Low Risk (David Waterhouse PI) Emb only
4 courses VAC for all patients; Subset A stops
4 more VA courses for subset B
Stage 1, clinical group I/II & orbital group III, stage 2
clinical group I, II
Stage 1, group III not orbit or stage 3 clinical group I/II
Intermediate risk (Doug Hawkins PI)
Randomize VAC vs VAC alternating with
Vincristine/Irinotecan
Rhabdomyosarcoma
Patients Presenting with Metastases
Brenda Weigel PI
Intensive regimen
Rx
Vincristine, irinotecan window
VDC
IE
Iriniotecan/vcr during radiation
NRSTS
NRSTS: Risk based rx, Sherry Spunt PI
Infantile fibrosarcoma, Mignon Loh PI
7 cycles ID
VAC, stopping C before infertility likely
Convert non-operable to operable
Desmoid tumors, Steve Skapek PI
f/u to mtx/vbl study
Sulindac and tamoxifen
Biology Trials
Collecting specimens at diagnosis for each
tumor type
Collection process has been extremely
successful
Committees review concepts for use of the
tissue