Combination Chemotherapy With or Without Temsirolimus in Treating Patients With Intermediate Risk Rhabdomyosarcoma

Not Recruiting

Trial ID: NCT02567435


This randomized phase III trial studies how well combination chemotherapy (vincristine sulfate, dactinomycin, cyclophosphamide alternated with vincristine sulfate and irinotecan hydrochloride or vinorelbine) works compared to combination chemotherapy plus temsirolimus in treating patients with rhabdomyosarcoma (cancer that forms in the soft tissues, such as muscle), and has an intermediate chance of coming back after treatment (intermediate risk). Drugs used work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Combination chemotherapy and temsirolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. It is not yet known whether chemotherapy plus temsirolimus is more effective than chemotherapy alone in treating patients with intermediate-risk rhabdomyosarcoma.

Official Title

A Randomized Phase 3 Study of Vincristine, Dactinomycin, Cyclophosphamide (VAC) Alternating With Vincristine and Irinotecan (VI) Versus VAC/VI Plus Temsirolimus (TORI, Torisel, NSC# 683864) in Patients With Intermediate Risk (IR) Rhabdomyosarcoma (RMS)


Inclusion Criteria:

   - Feasibility Phase: Patients must be < 21 years of age at the time of enrollment;
   please note: the feasibility phase is complete, effective with amendment #1

   - Efficacy Phase: Patients must be =< 40 years of age at the time of enrollment

   - Patients with newly diagnosed RMS of any subtype, except adult-type pleomorphic, based
   upon institutional histopathologic classification, are eligible to enroll on the study
   based upon stage, group, and age, as below

   - RMS types included under embryonal rhabdomyosarcoma (ERMS) include those classified in
   the 1995 International Classification of Rhabdomyosarcoma (ICR) as ERMS (classic,
   spindle cell, and botryoid variants), which are reclassified in the 2013 World Health
   Organization (WHO) classification as ERMS (classic, dense and botryoid variants) and
   spindle cell/sclerosing RMS (encompassing the historical spindle cell ERMS variant and
   the newly recognized sclerosing RMS variant); classification of alveolar
   rhabdomyosarcoma (ARMS) in the 2013 WHO classification is the same as in the ICR and
   includes classic and solid variants

      - ERMS

         - Stage 1, group III (non-orbit)

         - Stage 3, group I/II

         - Stage 2/3, group III

         - Stage 4, group IV, < 10 years old

      - ARMS:

         - Stages 1-3, groups I-III

   - Specimen Submission: Patients must have sufficient tissue available for the required
   biology study

   - Lansky performance status score >= 50 for patients =< 16 years of age; Karnofsky
   performance status score >= 50 for patients > 16 years of age

   - Peripheral absolute neutrophil count (ANC) >= 750/uL

   - Platelet count >= 75,000/uL

   - Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70
   mL/min/1.73 m^2 or a serum creatinine based on age/gender as follows:

      - 1 month to < 6 months old: 0.4 mg/dl (male), 0.4 mg/dl (female)

      - 6 months to < 1 year old: 0.5 mg/dl (male), 0.5 mg/dl (female)

      - 1 to < 2 years old: 0.6 mg/dl (male), 0.6 mg/dl (female)

      - 2 to < 6 years old: 0.8 mg/dl (male), 0.8 mg/dl (female)

      - 6 to < 10 years old: 1 mg/dl (male), 1 mg/dl (female)

      - 10 to < 13 years old: 1.2 mg/dl (male), 1.2 mg/dl (female)

      - 13 to < 16 years old: 1.5 mg/dl (male), 1.4 mg/dl (female)

      - >= 16 years old: 1.7 mg/dl (male), 1.4 mg/dl (female)

      - Patients with an elevated serum creatinine due to obstructive hydronephrosis
      secondary to tumor are still eligible; however, patients with urinary tract
      obstruction by tumor must have unimpeded urinary flow established via diversion
      (i.e. percutaneous nephrostomies or ureteric stents) of the urinary tract

   - Total bilirubin =< 1.5 x upper limit of normal (ULN) for age

   - All patients and/or their parents or legal guardians must sign a written informed

   - All institutional, Food and Drug Administration (FDA), and National Cancer Institute
   (NCI) requirements for human studies must be met.

Exclusion Criteria:

   - Patients who have previously received temsirolimus, another mTOR inhibitor, or any
   other investigational agent

   - Patients who have received any chemotherapy (excluding steroids) and/or RT prior to
   this enrollment

   - Patients with uncontrolled hyperglycemia

   - Patients with uncontrolled hyperlipidemia

   - Sexually active patients of reproductive potential who have not agreed to use an
   effective contraceptive method for the duration of their study participation and for
   at least 3 months after treatment is completed

   - Female patients who are pregnant are not eligible since fetal toxicities or
   teratogenic effects have been noted for several of the study drugs; Note: A pregnancy
   test is required for female patients of childbearing potential prior to study entry

   - Lactating females who plan to breastfeed their infants are not eligible


drug: Cyclophosphamide

biological: Dactinomycin

drug: Irinotecan Hydrochloride

other: Laboratory Biomarker Analysis

other: Questionnaire Administration

radiation: Radiation Therapy

drug: Temsirolimus

drug: Vincristine Sulfate

drug: Vinorelbine

Not Recruiting

Contact Information

Stanford University
School of Medicine
300 Pasteur Drive
Stanford, CA 94305
Jenny Joaquin

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