SARC024: A Blanket Protocol to Study Oral Regorafenib in Patients With Selected Sarcoma Subtypes

Inclusion Criteria:

   - Age ≥ 10 year for Liposarcoma, Osteosarcoma, Ewing sarcoma and Mesenchymal
   Chondrosarcoma; Age ≥ 5 years for Rhabdomyosarcoma cohorts

   - Weight ≥ 15 kg (33 lb)

   - Patients must have histologically or cytologically confirmed advanced/metastatic
   liposarcoma, osteogenic sarcoma, Ewing/Ewing-like sarcoma of soft tissue or bone,
   fusion-positive alveolar rhabdomyosarcoma or embryonal
   rhabdomyosarcoma/fusion-negative alveolar rhabdomyosarcoma , or mesenchymal
   chondrosarcoma

   - WHO Performance Status 0, 1 or 2. A maximum of 1/3 of patients in cohorts A & B may be
   WHO performance status 2

   - At least one prior line of systemic therapy for the sarcoma diagnosis (neoadjuvant,
   adjuvant or metastatic disease)

   - All acute toxic effects of any prior treatment have resolved to NCI-CTCAE v 4.0 Grade
   1 or less (except alopecia) at the time of signing the Informed Consent Form (ICF)

   - Subject must be able to swallow and retain oral medication

   - At least one site of measurable disease on x-ray/CT/MRI scan as defined by RECIST 1.1

   - Adequate organ function within 14 days of registration

   - Written, voluntary informed consent

   - Fertile men and women of childbearing potential must agree to use an effective method
   of birth control from Day 1 of study and for 3 months after last study drug
   administration in both sexes, as assessed by the investigator. Women of childbearing
   potential include pre-menopausal women and women within the first 2 years of the onset
   of menopause. Women of childbearing potential must have a negative pregnancy test less
   than or equal to seven days prior to Day 1 of study. The definition of adequate
   contraception will be based on the judgement of the investigator.

   - Evidence of progression of disease as defined by RECIST 1.1 (i.e. new disease sites or
   20% growth of index lesions) within 6 months of registration

   - Patients with central nervous system disease are eligible for enrollment if they have
   received prior radiotherapy or surgery to sites of CNS (central nervous system)
   metastatic disease and are without evidence of clinical progression for at least 12
   weeks after therapy

Exclusion Criteria:

   - Patients with documentation of well differentiated liposarcoma only (of the well
   differentiated/dedifferentiated liposarcoma family) are specifically excluded, owing
   to its characteristically slow growth. If high grade areas are suspected
   (dedifferentiation), but not proved by pathology analysis (e.g. after primary
   resection of a well-differentiated liposarcoma), a biopsy must be performed to
   demonstrate the high-grade dedifferentiated disease

   - Prior systemic therapy with a small molecule oral kinase inhibitor, including but not
   limited to: pazopanib, sunitinib, sorafenib, everolimus, sirolimus, vemurafenib,
   dasatinib and trametinib

   - Previous assignment to treatment during this study. Subjects permanently withdrawn
   from study participation will not be allowed to re-enter study. Patients who progress
   on placebo are specifically allowed to enroll on the treatment arm of the study if
   they meet all other entry criteria

   - Concurrent, clinically significant, active malignancies within 12 months of study
   enrollment

   - Patients with severe and/or uncontrolled concurrent medical disease that in the
   opinion of the investigator could cause unacceptable safety risks or compromise
   compliance with the protocol

   - Major surgery within 28 days prior to study registration or those patients who have
   not recovered adequately from prior surgery

   - Patients who have received wide field radiotherapy ≤ 28 days (defined as > 50% of
   volume of pelvis bones or equivalent) or limited field radiation for palliation < 14
   days prior to study registration or those patients who have not recovered adequately
   from side effects of such therapy

   - Patients who have received prior systemic therapy < 14 days prior to study
   registration or have not recovered adequately from toxicities to CTCAE v. 4.03 grade 1
   or less; prior investigational therapy may not have been given < 5 half-lives of last
   dose of treatment, or < 14 days, whichever is greater

   - Patients who have had prior autologous, or allogeneic bone marrow transplant

   - Uncontrolled hypertension (systolic pressure >140 mm Hg or diastolic pressure > 90 mm
   Hg [NCI-CTCAE v 4.0] on repeated measurement) despite optimal medical management

   - Active or clinically significant cardiac disease including: Congestive heart
   failure-New York Heart Association (NYHA) > class II, Active coronary artery disease,
   Cardiac arrhythmias requiring anti-arrhythmic therapy other than beta blockers or
   digoxin, Unstable angina (anginal symptoms at rest), new onset angina within 3 months
   before randomization, or myocardial infarction within 6 months before randomization

   - Evidence or history of bleeding diathesis

   - Any hemorrhage or bleeding event ≥ NCI CTCAE Grade 3 within 4 weeks prior to study
   registration

   - Subjects with thrombotic, embolic, venous, or arterial events, such as cerebrovascular
   accident (including transient ischemic attacks) deep vein thrombosis or pulmonary
   embolism within 6 months of start of study treatment

   - Known history of human immunodeficiency virus (HIV) infection or current chronic or
   active hepatitis B or C infection requiring treatment with antiviral therapy.

   - Ongoing infection > Grade 2 NCI-CTCAE v 4.03

   - Presence of a non-healing wound, non-healing ulcer, or benign bone fracture (patients
   with stress insufficiency fractures e.g. from osteoporosis or pathological fracture
   from tumor are eligible for study)

   - Patients with seizure disorder requiring medication

   - Proteinuria > 100 mg/dl on urine analysis

   - Interstitial lung disease with ongoing signs and symptoms at the time of informed
   consent

   - Pleural effusion or ascites that causes respiratory compromise (≥ NCI-CTCAE version
   4.03 Grade 2 dyspnea)

   - History of organ allograft (including corneal transplant).

   - Known or suspected allergy or hypersensitivity to regorafenib, or excipients of the
   formulations given during the course of this trial

   - Any malabsorption condition.

   - Women who are pregnant or breast-feeding.

   - Any condition which, in the investigator's opinion, makes the subject unsuitable for
   trial participation

   - Substance abuse, medical, psychological or social conditions that may interfere with
   the subject's participation in the study or evaluation of the study results

   - Inability to comply with protocol required procedures

   - Use of any herbal remedy (e.g. St. John wort [Hypericum perforatum])