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Protocol for Patients With Newly-Diagnosed Non-Metastatic Osteosarcoma - A POG/CCG Pilot Intergroup Study

Phase 3
30 Years
Not Enrolling
Cardiac Toxicity, Sarcoma

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Trial Information

Protocol for Patients With Newly-Diagnosed Non-Metastatic Osteosarcoma - A POG/CCG Pilot Intergroup Study

OBJECTIVES: I. Compare the efficacy of three intensification regimens (doxorubicin vs
doxorubicin plus ifosfamide vs doxorubicin plus ifosfamide and etoposide) in patients with
newly diagnosed, previously untreated, nonmetastatic osteosarcoma. II. Determine the effect
of postoperative dose intensification on outcome in patients with standard response to
preoperative chemotherapy. III. Determine the effect of dexrazoxane cardioprotection during
standard induction therapy on histologic response in these patients. IV. Evaluate biological
factors that may predict outcome in these patients. V. Determine the safety of dexrazoxane
administered with doxorubicin in combination with cisplatin or cisplatin and ifosfamide in
these patients. VI. Determine the effect of dexrazoxane on cytotoxicity as measured by tumor
necrosis at definitive surgery in these patients. VII. Assess the feasibility of
administering doxorubicin with dexrazoxane cardioprotection or high dose ifosfamide with
etoposide to standard risk patients who are also receiving methotrexate and cisplatin.

OUTLINE: This is a multicenter study. Patients are enrolled sequentially on 1 of 3 pilot
intensification regimens. After surgery to completely remove the primary tumor, patients are
assigned to 1 of 2 adjuvant chemotherapy groups based on percent necrosis at limb salvage.
Pilot 1: (Closed to accrual as of 6/2/2000) Patients receive dexrazoxane IV followed
immediately by doxorubicin IV over 20 minutes plus cisplatin IV over 4 hours on days 1 and 2
of weeks 1 and 6. Methotrexate IV over 4 hours is administered on day 1 of weeks 4, 5, 9,
and 10. Patients undergo surgery on week 11. Adjuvant chemotherapy begins on day 1 of week
13. Group 1 (good response to neoadjuvant chemotherapy): Patients receive methotrexate IV
over 4 hours every 3 weeks for 6 courses, beginning on week 13. Patients also receive
dexrazoxane and doxorubicin every 3 weeks for 4 courses, beginning on week 14. Cisplatin is
administered with the first 2 courses of dexrazoxane and doxorubicin. Group 2 (standard
response to neoadjuvant chemotherapy): Patients receive methotrexate and cisplatin as in
group 1 plus dexrazoxane and doxorubicin for 6 courses. Pilot 2: Patients receive
preoperative therapy comprised of dexrazoxane, doxorubicin, and methotrexate as in pilot 1.
Ifosfamide IV over 4 hours is also administered on days 1-5 of week 1. Patients undergo
surgery on week 11, then begin adjuvant chemotherapy on week 13. Group 1: Patients receive
methotrexate, dexrazoxane, and doxorubicin as in pilot 1, group 1. Ifosfamide is also
administered on weeks 14 and 20. Cisplatin is administered on weeks 17, 23, and 26. Group 2:
Patients receive methotrexate, dexrazoxane, and doxorubicin as in pilot 1, group 2.
Ifosfamide is administered on weeks 14, 20, 26, and 31. Cisplatin is administered on weeks
17, 23, and 29. Pilot 3: (Open to accrual as of 6/2/2000) Patients receive preoperative
therapy comprised of methotrexate, dexrazoxane, doxorubicin, ifosfamide, and cisplatin as in
pilot 2. Patients undergo surgery on week 11, then begin adjuvant chemotherapy on week 13.
Group 1: Patients receive methotrexate, dexrazoxane, doxorubicin, ifosfamide, and cisplatin
as in pilot 2, group 1. Group 2: Patients receive methotrexate on weeks 13, 19, 29, 32, 35,
and 36, high dose ifosfamide and etoposide IV over 4 hours on days 1-5 of weeks 14, 23, and
26, and cisplatin on weeks 20, 30, and 33. Dexrazoxane and doxorubicin are administered on
weeks 17, 20, 30, and 33. Patients are followed every 3 months for 1 year, every 6 months
for 4 years and then annually thereafter.

PROJECTED ACCRUAL: Approximately 180 patients will be accrued for this study within 2 years.

Inclusion Criteria

DISEASE CHARACTERISTICS: Histologically proven newly diagnosed moderate or high grade
osteosarcoma without metastases No prior treatment, including complete resection No
parosteal or periosteal sarcoma No osteosarcoma associated with Paget's disease No
nonresectable tumors or tumors that may result in marginal or interlesion resection Must
be enrolled on protocol POG-9851

PATIENT CHARACTERISTICS: Age: 30 and under Performance status: ECOG 0-2 Life expectancy:
Not specified Hematopoietic: Absolute neutrophil count at least 1,000/mm3 Platelet count
at least 100,000/mm3 Hepatic: Bilirubin no greater than 1.5 times normal SGOT no greater
than 3 times normal Renal: Creatinine normal Phosphate at least 3.0 mg/dL without
supplementation Cardiovascular: Shortening fraction at least 28% by echocardiogram If
echocardiogram unsatisfactory, must have ejection fraction at least 50% No history of
pericarditis or myocarditis No symptomatic arrhythmia or symptomatic cardiac conduction

PRIOR CONCURRENT THERAPY: See Disease Characteristics Biologic therapy: Not specified
Chemotherapy: No prior chemotherapy Endocrine therapy: Not specified Radiotherapy: No
prior radiotherapy Surgery: See Disease Characteristics

Type of Study:


Study Design:

Primary Purpose: Treatment

Principal Investigator

Cindy Schwartz, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Sidney Kimmel Comprehensive Cancer Center


United States: Federal Government

Study ID:




Start Date:

September 1999

Completion Date:

Related Keywords:

  • Cardiac Toxicity
  • Sarcoma
  • localized osteosarcoma
  • cardiac toxicity
  • Osteosarcoma
  • Sarcoma



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Mayo Clinic Cancer Center Rochester, Minnesota  55905
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Walter Reed Army Medical Center Washington, District of Columbia  20307-5000
Emory University Hospital - Atlanta Atlanta, Georgia  30322
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Indiana University Cancer Center Indianapolis, Indiana  46202-5265
University of Massachusetts Memorial Medical Center Worcester, Massachusetts  01655
University of Minnesota Cancer Center Minneapolis, Minnesota  55455
University of Mississippi Medical Center Jackson, Mississippi  39216-4505
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Tripler Army Medical Center Honolulu, Hawaii  96859-5000
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Children's Hospital of Michigan Detroit, Michigan  48201
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Presbyterian Healthcare Charlotte, North Carolina  28233-3549
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Oklahoma Memorial Hospital Oklahoma City, Oklahoma  73126-0307
Medical City Dallas Hospital Dallas, Texas  75230
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Vermont Cancer Center Burlington, Vermont  05401-3498
Midwest Children's Cancer Center Milwaukee, Wisconsin  53226
University of California San Diego Cancer Center La Jolla, California  92093-0658
UCSF Cancer Center and Cancer Research Institute San Francisco, California  94115-0128
Marlene & Stewart Greenebaum Cancer Center, University of Maryland Baltimore, Maryland  21201
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Holden Comprehensive Cancer Center at The University of Iowa Iowa City, Iowa  52242-1009
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NYU School of Medicine's Kaplan Comprehensive Cancer Center New York, New York  10016
Boston Floating Hospital Infants and Children Boston, Massachusetts  02111
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Baptist Hospital of Miami Miami, Florida  33176-2197
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Naval Medical Center, Portsmouth Portsmouth, Virginia  23708-2197
Massey Cancer Center Richmond, Virginia  23298-0037
St. Vincent Hospital Green Bay, Wisconsin  54307-3508
University of Wisconsin Comprehensive Cancer Center Madison, Wisconsin  53792
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Baltimore, Maryland  21231-2410
Dana-Farber Cancer Institute Boston, Massachusetts  02115
Cancer Research Center of Hawaii Honolulu, Hawaii  96813
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University of Arkansas for Medical Sciences Little Rock, Arkansas  72205
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Herbert Irving Comprehensive Cancer Center New York, New York  10032
Madigan Army Medical Center Tacoma, Washington  98431-5048
Sutter Cancer Center Sacramento, California  95816
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Veterans Affairs Medical Center - Fargo Fargo, North Dakota  58102
Cancer Institute of New Jersey New Brunswick, New Jersey  08901
University of Nebraska Medical Center Omaha, Nebraska  68198-3330
Hackensack University Medical Center Hackensack, New Jersey  07601
Long Beach Memorial Medical Center Long Beach, California  90806
Children's Hospital Los Angeles Los Angeles, California  90027-0700
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Children's National Medical Center Washington, District of Columbia  20010-2970
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Children's Memorial Hospital, Chicago Chicago, Illinois  60614
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Scott and White Clinic Temple, Texas  76508
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