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Efficacy and Tolerance Adjuvant High-Dose Thiotepa With Peripheral Stem Cell Rescue Associated With Conventional Chemotherapy in Children and Adults With Relapsed Osteosarcoma

Phase 2
1 Year
50 Years
Open (Enrolling)

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Trial Information

Efficacy and Tolerance Adjuvant High-Dose Thiotepa With Peripheral Stem Cell Rescue Associated With Conventional Chemotherapy in Children and Adults With Relapsed Osteosarcoma

Despite the absence of tumor registry, approximately 150 new cases of osteosarcoma are
reported each year in France (100 cases per year in children and 50 cases in adults), of
which 15 to 20% are metastatic. The standardized impact rate in the world population is
estimated at 3 per million inhabitants per year.

Further to the initial standard care, about 45% of the patients relapse within a median
interval of 20 months (range 3 months - 10 years).

Results of the OS94 study and of the investigation performed within the CRLCC indicate that
25 to 30 patients (children and adults) experience an osteosarcoma relapse each year in

Results of the five major published series indicate that the 5-year overall survival rate of
patients in first relapse is between 23 and 28%, with a median post-relapse survival of 10
to 17 months. Multiple relapse cases are also reported in the COSS study, with a median time
to second relapse of 0.8 year.

At present, there is no reference treatment for the standard care of osteosarcoma relapse in

Some recommendations have been given in the OS94 protocol, but they are generally not
followed or they are implemented in a heterogeneous manner.

Thiotepa (N N' N'' triethylenethiophosphoramide), an alkylating agent of the chemical family
of ethylene-imines, is known for its antitumor effect in a number of malignant tumors.

Its efficacy in osteosarcoma has been reported in the literature. A retrospective study of
the SFCE (French Society for Childhood Cancer, results not yet published) in 45 patients
presenting with refractory osteosarcoma or relapse has shown a radiological reaction rate of

Moreover, a preliminary investigation performed by the CLB in 2007 within the framework of
the SFCE study explored all relapse cases diagnosed between the beginning of 2004 and the
end of 2006. Results showed that about 35% of the patients with osteosarcoma relapses are
treated with high-dose thiotepa while the efficacy and tolerance of this therapeutic
strategy have never been assessed.

Altogether, these results led the SFCE osteosarcoma group to propose the evaluation of the
efficacy and tolerance of this high-dose thiotepa chemotherapy within a clinical trial and
to include the drug in the standard care of osteosarcoma in relapse.

Inclusion Criteria:

- Age > 1 year and < 50 years

- First osteosarcoma relapse, either local or metastatic, or second relapse after
exclusive surgery NB: Whenever possible, only patients with histological evidence of
relapse will be included.

- Indication for chemotherapy confirmed by a multidisciplinary committee.

- Surgical resection of all tumor sites must be possible, either as first-line therapy
or after chemotherapy.

- Lansky score ≥ 60%, or ECOG Performance Status ≤ 2

- ≥ 21-day interval after first-line chemotherapy

- Blood tests, renal and liver functions within the normal range for age with, in
particular, 7 days prior to study entry, blood or serum values as follows:

- blood: neutrophil count > 1 G/L; platelets >100 G/L

- renal: serum creatinine ≤ 1.5 x ULN depending on age; patients with serum creatinine
values > 1.5 x ULN are eligible if creatinine clearance is > 70 mL/min/1.73 m²

- liver: total bilirubin < 2 x ULN; ASAT and ALAT ≤ 5 x ULN

- cardiac: isotopic or echographic Left Ventricular Ejection Fraction > 50 %.

- Signed written informed consent; for children, signed consent from the patient
(depending on age) and from the parents or legal representative is mandatory

- Documented negative serum βHCG for female patients of childbearing age

- Affiliation with health insurance.

Exclusion Criteria:

- Patients with multiple relapses for whom surgical resection seems impossible, even
after chemotherapy.

- Patients already treated with high-dose chemotherapy regimens

- Patients with a contra-indication to the treatment proposed

- Patients not eligible for leukapheresis

- Two-year follow-up impossible due to social, family, geographic or psychological

- Patient included in another protocol of clinical research

- Pregnant or lactating women.

Type of Study:


Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Estimate the overall survival rate

Outcome Time Frame:

24 months

Safety Issue:


Principal Investigator


Investigator Role:

Principal Investigator

Investigator Affiliation:

Institut d'Hématologie et d'Oncologie Pédiatrique (IHOP) - CLB


France: Afssaps - Agence française de sécurité sanitaire des produits de santé (Saint-Denis)

Study ID:




Start Date:

July 2009

Completion Date:

September 2016

Related Keywords:

  • Osteosarcoma
  • Conventional chemotherapy
  • cytapheresis
  • Peripheral stem cell autograft
  • Surgical resection
  • Thiotepa
  • Osteosarcoma