Inhaled Sargramostim in Treating Patients With First Pulmonary (Lung) Recurrence of Osteosarcoma
Metastatic Cancer, Sarcoma
About this trial
This is an interventional treatment trial for Metastatic Cancer focused on measuring metastatic osteosarcoma, recurrent osteosarcoma, lung metastases
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed osteosarcoma at primary diagnosis Lesions detected in at least 1 lung that are consistent with metastatic disease and approachable with thoracotomy No prior recurrence of osteosarcoma No other sites of metastases Resectable pulmonary nodule(s), defined as nodule(s) that are removable without performing a pneumonectomy (e.g., nodules immediately adjacent to the main stem bronchus or main pulmonary vessels) Prior thoracotomy allowed in patients with imaging consistent with metastatic involvement in both lungs provided the lung on which the thoracotomy was performed is disease-free No pleural effusion or pleural based nodules PATIENT CHARACTERISTICS: Age 39 and under Performance status Karnofsky 50-100% (patients over 16 years of age) Lansky 50-100% (patients 16 years of age and under) Life expectancy At least 8 weeks Hematopoietic Not specified Hepatic Not specified Renal Not specified Pulmonary No evidence of dyspnea at rest No exercise intolerance Pulse oximetry at least 94% Baseline Forced expiratory volume in 1 second (FEV_1) at least 80% of predicted No history of asthma No history of reactive airway disease No history of bronchospasm Other Willing and able to perform inhalation therapy No medical contraindication to surgical excision Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception PRIOR CONCURRENT THERAPY: Biologic therapy No other concurrent immunotherapy No other concurrent immunomodulating agents Chemotherapy No concurrent anticancer chemotherapy Endocrine therapy No concurrent steroids by any route Radiotherapy Not specified Surgery See Disease Characteristics No concurrent thoracoscopy or video-assisted thoracic surgery Other No more than 1 prior treatment regimen for osteosarcoma No concurrent participation in another COG therapeutic study
Sites / Locations
- Lurleen Wallace Comprehensive Cancer at University of Alabama - Birmingham
- Phoenix Children's Hospital
- Arizona Cancer Center at University of Arizona Health Sciences Center
- Arkansas Cancer Research Center at University of Arkansas for Medical Sciences
- Southern California Permanente Medical Group
- Loma Linda University Cancer Institute at Loma Linda University Medical Center
- Jonathan Jaques Children's Cancer Center at Miller Children's Hospital
- Children's Hospital and Research Center Oakland
- University of California Davis Cancer Center
- UCSF Helen Diller Family Comprehensive Cancer Center
- Stanford Cancer Center
- Alfred I. duPont Hospital for Children
- Lombardi Comprehensive Cancer Center at Georgetown University Medical Center
- Children's National Medical Center
- Lee Cancer Care of Lee Memorial Health System
- University of Florida Shands Cancer Center
- Nemours Children's Clinic
- University of Miami Sylvester Comprehensive Cancer Center - Miami
- Miami Children's Hospital
- Baptist-South Miami Regional Cancer Program
- Nemours Children's Clinic - Orlando
- Sacred Heart Cancer Center at Sacred Heart Hospital
- All Children's Hospital
- St. Joseph's Cancer Institute at St. Joseph's Hospital
- Kaplan Cancer Center at St. Mary's Medical Center
- Winship Cancer Institute of Emory University
- Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center
- Mountain States Tumor Institute at St. Luke's Regional Medical Center
- Children's Memorial Hospital - Chicago
- Simmons Cooper Cancer Institute
- Indiana University Melvin and Bren Simon Cancer Center
- Kansas Masonic Cancer Research Institute at the University of Kansas Medical Center
- Lucille P. Markey Cancer Center at University of Kentucky
- Kosair Children's Hospital
- Alvin and Lois Lapidus Cancer Institute at Sinai Hospital
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
- Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute
- Barbara Ann Karmanos Cancer Institute
- Hurley Medical Center
- Butterworth Hospital at Spectrum Health
- Van Elslander Cancer Center at St. John Hospital and Medical Center
- Breslin Cancer Center at Ingham Regional Medical Center
- Mayo Clinic Cancer Center
- University of Mississippi Cancer Clinic
- Children's Mercy Hospital
- Hackensack University Medical Center Cancer Center
- Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School
- Newark Beth Israel Medical Center
- University of New Mexico Cancer Center
- Roswell Park Cancer Institute
- Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center
- James P. Wilmot Cancer Center at University of Rochester Medical Center
- SUNY Upstate Medical University Hospital
- Blumenthal Cancer Center at Carolinas Medical Center
- Duke Comprehensive Cancer Center
- Akron Children's Hospital
- Cleveland Clinic Taussig Cancer Center
- Nationwide Children's Hospital
- Children's Medical Center - Dayton
- Oklahoma University Cancer Institute
- Legacy Emanuel Hospital and Health Center and Children's Hospital
- Oregon Health and Science University Cancer Institute
- Lehigh Valley Hospital - Muhlenberg
- Penn State Cancer Institute at Milton S. Hershey Medical Center
- Children's Hospital of Philadelphia
- St. Christopher's Hospital for Children
- Children's Hospital of Pittsburgh
- Palmetto Health South Carolina Cancer Center
- Greenville Hospital Cancer Center
- East Tennessee Children's Hospital
- Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas
- Cook Children's Medical Center - Fort Worth
- M. D. Anderson Cancer Center at University of Texas
- Covenant Children's Hospital
- University of Texas Health Science Center at San Antonio
- CCOP - Scott and White Hospital
- Fletcher Allen Health Care - University Health Center Campus
- Children's Hospital and Regional Medical Center - Seattle
- Providence Cancer Center at Sacred Heart Medical Center
- St. Vincent Hospital Regional Cancer Center
- University of Wisconsin Paul P. Carbone Comprehensive Cancer Center
- Marshfield Clinic - Marshfield Center
- Midwest Children's Cancer Center at Children's Hospital of Wisconsin
- Westmead Institute for Cancer Research at Westmead Hospital
- Princess Margaret Hospital for Children
- CancerCare Manitoba
- IWK Health Centre
- McMaster Children's Hospital at Hamilton Health Sciences
- Montreal Children's Hospital at McGill University Health Center
- Hopital Sainte Justine
- Saskatoon Cancer Centre at the University of Saskatchewan
- Centre Hospitalier Universitaire de Quebec
- San Jorge Children's Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Group 1 (unilateral recurrence) - Sargramostim and thoractomy
Group 2 (bilateral recurrence) - Sargramostim and thoractomy
Patients receive initial inhalation therapy inhaled sargramostim (GM-CSF) twice daily on days 1-7. Treatment repeats every other week every 14 days for a total of 2 courses. Patients undergo surgical procedure thoracotomy on day 22. Beginning on day 29, or as soon as possible thereafter, patients begin post-thoracotomy inhalation therapy for up to 12 additional courses. Treatment continues in the absence of disease progression or unacceptable toxicity. Patients are followed every 2 months for 1 year, every 4 months for 1 year, every 6 months for 3 years, and then annually thereafter.
Patients may be enrolled on study either before or after the first thoracotomy procedure. For the first thoracotomy, patients undergo surgical procedure unilateral thoracotomy. Patients receive initial inhalation therapy inhaled GM-CSF, as soon as possible after recovery from first thoracotomy, twice daily on days 1-7. Treatment repeats every other week every 14 days for a total of 2 courses. Patients undergo surgical procedure contralateral thoracotomy on day 22. Beginning on day 29, or as soon as possible, patients begin post-thoracotomy inhalation therapy as above for up to 12 additional courses. Treatment continues in the absence of disease progression or unacceptable toxicity. Patients are followed every 2 months for 1 year, every 4 months for 1 year, every 6 months for 3 years, and then annually thereafter.