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Bevacizumab and Radiation Therapy for Sarcomas

Primary Purpose

Soft Tissue Sarcoma, Fibrous Histiocytoma, Liposarcoma

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Bevacizumab
Radiation Therapy
Surgery
Sponsored by
Massachusetts General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Soft Tissue Sarcoma focused on measuring Avastin

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Primary soft tissue sarcoma (STS) or an isolated local recurrence of STS. Open incisional biopsy or core biopsies should be performed within 8 weeks prior to registration Tumor grade of intermediate or high grade Tumor must be located on the upper extremity, the lower extremity, trunk, retroperitoneum, or pelvis Primary tumors must be > 5.0cm in maximal diameter and local recurrence can be any size 18 years of age or older Zubrod performance status of 0-2 Adequate organ and marrow function Exclusion Criteria: Metastatic disease Pregnant or lactating women HIV positive patients Prior treatment with radiation, chemotherapy or biotherapy for this tumor History or evidence of central nervous system (CNS) disease Serious, non-healing wound, ulcer, or bone fracture Clinically significant cardiovascular disease, New York Heart Association (NYHA) Grade II or greater congestive heart failure, serious cardiac arrhythmia requiring medication, or Grade II or greater peripheral vascular disease within 1 year History of stroke within the past 6 months Major surgical procedure or significant traumatic injury within 28 days Current or recent (within 10 days) use of full-dose oral or parenteral anticoagulants or thrombolytic agents. Presence of bleeding diathesis or coagulopathy Proteinuria at baseline or clinically significant impairment of renal function History of abdominal fistula, gastrointestinal perforation, or inta-abdominal abscess within the past 6 months Documented history of uncontrolled seizures Grade 2 or greater sensory neuropathy based upon the NCI CTCAE, version 3.0 Known history of deep vein thrombosis or pulmonary embolus Known hypercoagulable disorder History of hepatic cirrhosis or current hepatic dysfunction

Sites / Locations

  • Massachusetts General Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Bevacizumab, Radiation, and Surgery

Arm Description

Bevacizumab 5mg/kg, external beam radiation therapy (XRT), surgery, Intraoperative radiation therapy (IORT), and postoperative external beam radiation therapy (Post-op XRT)

Outcomes

Primary Outcome Measures

Objective Response Rate for Neoadjuvant Bevacizumab Combined With Radiation Therapy for Intermediate and High-risk Soft Tissue Sarcomas.
The count of participants with greater than or equal to 80% pathological necrosis in the resected specimen following neoadjuvant bevacizumab and radiation.

Secondary Outcome Measures

Change in Median Microvessel Density (MVD) After Bevacizumab Alone
The percentage change in median microvessel density (MVD) after Bevacizumab treatment alone
Average Change in Blood Flow, Blood Volume,and Permeability Surface Area
The percentage reduction in blood flow, blood volume,and permeability surface area of the tumor following combination therapy as determined by perfusion CT (computerized tomography) scan. The percent change represents the combined average percent change for flow, volume, and permeability together.
Local Control Rate
The number of patients with local recurrence after a median follow-up of 24 months. Local recurrence is defined as disease progression (new cancer growth) at the primary cancer site.
Distant Recurrence
The number of participants with distant recurrence at the time of last follow-up. Distant recurrence is when cancer has spread (metastasized) to areas farther away from where the primary cancer site is.
Disease Free Survival
The median amount of time from the end of treatment until to distant recurrence. Distant recurrence is when cancer spreads to areas in the body away from the primary cancer site.

Full Information

First Posted
July 21, 2006
Last Updated
April 14, 2017
Sponsor
Massachusetts General Hospital
Collaborators
National Institutes of Health (NIH), National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00356031
Brief Title
Bevacizumab and Radiation Therapy for Sarcomas
Official Title
A Phase II Study of Neoadjuvant Bevacizumab and Radiation Therapy for Resectable Soft Tissue Sarcomas
Study Type
Interventional

2. Study Status

Record Verification Date
April 2017
Overall Recruitment Status
Completed
Study Start Date
July 2006 (undefined)
Primary Completion Date
March 2010 (Actual)
Study Completion Date
March 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Massachusetts General Hospital
Collaborators
National Institutes of Health (NIH), National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The main purpose of this study is to test the effectiveness of bevacizumab in combination with radiation therapy to see what effects (good or bad) they have on patients with soft tissue sarcoma. Bevacizumab is an antibody designed specifically to slow or stop the growth of cancerous tumors by decreasing the blood supply to the tumor. Bevacizumab is approved by the FDA in combination with intravenous 5-fluorouracil-based chemotherapy as a treatment for patients with cancer of the colon or rectum that has spread. However, the use of bevacizumab in combination with radiation for sarcomas is still under investigation.
Detailed Description
The dose of bevacizumab and radiation therapy will be the same for all participants throughout the study. Bevacizumab will be given as an intravenous infusion every 2 weeks for a total of 4 doses. Radiation therapy will begin 2 weeks after the first bevacizumab infusion and will be delivered 5 days per week over a period of 6 weeks. This is done as an outpatient procedure. Each 2 week period will be considered a separate treatment cycle. Participants will be treated with radiation therapy for a maximum of 3 cycles (6 weeks). A surgeon will evaluate the participants tumor by radiologic studies before study treatment to determine if surgical removal is possible. After the completion of study treatment, a surgeon will repeat the evaluation of the tumor. Surgery will performed 6-7 weeks after the completion of radiation therapy.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Soft Tissue Sarcoma, Fibrous Histiocytoma, Liposarcoma, Leiomyosarcoma, Fibrosarcoma, Synovial Sarcoma
Keywords
Avastin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
20 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Bevacizumab, Radiation, and Surgery
Arm Type
Experimental
Arm Description
Bevacizumab 5mg/kg, external beam radiation therapy (XRT), surgery, Intraoperative radiation therapy (IORT), and postoperative external beam radiation therapy (Post-op XRT)
Intervention Type
Drug
Intervention Name(s)
Bevacizumab
Other Intervention Name(s)
Avastin
Intervention Description
Bevacizumab 5mg/kg given intravenously every 2 weeks for a total of 4 doses
Intervention Type
Radiation
Intervention Name(s)
Radiation Therapy
Intervention Description
External beam radiation given two weeks after the first bevacizumab infusion and delivered 5 days a week at 1.8 Gy per day, over 6 weeks. Total radiation dose is 50.4 Gy. For patients with tumors in the retroperitoneum or pelvis, intraoperative radiation therapy (10-20 Gy) may be given for close or positive margins at the discretion of the radiation oncologist and surgeon. For patients with tumors in the extremity or trunk, post-operative external beam radiation therapy (10-20 Gy) will be given for close or positive margins assuming wound healing is good.
Intervention Type
Procedure
Intervention Name(s)
Surgery
Intervention Description
Surgical resection is performed 6-7 weeks after completion of neoadjuvant therapy.
Primary Outcome Measure Information:
Title
Objective Response Rate for Neoadjuvant Bevacizumab Combined With Radiation Therapy for Intermediate and High-risk Soft Tissue Sarcomas.
Description
The count of participants with greater than or equal to 80% pathological necrosis in the resected specimen following neoadjuvant bevacizumab and radiation.
Time Frame
3 years
Secondary Outcome Measure Information:
Title
Change in Median Microvessel Density (MVD) After Bevacizumab Alone
Description
The percentage change in median microvessel density (MVD) after Bevacizumab treatment alone
Time Frame
baseline and 3 years
Title
Average Change in Blood Flow, Blood Volume,and Permeability Surface Area
Description
The percentage reduction in blood flow, blood volume,and permeability surface area of the tumor following combination therapy as determined by perfusion CT (computerized tomography) scan. The percent change represents the combined average percent change for flow, volume, and permeability together.
Time Frame
3 years
Title
Local Control Rate
Description
The number of patients with local recurrence after a median follow-up of 24 months. Local recurrence is defined as disease progression (new cancer growth) at the primary cancer site.
Time Frame
3 years
Title
Distant Recurrence
Description
The number of participants with distant recurrence at the time of last follow-up. Distant recurrence is when cancer has spread (metastasized) to areas farther away from where the primary cancer site is.
Time Frame
3 years
Title
Disease Free Survival
Description
The median amount of time from the end of treatment until to distant recurrence. Distant recurrence is when cancer spreads to areas in the body away from the primary cancer site.
Time Frame
3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Primary soft tissue sarcoma (STS) or an isolated local recurrence of STS. Open incisional biopsy or core biopsies should be performed within 8 weeks prior to registration Tumor grade of intermediate or high grade Tumor must be located on the upper extremity, the lower extremity, trunk, retroperitoneum, or pelvis Primary tumors must be > 5.0cm in maximal diameter and local recurrence can be any size 18 years of age or older Zubrod performance status of 0-2 Adequate organ and marrow function Exclusion Criteria: Metastatic disease Pregnant or lactating women HIV positive patients Prior treatment with radiation, chemotherapy or biotherapy for this tumor History or evidence of central nervous system (CNS) disease Serious, non-healing wound, ulcer, or bone fracture Clinically significant cardiovascular disease, New York Heart Association (NYHA) Grade II or greater congestive heart failure, serious cardiac arrhythmia requiring medication, or Grade II or greater peripheral vascular disease within 1 year History of stroke within the past 6 months Major surgical procedure or significant traumatic injury within 28 days Current or recent (within 10 days) use of full-dose oral or parenteral anticoagulants or thrombolytic agents. Presence of bleeding diathesis or coagulopathy Proteinuria at baseline or clinically significant impairment of renal function History of abdominal fistula, gastrointestinal perforation, or inta-abdominal abscess within the past 6 months Documented history of uncontrolled seizures Grade 2 or greater sensory neuropathy based upon the NCI CTCAE, version 3.0 Known history of deep vein thrombosis or pulmonary embolus Known hypercoagulable disorder History of hepatic cirrhosis or current hepatic dysfunction
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Yen-Lin Chen, MD
Organizational Affiliation
Massachusetts General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
20932656
Citation
Yoon SS, Duda DG, Karl DL, Kim TM, Kambadakone AR, Chen YL, Rothrock C, Rosenberg AE, Nielsen GP, Kirsch DG, Choy E, Harmon DC, Hornicek FJ, Dreyfuss J, Ancukiewicz M, Sahani DV, Park PJ, Jain RK, Delaney TF. Phase II study of neoadjuvant bevacizumab and radiotherapy for resectable soft tissue sarcomas. Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):1081-90. doi: 10.1016/j.ijrobp.2010.07.024. Epub 2010 Oct 6.
Results Reference
result
PubMed Identifier
32827353
Citation
Vatner R, James CD, Sathiaseelan V, Bondra KM, Kalapurakal JA, Houghton PJ. Radiation therapy and molecular-targeted agents in preclinical testing for immunotherapy, brain tumors, and sarcomas: Opportunities and challenges. Pediatr Blood Cancer. 2021 May;68 Suppl 2:e28439. doi: 10.1002/pbc.28439. Epub 2020 Aug 22.
Results Reference
derived

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Bevacizumab and Radiation Therapy for Sarcomas

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