Denosumab in Treating Patients With Recurrent or Refractory Osteosarcoma
Metastatic Osteosarcoma, Recurrent Osteosarcoma, Refractory Osteosarcoma
About this trial
This is an interventional treatment trial for Metastatic Osteosarcoma
Eligibility Criteria
Inclusion Criteria:
- Female patients must have a bone age of equal to or greater than 12 years of age as determined by local read of appropriate radiographic imaging
- Male patients must have a bone age of equal to or greater than 14 years of age as determined by local read of appropriate radiographic imaging
- Patients must have relapsed or become refractory to conventional therapy, with a regimen including some combination of high dose methotrexate, doxorubicin, cisplatin, ifosfamide and etoposide; and have had histologic verification of osteosarcoma at original diagnosis or at the time of recurrence
- Cohort 1 patients must have measurable disease according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1
Cohort 2 patients must have had a complete resection of all sites of metastatic disease within 30 days prior to enrollment
Patients will only be eligible after they have undergone complete surgical resection of suspected metastatic disease that is histopathologically confirmed to be osteosarcoma prior to enrollment
- Note: the definition of complete resections is: gross resection of all disease as per the operating surgeon; post-operative imaging is not required for confirmation of complete resection
Patients must undergo resection of any lung lesion meeting criteria for likely metastatic disease, defined as:
- 3 or more lesions > 5 mm in diameter OR a single lesion > 1 cm
Patients with lung as the only site of resected metastatic disease must have refused participation in protocol AOST1421
- Note: This applies if AOST1421 is open to enrollment at the enrolling institution on the day the patient consents
- Patient must have adequate tumor specimen available for submission
- Patients must have a performance status corresponding to Eastern Cooperative Oncology Group (ECOG) scores of 0, 1 or 2; use Karnofsky for patients > 16 years of age and Lansky for patients =< 16 years of age
Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 mL/min/1.73 m^2 or a serum creatinine based on age/gender as follows:
- Age: 11 to < 13 years old; 1.2 (male, female) maximum serum creatinine (mg/dL)
- Age: 13 to < 16 years old; 1.5 (male), 1.4 (female) maximum serum creatinine (mg/dL)
- Age: >= 16 years old; 1.7 (male), 1.4 (female) maximum serum creatinine (mg/dL)
- Total bilirubin =< 1.5 x upper limit of normal (ULN) for age
- Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) or serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) < 2.5 x ULN for age
- Serum calcium or albumin-adjusted serum calcium >= 2.0 mmol/L (8.0 mg/dL) and =< 2.9 mmol/L (11.5 mg/dL)
Exclusion Criteria:
- Patients with known sensitivity to any of the products to be administered during the study (eg, mammalian derived products, calcium or vitamin D)
- Patients who are receiving other cancer directed therapy at the time of enrollment
- Patients who have previously received denosumab
- Patients who have previously received mithramycin, strontium-89, samarium-153 or rhenium
- Patients receiving bisphosphonates
Pre-existing conditions
- Disorders associated with abnormal bone metabolism
- Hypocalcemia that is not corrected with oral calcium supplementation
- Vitamin D < 20 mg/mL
- Paget's disease
- Prior history or current evidence of osteonecrosis of the jaw
- Any dental or oral condition likely to result in disruption of mucosal integrity during denosumab therapy including: active dental or jaw condition requiring oral surgery or tooth extraction; non-healed dental or oral surgery or planned invasive dental procedures during the anticipated course of study therapy
- Unstable systemic disease, excluding osteosarcoma, such as unstable proximal renal tubule dysfunction (Fanconi syndrome) or congestive heart failure
Pregnancy and breast feeding
- Female patients who are pregnant; a pregnancy test is required for female patients of childbearing potential
- Lactating females who plan to breastfeed their infants while on study therapy and through 5 months after completion of study therapy
- Sexually active patients of reproductive potential who have not agreed to use an effective contraceptive method for the duration of their study participation and for 5 months after the end of study treatment
- All patients and/or their parents or legal guardians must sign a written informed consent
- All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met
Sites / Locations
- Children's Hospital of Alabama
- Phoenix Childrens Hospital
- Banner University Medical Center - Tucson
- Arkansas Children's Hospital
- Kaiser Permanente-Anaheim
- Kaiser Permanente-Bellflower
- Kaiser Permanente Downey Medical Center
- Kaiser Permanente-Fontana
- Loma Linda University Medical Center
- Children's Hospital Los Angeles
- Kaiser Permanente Los Angeles Medical Center
- Valley Children's Hospital
- Children's Hospital and Research Center at Oakland
- Children's Hospital of Orange County
- University of California Davis Comprehensive Cancer Center
- Kaiser Permanente-San Diego Zion
- Rady Children's Hospital - San Diego
- UCSF Medical Center-Mission Bay
- Children's Hospital Colorado
- Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center
- Connecticut Children's Medical Center
- Alfred I duPont Hospital for Children
- Children's National Medical Center
- University of Florida Health Science Center - Gainesville
- Nemours Children's Clinic-Jacksonville
- University of Miami Miller School of Medicine-Sylvester Cancer Center
- Nicklaus Children's Hospital
- AdventHealth Orlando
- Nemours Children's Hospital
- Johns Hopkins All Children's Hospital
- Saint Joseph's Hospital/Children's Hospital-Tampa
- Saint Mary's Hospital
- Children's Healthcare of Atlanta - Egleston
- Kapiolani Medical Center for Women and Children
- Saint Luke's Mountain States Tumor Institute
- Centralia Oncology Clinic
- Lurie Children's Hospital-Chicago
- University of Illinois
- University of Chicago Comprehensive Cancer Center
- Carle on Vermilion
- Cancer Care Specialists of Illinois - Decatur
- Carle Physician Group-Effingham
- Crossroads Cancer Center
- Carle Physician Group-Mattoon/Charleston
- Cancer Care Center of O'Fallon
- Saint Jude Midwest Affiliate
- Carle Cancer Center
- The Carle Foundation Hospital
- Riley Hospital for Children
- Saint Vincent Hospital and Health Care Center
- University of Iowa/Holden Comprehensive Cancer Center
- University of Kentucky/Markey Cancer Center
- Norton Children's Hospital
- Ochsner Medical Center Jefferson
- Maine Children's Cancer Program
- Sinai Hospital of Baltimore
- Johns Hopkins University/Sidney Kimmel Cancer Center
- Walter Reed National Military Medical Center
- Brigham and Women's Hospital
- Dana-Farber Cancer Institute
- UMass Memorial Medical Center - University Campus
- C S Mott Children's Hospital
- Wayne State University/Karmanos Cancer Institute
- Ascension Saint John Hospital
- Helen DeVos Children's Hospital at Spectrum Health
- Bronson Methodist Hospital
- Children's Hospitals and Clinics of Minnesota - Minneapolis
- University of Minnesota/Masonic Cancer Center
- Mayo Clinic in Rochester
- University of Mississippi Medical Center
- Children's Mercy Hospitals and Clinics
- Washington University School of Medicine
- Mercy Hospital Saint Louis
- Children's Hospital and Medical Center of Omaha
- University of Nebraska Medical Center
- Sunrise Hospital and Medical Center
- Alliance for Childhood Diseases/Cure 4 the Kids Foundation
- Dartmouth Hitchcock Medical Center
- Hackensack University Medical Center
- Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital
- Rutgers Cancer Institute of New Jersey
- Newark Beth Israel Medical Center
- University of New Mexico Cancer Center
- Albany Medical Center
- Roswell Park Cancer Institute
- Laura and Isaac Perlmutter Cancer Center at NYU Langone
- NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
- Memorial Sloan Kettering Cancer Center
- University of Rochester
- State University of New York Upstate Medical University
- UNC Lineberger Comprehensive Cancer Center
- Carolinas Medical Center/Levine Cancer Institute
- Wake Forest University Health Sciences
- Sanford Broadway Medical Center
- Children's Hospital Medical Center of Akron
- UHHS-Chagrin Highlands Medical Center
- Cincinnati Children's Hospital Medical Center
- Case Western Reserve University
- Rainbow Babies and Childrens Hospital
- Cleveland Clinic Foundation
- Nationwide Children's Hospital
- Dayton Children's Hospital
- University of Oklahoma Health Sciences Center
- Oregon Health and Science University
- Penn State Children's Hospital
- Children's Hospital of Philadelphia
- Children's Oncology Group
- Saint Christopher's Hospital for Children
- Children's Hospital of Pittsburgh of UPMC
- Rhode Island Hospital
- Medical University of South Carolina
- Prisma Health Richland Hospital
- Sanford USD Medical Center - Sioux Falls
- Saint Jude Children's Research Hospital
- Vanderbilt University/Ingram Cancer Center
- Dell Children's Medical Center of Central Texas
- Driscoll Children's Hospital
- Medical City Dallas Hospital
- UT Southwestern/Simmons Cancer Center-Dallas
- Cook Children's Medical Center
- Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
- Children's Hospital of San Antonio
- University of Texas Health Science Center at San Antonio
- Primary Children's Hospital
- University of Vermont and State Agricultural College
- University of Virginia Cancer Center
- Children's Hospital of The King's Daughters
- Virginia Commonwealth University/Massey Cancer Center
- Seattle Children's Hospital
- Providence Sacred Heart Medical Center and Children's Hospital
- West Virginia University Healthcare
- Children's Hospital of Wisconsin
- University of Alberta Hospital
- IWK Health Centre
- McMaster Children's Hospital at Hamilton Health Sciences
- Children's Hospital
- Hospital for Sick Children
- The Montreal Children's Hospital of the MUHC
- Centre Hospitalier Universitaire de Quebec
- San Jorge Children's Hospital
- University Pediatric Hospital
Arms of the Study
Arm 1
Experimental
Treatment (denosumab)
Patients receive denosumab SC on day 1 (days 1, 8, and 15 of course 1 only). Treatment repeats every 4 weeks (28 days) for up to 24 months or 26 courses, whichever occurs first, in the absence of disease progression or unacceptable toxicity.