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Methotrexate, Trimetrexate Glucuronate, and Leucovorin in Treating Patients With Refractory or Recurrent Osteosarcoma

Primary Purpose

Sarcoma

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
leucovorin calcium
methotrexate
trimetrexate glucuronate
Sponsored by
Memorial Sloan Kettering Cancer Center
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Sarcoma focused on measuring recurrent osteosarcoma

Eligibility Criteria

1 Year - 35 Years (Child, Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: Histologically confirmed malignant osteosarcoma High-grade disease Recurrent or refractory disease after prior standard chemotherapy comprising methotrexate, doxorubicin, cisplatin, and ifosfamide No low-grade osteosarcoma No parosteal or periosteal sarcoma No osteosarcoma arising in premalignant bony lesions (e.g., Paget's disease) OR in a prior radiotherapy field No symptomatic or known brain or leptomeningeal involvement PATIENT CHARACTERISTICS: Age 1 to 35 Performance status Karnofsky 70-100% (for patients > 16 years of age) Lansky 70-100% (for patients ≤ 16 years of age) Life expectancy At least 3 months Hematopoietic Absolute neutrophil count ≥ 1,000/mm^3 Platelet count ≥ 75,000/mm^3 Hepatic Bilirubin ≤ 1.5 times normal AST and ALT ≤ 5 times normal Albumin ≥ 2 g/dL No clinically significant liver disease Renal Creatinine ≤ 1.5 times normal OR Creatinine clearance or radioisotope glomerular filtration rate ≥ lower limit of normal Cardiovascular Shortening fraction ≥ 27% by echocardiogram OR Ejection fraction ≥ 50% by gated radionuclide study No congestive heart failure No angina pectoris No myocardial infarction within the past year No uncontrolled arterial hypertension No uncontrolled arrhythmias Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No history of significant neurological or psychiatric disorder No active infection No symptomatic peripheral neuropathy ≥ grade 2 No other serious illness or medical condition PRIOR CONCURRENT THERAPY: Biologic therapy At least 7 days since prior biologic therapy At least 6 months since prior allogeneic stem cell transplantation AND no evidence of active graft-versus-host disease No concurrent sargramostim (GM-CSF) Chemotherapy See Disease Characteristics More than 2 weeks since prior myelosuppressive chemotherapy (4 weeks for nitrosoureas) Endocrine therapy Not specified Radiotherapy See Disease Characteristics At least 2 weeks since prior local palliative radiotherapy (small port) At least 6 months since prior craniospinal radiotherapy At least 6 months since prior radiotherapy to ≥ 50% of the pelvis At least 6 weeks since prior substantial radiotherapy to the bone marrow Surgery Not specified Other Recovered from prior therapy More than 30 days since prior and no other concurrent investigational drugs More than 30 days since prior and no concurrent participation in another clinical trial No concurrent medications that may interact with study drugs

Sites / Locations

  • Memorial Sloan-Kettering Cancer Center

Outcomes

Primary Outcome Measures

Maximum tolerated dose (MTD) after 1 course of treatment
Dose-limiting toxicities as assessed by hematology and biochemistry testing on days 1, 8, and 28 of each course

Secondary Outcome Measures

Antitumor activity as measured by radiographic response using RECIST criteria after every 2 courses of treatment
Antitumor activity as measured by pathologic response using the Huvos grading system to evaluate post-treatment tumor necrosis at time of tumor resection after completion of study treatment

Full Information

First Posted
July 12, 2005
Last Updated
January 15, 2013
Sponsor
Memorial Sloan Kettering Cancer Center
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00119301
Brief Title
Methotrexate, Trimetrexate Glucuronate, and Leucovorin in Treating Patients With Refractory or Recurrent Osteosarcoma
Official Title
Phase I Study of High Dose Methotrexate With Simultaneous Trimetrexate and Leucovorin in Patients With Recurrent Osteosarcoma
Study Type
Interventional

2. Study Status

Record Verification Date
January 2013
Overall Recruitment Status
Completed
Study Start Date
April 2005 (undefined)
Primary Completion Date
April 2007 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Name of the Sponsor
Memorial Sloan Kettering Cancer Center
Collaborators
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
RATIONALE: Drugs used in chemotherapy, such as methotrexate, trimetrexate glucuronate, and leucovorin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) may kill more tumor cells. PURPOSE: This phase I trial is studying the side effects and best dose of trimetrexate glucuronate when given together with methotrexate and leucovorin in treating patients with refractory or recurrent osteosarcoma.
Detailed Description
OBJECTIVES: Primary Determine the maximum tolerated dose of trimetrexate glucuronate when administered with high-dose methotrexate and leucovorin calcium in patients with refractory or recurrent high-grade osteosarcoma. Secondary Determine the dose-limiting toxic effects of this regimen in these patients. Determine, preliminarily, the antitumor activity of this regimen in these patients. OUTLINE: This is a dose-escalation study of trimetrexate glucuronate. Patients receive high-dose methotrexate IV over 4 hours on days 1 and 8 and oral trimetrexate glucuronate twice daily on days 2-6 and 9-13. Patients also receive leucovorin calcium IV continuously over 24 hours or orally 2 or 4 times daily on days 9-14. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of trimetrexate glucuronate until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. PROJECTED ACCRUAL: A maximum of 18 patients will be accrued for this study within 2 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Sarcoma
Keywords
recurrent osteosarcoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Enrollment
18 (Anticipated)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
leucovorin calcium
Intervention Type
Drug
Intervention Name(s)
methotrexate
Intervention Type
Drug
Intervention Name(s)
trimetrexate glucuronate
Primary Outcome Measure Information:
Title
Maximum tolerated dose (MTD) after 1 course of treatment
Title
Dose-limiting toxicities as assessed by hematology and biochemistry testing on days 1, 8, and 28 of each course
Secondary Outcome Measure Information:
Title
Antitumor activity as measured by radiographic response using RECIST criteria after every 2 courses of treatment
Title
Antitumor activity as measured by pathologic response using the Huvos grading system to evaluate post-treatment tumor necrosis at time of tumor resection after completion of study treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
1 Year
Maximum Age & Unit of Time
35 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed malignant osteosarcoma High-grade disease Recurrent or refractory disease after prior standard chemotherapy comprising methotrexate, doxorubicin, cisplatin, and ifosfamide No low-grade osteosarcoma No parosteal or periosteal sarcoma No osteosarcoma arising in premalignant bony lesions (e.g., Paget's disease) OR in a prior radiotherapy field No symptomatic or known brain or leptomeningeal involvement PATIENT CHARACTERISTICS: Age 1 to 35 Performance status Karnofsky 70-100% (for patients > 16 years of age) Lansky 70-100% (for patients ≤ 16 years of age) Life expectancy At least 3 months Hematopoietic Absolute neutrophil count ≥ 1,000/mm^3 Platelet count ≥ 75,000/mm^3 Hepatic Bilirubin ≤ 1.5 times normal AST and ALT ≤ 5 times normal Albumin ≥ 2 g/dL No clinically significant liver disease Renal Creatinine ≤ 1.5 times normal OR Creatinine clearance or radioisotope glomerular filtration rate ≥ lower limit of normal Cardiovascular Shortening fraction ≥ 27% by echocardiogram OR Ejection fraction ≥ 50% by gated radionuclide study No congestive heart failure No angina pectoris No myocardial infarction within the past year No uncontrolled arterial hypertension No uncontrolled arrhythmias Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No history of significant neurological or psychiatric disorder No active infection No symptomatic peripheral neuropathy ≥ grade 2 No other serious illness or medical condition PRIOR CONCURRENT THERAPY: Biologic therapy At least 7 days since prior biologic therapy At least 6 months since prior allogeneic stem cell transplantation AND no evidence of active graft-versus-host disease No concurrent sargramostim (GM-CSF) Chemotherapy See Disease Characteristics More than 2 weeks since prior myelosuppressive chemotherapy (4 weeks for nitrosoureas) Endocrine therapy Not specified Radiotherapy See Disease Characteristics At least 2 weeks since prior local palliative radiotherapy (small port) At least 6 months since prior craniospinal radiotherapy At least 6 months since prior radiotherapy to ≥ 50% of the pelvis At least 6 weeks since prior substantial radiotherapy to the bone marrow Surgery Not specified Other Recovered from prior therapy More than 30 days since prior and no other concurrent investigational drugs More than 30 days since prior and no concurrent participation in another clinical trial No concurrent medications that may interact with study drugs
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Paul A. Meyers, MD
Organizational Affiliation
Memorial Sloan Kettering Cancer Center
Official's Role
Study Chair
Facility Information:
Facility Name
Memorial Sloan-Kettering Cancer Center
City
New York
State/Province
New York
ZIP/Postal Code
10021
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Methotrexate, Trimetrexate Glucuronate, and Leucovorin in Treating Patients With Refractory or Recurrent Osteosarcoma

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