Samarium Sm 153 and Stem Cell Transplant Followed By Radiation Therapy Patients With Osteosarcoma
Condition: Sarcoma
MeSH terms: Sarcoma; Osteosarcoma
Study type: Interventional
Phase: Phase 2

Summary: 
      RATIONALE: Radioactive drugs, such as samarium Sm 153 lexidronam pentasodium, may carry
      radiation directly to tumor cells and not harm normal cells. A peripheral stem cell
      transplant may be able to replace blood-forming cells that were destroyed by chemotherapy and
      samarium Sm 153 lexidronam pentasodium. Radiation therapy uses high-energy x-rays to kill
      tumor cells. Giving samarium Sm 153 lexidronam pentasodium together with a peripheral stem
      cell transplant and radiation therapy may kill more tumor cells.

      PURPOSE: This phase II trial is studying how well giving samarium Sm 153 lexidronam
      pentasodium together with autologous stem cell transplant and radiation therapy works in
      treating patients with recurrent or refractory, metastatic, or unresectable osteosarcoma.
    

Detailed description: 
      OBJECTIVES:

      Primary

        -  Determine the clinical response in patients with recurrent or refractory, metastatic, or
           unresectable osteosarcoma treated with high-dose samarium Sm 153 lexidronam pentasodium
           (^153Sm-EDTMP) and autologous peripheral blood stem cell transplantation followed by
           external-beam radiotherapy.

        -  Correlate the amount of radiation delivered to a tumor with low-dose ^153Sm-EDTMP with
           that of high-dose ^153Sm-EDTMP in patients treated with this regimen.

      Secondary

        -  Determine the overall and progression-free survival of patients treated with this
           regimen.

        -  Determine the toxicity of this regimen in these patients.

        -  Determine the long-term effects of this regimen in these patients.

        -  Determine the predictive value of fludeoxyglucose F 18 positron emission tomography
           (FDG-PET), diffusion-weighted MRI, and magnetic resonance spectroscopy for evaluation of
           treatment response in patients treated with this regimen.

      OUTLINE: Patients are stratified according to resectability of the primary tumor (recurrent,
      refractory, or very high-risk disease vs unresectable primary tumor).

        -  Mobilization and collection of autologous peripheral blood stem cells (PBSCs)* :
           Patients receive ifosfamide IV daily for 5 days followed by filgrastim (G-CSF)
           subcutaneously daily. Patients then undergo leukapheresis for collection of autologous
           PBSCs until ≥ 2 x 10^6 CD34 (cluster of differentiation 34)-positive cells/kg are
           collected.

      NOTE: *Patients who have undergone PBSC collection before study entry proceed to high-dose
      samarium Sm 153 lexidronam pentasodium (153Sm-EDTMP) infusion without mobilization and
      collection of autologous PBSCs.

        -  153Sm-EDTMP infusion: Patients receive a trace dose of ^153Sm-EDTMP** IV over 1-2
           minutes and undergo bone scan 4, 24, and 48-72 hours later. Six weeks later, patients
           receive high-dose ^153Sm-EDTMP IV over 1-2 minutes and undergo repeat bone scans 4, 24,
           and 48-72 hours later.

      NOTE: **Patients may receive the trace dose on protocol JHOC (Johns Hopkins Oncology
      Center)-J0094.

        -  Autologous peripheral blood stem cell transplantation (PBSCT): Between 12-14 days after
           administration of high-dose ^153Sm-EDTMP, patients undergo autologous PBSCT. Beginning 2
           days later, patients receive G-CSF IV daily.

        -  External-beam radiotherapy: Patients then undergo external-beam radiotherapy to the
           sites of bulky disease.

        -  Surgery: Some patients may also undergo surgical resection of residual disease. After
           completion of study treatment, patients are followed periodically for up to 3 years.

      PROJECTED ACCRUAL: A total of 54 patients will be accrued for this study.
    

Intervention name(s): filgrastim; ifosfamide; peripheral blood stem cell transplantation; Sm-EDTMP (low dose); sm-EDTMP (higher dose)
Intervention type(s): Biological; Drug; Procedure; Radiation; Radiation
Intervention description(s): Filgrastim will be administered post post chemotherapy until target WBC (white blood cell) count is achieved.; Ifosfamide administered IV.; Peripheral blood stem cell transplantation is done 14 days after 2nd dose of Samarium is delivered; Sm-EDTMP (low dose) administered after autologous stem cell collection; Upon blood cell count recovery from Sm-EDTMP (low dose), Sm-EDTMP (higher dose) is administered followed in 14 days by peripheral blood stem cell transplantation.
Other intervention name(s): Neupogen; Ifex
Intervention MeSH terms: Ifosfamide; Samarium Sm-153 lexidronam
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: recurrent osteosarcoma; metastatic osteosarcoma; localized osteosarcoma