Natural History and Biospecimen Acquisition for Children and Adults With Rare Solid Tumors

Study Overview
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Brief Summary
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Background: Approximately 150 cases of cancer per one million per year are considered rare cancers. While all tumors originate from genetic changes, a small percentage of these tumors are familial. Researchers want to study these changes in biological samples from people with rare tumors in order to learn more about how these tumors develop. The information obtained from this study may lead to improved screening, preventive guidelines, and treatments. Objective: To better understand rare cancers and hereditary cancer syndromes. Eligibility: People who have a rare tumor, a family history of a rare tumor, a hereditary cancer syndrome, or a mutation that leads to rare tumors. Design: Participants will be screened with questions about their medical history and/or that of their family members. They will give a saliva sample. Participants who have a tumor will have their medical records and tests reviewed. They will answer questions about their wellbeing and needs. They may provide a tumor tissue sample. Participants may also have: Physical exam Clinical photography Blood, urine, saliva, and stool samples taken Consultation with specialists A scan that produces a picture of the body. Either one that uses a small amount of radiation, or one that uses a magnetic field. Genetic testing/genetic counseling. Participants will be contacted once a year. They will answer updated questions about their medical and family history. Participants will be asked to contact the study team if there are changes in their tumors. Participants may be invited to join focus groups for people with the same diagnosis of rare tumors. Participants may be invited to participate in other NIH protocols. **************************************** **************************************** RARE TUMOR LIST: Acinar cell carcinoma of the pancreas Adamantinoma Adenosqaumous carcinoma of the pancreas Adrenocortical carcinoma Alveolar soft part sarcoma Anaplastic Thyroid Cancer Angiosarcoma Atypical Teratoid Rhabdoid Tumor/MRT Carcinoid Carcinoma of Unknown Primary Chondrosarcoma Chondromyxoid fibroma Chordoma Clear cell renal carcinoma Clear Cell Sarcoma Clear cell sarcoma of kidney Conventional chordoma Dedifferentiated chordoma Desmoid Desmoplastic small round cell tumor Epithelioid hemangioendothelioma Esthenioneuroblastoma Ewing Sarcoma Fibrolamellar carcinoma Fusion negative rhabdomyosarcoma Fusion positive renal cell carcinoma Fusion positive rhabdomyosarcoma Gastro-enteropancreatic neuroendocrine tumor Hepatoblastoma Hereditary Diffuse Gastric Cancer Inflammatory myofibroblastic tumor Kaposiform hemangioendothelioma Malignant ectomesenchymal tumor Malignant peripheral nerve sheath tumor Malignant triton tumor Medullary thyroid cancer Mixed acinar adenocarcinoma Mixed acinar neuroendocrine carcinoma Myxoid Liposarcoma Neuroblastoma Neuroendocrine tumors NUT midline carcinoma Osteosarcoma Pancreas ductal adenocarcinoma with squamous features Pancreatic acinar cell carcinoma Papillary renal cell carcinoma Paraganglioma Parosteal Osteosarcoma Periosteal Osteosarcoma Peripheral nerve sheath tumor Peripheral primitive neuroectodermal tumor Pheochromocytoma Pituitary cancer Poorly differentiated chordoma Renal medullary carcinoma Rhabdomyosarcoma Round cell Liposarcoma Schwannoma Sclerosing Epithelioid Fibrosarcoma SDH deficient GIST SMARCB1 deficient tumors SMARCA4 deficient tumors Synovial sarcoma Undifferentiated Sarcoma **************************************** ****************************************

Detailed Description
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Background: Rare tumors are defined as fewer than 150 incident cases per one million per year. Consequently, only 11 tumor types are common in U.S. adults (prostate, breast, lung/bronchus, colon, uterus, bladder, melanoma, rectum, ovary, non-Hodgkin lymphoma, and kidney/renal pelvis neoplasms) and will not be studied in this trial. One-quarter of all adults with tumor have a rare tumor diagnosis. All pediatric tumors meet this definition of rare affecting < 1% individuals younger than 20 years per year in the US. Notably, there is a group of solid tumors that occur so infrequently in children and adults that little is known about the natural history of these tumors, their clinical behavior, molecular/genetic characteristics, optimal management, and drug response. The NCI and the NIH Clinical Center infrastructure are uniquely suited to conduct studies of rare tumors. There is a precedent in the NCI when even non-interventional studies or initiatives were paradigm-changing. The NCI neurofibromatosis type 1 natural history study allowed the development of groundbreaking interventional trials in participants with plexiform neurofibromas. The Pediatric and Wild-Type Gastrointestinal Stromal Tumor (GIST) Clinic, which involves intramural and extramural experts, not only provided the background for discovery of the molecular features of a very rare disease such as succinate dehydrogenase deficient GIST, but also was able identify therapeutic strategies for this group of participants (for example, avoidance of unnecessarily aggressive surgery). Similarly, studies in adults at the CCR have tremendously advanced the understanding of rare solid tumors occurring primarily in adults such as thymoma, renal cell cancer, and endocrine tumors. Systematic and longitudinal collection and annotation of clinical history, tissue samples, imaging studies, patient reported outcomes, and other pertinent information in participants with these rare tumors and return of results to participants will provide a service to the participants themselves and to the medical community, in line with the NIH mission of to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability . Objective: To comprehensively and longitudinally evaluate the natural history of participants with rare solid tumors or tumor predisposition syndromes, estimating and defining their clinical spectrum (e.g. disease course and survival). Eligibility: Participants with a diagnosis of a rare solid tumor (fewer than 15 cases in 100,000 people per year). OR Relatives of participants with diagnosis of rare solid tumors OR Carriers of germline genetic variants that predispose to rare solid tumor and their relatives. Design: This will be a long-term study to comprehensively study participants (and their relatives) with select rare tumors. Initially participants will provide clinical information (medical history, family medical history, imaging studies and reports, surgical pathology reports, genetic test results, patient-reported outcomes) and biospecimens (archival pathology specimen and saliva) for review by and feedback from the study team. If indicated, participants will be invited to the study site for additional evaluations and consultation, including clinical phenotyping, genotyping, imaging of tumor sites, and patient reported or other appropriate outcomes. After evaluation, participants will be provided with recommendations about possible treatment options and might be enrolled into disease specific sub-protocols of this trial. Since long-term follow-up of individuals with rare tumors, their family members at high risk for developing tumors, and carriers of germline genetic variants is a major feature of the study, we intend to maintain active contact with study subjects for as long as possible. In addition to evaluating individual participants, this protocol will allow bringing groups of participants (approximately 10-20) with specific rare tumors for a rare tumor clinic on the same day to allow for development of a deeper understanding of rare tumors through the conduct of focus groups.

Official Title
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Natural History and Biospecimen Acquisition Study for Children and Adults With Rare Solid Tumors

Conditions
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Malignant Solid Tumors, Other Neoplasms Solid Tumors, Pediatric Solid Tumor, Refractory Solid Tumors, Solid Tumor

Participation Criteria
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Eligibility Criteria
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INCLUSION CRITERIA: Cohort 1: Participants with a diagnosis of a rare solid tumor (fewer than 15 cases in 100,000 people per year). There are no age restrictions beyond the neonatal period (4 weeks). OR -Cohort 2: Participants without a rare tumor who have a germline genetic variant that predisposes to a rare solid tumor OR -Cohort 3: Relatives of participants with diagnosis of rare solid tumors who do NOT have a known germline variant that predisposes to a rare solid tumor OR Cohort 4: Parent/guardian of child participating in a focus group if not already enrolled on the study. Ability of subject or Legally Authorized Representative (LAR) to understand and the willingness to sign a written informed consent document. EXCLUSION CRITERIA: None

Ages Eligible for Study
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Minimum Age: 4 Weeks

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| 1/Cohort 1<br>Subjects with a diagnosis of rare tumor (fewer than 15 cases in 100,000 people per year) | |
| 2/Cohort 2<br>Relatives of subjects with a rare tumor who have a germline genetic variant that predispose to a rare solid tumor or a subject who has a germline genetic variant that predispose to a rare solid tumor | |
| 3/Cohort 3<br>Relatives of subjects with a diagnosis of rare tumor that do NOT have known germline genetic variants that predispose to a rare solid tumor. | |
| 4/ Cohort 4<br>Parents/guardians of children with a diagnosis of rare tumor participating in focus groups (if not enrolled in Cohorts 1, 2 or 3) | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To comprehensively and longitudinally evaluate the natural history of patients with rare solid tumors or tumor predisposition syndromes, estimating and defining their clinical spectrum (e.g. disease course and survival) | To comprehensively and longitudinally evaluate the natural history of patients with rare solid tumors or tumor predisposition syndromes, estimating and defining their clinical spectrum (e.g. disease course and survival) | 10 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Service to the Patients, Knowledge about the Nature of Cancer, Cancer Evaluations, Natural History