Anlotinib and Irinotecan for Ewing Sarcoma

Study Overview
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Brief Summary
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The investigators explored the activity of anlotinib combined with irinotecan in patients with relapsed and metastatic Ewing Sarcoma.

Detailed Description
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After standard multimodal therapy, the prognosis of relapsed and metastatic Ewing Sarcoma is dismal and unchanged over the last decades.Thus, the investigators explored the activity of anlotinib combined with irinotecan in patients with relapsed and metastatic Ewing Sarcoma after the failure of first-line chemotherapy with doxorubicin, vincristine, cyclophosphamide, ifosphamide and etoposide.

Official Title
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Anlotinib and Irinotecan for Advanced Ewing Sarcoma After Failure of Standard Multimodal Therapy

Conditions
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Ewing's Tumor Metastatic

Intervention / Treatment
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* Drug: Anlotinib
* Drug: Irinotecan


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Histologically confirmed Ewing sarcoma. Evidence of Ewing sarcoma translocation by fluorescence in situ hybridization (FISH) or real-time polymerase chain reaction (RT-PCT). Recurrent or refractory tumors with no known curative treatment options according to the judgment of the investigator. Prior treatment consisted of standard Ewing Sarcoma chemotherapy agents including doxorubicin, vincristine, cyclophosphamide, ifosfamide and etoposide; metastatic relapsed and unresectable progressive disease (PD); Life expectancy of ≥ 3 months. Eastern Cooperative Oncology Group performance status 0-1 Measurable disease on CT or MRI by RECIST 1.1. Adequate organ function. Time elapsed from previous therapy must be ≥ 3 weeks for systemic therapy, ≥ 2 weeks for radiation therapy or major surgery. Patients who have undergone autologous hematopoietic stem cell transplantation are eligible once they have recovered from all toxicities from therapy. Patients who have received allogeneic hematopoietic stem cell transplantation will be eligible 6 months after the procedure provided there is no evidence of active graft-versus-host disease and immunosuppressive treatment has been discontinued for at least 30 days. Patients with central nervous system disease are eligible for enrollment if they have received prior radiotherapy or surgery to sites of central nervous system metastatic disease, have been off glucocorticoids for at least 4 weeks, have no overt evidence of neurological deficit and are ≥ 6 weeks from completion of brain irradiation. Females of childbearing potential as well as males and their partners must agree to use an effective form of contraception during the study and for 6 months following the last dose of study medication. Exclusion Criteria: Clinically significant unrelated illness which would, in the judgment of the treating physician, compromise the patient's ability to tolerate the investigational agent or be likely to interfere with the study procedures or results. Prior treatment consisted of anlotinib, any other antiangiogenic TKIs, or irinotecan. Patients with baseline corrected QT interval(QTc) > 480 msec. Known hypersensitivity reaction to anlotinib or any of its components, and irinotecan or any of its components. Concomitant use of any other investigational or anticancer agent(s). Pregnant patients or patients who are breast feeding. Subjects capable of pregnancy (post menarche and not post-menopausal, defined as over 12 months since final menstrual period) must have a negative pregnancy test within 7 days prior to first dose. Inability to swallow capsules or water. Other clinically significant malignant disease diagnosed within the previous 5 years, excluding intra-epithelial cervical neoplasia or non-melanoma skin cancer. Known persistent (> 4 weeks) ≥ Grade 2 neutropenia, ≥ Grade 2 thrombocytopenia or > Grade 3 anemia from prior cancer therapy. Other kinds of malignant tumors at the same time.

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Anlotinib and Irinotecan(phase 1b)<br>Anlotinib 12 or 8 mg/d PO on days 1-14 q3w. Irinotecan 20 or 15mg/m^2/d over 60 minutes on days 1-5 and 8-12 q3w. Vincristine 1.4mg/m^2/d IV on days 1,8 q3w. Treatment repeats every 3 weeks for at least 2 courses in the absence of disease progression or unacceptable toxicity. | Drug: Anlotinib<br>* Anlotinib 12 or 8 mg/d po D1-14 q3w<br>* Other names: AL3818;Drug: Irinotecan<br>* Irinotecan 20 or 15mg/m^2/d IV over 60 minutes on days 1-5 and 8-12, q3w<br>* Other names: Camptosar;|
| Experimental: Anlotinib and Irinotecan(phase 2)<br>Anlotinib 12 or 8 mg/d PO on days 1-14 q3w. Irinotecan 20 or 15 mg/m^2/d IV over 60 minutes on days 1-5 and 8-12 q3w. The final dose of anlotinib and irinotecan depends on the result from previous phase Ib study. Vincristine 1.4mg/m^2/d IV on days 1,8 q3w. Treatment repeats every 3 weeks for at least 2 courses in the absence of disease progression or unacceptable toxicity. | Drug: Anlotinib<br>* Anlotinib 12 or 8 mg/d po D1-14 q3w<br>* Other names: AL3818;Drug: Irinotecan<br>* Irinotecan 20 or 15mg/m^2/d IV over 60 minutes on days 1-5 and 8-12, q3w<br>* Other names: Camptosar;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximum tolerated dose (MTD) (phase 1b) | evaluate the maximum tolerated dose (MTD) of combination therapy with irinotecan and anlotinib | 12 months | 
| Object response rate(ORR) at 12 weeks (phase 2) | complete response (CR) + partial response (PR) at 12 weeks | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Progression-free survival(PFS) | Calculated from the date of treatment start until the time of disease progression or death, whichever comes first. | 2 years | 
| Overall survival(OS) | Calculated from the date of treatment start until last follow-up or death, whichever comes first. | 2 years | 
| Adverse Effect | Adverse effect measured by CTCAE v.4 (Common Terminology Criteria for Adverse Events) | 2 years | 
| Quality of Life (QoL) | Quality of Life measured by EORTC QLQ(quality of life questionnair) C-30 for adults or PedsQL3.0 for children. | 2 years | 
| Pain management | Pain management measured by Visual Analog Score for pain. | 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Ewing Sarcoma, Anlotinib, Irinotecan, Refractory, Metastatic