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Children’s Oncology Group Sarcoma Plans Holcombe E. Grier MD For the Children’s Oncology Group.

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Presentation on theme: "Children’s Oncology Group Sarcoma Plans Holcombe E. Grier MD For the Children’s Oncology Group."— Presentation transcript:

1 Children’s Oncology Group Sarcoma Plans Holcombe E. Grier MD For the Children’s Oncology Group

2 Lots of Folks Involved Bone Sarcoma Committee  Neyssa Marina- chair  Rich Gorlick- vice chair  Mark Bernstein- previous chair of bone sarcoma committee  Mark Krailo- biostatistician Soft Tissue Sarcoma Committee  William Meyer- chair  Doug Hawkins- vice chair  James Anderson- biostatistician

3 Plan: Present Upfront and Relapsed Trials for Following Diseases Bone tumors  Osteosarcoma  Ewing Sarcoma Soft Tissue Sarcomas  Rhabdomyosarcoma  Non-Rhabo STS  Infantile fibrosarcoma  Desmoid tumor

4 Osteosarcoma: Up front trials Patients without metastases: Euramos (Neyssa Marina USA chair) Metastatic:  Recently completed trial of feasibility of adding transtuzumab (herceptan) to MAP (David Ebb)  Plan to incorporate bisphosfonates (zolendronic acid) into MAP background

5 Osteosarcoma-Treatment at First Pulmonary Relapse: Inhaled GM-CSF (Arndt PI) For patients with bilateral mets  Resect one side  2 cycles GM-CSF  Resect other side- measure Fas/FasL in tumor Also using for patients with unilateral disease Disease free interval will be measured

6 Ewing Sarcoma: Upfront treatment Patients without metastases  Still analyzing dose compression trial (Rick Womer)  Next trial will incorporate topotecan/cyclophosphamide pair (Mason Bond) Patients with metastases  EuroEwings: pulmonary mets (Doug Hawkins)  Metranomic therapy (Judy Felgenhauer)

7 Schema: AEWS0031 (Mason Bond) RANDOMIZERANDOMIZE VAdCA alt with I/E Duration 48 weeks VAdCA alt with I/E alt with V/T/C

8 Metronomic Therapy for Patients Presenting with Extensive Metastases PI Felgenhauer Standard therapy backbone (Vcr, Dox, Cyclophos alt with ifosfamide/etoposide) Overlay of  Celecoxib 250 mg/m 2 per day  Vinblastine 1 mg/m 2 three times weekly Objective is feasibility of regimen, estimation of EFS, assessment of surrogate angiogen. markers Will reach accrual soon

9 Concept for Next Trial for Patients with Extensive Metastases Pilot to look at addition of irinotecan/temozolomide to standard therapy Goal will be feasibility Also considering bevacizumab randomization

10 Rhabdomyosarcoma-Up Front Patients Without Metastases Low Risk (David Waterhouse PI) Emb only  4 courses VAC for all patients; Subset A stops Stage 1, clinical group I/II & orbital group III, stage 2 clinical group I, II  4 more VA courses for subset B Stage 1, group III not orbit or stage 3 clinical group I/II Intermediate risk (Doug Hawkins PI)  Randomize VAC vs VAC alternating with Vincristine/Irinotecan

11 Rhabdomyosarcoma Patients Presenting with Metastases Brenda Weigel PI Intensive regimen Rx  Vincristine, irinotecan window  VDC  IE  Iriniotecan/vcr during radiation

12 NRSTS NRSTS: Risk based rx, Sherry Spunt PI  7 cycles ID Infantile fibrosarcoma, Mignon Loh PI  VAC, stopping C before infertility likely  Convert non-operable to operable Desmoid tumors, Steve Skapek PI  f/u to mtx/vbl study  Sulindac and tamoxifen

13 Biology Trials Collecting specimens at diagnosis for each tumor type Collection process has been extremely successful Committees review concepts for use of the tissue

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