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Tester une nouvelle combinaison de médicaments anticancéreuses chez les patients nouvellement diagnostiqués avec du sarcome d'Ewing qui ont un cancer qui s'est propagé à d'autres parties du corps

2 octobre 2026 mis à jour par: Children's Oncology Group

Essai de phase 2/3 randomisée de la vincristine-irinotécan-régorafenib en combinaison avec la vincristine-doxorubicine-cyclophosphamide (VDC) et l'ifosfamide-étoposide (IE) chez les patients atteints de sarcome métastatique métastatique nouvellement diagnostiqué (IE) chez le sarcome d'ewing métastatique nouvellement diagnostiqué (IE) chez les ewing métastatiques nouvellement diagnostiqués (IE).

This phase II/III trial compares the effect of vincristine, irinotecan, and regorafenib (VIrR) in combination with vincristine, doxorubicin, cyclophosphamide (VDC), ifosfamide and etoposide (IE) to usual treatment with VDC/IE for the treatment of newly diagnosed Ewing sarcoma or other round cell sarcomas that have spread from where they first started (primary site) to other places in the body (metastatic). Vincristine is in a class of medications called vinca alkaloids. It works by stopping tumor cells from growing and dividing and may kill them. Irinotecan is in a class of antineoplastic medications called topoisomerase I inhibitors. It blocks a certain enzyme needed for cell division and deoxyribonucleic acid (DNA) repair and may kill tumor cells. Regorafenib, a type of kinase inhibitor and a type of antiangiogenesis agent, blocks certain proteins, which may help keep tumor cells from growing. It may also prevent the growth of new blood vessels that tumors need to grow. Doxorubicin is in a class of medications called anthracyclines. Doxorubicin damages the cell's DNA and may kill tumor cells. It also blocks a certain enzyme needed for cell division and DNA repair. Cyclophosphamide is in a class of medications called alkylating agents. It works by damaging the cell's DNA and may kill tumor cells. It may also lower the body's immune response. Ifosfamide, a type of alkylating agent and a type of antimetabolite, attaches to DNA in cells and may kill tumor cells. Etoposide is in a class of medications known as podophyllotoxin derivatives. It blocks a certain enzyme needed for cell division and DNA repair and may kill tumor cells. Giving VIrR/VDC/IE may be more effective than usual treatment with VDC/IE in treating patients with newly diagnosed metastatic Ewing sarcoma or other round cell sarcomas.

Aperçu de l'étude

Description détaillée

PRIMARY OBJECTIVE:

I. To determine if the event-free survival (EFS) in patients with newly diagnosed metastatic Ewing sarcoma is improved when treated with vincristine-irinotecan-regorafenib (VIrR) after initial treatment with vincristine-doxorubicin-cyclophosphamide (VDC) and ifosfamide-etoposide (IE) compared to patients treated with 17 cycles of interval compressed VDC and IE chemotherapy.

SECONDARY OBJECTIVES:

I. To compare the overall survival (OS) of patients with newly diagnosed metastatic Ewing sarcoma treated with VDC/IE/VIrR versus VDC/IE.

II. To compare the toxicity profile of VDC/IE/VIrR to VDC/IE in patients with newly diagnosed metastatic Ewing sarcoma, using both investigator-reported and patient-reported Common Terminology Criteria for Adverse Events (CTCAE).

III. To describe the feasibility and toxicity of augmented dose radiotherapy with 64.8 Gy as local control for patients with newly diagnosed metastatic Ewing sarcoma with large primary tumors.

IV. To prospectively validate that circulating tumor-derived DNA (ctDNA) levels greater than or equal to 5% at the time of diagnosis are associated with increased risk of EFS-event for patients with newly diagnosed metastatic Ewing sarcoma.

V. To prospectively validate that elevated ctDNA levels greater than or equal to 0.5% burden following one cycle of chemotherapy are associated with increased risk of EFS-event for patients with newly diagnosed metastatic Ewing sarcoma.

EXPLORATORY OBJECTIVES:

I. To estimate 1- and 2-year EFS and response rate for patients with newly diagnosed, eligible metastatic round cell sarcomas other than Ewing sarcoma.

II. To characterize the change in fludeoxyglucose F-18 (FDG)-positron emission tomography (PET) imaging response of primary disease site at the end of Induction chemotherapy and its association with EFS.

III. To explore distinguishing histologic attributes of Ewing sarcoma and round cell sarcomas that mimic Ewing sarcoma.

IV. To collect bone marrow and tissue samples to bank for future research. V. To explore other ctDNA predictor variables, time points, and potential association with EFS in patients with newly diagnosed metastatic Ewing sarcoma.

VI. To estimate the frequency of selected toxicities by Patient Reported Outcomes (PRO)-CTCAE and symptom bother by Functional Assessment of Cancer Therapy General Questionnaire (FACT-G) and to evaluate if these findings are associated with duration of protocol therapy and treatment arm.

OUTLINE:

INDUCTION: Patients receive vincristine intravenously (IV) on days 1 and 8, doxorubicin IV over 3-15 minutes on days 1 and 2, and cyclophosphamide IV over 30-60 minutes on day 1 of cycles 1, 3 and 5. Patients also receive ifosfamide IV over 1 hour and etoposide IV over 1 hour on days 1-5 of cycles 2, 4 and 6. Cycles repeat every 14 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. Patients then undergo surgery or radiation therapy per investigator choice.

CONSOLIDATION I: Patients receive vincristine IV on days 1 and 8, doxorubicin IV over 3-15 minutes on days 1 and 2, and cyclophosphamide IV over 30-60 minutes on day 1 of cycles 1 and 2. Patients also receive ifosfamide IV over 1 hour and etoposide IV over 1 hour on days 1-5 of cycles 3 and 4. Cycles repeat every 14 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.

CONSOLIDATION II: After 10 cycles of therapy, patients with Ewing Sarcoma are randomized to 1 of 2 regimens. Patients with a diagnosis of other eligible metastatic round cell sarcomas are assigned to Regimen A.

REGIMEN A: Patients receive vincristine IV on days 1 and 8 and cyclophosphamide IV over 30-60 minutes on day 1 of cycles 1, 3, 5 and 7. Patients also receive ifosfamide IV over 1 hour and etoposide IV over 1 hour on days 1-5 of cycles 2, 4 and 6. Cycles repeat every 14 days for up to 7 cycles in the absence of disease progression or unacceptable toxicity. After systemic therapy completed, patients undergo metastatic site radiation therapy.

REGIMEN B: Patients receive vincristine IV on days 1 and 8 and irinotecan IV over 90 minutes on days 1-5 of each cycle. Patients also receive regorafenib orally (PO) on days 8-14 or 15-21 of cycle 1, and then on days 8-21 of cycles thereafter. Cycles repeat every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. After systemic therapy completed, patients undergo metastatic site radiation therapy.

Additionally, patients undergo blood sample collection, echocardiography, magnetic resonance imaging (MRI), computed tomography (CT), chest CT, and/or FDG-PET throughout the study. Patients may also undergo optional collection of tumor tissue and/or bone marrow aspiration and biopsy on study.

After completion of study treatment, patients are followed every 3 months for years 1 and 2, every 6 months for years 3 and 4 then every 12 months for years 5-10.

Type d'étude

Interventionnel

Inscription (Réel)

2

Phase

  • Phase 2
  • Phase 3

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Lieux d'étude

    • Alabama
      • Birmingham, Alabama, États-Unis, 35233
        • Children's Hospital of Alabama
    • Hawaii
      • Honolulu, Hawaii, États-Unis, 96826
        • Kapiolani Medical Center for Women and Children
    • Illinois
      • Chicago, Illinois, États-Unis, 60611
        • Lurie Children's Hospital-Chicago
      • Peoria, Illinois, États-Unis, 61637
        • OSF Children's Hospital of Illinois
    • Pennsylvania
      • Philadelphia, Pennsylvania, États-Unis, 19134
        • Saint Christopher's Hospital for Children
    • South Carolina
      • Columbia, South Carolina, États-Unis, 29203
        • Prisma Health Richland Hospital
      • Greenville, South Carolina, États-Unis, 29605
        • BI-LO Charities Children's Cancer Center
    • Tennessee
      • Knoxville, Tennessee, États-Unis, 37916
        • East Tennessee Childrens Hospital

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

12 ans à 50 ans (Enfant, Adulte)

Accepte les volontaires sains

Non

Sexes éligibles pour l'étude

Tout

La description

Inclusion Criteria:

  • All patients must be enrolled on APEC14B1 and consented to the Molecular Characterization Initiative (Part A) prior to enrollment and treatment on AEWS2431

  • Patients must be ≥ 12 months to ≤ 50 years of age at time of enrollment

  • Newly diagnosed Ewing sarcoma and other round cell sarcomas as follows. For the purposes of eligibility, the following pathology diagnoses are eligible and molecular confirmation is not required to enroll:

    • Histologically confirmed Ewing sarcoma
    • Suspected Ewing sarcoma with molecular confirmation pending
    • Suspected high grade round cell sarcomas/sarcomas with eligible molecular alterations, pending molecular confirmation
    • Round cell sarcoma consistent with Ewing sarcoma
    • Round cell sarcoma not otherwise specified
    • Round cell sarcoma
    • Round cell sarcomas with EWSR1-non-ETS fusion
    • CIC-rearranged sarcoma
    • Sarcoma with BCOR genetic alterations
  • Patients with the following pathologic diagnoses that are known to contain EWSR1 or FUS fusions are not eligible:

    • Angiomatoid fibrous histiocytoma
    • Extraskeletal myxoid chondrosarcoma
    • Desmoplastic small round cell tumor
    • Clear cell sarcoma
    • Myxoid liposarcoma
  • If clinical molecular testing that reports both fusion partners has been successfully completed by the site prior to enrollment, patients may only enroll if that testing reported one of the eligible fusions

  • All patients must have evidence of distant metastatic disease. Biopsy of metastatic sites is not required. For this study, distant metastatic disease is defined as one or more of the following:

    • Lesions which are discontinuous from the primary tumor, are not regional lymph nodes, and do not share a bone or body cavity with the primary tumor. Skip lesions in the same bone as the primary tumor do not constitute metastatic disease. Skip lesions in an adjacent bone are considered bone metastasis. If there is any doubt whether lesions are metastatic, a biopsy of those lesions should be performed

    • Contralateral pleural effusion and/or contralateral pleural nodules

    • Distant lymph node involvement

    • Patients with pulmonary nodules are considered to have metastatic disease if the patient has:

      • Solitary nodule ≥ 0.5 cm or multiple nodules of ≥ 0.3 cm unless lesion is biopsied and negative for tumor
      • Patients with solitary nodule < 0.5 cm or multiple nodules < 0.3 cm are not considered to have lung metastasis unless biopsy documents tumor
    • Bone marrow metastatic disease (bone marrow disease) is based on morphologic evidence of Ewing sarcoma based on hematoxylin and eosin (H&E) stains. In the absence of morphologic evidence of marrow involvement on H&E, patients with bone marrow involvement detected ONLY by flow cytometry, reverse transcriptase-polymerase chain reaction (RT-PCR), fluorescence in situ hybridization (FISH), immunohistochemistry or PET-CT will NOT be considered to have clinical bone marrow involvement for the purposes of this study

  • Creatinine clearance or radioisotope glomerular filtration rate (GFR) ≥ 50 mL/min/1.73 m^2 or serum creatinine based on age/sex as follows:

    • Age: 1 to < 2 years: Male 0.6; female 0.6
    • Age: 2 to < 6 years: Male 0.8; female 0.8
    • Age: 6 to < 10 years: Male 1; female 1
    • Age: 10 to < 13 years: Male 1.2; female 1.2
    • Age: 13 to < 16 years: Male 1.5; female 1.4
    • Age: ≥ 16 years: Male 1.7; female 1.4 OR
    • A 24-hour urine creatinine clearance ≥ 50 mL/min/1.73 m^2 OR
    • A GFR ≥ 50 mL/min/1.73 m^2. GFR must be performed using direct measurement with a nuclear blood sampling method OR direct small molecule clearance method (iothalamate or other molecule per institutional standard)
  • Total bilirubin ≤ 1.5 x upper limit of normal (ULN) for age

  • Serum glutamic pyruvic transaminase (SGPT) (alanine aminotransferase [ALT]) ≤ 3 x ULN for age (except for patients with liver metastasis who may enroll if ALT ≤ 5 times ULN for age)

    • Note: For the purpose of this study, the ULN for SGPT (ALT) has been set to the value of 45 U/L
  • Shortening fraction of ≥ 27% by echocardiogram, or ejection fraction of ≥ 50% by echocardiogram

  • No known congenital QT syndrome

  • No known family history of congenital QT syndrome

  • Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, patients should be class II or better

  • Known HIV-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial

Exclusion Criteria:

  • Patients with regional node involvement as their only site of disease beyond the primary tumor

  • Patients whose primary tumors arise in the intra-dural soft tissue (e.g., brain and spinal cord)

    • Note: metastatic disease is allowable
  • Patients with known Charcot-Marie-Tooth disease

  • Patients who have had complete or partial resection of the primary tumor at initial diagnosis will only be eligible if adequate imaging (CT or MRI for most primary tumor sites) was obtained prior to surgery

  • Patients who have received prior chemotherapy for current diagnosis, except for patients who have started cycle 1 VDC post-consent and within the timelines allowed for

  • Patients who have received prior radiation therapy for current diagnosis

  • Patients previously treated with a multitargeted tyrosine kinase inhibitor

  • History of organ allograft (including allogeneic bone marrow transplant)

  • Known hypersensitivity to regorafenib

  • Active or chronic hepatitis B or C, or chronic hepatitis B or C requiring treatment with antiviral therapy

  • Patients receiving strong CYP3A4 inducers or strong CYP3A4 inhibitors

  • Female patients who are pregnant since fetal toxicities and teratogenic effects have been noted for several of the study drugs. A pregnancy test is required for female patients of childbearing potential

  • Lactating females who plan to breastfeed their infants

  • Females of childbearing potential must agree to either practice medically accepted highly-effective methods of contraception or abstain from heterosexual intercourse for the duration of the protocol therapy through 12 months after the last dose of cyclophosphamide or ifosfamide, 6 months after the last dose of doxorubicin, etoposide, and irinotecan, and 7 months after the last dose of regorafenib, whichever is longer

  • Male patients with female partners of childbearing potential must agree to either practice a medically accepted highly-effective methods of contraception or abstain from heterosexual intercourse for the duration of the protocol therapy through 6 months after the last dose of doxorubicin and ifosfamide, 4 months after the last dose of cyclophosphamide, etoposide and regorafenib, and 3 months after the last dose of irinotecan, whichever is longer

  • All patients and/or their parents or legal guardians must sign a written informed consent

  • All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

  • Objectif principal: Traitement
  • Répartition: Randomisé
  • Modèle interventionnel: Affectation parallèle
  • Masquage: Aucun (étiquette ouverte)

Armes et Interventions

Groupe de participants / Bras
Intervention / Traitement
Comparateur actif: Regimen A (VDC/IE)

See Detailed description

Given IV

Autres noms:
  • Cytoxane
  • CTX
  • (-)-Cyclophosphamide
  • 2H-1,3,2-Oxazaphosphorine, 2-[bis(2-chloroéthyl)amino]tétrahydro-, 2-oxyde, monohydraté
  • Carloxane
  • Ciclofosfamida
  • Ciclofosfamide
  • Cicloxal
  • Clafène
  • Clapène
  • CP monohydraté
  • CYCLO-cellule
  • Cycloblastine
  • Cyclophosphame
  • Cyclophosphamide monohydraté
  • Monohydrate de cyclophosphamide
  • Cyclophosphamide
  • Cyclophosphane
  • Cyclostine
  • Cytophosphane
  • Fosfaséron
  • Genoxal
  • Genuxal
  • Lédoxine
  • Mitoxane
  • Néosar
  • Revimmuniser
  • Syklofosfamide
  • WR-138719
  • Asta B 518
  • B-518
  • B518
  • WR 138719
  • WR138719
  • Frindovyx

Given IV

Autres noms:
  • Adriamycine
  • 5,12-naphtacènedione, 10-[(3-amino-2,3,6-tridésoxy-alpha-L-lyxo-hexopyranosyl)oxy]-7,8, 9,10-tétrahydro-6,8,11-trihydroxy -8-(hydroxyacétyl)-1-méthoxy-, chlorhydrate, (8S-cis)- (9CI)
  • SMA
  • Adriacine
  • Chlorhydrate d'adriamycine
  • Adriamycine PFS
  • Adriamycine RDF
  • ADRIAMYCINE, CHLORHYDRATE
  • Adriblastine
  • Adrimédac
  • Chloridrato de Doxorrubicina
  • DOX
  • DOXO-CELLULAIRE
  • Doxolem
  • Doxorubicine HCl
  • Doxorubicine.HCl
  • Doxorubine
  • Farmiblastine
  • FI 106
  • FI-106
  • hydroxydaunorubicine
  • Rubex
  • FI106

Given IV

Autres noms:
  • Oncovin
  • Kyocristine
  • Sulfate de leurocristine
  • Leurocristine, sulfate
  • Vincasar
  • Vincoside
  • Vincrex
  • Vincristine, sulfate

Undergo CT

Autres noms:
  • TDM
  • CHAT
  • Scanner
  • Tomographie axiale informatisée
  • Tomographie assistée par ordinateur
  • Tomodensitométrie
  • tomographie
  • Tomographie axiale informatisée (procédure)
  • Tomodensitométrie (TDM)
  • Scan de chat diagnostique
  • Type de service de scan de chat diagnostique

Undergo MRI

Autres noms:
  • IRM
  • Résonance magnétique
  • Balayage d'imagerie par résonance magnétique
  • Imagerie Médicale, Résonance Magnétique / Résonance Magnétique Nucléaire
  • M
  • Imagerie IRM
  • Imagerie RMN
  • NMRI
  • Imagerie par résonance magnétique nucléaire
  • Imagerie par résonance magnétique (IRM)
  • IRMs
  • Imagerie par résonance magnétique (procédure)
  • IRM structurelle

Ancillary studies

Undergo bone marrow aspiration and biopsy

Undergo bone marrow aspiration and biopsy

Autres noms:
  • Biopsie de la moelle osseuse
  • Biopsie, Moelle Osseuse

Given IV

Autres noms:
  • Déméthyl épipodophyllotoxine éthylidine glucoside
  • EPEG
  • Dernière configuration
  • Toposar
  • Vepesid
  • PV 16
  • VP16-213
  • VP-16
  • VP-16-213
  • VP16
  • VP 16213
  • VP-16213
  • VP16213

Given IV

Autres noms:
  • Asta Z 4942
  • Asta Z-4942
  • Cyfos
  • Holoxane
  • Ifex
  • IFO
  • Cellule IFO
  • Ifolem
  • Ifomida
  • Ifomide
  • Ifosfamidum
  • Ifoxane
  • IFX
  • Iphosphamide
  • Iso-Endoxan
  • Isoendoxane
  • Isophosphamide
  • Mitoxane
  • MJF 9325
  • MJF-9325
  • Naxamide
  • Seromida
  • Tronoxal
  • Z 4942
  • Z-4942

Undergo radiation

Autres noms:
  • Radiothérapie du cancer
  • ENERGY_TYPE
  • Irradier
  • Irradié
  • Irradiation
  • Radiation
  • Radiothérapie, SAI
  • Radiothérapie
  • RT
  • Thérapie, Radiation
  • Type d'énergie

Undergo echocardiography

Autres noms:
  • Échocardiographie
  • CE

Undergo surgery

Autres noms:
  • Opération
  • Type de chirurgie
  • Chirurgical
  • Intervention chirurgicale
  • Interventions chirurgicales
  • Chirurgie, SAI

Given FDG

Autres noms:
  • 18FDG
  • FDG
  • fludésoxyglucose F 18
  • Fludésoxyglucose (18F)
  • Fludésoxyglucose F18
  • Fluor-18 2-Fluoro-2-désoxy-D-Glucose
  • Fluorodésoxyglucose F18

Undergo FDG PET

Autres noms:
  • Imagerie médicale, Tomographie par émission de positrons
  • ANIMAUX
  • TEP-scan
  • Scan de tomographie par émission de positrons
  • Tomographie par émission de positrons
  • PT
  • Tomographie par émission de positrons (procédure)

Undergo bone marrow aspiration and biopsy

Autres noms:
  • Bx
  • BIOPSIE_TYPE
  • Biopsie

Undergo tissue and/or blood sample collection

Autres noms:
  • Collecte d'échantillons biologiques
  • Spécimen biologique collecté
  • Collecte de spécimens
  • Collection d'échantillons
Expérimental: Regimen B (VIrR/VDC/IE)

See Detailed Description

Given IV

Autres noms:
  • Cytoxane
  • CTX
  • (-)-Cyclophosphamide
  • 2H-1,3,2-Oxazaphosphorine, 2-[bis(2-chloroéthyl)amino]tétrahydro-, 2-oxyde, monohydraté
  • Carloxane
  • Ciclofosfamida
  • Ciclofosfamide
  • Cicloxal
  • Clafène
  • Clapène
  • CP monohydraté
  • CYCLO-cellule
  • Cycloblastine
  • Cyclophosphame
  • Cyclophosphamide monohydraté
  • Monohydrate de cyclophosphamide
  • Cyclophosphamide
  • Cyclophosphane
  • Cyclostine
  • Cytophosphane
  • Fosfaséron
  • Genoxal
  • Genuxal
  • Lédoxine
  • Mitoxane
  • Néosar
  • Revimmuniser
  • Syklofosfamide
  • WR-138719
  • Asta B 518
  • B-518
  • B518
  • WR 138719
  • WR138719
  • Frindovyx

Given IV

Autres noms:
  • Adriamycine
  • 5,12-naphtacènedione, 10-[(3-amino-2,3,6-tridésoxy-alpha-L-lyxo-hexopyranosyl)oxy]-7,8, 9,10-tétrahydro-6,8,11-trihydroxy -8-(hydroxyacétyl)-1-méthoxy-, chlorhydrate, (8S-cis)- (9CI)
  • SMA
  • Adriacine
  • Chlorhydrate d'adriamycine
  • Adriamycine PFS
  • Adriamycine RDF
  • ADRIAMYCINE, CHLORHYDRATE
  • Adriblastine
  • Adrimédac
  • Chloridrato de Doxorrubicina
  • DOX
  • DOXO-CELLULAIRE
  • Doxolem
  • Doxorubicine HCl
  • Doxorubicine.HCl
  • Doxorubine
  • Farmiblastine
  • FI 106
  • FI-106
  • hydroxydaunorubicine
  • Rubex
  • FI106

Given IV

Autres noms:
  • Oncovin
  • Kyocristine
  • Sulfate de leurocristine
  • Leurocristine, sulfate
  • Vincasar
  • Vincoside
  • Vincrex
  • Vincristine, sulfate

Undergo CT

Autres noms:
  • TDM
  • CHAT
  • Scanner
  • Tomographie axiale informatisée
  • Tomographie assistée par ordinateur
  • Tomodensitométrie
  • tomographie
  • Tomographie axiale informatisée (procédure)
  • Tomodensitométrie (TDM)
  • Scan de chat diagnostique
  • Type de service de scan de chat diagnostique

Undergo MRI

Autres noms:
  • IRM
  • Résonance magnétique
  • Balayage d'imagerie par résonance magnétique
  • Imagerie Médicale, Résonance Magnétique / Résonance Magnétique Nucléaire
  • M
  • Imagerie IRM
  • Imagerie RMN
  • NMRI
  • Imagerie par résonance magnétique nucléaire
  • Imagerie par résonance magnétique (IRM)
  • IRMs
  • Imagerie par résonance magnétique (procédure)
  • IRM structurelle

Ancillary studies

Undergo bone marrow aspiration and biopsy

Undergo bone marrow aspiration and biopsy

Autres noms:
  • Biopsie de la moelle osseuse
  • Biopsie, Moelle Osseuse

Given IV

Autres noms:
  • Déméthyl épipodophyllotoxine éthylidine glucoside
  • EPEG
  • Dernière configuration
  • Toposar
  • Vepesid
  • PV 16
  • VP16-213
  • VP-16
  • VP-16-213
  • VP16
  • VP 16213
  • VP-16213
  • VP16213

Given IV

Autres noms:
  • Asta Z 4942
  • Asta Z-4942
  • Cyfos
  • Holoxane
  • Ifex
  • IFO
  • Cellule IFO
  • Ifolem
  • Ifomida
  • Ifomide
  • Ifosfamidum
  • Ifoxane
  • IFX
  • Iphosphamide
  • Iso-Endoxan
  • Isoendoxane
  • Isophosphamide
  • Mitoxane
  • MJF 9325
  • MJF-9325
  • Naxamide
  • Seromida
  • Tronoxal
  • Z 4942
  • Z-4942

Given IV

Autres noms:
  • Campto
  • Camptosar
  • U-101440E
  • CPT-11
  • Camptothécine 11
  • Camptothécine-11
  • CPT 11
  • Irinomedac
  • Chlorhydrate d'irinotécan trihydraté
  • Monochlorhydrate d'irinotécan trihydraté
  • CPT11
  • U101440E

Undergo radiation

Autres noms:
  • Radiothérapie du cancer
  • ENERGY_TYPE
  • Irradier
  • Irradié
  • Irradiation
  • Radiation
  • Radiothérapie, SAI
  • Radiothérapie
  • RT
  • Thérapie, Radiation
  • Type d'énergie

Undergo echocardiography

Autres noms:
  • Échocardiographie
  • CE

Undergo surgery

Autres noms:
  • Opération
  • Type de chirurgie
  • Chirurgical
  • Intervention chirurgicale
  • Interventions chirurgicales
  • Chirurgie, SAI

Given FDG

Autres noms:
  • 18FDG
  • FDG
  • fludésoxyglucose F 18
  • Fludésoxyglucose (18F)
  • Fludésoxyglucose F18
  • Fluor-18 2-Fluoro-2-désoxy-D-Glucose
  • Fluorodésoxyglucose F18

Undergo FDG PET

Autres noms:
  • Imagerie médicale, Tomographie par émission de positrons
  • ANIMAUX
  • TEP-scan
  • Scan de tomographie par émission de positrons
  • Tomographie par émission de positrons
  • PT
  • Tomographie par émission de positrons (procédure)

Undergo bone marrow aspiration and biopsy

Autres noms:
  • Bx
  • BIOPSIE_TYPE
  • Biopsie

Undergo tissue and/or blood sample collection

Autres noms:
  • Collecte d'échantillons biologiques
  • Spécimen biologique collecté
  • Collecte de spécimens
  • Collection d'échantillons

Given PO

Autres noms:
  • Stivarga
  • BAY 73-4506 Monohydraté
  • BAY-73-4506 Monohydraté
  • Régorafénib monohydraté

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Description de la mesure
Délai
Time to event-free survival (EFS) post-Consolidation I (C1)
Délai: From randomization to progression or relapse, diagnosis of a second malignant neoplasm, death, or last patient contact, whichever occurs first, assessed up to 10 years

Analysis will be done by associating each patient's outcome with the individual's randomized treatment assignment. The associated statistical tests will be stratified according to grouping.

From randomization to progression or relapse, diagnosis of a second malignant neoplasm, death, or last patient contact, whichever occurs first, assessed up to 10 years

Mesures de résultats secondaires

Mesure des résultats
Description de la mesure
Délai
Overall survival-C1
Délai: From randomization to death or last patient contact, whichever occurs first, assessed up to 10 years

The stratified one-sided logrank test will be the primary statistical methodology for assessing the null statistical hypothesis.

From randomization to death or last patient contact, whichever occurs first, assessed up to 10 years
Incidence of adverse events
Délai: Up to 30 days after last dose of study treatment

Toxicity will be coded according to the Common Terminology Criteria for Adverse Events (CTCAE) version (v) 5.

Up to 30 days after last dose of study treatment
Feasibility of augmented dose radiotherapy (ADRT) as local control
Délai: Up to point of radiation therapy (RT) termination

The actual RT delivered will be compared with the treatment plan until the point of RT termination as assessed by central review. Will consider ADRT to be feasible to deliver if there is evidence that the patient-specific probability of feasibility-failure is less than 15%.

Up to point of radiation therapy (RT) termination
Toxicity of ADRT as local control
Délai: Up to 30 days after ADRT is completed

Will be evaluated using CTCAE v 5.

Up to 30 days after ADRT is completed
Validation of circulating tumor-derived deoxyribonucleic acid (ctDNA) levels greater than or equal to 5% at the time of diagnosis are associated with increased risk of EFS-event
Délai: At time of diagnosis

Will compare the risk for EFS-event from enrollment for groups of patients defined by percent ctDNA at diagnosis using a two-sided logrank test.

At time of diagnosis
Validation of ctDNA levels greater than or equal to 0.5% following one cycle of chemotherapy are associated with increased risk of EFS-event
Délai: Following one cycle of chemotherapy at induction (cycle length = 14 days)

Will compare the risk for EFS-event from enrollment for groups of patients defined by percent ctDNA at induction cycle 1 day 14 using a two-sided logrank test.

Following one cycle of chemotherapy at induction (cycle length = 14 days)

Autres mesures de résultats

Mesure des résultats
Description de la mesure
Délai
EFS and response rate for patients with newly diagnosed eligible metastatic round cell sarcomas
Délai: At 1 and 2 years

The 95% confidence bounds will be calculated according to the complementary log-log transformation. Will report the 1-, 2- and 3-year estimate EFS probabilities as well as the confidence intervals.

At 1 and 2 years
Change in fludeoxyglucose F-18 positron emission tomography imaging response of primary disease site and its association with EFS
Délai: At the end of 6 cycles of induction chemotherapy (cycle length = 14 days)

Will calculate the percent change in standardized uptake value (SUV). Will fit a Cox proportional hazards regression model for hazard of EFS-event with percent change in SUV included as an independent variable. Nonlinearity will be formally tested using a two degree of freedom Wald test of size 0.05 for the null hypothesis. The functional form of the relationship between hazard of EFS-event and percent change in SUV will be explored by plotting the model-predicted hazard on the logarithmic scale against percent change in SUV with 95% confidence bands. This plot will be examined for natural inflection points in the curve representing potentially informative categories of percent change in SUV. If the p-value for this test is not significant at the 0.05 level, will remove the nonlinear spline terms refitting the model with linear percent change in SUV, and will report the associated hazard ratio and 95% confidence interval.

At the end of 6 cycles of induction chemotherapy (cycle length = 14 days)
Histologic attributes of Ewing sarcoma and round cell sarcomas that mimic Ewing sarcoma
Délai: Up to 10 years

Qualitative characteristics will be quantified with the observed proportion in each category and the associated confidence interval. The sample mean, median, standard deviation, 25th percentile and 75th percentile will be used to characterize the distribution of the quantitative characteristics.

Up to 10 years
ctDNA burden as a continuous variable
Délai: Up to following two cycles of chemotherapy (cycle length = 14 days)

Will evaluate differences in hazard of EFS event by ctDNA as a continuous variable modeled as a restricted cubic spline in a proportional hazards regression model.

Up to following two cycles of chemotherapy (cycle length = 14 days)
ctDNA burden prior to induction cycle 3
Délai: Following two cycles of chemotherapy (cycle length = 14 days)

Will evaluate whether there is an increased risk of EFS event by ctDNA burden dichotomized at 0.5% prior to induction cycle 3 using a two-sided logrank test.

Following two cycles of chemotherapy (cycle length = 14 days)
Change in ctDNA burden from diagnosis to local control
Délai: Up to following two cycles of chemotherapy (cycle length = 14 days)

Will evaluate differences in hazard of EFS event by change in ctDNA burden as a continuous variable modeled as a restricted cubic spline in a proportional hazards regression model.

Up to following two cycles of chemotherapy (cycle length = 14 days)
ctDNA burden after consolidation 1
Délai: Up to 6 months after completion of planned therapy

Will evaluate whether there is an increased risk of EFS event by ctDNA burden dichotomized at 0.5% after consolidation cycle 1 using a two-sided logrank test.

Up to 6 months after completion of planned therapy
Frequency of ctDNA clearance
Délai: Through end of consolidation 2 cycle 2 (cycle length = 14 days)

Will describe (proportion and 95% confidence interval overall and stratified by study regimen) the frequency of ctDNA clearance by consolidation 2 cycle 2 among those who have ctDNA burden > 0.5% at the start of consolidation 2.

Through end of consolidation 2 cycle 2 (cycle length = 14 days)
Frequency of ctDNA-based genetic mutations
Délai: At diagnosis

Will describe (proportion and 95% confidence intervals) of genetic mutations detected in ctDNA at diagnosis.

At diagnosis
Frequency of selected toxicities by Patient Reported Outcomes Version of Common Terminology Criteria for Adverse Events (PRO-CTCAE)
Délai: Up to 12 months after completion of systemic therapy

Will be evaluated using the PRO-CTCAE.

Up to 12 months after completion of systemic therapy
Frequency of selected toxicities by Functional Assessment of Cancer Therapy General Questionnaire (FACT-G)
Délai: Up to 12 months after completion of systemic therapy

Will be evaluated using the FACT-G.

Up to 12 months after completion of systemic therapy

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Les enquêteurs

  • Chercheur principal: Bhuvana A Setty, Children's Oncology Group

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude (Réel)

10 novembre 2025

Achèvement primaire (Réel)

30 juin 2026

Achèvement de l'étude (Réel)

22 septembre 2026

Dates d'inscription aux études

Première soumission

6 février 2025

Première soumission répondant aux critères de contrôle qualité

6 février 2025

Première publication (Réel)

11 février 2025

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Réel)

5 octobre 2026

Dernière mise à jour soumise répondant aux critères de contrôle qualité

2 octobre 2026

Dernière vérification

1 octobre 2026

Plus d'information

Termes liés à cette étude

Termes MeSH pertinents supplémentaires

Autres numéros d'identification d'étude

  • AEWS2431
  • U10CA180886 (Subvention/contrat des NIH des États-Unis)
  • AEWS2431 (Autre identifiant: CTEP)
  • NCI-2025-00801 (Identificateur de registre: CTRP (Clinical Trial Reporting Program))
  • AEWS2431 (Autre identifiant: Children's Oncology Group)

Informations sur les médicaments et les dispositifs, documents d'étude

Étudie un produit pharmaceutique réglementé par la FDA américaine

Oui

Étudie un produit d'appareil réglementé par la FDA américaine

Non

Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .

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