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Thalidomide in Treating Patients With Recurrent or Persistent Carcinosarcoma of the Uterus

A Phase II Evaluation of Thalidomide (NSC #66847) in the Treatment of Recurrent or Persistent Carcinosarcoma of the Uterus

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00025506
Enrollment
55
Registered
2003-01-27
Start date
2001-09-30
Completion date
2013-01-31
Last updated
2019-07-24

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Recurrent Uterine Corpus Sarcoma, Uterine Carcinosarcoma

Brief summary

This phase II trial is studying how well thalidomide works in treating patients with carcinosarcoma of the uterus that has come back or that does not go to remission (decrease or disappear but may still be in the body) despite treatment. Thalidomide may stop the growth of cancer by stopping blood flow to the tumor.

Detailed description

OBJECTIVES: Primary I. Determine the antitumor cytostatic activity of thalidomide, as measured by the probability of progression-free survival (PFS) for at least 6 months, in patients with recurrent or persistent uterine carcinosarcoma. II. Determine the nature and degree of toxicity of this drug in these patients. Secondary I. Determine the partial and complete response rates in patients treated with this drug. II. Determine the duration of PFS and overall survival of patients treated with this drug. III. Determine the effect of this drug on initial performance status and histological grade in these patients. IV. Correlate serum and plasma biomarkers, including vascular endothelial growth factor and basic fibroblast growth factor, with clinical outcome (i.e., PFS) in patients treated with this drug. OUTLINE: This is a multicenter study. Patients receive oral thalidomide once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter. PROJECTED ACCRUAL: A total of 19-51 patients will be accrued for this study within 3 years.

Interventions

OTHERLaboratory Biomarker Analysis

Correlative studies

DRUGThalidomide

Given orally

Sponsors

Gynecologic Oncology Group
CollaboratorNETWORK
National Cancer Institute (NCI)
Lead SponsorNIH

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
FEMALE
Healthy volunteers
No

Inclusion criteria

* Histologically confirmed uterine sarcoma * Carcinosarcoma (malignant mixed müllerian tumor) * Homologous or heterologous type * Recurrent or persistent with documented disease progression after prior local therapy * At least 1 unidimensionally measurable target lesion * At least 20 mm by conventional techniques, including palpation, plain x-ray, CT scan, or MRI * At least 10 mm by spiral CT scan * Tumors within a previously irradiated field are considered non-target lesions * Must have received 1 prior initial chemotherapy regimen (including high-dose ,consolidation, or extended therapy after surgical or nonsurgical assessment) for carcinosarcoma * No documented brain metastases since diagnosis of cancer * Patients with stable CNS deficits are allowed provided that there is no evidence of brain metastases on CT scan or MRI * Ineligible for a higher priority Gynecologic Oncology Group (GOG) protocol (if one exists), including any active phase III GOG protocol for the same patient population * Performance status - GOG 0-2 if received 1 prior therapy regimen * Performance status - GOG 0-1 if received 2 prior therapy regimens * Absolute neutrophil count at least 1,500/mm\^3 * Platelet count at least 100,000/mm\^3 * Bilirubin no greater than 1.5 times upper limit of normal (ULN) * SGOT no greater than 2.5 times ULN * Alkaline phosphatase no greater than 2.5 times ULN * Creatinine no greater than 1.5 times ULN * Creatinine clearance greater than 60 mL/min * Not pregnant * Negative pregnancy test * Fertile patients must use at least 1 highly active method of contraception and 1 additional effective method of contraception for at least 4 weeks before, during, and for at least 4 weeks after study participation * No seizure disorders since diagnosis of cancer * Patients with a history of seizure disorders are allowed provided that the seizures have been stable (i.e., no seizure within the past 12 months) while on an appropriately monitored treatment regimen * No active infection requiring antibiotics * No greater than grade 1 sensory or motor neuropathy * No other invasive malignancy within the past 5 years except nonmelanoma skin cancer * At least 3 weeks since prior immunologic agents for uterine sarcoma * No prior thalidomide * See Disease Characteristics * At least 3 weeks since prior chemotherapy for uterine sarcoma and recovered * No more than 1 prior cytotoxic chemotherapy regimen for recurrent or persistent uterine sarcoma * No prior non-cytotoxic chemotherapy for recurrent or persistent uterine sarcoma * No concurrent bisphosphonates (e.g., zoledronate) * At least 1 week since prior hormonal therapy for uterine sarcoma * Concurrent hormone replacement therapy allowed * See Disease Characteristics * At least 3 weeks since prior radiotherapy for uterine sarcoma and recovered * No prior radiotherapy to more than 25% of marrow-bearing areas * See Disease Characteristics * Recovered from prior surgery * At least 3 weeks since any other prior therapy for uterine sarcoma * No prior anticancer therapy that would preclude study

Design outcomes

Primary

MeasureTime frameDescription
Progression-free Survival (PFS) > 6 MonthsEvery other cycle for 6 monthsProgression is defined according to RECIST v1.0 as at least a 20% increase in the sum of LD target lesions taking as reference the smallest sum LD recorded since study entry, the appearance of one or more new lesions, death due to disease without prior objective documentation of progression, global deterioration in health status attributable to the disease requiring a change in therapy without objective evidence of progression, or unequivocal progression of existing non-target lesions.
Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Each cycle during treatment and 30 days after the last treatment (average 4 months)

Secondary

MeasureTime frameDescription
Tumor ResponseFor those patients whose disease can be evaluated by physical examination, response was assessed prior to each 28-day cycle. CT scan or MRI if used to follow lesion for measurable disease every other cycle. (average = 4 months)RECIST 1.0 defines complete response as the disappearance of all target lesions and non-target lesions and no evidence of new lesions documented by two disease assessments at least 4 weeks apart. Partial response is defined as at least a 30% decrease in the sum of longest dimensions (LD) of all target measurable lesions taking as reference the baseline sum of LD. There can be no unequivocal progression of non-target lesions and no new lesions. Documentation by two disease assessments at least 4 weeks apart is required. In the case where the ONLY target lesion is a solitary pelvic mass measured by physical exam, which is not radiographically measurable, a 50% decrease in the LD is required. These patients will have their response classified according to the definitions stated above. Complete and partial responses are included in the objective tumor response rate.
Initial Performance StatusbaselinePerformance status 0 = Fully active, able to carry on all pre-disease performance without restriction. Performance status 1 = Restricted in physically strenuous activity but ambulatory and able to carry out work of light or sedentary nature, e.g., light housework, office work. Performance status 2 = Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours.
Initial Histologic GradeBaselineG3 - Predominantly solid or entirely undifferentiated carcinoma. Not graded - tumor grade not reported.
Overall SurvivalFrom study entry to death or last contact, up to 5 years.The observed length of life from entry into the study to death or the date of last contact.
Progression Free SurvivalEvery other cycle until progression or death, up to 5 years.Progression is defined according to RECIST v1.0 as at least a 20% increase in the sum of LD target lesions taking as reference the smallest sum LD recorded since study entry, the appearance of one or more new lesions, death due to disease without prior objective documentation of progression, global deterioration in health status attributable to the disease requiring a change in therapy without objective evidence of progression, or unequivocal progression of existing non-target lesions.

Other

MeasureTime frame
Serum and Plasma Concentrations of VEGF and bFGF With PFSUp to 5 years
Serum and Plasma Concentrations of Vascular Endothelial Growth Factor (VEGF) and bFGFUp to 5 years

Countries

United States

Participant flow

Recruitment details

The study was activated on 9/4/2001 and closed to accrual on 3/3/2008 (suspended from 6/30/2003 to 8/1/2005).

Participants by arm

ArmCount
Thalidomide
Thalidomide 200 mg PO once a day initial dose (each 28-day period will be considered one cycle). Dose increased by 200 mg every 2 weeks to maximum dose of 1000 mg/day until disease progression or adverse effects prohibit further therapy.
45
Total45

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyIneligible: clerical error1
Overall StudyIneligible: inadequate pathology2
Overall StudyIneligible: wrong cell type5
Overall StudyNever Treated2

Baseline characteristics

CharacteristicThalidomide
Age, Continuous65.6 years
STANDARD_DEVIATION 8.9
Age, Customized
30-39 years
1 participants
Age, Customized
40-49 years
1 participants
Age, Customized
50-59 years
7 participants
Age, Customized
60-69 years
23 participants
Age, Customized
70-79 years
11 participants
Age, Customized
80-89 years
2 participants
Histologic type
Carcinosarcoma-heterologous
16 participants
Histologic type
Carcinosarcoma-homologous
22 participants
Histologic type
Carcinosarcoma, MMT
7 participants
Region of Enrollment
United States
45 participants
Sex: Female, Male
Female
45 Participants
Sex: Female, Male
Male
0 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
45 / 45
serious
Total, serious adverse events
15 / 45

Outcome results

Primary

Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0

Time frame: Each cycle during treatment and 30 days after the last treatment (average 4 months)

Population: Eligible and evaluable patients

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
ThalidomideFrequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Anemia22 Participants
ThalidomideFrequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Neutropenia41 Participants
ThalidomideFrequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Nausea31 Participants
ThalidomideFrequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Metabolic40 Participants
ThalidomideFrequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Anorexia42 Participants
ThalidomideFrequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Vomiting36 Participants
ThalidomideFrequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Fatigue22 Participants
ThalidomideFrequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Dermatologic39 Participants
ThalidomideFrequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Other neurologic31 Participants
ThalidomideFrequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Cardiovascular31 Participants
ThalidomideFrequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Thrombocytopenia44 Participants
ThalidomideFrequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Neuropathy (sensory)27 Participants
ThalidomideFrequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Pain38 Participants
ThalidomideFrequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Constipation27 Participants
Grade 1Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Pain4 Participants
Grade 1Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Cardiovascular9 Participants
Grade 1Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Neuropathy (sensory)12 Participants
Grade 1Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Vomiting4 Participants
Grade 1Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Other neurologic2 Participants
Grade 1Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Constipation6 Participants
Grade 1Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Anorexia2 Participants
Grade 1Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Nausea4 Participants
Grade 1Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Metabolic3 Participants
Grade 1Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Fatigue5 Participants
Grade 1Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Neutropenia1 Participants
Grade 1Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Thrombocytopenia1 Participants
Grade 1Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Dermatologic4 Participants
Grade 1Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Anemia9 Participants
Grade 2Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Constipation9 Participants
Grade 2Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Neuropathy (sensory)5 Participants
Grade 2Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Neutropenia3 Participants
Grade 2Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Pain2 Participants
Grade 2Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Dermatologic2 Participants
Grade 2Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Vomiting4 Participants
Grade 2Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Cardiovascular2 Participants
Grade 2Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Thrombocytopenia0 Participants
Grade 2Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Other neurologic6 Participants
Grade 2Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Anorexia1 Participants
Grade 2Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Anemia9 Participants
Grade 2Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Fatigue15 Participants
Grade 2Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Nausea6 Participants
Grade 2Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Metabolic0 Participants
Grade 3Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Other neurologic6 Participants
Grade 3Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Nausea4 Participants
Grade 3Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Vomiting1 Participants
Grade 3Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Constipation3 Participants
Grade 3Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Anorexia0 Participants
Grade 3Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Fatigue3 Participants
Grade 3Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Neutropenia0 Participants
Grade 3Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Thrombocytopenia0 Participants
Grade 3Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Anemia4 Participants
Grade 3Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Neuropathy (sensory)1 Participants
Grade 3Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Cardiovascular1 Participants
Grade 3Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Dermatologic0 Participants
Grade 3Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Metabolic2 Participants
Grade 3Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Pain1 Participants
Grade 4Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Thrombocytopenia0 Participants
Grade 4Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Neutropenia0 Participants
Grade 4Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Cardiovascular2 Participants
Grade 4Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Dermatologic0 Participants
Grade 4Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Fatigue0 Participants
Grade 4Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Anorexia0 Participants
Grade 4Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Constipation0 Participants
Grade 4Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Pain0 Participants
Grade 4Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Metabolic0 Participants
Grade 4Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Vomiting0 Participants
Grade 4Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Neuropathy (sensory)0 Participants
Grade 4Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Nausea0 Participants
Grade 4Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Other neurologic0 Participants
Grade 4Frequency and Severity of Adverse Effects as Assessed by Common Toxicity Criteria (CTC) v2.0Anemia1 Participants
Primary

Progression-free Survival (PFS) > 6 Months

Progression is defined according to RECIST v1.0 as at least a 20% increase in the sum of LD target lesions taking as reference the smallest sum LD recorded since study entry, the appearance of one or more new lesions, death due to disease without prior objective documentation of progression, global deterioration in health status attributable to the disease requiring a change in therapy without objective evidence of progression, or unequivocal progression of existing non-target lesions.

Time frame: Every other cycle for 6 months

Population: Eligible and treated patients.

ArmMeasureValue (NUMBER)
ThalidomideProgression-free Survival (PFS) > 6 Months17.8 percentage of participants
Secondary

Initial Histologic Grade

G3 - Predominantly solid or entirely undifferentiated carcinoma. Not graded - tumor grade not reported.

Time frame: Baseline

Population: Eligible and evaluable patients

ArmMeasureCategoryValue (COUNT_OF_PARTICIPANTS)
ThalidomideInitial Histologic GradeGrade 34 Participants
ThalidomideInitial Histologic GradeNot graded41 Participants
Secondary

Initial Performance Status

Performance status 0 = Fully active, able to carry on all pre-disease performance without restriction. Performance status 1 = Restricted in physically strenuous activity but ambulatory and able to carry out work of light or sedentary nature, e.g., light housework, office work. Performance status 2 = Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours.

Time frame: baseline

Population: Eligible and evaluable patients

ArmMeasureCategoryValue (COUNT_OF_PARTICIPANTS)
ThalidomideInitial Performance StatusPerformance status = 030 Participants
ThalidomideInitial Performance StatusPerformance status = 112 Participants
ThalidomideInitial Performance StatusPerformance status = 23 Participants
Secondary

Overall Survival

The observed length of life from entry into the study to death or the date of last contact.

Time frame: From study entry to death or last contact, up to 5 years.

Population: Eligible and treated patients.

ArmMeasureValue (MEDIAN)
ThalidomideOverall Survival5.9 months
Secondary

Progression Free Survival

Progression is defined according to RECIST v1.0 as at least a 20% increase in the sum of LD target lesions taking as reference the smallest sum LD recorded since study entry, the appearance of one or more new lesions, death due to disease without prior objective documentation of progression, global deterioration in health status attributable to the disease requiring a change in therapy without objective evidence of progression, or unequivocal progression of existing non-target lesions.

Time frame: Every other cycle until progression or death, up to 5 years.

Population: Eligible and treated patients

ArmMeasureValue (MEDIAN)
ThalidomideProgression Free Survival1.91 months
Secondary

Tumor Response

RECIST 1.0 defines complete response as the disappearance of all target lesions and non-target lesions and no evidence of new lesions documented by two disease assessments at least 4 weeks apart. Partial response is defined as at least a 30% decrease in the sum of longest dimensions (LD) of all target measurable lesions taking as reference the baseline sum of LD. There can be no unequivocal progression of non-target lesions and no new lesions. Documentation by two disease assessments at least 4 weeks apart is required. In the case where the ONLY target lesion is a solitary pelvic mass measured by physical exam, which is not radiographically measurable, a 50% decrease in the LD is required. These patients will have their response classified according to the definitions stated above. Complete and partial responses are included in the objective tumor response rate.

Time frame: For those patients whose disease can be evaluated by physical examination, response was assessed prior to each 28-day cycle. CT scan or MRI if used to follow lesion for measurable disease every other cycle. (average = 4 months)

Population: Eligible and treated patients.

ArmMeasureValue (NUMBER)
ThalidomideTumor Response4.4 percentage of participants
Other Pre-specified

Serum and Plasma Concentrations of Vascular Endothelial Growth Factor (VEGF) and bFGF

Time frame: Up to 5 years

Other Pre-specified

Serum and Plasma Concentrations of VEGF and bFGF With PFS

Time frame: Up to 5 years

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026