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Methotrexate, Trimetrexate Glucuronate, and Leucovorin in Treating Patients With Refractory or Recurrent Osteosarcoma

Phase I Study of High Dose Methotrexate With Simultaneous Trimetrexate and Leucovorin in Patients With Recurrent Osteosarcoma

Status
Completed
Phases
Phase 1
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00119301
Enrollment
18
Registered
2005-07-13
Start date
2005-04-30
Completion date
Unknown
Last updated
2013-01-17

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

Conditions

Sarcoma

Keywords

recurrent osteosarcoma

Brief summary

RATIONALE: Drugs used in chemotherapy, such as methotrexate, trimetrexate glucuronate, and leucovorin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) may kill more tumor cells. PURPOSE: This phase I trial is studying the side effects and best dose of trimetrexate glucuronate when given together with methotrexate and leucovorin in treating patients with refractory or recurrent osteosarcoma.

Detailed description

OBJECTIVES: Primary * Determine the maximum tolerated dose of trimetrexate glucuronate when administered with high-dose methotrexate and leucovorin calcium in patients with refractory or recurrent high-grade osteosarcoma. Secondary * Determine the dose-limiting toxic effects of this regimen in these patients. * Determine, preliminarily, the antitumor activity of this regimen in these patients. OUTLINE: This is a dose-escalation study of trimetrexate glucuronate. Patients receive high-dose methotrexate IV over 4 hours on days 1 and 8 and oral trimetrexate glucuronate twice daily on days 2-6 and 9-13. Patients also receive leucovorin calcium IV continuously over 24 hours or orally 2 or 4 times daily on days 9-14. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of trimetrexate glucuronate until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. PROJECTED ACCRUAL: A maximum of 18 patients will be accrued for this study within 2 years.

Interventions

DRUGleucovorin calcium
DRUGmethotrexate

Sponsors

National Cancer Institute (NCI)
CollaboratorNIH
Memorial Sloan Kettering Cancer Center
Lead SponsorOTHER

Study design

Primary purpose
TREATMENT

Eligibility

Sex/Gender
ALL
Age
1 Years to 35 Years
Healthy volunteers
No

Inclusion criteria

DISEASE CHARACTERISTICS: * Histologically confirmed malignant osteosarcoma * High-grade disease * Recurrent or refractory disease after prior standard chemotherapy comprising methotrexate, doxorubicin, cisplatin, and ifosfamide * No low-grade osteosarcoma * No parosteal or periosteal sarcoma * No osteosarcoma arising in premalignant bony lesions (e.g., Paget's disease) OR in a prior radiotherapy field * No symptomatic or known brain or leptomeningeal involvement PATIENT CHARACTERISTICS: Age * 1 to 35 Performance status * Karnofsky 70-100% (for patients \> 16 years of age) * Lansky 70-100% (for patients ≤ 16 years of age) Life expectancy * At least 3 months Hematopoietic * Absolute neutrophil count ≥ 1,000/mm\^3 * Platelet count ≥ 75,000/mm\^3 Hepatic * Bilirubin ≤ 1.5 times normal * AST and ALT ≤ 5 times normal * Albumin ≥ 2 g/dL * No clinically significant liver disease Renal * Creatinine ≤ 1.5 times normal OR * Creatinine clearance or radioisotope glomerular filtration rate ≥ lower limit of normal Cardiovascular * Shortening fraction ≥ 27% by echocardiogram OR * Ejection fraction ≥ 50% by gated radionuclide study * No congestive heart failure * No angina pectoris * No myocardial infarction within the past year * No uncontrolled arterial hypertension * No uncontrolled arrhythmias Other * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception * No history of significant neurological or psychiatric disorder * No active infection * No symptomatic peripheral neuropathy ≥ grade 2 * No other serious illness or medical condition PRIOR CONCURRENT THERAPY: Biologic therapy * At least 7 days since prior biologic therapy * At least 6 months since prior allogeneic stem cell transplantation AND no evidence of active graft-versus-host disease * No concurrent sargramostim (GM-CSF) Chemotherapy * See Disease Characteristics * More than 2 weeks since prior myelosuppressive chemotherapy (4 weeks for nitrosoureas) Endocrine therapy * Not specified Radiotherapy * See Disease Characteristics * At least 2 weeks since prior local palliative radiotherapy (small port) * At least 6 months since prior craniospinal radiotherapy * At least 6 months since prior radiotherapy to ≥ 50% of the pelvis * At least 6 weeks since prior substantial radiotherapy to the bone marrow Surgery * Not specified Other * Recovered from prior therapy * More than 30 days since prior and no other concurrent investigational drugs * More than 30 days since prior and no concurrent participation in another clinical trial * No concurrent medications that may interact with study drugs

Design outcomes

Primary

MeasureTime frame
Maximum tolerated dose (MTD) after 1 course of treatment
Dose-limiting toxicities as assessed by hematology and biochemistry testing on days 1, 8, and 28 of each course

Secondary

MeasureTime frame
Antitumor activity as measured by radiographic response using RECIST criteria after every 2 courses of treatment
Antitumor activity as measured by pathologic response using the Huvos grading system to evaluate post-treatment tumor necrosis at time of tumor resection after completion of study treatment

Countries

United States

Outcome results

None listed

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