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SARC024: A Blanket Protocol to Study Oral Regorafenib in Patients With Selected Sarcoma Subtypes

SARC024: A Blanket Protocol to Study Oral Regorafenib in Patients With Selected Sarcoma Subtypes

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02048371
Enrollment
131
Registered
2014-01-29
Start date
2014-07-31
Completion date
2022-05-31
Last updated
2023-11-07

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

Conditions

Ewing/Ewing-like Sarcoma, Liposarcoma, Mesenchymal Chondrosarcoma, Osteogenic Sarcoma, Rhabdomyosarcoma

Brief summary

Although regorafenib was approved for use in patients who had progressive GIST despite imatinib and/or sunitinib on the basis of phase II and phase III data, it has not been examined in a systematic fashion in patients with other forms of sarcoma. Given the activity of sorafenib, sunitinib and pazopanib in soft tissue sarcomas, and evidence of activity of sorafenib in osteogenic sarcoma and possibly Ewing/Ewing-like sarcoma, there is precedent to examine SMOKIs (small molecule oral kinase inhibitors) such as regorafenib in sarcomas other than GIST. It is also recognized that SMOKIs (small molecule oral kinase inhibitors)such as regorafenib, sorafenib, pazopanib, and sunitinib have overlapping panels of kinases that are inhibited simultaneously. While not equivalent, most of these SMOKIs (small molecule oral kinase inhibitors) block vascular endothelial growth factor and platelet derived growth factors receptors (VEGFRs and PDGFRs), speaking to a common mechanism of action of several of these agents.

Detailed description

Although regorafenib was approved for use in patients who had progressive GIST despite imatinib and/or sunitinib on the basis of phase II and phase III data, it has not been examined in a systematic fashion in patients with other forms of sarcoma. Given the activity of sorafenib, sunitinib and pazopanib in soft tissue sarcomas, and evidence of activity of sorafenib in osteogenic sarcoma and possibly Ewing/Ewing-like sarcoma, there is precedent to examine SMOKIs (small molecule oral kinase inhibitors) such as regorafenib in sarcomas other than GIST. It is also recognized that SMOKIs (small molecule oral kinase inhibitors)such as regorafenib, sorafenib, pazopanib, and sunitinib have overlapping panels of kinases that are inhibited simultaneously. While not equivalent, most of these SMOKIs (small molecule oral kinase inhibitors) block vascular endothelial growth factor and platelet derived growth factors receptors (VEGFRs and PDGFRs), speaking to a common mechanism of action of several of these agents

Interventions

DRUGRegorafenib

Adults: 160 mg daily; 21 days on and 7 days off Pediatrics: 82mg/m2 (rounding to the nearest 20mg) daily; 21 days on and 7 days off

DRUGPlacebo

21 days on and 7 days off

Sponsors

Sarcoma Alliance for Research through Collaboration
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)

Eligibility

Sex/Gender
ALL
Age
5 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Age ≥ 10 year for Liposarcoma, Osteosarcoma, Ewing sarcoma and Mesenchymal Chondrosarcoma; Age ≥ 5 years for Rhabdomyosarcoma cohorts * Weight ≥ 15 kg (33 lb) * Patients must have histologically or cytologically confirmed advanced/metastatic liposarcoma, osteogenic sarcoma, Ewing/Ewing-like sarcoma of soft tissue or bone, fusion-positive alveolar rhabdomyosarcoma or embryonal rhabdomyosarcoma/fusion-negative alveolar rhabdomyosarcoma , or mesenchymal chondrosarcoma * WHO Performance Status 0, 1 or 2. A maximum of 1/3 of patients in cohorts A & B may be WHO performance status 2 * At least one prior line of systemic therapy for the sarcoma diagnosis (neoadjuvant, adjuvant or metastatic disease) * All acute toxic effects of any prior treatment have resolved to NCI-CTCAE v 4.0 Grade 1 or less (except alopecia) at the time of signing the Informed Consent Form (ICF) * Subject must be able to swallow and retain oral medication * At least one site of measurable disease on x-ray/CT/MRI scan as defined by RECIST 1.1 * Adequate organ function within 14 days of registration * Written, voluntary informed consent * Fertile men and women of childbearing potential must agree to use an effective method of birth control from Day 1 of study and for 3 months after last study drug administration in both sexes, as assessed by the investigator. Women of childbearing potential include pre-menopausal women and women within the first 2 years of the onset of menopause. Women of childbearing potential must have a negative pregnancy test less than or equal to seven days prior to Day 1 of study. The definition of adequate contraception will be based on the judgement of the investigator. * Evidence of progression of disease as defined by RECIST 1.1 (i.e. new disease sites or 20% growth of index lesions) within 6 months of registration * Patients with central nervous system disease are eligible for enrollment if they have received prior radiotherapy or surgery to sites of CNS (central nervous system) metastatic disease and are without evidence of clinical progression for at least 12 weeks after therapy

Exclusion criteria

* Patients with documentation of well differentiated liposarcoma only (of the well differentiated/dedifferentiated liposarcoma family) are specifically excluded, owing to its characteristically slow growth. If high grade areas are suspected (dedifferentiation), but not proved by pathology analysis (e.g. after primary resection of a well-differentiated liposarcoma), a biopsy must be performed to demonstrate the high-grade dedifferentiated disease * Prior systemic therapy with a small molecule oral kinase inhibitor, including but not limited to: pazopanib, sunitinib, sorafenib, everolimus, sirolimus, vemurafenib, dasatinib and trametinib * Previous assignment to treatment during this study. Subjects permanently withdrawn from study participation will not be allowed to re-enter study. Patients who progress on placebo are specifically allowed to enroll on the treatment arm of the study if they meet all other entry criteria * Concurrent, clinically significant, active malignancies within 12 months of study enrollment * Patients with severe and/or uncontrolled concurrent medical disease that in the opinion of the investigator could cause unacceptable safety risks or compromise compliance with the protocol * Major surgery within 28 days prior to study registration or those patients who have not recovered adequately from prior surgery * Patients who have received wide field radiotherapy ≤ 28 days (defined as \> 50% of volume of pelvis bones or equivalent) or limited field radiation for palliation \< 14 days prior to study registration or those patients who have not recovered adequately from side effects of such therapy * Patients who have received prior systemic therapy \< 14 days prior to study registration or have not recovered adequately from toxicities to CTCAE v. 4.03 grade 1 or less; prior investigational therapy may not have been given \< 5 half-lives of last dose of treatment, or \< 14 days, whichever is greater * Patients who have had prior autologous, or allogeneic bone marrow transplant * Uncontrolled hypertension (systolic pressure \>140 mm Hg or diastolic pressure \> 90 mm Hg \[NCI-CTCAE v 4.0\] on repeated measurement) despite optimal medical management * Active or clinically significant cardiac disease including: Congestive heart failure-New York Heart Association (NYHA) \> class II, Active coronary artery disease, Cardiac arrhythmias requiring anti-arrhythmic therapy other than beta blockers or digoxin, Unstable angina (anginal symptoms at rest), new onset angina within 3 months before randomization, or myocardial infarction within 6 months before randomization * Evidence or history of bleeding diathesis * Any hemorrhage or bleeding event ≥ NCI CTCAE Grade 3 within 4 weeks prior to study registration * Subjects with thrombotic, embolic, venous, or arterial events, such as cerebrovascular accident (including transient ischemic attacks) deep vein thrombosis or pulmonary embolism within 6 months of start of study treatment * Known history of human immunodeficiency virus (HIV) infection or current chronic or active hepatitis B or C infection requiring treatment with antiviral therapy. * Ongoing infection \> Grade 2 NCI-CTCAE v 4.03 * Presence of a non-healing wound, non-healing ulcer, or benign bone fracture (patients with stress insufficiency fractures e.g. from osteoporosis or pathological fracture from tumor are eligible for study) * Patients with seizure disorder requiring medication * Proteinuria \> 100 mg/dl on urine analysis * Interstitial lung disease with ongoing signs and symptoms at the time of informed consent * Pleural effusion or ascites that causes respiratory compromise (≥ NCI-CTCAE version 4.03 Grade 2 dyspnea) * History of organ allograft (including corneal transplant). * Known or suspected allergy or hypersensitivity to regorafenib, or excipients of the formulations given during the course of this trial * Any malabsorption condition. * Women who are pregnant or breast-feeding. * Any condition which, in the investigator's opinion, makes the subject unsuitable for trial participation * Substance abuse, medical, psychological or social conditions that may interfere with the subject's participation in the study or evaluation of the study results * Inability to comply with protocol required procedures * Use of any herbal remedy (e.g. St. John wort \[Hypericum perforatum\])

Design outcomes

Primary

MeasureTime frameDescription
Progression-free Survival (PFS). Cohort A and Cohort Bup to 3 yearsThe progression-free survival is the length of time during and after the treatment of a disease, such as cancer, that a patient lives with the disease but it does not get worse. Cohort A (liposarcoma) and Cohort B (osteosarcoma). PFS will be evaluated according to RECIST (Response Evaluation Criteria In Solid Tumors) 1.1, where a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions.
Progression-free Survival (PFS). Cohort C, Cohort D, and Cohort Eup to 16 weeksThe progression-free survival is the length of time during and after the treatment of a disease, such as cancer, that a patient lives with the disease but it does not get worse. Cohort C (Ewing/Ewing-like sarcoma). PFS will be evaluated according to RECIST (Response Evaluation Criteria In Solid Tumors) 1.1.

Secondary

MeasureTime frameDescription
Progression-free Survival (PFS), Cohorts A and B, After Crossover.up to 3 yearsThe progression-free survival is the length of time during and after the treatment of a disease, such as cancer, that a patient lives with the disease but it does not get worse.
Response Rate (RR), Cohorts A and B, After Crossover.up to 3 yearsThe response rate (RR) is the percentage of patients whose cancer shrinks or disappears after treatment.
The Number of Participants With Reported CTCAE (Common Terminology Criteria for Adverse Events) Version 4.03 Adverse Events. All Cohorts.up to 3 yearsCommon Toxicity Criteria, also referred to as the Common Terminology Criteria for Adverse Events (CTCAE), is a standardized classification of side effects used in assessing drugs for cancer therapy. Cohorts A, B, C, and D.
Overall Survival (OS). Cohorts A and B, After Crossover.up to 3 yearsOverall survival (OS) is the length of time from either the date of diagnosis or the start of treatment for a disease, such as cancer, that patients diagnosed with the disease are still alive.
Disease Specific Survival (DSS). Cohorts A and B, After Crossover.up to 3 yearsDisease-specific survival refers to the percentage of people in a study or treatment group who have not died from a specific disease in a defined period of time.
Time to Tumor Progression (TTP), Cohorts A and B, After Crossover.up to 3 yearsTime to tumor progression (TTP) is the length of time from the date of diagnosis or the start of treatment for a disease until the disease starts to get worse or spread to other parts of the body.
Overall Response Rate (ORR). All Cohorts.up to 3 yearsThe overall response rate (ORR) is the percentage of patients whose cancer shrinks or disappears after treatment. ORR will be evaluated according to RECIST (Response Evaluation Criteria In Solid Tumors) 1.1

Countries

United States

Participant flow

Pre-assignment details

Study enrollment ended early due to slow enrollment.

Participants by arm

ArmCount
Cohort A: Liposarcoma
Adults: 160 mg daily; 21 days on and 7 days off Pediatrics: 82mg/m2 (rounding to the nearest 20mg) daily; 21 days on and 7 days off Regorafenib Regorafenib: Adults: 160 mg daily; 21 days on and 7 days off Pediatrics: 82mg/m2 (rounding to the nearest 20mg) daily; 21 days on and 7 days off
24
Cohort A: Liposarcoma, Placebo
21 days on and 7 days off Placebo Placebo: 21 days on and 7 days off
24
Cohort B: Osteosarcoma
Adults: 160 mg daily; 21 days on and 7 days off Pediatrics: 82mg/m2 (rounding to the nearest 20mg) daily; 21 days on and 7 days off Regorafenib Regorafenib: Adults: 160 mg daily; 21 days on and 7 days off Pediatrics: 82mg/m2 (rounding to the nearest 20mg) daily; 21 days on and 7 days off
22
Cohort B: Osteosarcoma, Placebo
21 days on and 7 days off Placebo Placebo: 21 days on and 7 days off
20
Cohort C: Ewing Sarcoma
Adults: 160 mg daily; 21 days on and 7 days off Pediatrics: 82mg/m2 (rounding to the nearest 20mg) daily; 21 days on and 7 days off Regorafenib Regorafenib: Adults: 160 mg daily; 21 days on and 7 days off Pediatrics: 82mg/m2 (rounding to the nearest 20mg) daily; 21 days on and 7 days off
30
Cohort D: Rhabdomyosarcoma
Adults: 160 mg daily; 21 days on and 7 days off Pediatrics: 82mg/m2 (rounding to the nearest 20mg) daily; 21 days on and 7 days off Regorafenib Regorafenib: Adults: 160 mg daily; 21 days on and 7 days off Pediatrics: 82mg/m2 (rounding to the nearest 20mg) daily; 21 days on and 7 days off
10
Cohort E: Mesenchymal Chondrosarcoma
Adults: 160 mg daily; 21 days on and 7 days off Pediatrics: 82mg/m2 (rounding to the nearest 20mg) daily; 21 days on and 7 days off Regorafenib Regorafenib: Adults: 160 mg daily; 21 days on and 7 days off Pediatrics: 82mg/m2 (rounding to the nearest 20mg) daily; 21 days on and 7 days off
1
Total131

Baseline characteristics

CharacteristicCohort A: LiposarcomaCohort A: Liposarcoma, PlaceboCohort B: OsteosarcomaCohort B: Osteosarcoma, PlaceboCohort C: Ewing SarcomaCohort D: RhabdomyosarcomaCohort E: Mesenchymal ChondrosarcomaTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants0 Participants0 Participants4 Participants0 Participants4 Participants
Age, Categorical
>=65 years
7 Participants12 Participants1 Participants4 Participants1 Participants0 Participants0 Participants25 Participants
Age, Categorical
Between 18 and 65 years
17 Participants12 Participants21 Participants16 Participants29 Participants6 Participants1 Participants102 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants1 Participants4 Participants2 Participants1 Participants2 Participants0 Participants10 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
23 Participants22 Participants17 Participants17 Participants28 Participants6 Participants1 Participants114 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
1 Participants1 Participants1 Participants1 Participants1 Participants2 Participants0 Participants7 Participants
Race (NIH/OMB)
American Indian or Alaska Native
1 Participants0 Participants0 Participants1 Participants0 Participants0 Participants0 Participants2 Participants
Race (NIH/OMB)
Asian
0 Participants3 Participants2 Participants3 Participants2 Participants1 Participants0 Participants11 Participants
Race (NIH/OMB)
Black or African American
5 Participants1 Participants5 Participants0 Participants0 Participants0 Participants0 Participants11 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants1 Participants0 Participants0 Participants0 Participants0 Participants1 Participants
Race (NIH/OMB)
Unknown or Not Reported
2 Participants0 Participants2 Participants1 Participants1 Participants1 Participants0 Participants7 Participants
Race (NIH/OMB)
White
16 Participants20 Participants12 Participants15 Participants27 Participants8 Participants1 Participants99 Participants
Sex: Female, Male
Female
14 Participants6 Participants16 Participants6 Participants10 Participants5 Participants0 Participants57 Participants
Sex: Female, Male
Male
10 Participants18 Participants6 Participants14 Participants20 Participants5 Participants1 Participants74 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
EG004
affected / at risk
EG005
affected / at risk
EG006
affected / at risk
EG007
affected / at risk
deaths
Total, all-cause mortality
25 / 397 / 926 / 338 / 917 / 304 / 62 / 40 / 1
other
Total, other adverse events
26 / 398 / 926 / 336 / 922 / 302 / 61 / 40 / 1
serious
Total, serious adverse events
28 / 397 / 924 / 337 / 921 / 304 / 62 / 40 / 1

Outcome results

Primary

Progression-free Survival (PFS). Cohort A and Cohort B

The progression-free survival is the length of time during and after the treatment of a disease, such as cancer, that a patient lives with the disease but it does not get worse. Cohort A (liposarcoma) and Cohort B (osteosarcoma). PFS will be evaluated according to RECIST (Response Evaluation Criteria In Solid Tumors) 1.1, where a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions.

Time frame: up to 3 years

ArmMeasureValue (MEDIAN)
Cohort A: LiposarcomaProgression-free Survival (PFS). Cohort A and Cohort B1.87 months
Cohort A: Liposarcoma, PlaceboProgression-free Survival (PFS). Cohort A and Cohort B2.07 months
Cohort B: OsteosarcomaProgression-free Survival (PFS). Cohort A and Cohort B3.6 months
Cohort B: Osteosarcoma, PlaceboProgression-free Survival (PFS). Cohort A and Cohort B1.7 months
Primary

Progression-free Survival (PFS). Cohort C, Cohort D, and Cohort E

The progression-free survival is the length of time during and after the treatment of a disease, such as cancer, that a patient lives with the disease but it does not get worse. Cohort C (Ewing/Ewing-like sarcoma). PFS will be evaluated according to RECIST (Response Evaluation Criteria In Solid Tumors) 1.1.

Time frame: up to 16 weeks

ArmMeasureValue (MEDIAN)
Cohort A: LiposarcomaProgression-free Survival (PFS). Cohort C, Cohort D, and Cohort E3.4 months
Cohort A: Liposarcoma, PlaceboProgression-free Survival (PFS). Cohort C, Cohort D, and Cohort E1.82 months
Cohort B: OsteosarcomaProgression-free Survival (PFS). Cohort C, Cohort D, and Cohort ENA months
Secondary

Disease Specific Survival (DSS). Cohorts A and B, After Crossover.

Disease-specific survival refers to the percentage of people in a study or treatment group who have not died from a specific disease in a defined period of time.

Time frame: up to 3 years

Population: Participants who started on placebo and crossed over to active drug upon progression.

ArmMeasureValue (MEDIAN)
Cohort A: LiposarcomaDisease Specific Survival (DSS). Cohorts A and B, After Crossover.7.98 months
Cohort A: Liposarcoma, PlaceboDisease Specific Survival (DSS). Cohorts A and B, After Crossover.16.11 months
Secondary

Overall Response Rate (ORR). All Cohorts.

The overall response rate (ORR) is the percentage of patients whose cancer shrinks or disappears after treatment. ORR will be evaluated according to RECIST (Response Evaluation Criteria In Solid Tumors) 1.1

Time frame: up to 3 years

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Cohort A: LiposarcomaOverall Response Rate (ORR). All Cohorts.0 Participants
Cohort A: Liposarcoma, PlaceboOverall Response Rate (ORR). All Cohorts.1 Participants
Cohort B: OsteosarcomaOverall Response Rate (ORR). All Cohorts.3 Participants
Cohort B: Osteosarcoma, PlaceboOverall Response Rate (ORR). All Cohorts.0 Participants
Cohort C: Ewing SarcomaOverall Response Rate (ORR). All Cohorts.3 Participants
Cohort D: RhabdomyosarcomaOverall Response Rate (ORR). All Cohorts.0 Participants
Cohort E: Mesenchymal ChondrosarcomaOverall Response Rate (ORR). All Cohorts.0 Participants
Secondary

Overall Survival (OS). Cohorts A and B, After Crossover.

Overall survival (OS) is the length of time from either the date of diagnosis or the start of treatment for a disease, such as cancer, that patients diagnosed with the disease are still alive.

Time frame: up to 3 years

Population: Participants who started on placebo and crossed over to active drug after progression.

ArmMeasureValue (MEDIAN)
Cohort A: LiposarcomaOverall Survival (OS). Cohorts A and B, After Crossover.7.98 months
Cohort A: Liposarcoma, PlaceboOverall Survival (OS). Cohorts A and B, After Crossover.16.11 months
Secondary

Progression-free Survival (PFS), Cohorts A and B, After Crossover.

The progression-free survival is the length of time during and after the treatment of a disease, such as cancer, that a patient lives with the disease but it does not get worse.

Time frame: up to 3 years

Population: Participants who started on placebo in Cohorts A and B, then crossed over to active drug after progression.

ArmMeasureValue (MEDIAN)
Cohort A: LiposarcomaProgression-free Survival (PFS), Cohorts A and B, After Crossover.1.68 months
Cohort A: Liposarcoma, PlaceboProgression-free Survival (PFS), Cohorts A and B, After Crossover.5.78 months
Secondary

Response Rate (RR), Cohorts A and B, After Crossover.

The response rate (RR) is the percentage of patients whose cancer shrinks or disappears after treatment.

Time frame: up to 3 years

Population: Participants who started on placebo then crossed over to active drug.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Cohort A: LiposarcomaResponse Rate (RR), Cohorts A and B, After Crossover.0 Participants
Cohort A: Liposarcoma, PlaceboResponse Rate (RR), Cohorts A and B, After Crossover.0 Participants
Secondary

The Number of Participants With Reported CTCAE (Common Terminology Criteria for Adverse Events) Version 4.03 Adverse Events. All Cohorts.

Common Toxicity Criteria, also referred to as the Common Terminology Criteria for Adverse Events (CTCAE), is a standardized classification of side effects used in assessing drugs for cancer therapy. Cohorts A, B, C, and D.

Time frame: up to 3 years

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Cohort A: LiposarcomaThe Number of Participants With Reported CTCAE (Common Terminology Criteria for Adverse Events) Version 4.03 Adverse Events. All Cohorts.12 Participants
Cohort A: Liposarcoma, PlaceboThe Number of Participants With Reported CTCAE (Common Terminology Criteria for Adverse Events) Version 4.03 Adverse Events. All Cohorts.15 Participants
Cohort B: OsteosarcomaThe Number of Participants With Reported CTCAE (Common Terminology Criteria for Adverse Events) Version 4.03 Adverse Events. All Cohorts.6 Participants
Cohort B: Osteosarcoma, PlaceboThe Number of Participants With Reported CTCAE (Common Terminology Criteria for Adverse Events) Version 4.03 Adverse Events. All Cohorts.9 Participants
Cohort C: Ewing SarcomaThe Number of Participants With Reported CTCAE (Common Terminology Criteria for Adverse Events) Version 4.03 Adverse Events. All Cohorts.6 Participants
Cohort D: RhabdomyosarcomaThe Number of Participants With Reported CTCAE (Common Terminology Criteria for Adverse Events) Version 4.03 Adverse Events. All Cohorts.2 Participants
Cohort E: Mesenchymal ChondrosarcomaThe Number of Participants With Reported CTCAE (Common Terminology Criteria for Adverse Events) Version 4.03 Adverse Events. All Cohorts.0 Participants
Secondary

Time to Tumor Progression (TTP), Cohorts A and B, After Crossover.

Time to tumor progression (TTP) is the length of time from the date of diagnosis or the start of treatment for a disease until the disease starts to get worse or spread to other parts of the body.

Time frame: up to 3 years

Population: Participants who crossed over to active drug after placebo.

ArmMeasureValue (MEDIAN)
Cohort A: LiposarcomaTime to Tumor Progression (TTP), Cohorts A and B, After Crossover.1.76 months
Cohort A: Liposarcoma, PlaceboTime to Tumor Progression (TTP), Cohorts A and B, After Crossover.5.78 months

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