Alveolar Soft Part Sarcoma, Angiomatoid Fibrous Histiocytoma, Atypical Fibroxanthoma, Clear Cell Sarcoma of Soft Tissue, Epithelioid Malignant Peripheral Nerve Sheath Tumor, Epithelioid Sarcoma, Extraskeletal Myxoid Chondrosarcoma, Extraskeletal Osteosarcoma, Fibrohistiocytic Neoplasm, Fibrosarcoma, Inflammatory Myofibroblastic Tumor, Intimal Sarcoma, Leiomyosarcoma, Liposarcoma, Liver Embryonal Sarcoma, Low Grade Fibromyxoid Sarcoma, Low Grade Myofibroblastic Sarcoma, Malignant Peripheral Nerve Sheath Tumor, Malignant Skin Granular Cell Tumor, Malignant Triton Tumor, Mesenchymal Chondrosarcoma, Myxofibrosarcoma, Myxoid Chondrosarcoma, Myxoinflammatory Fibroblastic Sarcoma, Nerve Sheath Neoplasm, PEComa, Pericytic Neoplasm, Plexiform Fibrohistiocytic Tumor, Sclerosing Epithelioid Fibrosarcoma, Skin Glomus Tumor, Stage IB Soft Tissue Sarcoma AJCC v7, Stage IIB Soft Tissue Sarcoma AJCC v7, Stage III Soft Tissue Sarcoma AJCC v7, Stage IV Soft Tissue Sarcoma AJCC v7, Synovial Sarcoma, Undifferentiated High Grade Pleomorphic Sarcoma of Bone
Conditions
Brief summary
This randomized phase II/III trial studies how well pazopanib, when combined with chemotherapy and radiation therapy or radiation therapy alone, work in the treatment of patients with newly diagnosed non-rhabdomyosarcoma soft tissue sarcomas that can eventually be removed by surgery. Radiation therapy uses high energy x-rays to kill tumor cells. Drugs used in chemotherapy, such as ifosfamide and doxorubicin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Pazopanib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. It is not yet known whether these therapies can be safely combined and if they work better when given together in treating patients with non-rhabdomyosarcoma soft tissue sarcomas.
Detailed description
PRIMARY OBJECTIVES: I. To identify the dose of pazopanib that is feasible when given in combination with radiation or chemoradiation in pediatric and adult patients newly diagnosed with unresected intermediate- and high-risk non rhabdomyosarcoma soft tissue sarcomas (NRSTS). II. To compare the rates of near complete pathologic response (\> 90% necrosis) with the addition of pazopanib to preoperative chemoradiation versus preoperative chemoradiation alone for potentially resectable \> 5 cm, grade 2 or 3 intermediate to high risk chemotherapy-sensitive NRSTS in the phase II portion of the study for this cohort. III. To compare the rates of near complete pathologic response (\> 90% necrosis) with the addition of pazopanib to preoperative radiotherapy versus preoperative radiotherapy alone for potentially resectable intermediate to high risk adult and pediatric NRSTS in the phase II portion of the study for this cohort (using a phase II decision rule to go onto the phase III portion of the study). IV. To compare the rates of event-free survival (EFS) with the addition of pazopanib to preoperative radiotherapy versus preoperative radiotherapy alone for localized intermediate to high risk adult and pediatric NRSTS in the phase III portion of the study for this cohort if the phase II decision rule is passed. SECONDARY OBJECTIVES: I. To estimate the rates of local failure, regional failure, distant metastasis free survival, disease-free survival, and overall survival with the addition of pazopanib to preoperative chemoradiation or preoperative radiation in intermediate to high risk adult and pediatric NRSTS. II. To compare the pattern of recurrence (local, regional and distant) between preoperative chemoradiation or radiation with the addition of pazopanib for adult and pediatric NRSTS. III. To define the toxicities of ifosfamide and doxorubicin chemotherapy and radiation when used in combination with pazopanib in intermediate to high risk adult and pediatric NRSTS. IV. To define the toxicities of preoperative radiotherapy when used in combination with pazopanib in intermediate to high risk adult and pediatric NRSTS. EXPLORATORY OBJECTIVES: I. To gain insight into the disease biology of childhood and adult NRSTS through analysis of actionable mutations and whole genome sequencing. II. To determine if microvessel density and circulating tumor deoxyribonucleic acid (DNA) predict response to pazopanib and outcome. III. To determine the effect of pazopanib on doxorubicin exposure in children and adults with NRSTS. IV. To evaluate change in fludeoxyglucose F 18 (FDG) positron emission tomography (PET) maximum standard uptake value (SUVmax) from baseline to week 10 or 13 in patients with unresected tumors and to correlate this change with pathologic response and EFS. V. To compare the rate of response by standard imaging and pathologic assessment to determine which correlates better with local tumor control, distant tumor control, EFS, and overall survival. OUTLINE: This study starts as a dose-escalation study of pazopanib. CHEMOTHERAPY COHORT: Patients eligible for chemotherapy cohort are randomized to 1 of 2 treatment regimens. REGIMEN A: INDUCTION PHASE: Patients receive pazopanib orally (PO) once daily (QD) on weeks 1-12, ifosfamide intravenously (IV) over 2-4 hours on days 1-3 on weeks 1, 4, 7, 10, and doxorubicin IV over 1-15 minutes on days 1-2 on weeks 1 and 4. At least 24 hours after the completion of week 4 doxorubicin, patients undergo radiation therapy on weeks 4-10. SURGERY: Patients undergo surgery on week 13. CONTINUATION PHASE: Patients receive pazopanib PO QD on weeks 16-25, ifosfamide IV over 2-4 hours on days 1-3 on weeks 16 and 19, and doxorubicin IV over 1-15 minutes on days 1-2 on weeks 16, 19, and 22. If applicable, patients undergo additional radiation therapy at week 16 REGIMEN B: INDUCTION PHASE: Patients receive ifosfamide IV over 2-4 hours on days 1-3 on weeks 1, 4, 7, 10 and doxorubicin hydrochloride IV over 1-15 minutes on days 1-2 on weeks 1 and 4. At least 24 hours after the completion of week 4 doxorubicin, patients undergo radiation therapy on weeks 4-10. SURGERY: Patients undergo surgery on week 13. CONTINUATION PHASE: Patients receive ifosfamide IV over 2-4 hours on days 1-3 on weeks 16 and 19 and doxorubicin IV over 1-15 minutes on days 1-2 on weeks 16, 19, and 22. If applicable, patients undergo additional radiation therapy at week 16. NON-CHEMOTHERAPY COHORT: Patients eligible for non-chemotherapy cohort are randomized to 1 of 2 treatment regimens. REGIMEN C: INDUCTION PHASE: Patients receive pazopanib PO QD on weeks 1-9. Patients undergo radiation therapy on weeks 1-7. SURGERY: Patients undergo surgery on week 10. CONTINUATION PHASE: Patients receive pazopanib PO QD on weeks 13-25. If applicable, patients undergo additional radiation therapy at week 13. REGIMEN D: INDUCTION PHASE: Patients undergo radiation therapy on weeks 1-7. SURGERY: Patients undergo surgery on week 10. CONTINUATION PHASE: If applicable, patients undergo additional radiation therapy at week 13. After completion of study treatment, patients are followed up at 6, 12, 18, 24, 30, 36, 48, and 60 months.
Interventions
Given IV
Given IV
Given IV
Given PO
Given PO
Undergo radiation therapy
Undergo surgery
Sponsors
Study design
Eligibility
Inclusion criteria
* Note: eligible patients must have a body surface area \>= 0.5 m\^2 AND be able to swallow whole tablets * Newly diagnosed and histopathologically confirmed, potentially resectable NRSTS of the extremity and trunk will be eligible for the chemotherapy or non-chemotherapy cohort based on: * Evidence of chemotherapy sensitivity of the histologic sarcoma subtype based on existing evidence from prior clinical trials * Sufficient risk of metastatic disease to warrant chemotherapy based on size and grade and * Medically deemed able or unable to undergo chemotherapy * Notes: an incisional biopsy or core biopsy is preferred; fine needle aspiration biopsy is not acceptable to establish the diagnosis * ELIGIBLE SITES: * Extremities: upper (including shoulder) and lower (including hip) * Trunk: body wall * INELIGIBLE SITES: Head and neck, visceral organs (with the exception of embryonal sarcoma of the liver), retroperitoneum, peritoneum, pelvis within the confines of the bony pelvis * ELIGIBILITY FOR CHEMOTHERAPY COHORT: * Stage T2a/b (\> 5 cm) and grade 2 or 3 AND * One of the following chemosensitive histologies as defined in the World Health Organization (WHO) classification of soft tissue tumors (with some evidence of good response to chemoradiation and of sufficient high risk of metastases, or clear evidence of metastases): * Unclassified soft tissue sarcomas that are too undifferentiated to be placed in a specific pathologic category in the WHO classification (often called "undifferentiated soft tissue sarcoma" or "soft tissue sarcoma not otherwise specified \[NOS\]") * Synovial sarcoma * Angiosarcoma of soft tissue * Adult fibrosarcoma * Mesenchymal (extraskeletal) chondrosarcoma * Leiomyosarcoma * Liposarcoma (excluding myxoid liposarcoma) * Undifferentiated pleomorphic sarcoma * Embryonal sarcoma of the liver * Patients meeting the above criteria (histology, size, and grade) with the EXCEPTION of histologies noted above may enroll on the chemotherapy cohort or the non-chemotherapy cohort at the discretion of the enrolling investigator; patients meeting these criteria with the EXCEPTION of histologies noted above but medically deemed unable to receive chemotherapy or who elect not to receive chemotherapy are eligible for the non-chemotherapy cohort * Patients with the following histologies are only eligible for the chemotherapy cohort and cannot enroll on the non-chemotherapy cohort: * Unclassified soft tissue sarcomas that are too undifferentiated to be placed in a specific pathologic category in the WHO classification (often called "undifferentiated soft tissue sarcoma" or "soft tissue sarcoma NOS") in patients \< 30 years of age * Synovial sarcoma * Embryonal sarcoma of the liver * ELIGIBILITY FOR NON-CHEMOTHERAPY COHORT: * Patients with any size of grade 2 or 3 of the following "intermediate (rarely metastasizing)" or "malignant" tumors, as defined in the WHO classification of soft tissue tumors for which we have consensus data of chemotherapy-resistance are eligible only for the non-chemotherapy cohort: * So-called fibrohistiocytic tumors - plexiform fibrohistiocytic tumor, giant cell tumor of soft tissues * Fibroblastic/myofibroblastic tumors - solitary fibrous tumor, malignant solitary fibrous tumor, inflammatory myofibroblastic tumor, low grade myofibroblastic sarcoma, myxoinflammatory fibroblastic sarcoma, atypical myxoinflammatory fibroblastic tumor, myxofibrosarcoma, low grade fibromyxoid sarcoma, sclerosing epithelioid fibrosarcoma * Tumors of uncertain differentiation - epithelioid sarcoma, alveolar soft part sarcoma, clear cell sarcoma of soft tissue, angiomatoid fibrous histiocytoma, ossifying fibromyxoid tumor, myoepithelioma, myoepithelial carcinoma, extraskeletal myxoid chondrosarcoma, neoplasms with perivascular epithelioid cell differentiation (PEComa), intimal sarcoma, atypical fibroxanthoma, mixed tumor NOS, phosphaturic mesenchymal tumor, malignant ossifying fibromyxoid tumor, malignant mixed tumor, malignant phosphaturic mesenchymal tumor * Chondro-osseous tumors - extraskeletal osteosarcoma * Pericytic (perivascular) tumors - malignant glomus tumor * Nerve sheath tumors - malignant peripheral nerve sheath tumor, malignant granular cell tumor, epithelioid malignant peripheral nerve sheath tumor, malignant Triton tumor * Undifferentiated sarcomas (with a specific pathologic category in the WHO classification) - undifferentiated round cell sarcoma, undifferentiated epithelioid sarcoma, undifferentiated spindle cell sarcoma * Patients meeting the criteria (histology, size, and grade) with the EXCEPTION of histologies noted above may enroll on the non-chemotherapy cohort at the discretion of the enrolling investigator; patients meeting these criteria with the EXCEPTION of histologies noted above but medically deemed unable to receive chemotherapy or who elect not to receive chemotherapy are eligible for the non-chemotherapy cohort; note that tumors arising in bone are NOT eligible for this study * Extent of disease: * Patients with non-metastatic and metastatic disease are eligible * Initially unresectable patients, with or without metastatic disease, are eligible as long as there is a commitment at enrollment to resect the primary tumor * Sufficient tissue and blood must be available to submit for required biology studies * Lansky performance status score \>= 70 for patients =\< 16 years of age * Karnofsky performance status score \>= 70 for patients \> 16 years of age * Absolute neutrophil count \>= 1500/uL; Note: no transfusions are permitted 7 days prior to laboratory studies to determine eligibility * Platelet count \>= 100,000/uL; Note: no transfusions are permitted 7 days prior to laboratory studies to determine eligibility * Hemoglobin \>= 8 g/dL for patients =\< 16 years of age; \>= 9 g/dL for patients \> 16 years of age; Note: no transfusions are permitted 7 days prior to laboratory studies to determine eligibility * Creatinine clearance or radioisotope glomerular filtration rate (GFR) \>= 70 mL/min/1.73 m\^2 or normal serum creatinine based on age/gender as follows: * 2 to \< 6 years; 0.8 mg/dL male; 0.8 mg/dL female * 6 to \< 10 years; 1 mg/dL male; 1 mg/dL female * 10 to \< 13 years; 1.2 mg/dL male; 1.2 mg/dL female * 13 to \< 16 years; 1.5 mg/dL male; 1.4 mg/dL female * \>= 16 years; 1.5 mg/dL male; 1.4 mg/dL female * Total bilirubin =\< 1.5 x upper limit of normal (ULN) for age * Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase \[AST\]) or serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase \[ALT\]) \< 2.5 x upper limit of normal (ULN) for age * Shortening fraction of \>= 27% by echocardiogram OR ejection fraction of \>= 50% by radionuclide angiogram * Corrected QT interval (QTc) \< 480 msec * No evidence of dyspnea at rest, no exercise intolerance, and a resting pulse oximetry reading \> 94% on room air if there is clinical indication for determination * Patients on low molecular weight heparin or Coumadin (with a stable international normalized ratio \[INR\]) are eligible * Patient must have a life expectancy of at least 3 months with appropriate therapy * 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
Exclusion criteria
* Patients with grade 1 NRSTS tumors of any size are not eligible * Patients with known central nervous system (CNS) metastases are not eligible; Note: brain imaging is not an eligibility requirement * Patients with evidence of active bleeding or bleeding diathesis will be excluded (Note: patients aged \> 17 years with excess of 2.5 mL of hemoptysis are not eligible) * Patients with gross total resection of the primary tumor prior to enrollment on ARST1321 are NOT eligible; patients who have experienced tumor recurrence after a gross total tumor resection are NOT eligible * Patients with uncontrolled hypertension are ineligible; uncontrolled hypertension is defined as follows: * Patients aged =\< 17 years: greater than 95th percentile systolic and diastolic blood pressure based on age and height which is not controlled by one anti-hypertensive medication * Patients aged \> 17 years: systolic blood pressure \>= 140 mmHg and/or diastolic blood pressure \>= 90 mmHg that is not controlled by one anti-hypertensive medication * Prior Therapy: * Patients must have had no prior anthracycline (e.g., doxorubicin, daunorubicin) or ifosfamide chemotherapy * Patients must have had no prior use of pazopanib or similar multi-targeted tyrosine kinase inhibitors (TKI) * Patients must have had no prior radiotherapy to tumor-involved sites * Note: patients previously treated for a non-NRSTS cancer are eligible provided they meet the prior therapy requirements; patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier are excluded * Other types of invasive malignancy that are not disease free within 3 years except for non-melanoma skin cancer, lentigo maligna, any carcinoma-in-situ or prostate cancer with low risk factors * CYTOCHROME P450 3A4 (CYP3A4) substrates WITH narrow therapeutic indices: patients chronically receiving medications known to be metabolized by CYP3A4 and with narrow therapeutic indices within 7 days prior to study enrollment, including but not limited to pimozide, aripiprazole, triazolam, ergotamine and halofantrine are not eligible; Note: the use of fentanyl is permitted * CYP3A4 Inhibitors: patients chronically receiving drugs that are known potent CYP3A4 inhibitors within 7 days prior to study enrollment, including but not limited to itraconazole, clarithromycin, erythromycin many non-nucleoside reverse-transcriptase inhibitors (NNRTIs), diltiazem, verapamil, and grapefruit juice are not eligible * CYP3A4 Inducers: patients chronically receiving drugs that are known potent CYP3A4 inducers within 14 days prior to study enrollment, including but not limited to carbamazepine, phenobarbital, phenytoin, rifampin, and St. John's wort are not eligible (with the exception of glucocorticoids) * Certain medications that are associated with a risk for QTc prolongation and/or Torsades de Pointes, although not prohibited, should be avoided or replaced with medications that do not carry these risks, if possible * Subjects with any condition that may impair the ability to swallow or absorb oral medications/investigational product including: * Any lesion, whether induced by tumor, radiation or other conditions, which makes it difficult to swallow capsules or pills * Prior surgical procedures affecting absorption including, but not limited to major resection of stomach or small bowel * Active peptic ulcer disease * Malabsorption syndrome * Subjects with any condition that may increase the risk of gastrointestinal bleeding or gastrointestinal perforation, including: * Active peptic ulcer disease * Known intraluminal metastatic lesions * Inflammatory bowel disease (e.g., ulcerative colitis, Crohn's disease) or other gastrointestinal conditions which increase the risk of perforation * History of abdominal fistula, gastrointestinal perforation or intra-abdominal abscess within 28 days prior to beginning study treatment * Subjects with any of the following cardiovascular conditions within the past 6 months * Cerebrovascular accident (CVA) or transient ischemic attack (TIA) * Cardiac arrhythmia * Admission for unstable angina * Cardiac angioplasty or stenting * Coronary artery bypass graft surgery * Pulmonary embolism, untreated deep venous thrombosis (DVT) or DVT which has been treated with therapeutic anticoagulation for less than 6 weeks * Arterial thrombosis * Symptomatic peripheral vascular disease * Class III or IV heart failure as defined by the New York Heart Association (NYHA) functional classification system; a subject who has a history of class II heart failure and is asymptomatic on treatment may be considered eligible * History of serious or non-healing wound, ulcer, or bone fracture * Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements * Patients who are unable to swallow whole tablets are not eligible * Patients with a body surface area \< 0.5 m\^2 are not eligible * Human immunodeficiency virus (HIV)-positive subjects on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with pazopanib; in addition, these subjects are at increased risk of lethal infections when treated with marrow-suppressive therapy * Patients who are receiving any other investigational agent(s) * Pregnancy and breast feeding: * Female patients who are pregnant are ineligible due to risks of fetal and teratogenic adverse events as seen in animal/human studies * Lactating females are not eligible unless they have agreed not to breastfeed their infants during treatment and for a period of 1 month following completion of treatment * Female patients of childbearing potential are not eligible unless a negative pregnancy test result has been obtained * Unwillingness to use an effective contraceptive method for the duration of their study participation and for at least 1 month after treatment is completed if sexually active with reproductive potential
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasible Dose: Pediatric | After the first 6 weeks of Induction | The dose of pazopanib that is feasible when given in combination with radiation or chemoradiation in pediatric unresected intermediate- and high-risk NRSTS patients. Initially, up to 10 patients (minimum of 3 patients ≥ 2 and \< 18 years of age and 3 patients ≥ 18 years of age) eligible for each of the two study cohorts were non-randomly assigned (to generate 8 patients evaluable for toxicity) to receive treatment with pazopanib at dose level 1. A protocol-defined list of pazopanib-associated adverse events were defined as dose-limiting toxicities. The pazopanib dose determined to be feasible was based on the number of patient-reported dose-limiting toxicities encountered. |
| Feasible Dose: Adult | After the first 6 weeks of Induction | The dose of pazopanib that is feasible when given in combination with radiation or chemoradiation in adult unresected intermediate- and high-risk NRSTS patients. Initially, up to 10 patients (minimum of 3 patients ≥ 2 and \< 18 years of age and 3 patients ≥ 18 years of age) eligible for each of the two study cohorts were non-randomly assigned (to generate 8 patients evaluable for toxicity) to receive treatment with pazopanib at dose level 1. A protocol-defined list of pazopanib-associated adverse events were defined as dose-limiting toxicities. The pazopanib dose determined to be feasible was based on the number of patient-reported dose-limiting toxicities encountered. |
| Percentage of Chemoradiotherapy Patients With Positive Pathologic Response at Week 13 | Week 13 after induction | A responder is defined by more than (90% tumor necrosis at week 13). A non-responder has less than 90% necrosis or progressive disease before week 13. |
| Percentage of Radiotherapy Patients With Positive Pathologic Response at Week 10 | Week 10 after induction | A responder is defined by more than 90% tumor necrosis at week 10. A non-responder has less than 90% necrosis or progressive disease before week 10. |
| Percentage of Radiotherapy Patients Failure Free at 5 Years Following Study Entry | From enrollment to up to 60 months | Time to the first occurrence of relapse, progression, secondary cancer or death from any cause. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Patients Local Failure Free at 5 Years Following Study Entry | From enrollment to up to 60 months | Defined as disease recurrence only at the primary site of disease at diagnosis. The relative risk of specific failure types will be estimated and compared descriptively using the Cox proportional hazard model. Data were obtained from institutional reported data. |
| Percentage of Patients Regional Failure Free at 5 Years Following Study Entry | From enrollment to up to 60 months | Defined as disease recurrence at lymph nodes regional to the primary disease site, with or without local failure but without distant failure. The relative risk of specific failure types will be estimated and compared descriptively using the Cox proportional hazard model. Data were obtained from institutional reported data. |
| Percentage of Patients Distant Failure Free at 5 Years Following Study Entry | From enrollment to up to 60 months | Defined as disease recurrence at sites other than the primary site and diagnosis and nodes regional to that site (metastatic disease, whether or not present at diagnosis), with or without loco-regional failure. The relative risk of specific failure types will be estimated and compared descriptively using the Cox proportional hazard model. Data were obtained from institutional reported data. |
| Percentage of Patients Who Experienced Grade 3 or Higher Toxicity Assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) | Reporting of adverse events was required from the start of protocol therapy and until 30 days from the last administration of study drugs; up to 1 year | Participants who experienced Grade 3 or higher toxicity was assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE). |
Countries
Canada, Puerto Rico, United States
Contacts
Children's Oncology Group
Participant flow
Pre-assignment details
All patients began at Dose-Finding Level 1. Dose-Finding Level 0 CR, Dose-Finding Level 2 CR, and Dose-Finding Level 0 RT never enrolled because protocol-defined dose de-escalation and escalation parameters were not met. Cohorts C and D were closed to further patient accrual on October 12, 2017 due to slower than anticipated enrollment.
Participants by arm
| Arm | Count |
|---|---|
| Dose-Finding Level 1 CR Dose-Finding Level 1 CR:
Adult: Pazopanib 600 mg; Pediatric: Pazopanib 350 mg/m2 | 10 |
| Dose-Finding Level 1 RT Dose-Finding Level 1 RT:
Adult: Pazopanib 600 mg; Pediatric: Pazopanib 350 mg/m2 | 11 |
| Dose-Finding Level 2 RT Dose-Finding Level 2 RT:
Adult: Pazopanib 800 mg; Pediatric: Pazopanib 450 mg/m2 | 10 |
| Regimen A Regimen A: Chemoradiation plus pazopanib | 49 |
| Regimen B Regimen B: Chemoradiation alone | 48 |
| Regimen C Regimen C: Radiation therapy plus pazopanib | 6 |
| Regimen D Regimen D: Radiation therapy alone | 6 |
| Total | 140 |
Baseline characteristics
| Characteristic | Dose-Finding Level 1 CR | Dose-Finding Level 1 RT | Dose-Finding Level 2 RT | Regimen A | Regimen B | Regimen C | Regimen D | Total |
|---|---|---|---|---|---|---|---|---|
| Age, Continuous | 225.1 Months STANDARD_DEVIATION 57.8 | 524.3 Months STANDARD_DEVIATION 270.3 | 407.3 Months STANDARD_DEVIATION 224.7 | 376.3 Months STANDARD_DEVIATION 243.4 | 356.2 Months STANDARD_DEVIATION 221.8 | 547.2 Months STANDARD_DEVIATION 260.6 | 722.8 Months STANDARD_DEVIATION 141.9 | 394.6 Months STANDARD_DEVIATION 242.3 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 2 Participants | 1 Participants | 1 Participants | 13 Participants | 9 Participants | 0 Participants | 0 Participants | 26 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 6 Participants | 9 Participants | 9 Participants | 34 Participants | 38 Participants | 6 Participants | 6 Participants | 108 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 2 Participants | 1 Participants | 0 Participants | 2 Participants | 1 Participants | 0 Participants | 0 Participants | 6 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants | 2 Participants | 1 Participants | 3 Participants | 6 Participants | 1 Participants | 0 Participants | 15 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 1 Participants | 1 Participants | 7 Participants | 3 Participants | 0 Participants | 1 Participants | 14 Participants |
| Race (NIH/OMB) White | 7 Participants | 8 Participants | 8 Participants | 39 Participants | 38 Participants | 5 Participants | 5 Participants | 110 Participants |
| Sex: Female, Male Female | 4 Participants | 3 Participants | 3 Participants | 30 Participants | 18 Participants | 2 Participants | 3 Participants | 63 Participants |
| Sex: Female, Male Male | 6 Participants | 8 Participants | 7 Participants | 19 Participants | 30 Participants | 4 Participants | 3 Participants | 77 Participants |
Adverse events
| Event type | EG000 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 |
|---|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 1 / 9 | 4 / 9 | 3 / 10 | 5 / 46 | 9 / 43 | 0 / 6 | 2 / 6 |
| other Total, other adverse events | 4 / 9 | 2 / 9 | 5 / 10 | 20 / 46 | 10 / 43 | 1 / 6 | 0 / 6 |
| serious Total, serious adverse events | 6 / 9 | 6 / 9 | 2 / 10 | 33 / 46 | 8 / 43 | 1 / 6 | 0 / 6 |
Outcome results
Feasible Dose: Adult
The dose of pazopanib that is feasible when given in combination with radiation or chemoradiation in adult unresected intermediate- and high-risk NRSTS patients. Initially, up to 10 patients (minimum of 3 patients ≥ 2 and \< 18 years of age and 3 patients ≥ 18 years of age) eligible for each of the two study cohorts were non-randomly assigned (to generate 8 patients evaluable for toxicity) to receive treatment with pazopanib at dose level 1. A protocol-defined list of pazopanib-associated adverse events were defined as dose-limiting toxicities. The pazopanib dose determined to be feasible was based on the number of patient-reported dose-limiting toxicities encountered.
Time frame: After the first 6 weeks of Induction
Population: Adult patients, excluding 1 ineligible patient in Dose-Finding RT group
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Pediatric Dose Finding CR Cohorts | Feasible Dose: Adult | 600 milligram |
| All Pediatric Dose Finding RT Cohorts | Feasible Dose: Adult | 800 milligram |
Feasible Dose: Pediatric
The dose of pazopanib that is feasible when given in combination with radiation or chemoradiation in pediatric unresected intermediate- and high-risk NRSTS patients. Initially, up to 10 patients (minimum of 3 patients ≥ 2 and \< 18 years of age and 3 patients ≥ 18 years of age) eligible for each of the two study cohorts were non-randomly assigned (to generate 8 patients evaluable for toxicity) to receive treatment with pazopanib at dose level 1. A protocol-defined list of pazopanib-associated adverse events were defined as dose-limiting toxicities. The pazopanib dose determined to be feasible was based on the number of patient-reported dose-limiting toxicities encountered.
Time frame: After the first 6 weeks of Induction
Population: Pediatric patients, excluding 1 ineligible patient in Dose-Finding CR group and 1 ineligible patient in Dose-Finding RT group
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Pediatric Dose Finding CR Cohorts | Feasible Dose: Pediatric | 350 milligram per square meter |
| All Pediatric Dose Finding RT Cohorts | Feasible Dose: Pediatric | 450 milligram per square meter |
Percentage of Chemoradiotherapy Patients With Positive Pathologic Response at Week 13
A responder is defined by more than (90% tumor necrosis at week 13). A non-responder has less than 90% necrosis or progressive disease before week 13.
Time frame: Week 13 after induction
Population: It was pre-specified to combine adult and pediatric participants for analysis as they received an equivalent dose of Pazopanib. There were no patients enrolled onto Dose-Finding Level 0 CR or Dose-Finding Level 2 CR. 19 Regimen A patients and 23 Regimen B patients were excluded.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Pediatric Dose Finding CR Cohorts | Percentage of Chemoradiotherapy Patients With Positive Pathologic Response at Week 13 | 66.67 Percentage of patients |
| All Pediatric Dose Finding RT Cohorts | Percentage of Chemoradiotherapy Patients With Positive Pathologic Response at Week 13 | 46.67 Percentage of patients |
| Regimen B | Percentage of Chemoradiotherapy Patients With Positive Pathologic Response at Week 13 | 24 Percentage of patients |
Percentage of Radiotherapy Patients Failure Free at 5 Years Following Study Entry
Time to the first occurrence of relapse, progression, secondary cancer or death from any cause.
Time frame: From enrollment to up to 60 months
Population: Data for the phase III portion of the study were never collected because the RT arm was closed earlier due to slow accrual.
Percentage of Radiotherapy Patients With Positive Pathologic Response at Week 10
A responder is defined by more than 90% tumor necrosis at week 10. A non-responder has less than 90% necrosis or progressive disease before week 10.
Time frame: Week 10 after induction
Population: It was pre-specified to combine adult and pediatric participants for analysis as they received an equivalent dose of Pazopanib. There were no patients enrolled onto Dose Level 0 RT. 3 Regimen C patients excluded: 1 patient did not receive treatment and 2 missing review; 4 Regimen D patients excluded due to missing review.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Pediatric Dose Finding CR Cohorts | Percentage of Radiotherapy Patients With Positive Pathologic Response at Week 10 | 0 Percentage of patients |
| All Pediatric Dose Finding RT Cohorts | Percentage of Radiotherapy Patients With Positive Pathologic Response at Week 10 | 40 Percentage of patients |
| Regimen B | Percentage of Radiotherapy Patients With Positive Pathologic Response at Week 10 | 0 Percentage of patients |
| Regimen D | Percentage of Radiotherapy Patients With Positive Pathologic Response at Week 10 | 0 Percentage of patients |
Percentage of Patients Distant Failure Free at 5 Years Following Study Entry
Defined as disease recurrence at sites other than the primary site and diagnosis and nodes regional to that site (metastatic disease, whether or not present at diagnosis), with or without loco-regional failure. The relative risk of specific failure types will be estimated and compared descriptively using the Cox proportional hazard model. Data were obtained from institutional reported data.
Time frame: From enrollment to up to 60 months
Population: Patients deemed ineligible in the original cohort are excluded. An additional five (5) patients are excluded in this 5-year analysis as they were deemed ineligible post the initial submission and publication.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Pediatric Dose Finding CR Cohorts | Percentage of Patients Distant Failure Free at 5 Years Following Study Entry | 77.78 percentage of participants |
| All Pediatric Dose Finding RT Cohorts | Percentage of Patients Distant Failure Free at 5 Years Following Study Entry | 33.33 percentage of participants |
| Regimen B | Percentage of Patients Distant Failure Free at 5 Years Following Study Entry | 70.00 percentage of participants |
| Regimen D | Percentage of Patients Distant Failure Free at 5 Years Following Study Entry | 59.89 percentage of participants |
| Regimen B | Percentage of Patients Distant Failure Free at 5 Years Following Study Entry | 62.62 percentage of participants |
| Regimen C | Percentage of Patients Distant Failure Free at 5 Years Following Study Entry | 80.00 percentage of participants |
| Regimen D | Percentage of Patients Distant Failure Free at 5 Years Following Study Entry | 66.67 percentage of participants |
Percentage of Patients Local Failure Free at 5 Years Following Study Entry
Defined as disease recurrence only at the primary site of disease at diagnosis. The relative risk of specific failure types will be estimated and compared descriptively using the Cox proportional hazard model. Data were obtained from institutional reported data.
Time frame: From enrollment to up to 60 months
Population: Patients deemed ineligible in the original cohort are excluded. An additional five (5) patients are excluded in this 5-year analysis as they were deemed ineligible post the initial submission and publication.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Pediatric Dose Finding CR Cohorts | Percentage of Patients Local Failure Free at 5 Years Following Study Entry | 100.00 percentage of participants |
| All Pediatric Dose Finding RT Cohorts | Percentage of Patients Local Failure Free at 5 Years Following Study Entry | 80.00 percentage of participants |
| Regimen B | Percentage of Patients Local Failure Free at 5 Years Following Study Entry | 100.00 percentage of participants |
| Regimen D | Percentage of Patients Local Failure Free at 5 Years Following Study Entry | 91.09 percentage of participants |
| Regimen B | Percentage of Patients Local Failure Free at 5 Years Following Study Entry | 87.32 percentage of participants |
| Regimen C | Percentage of Patients Local Failure Free at 5 Years Following Study Entry | 100.00 percentage of participants |
| Regimen D | Percentage of Patients Local Failure Free at 5 Years Following Study Entry | 83.33 percentage of participants |
Percentage of Patients Regional Failure Free at 5 Years Following Study Entry
Defined as disease recurrence at lymph nodes regional to the primary disease site, with or without local failure but without distant failure. The relative risk of specific failure types will be estimated and compared descriptively using the Cox proportional hazard model. Data were obtained from institutional reported data.
Time frame: From enrollment to up to 60 months
Population: Patients deemed ineligible in the original cohort are excluded. An additional five (5) patients are excluded in this 5-year analysis as they were deemed ineligible post the initial submission and publication.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Pediatric Dose Finding CR Cohorts | Percentage of Patients Regional Failure Free at 5 Years Following Study Entry | 100.00 percentage of participants |
| All Pediatric Dose Finding RT Cohorts | Percentage of Patients Regional Failure Free at 5 Years Following Study Entry | 100.00 percentage of participants |
| Regimen B | Percentage of Patients Regional Failure Free at 5 Years Following Study Entry | 100.00 percentage of participants |
| Regimen D | Percentage of Patients Regional Failure Free at 5 Years Following Study Entry | 100.00 percentage of participants |
| Regimen B | Percentage of Patients Regional Failure Free at 5 Years Following Study Entry | 100.00 percentage of participants |
| Regimen C | Percentage of Patients Regional Failure Free at 5 Years Following Study Entry | 100.00 percentage of participants |
| Regimen D | Percentage of Patients Regional Failure Free at 5 Years Following Study Entry | 100.00 percentage of participants |
Percentage of Patients Who Experienced Grade 3 or Higher Toxicity Assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE)
Participants who experienced Grade 3 or higher toxicity was assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE).
Time frame: Reporting of adverse events was required from the start of protocol therapy and until 30 days from the last administration of study drugs; up to 1 year
Population: Ineligible patients are excluded.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Pediatric Dose Finding CR Cohorts | Percentage of Patients Who Experienced Grade 3 or Higher Toxicity Assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) | Pediatric Patients | 60 Percentage of patients |
| All Pediatric Dose Finding CR Cohorts | Percentage of Patients Who Experienced Grade 3 or Higher Toxicity Assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) | Adult Patients | 75 Percentage of patients |
| All Pediatric Dose Finding RT Cohorts | Percentage of Patients Who Experienced Grade 3 or Higher Toxicity Assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) | Pediatric Patients | 66.67 Percentage of patients |
| All Pediatric Dose Finding RT Cohorts | Percentage of Patients Who Experienced Grade 3 or Higher Toxicity Assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) | Adult Patients | 66.67 Percentage of patients |
| Regimen B | Percentage of Patients Who Experienced Grade 3 or Higher Toxicity Assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) | Pediatric Patients | 33.33 Percentage of patients |
| Regimen B | Percentage of Patients Who Experienced Grade 3 or Higher Toxicity Assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) | Adult Patients | 57.14 Percentage of patients |
| Regimen D | Percentage of Patients Who Experienced Grade 3 or Higher Toxicity Assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) | Adult Patients | 86.67 Percentage of patients |
| Regimen D | Percentage of Patients Who Experienced Grade 3 or Higher Toxicity Assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) | Pediatric Patients | 75 Percentage of patients |
| Regimen B | Percentage of Patients Who Experienced Grade 3 or Higher Toxicity Assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) | Adult Patients | 36 Percentage of patients |
| Regimen B | Percentage of Patients Who Experienced Grade 3 or Higher Toxicity Assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) | Pediatric Patients | 33.33 Percentage of patients |
| Regimen C | Percentage of Patients Who Experienced Grade 3 or Higher Toxicity Assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) | Adult Patients | 40 Percentage of patients |
| Regimen C | Percentage of Patients Who Experienced Grade 3 or Higher Toxicity Assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) | Pediatric Patients | 0 Percentage of patients |
| Regimen D | Percentage of Patients Who Experienced Grade 3 or Higher Toxicity Assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) | Adult Patients | 0 Percentage of patients |
Change in Fludeoxyglucose F 18 (FDG) Positron Emission Tomography (PET) Maximum Standard Uptake Value (SUVmax)
To evaluate change in FDG PET maximum standard uptake value (SUVmax) from baseline to Week 10 or 13 in patients with unresected tumors and to correlate this change with pathologic response and EFS.
Time frame: From enrollment to week 10 or 13 prior to tumor resection
Mean Pharmacokinetic Parameters of Doxorubicin and Pazopanib
Pharmacokinetic parameters such as the clearance of doxorubicin and pazopanib will be estimated.
Time frame: Up to 48 hours after the end of infusion
Prevalence of Circulating Tumor DNA (ctDNA)
Descriptive analyses will be performed to summarize the prevalence of ctDNA.
Time frame: At diagnosis
Relative Frequency of Actionable Mutations
Descriptive statistical analyses will be provided to estimate the relative frequency of actionable mutations across the whole cohort and within more common histological subtypes, like synovial sarcoma and malignant peripheral nerve sheath tumors.
Time frame: At diagnosis
Relative Risk of Failure Based on Both Standard Imaging and Pathologic Assessment
To compare the rate of response by standard imaging and pathologic assessment to determine which correlates better with local tumor control, distant tumor control, event free survival, and overall survival.
Time frame: From enrollment up to 60 months