Recurrent Osteosarcoma, Refractory Osteosarcoma
Conditions
Brief summary
This phase I/II trial studies the side effects and best dose of hydroxychloroquine and how well it works when given together with gemcitabine and docetaxel in treating participants with osteosarcoma that has come back or does not respond to treatment. Drugs used in chemotherapy, such as gemcitabine, docetaxel, and hydroxychloroquine, 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.
Detailed description
PRIMARY OBJECTIVES: I. To determine the maximum tolerated dose (MTD) and preliminary safety of hydroxychloroquine (HCQ) when administered with gemcitabine and docetaxel (G+D) in patients with recurrent/metastatic osteosarcoma. (Phase I) II. To determine whether gemcitabine and docetaxel (G+D) in combination with hydroxychloroquine (HCQ) increases the disease control rate in patients with recurrent/metastatic osteosarcoma at 4 months as compared to historic controls. (Phase II) SECONDARY OBJECTIVES: I. To determine the objective response rate by Response Evaluation Criteria in Solid Tumors (RECIST) of the combination of G + D + HCQ in patients with recurrent/metastatic osteosarcoma. II. To estimate the event-free survival (EFS), progression-free survival (PFS), and overall survival (OS) for patients with recurrent/metastatic osteosarcoma treated with G+D+HCQ. III. To estimate the toxicity rates of oral HCQ when administered in conjunction with G+D. IV. To investigate the pharmacokinetics (PK) of the combination in patients with recurrent/metastatic osteosarcoma. EXPLORATORY OBJECTIVES: I. To describe the metabolic response rates of G + D + HCQ in patients recurrent/metastatic measurable osteosarcoma by positron emission tomography (PET)/computed tomography (CT) at 6 weeks. II. To assess pre-/post-treatment changes in autophagy biomarkers (autophagic vesicles, LC3B puncta, p62, and HMGB1), HSP27, and pHSP27 expression in tumor samples at baseline and during cycle #2 of treatment with G + D + HCQ. III. To assess the relationship between probability of response and/or disease control and tumor HSP27, pHSP27, ALDH1A1, and HLTF expression. IV. To complete functional proteomic profiling of autophagic and apoptotic pathways on tumor samples by RPPA and correlate findings with the probability response and disease control. OUTLINE: This is a phase I, dose-escalation study of hydroxychloroquine followed by a phase II study. Participants receive hydroxychloroquine orally (PO) once daily (QD) or twice daily (BID) on days 1-21, gemcitabine intravenously (IV) over 90 minutes on days 1 and 8, and docetaxel IV over 1 hours on day 8. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, participants are followed up at 1 year.
Interventions
DRUGDocetaxel
Given IV
DRUGGemcitabine
Given IV
DRUGHydroxychloroquine
Given PO
Sponsors
M.D. Anderson Cancer Center
National Cancer Institute (NCI)
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
12 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patient or patient's legally acceptable representative has provided informed consent * Patients must have a pathological diagnosis of osteosarcoma at original diagnosis or time of recurrence * Patients must have relapsed or become refractory to conventional therapy, with a regimen containing some combination of high dose methotrexate, doxorubicin, cisplatin, and/or ifosfamide * Patients may have either unresectable or potentially resectable disease. However, patients with potentially resectable disease must be willing to await surgery until after the primary efficacy endpoint is reached at 4 months * Patients must have measurable disease by RECIST 1.1 * Eastern Cooperative Oncology Group (ECOG) performance status of =\< 2. Use Karnofsky for patients \> 16 years old and Lansky for patients =\< 16 * Has archived tumor tissue and is willing to provide a tumor block or unstained slides or the patient is willing to undergo a pretreatment biopsy. Biopsy during cycle #2 of therapy is required. Biopsy at progression is strongly encouraged but will be optional * Absolute neutrophil count (ANC) \>= 1.0 x 10\^9/L * Platelet count \>= 100 x 10\^9/L * Hemoglobin \> 8 g/dL * Prothrombin time (PT) or partial thromboplastin time (PTT) \< 1.5 x upper limit of normal (ULN), except subjects on anticoagulation for venous thromboembolism * Calculated creatinine clearance or radioisotope glomerular filtration rate (GFR) \> 60 mL/min * Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) \< 2.5 x ULN for age * Total bilirubin \< 1.5 x ULN for age * Serum albumin \>= 2
Exclusion criteria
* Any disorder that compromises the ability of the patient or patient's legally acceptable representative to give written informed consent and/or to comply with the study procedures * Patients who will not be available for protocol required study visits, to the best of the subject and investigator's knowledge * History of hypersensitivity to any of the study agents (gemcitabine, docetaxel, or hydroxychloroquine) or to any component of the formulation * Patients who have previously received gemcitabine or docetaxel * Men and woman of reproductive potential, unwilling to practice a highly effective method of birth control for the duration of the study and continuing for 2 weeks (for women) and 12 weeks (for men) after receiving the last dose of study drug. Highly effective methods of birth control include sexual abstinence (men, women); vasectomy or a condom used with spermicide (men) in combination with barrier methods, hormonal birth control or intrauterine device (IUD) (women) * Women who are lactating/breastfeeding or planning to become pregnant during the duration of the study * History or current diagnosis of a second neoplasm. Exception: adequately treated non-melanoma skin cancer, curatively treated in-situ disease, or other solid tumors curatively treated with no evidence of disease for \>= 2 years * Myocardial infarction within 6 months of study day 1, symptomatic congestive heart failure (New York Heart Association \> class II), unstable angina, or unstable cardiac arrhythmia requiring medication, or uncontrolled hypertension (systolic \> 160 mmHg or diastolic \> 100 mmHg) * Active infection requiring intravenous (IV) antibiotics within 2 weeks of study enrollment * Significant gastrointestinal disorder(s) that in the opinion of the investigator (e.g., Crohn's disease, ulcerative colitis, extensive gastrointestinal resection) may influence drug absorption * Known positive test for human immunodeficiency virus (HIV) * Subjects with acute hepatitis B and C are not eligible. Subjects with chronic hepatitis B or C are eligible if their condition is stable and, in the opinion of the investigator and Amgen physician, if consulted, would not pose a risk to subject safety * Toxicities from prior anti-tumor therapy not resolved to Common Terminology Criteria for Adverse Events (CTCAE) grade 0 or 1, or to levels dictated in the eligibility criteria. Grade 2 toxicities from prior anti-tumor therapy that are considered irreversible (defined as having been present and stable for \> 4 weeks), such as stable grade 2 peripheral neuropathy or ifosfamide-related proteinuria, may be allowed if they are not otherwise described in the
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Maximum tolerated dose of hydroxychloroquine (Phase I) | Up to 21 days |
| Disease control rate (Phase II) | At 4 months |
Secondary
| Measure | Time frame |
|---|---|
| Event free survival | From enrollment to disease progression, death, or discontinuation of treatment for any reason, assessed up to 2 years |
| Overall response (complete response [CR] or partial response [PR] versus not CR or PR) | Up to 2 years |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORJohn A Livingston
M.D. Anderson Cancer Center
Outcome results
None listed