Tumors of the Ewing sarcoma family (ES) affect children, adolescents and young adults. The reported incidence is 0.6 cases per million inhabitants every year. The peak incidence occurs between 10 and 20 years and it is rarely diagnosed beyond 30. The ES is a severe disease with a progression-free survival after 5 years of 60% in cases without metastasis and deadly in the majority of patients presenting metastasis. The ES is considered a systemic disease because, despite receiving an adequate local treatment, over 90% of patients deaths occur due to disseminated disease. Combined therapy of surgery, radiotherapy and chemotherapy has led to an improvement in the prognosis, achieving a survival of about 60% in most series The MSKCC P6 protocol was developed for the treatment of high risk ES. In 2003, Kolb et al. reported the MSKCC experience after a 4-years follow-up of 68 patients who had been included from 1990 to 2001. Following the MSKCC P6 protocol, a survival rate of 82% was achieved in patients without metastasis, superior to the achieved with less intensive protocols. Following the guidelines of the MSKCC P6 protocol, in 2002 we modified the treatment schedule to create the modified P6 protocol (MP6). GEIS intends to develop MP6 as a clinical trial, which could provide the following potential advantages about current treatments: 1. Lower total dose of alkylating agents. 2. Early cardioprotection with dexrazoxane. 3. Radiotherapy adjusted to the initial response. 4. Pilot trial with the combination of Gemcitabine + Docetaxel for high-risk patients.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
43
* Vincristine, 2 mg/m\^2 IV bolus, day 1. * Doxorubicin: 75 mg/m\^2 per cycle, or 25 mg/m\^2/day x 3 days, IV infusion, 1 hour (after dexrazoxane administration at the dose of 10:1). * Dexrazoxane: administered at a dose of 10:1, before doxorubicin only in adults. * Cyclophosphamide: 2100 mg/m\^2 IV infusion, 6 hours, with MESNA protection, days 1 and 2. * MESNA: used with cyclophosphamide and ifosfamide. The total daily dose of MESNA is equivalent to at least 60% of the daily dose of cyclophosphamide or ifosfamide. * G-CSF: 5 micrograms/kg/day SC. It starts 24 hours after the last dose of chemotherapy and continues until the absolute neutrophil count is ≥ 750 mm\^3/L. * Ifosfamide: 1800 mg/m\^2/day IV infusion, 1 hour, days 1-5 of each cycle (9,000 mg/m\^2 total maximum dose). Window phase in high-risk patients (21-days cycle): * Gemcitabine: 1000 mg/m\^2 IV, 90 minutes on day 1 and 8. * Docetaxel 100 mg/m\^2, 2-3 hour infusion on day 8.
Surgical intervention aiming to completely resect the tumor with negative margins.
On the primary tumor bed in case of unresectable tumors, resected tumors with inadequate margins, or those with histologic response \<90%. Patients will receive radiotherapy 21 days after the completion of chemotherapy.
Hospital Clínic de Barcelona
Barcelona, Spain
Hospital de la Santa Creu i Sant Pau
Barcelona, Spain
Hospital Vall d'Hebron
Barcelona, Spain
Hospital Sant Joan de Déu
Esplugues de Llobregat, Spain
Institut Català d'Oncologia l'Hospitalet
L'Hospitalet de Llobregat, Spain
Hospital Ramón y Cajal
Madrid, Spain
Hospital Son Espases
Palma de Mallorca, Spain
Hospital Universitario de Canarias
San Cristóbal de La Laguna, Spain
Hospital Universitario Miguel Servet
Zaragoza, Spain
Progression Free Survival
Assessment of the progression free survival in all the patients enrolled in the study 3 years after the completion of the treatment under study.
Time frame: Assessment of the progression free survival in all the patients enrolled in the study 3 years after the completion of the treatment under study.
Objective response rate (ORR)
To assess the objective response rate to treatment (ORR) defined following EMEA criteria (CPMP/EWP/205/95/Rev.3/Corr.2) in high risk patients with Ewing's sarcoma treated with an early window phase of Gemcitabine + docetaxel (G + D).
Time frame: two months
Assessment of disease progression
To assess the disease progression, aiming to reach an index of disease progression \< 20% for high risk patients during the maintenance phase with Gemcitabine + Docetaxel.
Time frame: to reach an index of disease progression < 20% for high risk patients during the maintenance phase with Gemcitabine + Docetaxel.
evaluate the toxicity and tolerance to the treatment Gemcitabine + Docetaxel in high risk patients, and toxicity and tolerance of mP6 treatment in all patients.
To evaluate the toxicity and tolerance to the treatment Gemcitabine + Docetaxel in high risk patients, and toxicity and tolerance of mP6 treatment in all patients.
Time frame: 12 months
Assessment of bone marrow condition.
Molecular diagnosis and extension study of bone marrow in all patients included in the trial. Assessment of prognostic significance of the type of translocation and the molecular effect in the bone marrow.
Time frame: 24 months
Study the impact of patients treated with Cardioxane in cardioprotection
Creation of a cohort of patients treated with anthracyclines at high doses and early cardioprotection with dexrazoxane (Cardioxane). Long-term study of cardioprotection in these patients compared with historical series from the P6 protocol that did not received cardioprotection.
Time frame: 6 months
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