Combination Chemotherapy With or Without Temsirolimus in Treating Patients With Intermediate Risk Rhabdomyosarcoma

  • STATUS
    Recruiting
  • participants needed
    397
  • sponsor
    National Cancer Institute (NCI)
Updated on 15 April 2021
platelet count
cancer
vincristine
glomerular filtration rate
neutrophil count
irinotecan
cancer chemotherapy
vinorelbine
actinomycin
alveolar rhabdomyosarcoma

Summary

This randomized phase III trial studies how well combination chemotherapy (vincristine sulfate, dactinomycin, cyclophosphamide alternated with vincristine sulfate and irinotecan hydrochloride or vinorelbine) works compared to combination chemotherapy plus temsirolimus in treating patients with rhabdomyosarcoma (cancer that forms in the soft tissues, such as muscle), and has an intermediate chance of coming back after treatment (intermediate risk). Drugs used 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. Combination chemotherapy and temsirolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. It is not yet known whether chemotherapy plus temsirolimus is more effective than chemotherapy alone in treating patients with intermediate-risk rhabdomyosarcoma.

Description

PRIMARY OBJECTIVE:

I. To compare the event-free survival (EFS) of patients with intermediate-risk (IR) rhabdomyosarcoma (RMS) treated with surgery, radiotherapy, and vincristine (vincristine sulfate), dactinomycin, and cyclophosphamide (VAC) alternating with vincristine and irinotecan (irinotecan hydrochloride) (VI) (VAC/VI) with maintenance to that of patients treated with surgery, radiotherapy and VAC/VI plus temsirolimus with maintenance.

SECONDARY OBJECTIVE:

I. To compare the overall survival (OS) of patients with IR RMS treated with surgery, radiotherapy, and VAC alternating with VI with maintenance to that of patients treated with surgery, radiotherapy and VAC/VI plus temsirolimus with maintenance.

EXPLORATORY OBJECTIVES:

I. To compare the outcome of patients based on their FOXO1 fusion gene partner, by evaluating paired box (PAX) 3 versus (vs) PAX7 in all patients found to be FOXO1 fusion positive.

II. To compare the outcome of patients based on their [F18]-fluorodeoxy-D-glucose-positron emission tomography (FDG-PET) response at week 9 (positive or negative), as assessed by Deauville criteria (5-point).

III. To estimate the frequency of patients with circulating tumor deoxyribonucleic acid (DNA) (ctDNA) at diagnosis and subsequent time-points, and explore whether tumor-specific somatic variants are detectable in the ctDNA.

IV. To compare the outcome of patients (VAC/VI with or without temsirolimus) who have received maintenance therapy on ARST1431 to those who received VAC/VI on ARST0531.

OUTLINE

FEASIBILITY PHASE (THE FEASIBILITY PHASE IS COMPLETE, EFFECTIVE WITH AMENDMENT #1A): (< 21 years old): This is a dose-escalation study of temsirolimus.

Patients receive vincristine sulfate intravenously (IV) over 1 minute on day 1 of weeks 1-13, 16, 17, 19, 20, 22-26, 28, 31-34, 37, 38, and 40, dactinomycin IV over 1-5 or 10-15 minutes on day 1 of weeks 1, 7, 13, 22, 28, 34, and 40, cyclophosphamide IV over 60 minutes on day 1 of weeks 1, 7, 13, 22, 28, 34, and 40, irinotecan hydrochloride IV over 90 minutes on days 1-5 of weeks 4, 10, 16, 19, 25, 31, and 37, and temsirolimus IV over 30-60 minutes on days 1, 8, and 15. Patients also undergo radiation therapy (RT) beginning week 13 for up to 6.5 weeks. Courses with temsirolimus repeat every 21 days for 12 weeks in the absence of disease progression or unacceptable toxicity.

EFFICACY PHASE: Patients are randomized to Regimen A or B. Patients with disease that is ARMS FOXO1 fusion negative (stage I, group I/II, stage 1, group III [orbit] or stage II, group I/II) are assigned to Regimen C.

REGIMEN A (VAC/VI): Patients receive vincristine sulfate IV over 1 minute on day 1 of weeks 1-13, 16, 17, 19, 20, 22-26, 28, 31-34, 37, 38, and 40, dactinomycin IV over 1-5 or 10-15 minutes on day 1 of weeks 1, 7, 13, 22, 28, 34, and 40, cyclophosphamide IV over 60 minutes on day 1 of weeks 1, 7, 13, 22, 28, 34, and 40, irinotecan hydrochloride IV over 90 minutes on days 1-5 of weeks 4, 10, 16, 19, 25, 31, and 37. Patients also undergo primary site RT beginning at week 13 or metastatic site RT beginning at week 43 for up to 6.5 weeks. Treatment continues in the absence of disease progression or unacceptable toxicity. Patients then receive vinorelbine IV over 6-10 minutes on days 1, 8, and 15 and cyclophosphamide orally (PO) once daily (QD) on days 1-28. Cycles repeats every 28 days for 24 weeks in the absence of disease progression or unacceptable toxicity.

REGIMEN B (VAC/VI TEMSIROLIMUS): Patients receive vincristine sulfate IV over 1 minute on day 1 of weeks 1-13, 16, 17, 19, 20, 22-26, 28, 31-34, 37, 38, and 40, dactinomycin IV over 1-5 or 10-15 minutes on day 1 of weeks 1, 7, 13, 22, 28, 34, and 40, cyclophosphamide IV over 60 minutes on day 1 of weeks 1, 7, 13, 22, 28, 34, and 40, irinotecan hydrochloride IV over 90 minutes on days 1-5 of weeks 4, 10, 16, 19, 25, 31, and 37 and temsirolimus IV over 30-60 minutes on day 1 of weeks 1-12 and 21-42. Patients also undergo RT as in Regimen A. Treatment continues in the absence of disease progression or unacceptable toxicity. Patients then receive vinorelbine IV over 6-10 minutes on days 1, 8, and 15 and cyclophosphamide PO QD on days 1-28. Cycles repeats every 28 days for 24 weeks in the absence of disease progression or unacceptable toxicity.

MAINTENANCE PHASE (Patients in Regimen A or Regimen B): Patients receive vinorelbine IV over 6-10 minutes on days 1, 8, and 15 and cyclophosphamide orally (PO) once daily (QD) on days 1-28. Treatment repeats every 28 days for up to 6 cycles.

REGIMEN C (FOXO1 FUSION NEGATIVE): Patients receive vincristine sulfate IV over 1 minute on day 1 of weeks 1-10 and 13-22, dactinomycin IV over 1-5 or 10-15 minutes on day 1 of weeks 1, 4, 7, 10, 13, 16, 19, and 22, cyclophosphamide IV over 60 minutes on day 1 of weeks 1, 4, 7, and 10. Patients undergo RT beginning at week 13 for up to 6.5 weeks. Treatment continues in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 3 months for 1 year, every 4 months for 2 years, every 6 months for 1 year, and then annually for up to 10 years.

Details
Condition Embryonal rhabdomyosarcoma, Alveolar rhabdomyosarcoma, Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Sclerosing Rhabdomyosarcoma, Spindle Cell Rhabdomyosarcoma, Untreated Childhood Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma, Botryoid-Type Embryonal Rhabdomyosarcoma
Treatment radiation therapy, cyclophosphamide, laboratory biomarker analysis, questionnaire administration, vincristine sulfate, dactinomycin, Vinorelbine, irinotecan hydrochloride, Temsirolimus
Clinical Study IdentifierNCT02567435
SponsorNational Cancer Institute (NCI)
Last Modified on15 April 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Do you have any of these conditions: Sclerosing Rhabdomyosarcoma or Rhabdomyosarcoma or Embryonal rhabdomyosarcoma or Alveolar rhabdomyosarcoma or Spindle Cell Rhabdomyosarcoma or Botryoi...?
Do you have any of these conditions: Botryoid-Type Embryonal Rhabdomyosarcoma or Untreated Childhood Rhabdomyosarcoma or Alveolar rhabdomyosarcoma or Sclerosing Rhabdomyosarcoma or Spindl...?
Do you have any of these conditions: Spindle Cell Rhabdomyosarcoma or Botryoid-Type Embryonal Rhabdomyosarcoma or Sclerosing Rhabdomyosarcoma or Alveolar rhabdomyosarcoma or Untreated Chi...?
Do you have any of these conditions: Alveolar rhabdomyosarcoma or Botryoid-Type Embryonal Rhabdomyosarcoma or Sclerosing Rhabdomyosarcoma or Untreated Childhood Rhabdomyosarcoma or Rhabdo...?
Do you have any of these conditions: Embryonal rhabdomyosarcoma or Spindle Cell Rhabdomyosarcoma or Untreated Childhood Rhabdomyosarcoma or Rhabdomyosarcoma or Botryoid-Type Embryonal Rha...?
Do you have any of these conditions: Botryoid-Type Embryonal Rhabdomyosarcoma or Untreated Childhood Rhabdomyosarcoma or Spindle Cell Rhabdomyosarcoma or Alveolar rhabdomyosarcoma or Embr...?
Do you have any of these conditions: Embryonal rhabdomyosarcoma or Botryoid-Type Embryonal Rhabdomyosarcoma or Alveolar rhabdomyosarcoma or Sclerosing Rhabdomyosarcoma or Untreated Childh...?
Do you have any of these conditions: Rhabdomyosarcoma or Spindle Cell Rhabdomyosarcoma or Botryoid-Type Embryonal Rhabdomyosarcoma or Embryonal rhabdomyosarcoma or Alveolar rhabdomyosarco...?
Do you have any of these conditions: Sclerosing Rhabdomyosarcoma or Untreated Childhood Rhabdomyosarcoma or Embryonal rhabdomyosarcoma or Botryoid-Type Embryonal Rhabdomyosarcoma or Alveo...?
Do you have any of these conditions: Sclerosing Rhabdomyosarcoma or Spindle Cell Rhabdomyosarcoma or Untreated Childhood Rhabdomyosarcoma or Botryoid-Type Embryonal Rhabdomyosarcoma or Al...?
Do you have any of these conditions: Spindle Cell Rhabdomyosarcoma or Alveolar rhabdomyosarcoma or Rhabdomyosarcoma or Embryonal rhabdomyosarcoma or Sclerosing Rhabdomyosarcoma or Botryoi...?
Do you have any of these conditions: Sclerosing Rhabdomyosarcoma or Embryonal rhabdomyosarcoma or Alveolar rhabdomyosarcoma or Untreated Childhood Rhabdomyosarcoma or Spindle Cell Rhabdom...?
Do you have any of these conditions: Alveolar rhabdomyosarcoma or Untreated Childhood Rhabdomyosarcoma or Rhabdomyosarcoma or Botryoid-Type Embryonal Rhabdomyosarcoma or Embryonal rhabdom...?
Do you have any of these conditions: Sclerosing Rhabdomyosarcoma or Embryonal rhabdomyosarcoma or Untreated Childhood Rhabdomyosarcoma or Botryoid-Type Embryonal Rhabdomyosarcoma or Rhabd...?
Do you have any of these conditions: Untreated Childhood Rhabdomyosarcoma or Spindle Cell Rhabdomyosarcoma or Rhabdomyosarcoma or Embryonal rhabdomyosarcoma or Alveolar rhabdomyosarcoma o...?
Do you have any of these conditions: Untreated Childhood Rhabdomyosarcoma or Spindle Cell Rhabdomyosarcoma or Botryoid-Type Embryonal Rhabdomyosarcoma or Sclerosing Rhabdomyosarcoma or Al...?
Do you have any of these conditions: Botryoid-Type Embryonal Rhabdomyosarcoma or Rhabdomyosarcoma or Untreated Childhood Rhabdomyosarcoma or Spindle Cell Rhabdomyosarcoma or Alveolar rhab...?
Do you have any of these conditions: Untreated Childhood Rhabdomyosarcoma or Spindle Cell Rhabdomyosarcoma or Sclerosing Rhabdomyosarcoma or Embryonal rhabdomyosarcoma or Alveolar rhabdom...?
Gender: Male or Female
Do you have any of these conditions: Sclerosing Rhabdomyosarcoma or Botryoid-Type Embryonal Rhabdomyosarcoma or Rhabdomyosarcoma or Alveolar rhabdomyosarcoma or Embryonal rhabdomyosarcoma...?
Do you have any of these conditions: Embryonal rhabdomyosarcoma or Alveolar rhabdomyosarcoma or Sclerosing Rhabdomyosarcoma or Untreated Childhood Rhabdomyosarcoma or Spindle Cell Rhabdom...?
Do you have any of these conditions: Embryonal rhabdomyosarcoma or Rhabdomyosarcoma or Botryoid-Type Embryonal Rhabdomyosarcoma or Spindle Cell Rhabdomyosarcoma or Untreated Childhood Rha...?
Do you have any of these conditions: Spindle Cell Rhabdomyosarcoma or Embryonal rhabdomyosarcoma or Rhabdomyosarcoma or Botryoid-Type Embryonal Rhabdomyosarcoma or Untreated Childhood Rha...?
Do you have any of these conditions: Untreated Childhood Rhabdomyosarcoma or Rhabdomyosarcoma or Embryonal rhabdomyosarcoma or Spindle Cell Rhabdomyosarcoma or Botryoid-Type Embryonal Rha...?
Do you have any of these conditions: Sclerosing Rhabdomyosarcoma or Spindle Cell Rhabdomyosarcoma or Rhabdomyosarcoma or Alveolar rhabdomyosarcoma or Untreated Childhood Rhabdomyosarcoma ...?
Do you have any of these conditions: Untreated Childhood Rhabdomyosarcoma or Spindle Cell Rhabdomyosarcoma or Embryonal rhabdomyosarcoma or Botryoid-Type Embryonal Rhabdomyosarcoma or Alv...?
Is your age less than or equal to 40 yrs?
Do you have any of these conditions: Spindle Cell Rhabdomyosarcoma or Untreated Childhood Rhabdomyosarcoma or Sclerosing Rhabdomyosarcoma or Botryoid-Type Embryonal Rhabdomyosarcoma or Al...?
Do you have any of these conditions: Spindle Cell Rhabdomyosarcoma or Rhabdomyosarcoma or Alveolar rhabdomyosarcoma or Untreated Childhood Rhabdomyosarcoma or Sclerosing Rhabdomyosarcoma ...?
Do you have any of these conditions: Sclerosing Rhabdomyosarcoma or Untreated Childhood Rhabdomyosarcoma or Embryonal rhabdomyosarcoma or Spindle Cell Rhabdomyosarcoma or Alveolar rhabdom...?
Do you have any of these conditions: Embryonal rhabdomyosarcoma or Sclerosing Rhabdomyosarcoma or Alveolar rhabdomyosarcoma or Botryoid-Type Embryonal Rhabdomyosarcoma or Spindle Cell Rha...?
Do you have any of these conditions: Embryonal rhabdomyosarcoma or Sclerosing Rhabdomyosarcoma or Botryoid-Type Embryonal Rhabdomyosarcoma or Spindle Cell Rhabdomyosarcoma or Alveolar rha...?
Do you have any of these conditions: Rhabdomyosarcoma or Embryonal rhabdomyosarcoma or Alveolar rhabdomyosarcoma or Botryoid-Type Embryonal Rhabdomyosarcoma or Untreated Childhood Rhabdom...?
Do you have any of these conditions: Spindle Cell Rhabdomyosarcoma or Botryoid-Type Embryonal Rhabdomyosarcoma or Untreated Childhood Rhabdomyosarcoma or Alveolar rhabdomyosarcoma or Rhab...?
Feasibility Phase: Patients must be < 21 years of age at the time of enrollment; please note: the feasibility phase is complete, effective with amendment #1
Efficacy Phase: Patients must be =< 40 years of age at the time of enrollment
Patients with newly diagnosed RMS of any subtype, except adult-type pleomorphic, based upon institutional histopathologic classification, are eligible to enroll on the study based upon stage, group, and age, as below
RMS types included under embryonal rhabdomyosarcoma (ERMS) include those classified in the 1995 International Classification of Rhabdomyosarcoma (ICR) as ERMS (classic, spindle cell, and botryoid variants), which are reclassified in the 2013 World Health Organization (WHO) classification as ERMS (classic, dense and botryoid variants) and spindle cell/sclerosing RMS (encompassing the historical spindle cell ERMS variant and the newly recognized sclerosing RMS variant); classification of alveolar rhabdomyosarcoma (ARMS) in the 2013 WHO classification is the same as in the ICR and includes classic and solid variants
ERMS
Stage 1, group III (non-orbit)
Stage 3, group I/II
Stage 2/3, group III
Stage 4, group IV, < 10 years old
ARMS
Stages 1-3, groups I-III
Specimen Submission: Patients must have sufficient tissue available for the required biology study
Lansky performance status score >= 50 for patients =< 16 years of age; Karnofsky performance status score >= 50 for patients > 16 years of age
Peripheral absolute neutrophil count (ANC) >= 750/uL
Platelet count >= 75,000/uL
Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 mL/min/1.73 m^2 or a serum creatinine based on age/gender as follows
month to < 6 months old: 0.4 mg/dl (male), 0.4 mg/dl (female)
months to < 1 year old: 0.5 mg/dl (male), 0.5 mg/dl (female)
to < 2 years old: 0.6 mg/dl (male), 0.6 mg/dl (female)
to < 6 years old: 0.8 mg/dl (male), 0.8 mg/dl (female)
to < 10 years old: 1 mg/dl (male), 1 mg/dl (female)
to < 13 years old: 1.2 mg/dl (male), 1.2 mg/dl (female)
to < 16 years old: 1.5 mg/dl (male), 1.4 mg/dl (female)
>= 16 years old: 1.7 mg/dl (male), 1.4 mg/dl (female)
Patients with an elevated serum creatinine due to obstructive hydronephrosis secondary to tumor are still eligible; however, patients with urinary tract obstruction by tumor must have unimpeded urinary flow established via diversion (i.e. percutaneous nephrostomies or ureteric stents) of the urinary tract
Total bilirubin =< 1.5 x upper limit of normal (ULN) for age
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 who have previously received temsirolimus, another mTOR inhibitor, or any other investigational agent
Patients who have received any chemotherapy (excluding steroids) and/or RT prior to this enrollment
Patients with uncontrolled hyperglycemia
Patients with uncontrolled hyperlipidemia
Sexually active patients of reproductive potential who have not agreed to use an effective contraceptive method for the duration of their study participation and for at least 3 months after treatment is completed
Female patients who are pregnant are not eligible since fetal toxicities or teratogenic effects have been noted for several of the study drugs; Note: A pregnancy test is required for female patients of childbearing potential prior to study entry
Lactating females who plan to breastfeed their infants are not eligible
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