CombinaiR3 - First-line Treatment of Ewing Tumours With Primary Extrapulmonary Dissemination in Patients From 2 to 50 Years

IC 2015-13 CombinaiR3

Ewing's sarcoma and related tumours (ESFT) are rare tumours, with a peak incidence in the second decade of life. They start most often from bone, and are characterized by a specific translocation involving the so-called EWS gene. In one patient out of three, the staging procedures detect metastatic tumours at the diagnosis, most commonly in lungs, bones, and bone marrow. ESFT treatment strategy is multidisciplinary, combining primary chemotherapy, a local treatment, and consolidation chemotherapy. The primary metastatic dissemination is the most important prognostic factor, as the survival rate is around 70-75% for localized tumours, in contrast with less than 50% for patients with primary metastatic disease. Among primary metastatic patients, bone involvement and / or bone marrow strike markedly the prognosis of these patients. While the long-term survival of patients with isolated pleural pulmonary metastases is approximately 50%, whereas it is only from 0 to 25% in patients with bone marrow involvement. In 1999, the Intergroup EURO EWING built a new study protocol for patients with Ewing tumours. For the patients with primary extrapulmonary metastatic Ewing tumours (R3 patients), the protocol proposed a heavy induction chemotherapy, in order to propose a consolidation with high dose chemotherapy to a higher rate of patients. The high-dose Busulfan Melphalan chemotherapy (BuMel) was based on Busulfan (600 mg/m²) and Melphalan (140 mg/m²), with autologous peripheral blood stem cell (PBSC) support. Of note, for the full population of patients with metastatic disease, the 3-year EFS rate was 27% (SD 3%), and the OS rate was 34% (SD 4%), with a median follow-up of 3.9 years after diagnosis, and a median survival time of 1.6 years.

2016-12-01

2022-08-01

2023-11-01

Completed

Early phase I

45

Inclusion Criteria: 1. - Ewing tumour histologically or cytologically confirmed, harboring a specific transcript, and with extrapulmonary metastases (including nodal extension) - histology and FISH results must be consistent, specific transcript can be obtained after inclusions. 2. - Ewing tumour not previously treated. 3. - Age between 2 and 50 years. 4. - Measurable disease by cross sectional imaging (RECIST 1.1) or evaluable disease with functional metabolic, positron emission tomography scanner (PET SCAN) or other methods (e.g., cytology/histology). 5. - General status compatible with the study treatments (LANSKY score ≥ 50%, or Karnofsky ≥ 50%, or Eastern Cooperative Oncology Group (ECOG) ≤ 2). 6. - Adequate bone marrow function (not applicable in case of bone marrow disease). * Platelets ≥ 100 x 109 /L * Absolute Neutrophil Count (ANC) ≥ 1 x 109 /L * Hemoglobin ≥ 8g /dL. 7. - Adequate liver function : * Aspartate Aminotransferase (AST) and Alanine Transferase (ALT) ≤ 5 x Upper Limit Normal (ULN) * Total Bilirubin ≤ 2 Upper Limit Normal (ULN). If total bilirubin \> 2xULN, Bilirubin Conjugated Fraction (BCF) ≤ 2 x ULN 8. - No absolute contra-indication of Busulfan-Melphalan if radiotherapy of the primary tumour is necessary with specific attention to patient with primary spinal tumor. 9. - Adequate cardiac and renal functions: * Creatinine \< 1.5 of normal for age or clearance \> 60 ml/min/1.73 m²; * Left Ventricular Ejection Fraction (LVEF) \> 50% and/or shortening fraction \> 28%. 10. - No underlying disease contra-indicating the study treatments. 11. - Patient likely compliant with the recommended study medical monitoring during and after treatments. 12. - Patients of childbearing potential must agree to use adequate contraception for the duration of study treatments and up to 12 months for women and 6 months for men following completion of therapy. 13. - Females of childbearing potential must have a negative serum β-human chorionic gonadotropin (HCG) pregnancy test within 10 days prior study inclusion, and/or urine pregnancy test within 48 hours before the first administration of the study treatment. 14. - Patients covered by a health insurance system. 15. - Patient, or patient's legal representative, informed and having signed the informed consent. Exclusion Criteria: 1. - Age below 2 or greater than 50 years. 2. - Ewing tumour localized, or solely with pleural and/or lung metastases. 3. - Concomitant disease, particularly infectious disease, likely to interfere with patient's treatment. 4. - History of cancer, according to investigator's judgment. 5. - Life expectancy \< 2 months. 6. - Patient already included in another clinical trial with an investigational drug. 7. - Pregnant or breastfeeding patient. 8. - Person deprived of liberty or under guardianship. 9. - Patient likely unable to comply with the study medical monitoring for geographical, social or psychological reasons.

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2024-01-29