Chemotherapy + Surgery for Pleuropulmonary Blastoma

Age: < 65
Sex: Any
Trial Phase: Academic
Sponsor: Children's Hospitals and Clinics of Minnesota
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to find an effective treatment plan for Pleuropulmonary Blastoma (PPB), a rare childhood cancer, by testing chemotherapy and surgery. It examines how specific chemotherapy combinations work alongside surgery for different PPB types. For Type I PPB, surgery is followed by optional chemotherapy, while Types II and III receive more intensive chemotherapy (including drugs like Cyclophosphamide, Dactinomycin, Doxorubicin, Ifosfamide, and Vincristine) and possible additional surgeries. Children newly diagnosed with PPB or related conditions can participate. The trial seeks to establish a standard treatment approach and improve outcomes for children with this rare disease. As an unphased trial, it offers a unique opportunity to contribute to groundbreaking research that could shape future PPB treatments.

Will I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications. However, prior corticosteroid therapy is allowed, so you may be able to continue some medications.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that the VAC regimen, which includes Vincristine, Dactinomycin, and Cyclophosphamide, treats various cancers, such as rhabdomyosarcoma (a cancer affecting muscle tissue). Several studies indicate that patients generally tolerate this combination well. However, like most chemotherapy treatments, it can cause some side effects.

The IVADo regimen, which includes Ifosfamide, Vincristine, Dactinomycin, and Doxorubicin, has shown promising results in studies for children with type II and III pleuropulmonary blastoma. Research indicates that this treatment offers favorable event-free and overall survival rates. While side effects are possible, its use since 2007 and recommendation in specific cases suggest confidence in its safety.

Both regimens use drugs common in chemotherapy. Although side effects can occur, these regimens have been part of treatment programs for many years. Discuss potential side effects and benefits with a healthcare provider.12345

Why are researchers excited about this trial's treatments?

Researchers are excited about these treatments for pleuropulmonary blastoma (PPB) because they offer a tailored approach depending on the type of PPB. For Type I PPB, the treatment combines surgery with optional chemotherapy, specifically suggesting a combination of vincristine, dactinomycin, and cyclophosphamide (VAC). This approach allows for flexibility in treatment based on the physician's discretion. For Types II and III PPB, the unique combination of ifosfamide, vincristine, dactinomycin, and doxorubicin (IVADo) is used, potentially with additional surgeries and radiation if needed. This comprehensive and targeted strategy aims to address the aggressive nature of these cancer types more effectively than standard treatments.

What evidence suggests that this trial's treatments could be effective for Pleuropulmonary Blastoma?

Research has shown that certain chemotherapy treatments are often used for children with pleuropulmonary blastoma (PPB), a rare lung tumor. In this trial, participants with Type I PPB will undergo surgery, and the treating physician may use the VAC combination (vincristine, dactinomycin, and cyclophosphamide) for chemotherapy. For Types II and III PPB, participants will receive the IVADo combination (ifosfamide, vincristine, dactinomycin, and doxorubicin), which has shown promising results. Studies suggest that this treatment may lead to better outcomes compared to past cases without a standard treatment plan. Although no perfect treatment exists for everyone yet, these drug combinations are currently the best-supported options for managing the disease.36789

Who Is on the Research Team?

KA

Kris Ann Schultz, MD

Principal Investigator

Children's Hospitals and Clinics of Minnesota

Are You a Good Fit for This Trial?

This trial is for children and young adults up to 21 years old with a rare lung tumor called Pleuropulmonary Blastoma (PPB). It includes those newly diagnosed, or with prior PPB, confirmed by central pathology review. Patients must be able to give consent through a guardian and may have had previous corticosteroid therapy.

Inclusion Criteria

Diagnostic pathology for cases of diseases associated with PPB will also require registry central pathology review
If you have PPB Type I, you can participate in the study.
Informed consent by patient or parent/guardian. (also, where appropriate: assent and HIPPA consent)
See 8 more

Exclusion Criteria

I am unable to understand or give consent for treatment.
You have had central pathology review ruling out a diagnosis of pleuropulmonary blastoma.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

Surgery

Surgery is necessary for all types of PPB. For Type I, surgery is followed by optional chemotherapy. For Types II and III, surgery is followed by chemotherapy and possibly radiation therapy.

Chemotherapy

For Type I, optional chemotherapy with Vincristine, Dactinomycin, Cyclophosphamide (VAC) may be used. For Types II and III, combination chemotherapy with Ifosfamide, Vincristine, Dactinomycin, and Doxorubicin (IVADo) is recommended.

Radiation Therapy

Radiation therapy is recommended only for residual disease after maximum surgery in Types II and III PPB.

Follow-up

Participants are monitored for overall response to chemotherapy and survival, with a primary focus on event-free survival over a 5-year period.

5 years

What Are the Treatments Tested in This Trial?

Interventions

  • Cyclophosphamide
  • Dactinomycin
  • Doxorubicin
  • Ifosfamide
  • Vincristine
Trial Overview The trial tests a treatment program using drugs like Doxorubicin, Vincristine, Dactinomycin, Cyclophosphamide, and Ifosfamide on many patients to determine the effectiveness against PPB since there's no standard treatment due to its rarity.
How Is the Trial Designed?
2Treatment groups
Experimental Treatment
Group I: Types II and III PPB therapyExperimental Treatment5 Interventions
Group II: Type I PPB therapyExperimental Treatment3 Interventions

Cyclophosphamide is already approved in United States, European Union, Canada, Japan for the following indications:

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Approved in United States as Cytoxan for:
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Approved in European Union as Endoxan for:
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Approved in Canada as Neosar for:
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Approved in Japan as Endoxan for:

Find a Clinic Near You

Who Is Running the Clinical Trial?

Children's Hospitals and Clinics of Minnesota

Lead Sponsor

Trials
67
Recruited
5,022,000+

Published Research Related to This Trial

Caelyx/Doxil, a pegylated liposomal formulation of doxorubicin, has a unique pharmacokinetic profile that allows it to effectively target tumor sites while reducing toxicity compared to traditional doxorubicin.
It has been approved by the FDA and EMEA for treating AIDS-related Kaposi's sarcoma and recurrent epithelial ovarian cancer, and is being investigated for use in various other cancers, indicating its potential as a versatile treatment option.
Caelyx/Doxil for the treatment of metastatic ovarian and breast cancer.Tejada-Berges, T., Granai, CO., Gordinier, M., et al.[2022]
Paeonol (Pae) has been shown to protect against doxorubicin (Dox)-induced cardiotoxicity in both rat models and primary cardiomyocytes by enhancing mitochondrial fusion and restoring cardiac function.
The protective mechanism involves the PKCε-Stat3-Mfn2 signaling pathway, where Pae activates Stat3 to promote Mfn2-mediated mitochondrial fusion, without compromising the anticancer efficacy of Dox.
Paeonol protects against doxorubicin-induced cardiotoxicity by promoting Mfn2-mediated mitochondrial fusion through activating the PKCε-Stat3 pathway.Ding, M., Shi, R., Fu, F., et al.[2023]
Naringin (NR) demonstrated significant cardioprotective effects against doxorubicin (Dox)-induced cardiac toxicity in male Wistar rats, as shown by improved oxidative stress markers and mitochondrial function after NR treatment.
The study suggests that combining NR with Dox could enhance the safety of Dox chemotherapy by mitigating its harmful effects on the heart, making it a potential adjunct therapy in cancer treatment.
Ameliorative effect of naringin against doxorubicin-induced acute cardiac toxicity in rats.Kwatra, M., Kumar, V., Jangra, A., et al.[2022]

Citations

A Report From the International PPB/DICER1 Registry - PMCOutcomes for children with type II and type III pleuropulmonary blastoma following chemotherapy: a report from the International PPB/DICER1 Registry.
Testing a Standardized Approach to Surgery and ...This phase III trial tests how well surgery plus chemotherapy compared to surgery alone works in treating patients with type I pleuropulmonary blastoma ...
Childhood Pleuropulmonary Blastoma Treatment (PDQ®)Patient outcomes were favorable, although 11 children (9 with Type I and 2 with Type Ir) experienced progression to Type II or III (n = 8) or ...
Testing a Standardized Approach to Surgery and ...This phase III trial tests how well surgery plus chemotherapy compared to surgery alone works in treating patients with type I pleuropulmonary blastoma (PPB).
Chemotherapy for Children With Type II or III ...Chemotherapy with IVADo (ifosfamide, vincristine, actinomycin-D, and doxorubicin) appeared to be associated with similar or improved outcomes vs historical ...
6.pubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov/40948701/
Pleuropulmonary Blastoma in a Pediatric Patient: A Case ...Pleuropulmonary blastoma (PPB) is a rare, highly aggressive pulmonary tumor that typically presents in the pediatric population.
7.pubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov/36137255/
A Report From the International PPB/ DICER1 RegistryBeginning in 2007, the IVADo regimen (ifosfamide, vincristine, actinomycin-D, and doxorubicin) was recommended as a potential treatment ...
Regimen Offers Hope for Children with Type II and III ...Event-free and overall survival were similar to improved for children with type II and type III pleuropulmonary blastoma treated with IVADo ...
64Vincristine is in a class of medications called vinca alkaloids. It works by stopping tumor cells from growing and dividing and may kill them. Dactinomycin is a ...
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