Vinblastine, Celecoxib, and Combination Chemotherapy in Treating Patients With Newly-Diagnosed Metastatic Ewing's Sarcoma Family of Tumors
Vinblastine, Celecoxib, and Combination Chemotherapy in Treating Patients With Newly-Diagnosed Metastatic Ewing's Sarcoma Family of Tumors
RATIONALE: Drugs used in chemotherapy, such as vinblastine, work in different ways to stop
 tumor cells from dividing so they stop growing or die. Celecoxib may stop the growth of
 Ewing's sarcoma by stopping blood flow to the tumor. Combining more than one chemotherapy
 drug with celecoxib may kill more tumor cells.

 PURPOSE: Phase II trial to study the effectiveness of combining low-dose vinblastine and
 celecoxib with standard regimens of combination chemotherapy in treating patients who have
 newly-diagnosed metastatic Ewing's sarcoma family of tumors.
OBJECTIVES:

 -  Determine the feasibility and safety of low-dose vinblastine and celecoxib in
 combination with standard multiagent chemotherapy in patients with newly diagnosed
 metastatic Ewing's sarcoma family of tumors.

 -  Determine the event-free survival of patients treated with this regimen.

 -  Determine the pharmacokinetics of this regimen in these patients.

 OUTLINE: This is a pilot, multicenter study.

 -  Induction therapy: Patients receive the following alternating regimens:

 -  VAC (courses 1 and 3): Patients receive vincristine IV and cyclophosphamide IV over
 1 hour on day 1 and doxorubicin IV continuously on days 1 and 2 of weeks 1 and 7.

 -  IE (courses 2 and 4): Patients receive ifosfamide IV over 1 hour and etoposide IV
 over 1-2 hours on days 1-5 of weeks 4 and 10.

 Patients also receive filgrastim (G-CSF) subcutaneously (SC) beginning 24-48 hours after the
 last dose of chemotherapy and continuing until blood counts recover.

 Treatment repeats every 21 days for a total of 4 courses in the absence of disease
 progression or unacceptable toxicity.

 -  Local control and consolidation therapy: Beginning on week 13, patients are assigned to
 1 of 4 regimens based on disease status.

 -  Regimen A (surgery only): Patients who respond to induction chemotherapy undergo
 surgery on week 13. Patients then begin consolidation therapy on week 15 with the
 following alternating regimens:

 -  VAC (courses 5, 7, and 9): Patients receive VAC on weeks 15, 21, and 27.

 -  IE (courses 6, 8, 10, 12, and 14): Patients receive IE on weeks 18, 24, 30,
 36, and 42.

 -  VC (courses 11 and 13): Patients receive vincristine IV and cyclophosphamide
 IV over 1 hour on weeks 33 and 39.

 -  Regimen B (radiotherapy only): Patients with unresectable lesions undergo
 radiotherapy once daily 5 days a week for up to approximately 6 weeks beginning on
 week 13. Patients also receive consolidation therapy beginning on week 13, with the
 following alternating regimens:

 -  VAC (courses 5, 9, and 11): Patients receive VAC on weeks 13, 25, and 31.

 -  IE (courses 6, 8, 10, 12, and 14): Patients receive IE on weeks 16, 22, 28,
 34, and 40.

 -  VC (courses 7 and 13): Patients receive VC on weeks 19 and 37.

 -  Regimen C (surgery and radiotherapy): Patients who respond to induction
 chemotherapy undergo surgery on week 13. Patients who have inadequate margins after
 surgery undergo radiotherapy (as in regimen B) beginning on week 15. Patients also
 receive consolidation therapy, beginning on week 15, with the following alternating
 regimens:

 -  VAC (courses 5, 9, and 11): Patients receive VAC on weeks 15, 27, and 33.

 -  IE (courses 6, 8, 10, 12, and 14): Patients receive IE on weeks 18, 24, 30,
 36, and 42.

 -  VC (courses 7 and 13): Patients receive VC on weeks 21 and 39.

 -  Regimen D (preoperative radiotherapy): Patients with bulky lesions who do not have
 a good clinical and radiographic response to induction therapy begin consolidation
 therapy on week 13 with VAC (course 5) and undergo concurrent radiotherapy as in
 regimen B. Patients then receive IE on weeks 16 and 19 for courses 6 and 7.
 Patients undergo surgery on week 22. Patients continue consolidation therapy with
 the following alternating regimens:

 -  VAC (courses 8 and 9): Patients receive VAC on weeks 24 and 27.

 -  IE (courses 10, 12, and 14): Patients receive IE on weeks 30, 36, and 42.

 -  VC (courses 11 and 13): Patients receive VC on weeks 33 and 39. Patients
 receive G-CSF SC (as in induction therapy) during all consolidation courses.

 Consolidation therapy continues for 10 courses in the absence of disease progression or
 unacceptable toxicity.

 -  Vinblastine and celecoxib therapy: Throughout induction, local control, and
 consolidation therapies, patients also receive vinblastine IV 3 times a week (twice a
 week during the weeks that vincristine is given) and oral celecoxib twice daily,
 beginning on day 1 of course 1 and continuing until the completion of course 14.* NOTE:
 *To assess for safety, the first 6 patients enrolled receive vinblastine only during
 courses 1 and 2 and celecoxib is then added for all subsequent courses.

 Patients are followed every 3 months for 3 years and then every 6 months for 2 years.

 PROJECTED ACCRUAL: A total of 6-36 patients will be accrued for this study within 1.17 years.
DISEASE CHARACTERISTICS:

 -  Newly diagnosed Ewing's sarcoma family of tumors of the bone or soft tissues

 -  Paraspinal tumors of extra-dural origin and Askin's tumor of the chest wall are
 eligible

 -  Metastatic disease, defined by the following criteria:

 -  Lesions are discontinuous from the primary tumor, are not regional lymph nodes,
 and do not share a body cavity with the primary tumor

 -  A single pulmonary or pleural nodule greater than 1 cm OR multiple nodules
 greater than 0.5 cm are considered evidence of pulmonary or pleural metastases
 (unless there is another clear medical explanation for these lesions)

 -  Contralateral pleural effusions are considered metastatic disease

 -  No CNS involvement

 PATIENT CHARACTERISTICS:

 Age

 -  50 and under (at diagnosis)

 Performance status

 -  Lansky 50-100% (under 17 years of age)

 -  Karnofsky 50-100% (age 17 and over)

 -  Patients whose performance status is affected by a pathological fracture are
 allowed provided they are able to undergo treatment

 Life expectancy

 -  Not specified

 Hematopoietic

 -  Not specified

 Hepatic

 -  Bilirubin no greater than 1.5 times upper limit of normal (ULN)

 -  AST or ALT less than 5 times ULN

 Renal

 -  Creatinine adjusted according to age as follows*:

 -  No greater than 0.4 mg/dL (≤ 5 months)

 -  No greater than 0.5 mg/dL (6 months -11 months)

 -  No greater than 0.6 mg/dL (1 year-23 months)

 -  No greater than 0.8 mg/dL (2 years-5 years)

 -  No greater than 1.0 mg/dL (6 years-9 years)

 -  No greater than 1.2 mg/dL (10 years-12 years)

 -  No greater than 1.4 mg/dL (13 years and over [female])

 -  No greater than 1.5 mg/dL (13 years to 15 years [male])

 -  No greater than 1.7 mg/dL (16 years and over [male]) OR

 -  Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min*
 NOTE: *Unless these values are related to renal insufficiency secondary to tumor
 involvement that is expected to improve once the tumor mass is smaller (e.g., pelvic
 mass causing obstructive hydronephrosis)

 Cardiovascular

 -  Shortening fraction at least 27% by echocardiogram OR

 -  Ejection fraction at least 50% by MUGA

 Other

 -  Not pregnant or nursing

 -  Fertile patients must use effective contraception

 -  Body surface area at least 0.4 m^2

 -  No allergy to sulfa

 -  No aspirin hypersensitivity

 -  No asthma triad (asthma with nasal polyps, and urticaria)

 -  No other prior cancer, including nonmelanoma skin cancer

 PRIOR CONCURRENT THERAPY:

 Biologic therapy

 -  No prior bone marrow or stem cell transplantation

 Chemotherapy

 -  No prior chemotherapy

 Endocrine therapy

 -  Not specified

 Radiotherapy

 -  No prior radiotherapy

 Surgery

 -  Not specified

 Other

 -  No other concurrent nonsteroidal anti-inflammatory medications, including salicylates

 -  No concurrent dexrazoxane unless approved by the study investigator