Combination Chemotherapy and Biological Therapy in Treating Patients With High-Risk Ewing's Sarcoma
Combination Chemotherapy and Biological Therapy in Treating Patients With High-Risk Ewing's Sarcoma
RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so
 they stop growing or die. Biological therapies use different ways to stimulate the immune
 system and stop cancer cells from growing. Combining chemotherapy with biological therapy may
 kill more tumor cells.

 PURPOSE: Randomized phase II trial to study the effectiveness of combination chemotherapy
 with or without biological therapy in treating patients who have newly diagnosed high-risk
 Ewing's sarcoma.
OBJECTIVES: I. Compare the effects of dose intensive regimens of vincristine, doxorubicin,
 cyclophosphamide, and dexrazoxane with or without ImmTher (a muramyl dipeptide liposome) on
 the 2 year disease-free survival of patients with newly diagnosed high risk Ewing's sarcoma.
 II. Evaluate the feasibility and determine the toxicity of administering weekly ImmTher for 1
 year to these patients. III. Determine which therapy is worthy of further evaluation.

 OUTLINE: This is a randomized study. Patients are stratified according to the presence of
 bony metastases at diagnosis. Patients are randomized to one of two treatment arms. All
 patients receive dexrazoxane IV followed 30 minutes later by doxorubicin IV over 30 minutes
 on day 1, vincristine IV on day 1, and cyclophosphamide IV over 6 hours on days 1 and 2.
 Treatment is repeated every 3 weeks for 3-6 courses in the absence of disease progression or
 unacceptable toxicity. Patients are evaluated after course 3 and undergo surgery and/or
 radiation therapy. The next 3 courses of chemotherapy are administered after recovery from
 surgery/radiation therapy. Within 1 month after completion of all chemotherapy courses,
 patients randomized to arm I receive ImmTher IV over 60 minutes weekly for 1 year. Patients
 randomized to arm II receive no further therapy. Patients are followed every 6 weeks for 2
 years.

 PROJECTED ACCRUAL: A total of 105 patients will be accrued for this study within
 approximately 5 years.
DISEASE CHARACTERISTICS: Histologically proven high risk Ewing's family of tumors: Ewing's
 sarcoma of bone Extraosseous Ewing's sarcoma Peripheral neuroepithelioma Must have one of
 the following characteristics: Metastatic disease at diagnosis Primary tumor of the
 humerus, femur, or trunk Bulky (greater than 8 cm) tumor Elevated LDH prior to biopsy (at
 least 900 IU/mL)

 PATIENT CHARACTERISTICS: Age: 3 to 60 Performance status: Not specified Life expectancy:
 Not specified Hematopoietic: Granulocyte count at least 500/mm3 Platelet count at least
 75,000/mm3 Hemoglobin at least 8 g/dL (transfusion allowed) Hepatic: Bilirubin no greater
 than 1.5 mg/dL SGOT or SGPT no greater than 3 times normal Renal: BUN less than 30 mg/dL
 Creatinine no greater than 1.5 times normal for age OR Creatinine clearance at least 70
 mL/min Cardiovascular: Ejection fraction at least 50% OR Fractional shortening at least 29%
 Other: Not pregnant or nursing Fertile patients must use effective contraception

 PRIOR CONCURRENT THERAPY: Biologic therapy: Not specified Chemotherapy: No prior
 chemotherapy Endocrine therapy: Not specified Radiotherapy: Not specified Surgery: Not
 specified