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RecruitingInterventionalPhase 1

Metastatic Ewing's Trial Testing Schedule Enhancement to Improve Outcomes

NCT ID: NCT07194044Sponsor: H. Lee Moffitt Cancer Center and Research InstituteLast updated: 2026-05-15

Summary

This single arm study is designed to demonstrate the feasibility of a radically different approach for an exceptionally high-risk subset of MES with widely metastatic disease (WMES). We incorporate the use of evolutionary principles that apply to species and population dynamics as related to adaptation and extinction to populations of cancer cells that similarly adapt and that we are attempting to make extinct, resulting in a cure for the patient. Such principles include an initial intense first strike to deplete the bulk of the cancer cells, followed by a series of sequential second strikes towards eliminating residual, resistant populations, followed by a prolonged period of maintenance chemotherapy to eliminate any remnant cells, using agents generally regarded to be active against newly diagnosed ES.

Arms & interventions

  • DrugVincristine

    IV Push

  • DrugDoxorubicin

    IV

  • DrugCyclophosphamide

    IV and Maintenance PO

  • DrugIfosfamide

    IV

  • DrugActinomycin

    IV

  • DrugIrinotecan

    IV

  • DrugCabozantinib

    PO

  • DrugTopotecan

    IV

  • DrugTemozolomide

    IV

  • DrugEtoposide

    PO

  • DrugLiposomal doxorubicin

    IV

Outcome measures

Primary

  • Feasibility and Safety - Consolidation

    The treatment will be considered feasible if 70% of Ewing sarcoma patients make it through consolidation.

    Time frame: 16 months

  • Feasibility and Safety - Maintenance

    The treatment will be considered feasible if 50% of Ewing sarcoma patients make it through 6 cycles of maintenance.

    Time frame: 16 months

Secondary

  • Event-Free Survival

    Time frame: 3 years

  • Off Treatment Event Free Survival

    Time frame: 3 years

  • Overall Survival

    Time frame: 3 years

Eligibility criteria

Sex: AllAge: 1 Year and olderHealthy volunteers: No
Inclusion Criteria: * Patients must be \>1 year of age. There is no upper age limit. * Patients, in the opinion of the enrolling investigator, must be healthy enough to tolerate protocol therapy. * Patients must have a new histologic diagnosis of either: widely metastatic Ewing sarcoma or metastatic CIC-rearranged sarcoma. * Patients must have sufficient tissue submitted (flash frozen tissue, FFPE block, or up to 10 unstained FFPE slides) for correlative testing. This may be from a primary or metastatic site. * Patients must not have received any prior systemic therapy with the exception that they may have started an initial cycle of vincristine/doxorubicin/cyclophosphamide (VDC) prior to enrollment, i.e. VDC may have been given, but not ifosfamide/etoposide (IE). * Adequate organ function. * Males and females of reproductive potential may not participate unless they have agreed to the use of, at minimum, two methods of contraception during and after treatment or abstinence. * All patients and/or their parents or legal guardians must have the ability to understand and the willingness to sign a written informed consent or assent document. Exclusion Criteria: * Patients with localized disease or lung only metastases for Ewing sarcoma or localized disease for CIC-rearranged sarcomas. * Patients with central nervous system (CNS) tumors (primary or metastatic) are not eligible. * Patients who are receiving any other investigational agents for their cancer. * Patients with a history of cancer that was treated with myelosuppressive chemotherapy or radiation therapy. * Patients must not be receiving any additional medicines being given for the specific purpose of treating cancer. * Patients are ineligible if they have uncontrolled intercurrent illness. * Pregnancy or Breast Feeding: Pregnant or breast-feeding women will not be entered on this study, because there is no available information regarding human fetal or teratogenic toxicities. Females of childbearing potential must have a negative serum or urine pregnancy test within 72 hours prior to starting protocol therapy. * Patients who are considered unable to comply with the safety monitoring requirements of the study are not eligible.

Study locations (17)

University of Alabama at Birmingham (Children's of Alabama)

Birmingham, Alabama, 35233

Recruiting
Elizabeth Alva, MD · Principal Investigator

Phoenix Children's Hospital

Phoenix, Arizona, 85016

Not Yet Recruiting
Mona Nourani, DO · Principal Investigator

Connecticut Children's Medical Center

Hartford, Connecticut, 06106

Not Yet Recruiting
Michael Isakoff, MD · Principal Investigator

University of Florida

Gainesville, Florida, 32610

Recruiting
Joanne Lagmay, MD · Principal Investigator

Nemours Jacksonville

Jacksonville, Florida, 32207

Not Yet Recruiting
Anderson Collier III, MD · Principal Investigator

University of Miami

Miami, Florida, 33136

Recruiting
Aditi Dhir, MD · Principal Investigator

Moffitt Cancer Center

Tampa, Florida, 33612

Recruiting
Jonathan Metts, MD · Principal Investigator
Mihaela Druta, MD · Sub Investigator
Andrew Brohl, MD · Sub Investigator
Mauricio Silva Almeida Ribeiro, MD · Sub Investigator
Isabel Canizares, APRN · Sub Investigator
Desiree Morales, APRN · Sub Investigator
Rikesh Makanji, MD · Sub Investigator
Nataranjan Raghunand, MD · Sub Investigator
Arash Naghavi, MD · Sub Investigator

University of Kentucky

Lexington, Kentucky, 40536

Not Yet Recruiting
Thomas Badgett, MD · Principal Investigator

Helen DeVos Children's Hospital

Grand Rapids, Michigan, 49503

Not Yet Recruiting
David Hoogstra, MD · Principal Investigator

Roswell Park Comprehensive Cancer Center

Buffalo, New York, 14263

Not Yet Recruiting
Ajay Gupta, MD · Principal Investigator

Montefiore Medical Center

The Bronx, New York, 10467

Not Yet Recruiting
Alice Lee, MD · Principal Investigator

University of North Carolina

Chapel Hill, North Carolina, 27599

Not Yet Recruiting
Patrick Thompson, MD · Principal Investigator

Levine Cancer Institute

Charlotte, North Carolina, 28204

Not Yet Recruiting
Erin Trovillion, MD · Principal Investigator

Cleveland Clinic Children's

Cleveland, Ohio, 44195

Not Yet Recruiting
Matteo Trucco, MD · Principal Investigator

Nationwide Children's Hospital

Columbus, Ohio, 43205

Recruiting
Bhuvana Setty, MD · Principal Investigator

Vanderbilt University Medical Center

Nashville, Tennessee, 37232

Not Yet Recruiting
Scott Borinstein, MD · Principal Investigator

Primary Children's Hospital

Salt Lake City, Utah, 84113

Not Yet Recruiting
Matthew Dietz, DO · Principal Investigator