Recruiting
Phase 2

Sirolimus & Metronomic Chemotherapy

Sponsor:

Emory University

Code:

NCT04469530

Conditions

Solid Tumor

Eligibility Criteria

Sex: All

Age: 1 - 30

Healthy Volunteers: Not accepted

Interventions

Sirolimus

Cyclophosphamide

Etoposide

Celecoxib

Study Details

Brief summary:

The primary objective of this study is to improve the 2-year progression-free survival in children with high-risk solid tumors who are administered a maintenance regimen with continuous sirolimus administered on a backbone of metronomic chemotherapy following the completion of "standard" therapy, as compared to high-risk solid tumor patients treated with observation alone following completion of "standard" therapy.

Conditions

Solid Tumor

Study ID

NCT04469530

Start date

Sep 16, 2020

Status verified date

Feb, 2026

Completion date

Feb, 2029

Anticipated

Primary completion date

Feb, 2029

Anticipated

Eligibility Criteria

Eligibility Criteria

Sex: All

Age: 1 - 30

Healthy Volunteers: Not accepted

Inclusion Criteria:

  • Subjects must be ≥ 12 months and ≤ 30 years of age at the time of study enrollment.
  • Subjects must have one of the following high-risk malignant pediatric extracranial solid tumors and be in complete remission or have minimal abnormalities on imaging studies after completion of upfront therapy administered with curative intent (cohort 1) or after completion of initial relapse regimen.

  • Prospective Cohort 1:

  • Metastatic/unresectable osteosarcoma, metastatic Ewing or Ewing-like sarcoma, high-risk rhabdomyosarcoma, metastatic non-rhabdomyosarcoma soft tissue sarcoma, desmoplastic small round cell tumor (DSRCT), malignant rhabdoid tumor.
  • Additional high-risk solid tumors at the request of the treating physician after approval by the study chair.
  • Primary central nervous system (CNS) tumors and lymphomas are not eligible.
  • Prospective Cohort 2: Recurrent extracranial solid tumor (any histology) in second complete remission following completion of initial relapse regimen.
  • Subjects must have had histologic verification of malignancy at original diagnosis or relapse.
  • Subjects must be in complete remission or with minimal radiological abnormalities. Baseline imaging should be the end of therapy imaging obtained at the completion of "standard" upfront therapy (cohort 1) or at the completion of initial relapse regimen (cohort 2).
  • Karnofsky ≥ 50% for subjects > 16 years of age and Lansky ≥ 50% for subjects ≤ 16 years of age.
  • Subjects must have fully recovered from the acute non-hematologic toxic effects of all prior anti-cancer therapy and meet hematologic count parameters. Chronic non-hematologic toxic effects of prior anti-cancer therapy (ie peripheral neuropathy) must be improved to at least grade 2 and be stable or improving on current management.
  • Adequate bone marrow function defined as absolute neutrophil count (ANC) ≥ 750/μL and platelet count ≥ 50,000/μL (transfusion independent, defined as not receiving platelet transfusions within 7 days prior to enrollment).
  • Adequate renal function defined as creatinine clearance or radioisotope glomerular filtration rate (GFR) 70ml/min/1.73 m2 or serum creatinine based on age/gender values derived from the Schwartz formula for estimating GFR utilizing child length and stature data published by the Centers for Disease Control and Prevention (CDC).
  • Adequate liver function defined as: total bilirubin ≤ 2x upper limit of normal (ULN), and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 225 U/L (5x the ULN).
  • Serum triglyceride level ≤300 mg/dL and serum cholesterol ≤ 300 mg/dL.
  • Random blood glucose ≤ 1.5x ULN for age.
  • Adequate pulmonary function defined as normal pulmonary function tests (PFTs), if there is a clinical indication for determination (dyspnea at rest, known requirement for supplemental oxygen). For subjects who do not have respiratory symptoms (no dyspnea at rest, O2 sat ≥ 93% on room air), PFTs are not required.

Exclusion Criteria:

  • Pregnant or breast-feeding women will not be entered on this study as there may be fetal risks or teratogenic toxicities. Pregnancy tests must be obtained in girls who are post-menarchal. Males or females of reproductive potential may not participate unless they have agreed to use an effective contraceptive method during treatment and for 3 months after stopping treatment.
  • Concomitant Medication

  • Subjects receiving corticosteroids must be on a stable or decreasing dose of corticosteroid for the prior 7 days.
  • Subjects who are currently receiving enzyme inducing anticonvulsants are not eligible.
  • Subjects must not be receiving potent CYP3A4 inducers or inhibitors.
  • Subjects who are currently receiving another investigational drug are not eligible.
  • Subjects who are currently receiving any other anti-cancer agents are not eligible.
  • Subjects who have an uncontrolled infection are not eligible.
  • Subjects enrolled on a clinical trial for upfront therapy or relapse therapy for those patients in second complete remission.
  • Subjects who in the opinion of the investigator may not be able to comply with the safety monitoring requirements of the study are not eligible.

Study Design

Enrollment

55 participants

Anticipated

Allocation

Non randomized

Intervention Model

Parallel Assignment

Primary purpose

Treatment

Interventions and Outcome Measures

Arms

experimental: Maintenance Chemotherapy Regimen

Participants with metastatic osteosarcoma, metastatic Ewing sarcoma, high-risk rhabdomyosarcoma, metastatic non-rhabdomyosarcoma soft tissue sarcoma (NRSTS), desmoplastic small round cell tumor (DSRCT), and malignant rhabdoid tumor (MRT) in first complete remission (cohort 1) or participants with recurrent solid tumors (any histology) in second complete remission (cohort 2), receiving a maintenance chemotherapy regimen administered as a 12-month course of continuous sirolimus with celecoxib and low-dose oral etoposide alternating every 21 days with low-dose oral cyclophosphamide following the completion of "standard" therapy.

no intervention: Historical Control Cohort Receiving Standard Therapy

This study arm is a historical control cohort of patients matched with cohort 1 on diagnosis, age, metastatic site, and date of diagnosis. The matched historical controls will be obtained from the same treating institution as the corresponding case to account for institutional differences in treatment and supportive care. Patients in the historical control cohort received standard therapy.

Interventions

Sirolimus

Sirolimus is given at a dose of 2 mg/m2 once daily. The amber oral dose syringe should be used to withdraw the prescribed amount of sirolimus oral solution from the bottle. The solution can be drunk or administered at once to assure delivery of all of the medication. It is safe for administration through a nasogastric or G-tube. For tablets, the tablet should not be crushed, split, or otherwise altered. As with the liquid dosing form, the tablets should be given within two hours each day and should be at consistent intervals with regard to meals.

Cyclophosphamide

A synthetic antineoplastic drug chemically related to the nitrogen mustards. The drug is administered orally daily, in the formulation appropriate for age.

The solution should be diluted in 20-30 ml of appropriate liquid before administration through nasogastric (NG) tube or gastrostomy (G) tube, with adequate flushing after administration to prevent obstruction of the feeding tube.

Etoposide

A semisynthetic derivative of podophyllotoxin which functions as mitotic inhibitor but does not interfere with microtubular assembly. The drug is administered orally daily, in the formulation appropriate for age.

Celecoxib

The drug is administered orally daily, in the formulation appropriate for age.The solution is safe for administration through a nasogastric or G-tube.

Primary outcome measure

  • Two-year progression-free survival in patients with high-risk solid tumors [ Time Frame: up to 2 years ]

Central Contacts and Locations

Central contacts

Kathryn Sutton, MD

404-785-1651Kathryn.Sutton@choa.org

Locations

Aflac Cancer & Blood Disorders Centers

Recruiting

Atlanta, Georgia, United States, 30329

Contacts

Kathryn Sutton, MD

4047851651Kathryn.Sutton@choa.org

Children's Healthcare of Atlanta

Recruiting

Atlanta, Georgia, United States, 30329

Contacts

Kathryn Sutton, MD

404-785-1651Kathryn.Sutton@choa.org

Washington University School of Medicine

Recruiting

St Louis, Missouri, United States, 63110

Contacts

Amy Armstrong, MD

(314) 454-6018armstrongae@wustl.edu

Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC)

Recruiting

Pittsburgh, Pennsylvania, United States, 15224

Contacts

Andrew Bukowinski, MD, MS

(412) 692-8864Andrew.bukowinski2@chp.edu

Texas Children's Cancer Center

Recruiting

Houston, Texas, United States, 77030

Contacts

Sarah Kappa, MD

(832) 824-4724sskappa@texaschildrens.org

More Information

Sponsor

Emory University

Last update posted

Feb 27, 2026

Last verified

Feb, 2026

Keywords

  • Pediatrics
  • Chemotherapy
  • Remission
  • Survival

Trial information was received from ClinicalTrials.gov and was last updated on 2026-09-09. This information was provided to ClinicalTrials.gov by Emory University on 2026-02-27.