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Lay Description

This phase III trial is studying vincristine, dactinomycin, and doxorubicin with or without radiation therapy or observation only to see how well they work in treating patients undergoing surgery for newly diagnosed stage I, stage II, or stage III Wilms' tumor. Drugs used in chemotherapy, such as vincristine, dactinomycin, and doxorubicin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving these treatments after surgery may kill any tumor cells that remain after surgery. Sometimes, after surgery, the tumor may not need additional treatment until it progresses. In this case, observation may be sufficient.

Category

  • Cancers and Other Neoplasms
IRB Number
20070093HU
NCT Number
NCT00352534
Open to Enrollment
Yes

Eligibility

Eligible Ages
Under29 Years
Eligible Genders
All
Accepts Healthy Volunteers
No

Inclusion Criteria

  • Histologically confirmed Wilms' tumor

    • Newly diagnosed stage I-III disease
    • Favorable histology
  • No moderate- or high-risk Wilms' predisposition syndromes

  • Must meet 1 of the following disease stratification categories:

    • Very low-risk disease

      • Stage I disease
      • Age < 2 years
      • Tumor weight < 550 g
      • Regional lymph nodes histologically negative (must have been sampled)
      • No pulmonary metastases on CT scan of chest
      • No synchronous bilateral Wilms tumors (Stage V)

      • Not predisposed to develop bilateral Wilms tumors, defined as unilateral Wilms tumor and any of the following:

        • Aniridia
        • Beckwith-Wiedemann syndrome
        • Simpson-Golabi-Behmel syndrome
        • Denys-Drash syndrome or other associated genito-urinary anomalies
        • Multicentric WT or unilateral WT with contralateral nephrogenic rest(s) in a child < 1 year of age
        • Diffuse hyperplastic perilobar nephroblastomatosis

    • Standard-risk disease meeting 1 of the following criteria:

      • Disease does not require radiotherapy

        • LOH at chromosomes 1p and 16q for stage I or II

        • Stage I disease meeting 1 of the following criteria:

          • Age ≥ 2 years to age < 30 years
          • Tumor weight ≥ 500 g

        • Stage II disease

          • Age < 30 years
          • Any tumor weight

      • Disease requires radiotherapy

        • No LOH at chromosomes 1p and 16q*
        • Stage III disease
  • Must be enrolled on protocol COG-AREN03B2
  • Karnofsky performance status (PS) 50-100% for patients > 16 years old
  • Lansky PS 50-100% for patients ≤ 16 years old
  • Bilirubin (direct) ≤ 1.5 times upper limit of normal (ULN)
  • AST or ALT < 2.5 times ULN
  • Shortening fraction ≥ 27% by echocardiogram OR ejection fraction ≥ 50% by radionuclide angiogram (standard-risk disease)
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patient must use effective contraception

  • No prior tumor-directed chemotherapy or radiotherapy

    • Patients transferring from AREN03B2 with LOH 1p and 16q allowed

Exclusion Criteria

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Study Design

Arm Groups

Study Contact

Virginia Diaz
(210) 562-9149
diazvr@uthscsa.edu

Principal Investigator
Anne-Marie Langevin