Clinical Trials Search at Vanderbilt-Ingram Cancer Center

Inclusion Criteria:

Histologically proven primary high risk leiomyosarcoma (LMS) or liposarcoma (LPS) of retroperitoneal space or infra-peritoneal spaces of pelvis * LMS: ** Grades 2 and 3 LMS of minimum size 5 cm * LPS (diagnosis based on MDM2 and CDK4 expression on immunohistochemistry [IHC]; additional proof of MDM2 amplification is highly recommended but not mandatory): ** Grade 3 DDLPS OR ** Confirmed grade 2 DDLPS on biopsy only if: *** Federation Nationale des Centres de Lutte Contre Le Cancer (FNCLCC) score = 5 AND clear necrosis on imaging (whether or not present on the biopsy) OR *** High risk gene profile as determined by the Complexity INdex in SARComas (CINSARC-high)

Unifocal tumor

Resectable tumor: resectability is based on pre-operative imaging performed within 28 days before randomization (CT-abdomen, potentially also with MRI) and has to be defined by the local treating sarcoma team. A patient is not considered resectable when the expectation is that only an R2 resection is feasible * Criteria for non-resectability are: ** Involvement of the superior mesenteric artery, aorta, coeliac trunk and/or portal vein ** Involvement of bone ** Growth into the spinal canal ** Progression of retro-hepatic inferior vena cava leimyosarcoma towards the right atrium ** Infiltration of multiple major organs like liver, pancreas and or major vessels

Patient must have radiologically measurable disease (Response Evaluation Criteria in Solid Tumors [RECIST] 1.1), as confirmed by imaging within the 28 days prior to randomization. CT thorax abdomen pelvis with IV contrast is the preferred imaging modality. In case of any contra-indications (medical or regulatory), it is allowed to perform a non-contrast CT thorax + MRI abdomen & pelvis

Collection of tumor tissue and blood samples for central pathology review and translational research are mandatory. If tumor tissue is not available and/or patient does not consent, patient will not be eligible for this trial

>= 18 years old (no upper age limit)

World Health Organization (WHO) performance status = 2

Hemoglobin > 9.0 g/dL or 5.6 mmol/L (within 21 days prior to randomization) * Note: Platelet transfusions is allowed to achieve these baseline values; red blood cell transfusion is not allowed

Absolute neutrophils > 1.5 x 10^9/L (within 21 days prior to randomization) * Note: Platelet transfusions is allowed to achieve these baseline values; red blood cell transfusion is not allowed

Platelets > 100 x 10^9/L (within 21 days prior to randomization) * Note: Platelet transfusions is allowed to achieve these baseline values; red blood cell transfusion is not allowed

Partial thromboplastin time = 1.0 times upper limit of normal (1.0 x ULN) of institutional limits and prothrombin time = 1.0 x upper limit of normal (ULN) of institutional limits (within 21 days prior to randomization) * Note: for patient under anticoagulant treatment international normalized ratio (INR) must be controlled and in the therapeutic target range according to local guidelines

Estimated glomerular filtration rate (eGFR) > 50 ml/min/m^2 (modification of diet in renal disease [MDRD] formula) (within 21 days prior to randomization)

No proteinuria >= grade 2 (Common Terminology Criteria for Adverse Events [CTCAE] version [v] 5.0) (within 21 days prior to randomization)

Bilirubin = 1.0 x ULN of institutional limits (within 21 days prior to randomization). If isolated elevated bilirubin 2 x ULN and Gilberts syndrome suspected, suggest repeating bloods after food. If bilirubin improves to meet the criteria above this is acceptable. More severe persistent hepatic impairment of whatever cause would exclude the patient from treatment till resolved

Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) = 1.5 x ULN (within 21 days prior to randomization)

Clinically normal cardiac function based on left ventricular ejection fraction (LVEF) >= 50% as assessed either by multi-gated acquisition scan (MUGA) or cardiac ultrasound and 12 lead electrocardiogram (ECG) without clinically relevant abnormalities (within 21 days prior to randomization)

American Society of Anaesthesiologist (ASA) score 3

Women of child bearing potential (WOCBP) must have a negative serum pregnancy test within 3 days prior to randomization * Note: a woman is considered of childbearing potential, i.e. fertile, if she is following menarche. She remains of childbearing potential until she becomes post-menopausal or permanently sterile. Permanent sterilization methods include hysterectomy, bilateral salpingectomy and bilateral oophorectomy. A postmenopausal state is defined as no menses for 12 months without an alternative medical cause. A high follicle stimulating hormone (FSH) level in the postmenopausal range may be used to confirm a post-menopausal state in women not using hormonal contraception or hormonal replacement therapy. However in the absence of 12 consecutive months without menses, a single FSH measurement is insufficient

WOCBP in both arms should use highly effective birth control measures, during the study treatment period and for at least 6 months after the last dose of chemotherapy or date of surgery (except for women receiving chemotherapy with ifosfamide who should continue contraception until 1 year after last day of treatment). A highly effective method of birth control is defined as a method which results in a low failure rate (i.e. less than 1% per year) when used consistently and correctly

For men in the experimental arm: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive measures, and agreement to refrain from donating sperm

Female subjects who are breast feeding should discontinue nursing prior to the first day of study treatment and until 6 months after the last study treatment

Before patient randomization, written informed consent must be given according to International Conference on Harmonisation (ICH)/Good Clinical Practice (GCP), and national/local regulations



Exclusion Criteria:

Sarcoma originating from bone structure, abdominal or gynecological viscera

Extension through the sciatic notch or across the diaphragm

Tumor grading not assessable from biopsy

Metastatic disease

Any previous surgery (excluding diagnostic biopsy), radiotherapy or systemic therapy for the present tumor

Hypersensitivity to doxorubicin, ifosfamide, dacarbazine or to any of their metabolites or to any of their excipients

Congestive heart failure

Angina pectoris

Acute inflammatory heart disease

Myocardial infarction within 1 year before randomization

Uncontrolled arterial hypertension defined as blood pressure >= 150/100 mm Hg despite optimal medical therapy

Uncontrolled cardiac arrhythmia

Previous treatment with maximum cumulative doses (450 mg/m^2 doxorubicin or equivalent 900 mg/m^2 epirubicin) of doxorubicin, daunorubicin, epirubicin, idarubicin, and/or other anthracyclines and anthracenediones

Active and uncontrolled infections, in particular urinary tract infections

Vaccination with live vaccines within 30 days prior to study entry

Inflammation of the urinary bladder (interstitial cystitis) and/or obstructions of the urine flow

Other invasive malignancy within 5 years, with the exception of adequately treated non-melanoma skin cancer, localized cervical cancer, localized and Gleason = 6 prostate cancer

Uncontrolled severe illness, medical condition (including uncontrolled diabetes), other than the primary LPS or LMS of the retroperitoneum

Any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before randomization in the trial

Known contraindication to imaging tracer and to MRI