Inclusion Criteria:
- Patients must have had histologic verification of osteosarcoma at original diagnosis
or relapse
- Patients with diagnoses of osteosarcoma and confirmed HER2 expression of > 10% of
osteosarcoma cells are eligible for the intervention
- Note: There is a mandatory tissue submission for HER2 staining during the
Step 0 Eligibility Screening process. Metastatic tissue, when possible from
the most recent relapse, is strongly preferred for HER2 staining over
archival tissue from primary resection or diagnostic biopsy. The evaluation
period for HER2 staining to determine eligibility for therapy will be less
than 4 weeks from screening enrollment
- Patients must have measurable disease according to Response Evaluation Criteria in
Solid Tumors (RECIST) 1.1. Patients with clinically inactive brain metastases may be
included in the study. Patients with treated brain metastases that are no longer
symptomatic and who require no treatment with corticosteroids or anticonvulsants may
be included in the study if they have recovered from the acute toxic effect of
radiotherapy
- Patient's current disease state must be one for which they have received at least
standard initial therapy, defined as systemic therapy combined with either radiation
or surgery for local control of the primary tumor at diagnosis. Prior therapy after
relapse is not required
- Patients must have a performance status corresponding to Eastern Cooperative Oncology
Group (ECOG) scores of 0 or 1. Use Karnofsky for patients > 16 years of age and Lansky
for patients =< 16 years of age. Patients who are non-ambulatory as a result of prior
surgical treatment for osteosarcoma should be considered ambulatory for the purposes
of assessing performance status
- Patients must have recovered from the acute toxic effects of all prior anti-cancer
therapy and must meet the following minimum duration from prior anti-cancer directed
therapy prior to enrollment. If after the required timeframe, the numerical
eligibility criteria are met, e.g., blood count criteria, the patient is considered to
have recovered adequately
- Cytotoxic chemotherapy or other anti-cancer agents known to be myelosuppressive:
For agents not listed, the duration of this interval must be discussed with the
study chair and the study-assigned Research Coordinator prior to enrollment
- >= 21 days after the last dose of myelosuppressive chemotherapy (42 days if
prior nitrosourea)
- Anti-cancer agents not known to be myelosuppressive (e.g., not associated with
reduced platelet or absolute neutrophil count [ANC] counts): >= 7 days after the
last dose of agent
- Antibodies: >= 4 weeks (28 days) must have elapsed from infusion of last dose of
antibody, and toxicity related to prior antibody therapy must be recovered to
grade =< 1
- Corticosteroids
- Hematopoietic growth factors: >= 14 days after the last dose of a long-acting
growth factor (e.g. pegfilgrastim) or 7 days for short-acting growth factor. For
agents that have known adverse events occurring beyond 7 days after
administration, this period must be extended beyond the time during which adverse
events are known to occur
- Interleukins, interferons and cytokines (other than hematopoietic growth
factors): >= 21 days after the completion of interleukins, interferon or
cytokines (other than hematopoietic growth factors)
- Stem cell Infusions (with or without total body irradiation [TBI]):
- Allogeneic (non-autologous) bone marrow or stem cell transplant, or any stem
cell infusion including donor lymphocyte infusion (DLI) or boost infusion:
>= 84 days after infusion and no evidence of graft versus host disease
(GVHD)
- Autologous stem cell infusion including boost infusion: >= 30 days
- Vellular therapy: >= 30 days after the completion of any type of cellular therapy
(e.g., modified T cells, natural killer [NK] cells, dendritic cells, etc.)
- Radiation therapy (XRT)/external beam irradiation including protons: >= 4 weeks
(28 days) including palliative radiation therapy to the chest. >= 14 days after
palliative local XRT to areas other than the chest or for whole brain
radiotherapy
- Radiopharmaceutical therapy (e.g., radiolabeled antibody, samarium): >= 42 days
after systemically administered radiopharmaceutical therapy
- Patients must not have received prior HER2 therapies including antibody drug
conjugates (e.g. TDM-1 or DS-8201a), HER2 directed cellular therapies, HER2
receptor therapy (e.g. trastuzumab, pertuzumab) or small molecule antagonists of
HER2 (e.g lapatinib or neratinib)
- Patients must be at least 7 days from the date of last surgery
- Peripheral absolute neutrophil count (ANC) >= 1000/mm^3, (granulocyte
colony-stimulating factor [G-CSF] administration is not allowed within 1 week prior to
Step 1 screening assessment) (for patients with solid tumors without known bone marrow
involvement)
- Platelet count >= 100,000/mm^3 (transfusion independent, defined as not receiving
platelet transfusions for at least 7 days prior to enrollment) (for patients with
solid tumors without known bone marrow involvement)
- Hemoglobin >= 8.0 g/dL at baseline (Red Blood Cell transfusion is not allowed within 1
week prior to screening assessment) (for patients with solid tumors without known bone
marrow involvement)
- Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 60
mL/min/1.73 m^2 or a serum creatinine based on age/gender as follows:
- Age: 12 to < 13 years; Maximum serum creatinine (mg/dL): 1.2 (male); 1.2 (female)
- Age: 13 to < 16 years; Maximum serum creatinine (mg/dL): 1.5 (male); 1.4 (female)
- Age: >= 16 years; Maximum serum creatinine (mg/dL): 1.7 (male); 1.4 (female)
- For participants less than 18 years of age that screen fail only based on
creatinine, a 24 hour urine collection may be used instead to confirm
eligibility. A calculated GFR > 60 mL/min/1.73 m^2 using a 24 hour
collection will meet criteria for inclusion on this trial
- Bilirubin (sum of conjugated + unconjugated or total) =< 1.5 x upper limit of normal
(ULN) for age. For patients with documented Gilbert's syndrome (unconjugated
hyperbilirubinemia) bilirubin must be < 3 x ULN for age (patients with solid tumors)
- Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) and
serum glutamic-oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) =< 3
x ULN. (if liver metastases present =< 5 x ULN). For the purpose of this study, the
ULN for ALT is 45 U/L regardless of baseline and the ULN for AST is 50 U/L regardless
of baseline (patients with solid tumors)
- Serum albumin >= 2.5 g/dL (patients with solid tumors)
- International normalized ratio (INR)/prothrombin time (PT) and either partial
thromboplastin or activated partial thromboplastin time (aPTT) =< 1.5 x ULN (patients
with solid tumors)
- Shortening fraction of >= 27% by echocardiogram, or ejection fraction of >= 50% by
either an echocardiogram (ECHO) or multigated acquisition (MUGA) scan within 28 days
before Step 1 enrollment
- Corrected QT interval (QTc) prolongation to < 470 ms (females) or < 450 ms (males)
based on average triplicate 12-lead electrocardiogram (ECG)
- Pulse oximetry > 93% on room air
- Patients with seizure disorder may be enrolled if on anticonvulsants and well
controlled as evidenced by no increase in seizure frequency in the prior 7 days
- Nervous system disorders (Common Terminology Criteria for Adverse Events [CTCAE]
version [v]5) resulting from prior chemotherapy, surgery, and/or radiation must be =<
grade 2, with the exception of decreased tendon reflex (DTR). Any grade of DTR is
eligible
- All patients and/or their parents or legally authorized representatives must sign a
written informed consent. Assent, when appropriate, will be obtained according to
institutional guidelines
Exclusion Criteria:
- Pregnant, planning to become pregnant, or breast-feeding women will not be entered on
this study because there is yet no available information regarding human fetal 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 two effective methods of birth control, including a medically
accepted barrier or contraceptive method (e.g., male or female condom) for the
duration of the study and upon completion of the study and for at least 7 months for
females and 4 months for males after the last dose of study drug. Abstinence is an
acceptable method of birth control
- Methods considered as highly effective methods of contraception include:
- Combined (estrogen and progestogen containing) hormonal contraception
associated with inhibition of ovulation:
- Oral
- Intravaginal
- Transdermal
- Progestogen-only hormonal contraception associated with inhibition of
ovulation:
- Oral
- Injectable
- Implantable
- Intrauterine device (IUD)
- Intrauterine hormone-releasing system (IUS)
- Bilateral tubal occlusion
- Vasectomized partner
- Complete sexual abstinence defined as refraining from heterosexual
intercourse. Periodic abstinence (calendar, symptothermal, post-ovulation
methods) is not an acceptable method of contraception
- Non-child-bearing potential defined as pre-menopausal females with a documented tubal
ligation or hysterectomy; or postmenopausal defined as 12 months of spontaneous
amenorrhea (in questionable cases, a blood sample with simultaneous
follicle-stimulating hormone [FSH] > 40 mIU/mL and estradiol < 40 pg/mL [< 147 pmol/L]
is confirmatory). Females on hormone replacement therapy (HRT) and whose menopausal
status is in doubt will be required to use one of the contraception methods outlined
for women of child-bearing potential if they wish to continue their HRT during the
study. Otherwise, they must discontinue HRT to allow confirmation of post-menopausal
status prior to study enrollment. For most forms of HRT, at least 2-4 weeks will
elapse between the cessation of therapy and the blood draw; this interval depends on
the type and dosage of HRT. Following confirmation of their post-menopausal status,
they can resume use of HRT during the study without use of a contraceptive method
- Male subjects must not freeze or donate sperm starting at Screening and throughout the
study period, and at least 4 months after the final study drug administration.
Preservation of sperm should be considered prior to enrolment in this study
- Female subjects must not donate, or retrieve for their own use, ova from the time of
Screening and throughout the study treatment period, and for at least 7 months after
the final study drug administration
- Patients receiving corticosteroids who have not been on a stable or decreasing dose of
corticosteroid for at least 7 days prior to enrollment are not eligible. If used to
modify immune adverse events related to prior therapy, >= 14 days must have elapsed
since last dose of corticosteroid
- Patients who are currently receiving another investigational drug are not eligible
- Patients who are currently receiving other anti-cancer agents are not eligible
- Patients who are receiving cyclosporine, tacrolimus or other agents to prevent
graft-versus-host disease post bone marrow transplant are not eligible for this trial
- Patients who are receiving chloroquine or hydroxychloroquine within 14 days are not
eligible for this trial
- Patients who have received a prior solid organ transplantation are not eligible
- Patients with a medical history of myocardial infarction within 180 days before
enrollment, symptomatic congestive heart failure (CHF) (New York Heart Association
Class II to IV) or troponin levels consistent with myocardial infarction as defined
according to the manufacturer 28 days prior to enrollment are not eligible
- Patients who have a pleural effusion, ascites or pericardial effusion that requires
drainage, peritoneal shunt, or Cell-free and Concentrated Ascites Reinfusion Therapy
(CART) are not eligible
- Patients who have spinal cord compression or clinically active central nervous system
metastases, defined as untreated and symptomatic, or requiring therapy with
corticosteroids or anticonvulsants to control associated symptoms are not eligible
- Patients with a known history of severe hypersensitivity to DS-8201a or any excipient
contained in the DS-8201a drug formulation are not eligible
- Patients who have an uncontrolled infection or non-healing surgical site are not
eligible
- Patients with a known history of substance abuse or any other clinically significant
medical conditions (i.e. psychological conditions) that may, in the opinion of the
investigator, interfere with the patient's participation in the clinical study or
evaluation of the clinical study results are not eligible
- Patients who have pulmonary compromise, ex hypoxia, resulting from intercurrent
pulmonary illnesses including, but not limited to, any underlying pulmonary disorder
(i.e. pulmonary emboli within three months of the study enrollment, severe asthma,
severe chronic obstructive pulmonary disease (COPD), restrictive lung disease, pleural
effusion etc.), or prior pneumonectomy are not eligible
- Patients who have a history of (non-infectious) ILD (interstitial lung
disease)/pneumonitis that required steroids, has current ILD/pneumonitis, or where
suspected ILD/pneumonitis cannot be ruled out by imaging at screening are not eligible
- Patients who have a pleural effusion, ascites or pericardial effusion that requires
drainage, peritoneal shunt, or cell-free and concentrated ascites reinfusion therapy
(CART) are not eligible. (Drainage and CART are not allowed within 2 weeks prior to
screening assessment)
- Patients who, in the opinion of the investigator, may not be able to comply with the
safety monitoring requirements of the study are not eligible
