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RecruitingLast updated: 9 April 2024

REGO-EWING: This study is testing the feasibility of treatment with targeted therapy (called regorafenib) with conventional chemotherapy in people with newly diagnosed, multimetastatic Ewing sarcomaPhase Ib Study of the Combination of Regorafenib With Conventional Chemotherapy for the Treatment of Newly Diagnosed Patients With Multimetastatic Ewing Sarcoma

Clinical summary


All eligible participants willr eceive standard Ewing sarcoma treatment in addition to regorafenib targeted therapy.

Standard Ewing sarcoma treatment consists of: induction chemotherapy (VDC/IE) and local treatment (sugery/radiation therapy), followed by consolidation chemotherapy (VC/IE/Bu-Mel) according to physician and patient choice.

Regorafenib will be administered during induction chemotherapy (VDC/IE) and during consolidation chemotherapy with conventional chemotherapy (VC/IE) but not Bu-Mel therapy.

Conventional chemotherapy will be administered at the recommended dose (100%) and only regorafenib will be escalated/de-escalated, starting at DL0:

  • DL1: 82mg/m^2 once daily for 21 days/28 days (max 160mg) (100% of the RP2D)
  • DL0 (starting dose): 66mg/m^2 once daily for 21 days/28 days (max 120mg) 80% of the RP2D)
  • DL-1: 50mg/m^2 once daily for 21 days/28 days (max 80mg) (60% of the RP2D) Regorafenib will be stopped 2 weeks before planned surgery of the primary tumour and reintroduced when adequate wound healing is obtained, in addition with consolidation VC/IE chemotherapy.

Regorafenib will only be given in addition to radiation therapy in case the primary tumour is located in the extremities. In case of primary tumours located in the pelvis, abdomen, thorax, spine, brain, head or neck, regorafenib will be stopped at least 1 week before start of radiation therapy. 


This trial is treating patients with metastatic Ewing sarcoma who have had no prior treatment except for surgery


Sarcoma Cancers Sarcoma


People2 - 50



Trial Acronym


More information

Trial Identifiers

Use the hyperlinks, where available to access additional clinical trial information.

  • NCT05830084
  • 2023-503322-39-00; 2022-002874-10; 2022/3545

Trial sponsor

Gustave Roussy, Cancer Campus, Grand Paris

Scientific Title

Phase Ib Study of the Combination of Regorafenib With Conventional Chemotherapy for the Treatment of Newly Diagnosed Patients With Multimetastatic Ewing Sarcoma



  1. Any histologically and genetically confirmed Ewing sarcoma of bone or soft tissue, or round cell sarcomas which are 'Ewing's-like' but negative for EWSR1 gene rearrangement
  2. Metastatic disease
  3. Age ≥2 years and <50 years (from second birthday to 49 years 364 days)
  4. Patient assessed as medically fit to receive the Ewing sarcoma standard multimodal treatment and regorafenib, including:

    • Absolute Neutrophil Count (ANC) ≥ 0.75x10^9/L, platelets ≥ 75x10^9/L.
    • Alanine aminotransferase (ALT), and aspartate aminotransferase (AST) ≤ 5×ULN
    • Bilirubin ≤ 2×ULN
    • Creatinine < 2x ULN or creatinine clearance >60 ml/min/1.73 m^2
    • International normalized ratio (INR)/ Partial thromboplastin time (PTT). INR and PTT ≤ 1.5 x ULN. INR & PTT ≤ 1.5xULN
  5. Adequate cardiac function as evidenced by left ventricular ejection fraction (LVEF) ≥50%) at baseline, as determined by echocardiography
  6. Adequately controlled blood pressure (BP) with or without antihypertensive medications, defined as: a BP <95th percentile for sex, age, and height at screening (as per National Heart Lung and Blood Institute [NHLBI] guidelines) and no change in antihypertensive medications within 1 week prior to Cycle 1 Day 1. Patients >18 years old should have BP ≤ 150/90 mmHg.
  7. No prior treatment for Ewing sarcoma other than surgery
  8. Negative pregnancy test for female patients of childbearing potential within 7 days prior to study registration.
  9. Patient agrees to use highly effective contraception during therapy and for 12 months after last trial treatment (females) or 6 months after last trial treatment (males), where applicable
  10. Subject must be able to swallow and retain oral medication.
  11. Written informed consent from the patient and/or the parent/legal guardian, according to local, regional or national regulation prior to any study specific procedures.
  12. Patients must be affiliated to a social security system or beneficiary of the same, as per local regulatory requirements (France only)


  1. Localized tumor or metastatic disease to lung/pleura only.
  2. Contra-indication to the Ewing sarcoma standard multimodal treatment
  3. Pregnant or breastfeeding women or intending to become pregnant during the study.
  4. Follow-up not possible due to social, geographic or psychological reasons
  5. Impairment of gastrointestinal (GI) function or GI disease that may significantly alter absorption of oral drugs
  6. A clinically significant ECG abnormality, including a marked prolonged QTcF interval (eg, a repeated demonstration of a QTcF interval >480 msec) Clinically significant, uncontrolled heart disease (including history of any cardiac arrhythmias, e.g., ventricular, supraventricular, nodal arrhythmias, or conduction abnormality, unstable angina, active coronary artery disease and myocardial infarction within 6 months before randomization.) Uncontrolled hypertension (systolic pressure >150 mmHg or diastolic pressure > 90 mmHg on repeated measurement) despite optimal medical management
  7. Previous arterial or venous thromboembolisms Grade ≥ 3 per CTCAE v5.0
  8. Hypersensitivity to any active substance or to any excipients
  9. Radiographic evidence of encasement or invasion of a major blood vessel or of intratumoral cavitation
  10. Major surgical procedure or significant traumatic injury within 28 days before starting study treatment
  11. Non-healing wound, ulcer or bone fracture.
  12. Interstitial lung disease with ongoing signs and symptoms.
  13. Any other medical or other condition that, in the opinion of the investigator(s), would preclude the subject's participation in this clinical study


  • You are able to swallow medication by mouth.
  • You have been diagnosed with cancer, but have not received any treatment.
  • Your cancer has spread to other parts of the body.


  • You have certain types of non-cancer medical conditions.
  • You have had certain treatments, surgical procedures or drugs.

Clinical trials have complex eligibility criteria.

Ask your doctor if this trial could be right for you.

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