Denosumab in Treating Patients With Recurrent or Refractory Osteosarcoma

Inclusion Criteria

• Female patients must have a bone age of equal to or greater than 12 years of age as determined by local read of appropriate radiographic imaging
• Male patients must have a bone age of equal to or greater than 14 years of age as determined by local read of appropriate radiographic imaging
• Patients must have relapsed or become refractory to conventional therapy, with a regimen including some combination of high dose methotrexate, doxorubicin, cisplatin, ifosfamide and etoposide; and have had histologic verification of osteosarcoma at original diagnosis or at the time of recurrence
• Cohort 1 patients must have measurable disease according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1
• Cohort 2 patients must have had a complete resection of all sites of metastatic disease within 30 days prior to enrollment
• Patients will only be eligible after they have undergone complete surgical resection of suspected metastatic disease that is histopathologically confirmed to be osteosarcoma prior to enrollment
• Note: the definition of complete resections is: gross resection of all disease as per the operating surgeon; post-operative imaging is not required for confirmation of complete resection
• Patients must undergo resection of any lung lesion meeting criteria for likely metastatic disease, defined as:
• 3 or more lesions > 5 mm in diameter OR a single lesion > 1 cm
• Patients with lung as the only site of resected metastatic disease must have refused participation in protocol AOST1421
• Note: This applies if AOST1421 is open to enrollment at the enrolling institution on the day the patient consents
• Patient must have adequate tumor specimen available for submission
• Patients must have a performance status corresponding to Eastern Cooperative Oncology Group (ECOG) scores of 0, 1 or 2; use Karnofsky for patients > 16 years of age and Lansky for patients = = 70 mL/min/1.73 m^2 or a serum creatinine based on age/gender as follows:
• Age: 11 to = 16 years old; 1.7 (male), 1.4 (female) maximum serum creatinine (mg/dL)
• Total bilirubin = = 2.0 mmol/L (8.0 mg/dL) and =< 2.9 mmol/L (11.5 mg/dL)

Exclusion Criteria

• Patients with known sensitivity to any of the products to be administered during the study (eg, mammalian derived products, calcium or vitamin D)
• Patients who are receiving other cancer directed therapy at the time of enrollment
• Patients who have previously received denosumab
• Patients who have previously received mithramycin, strontium-89, samarium-153 or rhenium
• Patients receiving bisphosphonates
• Pre-existing conditions
• Disorders associated with abnormal bone metabolism
• Hypocalcemia that is not corrected with oral calcium supplementation
• Vitamin D < 20 mg/mL
• Paget's disease
• Prior history or current evidence of osteonecrosis of the jaw
• Any dental or oral condition likely to result in disruption of mucosal integrity during denosumab therapy including: active dental or jaw condition requiring oral surgery or tooth extraction; non-healed dental or oral surgery or planned invasive dental procedures during the anticipated course of study therapy
• Unstable systemic disease, excluding osteosarcoma, such as unstable proximal renal tubule dysfunction (Fanconi syndrome) or congestive heart failure
• Pregnancy and breast feeding
• Female patients who are pregnant; a pregnancy test is required for female patients of childbearing potential
• Lactating females who plan to breastfeed their infants while on study therapy and through 5 months after completion of study therapy
• Sexually active patients of reproductive potential who have not agreed to use an effective contraceptive method for the duration of their study participation and for 5 months after the end of study treatment
• All patients and/or their parents or legal guardians must sign a written informed consent
• All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirement