Brief description of trial (Data source: BASEC)
Die derzeitige Standardtherapie für Kinder und Jugendliche mit einem Nierentumor mit Metastasen umfasst eine kurze Chemotherapie, eine anschliessende Operation des Nierentumors und eventuell der Metastasen, sowie eine längere Chemotherapie nach der Operation. Einige Patientinnen und Patienten benötigen zusätzlich eine Strahlentherapie.
In dieser Studie werden zwei verschiedene Arten der Chemotherapie vor der Operation verglichen. Beide Therapien sind als sehr wirksam bekannt und schon lange bei Kindern und Jugendlichen mit Krebs in Gebrauch. Sie unterscheiden sich allerdings in ihren Nebenwirkungen. Die bisher bekannten Informationen haben gezeigt, dass die derzeitige Standardtherapie gelegentlich schwere, lebensbedrohliche Nebenwirkungen verursacht. Deshalb wird untersucht, ob die Vergleichstherapie, bei der Nebenwirkungen weniger häufig und weniger schwerwiegend auftreten, die Krankheit gleich gut heilen kann wie die Standardtherapie. Das Hauptziel der Studie ist somit, die möglichst wirksamste Behandlung vor der Operation mit den geringsten Nebenwirkungen zu bestimmen.
Health conditions investigated(Data source: BASEC)
Nierentumor mit Metastasen (Stadium IV)
Health conditions
(Data source: WHO)
Stage IV childhood renal tumours;Therapeutic area: Diseases [C] - Cancer [C04]
Rare disease
(Data source: BASEC)
No
Intervention investigated (e.g. drug, therapy or campaign)
(Data source: BASEC)
In einem ersten Schritt werden die radiologischen Aufnahmen (z.B. Ultraschall und MRI Bilder) der Patientinnen und Patienten zu einer Fachperson geschickt, welche die Existenz von Metastasen außerhalb des Nierentumors prüft. Nachdem die Fachperson die Diagnose bestätigt hat, beginnt die erste Chemotherapie. Die derzeitige Standardtherapie besteht aus den drei Medikamenten Actinomycin D, Vincristin und Doxorubicin und wird kurz ‘VAD’ genannt. Die Vergleichstherapie besteht aus den drei Medikamenten Vincristin, Carboplatin und Etoposid und wird mit ‘VCE’ abgekürzt. Beide Chemotherapien dauern sechs Wochen. Da zurzeit nicht bekannt ist, welche Behandlung für Kinder und Jugendliche mit einem Nierentumor besser ist, entscheidet ein Computer zufällig, welche Patientinnen und Patienten welche Therapie erhalten.
Die weitere Behandlung nach Abschluss der Studientherapie umfasst die Operation des Tumors und eventuell der Metastasen, gefolgt von einer weiteren Chemotherapie und möglicherweise einer Bestrahlung. Die gesamte weitere Behandlung dauert circa 30 Wochen und ist nicht Teil der Studie SIOP Randomet 2017. Den behandelnden Ärztinnen und Ärzten von Studienteilnehmern stehen aber weiter die Erfahrung und das Wissen von Referenzstrahlentherapeuten, Referenzchirurgen und der internationalen Studienleitung zur Verfügung, die Einblick in die Behandlung vieler Kinder mit dieser Erkrankung haben. Zudem werden Proben des operierten Tumors von einem erfahrenen Referenzpathologen im Labor untersucht. Die Ergebnisse dieser Untersuchung können sowohl auf die Wahl der weiteren Chemotherapie, als auch auf die Entscheidung für oder gegen eine Bestrahlung einen wichtigen Einfluss haben.
Nach Abschluss der gesamten Behandlung werden die Patientinnen und Patienten für mindestens zwei Jahre auf Anzeichen eines Wiederauftretens der Krankheit und späte Nebenwirkungen überwacht. In Begleitprojekten soll ferner untersucht werden, ob neue klinische und molekulare Eigenschaften des Tumors entdeckt werden können, die eine weitere Verbesserung der Therapie ermöglichen.
Interventions
(Data source: WHO)
Product Name: D-Actinomycin
Pharmaceutical Form: Solution for infusion
INN or Proposed INN: dactinomycin
CAS Number: 50-76-0
Other descriptive name: DACTINOMYCIN
Product Name: Carboplatin
Pharmaceutical Form:
INN or Proposed INN: Carboplatin
CAS Number: 41575-94-4
Other descriptive name: CARBOPLATIN
Product Name: Doxorubicin
Pharmaceutical Form:
INN or Proposed INN: DOXORUBICIN
CAS Number: 23214-92-8
Product Name: Etoposid
Pharmaceutical Form:
INN or Proposed INN: Etoposid
CAS Number: 33419-42-0
Other descriptive name: ETOPOSIDE
Product Name: Vincristine
Pharmaceutical Form:
INN or Proposed INN: VINCRISTINE
CAS Number: 57-22-7
Criteria for participation in trial
(Data source: BASEC)
Erste Diagnose eines Nierentumors mit Metastasen
Patientinnen und Patienten älter als drei Monate und jünger als 18 Jahre zum Zeitpunkt der Diagnose
Exclusion criteria
(Data source: BASEC)
Zweijährige Nachbeobachtung nach Therapieabschluss nicht möglich
Bereits erhaltene Chemotherapie oder operative Nierenentfernung vor Studienbeginn
Inclusion/Exclusion Criteria
(Data source: WHO)
Gender:
Female: yes
Male: yes
Inclusion criteria:
- Children <18 years at date of diagnosis and >3months
- Patients suffering from metastatic renal tumour at initial diagnosis, having at least one circumscript, non-calcified (pulmonary) nodule (or other lesion highly suspicious of metastasis according to criteria for metastatic disease) =3 mm as determined by chest CT-scan and abdominal CT-scan/MRI (for radiological details please refer to section 12.8).
- Metastatic childhood renal tumour must be confirmed by central review.
- Signed informed consent form(s) prior to study entry according to national guidelines and GCP guidelines
- Understand and voluntarily provide permission (subjects and when applicable, parental/legal representative(s)) to the ICF prior to conducting any study related assessments/procedures
- Able to adhere to the study visit schedule and other protocol requirements
- No pre-existing and ongoing cardiac malfunction disease (insufficiency, malign arrhythmias)
- No pre-existing and ongoing liver function deficiency that is not controllable by substitution
Are the trial subjects under 18? yes
Number of subjects for this age range: 406
F.1.2 Adults (18-64 years) no
F.1.2.1 Number of subjects for this age range
F.1.3 Elderly (>=65 years) no
F.1.3.1 Number of subjects for this age range
Exclusion criteria:
- inability to be followed until two years after treatment
- other chemotherapy prior to enrolment
- Patient and/or parental/legal representative(s) denied randomization
- primary nephrectomy
- histology other than nephroblastoma if confirmed by upfront tumour biopsy/cutting needle biopsy
- pregnancy or lactation
- Fertile female with child bearing potential and fertile male subjects who refuse using highly effective contraceptive measures
- Treated by any investigational agent in a clinical study within previous 4 weeks
- hypersensitivity to the active substances or other excipients contained in the investigational medical products listed in the summary of product characteristics (SmPC) or Investigators Brochure (IB).
- unwillingness to follow adequate supportive measures including transfusion of blood products if medically needed
- inability to receive chemotherapy according to the protocol, this is particulary true for:
a.acute kidney failure needing dialysis treatment
b.pre-existing peripheral neuropathy
- Active, uncontrolled life threatening Infection (e.g. Acute Hepatitis, Pneumonia, AIDS, Varizella)
- known chromosomal instability/susceptibility (e.g. Fanconi Anemia, Nejjmegen Breakage Syndrome)
- participation in other interventional trials (registration in observational non-interventional studies is acceptable)
- age at start of treatment <3 months or >18 years
- any other medical condition incompatible with the protocol treatment
-
Further information on trial
Date trial registered
Jun 25, 2018
Incorporation of the first participant
Dec 5, 2019
Recruitment status
Authorised-recruitment may be ongoing or finished
Academic title
(Data source: WHO)
Randomized multi-centre open-label non-inferiority phase 3 clinical trial for patients with a stage IV childhood renal tumour comparing upfront Vincristine, Actinomycin-D and Doxorubicin (VAD, standard arm) with upfront Vincristine, Carboplatin and Etoposide (VCE, experimental arm)
Type of trial
(Data source: WHO)
Interventional clinical trial of medicinal product
Design of the trial
(Data source: WHO)
Controlled: yes Randomised: yes Open: yes Single blind: no Double blind: no Parallel group: no Cross over: no Other: no If controlled, specify comparator, Other Medicinial Product: yes Placebo: no Other: no Number of treatment arms in the trial: 2
Phase
(Data source: WHO)
Human pharmacology (Phase I): noTherapeutic exploratory (Phase II): noTherapeutic confirmatory - (Phase III): yesTherapeutic use (Phase IV): no
Primary end point
(Data source: WHO)
Main Objective: To determine non-inferiority of upfront 6 weeks of VCE to VAD in the overall metastatic response rate (MetRR) in newly diagnosed stage 4 WT. The MetRR will include the pulmonary response rate (PRR) and the response rate on non-pulmonary metastasis (NPRR).;Secondary Objective: - acute toxicitiy of preoperative chemotherapy
- histological composition and local stage distribution of the primary tumour
- tumour volume reduction
- EFS and OS after 2 and 5 years
- short term and long term effects
- role of molecular markers
- assess and review the standard imaging criteria in use of pulmonary matastases
- investigating the imaging characteristics of lung metastasis in routine chest imaging in correlation with outcome;Primary end point(s): Percentage of patients with radiologic complete response (CR) of any metastasis and/or Very Good Partial Response (VGPR) of lung metastasis of childhood renal tumours after 6 weeks of preoperative chemotherapy (Section 12.5 for definitions of metastatic response);Timepoint(s) of evaluation of this end point: 6 weeks after start of preoperative chemotherapy of the last patient
Secundary end point
(Data source: WHO)
Secondary end point(s): - Radiologic response to preoperative treatment:
Metastatic response assessment:
- Percentage of patients after 6 weeks of preoperative chemotherapy achieving a CR after surgery of metastasis at time of nephrectomy
- Percentage of patients with complete response +/- VGPR of (pulmonary) metastasis of nephroblastoma after 6 weeks of preoperative chemotherapy + 9 weeks adjuvant chemotherapy.
- Percentage of patients with complete response +/- VGPR of (pulmonary) metastasis of nephroblastoma after preoperative chemotherapy + 9 weeks adjuvant chemotherapy + metastasectomy
- Percentage of patients with remaining metastatic disease after surgery that achieve a CR at week 9 of adjuvant chemotherapy
- Percentage of patients with complete response +/- VGPR of (pulmonary) metastasis of nephroblastoma at the end of adjuvant chemotherapy ? metastasectomy ? RT
- Percentage of patients with radiologic complete response (CR) of any metastasis or Very Good Partial Response (VGPR) of lung metastasis of nephroblastoma after 6 weeks of preoperative chemotherapy of patients with remaining metastatic disease after surgery that achieve a CR at week 9 of adjuvant chemotherapy
- Primary tumour volume shrinkage after 6 weeks of preoperative chemotherapy
- Primary tumour volume after 6 weeks of preoperative chemotherapy
- Number of metastases at diagnosis and after preoperative treatment
- Maximum diameters of the largest metastases at diagnosis and after preoperative treatment
- Histologic & molecular response to preoperative treatment:
- Stage distribution of local tumour
- Histologic subtype distribution of local tumour (LR, IR, HR)
- Histologic subtype distribution of resected nodules/metastsis (LR, IR, HR)
- Percentage of blastema and blastemal residual volume in local tumour
- Percentage of patients with <10 ml of blastemal residual volume in resected nephroblastoma after 6 weeks of preoperative chemotherapy
- Percentage of necrosis in local tumour
- Percentage of patients with complete necrosis in resected nodules
- Percentage of patients with 1q gain being in CR/VGPR in both arms.
- Treatment burden, complications, side effects and toxicity:
- Percentage of patients requiring pulmonary radiotherapy in first line
- Percentage of patients suffering Grade 3 or 4 ALAT or bilirubin increase during preoperative treatment
- Percentage of patients suffering from SOS during preoperative treatment according to EBMT criteria [48]
- Percentage of patients suffering any Grade 4 or grade 5 toxicity during preoperative chemotherapy.
- Overall duration of preoperative treatment per arm as determined as interval D1 ? date of nephrectomy
- Delay in timing of nephrectomy: % of patients with more than 8 weeks since start of preoperative chemotherapy because of toxicity
- Percentage of (peri-)operative complications (haemorrhage, rupture, thromboembolism)
- Outcome:
- Event-free survival at 2 and 5 years for the whole cohort and according to study arm (VAD/VCE) and according to 1qGain
- Overall survival at 2 and 5 years for the whole cohort and according to study arm (VAD/VCE) and according to 1qGain
;Timepoint(s) of evaluation of this end point: after surgery (6 weeks), 9 weeks after initiation of postoperative treatment (if applicable), at the end of overall treatment, 2 years and 5 years (if applicable)
Contact information
(Data source: WHO)
King Baudoin Foundation
Trial results
(Data source: WHO)
Results summary
Randomized multi-centre open-label non-inferiority phase 3 clinical trial for patients with a stage IV childhood renal tumour comparing upfront Vincristine, Actinomycin-D and Doxorubicin (VAD, standard arm) with upfront Vincristine, Carboplatin and Etoposide (VCE, experimental arm)
Link to the results in the primary register
no information available yet
Information on the availability of individual participant data
no information available yet
Trial sites
Trial sites in Switzerland
(Data source: BASEC)
Aarau, Basel, Bellinzona, Bern, Geneva, Lausanne, Luzern, St. Gallen, Zurich
Countries
(Data source: WHO)
Austria, Belgium, Brazil, Czech Republic, Denmark, France, Germany, Greece, Holy See (Vatican City State), Hungary, Ireland, Italy, Netherlands, Norway, Poland, Portugal, Spain, Sweden, Switzerland, United Kingdom
Contact for further information on the trial
Details of contact in Switzerland
(Data source: BASEC)
Dr. med. Sabine Kroiss
+41 44 266 70 57
sabine.kroiss@kispi.uzh.ch
Contact for general information
(Data source: WHO)
PD Dr. Rhoikos Furtw?ngler
Kirrberger Stra?e Geb?ude 9
SIOP Randomet Studienzentrale
rhoikos.furtwaengler@uks.eu
Contact for scientific information
(Data source: WHO)
PD Dr. Rhoikos Furtw?ngler
Kirrberger Stra?e Geb?ude 9
SIOP Randomet Studienzentrale
rhoikos.furtwaengler@uks.eu
Authorisation by the ethics committee (Data source: BASEC)
Name of the authorising ethics committee (for multicentre studies only the lead committee)
Kantonale
Ethikkommission Zürich
Date of authorisation by the ethics committee
02.03.2021
Further trial identification numbers
Trial identification number of the ethics committee (BASEC-ID)
(Data source: BASEC)
2020-02881
Secondary ID (Data source: WHO)
Randomet2017
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