Adjuvant Chemotherapy in cfHPV-DNA Plasma Positive Patients: A Biomarker In Locally Advanced Cervical Cancer

Official title

Adjuvant Chemotherapy in Cell-free Human Papillomavirus Deoxyribonucleic Acid (cfHPV-DNA) Plasma Positive Patients: A Biomarker In Locally Advanced Cervical Cancer (CC)

Overview

This study hypothesizes that patients who persist with cell-free human papillomavirus deoxyribonucleic acid (cfHPV-DNA) plasma expression at the end of standard treatment, can derive the benefit of using adjuvant chemotherapy in locally advanced cervical cancer (CC). After standard treatment based on concomitant chemoradiotherapy regime, a qualitative and quantitative research of cfHPV-DNA in plasma of patients will be conducted. Patients who have positive research for plasma cfHPV-DNA at the end of chemoradiotherapy treatment will be randomized to receive two additional cycles of adjuvant chemotherapy or observation. Patients will be followed with conduction of computed tomography (CT) scan of the thorax and magnetic resonance (MRI) of abdomen and pelvis and clinical and gynecological examination at every four months.

Detailed description

A prospective, randomized, multicenter, national, superiority, parallel, clinical trial, design to evaluate the use of adjuvant chemotherapy in patients with locally advanced cervical cancer selected by cfDNA-HPV biomarker. Patients will be randomized by stratified randomization process to belong to one of the groups: control (Group B) or intervention (Group C), emphasizing homogeneity of risk factors between them. A randomized list will be generated by using a suitable software, using variable size blocks (2 or 4), with stratification for site and staging. The confidentiality of the randomization list will be maintained through an automated, centralized, Internet-based randomization system, available 24 hours a day (RedCap). Selected patients must receive standard treatment based on concomitant chemoradiotherapy regime, with dose of radiation of 40-50 greys (Gy) (considering additional boost of 10-15 Gy in lymph nodes, radiologically or surgically, compromised) and brachytherapy of 30-40 Gy and cisplatin 40mg/m2 weekly. After four weeks of the end of treatment, a qualitative and quantitative research of cfHPV-DNA in plasma of patients will be conducted. Those with a negative qualitative research result will leave the study. Patients who have positive research for plasma 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 69, 73, 82 cfHPV-DNA at the end of chemoradiotherapy treatment will be randomized to receive two additional cycles of adjuvant chemotherapy or observation. In those cases in which the duration of radiochemotherapy treatment exceeds 84 days, patients must undergo imaging examination (chest, abdomen and pelvis CT) in order to exclude pre-randomization metastatic disease. Patients will be followed with conduction of computed tomography (CT) scan of the thorax and magnetic resonance (MRI) of abdomen and pelvis and clinical and gynecological examination at every four months.

Interventions

• Drug cisplatin, gemcitabine
  Two additional cycles of cisplatin-based adjuvant chemotherapy 50mg/m2 D1 and gemcitabine 1000mg/m2 D1 and D8 at every 21 days.
• Other Follow-up
  Patients will be followed with plasma cfDNA-HPV, computed tomography (CT) scan of the thorax and magnetic resonance (MRI) of abdomen and pelvis and clinical and gynecological examination at every four months.

Primary outcome measures

• Progression free survival [Time frame: 120 days]

Secondary outcome measures (4)

• Overall survival [Time frame: 120 days]
• Overall response rate [Time frame: 120 days]
• Quality of life measures (EORTC QLQ-C30 and QLC-CX24) [Time frame: 21 to 120 days]
• Toxicity according to the Common Terminology Criteria for Adverse Events v.5.0 [Time frame: 7 to 120 days]

Eligibility criteria

Inclusion criteria

• International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IB3 to IVA will be included prospectively.
• Previous standard treatment based on concomitant chemoradiotherapy regimen.
• Karnofsky performance status score ≥70, with estimated life expectancy ≥12 weeks,
• Immunocompetent,
• Positive research for types 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 69, 73, 82 cfHPV-DNA in plasma at the end of chemoradiotherapy,
• Proper hematological, liver and kidney functions. Inclusion criteria will include absolute neutrophils count ≥1.5 x 109/L, platelets ≥100 x 10/L, serum bilirubin ≤ 2.0 x upper limit of normal (ULN), calculated creatinine clearance ≥50 mL/min and alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase ≤ 2.5 x ULN.
• Patients of child-bearing potential were obligated to use an approved contraceptive method during and for 3 months after the study;
• Agree with research procedures, by signing the Informed Consent Form (ICF).

Exclusion criteria

• Previous cervical cancer or other malignancies,
• Pregnant women,
• Inability to perform concurrent cisplatin based-chemoradiotherapy.
• Tumors containing different HPV genotypes
• Absence of anatomopathological examination to prove the diagnosis and/or staging examinations.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Brazil · 26 centers

• Centro Integrado de Pesquisa da Amazônia, CINPAM — Manaus
• Hospital Evangélico de Cachoeiro de Itapemirim — Cachoeiro de Itapemirim
• Hospital Samur — Vitória da Conquista
• Hospital de Base do Distrito Federal — Brasília
• Hospital do Câncer de Muriaé — Muriaé
• Centro de Oncologia de Cascavel, CEONC — Cascavel
• União Oeste Paranaense de Estudos e Combate ao Câncer, UOPECCAN — Cascavel
• Centro Integrado de Oncologia de Curitiba, CIONC — Curitiba
• … and 18 more centers

Identifiers

NCT: NCT05764044 · AddChemo CC Trial

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗