Cryoablation Versus Medical Therapy in Desmoid Tumors Progressing After Watchful Waiting

Official title

A Phase II Multicentric, Randomized Trial Assessing Cryoablation Versus Medical Therapy in Desmoid Tumors Progressing After Watchful Waiting

Overview

"Wait \& see" is currently the standard of care of recently diagnosed desmoid tumors (DT). In case of progression or symptomatic disease, medical therapy is nowadays widely used including chemotherapy. Cryoablation has proven to be beneficial for the treatment of large, progressive and symptomatic DT. This randomized phase II trial aims to compare cryoablation versus medical therapy in DT patients progressing after the "wait \& see" period. Moreover, a cross-over design has been anticipated to allow all patients to undergo cryoablation if necessary.

Interventions

• Procedure Cryoablation
  Percutaneous imaging-guided cryoablation
• Drug Chemotherapy drug
  Either : methotrexate 30mg/m² + vinblastine 6mg/m² (IV infusion) once/week for 6 months, then every other week from months 7 to 12, or vinorelbine : for adults : 90mg/week (per os: 3x30mg, soft capsules) for 12 months; for adolescents: 60mg/m2/week (capped at 90mg/week) for 12 months

Primary outcome measures

• Rate of non-progressive disease [Time frame: 12 months after treatment initiation (Day 0+12months)]

Secondary outcome measures (8)

• Progression-free survival 1 [Time frame: from treatment initiation to PD or 24 months whichever comes first]
• Rate of patients who cross over to the other arm [Time frame: 24 months after treatment initiation]
• Rate of complete response [Time frame: 12 months after treatment initiation and 12 months after cross-over]
• Secondary Progression-free survival 2 [Time frame: Through study completion, up to 39 months]
• Incidence of Treatment-Emergent Adverse Events as assessed by NCI-CTCAE version 5.0 toxicity scale [Time frame: Through study completion, up to 39 months]
• QUALITY OF LIFE assessed by EUROQOL EQ 5D before and after treatment [Time frame: Screening visit, Month 1, Month 2, Month 3, Month 6, Month 9 and Month 12 after treatment initiation]
• PAIN assessed by brief pain inventory (BPI) before and after treatment [Time frame: Screening visit, Day 0/Day 1, Month 1, Month 2, Month 3, Month 6, Month 9 and Month 12 after treatment initiation]
• Health economics assessment [Time frame: Through study completion, up to 39 months]

Eligibility criteria

Inclusion criteria

• Subject (male or female) with extra-peritoneal desmoid tumor (confirmed by prior biopsy by an experienced pathologist within the RRePS network)
• 13 years of age or older
• Measurable viable tumor (according to the mRECIST criteria using MRI. The baseline MRI imaging is mandatory in the 2 months prior to treatment initiation (D0).
• Progressive disease (according to the mRECIST criteria) after the watchful waiting period or significant increase in symptoms requiring an active therapy, as advised in a multidisciplinary sarcoma tumor board
• Tumor deemed accessible for cryoablation procedure by the operator in a type I center. (In pediatric cases, a careful site tumor analysis will be performed with interventional radiologist to ensure for limited consequence of cryoablation in pediatric patients especially regarding growth plates).
• 100 % of destruction of the tumor achievable in one procedure of cryoablation with 1cm security margin according to assessment by referral center (type 1) for cryoablation
• ECOG performance status 0-2 at inclusion visit
• Biological and hematological parameters (neutrophils ≥ 1,5.109/L ; platelet count ≥ 100.109/L ; no significant hemostatic abnormalities) in the 4 weeks prior to treatment initiation (D0)
• Subject able to understand the objectives and risks of the research and to give dated and signed informed consent. For minors, the consent of the 2 parents must be obtained.
• Subject affiliated to a social health insurance plan
• For a woman of childbearing age: negative blood pregnancy test at screening/inclusion visit
• Subject agreeing to use a contraceptive method

Exclusion criteria

• Intra-peritoneal or multifocal desmoid tumor
• Concurrent or prior use of any antitumor agent for the current desmoid tumor
• Relapse after surgery for desmoid tumor
• Any contraindication including known hypersensitivity to vinorelbine or other vinca-alkaloids, or other constituents to navelbine, to vinblastine, to methotrexate or any excipients, such as, but not limited to current or recent (within 2 weeks) severe infection, severe renal failure, severe hepatic injury, chronic respiratory failure
• Any contraindication including hypersensitivity to gadoteric acid, meglumine or any drug containing gadolinium
• Concomitant treatment with: yellow fever vaccine, prophylactic treatment with phenytoin, trimethoprim, ciprofloxacin, penicillins, probenecid, acetylsalicylic acid, NSAIDs, PPIs, acitretin, azote protoxide, St John's wort
• Any contra-indication for the procedure as stated by the interventional radiologist in terms of tumor size, proximity to neural/vascular structures or adjacent organs at risk making the procedure at unacceptable risk
• Impaired hemostasis, that may interfere with the conduct of the cryoablation
• Contraindication to any form of sedation
• Others contra-indications to MRI
• Pregnancy or breastfeeding
• Concurrent participation in other experimental studies that could affect endpoints of the present study
• Impossibility to give the subject informed information (subject in an emergency situation, patient with comprehension difficulties ...)
• Psychiatric disorders
• Incompetent subject (subject to a legal protection measure: curatorship, guardianship, future protection mandate, family habilitation)

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

Crossover

Masking

Open label

Primary purpose

Treatment

Study locations

France · 13 centers

• Service d'oncologie/CHU de Besançon — Besançon
• Service d'Oncologie Médicale, Service de Radiologie Interventionnelle, Institut BERGONNIE — Bordeaux
• Service d'Oncologie Médicale, Service de Radiologie Interventionnelle-Centre François BACL — Caen
• Service d'Oncologie Médicale -Centre Georges François LECLERC — Dijon
• Service d'Oncologie Médicale, Service de Radiologie Interventionnelle-Centre Léon BERARD — Lyon
• Service d'Oncologie Médicale, service de Radiologie Interventionnelle,CHU de Marseille, Ho — Marseille
• Service de Radiologie-CHU de Nantes — Nantes
• Service d'Oncologie Médicale-Centre Antoine LACASSAGNE — Nice
• … and 5 more centers

Identifiers

NCT: NCT06081400 · 7361

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗