High Risk Neuroblastoma Study 1.8 of SIOP-Europe (SIOPEN)

Официальное название

High Risk Neuroblastoma Study 1 of SIOP-Europe (SIOPEN)

Обзор

This is a randomized study of the European SIOP Neuroblastoma Group (SIOPEN) in high-risk neuroblastoma (stages 2, 3, 4 and 4s MYCN-amplified neuroblastoma, stage 4 MYCN non amplified \> 12 months at diagnosis). The protocol consists of a rapid, dose intensive induction chemotherapy, peripheral blood stem cell harvest, attempted complete excision of the primary tumour, myeloablative therapy followed by peripheral blood stem cell rescue, radiotherapy to the site of the primary tumour and immunotherapy (R4 randomization - isotretinoin and ch14.18/CHO (Dinutuximab beta, Qarziba ®).), with or without s.c. aldesleukin (IL-2)). Patients diagnosed after the closure of R3 randomization will not be R4 randomized. For these patients the use of ch14.18/CHO antibody is recommended without scIL-2 as continuous infusion as standard of care outside of controlled trials. ch14.18/CHO received marketing authorization by EMA in May 2017 (Qarziba ®). In the induction phase, all patients receive Rapid COJEC following the result of the R3 randomization which was closed on June 8th, 2017 after inclusion of 630 patients as planned. Following induction treatment peripheral blood stem cell harvest (PBSCH) is performed and complete excision of the primary tumour will be attempted. Patients with an inadequate metastatic response to allow BuMel MAT followed by PBSCR at the end of induction should receive 2 TVD (Topotecan, Vincristine, Doxorubicin) cycles. After Rapid COJEC induction, localized patients will proceed to consolidation. Patients aged 12-18 months at diagnosis, with stage 4 neuroblastoma, no MYCN amplification and without segmental chromosomal alterations (SCAs) are thought to have a good prognosis and will stop treatment after induction therapy and surgery to the primary tumour. Consolidation consists of BuMel MAT based on the results of the R1 randomization followed by peripheral blood stem cell rescue (PBSCR) and radiotherapy to the site of the primary tumour. The R2 immunotherapy randomization using ch14.18/CHO as 8 hour infusion on 5 consecutive days ( total dose (100mg/m²) with or without aldesleukin (IL-2) alternated with isotretinoin (13-cis-RA) is closed. The amended R4 immunotherapy randomization using ch14.18/CHO as continuous infusion (total dose 100mg/m² over 10 days) with or without aldesleukin (IL-2) alternated with isotretinoin (13-cis-RA) has accrued according to plan with results pending awaiting data maturity and DMC approval.

Подробное описание

In this protocol the term high-risk neuroblastoma refers to children with either

* disseminated disease (INSS stage 4: about 40 to 50% of all neuroblastoma) over the age of one or * INSS stage 2 and 3 disease with amplification of the MycN proto-oncogene Between 10% and 20% of children with stage 3 and occasional patients with stage 2 disease are characterized by amplification of the MycN gene in their tumours. This biological characteristic has clearly been shown to be associated with a greater risk of relapse and death from disease progression. These patients may benefit from very aggressive treatment and, based on this hypothesis, they are included in this protocol. Infants (\< 12 months at diagnosis) with MYCN amplified tumors are included.

Children with this type of presentation and age represent the largest neuroblastoma subgroup. Their prognosis remains poor in most cases and our ability to predict the clinical course and the outcome of the individual patient is modest.

Primary objectives:

R0 randomization: R0 was opened with the study activation in February 2002 and closed in November 2005. The randomized use of G-CSF during COJEC induction resulted in the recommendation of the prophylactic use of G-CSF to prevent episodes of febrile neutropenia (Ladenstein R, Valteau-Couanet D, Brock P, et al. Randomized Trial of prophylactic granulocyte colony-stimulating factor during rapid COJEC induction in pediatric patients with high-risk neuroblastoma: the European HR-NBL1/SIOPEN study. J Clin Oncol. 2010 Jul 20;3516-24).

R1 randomization: R1 was opened with the study activation in February 2002 and closed in 10/2010 following the results showing significant superiority of myeloablative therapy (MAT) with busulfan and melphalan over continuous infusion of carboplatin, etoposide and melphalan (CEM). BuMel is now the standard MAT (Ladenstein R, Pötschger U, Pearson ADJ, et al. Busulfan and melphalan versus carboplatin, etoposide, and melphalan as high-dose chemotherapy for high-risk neuroblastoma (HR-NBL1/SIOPEN): an international, randomized, multi-arm, open-label, phase 3 trial. Lancet Oncol. 2017 Apr;500-14).

R2 randomization: R2 was activated in November 2006 (13-cis retinoic acid +/- chimeric ch14.18/CHO antibody), modified in July 2009 and suspended in August 2013. R2 randomization tested the hypothesis that immunotherapy with ch14.18/CHO and subcutaneous aldesleukin (IL-2, Proleukin®), following MAT and autologous stem cell transplantation, in addition to differentiation therapy with 13-cis retinoic acid, will improve 3-year EFS in patients with high-risk neuroblastoma (ASCO 2016: Ladenstein R, et al J Clin Oncol 34, 2016 (suppl; abstr 10500)).

R3 randomization: R3 was opened in June 2011 and tests the hypothesis that modified N7 induction regimen will improve the metastatic response rates or event free survival (EFS) as compared to Rapid COJEC. As of June 8th, 2017 R3 randomization reached the target of 630 randomized patients as planned. There was no difference in event free survival rate between both regimens (Rapid COJEC and modified N7), but modified N7 had a significantly higher grade 3 and 4 toxicity profile. Therefore, Rapid COJEC is maintained as the SIOPEN standard induction treatment with G-CSF support based on the results of the R0 randomization open from 2002 top 2005 This change has been implemented in amendment 8 of the protocol.

R4 randomization: R4 was activated in April 2014. The SIOPEN long term infusion (LTI) ch14.18/CHO trial successfully lowered the toxicity profile by prolonging the infusion time of the same total ch14.18/CHO antibody dose of 100 mg/m² to 10 days of continuous infusion in relapsed /refractory patients. Hence the HRNBL1/SIOPEN study committee wished to implement this more favorable immunotherapy dosing schedule for the time till the induction question R3 was answered and the HRNBL1/SIOPEN trial may be closed. Considering the high R2 dropout rate of patients unable to receive all immunotherapy cycles in the IL-2 s.c. combination treatment arm and not observing this effect in the current SIOPEN LTI trial, it is suggested to address the IL-2sc dose in the new R4. Therefore the potential synergistic effect of sc IL-2 will be addressed again with 50% of the original s.c. IL-2 dose. The IL-2sc dose will hence be reduced to 3 x 106 IU IL-2/m2/day s.c. in the HR-NBL1/SIOPEN R4 amendment instead of 6 x 106 IU IL-2/m2/day s.c as used in the SIOPEN LTI trial. In the second week of each IT course s.c.IL-2 will be given on days 2, 4, 6, 8, 10 in parallel to the ch14.18/CHO ctn infusion and not during the first 5 days in week 2 as scheduled in the SIOPEN LTI trial. R4 randomization is closed for patients diagnosed after June 8th, 2017, the closure date of R3 randomization. For these patients the use of ch14.18/CHO antibody is recommended without scIL-2 as continuous infusion (total dose 100 mg/m² over 10 days) as standard of care outside of controlled trials without scIL-2. The ch14.18/CHO monoclonal antibody received marketing authorization by EMA in May 2017 (dinutuximab beta, Qarziba®).

Вмешательства

• Препарат Vincristine
  given during Rapid COJEC and modified N7 therapy
• Препарат Aldesleukin
  Aldesleukin is given during MRD Treatment for patients randomised to the arm with IL-2
• Препарат ch14.18/CHO
  ch14.18/CHO antibody is given during MRD treatment
• Препарат Carboplatin
  Carboplatin is given during induction Treatment (R3 randomisation: Rapid COJEC arm)
• Препарат Etoposide
  Etoposide is given during Induction Treatment (both R3 randomisation arms)
• Препарат Cisplatin
  Cisplatin is given during Induction Treatment (both R3 randomisation arms)
• Препарат Cyclophosphamide
  Cyclophosphamid is given during Induction Treatment (both R3 randomisation arms)
• Препарат Doxorubicin
  Doxorubicin is given during Induction Treatment (R3 arm modified N7)
• Препарат G-CSF
  G-CSF is given during Induction Treatment
• Препарат Busulfan
  In case i.v. busulfan is not available, the use of oral busulfan is permitted, although not recommended.

Первичные конечные точки

• Event Free Survival (R1: MAT therapy) [Срок оценки: Up to three years]
• Event Free Survival (immunotherapy) [Срок оценки: Up to three years]
• Complete metastatic response (R3: Induction therapy) [Срок оценки: Up to 95 days]
• Event free survival (R3: Induction therapy) [Срок оценки: Up to three years]

Критерии участия

Критерии включения

• • Established diagnosis of neuroblastoma according to the International Neuroblastoma Staging System (INSS).

• Age below 21 years.
• High risk neuroblastoma defined as either:

• INSS stage 2, 3, 4, and 4s with MYCN amplification, or
• INSS stage 4 without MYCN amplification aged > 12 months at diagnosis
• Patients who have received no previous chemotherapy except for one cycle of etoposide and carboplatin (VP16/Carbo). In this situation patients will receive Rapid COJEC induction and the first Rapid COJEC cycle may be replaced by the first cycle VP16/Carbo (etoposide / carboplatin).
• Written informed consent, including agreement of parents or legal guardian for minors, to enter a randomised study if the criteria for randomisation are met.
• Tumour cell material available for determination of biological prognostic factors.
• Females of childbearing potential must have a negative pregnancy test. Patients of childbearing potential must agree to use an effective birth control method. Female patients who are lactating must agree to stop breast-feeding.
• Registration of all eligibility criteria with the data centre within 6 weeks from diagnosis.
• Provisional follow up of 5 years.
• National and local ethical committee approval.

Критерии исключения

Any negative answer concerning the inclusion criteria of the study

\-

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Нерандомизированное

Модель

Параллельные группы

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

Италия · 22 центра

• Ospedale G. Salesi — Ancona
• Universitŕ degli studi di Bari — Bari
• Ospedali Riuniti — Bergamo
• Ospedale S. Orsola — Bologna
• Ospedale Regionale per le Microcitemie — Cagliari
• Azienda Ospedaliera di Cosenza — Cosenza
• Azienda Ospedaliera A. Meyer — Florence
• Istituto Giannina Gaslini — Genoa
• … и ещё 14 центров

Великобритания · 21 центр

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Испания · 15 центров

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Франция · 13 центров

• Hopital d'Enfants Dijon — Dijon
• CHU de Grenoble — Grenoble
• CHR Pellegrin — Le Pellerin
• Centre Oscar Lambret de Lille — Lille
• Hopitaux de Marseille La Timone — Marseille
• CHR de Nantes — Nantes
• Hôpital Trousseau Paris — Paris
• Institut Curie — Paris
• … и ещё 5 центров

Польша · 10 центров

• Medical University of Bialystok — Bialystok
• Medical University of Bydgoszcz — Bydgoszcz
• Childrens' Hospital in Chorzów — Chorzów
• Medical University in Gdansk — Gdansk
• Upper Silesian Centre of Child and Mother's Care — Katowice
• University Children's Hospital — Krakow
• Children's University Hospital in Lublin — Lublin
• … и ещё 3 центра

Австралия · 6 центров

• Women and Children´s Hospital — Adelaide
• Lady Cilento Children´s Hospital — Brisbane
• John Hunter Children's Hospital — Newcastle
• Royal Children's Hospital Melbourne — Parkville
• Sydney Children's Hospital — Sydney
• Children´s Hospital Westmead — Westmead

Бельгия · 6 центров

• Cliniques universitaires St-Luc — Brussels
• Hôpital des Enfants — Brussels
• University Hospital Gent — Ghent
• UZ Gasthuisberg — Leuven
• CHR Citadelle — Liège
• Clinique de l'Espérance — Montegnée

Австрия · 5 центров

• St. Anna Kinderspital — Vienna
• Univ.-Klinik für Kinder- und Jugendheilkunde Graz — Graz
• Univ.Klinik f. Kinder-u. Jugendheilkunde Innsbruck — Innsbruck
• Landes- Kinderklinik Linz — Linz
• St. Johanns Spital LKH Salzburg — Salzburg

Венгрия · 5 центров

• Madarász Children Hospital Budapest — Budapest
• Semmelweis University of Budapest — Budapest
• University of Debrecen — Debrecen
• University of Pecs — Pécs
• University of Szeged — Szeged

Дания · 4 центра

• Aarhus Universitetshospital — Aarhus
• National State Hospital — Copenhagen
• University Hospital of Odense — Odense
• Skejby Hospital — Skejby

Греция · 4 центра

• "A&P Kyriakou" Children's Hospital — Athens
• Aghia Sophia Children's Hospital — Athens
• MITERA Hospital — Heraklion
• PEPAGNH University Hospital — Heraklion

Израиль · 3 центра

• Rambam Medical Centre — Haifa
• Schneider Children's Medical Center of Israel — Petah Tikva
• Sheba Medical Center — Tel Aviv

Норвегия · 3 центра

• Haukeland University Hospital — Bergen
• Rikshospitalet — Oslo
• University Hospital of North-Norway — Tromsø

Швеция · 2 центра

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Швейцария · 2 центра

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Чехия · 1 центр

• University Hospital Motol — Prague

Ирландия · 1 центр

• Dublin: OLHSC — Dublin

Португалия · 1 центр

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Словакия · 1 центр

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Словения · 1 центр

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Публикации

• Ladenstein R, Valteau-Couanet D, Brock P, Yaniv I, Castel V, Laureys G, Malis J, Papadakis V, Lacerda A, Ruud E, Kogner P, Garami M, Balwierz W, Schroeder H, Beck-Popovic M, Schreier G, Machin D, Potschger U, Pearson A. Randomized Trial of prophylactic granulocyte colony-stimulating factor during rapid COJEC induction in pediatric patients with high-risk neuroblastoma: the European HR-NBL1/SIOPEN PMID 20567002
• Ladenstein R, Potschger U, Pearson ADJ, Brock P, Luksch R, Castel V, Yaniv I, Papadakis V, Laureys G, Malis J, Balwierz W, Ruud E, Kogner P, Schroeder H, de Lacerda AF, Beck-Popovic M, Bician P, Garami M, Trahair T, Canete A, Ambros PF, Holmes K, Gaze M, Schreier G, Garaventa A, Vassal G, Michon J, Valteau-Couanet D; SIOP Europe Neuroblastoma Group (SIOPEN). Busulfan and melphalan versus carboplat PMID 28259608
• Ladenstein R, Potschger U, Valteau-Couanet D, Luksch R, Castel V, Yaniv I, Laureys G, Brock P, Michon JM, Owens C, Trahair T, Chan GCF, Ruud E, Schroeder H, Beck Popovic M, Schreier G, Loibner H, Ambros P, Holmes K, Castellani MR, Gaze MN, Garaventa A, Pearson ADJ, Lode HN. Interleukin 2 with anti-GD2 antibody ch14.18/CHO (dinutuximab beta) in patients with high-risk neuroblastoma (HR-NBL1/SIOPEN) PMID 30442501
• Morgenstern DA, Potschger U, Moreno L, Papadakis V, Owens C, Ash S, Pasqualini C, Luksch R, Garaventa A, Canete A, Elliot M, Wieczorek A, Laureys G, Kogner P, Malis J, Ruud E, Beck-Popovic M, Schleiermacher G, Valteau-Couanet D, Ladenstein R. Risk stratification of high-risk metastatic neuroblastoma: A report from the HR-NBL-1/SIOPEN study. Pediatr Blood Cancer. 2018 Nov;65(11):e27363. doi: 10.100 PMID 30015396
• Berbegall AP, Bogen D, Potschger U, Beiske K, Bown N, Combaret V, Defferrari R, Jeison M, Mazzocco K, Varesio L, Vicha A, Ash S, Castel V, Coze C, Ladenstein R, Owens C, Papadakis V, Ruud E, Amann G, Sementa AR, Navarro S, Ambros PF, Noguera R, Ambros IM. Heterogeneous MYCN amplification in neuroblastoma: a SIOP Europe Neuroblastoma Study. Br J Cancer. 2018 May;118(11):1502-1512. doi: 10.1038/s414 PMID 29755120
• Mueller I, Ehlert K, Endres S, Pill L, Siebert N, Kietz S, Brock P, Garaventa A, Valteau-Couanet D, Janzek E, Hosten N, Zinke A, Barthlen W, Varol E, Loibner H, Ladenstein R, Lode HN. Tolerability, response and outcome of high-risk neuroblastoma patients treated with long-term infusion of anti-GD2 antibody ch14.18/CHO. MAbs. 2018 Jan;10(1):55-61. doi: 10.1080/19420862.2017.1402997. Epub 2017 Dec 5 PMID 29120699
• Ladenstein R, Potschger U, Valteau-Couanet D, Luksch R, Castel V, Ash S, Laureys G, Brock P, Michon JM, Owens C, Trahair T, Chi Fung Chan G, Ruud E, Schroeder H, Beck-Popovic M, Schreier G, Loibner H, Ambros P, Holmes K, Castellani MR, Gaze MN, Garaventa A, Pearson ADJ, Lode HN. Investigation of the Role of Dinutuximab Beta-Based Immunotherapy in the SIOPEN High-Risk Neuroblastoma 1 Trial (HR-NBL1 PMID 32013055
• Bellini A, Potschger U, Bernard V, Lapouble E, Baulande S, Ambros PF, Auger N, Beiske K, Bernkopf M, Betts DR, Bhalshankar J, Bown N, de Preter K, Clement N, Combaret V, Font de Mora J, George SL, Jimenez I, Jeison M, Marques B, Martinsson T, Mazzocco K, Morini M, Muhlethaler-Mottet A, Noguera R, Pierron G, Rossing M, Taschner-Mandl S, Van Roy N, Vicha A, Chesler L, Balwierz W, Castel V, Elliott M PMID 34115544

Идентификаторы

NCT: NCT01704716 · HR-NBL-1.8 / SIOPEN

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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