Maintenance Oral Etoposide or Observation Following High-dose Chemo for GCT

Sponsor
Nabil Adra (Other)
Overall Status
Recruiting
CT.gov ID
NCT04804007
Collaborator
(none)
64
Enrollment
1
Location
2
Arms
69
Anticipated Duration (Months)
0.9
Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This is an open label randomized phase II trial of maintenance oral etoposide vs. observation in patinets with relapsed GCT treated with high-dose chemotherapy (HDCT) and peripheral-blood stem-cell transplant (PBSCT).

Detailed Description

This is a randomized phase 2 trial of maintenance etoposide versus observation following HDCT+PBSCT for relapsed GCT. Patients who completed HDCT+PBSCT within the past 16 weeks will enroll and randomize in 1:1 fashion to maintenance daily oral etoposide 50mg vs. observation only.

Study Design

Study Type:
Interventional
Anticipated Enrollment :
64 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Intervention Model Description:
Patients who completed HDCT+PBSCT within the past 16 weeks will enroll and randomize in 1:1 fashion to maintenance daily oral etoposide 50mg vs. observation only. Randomization will be stratified based on: -Presence of platinum refractory disease status defined by radiographic or serologic progression within 4 weeks of first-line cisplatin-based combination chemotherapy: yes vs. noPatients who completed HDCT+PBSCT within the past 16 weeks will enroll and randomize in 1:1 fashion to maintenance daily oral etoposide 50mg vs. observation only.Randomization will be stratified based on:-Presence of platinum refractory disease status defined by radiographic or serologic progression within 4 weeks of first-line cisplatin-based combination chemotherapy: yes vs. no
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
Randomized Phase 2 Trial of Maintenance Oral Etoposide or Observation Following High-dose Chemotherapy for Relapsed Metastatic Germ-Cell Tumor
Actual Study Start Date :
Mar 3, 2021
Anticipated Primary Completion Date :
Dec 1, 2024
Anticipated Study Completion Date :
Dec 1, 2026

Arms and Interventions

ArmIntervention/Treatment
Experimental: Maintenance Oral Etoposide

Maintenance daily oral Etoposide.

Drug: Etoposide
etoposide will be provided with prescription for etoposide 50mg orally daily for 21 days out of 28 day cycles. Cycles will be repeated every 4 weeks for a total of 3 cycles.

No Intervention: Observation

If randomized to Observation, subjects will jump to follow-up.

Outcome Measures

Primary Outcome Measures

  1. 12-month Progression Free Survival [time from the date of randomization to the date of disease relapse or death (i.e. up to 1 year)]

    Investigator determination of tumor progression (clinical, radiographic, tumor markers including AFP and hCG)

Secondary Outcome Measures

  1. 12-month Overall Survival [Time of registration to death from any cause (i.e. up to 1 year)]

  2. Assess toxicity and tolerability of maintenance etoposide [through study completion (i.e. up to 2 years)]

    Toxicities according to CTCAE v5 will be summarized by frequencies and rates calculated as the proportion of patients in the safety population experiencing SAEs, discontinuations due to AEs, and AEs.

Eligibility Criteria

Criteria

Ages Eligible for Study:
18 Years and Older
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:
  1. Written informed consent and HIPAA authorization for release of personal health information

  2. Age ≥ 18 years at the time of consent

  3. Histological or serological evidence of non-seminomatous GCT

  4. Relapsed disease after first-line cisplatin-based combination chemotherapy

  5. Completed salvage treatment with HDCT and PBSCT for 2 tandem cycles per Institutional Guidelines

  6. HDCT must have been used as the initial salvage chemotherapy regimen (2nd line therapy) 6.1. Note: 1 or 2 cycles of standard course regimens prior to HDCT are acceptable (regimens include VeIP [vinblastine+ifosfmaide+cisplatin] or TIP [paclitaxel+ifosfamide+cisplatin] or PVB [cisplatin+vinblastine+bleomycin]

  7. Normal or declining tumor markers (AFP and hCG) at time of screening

  8. Adverse events from prior therapy recovered to CTCAE v5.0 grade ≤ 2 at time of registration

  9. Women with ovarian germ cell tumors are eligible

  10. Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2 within 28 days of study registration

  11. Last dose of HDCT must be ≤16 weeks from study registration

  12. Adequate organ function lab values obtained within 28 days prior to study registration System Laboratory Value Hematological Absolute neutrophil count (ANC) ≥1,000 /mcL Platelets ≥100,000 / mcL Hemoglobin ≥8 g/dL Renal Serum creatinine <2mg/dL Hepatic Serum total bilirubin ≤ 1.5 X ULN OR Direct bilirubin ≤ ULN for subjects with total bilirubin levels > 1.5 ULN

AST (SGOT) and ALT (SGPT) ≤ 2.5 X ULN OR

  • 5 X ULN for subjects with liver metastases Coagulation International Normalized Ratio (INR) or Prothrombin Time (PT) ≤1.5 X ULN unless subject is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants Activated Partial Thromboplastin Time (aPTT) ≤1.5 X ULN unless subject is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants
  1. Male subjects should agree to use an adequate method of contraception starting with the first dose of study therapy through 30 days after last dose of study therapy

  2. If a female of childbearing potential, a negative urine pregnancy test within 28 days prior to receiving the first dose of study drug.

o Non-childbearing potential is defined as (by other than medical reasons):

  • ≥ 45 years of age and has not had menses for >2 years

  • Amenorrheic for < 2 years without a hysterectomy and/or oophorectomy and a follicle-stimulating hormone value in the postmenopausal range upon pre-study (screening) evaluation

  • Post hysterectomy or oophorectomy. Documented hysterectomy or oophorectomy must be confirmed with medical records of the actual procedure or confirmed by an ultrasound.

  1. For female patients of childbearing potential and male patients with partners of childbearing potential, agreement (by patient and/or partner) to use two forms of highly effective contraception (i.e., one that results in a low failure rate [< 1% per year] when used consistently and correctly) and to continue its use for 30 days after the last dose of study therapy.
Exclusion Criteria:
  1. Relapsed pure seminoma

  2. Rising tumor markers (AFP and hCG) at time of screening

  3. Patients who completed 2nd cycle of HDCT (time since last dose of HDCT) >16 weeks ago

  4. Treatment with any investigational agent within 28 days prior to study registration

  5. Other active malignancy requiring treatment in past 12 months

  6. History of psychiatric illness or social situations that would limit compliance with study requirements

  7. Active infection requiring systemic therapy

  8. Previous hypersensitivity to etoposide which did not recover with supportive care

  9. Pregnancy, lactation, or breastfeeding

  10. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.

Contacts and Locations

Locations

SiteCityStateCountryPostal Code
1Indiana University Melvin & Bren Simon Cancer CenterIndianapolisIndianaUnited States46202

Sponsors and Collaborators

  • Nabil Adra

Investigators

  • Principal Investigator: Nabil Adra, MD, Indiana University

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.
Responsible Party:
Nabil Adra, Assistant Professor of Medicine, Indiana University
ClinicalTrials.gov Identifier:
NCT04804007
Other Study ID Numbers:
  • CTO-IUSCCC-0742
First Posted:
Mar 18, 2021
Last Update Posted:
Feb 24, 2022
Last Verified:
Feb 1, 2022
Individual Participant Data (IPD) Sharing Statement:
No
Plan to Share IPD:
No
Studies a U.S. FDA-regulated Drug Product:
Yes
Studies a U.S. FDA-regulated Device Product:
No
Product Manufactured in and Exported from the U.S.:
No
Keywords provided by Nabil Adra, Assistant Professor of Medicine, Indiana University
Additional relevant MeSH terms:

Study Results

No Results Posted as of Feb 24, 2022