STRASS2: Surgery With Our Without Neoadjuvant Chemotherapy in High Risk RetroPeritoneal Sarcoma
Study Details
Study Description
Brief Summary
This is a multicenter, randomized, open label phase lll trial to assess whether preoperative chemotherapy, as an adjunct to curative-intent surgery, improves the prognosis of high risk DDLPS (dedifferentiated Liposarcoma) and LMS (Leiomyosarcoma) patients as measured by disease free survival.
After confirmation of eligibility criteria, patients will be randomized to either the standard arm or experimental arm.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 3 |
Detailed Description
Standard arm:
- Large en-bloc curative-intent surgery within 4 weeks following randomization- Experimental arm
Experimental arm:
-
3 cycles of neoadjuvant chemotherapy starting within 2 weeks following randomization:
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High grade LPS: ADM (doxorubicin) 75 mg/m2 (or the equivalent EpiADM 120 mg/m2) + ifosfamide 9 g/m3 Q3 weeks.
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LMS: ADM 75 mg/m2 + DTIC (dacarbazine) 1 g/m2 Q3 weeks
-
re-assessment of operability
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curative-intent surgery within 3-6 weeks of last cycle of chemotherapy
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Other: Standard arm Surgery alone |
Procedure: Surgery
Large en-bloc curative-intent surgery
|
| Experimental: Experimental arm Preoperative chemotherapy and surgery |
Drug: Preoperative chemotherapy
- High grade LPS: ADM 75 mg/m2 (or the equivalent EpiADM 120 mg/m2) + ifosfamide 9 g/m2 Q3 weeks
Note: the recommended dose of Ifosfamide can be modified according to national/institutional guidelines, given that the minimum threshold must be 7.5 g/m2 per cycle.
- LMS: ADM 75 mg/m2 + DTIC 1g/m2 Q3 weeks
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Disease free survival [7 years from first patient in]
Disease free survival will be measured from the data of randomization (as reference) to the date of recurrence or death, whichever occurs first.
Secondary Outcome Measures
- Overall survival (OS) [8 years from first patient in]
OS will be measured from the date of randomization to the date of death, whatever the cause.
- Local recurrence free survival [8 years from first patient in]
Local recurrence free survival will be measured from the date of randomization to the date of recurrence (local) or death, whichever occurs first.
- Recurrence free survival [8 years from first patient in]
Recurrence free survival will be measured from the date of randomization to the date of recurrence (local or distant) or death, whichever occurs first.
- Distant metastases free survival [8 years from first patient in]
Distant metastases free survival will be measured from the date of randomization to the date of distant metastases or death, whichever occurs first.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Histologically proven primary high risk leiomyosarcoma (LMS) or Liposarcoma (LPS) of retroperitoneal space or infra-peritoneal spaces of pelvis.
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LMS:
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Grades 2 and 3 of LMS can be included
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Minimum size of LMS tumor should be 5 cm
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LPS:
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Diagnosis should be confirmed based on MDM2 (Mouse double minute 2 homolog) and CDK4 (Cyclin-dependent kinase 4) expression on IHC (immunohistochemistry), while proof of MDM2 amplification is highly recommended.
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All grade 3 DDLPS can be included.
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DDLPS with confirmed grade 2 on biopsy can be included when:
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The grade 2 DDLPS has an FNCLCC score=5 (Fédération Nationale des Centres de Lutte Contre Le Cancer), has no necrosis on the biopsy but clear necrosis on imaging.
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The tumors carry a high risk gene profile as determined by the Complexity INdex in SARComas (CINSARC-high)
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Representative formalin fixed, paraffin embedded tumor blocks or unstained tissue slides must be available at baseline for histological central review.
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Unifocal tumor
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Absence of extension through the sciatic notch or across the diaphragm
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Resectable tumor: resectability is based on pre-operative imaging (CT-abdomen, potentially also with MRI) and has to be defined by the local treating sarcoma team. A patients is not considered resectable when the expectation is that only an R2 resection is feasible.
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Criteria for non-resectability are:
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Involvement of the superior mesenteric artery, aorta, coeliac trunk and/or portal vein
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Involvement of bone
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Growth into the spinal canal
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Progression of retro-hepatic inferior vena cava leiomyosarcoma towards the right atrium
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Infiltration of multiple major organs like liver, pancreas and/or major vessels
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Tumor not previously treated (no previous surgery (excluding diagnostic biopsy), radiotherapy or systemic therapy)
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Patient must have radiologically measurable disease (RECIST 1.1), as confirmed by imaging within the 28 days prior to randomization. CT thorax abdomen pelvis with IV contrast is the preferred imaging modality. In case of any contra-indications (medical or regulatory), it is allowed to perform a non-contrast CT thorax + MRI abdomen & pelvis.
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≥ 18 years old (no upper age limit)
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WHO (World Health Organization) performance status ≤ 2
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Adequate haematological and organ function:
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Haematological: haemoglobin > 9.0 g/dL or 5.6 mmol/L, absolute neutrophils > 1.5 x 109/L, platelets > 100 x 109/L Note: Platelet transfusions is allowed to achieve these baseline values
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Renal: estimated glomerular filtration rate (eGFR) > 50 ml/min/m2; No proteinuria CTCAE ≥ grade 2;
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Hepatic: Bilirubin ≤ 1.0 times upper limit of normal (1.0xULN) of institutional limits, ALT (alanine aminotransferase) and/or AST (aspartate transaminase) ≤1.5 x ULN. If isolated elevated bilirubin <2 x ULN and Gilberts syndrome suspected, suggest repeating bloods after food. If bilirubin improves to meet the criteria above this is acceptable. More severe persistent hepatic impairment of whatever cause would exclude the patient from treatment till resolved.
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Heart: Clinically normal cardiac function based on left ventricular ejection fraction (LVEF ≥ 50%) as assessed either by multi-gated acquisition scan (MUGA) or cardiac ultrasound and 12 lead ECG without clinically relevant abnormalities.
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American Society of Anesthesiologist (ASA) score < 3
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Women of child bearing potential (WOCBP) must have a negative serum pregnancy test within 7 days prior to the first dose of study treatment or surgery.
Note: a woman is considered of childbearing potential (WOCBP), i.e. fertile, following menarche and until becoming post menopausal unless permanently sterile.
Permanent sterilisation methods include hysterectomy, bilateral salpingectomy and bilateral oophorectomy.
A postmenopausal state is defined as no menses for 12 months without an alternative medical cause. A high follicle stimulating hormone (FSH) level in the postmenopausal range may be used to confirm a post-menopausal state in women not using hormonal contraception or hormonal replacement therapy. However in the absence of 12 months of amenorrhea, a single FSH measurement is insufficient..
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Patients of childbearing / reproductive potential should use highly effective birth control measures, as defined by the investigator, during the study treatment period and for at least 6 months after the last dose of treatment or date of surgery. A highly effective method of birth control is defined as a method which results in a low failure rate (i.e. less than 1% per year) when used consistently and correctly. Such methods include:
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Combined (oestrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal, transdermal)
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Progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable, implantable)
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Intrauterine device (IUD)
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Intrauterine hormone-releasing system (IUS)
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Bilateral tubal occlusion
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Vasectomized partner
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Sexual abstinence (the reliability of sexual abstinence needs to be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the patient)
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Female subjects who are breast feeding should discontinue nursing prior to the first day of study treatment and until 6 months after the last study treatment.
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Before patient registration/randomization, written informed consent must be given according to ICH/GCP, and national/local regulations.
Exclusion Criteria:
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Sarcoma originated from bone structure, abdominal or gynecological viscera
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Metastatic disease
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Tumors with extension through the sciatic notch or across the diaphragm
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Hypersensitivity to doxorubicin, ifosfamide, dacarbazine or to any of their metabolites or to any of their excipients
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Persistent myelosuppression
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Myocardial infarction within the last 6 months
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Uncontrolled cardiac arrhythmia
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Previous treatment with maximum cumulative doses (450mg/m² Doxorubicin or equivalent 900mg/m² EpiADM) of doxorubicin, daunorubicin, epirubicin, idarubicin, and/or other anthracyclines and anthracenediones
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Active and uncontrolled infections
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Vaccination with live vaccines within 30 days prior to study entry
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Inflammation of the urinary bladder (interstitial cystitis) and/or obstructions of the urine flow.
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Other invasive malignancy within 5 years, with the exception of adequately treated non-melanoma skin cancer, localized cervical cancer, localized and presumably cured prostate cancer.
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Uncontrolled severe illness, infection,medical condition (including, uncontrolled diabetes or hypertension), other than the Primary LPS or LMS of the retroperitoneum.
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Female patients who are pregnant or breastfeeding or female and male patients of reproductive potential who are not willing to employ effective birth control method.
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Any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before randomization in the trial
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Known contraindication to imaging tracer and to MRI
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Masaryk Memorial Cancer Institute | Brno | Czechia | 656 53 | |
| 2 | Centre Leon Berard | Lyon | France | 69008 | |
| 3 | Institut du Cancer de Montpellier | Montpellier | France | 34298 | |
| 4 | Institut Curie- Hopital de Paris | Paris | France | 75248 | |
| 5 | Hopitaux Universitaires de Strasbourg - Hautepierre | Strasbourg | France | 67098 | |
| 6 | Institut Gustave Roussy | Villejuif | France | 94805 | |
| 7 | Universitaetsklinikum Carl Gustav Carus | Dresden | Germany | 01307 | |
| 8 | UniversitaetsMedizin Mannheim | Mannheim | Germany | 68167 | |
| 9 | Centro Di Riferimento Oncologico | Aviano | Italy | 33081 | |
| 10 | IRCCS - Fondazione Piemonte Inst di Candiolo | Candiolo | Italy | ||
| 11 | IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori" | Meldola | Italy | ||
| 12 | Istituto Clinico Humanitas | Milano | Italy | ||
| 13 | Istituto Europeo di Oncologia | Milano | Italy | ||
| 14 | IRCCS - Istituto Nazionale dei Tumori | Milan | Italy | 20133 | |
| 15 | IRCCS - Istituto Oncologico Veneto | Padova | Italy | ||
| 16 | Policlinico Universitario Campus Bio-Medico- Oncology Center | Roma | Italy | ||
| 17 | Maria Sklodowska-Curie Memorial Cancer Centre - Maria Sklodowska-Curie National Research Institute of Oncology | Warsaw | Poland | ||
| 18 | National Cancer Institute | Bratislava | Slovakia | SK 833 10 | |
| 19 | Hospital De La Santa Creu I Sant Pau | Barcelona | Spain | 08041 | |
| 20 | Institut Catala d'Oncologia - ICO Badalona - Hospital Germans Trias i Pujol | Barcelona | Spain | ||
| 21 | Hospital Universitario San Carlos | Madrid | Spain | 28040 | |
| 22 | NHS Greater Glasgow and Clyde - Beatson West of Scotland Cancer Centre - Gartnavel General Hospital | Glasgow | United Kingdom | ||
| 23 | the Royal Marsden Hospital | London | United Kingdom |
Sponsors and Collaborators
- European Organisation for Research and Treatment of Cancer - EORTC
- Canadian Cancer Trials Group
- Eastern Cooperative Oncology Group
- Anticancer Fund, Belgium
- Australia and New Zealand Sarcoma Association
Investigators
- Study Chair: Alessandro Gronchi, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
- Study Chair: Winan van Houdt, The Netherlands Cancer Institute-Antoni Van Leeuwenhoekziekenhuis
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- EORTC 1809-STBSG