Doxorubicin Hydrochloride or Trabectedin in Treating Patients With Previously Untreated Advanced or Metastatic Soft Tissue Sarcoma
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| ClinicalTrials.gov Identifier: NCT01189253 |
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Recruitment Status :
Terminated
(Results of step1: none of the experimental arms fulfills expectations and the study will not continue as a phase III.)
First Posted : August 26, 2010
Last Update Posted : August 8, 2014
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RATIONALE: Drugs used in chemotherapy, such as doxorubicin hydrochloride and trabectedin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. It is not yet known whether trabectedin is more effective than doxorubicin hydrochloride in treating patients with advanced or metastatic soft tissue sarcoma.
PURPOSE: This randomized phase II/III trial is studying the safety of trabectedin compared with doxorubicin hydrochloride and to see how well they work in treating patients with advanced or metastatic soft tissue sarcoma.
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Sarcoma | Drug: doxorubicin hydrochloride Drug: trabectedin Other: laboratory biomarker analysis Procedure: quality-of-life assessment | Phase 2 Phase 3 |
OBJECTIVES:
- To evaluate whether trabectedin given as first-line chemotherapy for patients with previously untreated advanced or metastatic malignant soft tissue sarcoma prolongs progression-free survival as compared to doxorubicin hydrochloride.
- To identify and validate biomarkers (including, but not limited to, XPG, BRCA1, RAD51, BRCA2, ATM and CHK1) of sensitivity to trabectedin in order to allow the selection of patients that benefit most from trabectedin treatment. (Optional translational research)
OUTLINE: This is a multicenter, phase IIB study followed by a phase III study. Patients are stratified according to institution, age at registration (< 60 years old vs ≥ 60 years old), and presence of liver metastases (yes vs no).
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Phase IIB (step 1): Patients are randomized to 1 of 3 treatment arms.
- Arm I: Patients receive doxorubicin hydrochloride IV on day 1. Treatment repeats every 3 weeks for 6 courses in the absence of disease progression or unacceptable toxicity.
- Arm II: Patients receive trabectedin IV over 3 hours on day 1. Courses repeat every 3 weeks in the absence of disease progression or unacceptable toxicity.
- Arm III: Patients receive trabectedin IV continuously over 24 hours on day 1. Courses repeat every 3 weeks in the absence of disease progression or unacceptable toxicity.
At the end of step 1, the best regimen of trabectedin will be determined. Patients receiving the non-selected trabectedin regimen ("losing arm") are offered to cross over in order to receive the selected regimen of trabectedin.
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Phase III (step 2): Patients are randomized to 1 of 2 treatment arms.
- Arm I: Patients receive trabectedin IV on day 1 using the preferred regimen determined in step 1. Courses repeat every 3 weeks in the absence of disease progression or unacceptable toxicity.
- Arm II: Patients receive doxorubicin hydrochloride IV on day 1. Treatment repeats every 3 weeks for 6 courses in the absence of disease progression or unacceptable toxicity.
Patients complete quality of life questionnaire (EORTC QLQ-C30 version 3) at baseline, at 6, 12, 24, and 36 weeks during study, and at the end of study.
Tumor tissue block obtained at diagnosis may be analyzed to identify and validate biomarkers of sensitivity to trabectedin and for tissue microarrays.
After completion of study therapy, patients are followed up at 1 month, every 6 or 12 weeks until disease progression, and every 12 weeks thereafter.
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 133 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Treatment |
| Official Title: | TRUSTS: A Phase IIB/III Multicenter Study Comparing the Efficacy of TRabectedin Administered as a 3-Hour or 24-Hour Infusion to Doxorubicin in Patients With Advanced or Metastatic Untreated Soft Tissue Sarcoma |
| Study Start Date : | May 2011 |
| Actual Primary Completion Date : | June 2013 |
| Estimated Study Completion Date : | June 2015 |
| Arm | Intervention/treatment |
|---|---|
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Active Comparator: Doxorubicin 75 mg/m² every 3 weeks
Doxorubicin administered on day 1 every 3 weeks for a maximum of 6 cycles
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Drug: doxorubicin hydrochloride Other: laboratory biomarker analysis Procedure: quality-of-life assessment |
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Experimental: Trabectedin IV 3 hours
Trabectedin administered on day 1 every 3 weeks at the dose of 1.3 mg/m² until progression
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Drug: trabectedin Other: laboratory biomarker analysis Procedure: quality-of-life assessment |
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Experimental: Trabectedin IV 24 hours every 3 weeks
Trabectedin administered on day 1 every 3 weeks at the dose of 1.5 mg/m² over 24 hours until progression
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Drug: trabectedin Other: laboratory biomarker analysis Procedure: quality-of-life assessment |
- Progression-free survival as assessed by RECIST v 1.1 criteria (phase IIB and phase III)
- Safety (phase IIB)
- Overall survival (phase III)
- Response rate and response duration (phase III)
- Safety profile (phase III)
- Quality of life (phase III)
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| Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
DISEASE CHARACTERISTICS:
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Histologically confirmed intermediate- or high-grade malignant soft tissue sarcoma
- Advanced and/or metastatic disease
- Previously untreated disease
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The following tumor types are not allowed:
- Well-differentiated liposarcoma
- Embryonal rhabdomyosarcoma
- Chondrosarcoma (excluding extraskeletal myxoid chondrosarcoma)
- Osteosarcoma (excluding extraskeletal osteosarcoma)
- Ewing tumors/primitive neuroectodermal tumor (PNET)
- Gastrointestinal stromal tumors (GIST)
- Dermatofibrosarcoma protuberans
- Must have confirmed disease progression based on investigator's judgment prior to study enrollment
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Measurable disease according to RECIST v 1.1 criteria
- Tumor lesions situated in a previously irradiated area, or in an area subjected to other loco-regional therapy, are usually not considered measurable unless there has been demonstrated progression in the lesion
- Formalin fixed paraffin embedded tumor blocks or representative hematoxylin/eosin slides (preferably both) available (local histopathological diagnosis will be accepted for trial entry)
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No prior anticancer therapy for this disease
- No prior anthracycline
- Non-anthracycline therapy for nonmetastatic disease is acceptable
- No known history of CNS metastases or leptomeningeal tumor spread
PATIENT CHARACTERISTICS:
- WHO performance status 0-1
- Absolute neutrophil count ≥ 1.5 x 10^9/L
- Hemoglobin ≥ 9 g/dL
- Platelet count ≥ 100 x 10^9/L
- Bilirubin normal
- ALT/AST ≤ 2.5 times upper limit of normal (ULN)
- Alkaline phosphatase ≤ 2.5 times ULN, (if alkaline phosphatase > 2.5 times ULN, hepatic isoenzymes 5-nucleotidase and/or GGT must be within the normal range)
- Albumin > 30 g/L
- Serum creatinine ≤ 1.5 times ULN
- Creatinine clearance ≥ 30 mL/min
- Creatine phosphokinase (CPK) ≤ 2.5 times ULN
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception (double barrier method for men) 2 weeks prior to, during, and for 3 months (women) or 5 months (men) after completion of study therapy
- LVEF normal by MUGA scan or ECHO
- 12-lead ECG normal (without clinically significant abnormalities)
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None of the following unstable cardiac conditions:
- Congestive heart failure
- Angina pectoris
- Myocardial infarction within the past year
- Uncontrolled arterial hypertension, defined as BP ≥ 150/100 mm Hg despite optimal medical therapy
- Clinically significant arrhythmias
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No active or uncontrolled infections or serious illnesses or medical conditions, including a history of any of the following:
- Chronic alcohol abuse
- Hepatitis
- HIV
- Cirrhosis
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No history of malignancy within the past 5 years, except soft tissue sarcoma, basal cell or squamous cell carcinoma of the skin, carcinoma in situ of the cervix, resected incidental prostate cancer (staged pT2 with Gleason score ≤ 6 and postoperative PSA < 0.5 ng/mL)
- Patients with any history of malignancies who are disease-free for more than 5 years are eligible
- a history of malignancy and disease-free for more than 5 years
- No psychological, familial, sociological, or geographical condition potentially hampering compliance with the study protocol and follow-up schedule
- No concurrent alcohol consumption
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- At least 28 days since prior and no concurrent anticancer therapy including systemic therapy, radiotherapy, or surgery
- At least 28 days since prior and no other concurrent investigational agents
- No concurrent phenytoin, live attenuated vaccines, or yellow fever vaccine
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01189253
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| Study Chair: | Nguyen Binh Bui, MD | Institut Bergonié | |
| Principal Investigator: | James E. Butrynski, MD | Dana-Farber Cancer Institute |
| Responsible Party: | European Organisation for Research and Treatment of Cancer - EORTC |
| ClinicalTrials.gov Identifier: | NCT01189253 |
| Other Study ID Numbers: |
EORTC-62091 EORTC-62091 2009-014889-26 ( EudraCT Number ) EU-21059 PMAR-EORTC-62091 SARC-020 |
| First Posted: | August 26, 2010 Key Record Dates |
| Last Update Posted: | August 8, 2014 |
| Last Verified: | August 2013 |
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stage III adult soft tissue sarcoma stage IV adult soft tissue sarcoma adult alveolar soft-part sarcoma adult angiosarcoma adult desmoplastic small round cell tumor adult epithelioid sarcoma adult extraskeletal chondrosarcoma adult extraskeletal osteosarcoma |
adult fibrosarcoma adult leiomyosarcoma adult malignant fibrous histiocytoma adult malignant hemangiopericytoma adult malignant mesenchymoma adult neurofibrosarcoma adult synovial sarcoma |
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Sarcoma Neoplasms, Connective and Soft Tissue Neoplasms by Histologic Type Neoplasms Doxorubicin Liposomal doxorubicin Trabectedin Antibiotics, Antineoplastic |
Antineoplastic Agents Topoisomerase II Inhibitors Topoisomerase Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Antineoplastic Agents, Alkylating Alkylating Agents |