Cancer Associated Thrombosis, a Pilot Treatment Study Using Rivaroxaban (CASTA-DIVA)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT02746185
Recruitment Status : Recruiting
First Posted : April 21, 2016
Last Update Posted : August 29, 2017
Information provided by (Responsible Party):
Assistance Publique - Hôpitaux de Paris

Brief Summary:
The study will compare the efficacy and safety of oral rivaroxaban and subcutaneous dalteparin in patients with cancer associated thrombosis. It is designed as a non-inferiority open label randomized multicenter trial with blinded adjudication of outcome events.

Condition or disease Intervention/treatment Phase
Neoplasm Venous Thromboembolism Drug: rivaroxaban Drug: Low-molecular-weight heparin Phase 3

Detailed Description:
Patients with active cancer and symptomatic pulmonary embolism, proximal deep vein thrombosis, iliac or caval thrombosis will be randomly assigned to receive either dalteparin using the CLOT regimen or to oral rivaroxaban using the conventional dosage given in the Einstein studies. Experimental and control treatments will be given for three months. The main outcome at three month will include all symptomatic and incidentally discovered venous thromboembolic events including pulmonary embolism (either objectively confirmed and death due to pulmonary embolism), lower limb and upper limb deep vein thrombosis, iliac, caval and visceral thrombosis and any worsening of vascular obstruction which will be collected systematically at inclusion and at day 90. The safety end-points will consist of the rate of major bleedings and the composite of major and non-major but clinically significant bleedings at day 90. All outcome events will be blindly adjudicated by a central independent adjudication committee.

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 200 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Efficacy and Safety of Oral Rivaroxaban for the Treatment of Venous Thromboembolism in Patients With Active Cancer. A Pilot Study.
Study Start Date : September 2016
Estimated Primary Completion Date : March 2018
Estimated Study Completion Date : March 2018

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Arm Intervention/treatment
Active Comparator: Low-molecular-weight heparin
dalteparin, 200 IU/kg subcutaneously once daily for one month followed by 150 IU/kg subcutaneously once daily for 2 months
Drug: Low-molecular-weight heparin
dalteparin, 200 IU/kg OD for 4 weeks followed by 150 IU/kg OD for 8 weeks
Other Name: dalteparin
Experimental: Rivaroxaban
rivaroxaban, orally, 15 mg twice daily for 3 weeks followed by 20 mg once daily for 9 weeks
Drug: rivaroxaban
rivaroxaban, 15 mg BD (Bis in die) for 3 weeks followed by 20mg OD (Omni die) for 9 weeks
Other Name: xarelto

Primary Outcome Measures :
  1. Symptomatic DVT [ Time Frame: 3 months ]
    Recurrent VTE during the 3-month treatment period including all symptomatic DVT (lower limbs distal and proximal DVTs, iliac and caval thrombosis, visceral thrombosis and deep vein thrombosis of the arm)

  2. Symptomatic PE [ Time Frame: 3 months ]
    Recurrent VTE during the 3-month treatment period including symptomatic PE

  3. Unsuspected PE and DVT [ Time Frame: 3 months ]
    Recurrent VTE during the 3-month treatment period including clinically unsuspected PE and DVT discovered incidentally

  4. Worsening of pulmonary vascular or venous obstruction [ Time Frame: 3 months ]
    Recurrent VTE during the 3-month treatment period including worsening of pulmonary vascular obstruction or venous obstruction on the systematic examinations performed at the end of the 3-month treatment period

Secondary Outcome Measures :
  1. Major and clinically significant bleedings during the 3-month treatment period [ Time Frame: 3 months ]
    Major bleeding is defined according to the International Society on Thrombosis and Haemostasis (ISTH) criteria and includes any bleeding resulting in death; symptomatic bleeding in a critical organ including intracranial, intra spinal, intraocular, retroperitoneal, intra articular and pericardial bleeding and muscle bleeding resulting in compartment syndrome; symptomatic bleeding resulting in a decrease in the hemoglobin concentration of at least 2g/dL or resulting in the transfusion of at least two packs of blood red cells.

  2. Symptomatic recurrences of PE or DVT of the legs [ Time Frame: 3 months ]
    excluding visceral thrombosis, upper extremity deep vein thrombosis and clinically unsuspected PE and DVT diagnosed incidentally

  3. Major and non-major clinically significant bleedings at day 90 [ Time Frame: 3 months ]
    Clinically significant non-major bleedings are defined as any bleeding requiring hospitalization or a medical intervention including temporary withholding of anticoagulant treatment to stop bleeding.

  4. Mortality [ Time Frame: 3 months ]

Other Outcome Measures:
  1. Rivaroxaban plasma concentrations [ Time Frame: 3 months ]
    Area under the plasma concentration versus time curve (AUC) determined using a liquid chromatography-tandem mass spectrometry method

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Age > 18 years
  • Social security affiliation
  • Written informed consent
  • Solid active cancer, high grade lymphoma or myeloma treated with Immunomodulatory drugs (IMiDs) (thalidomide or lenalidomide). Active cancer is defined as the presence of measurable disease or ongoing (or planned) chemotherapy, radiotherapy or targeted therapy at inclusion.
  • Histologically or cytologically proven cancer.
  • Symptomatic venous thromboembolism objectively confirmed diagnosed because of symptoms or discovered incidentally
  • High-risk of recurrent Venous thromboembolism (VTE) defined by a score of 0 or ≥ 1, using the following criteria: female sex (+1), lung cancer (+1), breast cancer (-1) non metastatic tumor (-2), previous VTE (+1).

Exclusion Criteria:

  • Exclusive adjuvant hormonal treatment with no measurable residual disease
  • Sub-segmental isolated pulmonary embolism (PE) without associated proximal DVT
  • Isolated distal deep vein thrombosis (DVT) of the legs
  • Isolated upper-extremity DVT or superior vena cava thrombosis
  • Isolated visceral thrombosis
  • Platelet count < 50 000 G/L
  • Active bleeding
  • Hepatic disease associated with coagulopathy and clinically relevant bleeding risk including cirrhotic patients with Child Pugh B and C
  • Hemostatic defect with contraindication to anticoagulant treatment at therapeutic dosage
  • Vena cava filter at inclusion
  • Fibrinolytic therapy within 3 days preceding inclusion
  • Creatinine clearance < 30 ml/min according to Cockcroft-Gault formula
  • Previous heparin-induced thrombocytopenia
  • Anticoagulant treatment at curative dosage for more than 3 days before inclusion
  • Pregnancy or lack of effective contraceptive treatment for women of childbearing age
  • Treatment with both strong CYP3A4 and P-glycoprotein (PgP) inhibitors: protease inhibitors for HIV disease, systemic ketoconazole
  • Treatment with a strong CYP3A4 inducer: rifampicin, carbamazepine, phenytoin.
  • Life expectancy < 3 months
  • Eastern Cooperative Oncology Group (ECOG) level 3 or 4

Information from the National Library of Medicine

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 identifier (NCT number): NCT02746185

Contact: Guy Meyer, MD
Contact: Christine Lanau

CHU Amiens - Medecine vasculaire (003) Recruiting
Amiens, France
Contact: Marie-Antoinette SEVESTRE   
CHU Angers - Medecin Interne (002) Recruiting
Angers, France
Contact: Pierre Marie ROY   
Hopital Saint Andre - Medecine vasculaire (015) Recruiting
Bordeaux, France
Contact: Joël CONSTANS   
CHU Brest - Departement de medecin interne et pneumologie (008) Recruiting
Brest, France
Contact: Aurelien DELLUC   
CHU Le Bocage - Medecine interne 1 (014) Recruiting
Dijon, France
Contact: Nicolas FALVO   
CHU Grenoble - Medecine vasculaire (007) Recruiting
Grenoble, France
Contact: Gilles PERNOD   
Bicetre - Service de Pneumologie et de soins intensifs (018) Withdrawn
Le Kremlin Bicetre, France
Centre hospitalier Lyon Sud - Medecine interne (011) Recruiting
Lyon, France
Contact: Claire GRANGE   
Hopital Saint Eloi - Service de medecine Interne et Maladies Vasculaire (004) Withdrawn
Montpellier, France
CHRU de Nîmes - Pneumologie (012) Recruiting
Nîmes, France
Contact: Alain PROUST   
HEGP - Pneumologie et soins intensifs (001) Recruiting
Paris, France, 75015
Contact: Guy MEYER   
Cochin - Medecine interne (017) Withdrawn
Paris, France
Institut Curie - Soins de support en Cancerologie (020) Recruiting
Paris, France
Contact: Alexis BRUNOD   
Centre hospitalier de Pau - Service de Pneumologie (016) Withdrawn
Pau, France
CHU Saint Etienne - Medecin vasculaire et therapeutique (006) Recruiting
Saint Etienne, France
Contact: Laurent BERTOLETTI   
Hopital Saine Musse - Service de Medecine Vasculaire (010) Recruiting
Toulon, France
Contact: Antoine ELIAS   
CHU Rangueil - Medecin Vasculaire (019) Recruiting
Toulouse, France
Contact: Alessandra BURA   
Sponsors and Collaborators
Assistance Publique - Hôpitaux de Paris
Principal Investigator: Guy Meyer, MD APHP - HEGP

Responsible Party: Assistance Publique - Hôpitaux de Paris Identifier: NCT02746185     History of Changes
Other Study ID Numbers: P141204
First Posted: April 21, 2016    Key Record Dates
Last Update Posted: August 29, 2017
Last Verified: August 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Keywords provided by Assistance Publique - Hôpitaux de Paris:
venous thromboembolism
low-molecular weight heparin

Additional relevant MeSH terms:
Venous Thromboembolism
Embolism and Thrombosis
Vascular Diseases
Cardiovascular Diseases
Calcium heparin
Heparin, Low-Molecular-Weight
Fibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action
Factor Xa Inhibitors
Serine Proteinase Inhibitors
Protease Inhibitors
Enzyme Inhibitors