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Mitotane With or Without Cisplatin and Etoposide After Surgery in Treating Participants With Stage I-III Adrenocortical Cancer With High Risk of Recurrence (ADIUVO-2)

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ClinicalTrials.gov Identifier: NCT03583710
Recruitment Status : Recruiting
First Posted : July 11, 2018
Last Update Posted : February 27, 2020
Sponsor:
Collaborators:
Amercian Australian Asian Adrenal Alliance (A5)
European Network for the Study of Adrenal Tumors (ENS@T)
Information provided by (Responsible Party):
M.D. Anderson Cancer Center

Brief Summary:
This phase III trial studies how well mitotane alone works compared to mitotane with cisplatin and etoposide when given after surgery in treating participants with adrenocortical cancer that has a high risk of coming back. Cortisol can cause the growth of adrenocortical tumor cells. Antihormone therapy, such as mitotane, may lessen the amount of cortisol made by the body. Drugs used in chemotherapy, such as cisplatin and etoposide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether mitotane alone or mitotane with cisplatin and etoposide after surgery works better in treating participants with adrenocortical carcinoma.

Condition or disease Intervention/treatment Phase
ENSAT Stage I Adrenal Cortex Carcinoma ENSAT Stage II Adrenal Cortex Carcinoma ENSAT Stage III Adrenal Cortex Carcinoma Drug: Cisplatin Drug: Etoposide Drug: Mitotane Procedure: Quality-of-Life Assessment Phase 3

Detailed Description:

PRIMARY OBJECTIVES:

I. To compare the effect of adjuvant mitotane treatment alone (arm A) with that of adjuvant mitotane combined with four 21-day cycles of etoposide/cisplatin (arm B) on recurrence-free survival (RFS) in patients with high-risk adrenocortical carcinoma (ACC) after initial surgical resection.

SECONDARY OBJECTIVES:

I. Assess overall survival (OS), defined as the time interval between the date of randomization and the date of death from any cause.

II. Assess the effect of serum mitotane levels, disease stage, and surgical resection margins on clinical outcomes.

III. Assess the effect of early start (1-6 weeks from surgery) vs. late start (> 6 weeks from surgery) of adjuvant therapy on clinical outcomes.

IV. Assess serious adverse events (grade 3 and above) according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE, version 4.03).

V. Measure quality of life at baseline, 6 weeks, 6 months after the initiation of adjuvant therapy, and at the end of study participation (recurrence or completing study treatments) using a validated quality of life questionnaire (European Organization for Research and Treatment of Cancer [EORTC] QLQ-C30).

EXPLORATORY OBJECTIVES:

I. Perform molecular profiling on available tissue specimens obtained at the time of initial surgical resection (formalin-fixed paraffin-embedded or frozen tissues) to identify genomic alterations in primary tumors that are associated with the clinical end points. II. Evaluate markers to detect ACC recurrence or predict response to therapy (including steroid hormones and precursors, circulating tumor cells, and micro ribonucleic acid [microRNA]).

OUTLINE: Participants are randomized to 1 of 2 arms.

ARM A: Participants receive mitotane orally (PO) daily on days 1-21. Courses repeat every 21 days for 2 years in the absence of disease progression or unacceptable toxicity.

ARM B: Participants receive mitotane as in Arm A. Participants also receive cisplatin intravenously (IV) over 2 hours on day 1 and etoposide IV over 2 hours on days 1-3. Treatment repeats every 21 days for up to 4 courses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, participants are followed up every 6 months.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 240 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Mitotane With or Without Cisplatin and Etoposide After Surgery in Treating Participants With Stage I-III Adrenocortical Cancer With High Risk of Recurrence (ADIUVO-2)
Actual Study Start Date : August 20, 2018
Estimated Primary Completion Date : January 22, 2025
Estimated Study Completion Date : January 22, 2025


Arm Intervention/treatment
Experimental: Arm A (mitotane)
Participants receive mitotane PO daily on days 1-21. Courses repeat every 21 days for 2 years in the absence of disease progression or unacceptable toxicity.
Drug: Mitotane
Given PO
Other Names:
  • (o,p)-DDD
  • 1, 1-Dichloro-2-(o-chlorophenyl)-2-(p-chlorophenyl)ethane
  • 1-Chloro-2-[2,2-dichloro-1-(4-chlorophenyl)ethyl]benzene
  • 2, 2-Bis(2-chlorophenyl-4-chlorophenyl)-1,1-dichloroethane
  • 2, 4'-Dichlorodiphenyldichloroethane
  • CB 313
  • CB-313
  • Chloditan
  • Chlodithane
  • DDD
  • Ethane, 2-(o-chlorophenyl)-2-(p-chlorophenyl)-1,1-dichloro-
  • Khloditan
  • Lisodren
  • Lysodren
  • Mytotan
  • o,p' - DDD
  • o,p'-DDD
  • Ortho,para-DDD
  • WR-13045

Procedure: Quality-of-Life Assessment
Ancillary studies
Other Name: Quality of Life Assessment

Experimental: Arm B (mitotane, etoposide, cisplatin)
Participants receive mitotane as in Arm A. Participants also receive cisplatin IV over 2 hours on day 1 and etoposide IV over 2 hours on days 1-3. Treatment repeats every 21 days for up to 4 courses in the absence of disease progression or unacceptable toxicity.
Drug: Cisplatin
Given IV
Other Names:
  • Abiplatin
  • Blastolem
  • Briplatin
  • CDDP
  • Cis-diammine-dichloroplatinum
  • Cis-diamminedichloridoplatinum
  • Cis-diamminedichloro Platinum (II)
  • Cis-diamminedichloroplatinum
  • Cis-dichloramine Platinum (II)
  • Cis-platinous Diamine Dichloride
  • Cis-platinum
  • Cis-platinum II
  • Cis-platinum II Diamine Dichloride
  • Cismaplat
  • Cisplatina
  • Cisplatinum
  • Cisplatyl
  • Citoplatino
  • Citosin
  • Cysplatyna
  • DDP
  • Lederplatin
  • Metaplatin
  • Neoplatin
  • Peyrone's Chloride
  • Peyrone's Salt
  • Placis
  • Plastistil
  • Platamine
  • Platiblastin
  • Platiblastin-S
  • Platinex
  • Platinol
  • Platinol- AQ
  • Platinol-AQ
  • Platinol-AQ VHA Plus
  • Platinoxan
  • Platinum
  • Platinum Diamminodichloride
  • Platiran
  • Platistin
  • Platosin

Drug: Etoposide
Given IV
Other Names:
  • Demethyl Epipodophyllotoxin Ethylidine Glucoside
  • EPEG
  • Lastet
  • Toposar
  • Vepesid
  • VP 16-213
  • VP-16
  • VP-16-213

Drug: Mitotane
Given PO
Other Names:
  • (o,p)-DDD
  • 1, 1-Dichloro-2-(o-chlorophenyl)-2-(p-chlorophenyl)ethane
  • 1-Chloro-2-[2,2-dichloro-1-(4-chlorophenyl)ethyl]benzene
  • 2, 2-Bis(2-chlorophenyl-4-chlorophenyl)-1,1-dichloroethane
  • 2, 4'-Dichlorodiphenyldichloroethane
  • CB 313
  • CB-313
  • Chloditan
  • Chlodithane
  • DDD
  • Ethane, 2-(o-chlorophenyl)-2-(p-chlorophenyl)-1,1-dichloro-
  • Khloditan
  • Lisodren
  • Lysodren
  • Mytotan
  • o,p' - DDD
  • o,p'-DDD
  • Ortho,para-DDD
  • WR-13045

Procedure: Quality-of-Life Assessment
Ancillary studies
Other Name: Quality of Life Assessment




Primary Outcome Measures :
  1. Recurrence-free survival (RFS) [ Time Frame: From the time of randomization up to 2 years ]
    Starting from the date of randomization until documentation of radiological evidence of local recurrence, radiological evidence of distant recurrence, or death from any cause (whichever occurs first), RFS will be compared using the log-rank test between the two arms.

  2. Local recurrence of adrenocortical carcinoma (ACC) [ Time Frame: Up to 6 months ]
  3. Distant recurrence of ACC [ Time Frame: Up to 6 months ]

Secondary Outcome Measures :
  1. Overall survival (OS) [ Time Frame: From the time of randomization up to 2 years ]
    Overall survival will be compared using the log-rank test.



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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

Inclusion Criteria:

  • Have a histologically confirmed diagnosis of ACC (Weiss score of >= 3). (LinWeiss-Bisceglia system will be used for oncocytic ACC).
  • Have a high risk of relapse defined as: Stage I-III ACC (according to the European Network for the Study of Adrenal Tumors [ENSAT] classification) within 90 days of surgical resection of primary tumor with curative intent with either microscopically complete resection (R0, defined as no evidence of microscopic residual disease according to surgical reports, histopathology, and perioperative imaging), microscopically positive margins (R1), or undetermined margins (RX, based on surgical or pathological reports without unequivocal evidence of metastasis in the perioperative imaging). Each participating center will determine the pathological stages and resection margins AND Ki67 > 10% (to be determined by an experienced pathologist in each participating center and preferably via quantitative imaging analysis).
  • Have perioperative imaging (computed tomography [CT] with contrast, magnetic resonance imaging [MRI] of the chest/abdomen/pelvis, or fluorodeoxyglucose positron emission tomography [FDG-PET] CT) without unequivocal evidence of disease within 4 weeks before randomization. Patients with indeterminate non-specific nodules (< 1 cm for soft tissue lesions and < 1.5 cm in the short dimension for lymph nodes) will be permitted to participate in this study.
  • Have an Eastern Cooperative Oncology Group (ECOG) performance status 0-2.
  • Be able to comply with the protocol procedures.
  • Provide written informed consent.

Exclusion Criteria:

  • The time between primary surgery and randomization > 90 days.
  • They have undergone repeated surgery for recurrence of disease.
  • They have a history of recent or active prior malignancy, except for cured non-melanoma skin cancer, cured in situ cervical carcinoma, breast ductal carcinoma in situ, or other treated malignancies where there has been no evidence of disease for at least 2 years.
  • They have renal insufficiency (estimated glomerular filtration rate [GFR] < 50 mL/min/1.73 m^2). GFRs will be calculated according to the validated formula (Modification of Diet in Renal Disease [MDRD]).
  • They have significant liver insufficiency (serum bilirubin > 2 times the upper normal range)
  • They have significant liver insufficiency (serum alanine aminotransferase [ALT] or aspartate aminotransferase [AST] > 3 times the upper normal range)
  • Impaired bone marrow reserve (neutrophils < 1000/mm^3)
  • Impaired bone marrow reserve (platelets < 100,000/mm^3)
  • Pregnancy or breast feeding.
  • They have known congestive heart failure (ejection fraction < 45%). In patients with a history of cardiac disease, a baseline two-dimensional echocardiogram is needed as standard of care to document ejection fraction. In patients without prior cardiac disease, a baseline electrocardiogram (EKG) is sufficient if there is no evidence of acute ischemic changes or prior evidence of myocardial infarction. If EKG results are abnormal (ischemic changes, significant arrhythmia, or suggestion of prior myocardial infarction), a two-dimensional echocardiogram will be obtained to assess ejection fraction.
  • They have preexisting grade 2 peripheral neuropathy.
  • They underwent previous or current treatment with mitotane or other antineoplastic drugs for ACC.
  • They underwent previous radiotherapy for ACC.
  • They have any other severe acute or chronic medical or psychiatric condition or laboratory abnormality that would impart, in the judgment of the investigator, excess risk associated with study participation or study drug administration or that, in the judgment of the investigator, would make the patient inappropriate for entry into this study.

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 ClinicalTrials.gov identifier (NCT number): NCT03583710


Contacts
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Contact: Mouhammed Habra 713-792-2841 mahabra@mdanderson.org

Locations
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United States, Texas
M D Anderson Cancer Center Recruiting
Houston, Texas, United States, 77030
Contact: Mouhammed A. Habra    713-792-2841    mahabra@mdanderson.org   
Principal Investigator: Mouhammed A. Habra         
Sponsors and Collaborators
M.D. Anderson Cancer Center
Amercian Australian Asian Adrenal Alliance (A5)
European Network for the Study of Adrenal Tumors (ENS@T)
Investigators
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Principal Investigator: Mouhammed Habra M.D. Anderson Cancer Center
Principal Investigator: Massimo Terzolo San Luigi Gonzaga Hospital
Principal Investigator: Rossella Libé Cochin Hospital -Paris -France

Additional Information:
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Responsible Party: M.D. Anderson Cancer Center
ClinicalTrials.gov Identifier: NCT03583710    
Other Study ID Numbers: 2017-0948
NCI-2018-01101 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
2017-0948 ( Other Identifier: M D Anderson Cancer Center )
First Posted: July 11, 2018    Key Record Dates
Last Update Posted: February 27, 2020
Last Verified: February 2020

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Carcinoma
Adrenocortical Carcinoma
Adrenal Cortex Neoplasms
Recurrence
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Disease Attributes
Pathologic Processes
Adenocarcinoma
Adrenal Gland Neoplasms
Endocrine Gland Neoplasms
Neoplasms by Site
Adrenal Cortex Diseases
Adrenal Gland Diseases
Endocrine System Diseases
Cisplatin
Etoposide
Etoposide phosphate
Podophyllotoxin
Mitotane
Antineoplastic Agents
Antineoplastic Agents, Phytogenic
Topoisomerase II Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Keratolytic Agents
Dermatologic Agents
Tubulin Modulators