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Avastin Plus Chemotherapy vs. Avastin Plus Chemotherapy Guided by Cancer Stem Cell Test in Recurrent Ovarian Cancer (ACSCO)

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ClinicalTrials.gov Identifier: NCT03632798
Recruitment Status : Recruiting
First Posted : August 15, 2018
Last Update Posted : January 8, 2019
Sponsor:
Information provided by (Responsible Party):
Cordgenics, LLC

Brief Summary:

The purpose of this randomized clinical study is to confirm the utility of chemosensitivity (ChemoID) tumor testing on cancer stem cells as a predictor of clinical response in recurrent epithelial ovarian cancer (EOC), fallopian tube, or primary peritoneal cancer, regardless of platinum sensitivity.

Population studied will be female participants experiencing a 1st, 2nd, or 3rd recurrence of any stage epithelial ovarian cancer.


Condition or disease Intervention/treatment Phase
Recurrent Ovarian Cancer Diagnostic Test: ChemoID assay Drug: Chemotherapy Phase 3

Detailed Description:

This study is designed as a parallel group randomized controlled clinical trial to determine if recurrent Epithelial Ovarian Cancer (EOC) patients treated with Bevacizumab plus drugs predicted by the ChemoID assay will have better outcomes than patients treated with standard-of-care control therapy (Bevacizumab plus chemotherapy chosen by the Physician).

Upon obtaining informed consent, all eligible participants affected by 1st, 2nd, or 3rd relapse of EOC regardless of platinum sensitivity (both platinum sensitive and resistant) will have a tumor biopsy or a cancer-positive fluid collection sample to undergo ChemoID drug response testing with multiple FDA-approved chemotherapeutic agents.

Eligible participants will be randomized to a standard treatment arm with control treatment (Bevacizumab plus chemotherapy chosen by the Physician from the provided list), or to a study arm of Bevacizumab plus FDA-approved drugs selected by the ChemoID drug response assay.

A stratified randomization approach for treatment arm assignment will be used with strata based on relapse number, platinum sensitivity, and study site to ensure balance within these cells.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 300 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: parallel group randomized controlled clinical trial
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description: Study investigators will be kept blind to the schedule. All participants will be screened by the ChemoID drug response assay; however, the treating physician will receive the ChemoID results only for those participants who are randomized to receive ChemoID-guided treatment arm.
Primary Purpose: Diagnostic
Official Title: Avastin Plus Chemotherapy vs. Avastin Plus Chemotherapy Chosen by Cancer Stem Cell Chemosensitivity Testing in the Management of Patients With Recurrent Platinum-Resistant or -Sensitive Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer
Actual Study Start Date : August 1, 2018
Estimated Primary Completion Date : July 30, 2021
Estimated Study Completion Date : January 31, 2022

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Ovarian Cancer

Arm Intervention/treatment
Active Comparator: Physician Choice treatment

Participants will be treated with control chemotherapy treatment (Bevacizumab plus standard-of-care chemotherapy chosen by the Physician from the provided list).

Control chemotherapy treatment will be chosen from any of the following standard-of-care chemotherapy drugs or combinations:

  • Liposomal Doxorubicin;
  • Docetaxel;
  • Paclitaxel;
  • Carboplatin;
  • Cisplatin;
  • Gemcitabine;
  • Topotecan;
  • Carboplatin, Gemcitabine;
  • Cisplatin, Gemcitabine;
  • Carboplatin, Liposomal Doxorubicin;
  • Carboplatin, Paclitaxel;
  • Carboplatin, Docetaxel.

The treating physician will NOT receive the ChemoID assay results from the ChemoID lab.

Diagnostic Test: ChemoID assay

The ChemoID test is a CLIA-certified and CAP-accredited drug response assay performed by a hospital clinical pathology laboratory that uses patient's live tumor cells to indicate which chemotherapy agent (or combinations) will kill not only bulk of tumor cells, but importantly the cancer stem cells (CSCs) that are known to cause cancer to recur. During the assay, cancer stem cells and bulk tumor cells from an individual patient are exposed to FDA-approved chemotherapy drugs.

The test measures the cytotoxic effect of actual doses of standard-of-care chemotherapies. The ChemoID drug response assay reports a prioritized list of effective and ineffective chemotherapies. The test is designed to target cancer stem cells to mitigate tumor relapse.


Drug: Chemotherapy

Chemotherapies chosen by Physician or ChemoID assay are in the same list of FDA approved drugs to treat recurrent ovarian cancer.

Chemotherapy list:

  • Liposomal Doxorubicin;
  • Docetaxel;
  • Paclitaxel;
  • Carboplatin;
  • Cisplatin;
  • Gemcitabine;
  • Topotecan;
  • Carboplatin, Gemcitabine;
  • Cisplatin, Gemcitabine;
  • Carboplatin, Liposomal Doxorubicin;
  • Carboplatin, Paclitaxel;
  • Carboplatin, Docetaxel.
Other Name: List of cytotoxic chemotherapy drugs

Experimental: ChemoID-guided treatment

Participants will be treated with Bevacizumab plus ChemoID-guided standard-of-care chemotherapy drugs from the provided list.

ChemoID-guided treatment will be chosen from the following standard-of-care chemotherapy drugs or combinations:

  • Liposomal Doxorubicin;
  • Docetaxel;
  • Paclitaxel;
  • Carboplatin;
  • Cisplatin;
  • Gemcitabine;
  • Topotecan;
  • Carboplatin, Gemcitabine;
  • Cisplatin, Gemcitabine;
  • Carboplatin, Liposomal Doxorubicin;
  • Carboplatin, Paclitaxel;
  • Carboplatin, Docetaxel.

The treating physician will receive the ChemoID assay results from the ChemoID lab.

Diagnostic Test: ChemoID assay

The ChemoID test is a CLIA-certified and CAP-accredited drug response assay performed by a hospital clinical pathology laboratory that uses patient's live tumor cells to indicate which chemotherapy agent (or combinations) will kill not only bulk of tumor cells, but importantly the cancer stem cells (CSCs) that are known to cause cancer to recur. During the assay, cancer stem cells and bulk tumor cells from an individual patient are exposed to FDA-approved chemotherapy drugs.

The test measures the cytotoxic effect of actual doses of standard-of-care chemotherapies. The ChemoID drug response assay reports a prioritized list of effective and ineffective chemotherapies. The test is designed to target cancer stem cells to mitigate tumor relapse.


Drug: Chemotherapy

Chemotherapies chosen by Physician or ChemoID assay are in the same list of FDA approved drugs to treat recurrent ovarian cancer.

Chemotherapy list:

  • Liposomal Doxorubicin;
  • Docetaxel;
  • Paclitaxel;
  • Carboplatin;
  • Cisplatin;
  • Gemcitabine;
  • Topotecan;
  • Carboplatin, Gemcitabine;
  • Cisplatin, Gemcitabine;
  • Carboplatin, Liposomal Doxorubicin;
  • Carboplatin, Paclitaxel;
  • Carboplatin, Docetaxel.
Other Name: List of cytotoxic chemotherapy drugs




Primary Outcome Measures :
  1. Progression free survival (PFS) [ Time Frame: 36 months ]
    Progression free survival (PFS) in patients with recurrent epithelial ovarian cancer (EOC) who receive standard of care treatment (Bevacizumab plus chemotherapy chosen by the Physician from the provided list) versus Bevacizumab plus ChemoID drug response assay-directed chemotherapy.


Secondary Outcome Measures :
  1. Median Overall Survival (OS) [ Time Frame: 36 months ]
    Overall survival (OS) in patients with recurrent EOC who receive standard of care treatment (Bevacizumab plus chemotherapy chosen by the Physician from the provided list) versus Bevacizumab plus ChemoID drug response assay-directed chemotherapy.

  2. Objective Tumor Response [ Time Frame: 36 months ]
    ORR: partial or complete response by RECIST v1.1 (Response Evaluation Criteria In Solid Tumors)

  3. HRQOL [ Time Frame: 36 months ]
    Health-Related Quality of Life (HRQOL)



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:   Female
Gender Based Eligibility:   Yes
Gender Eligibility Description:   Ovarian Cancer is a female disease
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • 1. Informed consent obtained and signed;
  • 2. Willing and able to commit to study procedures including long-term follow-up visit(s);
  • 3. At least 18 years old at the time of enrollment;
  • 4. Negative pregnancy test for women of childbearing potential
  • 5. Experiencing 1st, 2nd, or 3rd recurrent epithelial ovarian cancer of any stage regardless of platinum sensitivity, (platinum-sensitive, -resistant, or -refractory);
  • 6. Histopathological or cytological confirmation of recurrent epithelial ovarian carcinoma, peritoneal cancer or fallopian tube cancer.
  • 7. Evaluable disease - defined as RECIST 1.1 measurable disease OR not measurable disease (defined as solid and/or cystic abnormalities on radiographic imaging that do not meet RECIST 1.1 definitions for target lesions OR ascites and/or pleural effusion that has been pathologically demonstrated to be disease-related in the setting of a CA125 > 2x ULN).
  • 8. At least 30 days post-cytotoxic chemotherapy and/or monoclonal antibody therapy prior to enrollment;
  • 9. Toxicities of prior therapy (excepting alopecia) should be resolved to less than or equal to Grade 1 as per CTCAE v4.0 (http://ctep.cancer.gov/protocol development/electronic_applications/ctc.htm). Patients with long-standing stable grade 2 neuropathy may be considered after discussion with the Study Chair.
  • 10. ECOG Performance Status Score of ≤ 2, KPS≥70, or 0-1 GOG status
  • 11. Adequate laboratory values within 60 days of enrollment to study defined as follows:

    1. WBC ≥ 3000/mm3
    2. Hgb ≥ 10 mg/dl
    3. Hct ≥ 28%
    4. Platelet count ≥ 100,000/μL
    5. Serum creatinine ≤ 2.0 mg/dl
    6. Total bilirubin ≤ 2.5 mg/dl
    7. AST/SGOT ≤ 3 times ULN. If intrahepatic liver metastases are present, AST and ALT must be ≤ 5 times institutional ULN.
    8. Random urine protein/creatinine ratio ≤ 1 or 24 hour urine protein < 0.1 gram.
  • 12. Appropriate for tissue sampling either by tumor biopsy or peritoneal or pleural fluid collection.

Exclusion Criteria:

  • 1. Estimated life expectancy of <6 months, as estimated by the investigator in consultation with participating oncologists;
  • 2. Ovarian cancer of a low grade serous, mucinous, or clear cell histology;
  • 3. Uncontrolled diabetes;
  • 4. Patients with clinically significant proteinuria; urine protein should be screened by urine protein-creatinine ratio (UPCR); the UPCR has been found to correlate directly with the amount of protein excreted in a 24 hour urine collection; specifically, a UPCR of 1.0 is equivalent to 1.0 gram of protein in a 24-hour urine collection; obtain at least 4 ml of a random urine sample in a sterile container (does not have to be a 24-hour urine); send sample to lab with request for urine protein and creatinine levels (separate requests); the lab will measure protein concentration (mg/dL) and creatinine concentration (mg/dL); the UPCR is derived as follows: protein concentration (mg/dL)/creatinine (mg/dL); patients must have a UPCR ≤ 1.0 to allow participation in the study;
  • 5. Symptomatic cardiac conditions;
  • 6. Contraindications to bevacizumab including uncontrolled hypertension, known arterial or venous thromboembolism, known nephrotic syndrome, history of abdominal fistula, GIP, or intra-abdominal abscess; clinical signs or symptoms of GI obstruction and/or requirement for parenteral hydration or nutrition; nonhealing wound, ulcer, or bone fracture; bleeding diathesis or significant coagulopathy; known CNS disease, clinically significant cardiovascular disease; and a major surgical procedure within 28 days of enrollment or anticipated to occur while participating in study;
  • 7. Enrollment in another clinical study that precludes allowing the oncologist to select chemotherapy regimens;
  • 8. Previously participated in this study;
  • 9. Any condition that would, in the opinion of the investigator, place the participant at an unacceptable risk, or render the participant unable to meet the requirements of the protocol (including long-term study follow-up).
  • 10. Documented history of ovarian cancer of a low malignant potential phenotype or unclear cell histology.
  • 11. CA-125 only disease without RECIST 1.1 measurable or otherwise evaluable disease
  • 12. Patients may not use any complementary or alternative medicines including natural herbal products or folk remedies as they may interfere with the effectiveness of the study treatments.

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): NCT03632798


Contacts
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Contact: Kelly J. Wilkinson, MD 601-984-5601 kjeanes@umc.edu

Locations
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United States, Mississippi
Univeristy of Mississippi Medical Center Recruiting
Jackson, Mississippi, United States, 39216
Contact: Kelly J Wilkinson, MD    888-815-2005    kjeanes@umc.edu   
Contact: Jennifer Barnes, RHIA, CCRP    601-815-4540    jbarnes@umc.edu   
United States, West Virginia
Charleston Area Medical Center Recruiting
Charleston, West Virginia, United States, 25326
Contact: Stephen Bush, MD    304-925-4200      
Contact: Augusta Kosowicz, PA-C, CCRC    304-388-9940    augusta.kosowicz@camc.org   
Edwards Comprehensive Cancer Center - Cabell Huntington Hospital Recruiting
Huntington, West Virginia, United States, 25705
Contact: Nadim Bou Zgheib, MD    304-399-6600    zgheib@marshall.edu   
Contact: Barbara Payne, RN    304-399-6617    Barbara.Payne@chhi.org   
Sponsors and Collaborators
Cordgenics, LLC
Investigators
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Principal Investigator: Kelly J Wilkinson, MD University of Mississippi Medical Center

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Responsible Party: Cordgenics, LLC
ClinicalTrials.gov Identifier: NCT03632798     History of Changes
Other Study ID Numbers: CG02EOC
First Posted: August 15, 2018    Key Record Dates
Last Update Posted: January 8, 2019
Last Verified: August 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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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 Cordgenics, LLC:
ChemoID
cancer stem cells
drug response assay
ovarian cancer

Additional relevant MeSH terms:
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Ovarian Neoplasms
Carcinoma, Ovarian Epithelial
Endocrine Gland Neoplasms
Neoplasms by Site
Neoplasms
Ovarian Diseases
Adnexal Diseases
Genital Diseases, Female
Genital Neoplasms, Female
Urogenital Neoplasms
Endocrine System Diseases
Gonadal Disorders
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Paclitaxel
Docetaxel
Cisplatin
Gemcitabine
Carboplatin
Doxorubicin
Liposomal doxorubicin
Bevacizumab
Topotecan
Antineoplastic Agents, Phytogenic
Antineoplastic Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action