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European Low and Intermediate Risk Neuroblastoma Protocol

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ClinicalTrials.gov Identifier: NCT01728155
Recruitment Status : Recruiting
First Posted : November 16, 2012
Last Update Posted : October 18, 2019
Sponsor:
Information provided by (Responsible Party):
Instituto de Investigacion Sanitaria La Fe

Study Description
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Brief Summary:

The European study, LINES 2009 (Low and Intermediate Risk Neuroblastoma European Study), groups together in a single protocol the treatment of all patients with "non high risk" neuroblastoma (NB), with stratification into two groups: low risk and intermediate risk. These two separate cohorts are included in one single protocol to enable patient data from these two groups to be entered into a common database, as the current prognostic classifications determining treatment may evolve further with subsequent more detailed molecular analysis of the tumours.

1. LOW RISK STUDY

The Low Risk Study is proposed in order to:

  • minimise the amount of treatment (chemotherapy and surgery) for all appropriate low risk patients, who in previous studies have been shown to have an excellent long-term outcome (as in the SIOPEN 99.1-2 infant neuroblastoma studies where the overall survival was greater than 97%(H. Rubie, JCO).

  • improve the EFS and maintain the OS (overall survival) in L2 and Ms patients with a SCA(Segmental Cromosomal Aberration) genomic profile tumour (presence of any segmental chromosomal change (SCA)) by electively treating these patients with chemotherapy despite the absence of symptoms.

    2) INTERMEDIATE RISK STUDY

The Intermediate Risk Study is proposed in order to:

  • reduce the amount of chemotherapy for differentiating histology INRG (International Neuroblastoma Risk Group) stage L2 NB and ganglioneuroblastoma nodular patients who in previous SIOPEN study have been shown to have an excellent long-term outcome;
  • increase the amount of treatment (radiotherapy and 13-cis-RA (13-cis-Retinoic Acid) for poorly differentiated or undifferentiated histology INRG stage L2 NB or ganglioneuroblastoma nodular patients in order to improve the EFS registered in the previous SIOPEN study;
  • improve the EFS (Event Free Survival) of MYCN (V-Myc myelocytomatosis viral related oncogene, NB derived ,avian )amplified INSS (International NB Staging System) stage 1 NB patients with the introduction of adjuvant treatment;
  • maintain the very good results obtained in previous SIOPEN study for INRG stage M infants with a moderate treatment.

NEONATAL SUPRARENAL MASSES

The incidence of suprarenal tumours/masses has increased in the last decade due to the expanded use of prenatal ultrasonography in routine obstetric care and in the neonatal and early infancy care. The differential diagnosis of these masses ranges from benign (adrenal haemorrhage) to malignant processes (neuroblastoma, adrenal carcinoma). Knowledge on perinatal suprarenal masses, although based on a relatively large literature, is scattered amongst studies on very few cases with no methodical approach and often short follow up. Therefore, the optimal management of these masses has not been clearly defined. Neuroblastoma at this age is an intriguing entity with a very good prognosis in most cases. The SIOPEN Group, based on their results in the first multicenter European Trial for infants with neuroblastoma (INES) and the world-wide experience provided in the literature, is launching this European surveillance study (Multi-centre, non-blinded, one armed prospective trial) for these masses. Treatment: Observation


Condition or disease Intervention/treatment Phase
LOW AND INTERMEDIATE PAEDIATRIC NEUROBLASTOMA AND NEONATAL SUPRARENAL MASSES Drug: chemotherapy Phase 3

Detailed Description:

1. LOW RISK STUDY

The low risk group of patients includes NB patients without MYCN amplification with or without life threatening symptoms in the following clinical situations:

  • Children aged ≤ 18 months with localised neuroblastoma associated with image defined risk factors precluding upfront surgery (stage INRG L2).

  • Children aged ≤ 12 months with disseminated neuroblastoma without bone, pleura, lung or CNS (Central Nervous System) disease (stage INRG Ms)

    2) INTERMEDIATE RISK STUDY

The intermediate risk group of patients includes NB patients in the following clinical situations:

  • Children aged >18 months with localised neuroblastoma without MYCN amplification, associated with image defined risk factors precluding upfront surgery (stage INRG L2).
  • Children aged ≤12 months with disseminated neuroblastoma involving bone, pleura, lung and/or CNS (stage INRG M), without MYCN amplification.
  • Children with localised resected NB (stage INSS I) with MYCN amplification. NEONATAL SUPRARENAL MASSES

The incidence of suprarenal tumours/masses has increased in the last decade due to the expanded use of prenatal ultrasonography in routine obstetric care and in the neonatal and early infancy care. The differential diagnosis of these masses ranges from benign (adrenal haemorrhage) to malignant processes (neuroblastoma, adrenal carcinoma). Knowledge on perinatal suprarenal masses, although based on a relatively large literature, is scattered amongst studies on very few cases with no methodical approach and often short follow up. Therefore, the optimal management of these masses has not been clearly defined. Neuroblastoma at this age is an intriguing entity with a very good prognosis in most cases. The SIOPEN Group, based on their results in the first multicenter European Trial for infants with neuroblastoma (INES) and the world-wide experience provided in the literature, is launching this European surveillance study (Multi-centre, non-blinded, one armed prospective trial) for these masses. Treatment: Observation

Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 685 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: European Low and Intermediate Risk Neuroblastoma Protocol
Study Start Date : December 2011
Estimated Primary Completion Date : December 2021
Estimated Study Completion Date : December 2031

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Neuroblastoma

Arms and Interventions
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Arm Intervention/treatment
No Intervention: Group1
initial observation (chemotherapy is only given if there is subsequent progression)
Active Comparator: Group 1: chemotherapy
chemotherapy and surgery
 Drug: chemotherapy
Experimental: Group 2
chemotherapy and surgery
 Drug: chemotherapy
Experimental: Group 3
chemotherapy and surgery
 Drug: chemotherapy
No Intervention: Group 4
Observation
Experimental: Group 5
chemotherapy
 Drug: chemotherapy
Experimental: Group 6
chemotherapy and surgery
 Drug: chemotherapy
Experimental: Group 7
chemotherapy and surgery
 Drug: chemotherapy
Experimental: Group 8
chemotherapy, surgery, radiotherapy and 13 cis-retinoic acid
 Drug: chemotherapy
Experimental: Group 9
chemotherapy, surgery, radiotherapy and 13 cis-retinoic acid
 Drug: chemotherapy
Experimental: Group 10
chemotherapy, surgery,
 Drug: chemotherapy


Outcome Measures
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Primary Outcome Measures :
  1. Primary aim for Low Risk Neuroblastoma [ Time Frame: 2 years ]
    To demonstrate through a randomisation between observation and chemotherapy that you can safely reduce treatment in a subgroup of L2 low risk patients (those without life threatening symptoms (LTS) and without any segmental chromosomal changes (SCA), i.e. study group 1) by giving less treatment than has been given historically while maintaining an excellent OS of 100%.

  2. Primary aim for Intermediate Risk Neuroblastoma [ Time Frame: 2 years ]
    To improve the EFS to 70% with an OS of 90% of INRG stage L2 patients over the age of 18 months, with poorly differentiated or undifferentiated tumour histology (INPC criteria), by the addition of radiotherapy and 13-cis RA compared to historical conventional treatment (study group 8).

  3. Primary Aim for Neonatal Suprarenal Masses [ Time Frame: 3 year ]
    To maintain a 3-year event free survival over 80% with a non-operative therapeutic approach (serial monitoring, surgery if warranted) in infants with a localised suprarenal mass discovered ante or neonatally.


Secondary Outcome Measures :
  1. To maintain a 2 year EFS of at least 90% and an OS of at least 95% in L2 patients with LTS without SCA (study group 2) [ Time Frame: 2 year ]
  2. To maintain the 2 year EFS of 85% and an OS of at least 98% in Ms patients without SCA (study groups 4 and 5) [ Time Frame: 2 year ]
  3. To improve the 2 year EFS to at least 90% and maintain the OS of close to 100% in L2 patients with SCA (Study Group 3) and improve the 2 year EFS to over 70% in Ms patients with SCA (study group 6) [ Time Frame: 2 year ]
  4. To evaluate adherence to the protocol recommendations regarding LTS [ Time Frame: 5 years ]
  5. To reduce surgical morbidity by promoting strict adherence to Image Defined-Risk Factors (IDRFs) to determine surgical resectability [ Time Frame: 5 year ]
  6. To define the long term follow-up and natural history of the Stage L2 non-resected masses that have remained IDRF positive at the end of treatment (study groups 1-3). [ Time Frame: 5 year ]
  7. To confirm in a larger patient cohort the excellent OS of 95% in stage M neuroblastoma without MYCN amplification, less than 12 months of age, when treated with moderate therapy (study group 10). [ Time Frame: 3 year ]
  8. Maintain the results of 3yr-EFS of 90% and 3yr-OS of 100% in stage L2 patients over the age of 18 months, with differentiating neuroblastoma or differentiating ganglioneuroblastoma nodular, despite a treatment reduction (group7) [ Time Frame: 3 year ]
  9. To improve the 3 year EFS to at least 50% and the 3 year OS to 80% in INSS stage I patients with MYCN amplified neuroblastoma by the addition of adjuvant treatment (study group 9). [ Time Frame: 3 year ]
  10. To evaluate the impact of the tumour genomic profile on patient outcome, in order to consider its role in the treatment stratification of these intermediate risk patients (all study groups). [ Time Frame: 5 years ]
  11. To manage infants with suprarenal masses discovered ante or neonatally with a uniform approach in Europe in a multicentre setting. [ Time Frame: 5 years ]
  12. To maintain an excellent overall survival with a non-operative therapeutic approach (serial monitoring, surgery if warranted) in infants with a localised suprarenal mass discovered ante or neonatally. [ Time Frame: 3 years ]
  13. To determine the 3-year surgery-free survival in infants with suprarenal masses discovered ante or neonatally and managed conservatively (non initial surgery). [ Time Frame: 3 years ]
  14. To find out the natural history of perinatal suprarenal masses, according to the definitions set up for the study. [ Time Frame: 5 years ]
  15. To study the kinetics of regression in those suspected suprarenal neuroblastomas in infants with suprarenal masses discovered ante or neonatally and managed conservatively (non initial surgery). [ Time Frame: 5 years ]
  16. To collect tissue from those suprarenal masses excised in order to perform standard and investigational pathological and biological studies (INPC, MYCN, 1p, 11). [ Time Frame: 5 years ]
  17. To collect frozen plasma from all patients included in the study in order to perform research. [ Time Frame: 5 years ]

Eligibility Criteria
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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.


Layout table for eligibility information
Ages Eligible for Study:   90 Days to 18 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

  1. LOW RISK STUDY

    Inclusion criteria for the whole low risk group:

    • informed consent and follow-up warranted; group assignment completed within 6 weeks from diagnosis; no prior chemotherapy or radiotherapy
    • Biopsy proven neuroblastoma
    • Tumour genomic profile obtained in a NRL according to guidelines
    • MYCN non-amplified

    Exclusion criteria for the whole low risk group:

    * Diagnosis of ganglioneuroma or ganglioneuroblastoma intermixed INRG Stage L2

    Inclusion criteria:

    *age ≤ 18 months

    Exclusion criteria:

    • any metastatic site
    • MYCN amplification
    • age > 18 months INRG Stage Ms

    Inclusion criteria:

    * age ≤ 12 months

    Exclusion criteria:

    • bone, pleura/lung and/or CNS metastasis
    • MYCN amplification
    • age > 12 months

  2. INTERMEDIATE RISK STUDY

    Inclusion criteria for the whole intermediate risk group:

    • informed consent and follow-up warranted; group assignment completed within 6 weeks from diagnosis; no prior chemotherapy or radiotherapy
    • Tumour material available for biological studies according to guidelines
    • Biopsy proven neuroblastoma confirmed in a National Reference Laboratory (NRL)

    Exclusion criteria for the whole intermediate risk group:

    * Diagnosis of ganglioneuroma or ganglioneuroblastoma intermixed

    INRG Stage L1 and INSS stage 1:

    Inclusion criteria:

    * MYCN amplified

    Exclusion criteria:

    • MYCN non-amplified
    • INSS stages 2, 3, 4, 4s

    INRG Stage L2:

    Inclusion criteria:

    • Histology: differentiating, poorly differentiated, undifferentiated neuroblastoma or ganglioneuroblastoma nodular
    • MYCN non-amplified
    • age >18 months

    Exclusion criteria:

    • neuroblastoma NOS
    • MYCN amplification.
    • age ≤ 18 months

    INRG Stage M:

    Inclusion criteria:

    • Any histology
    • MYCN non-amplified
    • age ≤ 12 months

    Exclusion criteria:

    • MYCN amplification
    • age > 12 months
  3. NEONATAL SUPRARENAL MASSES

Inclusion criteria:

  • Age less than or equal to 90 days when the suprarenal mass is discovered.
  • Suprarenal mass detected by ultrasound and/or MRI. The suprarenal mass may be cystic and/or solid, but IT CANNOT REACH THE MIDLINE AND should MEASURE ≤ 5 CM AT THE LARGEST DIAMETER.
  • No regional involvement: MRI scan does not show evidence of positive ipsi/contralateral lymph nodes or other spread outside the suprarenal gland.
  • No metastatic involvement.
  • Frozen plasma available.
  • Informed consent.
  • Availability to do the adequate follow-up

Exclusion criteria:

  • Age older than 90 days.
  • Suprarenal mass bigger than 5 cm.
  • Regional involvement.
  • Metastatic involvement.
  • Inability to undertake mandatory diagnostic studies (biological markers, US, MRI, MIBG).
  • Follow-up not guaranteed by parents/guardians.
Contacts and Locations
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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): NCT01728155


Contacts
Layout table for location contacts
Contact: Adela Cañete, MD, PhD 0034 96 124 49 04 canyete_ade@gva.es

Locations
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Sponsors and Collaborators
Instituto de Investigacion Sanitaria La Fe
Investigators
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Study Chair: Adela Cañete, MD, PhD Hospital Universitari i Politècnic La Fe, Valencia, Spain
Study Chair: Gudrun Schleiermacher Institut Curie
Study Chair: Kate Wheeler Oxford: John Radcliffe Hospital, UK
Study Chair: Andrea di Cataldo Policlinico Universitario, Italy
Study Chair: Vassilius Papadakis Aghia Sophia Children's Hospital, Athens
More Information
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Additional Information:

Publications:
Khafagi FA, Shapiro B, Gross MD. The adrenal gland. In: Maisey MN, Britton KE, Gilday DL, eds. Clinical Nuclear Medicine. 2nd ed: London Chapman & Hall 1989:271-91.
Moyes J, McCready VR, Fullbrook AC. Neuroblastoma MIBG in its diagnosis and management: Springer-Verlag Berlin and Heidelberg GmbH & Co. K 1989.

Layout table for additonal information
Responsible Party: Instituto de Investigacion Sanitaria La Fe
ClinicalTrials.gov Identifier: NCT01728155    
Other Study ID Numbers: LINES
First Posted: November 16, 2012    Key Record Dates
Last Update Posted: October 18, 2019
Last Verified: October 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by Instituto de Investigacion Sanitaria La Fe:
NEUROBLASTOMA, LOW RISK, INTERMEDIATE RISK
Additional relevant MeSH terms:
Layout table for MeSH terms
Neuroblastoma
Neuroectodermal Tumors, Primitive, Peripheral
Neuroectodermal Tumors, Primitive
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
 Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue