Neuroendocrine Carcinoma, Digestive Cancer
Conditions
Keywords
Neoadjuvant treatment, Adjuvant treatment
Brief summary
NEONEC is a single-phase, phase II study evaluating the efficacy of the 12-month neoadjuvant chemotherapy in patients with locally differentiated digestive NEC. The recommended chemotherapy is based on the current reference combination of platinum (cisplatin or carboplatin) and etoposide (VP16). For anorectal locations, radiochemotherapy is proposed to avoid the morbidity of conventional surgery. The objective of the study is to improve relapse-free survival (RFS) in NEC patients treated with neoadjuvant chemotherapy followed by surgery or chemoradiotherapy. In parallel, we will perform a prospective cohort study with patients whose diagnosis is made during surgery, who have not received neoadjuvant treatment, and who are offered an adjuvant treatment of the same type (combination of platinum and platinum salts and etoposide).
Detailed description
A total of 48 patients is to be included in phase II and 30 patients in prospective cohort during the inclusion period of phase II. Phase II study treatment: Neoadjuvant chemotherapy: Administration of 4 cycles of chemotherapy (3 months) with platinum based chemotherapy (carboplatin or cisplatin, at the choice of the investigator) + etoposide. Surgery or chemoradiotherapy depending on the tumor localization (the irradiation modalities and associated chemotherapy treatment will be left to the discretion of the referring radiotherapists according to current recommendations for each localization). Prospective cohort: * Surgery (prior to study entry) * Adjuvant chemotherapy : Administration of 4 cycles of chemotherapy (3 months) with platinum based chemotherapy (carboplatin or cisplatin, at the choice of the investigator) + etoposide.
Interventions
DRUGNeoadjuvant treatment
4 cycles of platinum-based chemotherapy (carboplatin or cisplatin) plus etoposide followed by surgery or chemoradiotherapy
Surgery (before study entry) followed by 4 cycles of platinum-based chemotherapy (carboplatin or cisplatin) plus etoposide
Sponsors
Fondation ARCAD
GERCOR - Multidisciplinary Oncology Cooperative Group
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Phase II and prospective cohort
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Phase II 1. Histologically proven digestive CNE, (the WHO 2017 classification: poorly differentiated and Ki 67 \> 20%), 2. Patients with localized CNE, without metastasis (computed tomography \[CT\], thoraco-abdominopelvic CT scan \[TAP\] according to RECIST 1.1; examinations performed no later than 21 days before starting the study treatment, possible locoregional lymph node involvement defined according to the TNM classification), 3. Positron emission tomography (PET) and CT for lymph node status and elimination of secondary visceral and/or bone disorders, 4. Resectable tumor, according to the consensus decision made during local multidisciplinary surgical consultation meeting, 5\. Age ≥ 18 years, 6. Written informed consent obtained from the patient, willing and able to comply with the protocol, 7. Registration in a National Health Care System (Protection Universelle Maladie \[PUMa\] included), 8. For female patients of childbearing potential, negative pregnancy test within 7 days before starting the study treatment. Men and women are required to use a reliable and adequate birth control during the study (if applicable) during the period of treatment and during 6 months from the last treatment administration. Prospective cohort 1. Patients with localized digestive CNE histologically proven on the operative specimen (the WHO 2017 classification: poorly differentiated and Ki 67\> 20%), 2. Localized, without metastasis on computed tomography \[CT\], thoracoabdominopelvic CT scan \[TAP\] RECIST 1.1, and/or locoregional lymph node involvement, 3. Age ≥ 18 years, 4. Written informed consent obtained from the patient, willing and able to comply with the protocol, 5. Registration in a National Health Care System (PUMa - Protection Universelle Maladie included), 6. For female patients of childbearing potential, negative pregnancy test within 7 days before starting the study treatment. Men and women are required to use a reliable and adequate birth control methods during the study (if applicable) during the period of treatment and during 6 months from the last treatment administration.
Exclusion criteria
Phase II 1. Well-differentiated NEC, whatever the grade, 2. Metastatic disease, 3. Cancer of unknown primary 4. Organ failure that does not allow chemotherapy treatment, 5. Previous malignancy within 5 years prior to the study except for cutaneous basal cell carcinoma and uterine cancer in situ 6. Tumor with a mixed component (component accounts for ≥ 30%), 7. Patient impossible to follow-up, 8. Other than platinum-etoposide chemotherapy administrated, 9. Tutelage or guardianship or patient protected by law Prospective cohort 1. Well-differentiated NEC, whatever the grade, 2. Metastatic disease, 3. Cancer of unknown primary 4. Organ failure that does not allow chemotherapy treatment, 5. Previous malignancy within 5 years prior to the study except for cutaneous basal cell carcinoma and uterine cancer in situ 6. Tumor with a mixed component (component accounts for ≥ 30%), 7. Patient impossible to follow-up, 8. Other than platinum-etoposide chemotherapy administrated, 9. Tutelage or guardianship or patient protected by law.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Relapse-free survival (RFS) - phase II | At 12 months | Interval between the date of the start of treatment (chemotherapy) and the date of first relapse or death (all causes). Relapse is defined according to RECIST version 1.1 criteria. |
| Relapse-free survival (RFS) - prospective cohort | At 12 months | Interval between the date of the start of treatment (chemotherapy) and the date of first relapse or death (all causes). Relapse is defined according to RECIST version 1.1 criteria. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of patients operated after neoadjuvant chemotherapy or receiving radiochemotherapy (if applicable) - Phase II | Up to 39 months | Number of patients operated after neoadjuvant chemotherapy or receiving |
| Overall survival (OS) - Phase II | up to 48 months | Overall survival (OS) is defined as the time from study enrollment to death (from any cause) or to the last date the patients was known to be alive. |
| Number of patient in response in pre-operative or prior radiochemotherapy (if applicable) - Phase II | At 3 months after the beginning of treatment (up to 36 months) | according to RECIST 1.1 |
| Number of participants with treatment-related adverse events grade 3-4 as assessed by National Cancer Institute-Common Terminology Criteria for Adverse Events [NCI-CTCAE] v5.0 - Phase II | Up to 43 months | Patients will be assessed for AEs throughout the study at every visit during treatment. Investigators using the NCI-CTCAE version 5.0 will grade the severity of AEs. Institute Common Terminology Criteria for Adverse Toxicity Study (NCI-CTCAE) version 5.0 |
| Number of participants with treatment-related adverse events grade 3-4 as assessed by National Cancer Institute-Common Terminology Criteria for Adverse Events [NCI-CTCAE] v5.0 - Prospective cohort | Up to 43 months | Patients will be assessed for AEs throughout the study at every visit during treatment. Investigators using the NCI-CTCAE version 5.0 will grade the severity of AEs. Institute Common Terminology Criteria for Adverse Toxicity Study (NCI-CTCAE) version 5.0 |
| Overall survival (OS) - Prospective cohort | Up to 48 months | Overall survival (OS) is defined as the time from study enrollment to death (from any cause) or to the last date the patients was known to be alive. |
| Number of patients who do not benefit from surgery or radiochemotherapy (if applicable) - Phase II | Up to 39 months | Number of patients who do not benefit from surgery or radiochemotherapy (if applicable) - Phase II |
Countries
France
Contacts
Primary ContactAnna PELLAT, MD
Backup ContactMarie-Line GARCIA-LARNICOL
Outcome results
None listed