Infantile Fibrosarcoma, Locally Advanced or Metastatic Infantile Fibrosarcoma Harboring an NTRK Gene Fusion
Conditions
Keywords
Advanced solid tumors, Infantile fibrosarcoma (IFS), Neurotrophic tyrosine receptor kinase (NTRK), Fusion Positive, Tropomyosin Receptor Kinase (TRK) fusion, Larotrectinib, External control
Brief summary
This is an observational study in which data from the past of children and young people with a specific cancer, called NTRK gene fusion positive infantile fibrosarcoma (IFS) is studied. IFS is a rare type of childhood cancer that commonly affects legs and arms. IFS cancers typically have specific changes in their building plans (genes) called NTRK gene fusion. NTRK stands for the specific gene that has been altered, the neurotrophic tyrosine kinase (NTRK) gene. This change to the building plan leads to the creation of an altered protein known as a TRK fusion protein, which can cause cancer cells to grow and to survive. The specific cancer is therefore also called TRK (tropomyosin receptor kinase) fusion-positive IFS. The study drug, larotrectinib (also called BAY2757556) works by blocking the altered TRK fusion protein. Larotrectinib is already available in Europe and in many other countries and is approved for doctors to prescribe to patients with NTRK gene fusion cancer which has spread to nearby tissues and/or lymph nodes or to other parts of the body. In France, HAS (the French authority in charge of evaluating health products and technologies) gave a positive opinion for the reimbursement of larotrectinib but only in the pediatric patients with IFS or another STS harboring a NTRK gene fusion, which is locally advanced or metastatic, and refractory or in relapse mainly due to the lack of comparative evidence. The main purpose of this study is to collect more data to learn how well larotrectinib works compared with current standard of care chemotherapy in people up to 21 years of age with NTRK gene fusion positive IFS that has spread to nearby tissues and/or lymph nodes (locally advanced) or other parts of the body (metastatic). To see how well larotrectinib works, researchers will make a comparison between * how long larotrectinib works well and * how long the standard of care works well. Working well means that the treatments can prevent the following from happening: * need for a new treatment for the cancer * need for radiation therapy for the cancer * need for surgery to treat the cancer, but which causes major damage to body parts * death. In addition to the above, data about medical problems related to the treatments in both groups and that may have required to stop the treatment will be compared. The data for the comparison will come from * an ongoing international study called SCOUT which was started in December 2015 (larotrectinib group) * international databases (standard of care chemotherapy group). Data will be from the year 2000 up to the present. There will be no required visits with a study doctor or required tests in this study.
Interventions
Pediatric patients with IFS harboring an NTRK gene fusion.
Standard of care for the patients from the eligible external cohorts.
Sponsors
Study design
Eligibility
Inclusion criteria
* Age ≤ 21 years old. * Locally advanced or metastatic Infantile Fibrosarcoma (IFS). * Identification of an NTRK gene fusion by a molecular biology assay. * Patients with available information on clinical, radiological characteristics of their tumor, therapies administered and outcomes. * Patients receiving larotrectinib in the SCOUT trial. * Patients receiving at least chemotherapy drugs in the historical control cohort(s). * No opposition from the patients and/or representatives for data use.
Exclusion criteria
* Patients treated with TRK inhibitors in the historical control cohort(s). * Patients with documented absence of NTRK gene fusion. * Patients participating in an investigational program with interventions outside of routine clinical practice.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to Medical Treatment Failure | up to 5.5 years for participants in SCOUT study and 22.5 years for participants in external historical control | Time to medical treatment failure was defined as the time (months) from the start of treatment to the date of the earliest event from: subsequent systemic treatment, radiation therapy, mutilating surgery or death due to any cause. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Mutilating Surgery Including Limb Amputation | up to 5.5 years for participants in SCOUT study and 22.5 years for participants in external historical control | Time to mutilating surgery including limb amputation was defined as the time from start date of Larotrectinib (for SCOUT) or start date of chemotherapy (for historical control cohorts) till the start date of a mutilating surgery (including limb amputation) |
| Time to First Radiation Therapy | up to 5.5 years for participants in SCOUT study and 22.5 years for participants in external historical control | Time to radiation therapy was defined as the time from start date of Larotrectinib (for SCOUT) or start date of chemotherapy(for historical control cohorts) till the start date of a radiation therapy, if any |
| Time to Subsequent Systemic Treatment | up to 5.5 years for participants in SCOUT study and 22.5 years for participants in external historical control | Time to subsequent systemic treatment was defined as the time from start date of Larotrectinib (for SCOUT) or start date of chemotherapy (for historical control cohorts) till the start date of a post-treatment systemic anti-cancer therapy, if any |
| Overall Survival | up to 5.5 years for participants in SCOUT study and 22.5 years for participants in external historical control | Number of participants with death due to any cause, alive, or lost to follow-up. |
| Number of Participants With Treatment Discontinuation Due to Treatment Emergent Adverse Events | up to 5.5 years for participants in SCOUT study and 22.5 years for participants in external historical control | Larotrectinib treatment for the SCOUT study and chemotherapy (first line) for the external historical control cohort(s). |
| Time to Complete Surgical Resection | up to 5.5 years for participants in SCOUT study and 22.5 years for participants in external historical control | Time to complete surgical resection (excluding amputation) was defined as the time from start date of Larotrectinib (for SCOUT) or start date of chemotherapy (for historical control cohorts) till the start date of a complete surgical resection (excluding amputation), if any |
Countries
France
Participant flow
Recruitment details
Study was conducted between 10-Mar-2022 (start retrospective observational study) and 13-Sep-2022 (table listing filles final) using secondary data. Three data sources were used in the study including SCOUT study (18 countries worldwide including France) and external historical control cohorts from the Institut Curie database and the Cooperative Weichteilsarkom Studiengruppe (CWS) database.
Pre-assignment details
In total, 93 patients were included in this study (IFS population). The larotrectinib arm of the study included 51 patients from the SCOUT study. The single comparator arm of patients that received conventional chemotherapy included in total 42 external control patients, pooled from the Institut Curie database (N=18) and the CWS database (N=24).
Participants by arm
| Arm | Count |
|---|---|
| Larotrectinib Pediatric patients (up to 21 years old) with Infantile fibrosarcoma (IFS) harboring an NTRK gene fusion who have been enrolled in the SCOUT study (Bayer Study ID: 20290; NCT02637687) and treated with larotrectinib. | 51 |
| External Controls External historical control patients treated with at least one chemotherapy-based regimen, pooled from the Institut Curie (CURIE) database (N=18) and the Cooperative Weichteilsarkom Studiengruppe (CWS) database (N=24). | 42 |
| Total | 93 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Discontinued study treatment | 22 | 41 |
| Overall Study | Ongoing with study treatment | 29 | 1 |
Baseline characteristics
| Characteristic | External Controls | Total | Larotrectinib |
|---|---|---|---|
| Age, Continuous | 0.73 years STANDARD_DEVIATION 1.81 | 1.43 years STANDARD_DEVIATION 2.91 | 2.01 years STANDARD_DEVIATION 3.49 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 42 Participants | 93 Participants | 51 Participants |
| Race (NIH/OMB) White | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Female | 15 Participants | 36 Participants | 21 Participants |
| Sex: Female, Male Male | 27 Participants | 57 Participants | 30 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 1 / 51 | 3 / 42 |
| other Total, other adverse events | 0 / 51 | 0 / 42 |
| serious Total, serious adverse events | 1 / 51 | 3 / 42 |
Outcome results
Time to Medical Treatment Failure
Time to medical treatment failure was defined as the time (months) from the start of treatment to the date of the earliest event from: subsequent systemic treatment, radiation therapy, mutilating surgery or death due to any cause.
Time frame: up to 5.5 years for participants in SCOUT study and 22.5 years for participants in external historical control
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Larotrectinib | Time to Medical Treatment Failure | Unweighted sample | NA months |
| Larotrectinib | Time to Medical Treatment Failure | Weighted sample | NA months |
| External Controls | Time to Medical Treatment Failure | Unweighted sample | NA months |
| External Controls | Time to Medical Treatment Failure | Weighted sample | 24.0 months |
Number of Participants With Treatment Discontinuation Due to Treatment Emergent Adverse Events
Larotrectinib treatment for the SCOUT study and chemotherapy (first line) for the external historical control cohort(s).
Time frame: up to 5.5 years for participants in SCOUT study and 22.5 years for participants in external historical control
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Larotrectinib | Number of Participants With Treatment Discontinuation Due to Treatment Emergent Adverse Events | 0 Participants |
| External Controls | Number of Participants With Treatment Discontinuation Due to Treatment Emergent Adverse Events | 1 Participants |
Overall Survival
Number of participants with death due to any cause, alive, or lost to follow-up.
Time frame: up to 5.5 years for participants in SCOUT study and 22.5 years for participants in external historical control
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Larotrectinib | Overall Survival | Dead | 1 Participants |
| Larotrectinib | Overall Survival | Alive | 50 Participants |
| External Controls | Overall Survival | Dead | 3 Participants |
| External Controls | Overall Survival | Alive | 39 Participants |
Time to Complete Surgical Resection
Time to complete surgical resection (excluding amputation) was defined as the time from start date of Larotrectinib (for SCOUT) or start date of chemotherapy (for historical control cohorts) till the start date of a complete surgical resection (excluding amputation), if any
Time frame: up to 5.5 years for participants in SCOUT study and 22.5 years for participants in external historical control
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Larotrectinib | Time to Complete Surgical Resection | Unweighted Sample | NA months |
| Larotrectinib | Time to Complete Surgical Resection | Weighted Sample | NA months |
| External Controls | Time to Complete Surgical Resection | Unweighted Sample | NA months |
| External Controls | Time to Complete Surgical Resection | Weighted Sample | 6.1 months |
Time to First Radiation Therapy
Time to radiation therapy was defined as the time from start date of Larotrectinib (for SCOUT) or start date of chemotherapy(for historical control cohorts) till the start date of a radiation therapy, if any
Time frame: up to 5.5 years for participants in SCOUT study and 22.5 years for participants in external historical control
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Larotrectinib | Time to First Radiation Therapy | Unweighted Sample | NA months |
| Larotrectinib | Time to First Radiation Therapy | Weighted Sample | NA months |
| External Controls | Time to First Radiation Therapy | Unweighted Sample | NA months |
| External Controls | Time to First Radiation Therapy | Weighted Sample | NA months |
Time to Mutilating Surgery Including Limb Amputation
Time to mutilating surgery including limb amputation was defined as the time from start date of Larotrectinib (for SCOUT) or start date of chemotherapy (for historical control cohorts) till the start date of a mutilating surgery (including limb amputation)
Time frame: up to 5.5 years for participants in SCOUT study and 22.5 years for participants in external historical control
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Larotrectinib | Time to Mutilating Surgery Including Limb Amputation | Unweighted Sample | NA months |
| Larotrectinib | Time to Mutilating Surgery Including Limb Amputation | Weighted Sample | NA months |
| External Controls | Time to Mutilating Surgery Including Limb Amputation | Unweighted Sample | NA months |
| External Controls | Time to Mutilating Surgery Including Limb Amputation | Weighted Sample | NA months |
Time to Subsequent Systemic Treatment
Time to subsequent systemic treatment was defined as the time from start date of Larotrectinib (for SCOUT) or start date of chemotherapy (for historical control cohorts) till the start date of a post-treatment systemic anti-cancer therapy, if any
Time frame: up to 5.5 years for participants in SCOUT study and 22.5 years for participants in external historical control
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Larotrectinib | Time to Subsequent Systemic Treatment | Unweighted Sample | NA months |
| Larotrectinib | Time to Subsequent Systemic Treatment | weighted Sample | NA months |
| External Controls | Time to Subsequent Systemic Treatment | Unweighted Sample | NA months |
| External Controls | Time to Subsequent Systemic Treatment | weighted Sample | 24.0 months |