A phase II, randomized, active-controlled, multi-center study comparing the efficacy and safety of targeted therapy or cancer immunotherapy guided by genomic profiling versus platinum-based chemotherapy in patients with cancer of unknown primary site who have recieved three cycles of platinum doublet chemotherapy
- Conditions
- Cancer of Unknown Primary SiteMedDRA version: 20.0Level: LLTClassification code 10032248Term: Other malignant neoplasm of unspecified siteSystem Organ Class: 100000004864Therapeutic area: Diseases [C] - Cancer [C04]
- Registration Number
- EUCTR2017-003040-20-HU
- Lead Sponsor
- F. Hoffmann-La Roche Ltd
- Brief Summary
Not available
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Authorised-recruitment may be ongoing or finished
- Sex
- All
- Target Recruitment
- 790
• Age >=18 years
• Histologically-confirmed unresectable poor-risk or unfavorable prognosis subset of CUP as defined by European Society for Medical Oncology 2015 clinical practice guidelines for CUP
• At least one lesion that is measurable according to Response Evaluation Criteria in Solid Tumors, Version 1.1 (RECIST v1.1)
• Availability of a tumor Formalin-fixed paraffin-embedded (FFPE) block <=4 months old at the start of creening that is expected to be sufficient for generation of a comprehensive genomic profile using Foundation Medicine tissue biopsy assay at a central reference pathology laboratory
• Availability of local pathology reports confirming compatibility with CUP diagnosis and the associated slides used for the diagnosis. If the slides used for the local test confirming local CUP diagnosis are not available, an FFPE block must be submitted that is sufficient to allow for central confirmation of CUP diagnosis
• No prior systemic therapy for the treatment of CUP
• ECOG performance status of 0 or 1
• Life expectancy >=12 weeks
• Eligible for platinum-based chemotherapy
• Adequate hematologic and end-organ function
• Agrees to use protocol defined methods of contraception
Are the trial subjects under 18? no
Number of subjects for this age range:
F.1.2 Adults (18-64 years) yes
F.1.2.1 Number of subjects for this age range 190
F.1.3 Elderly (>=65 years) yes
F.1.3.1 Number of subjects for this age range 600
• Squamous cell CUP
• Histology and immunohistology profiles that are not adenocarcinoma or poorly differentiated carcinoma / adenocarcinoma, i.e., non-epithelial cancer, extragonadal germ-cell tumor, neuroendocrine tumors, sarcoma, melanoma, mesothelioma, hematologic malignancies (list is not limitative)
• Patient with an immunohistochemistry profile that provides a definitive clinical indication of a primary
cancer with a specific treatment
• Patients belonging to any of the following subsets of CUP with favorable prognoses: Poorly differentiated carcinoma with midline distribution, Women with papillary adenocarcinoma of the peritoneal cavity, women with adenocarcinoma involving only the axillary lymph nodes, Squamous cell carcinoma of the cervical lymph nodes, poorly differentiated neuroendocrine tumors, Men with blastic bone metastases and elevated prostate-specific antigen, Patients with a single, small, potentially resectable tumor, Colon cancer-type CUP (including patients with a CK7 negative, CK20 positive, CDX-2 positive immunohistochemistry profile)
• Known presence of brain or spinal cord metastasis, as determined by CT or magnetic resonance imaging evaluation during screening
• History or known presence of leptomeningeal disease
• Known clinically significant history of liver disease consistent with Child-Pugh Class B or C, including active viral or other hepatitis, current alcohol abuse, or cirrhosis
• Human immunodeficiency virus infection
• Positive for hepatitis C virus antibody at screening. If a patient has a positive HCV antibody test at screening, an HCV RNA test must also be performed. A patient will be excluded from the study only if the HCV antibody and the HCV RNA test are positive. If the HCV antibody test is positive, but the HCV RNA test is negative, the patient may enroll in the study
• Positive for hepatitis B surface antigen (HBsAg) at screening. If HBsAg test is negative but the total hepatitis B core antibody test (HBcAb) is positive, hepatitis B virus DNA must be performed and if the resulting HBV DNA test is positive, the patient will be excluded from the study
• Active tuberculosis at screening
• Active infections requiring intravenous antibiotics
• Significant cardiovascular disease within 3 months prior to initiation of study treatment, unstable arrhythmia, or unstable angina
• Major surgical procedure, other than for diagnosis, within 1 week prior to initiation of study treatment
• History of malignancy other than CUP within 5 years prior to screening or history of previous cancer with a 5-year survival rate of < 10%.
• Prior allogeneic stem cell or solid organ transplantation
Study & Design
- Study Type
- Interventional clinical trial of medicinal product
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Main Objective: • To evaluate the efficacy of molecularly-guided therapy versus platinum-based chemotherapy in terms of Progression free survival in patients with CUP whose best response to 3 cycles of platinum induction chemotherapy was assessed complete response(CR), partial response(PR) or stable disease(SD);Secondary Objective: • To evaluate the efficacy of molecularly-guided therapy versus platinum-based chemotherapy in terms of overall survival, overall response rate and duration of clinical benefit in patients with CUP whose best response to 3 cycles of platinum induction chemotherapy was assessed CR, PR or SD<br>• To evaluate the safety of molecularly-guided therapy or chemotherapy in all patients in the study who receive targeted therapy or cancer immunotherapy<br><br>;Primary end point(s): 1. Progression-free survival;Timepoint(s) of evaluation of this end point: 1. Up to 60 months
- Secondary Outcome Measures
Name Time Method Secondary end point(s): Efficacy: <br>1. Overall survival<br>2. Overall response rate<br>3. Duration of clinical benefit<br>Safety:<br>4. Incidence, nature and severity of adverse events (AEs)<br>5. Incidence and reasons for any dose reductions, interruptions, or premature discontinuation of any component of study treatment<br>6. Clinically significant laboratory values and vital signs;Timepoint(s) of evaluation of this end point: 1-6. Up to 60 months