Dynamic Assessment of ctDNA in Patients With Cervical and Anal Canal Tumors to Optimize Follow-up and Clinical Outcomes in the Brazilian Unified Health System (SUS)
试验速览
- 阶段
- 2 期
- 状态
- 招募中
- 发起方
- 入组人数
- 150
- 试验地点
- 1
- 主要终点
- General Objective
研究概览
简要总结
After definitive radiotherapy (RT) treatment (with or without chemotherapy), cervical and anal canal neoplasms frequently exhibit disease persistence or recurrence. Due to the local inflammatory process post-treatment, response assessment by imaging (current gold standard) is limited, often necessitating multiple follow-ups and repeated invasive biopsies. Conventional follow-up is complex and costly, requiring equipment from secondary and tertiary services, trained radiologists, and patient exposure to radiation and contrast.
In this context of human papillomavirus(HPV)-related neoplasms, recent studies have demonstrated the role of ctDNA (circulating tumor DNA) in assessing the risk of recurrence or disease progression, providing a rationale for using the tool in two fronts:
- Optimizing follow-up based on serial monitoring of ctDNA;
- Selecting patients with positive ctDNA after RT, who are at high risk of recurrence, for treatment intensification.
Monitoring with ctDNA as a standalone follow-up tool in cases evolving with negative ctDNA after RT has the potential to replace imaging exams, being a minimally invasive test performed on a peripheral blood sample. Currently, ctDNA testing has expensive methodologies not available in the Unified Health System (SUS). This project aims to develop a methodology for ctDNA evaluation focused on HPV ctDNA research that is low-cost and executable in SUS, as well to assess the accuracy of this test in the population with HPV-related tumors.
Additionally, we will evaluate whether the early introduction of immunotherapy in patients with positive ctDNA after definitive treatment can increase cure rates. Immunotherapy already has a well-defined role in the treatment of metastatic HPV-related neoplasms. Recently, the use of anti-programmed death-1 (anti-PD1) has also shown benefits in patients with locally advanced cervical cancer with a high risk of recurrence who are candidates for chemoradiotherapy (CRT). Therefore, its use focused on HPV-related tumors, as well as a better understanding of which patients benefit from this strategy, warrants further investigation.
详细描述
The ANA study is a research project aimed at enhancing the treatment and outcomes for patients with cervical and anal canal cancer by using innovative diagnostic and therapeutic methods. The study consists of the following phases:
- Patient identification and selection;
- Recruitment of patients diagnosed with cervical or anal canal cancer who are candidates for treatment with radiotherapy (RT), with or without chemotherapy: patients will be selected based on specific criteria to ensure a representative cohort;
- Development and validation of the ctDNA HPV Test: development of a sensitive and specific test to detect HPV DNA in the blood. This test will undergo rigorous validation to ensure its accuracy and reliability;
- ctDNA monitoring: blood samples collection from patients during treatment and follow-up. ctDNA levels will be monitored in real-time to early detection of residual or recurrent disease. This non-invasive method aims to provide a more accurate assessment of treatment efficacy and disease progression. The results of ctDNA will be compared with traditional imaging methods.
- Complementary immunotherapy treatment: patients with positive ctDNA results after (chemo)radiotherapy will be considered for additional immunotherapy. This phase will evaluate the benefits of combining immunotherapy with standard (chemo)radiotherapy in order to improve patient outcomes;
- Follow-up and outcome evaluation: long-term follow-up of patients to assess clinical outcomes, including survival and quality of life.
The ANA study aims to set new standards in the follow-up and management of HPV-related cervical and anal canal cancer by improving patient care within the Brazilian public health system (SUS).
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Sequential
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Histological diagnosis of anal canal or cervical cancer.
- •Documented presence of HPV.
- •Locally confined or locally advanced disease, defined as:
- •Anal canal carcinoma stage I to III, according to American Joint Committee on Cancer (AJCC) 8th edition;
- •Cervical carcinoma stage I B2 to IV A, according to AJCC 8th edition.
- •Indication for definitive treatment with radiotherapy, with or without concomitant chemotherapy.
- •Eastern Cooperative Oncology Group (ECOG)-Performance Status (PS) 0 -
- •Age ≥ 18 years.
- •Signing of the Informed Consent Form (ICF).
- •HIV-positive patients may be included if Cluster of Differentiation 4(CD4) count is greater than or equal to
- •Patients may participate in other concurrent studies, as long as they do not involve interventions related to the treatment of the underlying cancer.
排除标准
- •Patients with unequivocal distant metastasis at diagnosis.
- •For participants with positive ctDNA after treatment, those candidates for participation in Phase II will be excluded if there is unequivocal radiological progression in the first imaging exam after the completion of radiotherapy (with or without chemotherapy) or routine indication for salvage surgery immediately after the conclusion of definitive treatment.
- •Need for recurrent blood transfusions, such as weekly frequency.
- •Another uncontrolled disease representing a life risk, as determined by medical judgment.
- •Personal history of another active invasive malignant neoplasm in the last 5 years, except for non-melanoma skin carcinomas and in situ carcinomas.
- •Pregnant individuals.
- •Active opportunistic infection or disease.
- •History of autoimmune diseases.
研究组 & 干预措施
Active laboratory monitoring
Phase I Monitoring through collection of laboratory tests
干预措施: ctDNA test (Diagnostic Test)
Intervention with Immunotherapy
Phase II for participants who are ctDNA positive after standard treatment.
Intervention will be with Pembrolizumab
干预措施: Pembrolizumab (Drug)
结局指标
主要结局
General Objective
时间窗: 2 years
The objective of this study is to develop and validate a low-cost ctDNA test focused on detecting HPV-associated ctDNA for use in patients within the Brazilian Unified Health System (SUS). The test will be evaluated for its effectiveness in improving traditional monitoring methods and guiding the intensification of adjuvant treatment for anogenital neoplasms, including anal canal and cervical cancer. The impact of the test will be measured by correlating ctDNA detection with clinical outcomes of patients over time.
次要结局
未报告次要终点
研究者
Maria del Pilar Estevez Diz
Oncologist, Principal Investigator
Instituto do Cancer do Estado de São Paulo