ATREUS Trial - A Phase II Study on the Activity of Trabectedin of Pretreated Epithelioid or Biphasic / Sarcomatoid Malignant Pleural Mesothelioma(MPM)
试验速览
- 阶段
- 2 期
- 状态
- 已完成
- 发起方
- 入组人数
- 145
- 试验地点
- 8
- 主要终点
- Progression Free Survival - PFS12w
研究概览
简要总结
The purpose of this study is to determine whether trabectedin is effective in the treatment of malignant pleural mesothelioma (MPM).
详细描述
There are no approved agents for second-line treatment of MPM in patients who failed first line pemetrexed plus platinum derivatives regimens. Chemotherapy options are limited and include gemcitabine, vinorelbine and other antifolate compounds. The role of second-line chemotherapy is therefore not yet established and second-line patient population is considered suitable for phase II studies with investigational agents.
Trabectedin is an originally natural marine product, now obtained by a semisynthetic process, that induces a delay in S phase progression and a blockade in G2 phase of the cell cycle by a mode of action that seems different from that of other DNA-damaging agents (see citations). Although the exact mechanism of action of trabectedin has not been fully elucidated yet, it appears to be unique compared to other anticancer agents (see citations). Trabectedin binds to N2 of guanines in the minor groove of DNA, causing a bending of the minor groove towards the major groove.
In the randomised clinical trials in metastatic leiomyosarcoma or liposarcoma and in recurrent platinum-sensitive ovarian cancer, trabectedin is infused at 1.5 mg/m2 as a 24-hour infusion or 1.3 mg/m2 as a 3 hour infusion every 3 weeks (see citations). Balancing efficacy with safety the short infusion is preferable in clinical practice.
In soft tissue sarcoma the response rate did not exceed 10%, however, trabectedin has been shown to provide disease control, with progression arrest rates exceeding 50% and progression-free survival rates exceeding 20% at 6 months. In pre-treated ovarian cancer the objective response rate was 30% with a median time to disease progression of 5.7 months.
Trabectedin has not been extensively employed in MPM, however in phase I studies, some objective response in heavily pre-treated mesothelioma patients was seen.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 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
- •Histologically proven unresectable MPM. In order to make a reproducible diagnosis, in particular regarding biphasic MPM, histology must derive from transthoracic biopsies (at least 3 representative samples) or from videothoracoscopy (at least 5 representative samples)
- •Age >18 years
- •Performance status 0-1 (ECOG)
- •Measurable disease (CT-PET) according to RECIST criteria modified for malignant pleural mesothelioma
- •Not more than one previous chemotherapy course (consisting of pemetrexed plus platinum derivative), excluded adjuvant therapy if PFS < 12 months
- •A minimum of 3 weeks since previous tumour directed therapy
- •Recovery from toxic effects of previous therapies to NCI CTC AE Grade 0-1
- •Patients who have received palliative radiation are eligible if <30% of bone marrow was irradiated and normal haematological function was completely regained
- •Haematologic variables: haemoglobin ≥ 9 g/dL, Absolute neutrophil count (ANC) ≥ 1,500/μL and Platelet count ≥ 100,000/μL
- •Serum creatinine ≤1.5 mg/dL or creatinine clearance ≥ 30 mL/min
- •Creatinine phosphokinase (CPK) ≤ 2.5 ULN
- •Hepatic function variables: Total bilirubin ≤ ULN, Total alkaline phosphatase ≤ 2.5 ULN or if > 2.5 ULN alkaline phosphatase liver fraction or GGT or 5' nucleotidase must be determined and ≤ ULN, AST (serum aspartate transaminase [SGOT]) and ALT (serum alaninetransaminase [SGPT]) must be ≤ 2.5 x ULN, Albumin ≥ 25 g/L
- •Signed informed consent
- •Adequate contraceptive methods for male patients whose partner is of childbearing age/potential, during the study and for three months after the end of treatment
排除标准
- •Radiotherapy with curative intent to thoracic wall (concomitant with or prior to chemotherapy)
- •Uncompensated diabetes mellitus or other condition absolutely contra-indicating dexamethasone (used as pre-medication)
- •Patients enrolled in other study with experimental drugs
- •Women of childbearing age/potential
- •Prior exposure to trabectedin
- •History of other malignancies (except basal cell carcinoma or cervical carcinoma in situ, adequately treated), unless in remission from 5 years or more and judged of negligible potential of relapse
- •Active viral hepatitis or chronic liver disease
- •Unstable cardiac condition, including congestive heart failure or angina pectoris, myocardial infarction within one year before enrolment, uncontrolled arterial hypertension or arrhythmias
- •Active major infection
- •Other serious concomitant illness
- •Brain / leptomeningeal involvement
研究组 & 干预措施
Trabectedin
Patients will receive trabectedin treatment
干预措施: Trabectedin (Drug)
结局指标
主要结局
Progression Free Survival - PFS12w
时间窗: 12 weeks
Proportion of patients free from progression or death at the second CT scan assessment performed at 12 weeks (Progression Free Survival - PFS12w) from the date of treatment start
次要结局
- Progression Free Survival (PFS)(24 months)
- Overall survival (OS)(24 months)
- Objective response rate(24 months)
- Trabectedin tolerability and safety(24 months)
- Pain Intensity (PI)(24 months)
- Pain type and characteristics(24 months)
- Antalgic treatments(24 months)
- microRNA (miRs) profile(24 months)
- High Mobility Group B1 (HMGB1) protein assessment(24 months)
- Blood Macrophages analysis(24 months)