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ICON8: Weekly Chemotherapy in Ovarian Cancer (ICON8)

Primary Purpose

Ovarian Cancer

Status
Unknown status
Phase
Phase 3
Locations
United Kingdom
Study Type
Interventional
Intervention
Carboplatin
Carboplatin
Paclitaxel
Paclitaxel
Sponsored by
Medical Research Council
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Ovarian Cancer focused on measuring Ovarian cancer, Epithelial ovarian carcinoma, Fallopian tube carcinoma, Primary serous peritoneal carcinoma, Gynaecological carcinoma, Randomised controlled trial

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Females aged 18 years or more
  • Signed informed consent and ability to comply with the protocol
  • Histologically confirmed, with core biopsy from a disease site as minimum requirement (cytology alone is insufficient for diagnosis):

    • Epithelial ovarian carcinoma
    • Primary peritoneal carcinoma of Müllerian histological type
    • Fallopian tube carcinoma
  • FIGO stage IC or above, which may be based on clinical and radiological assessment in patients who have not undergone immediate primary surgery
  • Confirmed high-risk histological subtype for patients with FIGO stage IC/IIA disease, namely:

    • High grade serous carcinoma
    • Clear cell carcinoma
    • Other histological subtype considered poorly differentiated/grade 3
  • ECOG Performance Status (PS) 0-2
  • Life expectancy > 12 weeks
  • Adequate bone marrow function:

    • Absolute Neutrophil Count (ANC) ≥ 1.5 x 109/l
    • Platelets (Plt) ≥ 100 x 109/l
    • Haemoglobin (Hb) ≥ 9g/dl (can be post transfusion)
  • Adequate liver function (within 28 days prior to randomisation):

    • Serum bilirubin (BR) ≤ 1.5 x ULN
    • Serum transaminases ≤ 3 x ULN in the absence of parenchymal liver metastases or ≤ 5 x ULN in the presence of parenchymal liver metastases
  • Adequate renal function as defined by GFR (Glomerular Filtration Rate) ≥ 30ml/min.

Exclusion Criteria:

  • Non-epithelial ovarian cancer, including malignant mixed Müllerian tumours (carcinosarcomas)
  • Peritoneal cancer that is not of Müllerian origin, including mucinous histology
  • Borderline tumours (tumours of low malignant potential)
  • Prior systemic anti-cancer therapy for ovarian cancer (for example chemotherapy, monoclonal antibody therapy, tyrosine kinase inhibitor therapy or hormonal therapy)
  • Previous malignancies within 5 years prior to randomisation apart from: adequately treated carcinoma in-situ of the cervix, breast ductal carcinoma in-situ, non-melanomatous skin cancer; or previous/synchronous early-stage endometrial cancer defined as stage IA (FIGO 2009) grade 1 or 2 endometrioid cancers with no lymphovascular space invasion
  • Pre-existing sensory or motor neuropathy grade ≥ 2
  • Evidence of any other disease/metabolic dysfunction that in the opinion of the investigator would put the subject at high-risk of treatment-related complications or prevent compliance with the trial protocol
  • Planned intraperitoneal cytotoxic chemotherapy
  • Any previous radiotherapy to the abdomen or pelvis
  • Sexually active women of childbearing potential not willing to use adequate contraception (e.g. oral contraceptives, intrauterine device or barrier method of contraception in conjunction with spermicidal jelly or surgically sterile) for the study duration and at least six months afterwards
  • Pregnant or lactating women
  • Treatment with any other investigational agent prior to protocol defined progression
  • Known hypersensitivity to carboplatin, paclitaxel or their excipients (including cremophor)
  • History or clinical suspicion of brain metastases or spinal cord compression. CT/MRI of the brain is mandatory in the case of suspected brain metastases. Spinal MRI is mandatory in the case of suspected spinal cord compression. Patients with brain or meningeal metastases are not eligible

Sites / Locations

  • Medical Research Council Clinical Trials UnitRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Experimental

Experimental

Arm Label

Arm 1 (Control Arm)

Arm 2 (Research arm)

Arm 3 (Research arm)

Arm Description

Carboplatin and paclitaxel on day 1 of a 21-day cycle for 6 cycles

Carboplatin on day 1 and dose-fractionated weekly paclitaxel on day 1, 8 and 15 of a 21-day cycle for 6 cycles

Dose-fractionated weekly carboplatin and weekly paclitaxel on day 1, 8 and 15 of a 21-day cycle for 6 cycles.

Outcomes

Primary Outcome Measures

Stage 1: Feasibility assessed as the number of cycles and dose intensity of protocol treatment delivered per patient.
Stage 1: Safety assessed as the rate of any ≥ grade 3 toxicity experienced per patient.
Stage 2: Progression Free Survival rate at 9 months after randomisation
Stage 3: Progression Free Survival
Stage 3: Overall Survival

Secondary Outcome Measures

Stage 3: Toxicity assessed by number of participants with adverse events
Assessment of toxicity profile of dose-fractionated chemotherapy
Stage 3: Quality of Life
Assessment of potential impact of dose-fractionated chemotherapy on functionality and well-being in patients undergoing first line treatment for ovarian cancer.
Stage 3: Health Economics
Cost-effectiveness analysis of dose-fractionated chemotherapy

Full Information

First Posted
June 20, 2012
Last Updated
July 26, 2012
Sponsor
Medical Research Council
Collaborators
Cancer Research UK
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1. Study Identification

Unique Protocol Identification Number
NCT01654146
Brief Title
ICON8: Weekly Chemotherapy in Ovarian Cancer
Acronym
ICON8
Official Title
An International Phase III Randomised Trial of Dose Fractionated Chemotherapy Compared to Standard Three Weekly Chemotherapy, Following Immediate Primary Surgery or as Part of Delayed Primary Surgery, for Women With Newly Diagnosed Epithelial Ovarian, Fallopian Tube or Primary Peritoneal Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
July 2012
Overall Recruitment Status
Unknown status
Study Start Date
June 2011 (undefined)
Primary Completion Date
June 2017 (Anticipated)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Medical Research Council
Collaborators
Cancer Research UK

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to determine if weekly chemotherapy (i.e. giving paclitaxel or carboplatin at a lower dose every week) is more effective than standard chemotherapy (paclitaxel and carboplatin given once every three weeks over 18 weeks) in treating ovarian cancer. The investigators also want to see if weekly chemotherapy causes more or fewer side-effects than standard chemotherapy.
Detailed Description
ICON8 is a three-arm, three stage trial. Patients will be randomised in a 1:1:1 ratio. Patients in arm 1 (control arm) will receive weekly carboplatin and paclitaxel on day 1 of a 21-day cycle for 6 cycles. Patients in arm 2 will receive carboplatin on day 1 and dose-fractionated weekly paclitaxel on day 1, 8 and 15 of a 21-day cycle for 6 cycles. Patients in arm 3 will receive dose-fractionated weekly carboplatin and dose-fractionated weekly paclitaxel on day 1, 8 and 15 of a 21-day cycle for 6 cycles. The trial will have three planned stages. Stage 1 will be conducted to confirm feasibility and safety of protocol treatment in all patients and separately in the Delayed Primary Surgery (DPS) patients. The outcome measure for stage 2 will be 9-month progression-free survival (PFS) rate. The primary outcome measures for stage 3 will be PFS and overall survival and secondary outcomes will be toxicity, Quality of Life and Health Economics. If pre-defined levels of deliverability, at stage 1, or activity, at stage 2, are not met then the research arms will be reconsidered.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ovarian Cancer
Keywords
Ovarian cancer, Epithelial ovarian carcinoma, Fallopian tube carcinoma, Primary serous peritoneal carcinoma, Gynaecological carcinoma, Randomised controlled trial

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
1485 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Arm 1 (Control Arm)
Arm Type
Active Comparator
Arm Description
Carboplatin and paclitaxel on day 1 of a 21-day cycle for 6 cycles
Arm Title
Arm 2 (Research arm)
Arm Type
Experimental
Arm Description
Carboplatin on day 1 and dose-fractionated weekly paclitaxel on day 1, 8 and 15 of a 21-day cycle for 6 cycles
Arm Title
Arm 3 (Research arm)
Arm Type
Experimental
Arm Description
Dose-fractionated weekly carboplatin and weekly paclitaxel on day 1, 8 and 15 of a 21-day cycle for 6 cycles.
Intervention Type
Drug
Intervention Name(s)
Carboplatin
Intervention Description
AUC5 by intravenous infusion over 30-60 minutes
Intervention Type
Drug
Intervention Name(s)
Carboplatin
Intervention Description
AUC2 by intravenous infusion over 30-60 minutes
Intervention Type
Drug
Intervention Name(s)
Paclitaxel
Intervention Description
175mg/m2 by intravenous infusion over 3 hours
Intervention Type
Drug
Intervention Name(s)
Paclitaxel
Intervention Description
80mg/m2 by intravenous infusion over 1 hour
Primary Outcome Measure Information:
Title
Stage 1: Feasibility assessed as the number of cycles and dose intensity of protocol treatment delivered per patient.
Time Frame
6 months after the 50th patient has been randomised to each arm and 6 months after the 50th patient with a plan to undergo delayed primary surgery has been randomised to each arm
Title
Stage 1: Safety assessed as the rate of any ≥ grade 3 toxicity experienced per patient.
Time Frame
6 months after the 50th patient has been randomised to each arm and 6 months after the 50th patient with a plan to undergo delayed primary surgery has been randomised to each arm
Title
Stage 2: Progression Free Survival rate at 9 months after randomisation
Time Frame
9 months after first 62 patients randomised per arm
Title
Stage 3: Progression Free Survival
Time Frame
PFS expected 1 year after last patient is randomised. OS expected 3 years after last patient is randomised.
Title
Stage 3: Overall Survival
Time Frame
PFS expected 1 year after last patient is randomised. OS expected 3 years after last patient is randomised.
Secondary Outcome Measure Information:
Title
Stage 3: Toxicity assessed by number of participants with adverse events
Description
Assessment of toxicity profile of dose-fractionated chemotherapy
Time Frame
Expected 1 year and 3 years after last patient is randomised.
Title
Stage 3: Quality of Life
Description
Assessment of potential impact of dose-fractionated chemotherapy on functionality and well-being in patients undergoing first line treatment for ovarian cancer.
Time Frame
Expected 1 year and 3 years after last patient is randomised.
Title
Stage 3: Health Economics
Description
Cost-effectiveness analysis of dose-fractionated chemotherapy
Time Frame
Expected 1 year and 3 years after last patient is randomised.

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Females aged 18 years or more Signed informed consent and ability to comply with the protocol Histologically confirmed, with core biopsy from a disease site as minimum requirement (cytology alone is insufficient for diagnosis): Epithelial ovarian carcinoma Primary peritoneal carcinoma of Müllerian histological type Fallopian tube carcinoma FIGO stage IC or above, which may be based on clinical and radiological assessment in patients who have not undergone immediate primary surgery Confirmed high-risk histological subtype for patients with FIGO stage IC/IIA disease, namely: High grade serous carcinoma Clear cell carcinoma Other histological subtype considered poorly differentiated/grade 3 ECOG Performance Status (PS) 0-2 Life expectancy > 12 weeks Adequate bone marrow function: Absolute Neutrophil Count (ANC) ≥ 1.5 x 109/l Platelets (Plt) ≥ 100 x 109/l Haemoglobin (Hb) ≥ 9g/dl (can be post transfusion) Adequate liver function (within 28 days prior to randomisation): Serum bilirubin (BR) ≤ 1.5 x ULN Serum transaminases ≤ 3 x ULN in the absence of parenchymal liver metastases or ≤ 5 x ULN in the presence of parenchymal liver metastases Adequate renal function as defined by GFR (Glomerular Filtration Rate) ≥ 30ml/min. Exclusion Criteria: Non-epithelial ovarian cancer, including malignant mixed Müllerian tumours (carcinosarcomas) Peritoneal cancer that is not of Müllerian origin, including mucinous histology Borderline tumours (tumours of low malignant potential) Prior systemic anti-cancer therapy for ovarian cancer (for example chemotherapy, monoclonal antibody therapy, tyrosine kinase inhibitor therapy or hormonal therapy) Previous malignancies within 5 years prior to randomisation apart from: adequately treated carcinoma in-situ of the cervix, breast ductal carcinoma in-situ, non-melanomatous skin cancer; or previous/synchronous early-stage endometrial cancer defined as stage IA (FIGO 2009) grade 1 or 2 endometrioid cancers with no lymphovascular space invasion Pre-existing sensory or motor neuropathy grade ≥ 2 Evidence of any other disease/metabolic dysfunction that in the opinion of the investigator would put the subject at high-risk of treatment-related complications or prevent compliance with the trial protocol Planned intraperitoneal cytotoxic chemotherapy Any previous radiotherapy to the abdomen or pelvis Sexually active women of childbearing potential not willing to use adequate contraception (e.g. oral contraceptives, intrauterine device or barrier method of contraception in conjunction with spermicidal jelly or surgically sterile) for the study duration and at least six months afterwards Pregnant or lactating women Treatment with any other investigational agent prior to protocol defined progression Known hypersensitivity to carboplatin, paclitaxel or their excipients (including cremophor) History or clinical suspicion of brain metastases or spinal cord compression. CT/MRI of the brain is mandatory in the case of suspected brain metastases. Spinal MRI is mandatory in the case of suspected spinal cord compression. Patients with brain or meningeal metastases are not eligible
Facility Information:
Facility Name
Medical Research Council Clinical Trials Unit
City
London
ZIP/Postal Code
WC2B 6NH
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Monique Tomiczek
Phone
02076704767
Email
icon8@ctu.mrc.ac.uk
First Name & Middle Initial & Last Name & Degree
Laura Farrelly
Phone
02076704789
Email
icon8@ctu.mrc.ac.uk

12. IPD Sharing Statement

Citations:
PubMed Identifier
35690073
Citation
Clamp AR, James EC, McNeish IA, Dean A, Kim JW, O'Donnell DM, Gallardo-Rincon D, Blagden S, Brenton J, Perren TJ, Sundar S, Lord R, Dark G, Hall M, Banerjee S, Glasspool RM, Hanna CL, Williams S, Scatchard KM, Nam H, Essapen S, Parkinson C, McAvan L, Swart AM, Popoola B, Schiavone F, Badrock J, Fananapazir F, Cook AD, Parmar M, Kaplan R, Ledermann JA. Weekly dose-dense chemotherapy in first-line epithelial ovarian, fallopian tube, or primary peritoneal cancer treatment (ICON8): overall survival results from an open-label, randomised, controlled, phase 3 trial. Lancet Oncol. 2022 Jul;23(7):919-930. doi: 10.1016/S1470-2045(22)00283-2. Epub 2022 Jun 9.
Results Reference
derived
PubMed Identifier
33357510
Citation
Morgan RD, McNeish IA, Cook AD, James EC, Lord R, Dark G, Glasspool RM, Krell J, Parkinson C, Poole CJ, Hall M, Gallardo-Rincon D, Lockley M, Essapen S, Summers J, Anand A, Zachariah A, Williams S, Jones R, Scatchard K, Walther A, Kim JW, Sundar S, Jayson GC, Ledermann JA, Clamp AR. Objective responses to first-line neoadjuvant carboplatin-paclitaxel regimens for ovarian, fallopian tube, or primary peritoneal carcinoma (ICON8): post-hoc exploratory analysis of a randomised, phase 3 trial. Lancet Oncol. 2021 Feb;22(2):277-288. doi: 10.1016/S1470-2045(20)30591-X. Epub 2020 Dec 22.
Results Reference
derived
PubMed Identifier
32615110
Citation
Blagden SP, Cook AD, Poole C, Howells L, McNeish IA, Dean A, Kim JW, O'Donnell DM, Hook J, James EC, White IR, Perren T, Lord R, Dark G, Earl HM, Hall M, Kaplan R, Ledermann JA, Clamp AR. Weekly platinum-based chemotherapy versus 3-weekly platinum-based chemotherapy for newly diagnosed ovarian cancer (ICON8): quality-of-life results of a phase 3, randomised, controlled trial. Lancet Oncol. 2020 Jul;21(7):969-977. doi: 10.1016/S1470-2045(20)30218-7.
Results Reference
derived
Links:
URL
http://www.icon8trial.org
Description
ICON8 Trial website

Learn more about this trial

ICON8: Weekly Chemotherapy in Ovarian Cancer

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