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Evaluation of FLT-PET and DWI-MRI in Patients With NSCLC Treated With a Platinum-based Doublet as Preoperative Chemo (EVIDENCE)

Primary Purpose

Non-small Cell Lung Carcinoma

Status
Unknown status
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
18F-FLT-PET/CT and DWI-MRI
Sponsored by
European Organisation for Research and Treatment of Cancer - EORTC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Non-small Cell Lung Carcinoma focused on measuring FLT-PET, DWI-MRI

Eligibility Criteria

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

Inclusion Criteria:

  • Age ≥ 18 years
  • WHO performance status 0-1 (Appendix C)
  • Histologically or cytological confirmed clinical stage II-IIIA non-small cell lung carcinoma (NSCLC), according to 7th TNM classification (Appendix D) (NOTE: patients with resectable N2 disease are also eligible)
  • Baseline standard imaging assessment & staging should be performed within 6 weeks prior to planned treatment start.
  • Patients must be candidate for curative intent surgery, and must be expected to complete the treatment.

    ♦♦ Adequate hematology and biochemical investigations, (should be done maximum 6 weeks before treatment starts)

  • Normal bone marrow function based on routine blood samples, i.e. neutrophils ≥ 1.5 x 109/L, platelets ≥ 75 x 109/L, hemoglobin ≥ 10.0 g/dL
  • Normal kidney function creatinine clearance ≥ 60 mL/min,
  • Normal liver function assessed by routine laboratory examinations, i.e. bilirubin < 1.5 x upper limit of normal (ULN), ALT< 3 x ULN
  • Patients must not have any contraindication for 18F-FLT-PET/CT or MRI procedures.
  • Patient primary lung tumor larger than 20 mm in diameter (measured by diagnostic CT or MRI).
  • Women of child bearing potential (WOCBP) must have a negative serum (or urine) pregnancy test before trial registration.
  • Patients of childbearing / reproductive potential should use adequate birth control measures, as defined by the investigator, during the study treatment period and for at least 6 months after the last study procedure. A highly effective method of birth control is defined as those which result in low failure rate (i.e. less than 1% per year) when used consistently and correctly.
  • Female subjects who are breast feeding should discontinue nursing before trial registration.
  • Before patient registration, written informed consent must be given according to ICH/GCP, and national/local regulations.

Exclusion Criteria:

  • Prior or current anticancer treatment for NSCLC, pre-operative therapy will include only chemotherapeutic drugs (pemetrexed is contraindicated), no other biological, targeted or radiotherapy is allowed
  • Treatment with any investigational drug substance within 4 weeks prior to registration.
  • Other malignancies in the 3 years prior to study entry with the exception of surgically cured carcinoma in situ of the cervix, in situ breast cancer, incidental finding of stage T1a or T1b prostate cancer, and basal/squamous cell carcinoma of the skin
  • Evidence of any medical condition which would impair the ability of the patient to participate in the trial or might preclude therapy with chemotherapeutic drugs according to routine medical practice (e.g. unstable or uncompensated respiratory, cardiac, hepatic or renal disease, known dihydropyrimidine dehydrogenase deficiency, active infection, uncontrolled diabetes mellitus; uncontrolled arterial hypertension, history of unstable myocardial infarction)
  • Any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before randomization in the trial.

Sites / Locations

  • Istituto Clinico HumanitasRecruiting
  • Royal Marsden Hospital - Sutton, SurreyRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Imaging arm

Arm Description

18F-FLT-PET/CT and DWI-MRI scans at baseline, at 14 days after first administration of chemotherapy and after up to 4 cycles of chemotherapy

Outcomes

Primary Outcome Measures

Percentage of Apparent Diffusion Coefficient (ADC) change
Percentage of Apparent Diffusion Coefficient (ADC) change at day 14 relative to baseline
Percentage of FLT uptake change
Percentage of FLT uptake change at day 14 relative to baseline
Pathological quantification (% viable residual tumor cells)
participants will receive chemotherapy for up to 12 weeks (4 cycles) and followed by surgery (with an expected surgical preparation of 2-4 weeks)

Secondary Outcome Measures

Pre-operative (post-treatment) ADC measurement
participants will receive chemotherapy for up to 12 weeks (4 cycles) and performed the DWI-MRI scan within one week prior to the surgery
Pre-operative (post-treatment) FLT uptake measurement
participants will receive chemotherapy for up to 12 weeks (4 cycles) and performed the FLT-PET scan within one week prior to the surgery
Tumor volume (baseline, day 14 and post-treatment)
Immunohistochemistry (IHC) cell proliferation marker Ki-67
Immunohistochemistry (IHC) cell proliferation marker Ki-67-index in diagnostic biopsy samples (if available) and surgical specimens.
Metabolic change from FDG-PET (if available)
standard imaging per routine practice

Full Information

First Posted
October 16, 2014
Last Updated
October 29, 2015
Sponsor
European Organisation for Research and Treatment of Cancer - EORTC
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1. Study Identification

Unique Protocol Identification Number
NCT02273271
Brief Title
Evaluation of FLT-PET and DWI-MRI in Patients With NSCLC Treated With a Platinum-based Doublet as Preoperative Chemo
Acronym
EVIDENCE
Official Title
Evaluation of 3'-Deoxy-3'-[18F]Fluorothymidine -PET and Diffusion Weighted Imaging -MRI in Patients With Early Stage Non-small Cell Lung Cancer Treated With a Platinum-based Doublet as Preoperative Chemotherapy
Study Type
Interventional

2. Study Status

Record Verification Date
October 2015
Overall Recruitment Status
Unknown status
Study Start Date
October 2015 (undefined)
Primary Completion Date
December 2016 (Anticipated)
Study Completion Date
February 2017 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
European Organisation for Research and Treatment of Cancer - EORTC

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of the study is to qualify, independently, tumor cell proliferation by 3'-Deoxy-3'-[18F]Fluorothymidine (FLT) -Positron Emission Tomography , and cell death by Diffusion Weighted Imaging (DWI) -Magnetic Resonance Imaging (MRI) compared to pathological quantification (% of viable tumor cells) of the primary tumor after pre-operative chemotherapy in patients with operable Non Small Cell Lung Cancer (NSCLC).
Detailed Description
This is a prospective, multicenter, single-arm imaging trial. Patients with NSCLC will undergo 18F-FLT-PET/CT and DWI-MRI scans on three separate occasions: at baseline, at 14 days (maximum +/- 1 days deviation is acceptable) after first administration of chemotherapy and finally after up to 4 cycles of chemotherapy, and then followed by surgery. The quantification of 18F-FLT SUV and ADC will be measured to assess tumor characteristics and response to therapy. Patients will be first registered into the EORTC system after signing the informed consent form. The site will have to complete all the study related procedures within 6 weeks prior to treatment and all eligibility criteria should be met before the patient can be enrolled into the study. Both 18F-FLT-PET/CT and DWI-MRI will be assessed independently in this trial. Therefore the overall type I error of 0.1 will be split by two in order to test independently each imaging biomarker with a one-sided type I error of 0.05. In order to demonstrate with 95% confidence interval (one sided) that the correlation between the imaging biomarker change and the pathological response is > 0.5 (H0: rho ≤ 0.5) with 90% power if the true correlation is 0.8 (H1: rho > 0.5), 31 lesions are needed. As, in this population, patients only have the primary tumor, 31 eligible and evaluable patients will be needed for each primary endpoint. If all included patients have both 18F-FLT-PET/CT and DWI-MRI then 31 eligible and evaluable patients will be enough. If some patients have only one type of scans (18F-FLT-PET/CT or DWI-MRI), the sample size would need to be adapted to have 31 patients with each type of scans. In addition, the total number of patients to be registered may be increased to 40 patients for each primary endpoint to take into account some screening failure. For the primary analysis of correlation between relative change in imaging biomarkers (18F-FLT-SUV or ADC) and pathological quantification, the correlation coefficient will be reported using a one-sided 95% confidence interval, and tested as a one-sided comparison to the null hypothesis (H0: ρ ≤ 0.5). All secondary objectives to correlate preoperative imaging biomarkers and IHC biological markers or tumor volume will use the same analysis as cited above with 99% confidence intervals. All measures will be analyzed in a random effect ANOVA model allowing for within center-variability. Quality assurance is planned for the control of data consistency, on-site monitoring, audits, and quality assurance in pathological response assessment and in imaging.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Non-small Cell Lung Carcinoma
Keywords
FLT-PET, DWI-MRI

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
31 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Imaging arm
Arm Type
Experimental
Arm Description
18F-FLT-PET/CT and DWI-MRI scans at baseline, at 14 days after first administration of chemotherapy and after up to 4 cycles of chemotherapy
Intervention Type
Other
Intervention Name(s)
18F-FLT-PET/CT and DWI-MRI
Intervention Description
Patients with NSCLC will undergo 18F-FLT-PET/CT and DWI-MRI scans on three separate occasions. Dedicated in-house developed software will be used to quantify 18F-FLT SUV and ADC to assess tumor characteristics and response to therapy.
Primary Outcome Measure Information:
Title
Percentage of Apparent Diffusion Coefficient (ADC) change
Description
Percentage of Apparent Diffusion Coefficient (ADC) change at day 14 relative to baseline
Time Frame
day 14 relative to baseline
Title
Percentage of FLT uptake change
Description
Percentage of FLT uptake change at day 14 relative to baseline
Time Frame
day 14 relative to baseline
Title
Pathological quantification (% viable residual tumor cells)
Description
participants will receive chemotherapy for up to 12 weeks (4 cycles) and followed by surgery (with an expected surgical preparation of 2-4 weeks)
Time Frame
in average at week 16 from baseline
Secondary Outcome Measure Information:
Title
Pre-operative (post-treatment) ADC measurement
Description
participants will receive chemotherapy for up to 12 weeks (4 cycles) and performed the DWI-MRI scan within one week prior to the surgery
Time Frame
in average at week 15 from baseline
Title
Pre-operative (post-treatment) FLT uptake measurement
Description
participants will receive chemotherapy for up to 12 weeks (4 cycles) and performed the FLT-PET scan within one week prior to the surgery
Time Frame
in average at week 15 from baseline
Title
Tumor volume (baseline, day 14 and post-treatment)
Time Frame
baseline, day 14 and post-treatment
Title
Immunohistochemistry (IHC) cell proliferation marker Ki-67
Description
Immunohistochemistry (IHC) cell proliferation marker Ki-67-index in diagnostic biopsy samples (if available) and surgical specimens.
Time Frame
1y
Title
Metabolic change from FDG-PET (if available)
Description
standard imaging per routine practice
Time Frame
in average at week 9 from baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age ≥ 18 years WHO performance status 0-1 (Appendix C) Histologically or cytological confirmed clinical stage II-IIIA non-small cell lung carcinoma (NSCLC), according to 7th TNM classification (Appendix D) (NOTE: patients with resectable N2 disease are also eligible) Baseline standard imaging assessment & staging should be performed within 6 weeks prior to planned treatment start. Patients must be candidate for curative intent surgery, and must be expected to complete the treatment. ♦♦ Adequate hematology and biochemical investigations, (should be done maximum 6 weeks before treatment starts) Normal bone marrow function based on routine blood samples, i.e. neutrophils ≥ 1.5 x 109/L, platelets ≥ 75 x 109/L, hemoglobin ≥ 10.0 g/dL Normal kidney function creatinine clearance ≥ 60 mL/min, Normal liver function assessed by routine laboratory examinations, i.e. bilirubin < 1.5 x upper limit of normal (ULN), ALT< 3 x ULN Patients must not have any contraindication for 18F-FLT-PET/CT or MRI procedures. Patient primary lung tumor larger than 20 mm in diameter (measured by diagnostic CT or MRI). Women of child bearing potential (WOCBP) must have a negative serum (or urine) pregnancy test before trial registration. Patients of childbearing / reproductive potential should use adequate birth control measures, as defined by the investigator, during the study treatment period and for at least 6 months after the last study procedure. A highly effective method of birth control is defined as those which result in low failure rate (i.e. less than 1% per year) when used consistently and correctly. Female subjects who are breast feeding should discontinue nursing before trial registration. Before patient registration, written informed consent must be given according to ICH/GCP, and national/local regulations. Exclusion Criteria: Prior or current anticancer treatment for NSCLC, pre-operative therapy will include only chemotherapeutic drugs (pemetrexed is contraindicated), no other biological, targeted or radiotherapy is allowed Treatment with any investigational drug substance within 4 weeks prior to registration. Other malignancies in the 3 years prior to study entry with the exception of surgically cured carcinoma in situ of the cervix, in situ breast cancer, incidental finding of stage T1a or T1b prostate cancer, and basal/squamous cell carcinoma of the skin Evidence of any medical condition which would impair the ability of the patient to participate in the trial or might preclude therapy with chemotherapeutic drugs according to routine medical practice (e.g. unstable or uncompensated respiratory, cardiac, hepatic or renal disease, known dihydropyrimidine dehydrogenase deficiency, active infection, uncontrolled diabetes mellitus; uncontrolled arterial hypertension, history of unstable myocardial infarction) Any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before randomization in the trial.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Oussama Karroum
Phone
003227741523
Email
oussama.karroum@eortc.be
First Name & Middle Initial & Last Name or Official Title & Degree
Leslie Herman
Phone
003227741511
Email
leslie.herman@eortc.be
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nandita deSouza
Organizational Affiliation
Royal Marsden Hospital - Sutton, Surrey
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Sanjay Popat
Organizational Affiliation
Royal Marsden Hospital - Chelsea, London
Official's Role
Study Chair
Facility Information:
Facility Name
Istituto Clinico Humanitas
City
Milano
ZIP/Postal Code
20089
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Arturo Chiti, Medical doctor
Phone
+39 02 8224 6621
Email
arturo.chiti@hunimed.eu
First Name & Middle Initial & Last Name & Degree
Arturo Chiti, MD
Facility Name
Royal Marsden Hospital - Sutton, Surrey
City
Sutton
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Nandita Desouza, MD
Phone
+44 2086613289
Email
nandita.desouza@icr.ac.uk
First Name & Middle Initial & Last Name & Degree
Nandita Desouza, MD
First Name & Middle Initial & Last Name & Degree
Sanjay Popat, MD

12. IPD Sharing Statement

Learn more about this trial

Evaluation of FLT-PET and DWI-MRI in Patients With NSCLC Treated With a Platinum-based Doublet as Preoperative Chemo

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