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Randomized Embolization Trial for NeuroEndocrine Tumor Metastases To The Liver

Primary Purpose

Neuroendocrine Tumor, Malignant, Liver Metastases

Status
Active
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Bland Embolization
Transarterial chemoembolization
Drug Eluting Beads Embolization
Sponsored by
Abramson Cancer Center at Penn Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Neuroendocrine Tumor, Malignant

Eligibility Criteria

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

Inclusion Criteria:

  • Participants 18 years and older;
  • Biopsy-proven neuroendocrine tumor.
  • Measurable metastasis to liver with at least one dimension ≥ 1.0 cm.
  • Tumor burden dominant in the liver AND liver tumor burden less than or equal to 70% of the total liver volume by visual estimate.
  • Not a candidate for surgical resection based on unresectability, anatomy, anesthesia risk, patient preference.
  • Symptoms uncontrolled by somatostatin analogues OR morphologically progressive tumor by RECIST 1.1 criteria in the liver OR baseline tumor burden >25% of the liver volume.
  • There must be no plans for the patient to receive other concomitant therapy while on this protocol treatment (other than somatostatin analogs or bone-strengthening agents).
  • Performance status 0-2 on Zubrod/ECOG Performance Scale;
  • Serum creatinine < 2.0 mg/dL;
  • Serum Bilirubin ≤ 2.0 mg/dL
  • Serum albumin ≥ 3.0 g/dL
  • Platelet count > 50 thousands/uL (corrected if needed)
  • INR ≤ 1.5 (corrected if needed)
  • All patients must be informed of the investigational nature of this study and must sign a study specific informed consent in accordance with institutional and federal guidelines prior to study entry.

Exclusion Criteria:

  • Pregnant or lactating women may not participate due to the embryotoxic effects of protocol treatment. Women/men of reproductive potential may not participate unless they have agreed to use an effective contraceptive method.
  • Prior hepatic arterial therapy or hepatic radiation therapy. Prior surgical resection or ablation of liver metastases is acceptable. Patients must be at least one month beyond prior chemotherapy, PRRT, ablation or surgery, and have recovered from all therapy-associated toxicities.
  • Active infection (Symptomatic bacterial and fungal infection - newly diagnosed and/or requiring treatment);
  • Choledochoenteric anastomosis; transpapillary biliary stent, or sphincterotomy of duodenal papilla
  • Absolute contraindication to intravenous iodinated contrast (Hx of significant previous contrast reaction, not mitigated by appropriate pre-medication).
  • Contraindications to arteriography and selective visceral catheterization:

    1. severe allergy or intolerance to contrast media, narcotics, sedatives, or atropine.
    2. bleeding diathesis not correctable by usual forms of therapy.
    3. severe peripheral vascular disease precluding catheterization.
  • Contraindications to hepatic artery embolization:

    1. portal vein occlusion without hepatopedal collateral flow demonstrated by angiography; or portal hypertension with hepatofugal flow.
    2. hepatic encephalopathy.

Sites / Locations

  • University of California San Francisco
  • Stanford University
  • Moffitt Cancer Center
  • Mount Sinai School of Medicine
  • Memorial Sloan Kettering Cancer Center
  • Oregon Health & Science University
  • Hospital of the University of Pennsylvania
  • University of Pittsburgh Medical Center
  • MD Anderson Cancer Center
  • Medical College of Wisconsin
  • Hospital Italiano de Buenos Aires
  • Sunnybrook Health Sciences Centre
  • Ospedale San Raffaele

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Arm 1 - BE

Arm 2 - TACE

Arm 3 - DEB - CLOSED

Arm Description

Lobar or segmental bland embolization (BE) with microspheres (50-500 microns) to 2-5 heartbeat stasis.

Lobar or segmental lipiodol conventional transarterial chemoembolization (TACE). Doxorubicin 50 mg dissolved in 10 mL dilute contrast and emulsified with 10-20 cc iodized oil, followed by 50-500 μm microspheres.

Lobar or segmental hepatic chemoembolization with DEBDOX (100-300 or 300-500 micron beads loaded with doxorubicin per manufacturer IFU monthly until entire tumor burden is treated.

Outcomes

Primary Outcome Measures

Abdominal MRI/Triple Phase CT
Hepatic progression-free interval (H-PFS)

Secondary Outcome Measures

Number of Adverse Events
Symptom-relief interval and toxicity

Full Information

First Posted
March 28, 2016
Last Updated
September 25, 2023
Sponsor
Abramson Cancer Center at Penn Medicine
Collaborators
Guerbet
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1. Study Identification

Unique Protocol Identification Number
NCT02724540
Brief Title
Randomized Embolization Trial for NeuroEndocrine Tumor Metastases To The Liver
Official Title
Randomized Embolization Trial for NeuroEndocrine Tumor Metastases To The Liver
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
March 2016 (Actual)
Primary Completion Date
March 2024 (Anticipated)
Study Completion Date
September 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Abramson Cancer Center at Penn Medicine
Collaborators
Guerbet

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The primary aim of this trial is to estimate the duration of hepatic progression-free survival (HPFS) in participants treated with bland embolization (BE), transcatheter arterial Lipiodol chemoembolization (TACE), and embolization by drug-eluting beads (DEB). The primary hypothesis is that chemoembolization will be nearly twice as durable as bland embolization; thatis, the hazard ratio for HPFS will be 1.76 or better.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Neuroendocrine Tumor, Malignant, Liver Metastases

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
162 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm 1 - BE
Arm Type
Experimental
Arm Description
Lobar or segmental bland embolization (BE) with microspheres (50-500 microns) to 2-5 heartbeat stasis.
Arm Title
Arm 2 - TACE
Arm Type
Experimental
Arm Description
Lobar or segmental lipiodol conventional transarterial chemoembolization (TACE). Doxorubicin 50 mg dissolved in 10 mL dilute contrast and emulsified with 10-20 cc iodized oil, followed by 50-500 μm microspheres.
Arm Title
Arm 3 - DEB - CLOSED
Arm Type
Experimental
Arm Description
Lobar or segmental hepatic chemoembolization with DEBDOX (100-300 or 300-500 micron beads loaded with doxorubicin per manufacturer IFU monthly until entire tumor burden is treated.
Intervention Type
Device
Intervention Name(s)
Bland Embolization
Other Intervention Name(s)
BE
Intervention Description
Lobar or segmental bland embolization with microspheres (50-500 microns) to 2-5 heartbeat stasis
Intervention Type
Combination Product
Intervention Name(s)
Transarterial chemoembolization
Other Intervention Name(s)
TACE
Intervention Description
Lobar or segmental lipiodol transarterial chemoembolization. Doxorubicin 50 mg dissolved in 10 mL dilute contrast and emulsified with 10-20 cc iodized oil, followed by 50-500 μm microspheres.
Intervention Type
Combination Product
Intervention Name(s)
Drug Eluting Beads Embolization
Other Intervention Name(s)
DEB
Intervention Description
CLOSED - Lobar or segmental hepatic chemoembolization with DEBDOX (100-300 or 300-500 micron beads loaded with doxorubicin per manufacturer IFU.
Primary Outcome Measure Information:
Title
Abdominal MRI/Triple Phase CT
Description
Hepatic progression-free interval (H-PFS)
Time Frame
2 years
Secondary Outcome Measure Information:
Title
Number of Adverse Events
Description
Symptom-relief interval and toxicity
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Participants 18 years and older; Biopsy-proven neuroendocrine tumor. Measurable metastasis to liver with at least one dimension ≥ 1.0 cm. Tumor burden dominant in the liver AND liver tumor burden less than or equal to 70% of the total liver volume by visual estimate. Not a candidate for surgical resection based on unresectability, anatomy, anesthesia risk, patient preference. Symptoms uncontrolled by somatostatin analogues OR morphologically progressive tumor by RECIST 1.1 criteria in the liver OR baseline tumor burden >25% of the liver volume. There must be no plans for the patient to receive other concomitant therapy while on this protocol treatment (other than somatostatin analogs or bone-strengthening agents). Performance status 0-2 on Zubrod/ECOG Performance Scale; Serum creatinine < 2.0 mg/dL; Serum Bilirubin ≤ 2.0 mg/dL Serum albumin ≥ 3.0 g/dL Platelet count > 50 thousands/uL (corrected if needed) INR ≤ 1.5 (corrected if needed) All patients must be informed of the investigational nature of this study and must sign a study specific informed consent in accordance with institutional and federal guidelines prior to study entry. Exclusion Criteria: Pregnant or lactating women may not participate due to the embryotoxic effects of protocol treatment. Women/men of reproductive potential may not participate unless they have agreed to use an effective contraceptive method. Prior hepatic arterial therapy or hepatic radiation therapy. Prior surgical resection or ablation of liver metastases is acceptable. Patients must be at least one month beyond prior chemotherapy, PRRT, ablation or surgery, and have recovered from all therapy-associated toxicities. Active infection (Symptomatic bacterial and fungal infection - newly diagnosed and/or requiring treatment); Choledochoenteric anastomosis; transpapillary biliary stent, or sphincterotomy of duodenal papilla Absolute contraindication to intravenous iodinated contrast (Hx of significant previous contrast reaction, not mitigated by appropriate pre-medication). Contraindications to arteriography and selective visceral catheterization: severe allergy or intolerance to contrast media, narcotics, sedatives, or atropine. bleeding diathesis not correctable by usual forms of therapy. severe peripheral vascular disease precluding catheterization. Contraindications to hepatic artery embolization: portal vein occlusion without hepatopedal collateral flow demonstrated by angiography; or portal hypertension with hepatofugal flow. hepatic encephalopathy.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michael C Soulen, MD, FSIR
Organizational Affiliation
University of Pennsylvania
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of California San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
94143
Country
United States
Facility Name
Stanford University
City
Stanford
State/Province
California
ZIP/Postal Code
94305
Country
United States
Facility Name
Moffitt Cancer Center
City
Tampa
State/Province
Florida
ZIP/Postal Code
33612
Country
United States
Facility Name
Mount Sinai School of Medicine
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States
Facility Name
Memorial Sloan Kettering Cancer Center
City
New York
State/Province
New York
ZIP/Postal Code
10065
Country
United States
Facility Name
Oregon Health & Science University
City
Portland
State/Province
Oregon
ZIP/Postal Code
97239
Country
United States
Facility Name
Hospital of the University of Pennsylvania
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
University of Pittsburgh Medical Center
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15213
Country
United States
Facility Name
MD Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
Medical College of Wisconsin
City
Milwaukee
State/Province
Wisconsin
ZIP/Postal Code
53226
Country
United States
Facility Name
Hospital Italiano de Buenos Aires
City
Buenos Aires
ZIP/Postal Code
C1191 ABH
Country
Argentina
Facility Name
Sunnybrook Health Sciences Centre
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M4N3M5
Country
Canada
Facility Name
Ospedale San Raffaele
City
Milan
ZIP/Postal Code
20132
Country
Italy

12. IPD Sharing Statement

Citations:
PubMed Identifier
30016989
Citation
Chen JX, Wileyto EP, Soulen MC. Randomized Embolization Trial for NeuroEndocrine Tumor Metastases to the Liver (RETNET): study protocol for a randomized controlled trial. Trials. 2018 Jul 17;19(1):390. doi: 10.1186/s13063-018-2782-5.
Results Reference
derived

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Randomized Embolization Trial for NeuroEndocrine Tumor Metastases To The Liver

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