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Evaluation of Percutaneous Cryotherapy in the Treatment of Plexiform Neurofibromas and Unresectable Neurofibromas in Neurofibromatosis Type 1 (CryoNF1)

Primary Purpose

Neurofibroma, Neurofibroma, Plexiform

Status
Not yet recruiting
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Cryotherapy
Sponsored by
Centre Leon Berard
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Neurofibroma

Eligibility Criteria

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

Inclusion Criteria:

  • Age ≥18 years;
  • Patient with neurofibromatosis type 1 according to NIH criteria ;
  • Patient with a benign neurofibromatous lesion that is painful and/or generates functional discomfort and is unresectable or with unacceptable scarring ;
  • Neutrophils > 1 G/l in the 14 days prior to inclusion;
  • Adequate coagulation test (as judged by the investigator);
  • Signed and dated informed consent document indicating that the patient has been informed of all aspects of the trial prior to enrolment
  • Covered by a medical insurance;

Exclusion Criteria:

  • Patient treated with concomitant chemotherapy and/or targeted therapies ;
  • Any contraindication to a percutaneous cryotherapy procedure, including the need for ice formation within 1 cm of the spinal cord, brain or other critical nerve structures, bowel or bladder (unless active or passive thermal protective maneuvers are performed);
  • Patient with malignant neurofibroma or MPNST ; NB: If tumor has progressed in the 12 months prior to inclusion: Prescription of a Pet scan and if SUV max T/F>1.5 targeted biopsy to confirm histology
  • Patient with neurofibroma in areas at risk for neurological sequelae;
  • Patient with cold urticaria with history of angioedema;
  • Any cognitive impairment or condition that may limit the use of numerical scales and quality of life questionnaires;
  • Patient for whom follow-up does not seem feasible even in the short term;
  • Participation in another clinical trial that may interfere with the evaluation of the primary endpoint;
  • Patient under tutorshio, curatorship or deprived of liberty;
  • Pregnant or breast-feeding woman;
  • Any contraindication to the performance of an MRI

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Percutaneous cryotherapy

    Arm Description

    Cryoablation of the tumor

    Outcomes

    Primary Outcome Measures

    To evaluate the impact of percutaneous cryotherapy on physical health-related quality of life (in patients with inoperable (or operable with mutilating surgery) neurofibroma.
    Rate of patients with clinically significant improvement in physical health-related quality of life. A patient will be considered successful if an increase of at least 3 points on the global physical score from the SF-36 questionnaire is observed at least once between baseline and 12 months after cryotherapy.

    Secondary Outcome Measures

    To assess each quality of life dimension of the Short Form-36 (SF-36) questionnaire;
    The score for each dimension, the mental global score and the physical global score from the SF-36 questionnaire
    To evaluate the tumor response
    Local control rate using REiNS and RECIST 1.1 criteria
    To evaluate the functional discomfort
    Functional discomfort assessed by a Likert scale
    To evaluate the patients' pain
    Pain assessed by the Brief Pain Inventory-Short Form (BPI-SF) questionnaire
    To evaluate the safety of percutaneous cryotherapy
    Tolerance of cryotherapy treatment assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) v5.0
    To evaluate patients' satisfaction
    Patient satisfaction with their first cryotherapy treatment assessed by a Likert scale
    To evaluate patients self-esteem
    Self-esteem assessed by a questionnaire consisting of items evaluated on a Likert scale
    To evaluate the need for multiple percutaneous cryotherapy procedures in case of incomplete response on the target lesion;
    Rate of patients for whom at least one additional percutaneous cryotherapy procedure is required
    To evaluate operating room occupancy time.
    Median operating room occupancy time calculated as the difference between operating room exit time and operating room entry time.

    Full Information

    First Posted
    December 21, 2021
    Last Updated
    January 19, 2022
    Sponsor
    Centre Leon Berard
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05199376
    Brief Title
    Evaluation of Percutaneous Cryotherapy in the Treatment of Plexiform Neurofibromas and Unresectable Neurofibromas in Neurofibromatosis Type 1
    Acronym
    CryoNF1
    Official Title
    Evaluation of Percutaneous Cryotherapy in the Treatment of Plexiform Neurofibromas and Unresectable Neurofibromas in Neurofibromatosis Type 1 (NF1)
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    January 2022
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    February 7, 2022 (Anticipated)
    Primary Completion Date
    February 7, 2025 (Anticipated)
    Study Completion Date
    February 7, 2026 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Centre Leon Berard

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    Neurofibromatosis type 1 (NF1) is an autosomal dominant disease affecting chromosome 17. It is manifested by a neurogenic tumor proliferation that forms cutaneous, subcutaneous or deep neurofibromas. Neurofibromas can cause functional discomfort, neurogenic pain that is difficult to treat, and severe cosmetic disorders. Treatment is essentially surgical. It is sometimes a heavy invasive surgery with complicated postoperative follow-up and significant scarring on the aesthetic level. Currently, no systemic treatment has proven its effectiveness in this pathology. Percutaneous cryotherapy is a cold thermoablation procedure using fine 17 G needles introduced into the lesion after targeting by imaging. This technique is used in the treatment of soft tissue tumors and desmoid tumors. The treatment of neurofibromas with percutaneous cryotherapy is not well known. Encouraging results (unpublished) have been observed in patients with NF1 treated with cryotherapy at the Léon Bérard Center. The beneficial effect was observed in terms of quality of life (in particular, pain) as well as a decrease in tumor size. On the basis of this first experience, it appears important to corroborate these preliminary results by a prospective study allowing the use of this technique to treat patients with unresectable or resectable neurofibromas but with mutilating surgery in a NF1 context.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Neurofibroma, Neurofibroma, Plexiform

    7. Study Design

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

    8. Arms, Groups, and Interventions

    Arm Title
    Percutaneous cryotherapy
    Arm Type
    Experimental
    Arm Description
    Cryoablation of the tumor
    Intervention Type
    Device
    Intervention Name(s)
    Cryotherapy
    Intervention Description
    The cryotherapy treatment lasts approximately 30 minutes during which two 10-minute freezing cycles are performed, separated by a reheating phase. During the freezing phases, the temperature is lowered below -40°C in the ablation zone, a temperature that is lethal for the cells.
    Primary Outcome Measure Information:
    Title
    To evaluate the impact of percutaneous cryotherapy on physical health-related quality of life (in patients with inoperable (or operable with mutilating surgery) neurofibroma.
    Description
    Rate of patients with clinically significant improvement in physical health-related quality of life. A patient will be considered successful if an increase of at least 3 points on the global physical score from the SF-36 questionnaire is observed at least once between baseline and 12 months after cryotherapy.
    Time Frame
    12 months after cryotherapy
    Secondary Outcome Measure Information:
    Title
    To assess each quality of life dimension of the Short Form-36 (SF-36) questionnaire;
    Description
    The score for each dimension, the mental global score and the physical global score from the SF-36 questionnaire
    Time Frame
    At baseline, at Month1 post cryotherapy ; Month 3 post cryotherapy; Month 6 post cryotherapy, Month 9 post cryotherapy, Month 12 post cryotherapy, Month 18 post cryotherapy and Month 24 post post cryotherapy ;
    Title
    To evaluate the tumor response
    Description
    Local control rate using REiNS and RECIST 1.1 criteria
    Time Frame
    Month 3, Month 6, Month 9, Month 12, Month 18 , and Month 24 after cryotherapy
    Title
    To evaluate the functional discomfort
    Description
    Functional discomfort assessed by a Likert scale
    Time Frame
    At baseline, Month 1; Month 3; Month 6, Month 9, Month12, Month18 and Month 24 post cryotherapy
    Title
    To evaluate the patients' pain
    Description
    Pain assessed by the Brief Pain Inventory-Short Form (BPI-SF) questionnaire
    Time Frame
    At baseline, Month 1; Month 3; Month 6, Month 9, Month 12, Month 18 and Month 24 post cryotherapy
    Title
    To evaluate the safety of percutaneous cryotherapy
    Description
    Tolerance of cryotherapy treatment assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) v5.0
    Time Frame
    From cryotherapy to 24 months after cryotherapy
    Title
    To evaluate patients' satisfaction
    Description
    Patient satisfaction with their first cryotherapy treatment assessed by a Likert scale
    Time Frame
    At Month 12 post-cryotherapy;
    Title
    To evaluate patients self-esteem
    Description
    Self-esteem assessed by a questionnaire consisting of items evaluated on a Likert scale
    Time Frame
    at baseline, Month 1; Month 3; Month 6, Month 9, Month12, Month 18 and Month 24 post-cryotherapy
    Title
    To evaluate the need for multiple percutaneous cryotherapy procedures in case of incomplete response on the target lesion;
    Description
    Rate of patients for whom at least one additional percutaneous cryotherapy procedure is required
    Time Frame
    From cryotherapy to 24 months after cryotherapy
    Title
    To evaluate operating room occupancy time.
    Description
    Median operating room occupancy time calculated as the difference between operating room exit time and operating room entry time.
    Time Frame
    At Day 0

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Age ≥18 years; Patient with neurofibromatosis type 1 according to NIH criteria ; Patient with a benign neurofibromatous lesion that is painful and/or generates functional discomfort and is unresectable or with unacceptable scarring ; Neutrophils > 1 G/l in the 14 days prior to inclusion; Adequate coagulation test (as judged by the investigator); Signed and dated informed consent document indicating that the patient has been informed of all aspects of the trial prior to enrolment Covered by a medical insurance; Exclusion Criteria: Patient treated with concomitant chemotherapy and/or targeted therapies ; Any contraindication to a percutaneous cryotherapy procedure, including the need for ice formation within 1 cm of the spinal cord, brain or other critical nerve structures, bowel or bladder (unless active or passive thermal protective maneuvers are performed); Patient with malignant neurofibroma or MPNST ; NB: If tumor has progressed in the 12 months prior to inclusion: Prescription of a Pet scan and if SUV max T/F>1.5 targeted biopsy to confirm histology Patient with neurofibroma in areas at risk for neurological sequelae; Patient with cold urticaria with history of angioedema; Any cognitive impairment or condition that may limit the use of numerical scales and quality of life questionnaires; Patient for whom follow-up does not seem feasible even in the short term; Participation in another clinical trial that may interfere with the evaluation of the primary endpoint; Patient under tutorshio, curatorship or deprived of liberty; Pregnant or breast-feeding woman; Any contraindication to the performance of an MRI
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Patrick COMBEMALE, MD
    Phone
    +33478785996
    Email
    patrick.combemale@lyon.unicancer.fr
    First Name & Middle Initial & Last Name or Official Title & Degree
    Amine BOUHAMAMA, MD
    Email
    amine.bouhamama@lyon.unicancer.fr

    12. IPD Sharing Statement

    Plan to Share IPD
    No

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    Evaluation of Percutaneous Cryotherapy in the Treatment of Plexiform Neurofibromas and Unresectable Neurofibromas in Neurofibromatosis Type 1

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