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Concurrent Once Daily Versus Twice Daily Radiotherapy for Limited Stage Small Cell Lung Cancer (CONVERT)

Primary Purpose

Lung Cancer

Status
Completed
Phase
Not Applicable
Locations
United Kingdom
Study Type
Interventional
Intervention
Once daily radiotherapy
Twice daily radiotherapy
Sponsored by
The Christie NHS Foundation Trust
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lung Cancer focused on measuring limited stage small cell lung cancer

Eligibility Criteria

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

Inclusion/exclusion criteria:

  • Either sex, age ≥18 years
  • Performance status ECOG grade 0-1. Patients with PS 2 whose general condition is explained by obstructive/bulky disease likely to improve after the first cycle of chemotherapy can be included at the discretion of the local investigator. Patients with PS 2 as a result of comorbid conditions will be excluded.
  • Histologically or cytologically confirmed SCLC
  • No patients with mixed small-cell and non-small-cell histologic features
  • No history of previous malignancy in the last 5 years (except non melanomatous skin or in-situ cervix carcinoma). Patients with previous malignancies (except breast cancer) and in remission for at least 5 years can be included.
  • Limited stage disease (Veterans Administration Lung Cancer Study Group) ie patients whose disease can be encompassed within a radical radiation portal.
  • No pleural or pericardial effusions proven to be malignant
  • RT target volume acceptable by the local radiotherapist
  • Pulmonary function

    1. FEV1 >1 litre or 40% predicted value
    2. KCO (DLCO/VA) >40%predicted
  • Maximum of one of the following adverse biochemical factors:

    1. Serum alkaline phosphatase more than >1.5 times the upper limit of normal (ULN)
    2. Serum sodium < Lower limit of Normal
    3. Serum LDH > ULN
  • Normal serum creatinine and calculated creatinine clearance >50 ml/min. If calculated creatinine clearance is <50 ml/mn according to the Cockroft and Gault formula, an EDTA clearance should be performed
  • Adequate haematological function

    1. Neutrophils >1.5 x 109/l
    2. Platelets >100 x 109/l
  • Adequate liver function: ALT & AST <= 2.5 x ULN
  • No other previous or concomitant illness or treatment which in the opinion of the clinician will interfere with the trial treatments or comparisons
  • No prior surgical resection of the primary tumour, no prior radiotherapy for lung cancer
  • Considered fit to receive any of the trial regimens
  • Female patients must satisfy the investigator that they are not pregnant, or are not of child-bearing potential, or are using adequate contraception. Men must also use adequate contraception, as etoposide is clastogenic.
  • Patients must not be breastfeeding
  • Patient has read the patient information sheet and has signed the consent form.
  • Patients available for follow-up

Sites / Locations

  • The Christie NHS Foundation Trust

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Once daily radiotherapy

Twice daily radiotherapy

Arm Description

Once daily radiotherapy

Twice daily radiotherapy

Outcomes

Primary Outcome Measures

Overall survival

Secondary Outcome Measures

Local progression-free survival
Metastasis-free survival
Toxicity of treatment
Cytotoxic dose intensity
Radiotherapy dose intensity

Full Information

First Posted
February 8, 2007
Last Updated
September 5, 2022
Sponsor
The Christie NHS Foundation Trust
Collaborators
Cancer Research UK, NCIC Clinical Trials Group, European Organisation for Research and Treatment of Cancer - EORTC, Spanish Lung Cancer Group, Groupe Francais De Pneumo-Cancerologie, Intergroupe Francophone de Cancerologie Thoracique
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1. Study Identification

Unique Protocol Identification Number
NCT00433563
Brief Title
Concurrent Once Daily Versus Twice Daily Radiotherapy for Limited Stage Small Cell Lung Cancer
Acronym
CONVERT
Official Title
A 2-Arm Randomized Controlled Trial of Concurrent Chemo-Radiotherapy Comparing Twice-Daily and Once-Daily Radiotherapy Schedules in Patients With Limited Stage Small Cell Lung Cancer (SCLC) and Good Performance Status [CONVERT]
Study Type
Interventional

2. Study Status

Record Verification Date
September 2022
Overall Recruitment Status
Completed
Study Start Date
April 2008 (undefined)
Primary Completion Date
February 2016 (Actual)
Study Completion Date
January 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
The Christie NHS Foundation Trust
Collaborators
Cancer Research UK, NCIC Clinical Trials Group, European Organisation for Research and Treatment of Cancer - EORTC, Spanish Lung Cancer Group, Groupe Francais De Pneumo-Cancerologie, Intergroupe Francophone de Cancerologie Thoracique

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Drugs used in chemotherapy, such as cisplatin and etoposide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Radiation therapy uses high-energy x-rays to kill tumor cells. It is not yet known which schedule of radiation therapy is more effective when given together with chemotherapy in treating small cell lung cancer. PURPOSE: This randomized phase III trial is studying two different schedules of radiation therapy to compare how well they work when given together with cisplatin and etoposide in treating patients with limited stage small cell lung cancer.
Detailed Description
OBJECTIVES: Primary Compare overall survival of patients with limited stage small cell lung cancer treated with chemoradiotherapy comprising cisplatin, etoposide, and once vs twice daily radiotherapy. Secondary Compare local progression-free survival of patients treated with these regimens. Compare metastasis-free survival of patients treated with these regimens. Compare the toxicity of these regimens in these patients. Compare response rates in patients treated with these regimens. Compare the cytotoxic dose intensity of these regimens in these patients. Compare the dose intensity of two different schedules of radiotherapy in these patients. OUTLINE: This is a multicenter, randomized, controlled study. Patients are stratified according to participating center, ECOG performance status (0-1 vs 2), and lactic dehydrogenase, sodium, and alkaline phosphatase levels. Patients are randomized to 1 of 2 treatment arms. Arm I: Patients receive cisplatin IV over 2 hours on days 1-3 OR on day 1 only and etoposide IV over 45-90 minutes on days 1-3. Treatment repeats every 21 days for up to 6 courses. During course 2, patients undergo concurrent radiotherapy once daily 5 days a week for 6½ weeks (total of 33 fractions). Arm II: Patients receive cisplatin and etoposide as in arm I. During courses 2 and 3, patients undergo concurrent radiotherapy twice daily 5 days a week for 3 weeks (total of 30 fractions). In both arms, treatment continues in the absence of disease progression or unacceptable toxicity. Beginning 3-4 weeks after completion of chemoradiotherapy, patients in both arms achieving a complete or partial response with no evidence of brain metastasis undergo prophylactic cranial irradiation once daily 5 days a week for 2 weeks (total of 10 fractions). After completion of study treatment, patients are followed every 3 months for 1 year, every 6 months for 2 years, and then annually thereafter. PROJECTED ACCRUAL: A total of 532 patients will be accrued for this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lung Cancer
Keywords
limited stage small cell lung cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
547 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Once daily radiotherapy
Arm Type
Experimental
Arm Description
Once daily radiotherapy
Arm Title
Twice daily radiotherapy
Arm Type
Active Comparator
Arm Description
Twice daily radiotherapy
Intervention Type
Radiation
Intervention Name(s)
Once daily radiotherapy
Intervention Description
Standard of care chemotherapy (cisplatin/etoposide) + once daily radiotherapy
Intervention Type
Radiation
Intervention Name(s)
Twice daily radiotherapy
Intervention Description
Standard of care chemotherapy (cisplatin/etoposide) + twice daily radiotherapy
Primary Outcome Measure Information:
Title
Overall survival
Time Frame
August 2015
Secondary Outcome Measure Information:
Title
Local progression-free survival
Time Frame
August 2015
Title
Metastasis-free survival
Time Frame
August 2015
Title
Toxicity of treatment
Time Frame
August 2015
Title
Cytotoxic dose intensity
Time Frame
August 2015
Title
Radiotherapy dose intensity
Time Frame
August 2015

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion/exclusion criteria: Either sex, age ≥18 years Performance status ECOG grade 0-1. Patients with PS 2 whose general condition is explained by obstructive/bulky disease likely to improve after the first cycle of chemotherapy can be included at the discretion of the local investigator. Patients with PS 2 as a result of comorbid conditions will be excluded. Histologically or cytologically confirmed SCLC No patients with mixed small-cell and non-small-cell histologic features No history of previous malignancy in the last 5 years (except non melanomatous skin or in-situ cervix carcinoma). Patients with previous malignancies (except breast cancer) and in remission for at least 5 years can be included. Limited stage disease (Veterans Administration Lung Cancer Study Group) ie patients whose disease can be encompassed within a radical radiation portal. No pleural or pericardial effusions proven to be malignant RT target volume acceptable by the local radiotherapist Pulmonary function FEV1 >1 litre or 40% predicted value KCO (DLCO/VA) >40%predicted Maximum of one of the following adverse biochemical factors: Serum alkaline phosphatase more than >1.5 times the upper limit of normal (ULN) Serum sodium < Lower limit of Normal Serum LDH > ULN Normal serum creatinine and calculated creatinine clearance >50 ml/min. If calculated creatinine clearance is <50 ml/mn according to the Cockroft and Gault formula, an EDTA clearance should be performed Adequate haematological function Neutrophils >1.5 x 109/l Platelets >100 x 109/l Adequate liver function: ALT & AST <= 2.5 x ULN No other previous or concomitant illness or treatment which in the opinion of the clinician will interfere with the trial treatments or comparisons No prior surgical resection of the primary tumour, no prior radiotherapy for lung cancer Considered fit to receive any of the trial regimens Female patients must satisfy the investigator that they are not pregnant, or are not of child-bearing potential, or are using adequate contraception. Men must also use adequate contraception, as etoposide is clastogenic. Patients must not be breastfeeding Patient has read the patient information sheet and has signed the consent form. Patients available for follow-up
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Corinne Faivre-Finn, MD
Organizational Affiliation
The Christie NHS Foundation Trust
Official's Role
Study Chair
Facility Information:
Facility Name
The Christie NHS Foundation Trust
City
Manchester
ZIP/Postal Code
M20 4BX
Country
United Kingdom

12. IPD Sharing Statement

Citations:
PubMed Identifier
31020334
Citation
Tay RY, Fernandez-Gutierrez F, Foy V, Burns K, Pierce J, Morris K, Priest L, Tugwood J, Ashcroft L, Lindsay CR, Faivre-Finn C, Dive C, Blackhall F. Prognostic value of circulating tumour cells in limited-stage small-cell lung cancer: analysis of the concurrent once-daily versus twice-daily radiotherapy (CONVERT) randomised controlled trial. Ann Oncol. 2019 Jul 1;30(7):1114-1120. doi: 10.1093/annonc/mdz122.
Results Reference
derived
PubMed Identifier
30520977
Citation
Salem A, Mistry H, Hatton M, Locke I, Monnet I, Blackhall F, Faivre-Finn C. Association of Chemoradiotherapy With Outcomes Among Patients With Stage I to II vs Stage III Small Cell Lung Cancer: Secondary Analysis of a Randomized Clinical Trial. JAMA Oncol. 2019 Mar 1;5(3):e185335. doi: 10.1001/jamaoncol.2018.5335. Epub 2019 Mar 14.
Results Reference
derived
PubMed Identifier
28642008
Citation
Faivre-Finn C, Snee M, Ashcroft L, Appel W, Barlesi F, Bhatnagar A, Bezjak A, Cardenal F, Fournel P, Harden S, Le Pechoux C, McMenemin R, Mohammed N, O'Brien M, Pantarotto J, Surmont V, Van Meerbeeck JP, Woll PJ, Lorigan P, Blackhall F; CONVERT Study Team. Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT): an open-label, phase 3, randomised, superiority trial. Lancet Oncol. 2017 Aug;18(8):1116-1125. doi: 10.1016/S1470-2045(17)30318-2. Epub 2017 Jun 20.
Results Reference
derived
PubMed Identifier
28362511
Citation
Groom N, Wilson E, Faivre-Finn C. Effect of accurate heart delineation on cardiac dose during the CONVERT trial. Br J Radiol. 2017 May;90(1073):20170036. doi: 10.1259/bjr.20170036. Epub 2017 Mar 31.
Results Reference
derived
PubMed Identifier
22014897
Citation
Colaco R, Sheikh H, Lorigan P, Blackhall F, Hulse P, Califano R, Ashcroft L, Taylor P, Thatcher N, Faivre-Finn C. Omitting elective nodal irradiation during thoracic irradiation in limited-stage small cell lung cancer--evidence from a phase II trial. Lung Cancer. 2012 Apr;76(1):72-7. doi: 10.1016/j.lungcan.2011.09.015. Epub 2011 Oct 19.
Results Reference
derived
PubMed Identifier
21353720
Citation
Sheikh H, Colaco R, Lorigan P, Blackhall F, Califano R, Ashcroft L, Taylor P, Thatcher N, Faivre-Finn C. Use of G-CSF during concurrent chemotherapy and thoracic radiotherapy in patients with limited-stage small-cell lung cancer safety data from a phase II trial. Lung Cancer. 2011 Oct;74(1):75-9. doi: 10.1016/j.lungcan.2011.01.020. Epub 2011 Feb 26.
Results Reference
derived

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Concurrent Once Daily Versus Twice Daily Radiotherapy for Limited Stage Small Cell Lung Cancer

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