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Endostar Combined With Chemotherapy for Stage Ⅳ Soft Tissue Sarcoma

Primary Purpose

Soft Tissue Sarcoma, Adult, Stage IIB

Status
Completed
Phase
Phase 2
Locations
China
Study Type
Interventional
Intervention
Endostar
Placebo
AIM regimen / GT regimen
Sponsored by
Tianjin Medical University Cancer Institute and Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Soft Tissue Sarcoma, Adult, Stage IIB focused on measuring Endostar, Soft Tissue Sarcoma, Chemotherapy

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients volunteered to participate in this study, signed informed consent;
  • Pathological diagnosis of stage Ⅳ of soft tissue sarcoma patients, clinical staging using the American Cancer Research Joint Commission (AJCC) TNM staging criteria. There is at least one extracranial measurable lesion based on CT or MRI.
  • 18 to 75 years old; the patient's physical condition Karnofsky score ≧ 60 points; ECG, blood, liver and kidney function were no abnormalities; expected survival ≧ 6 months.
  • Major organ function within 7 days prior to treatment, meeting the following criteria:

    1. Blood routine examination criteria (14 days without blood transfusion):

      • ①hemoglobin (HB) ≥ 90g / L;② neutrophil absolute value (ANC) ≥ 1.5 × 109 / L;③ platelet (PLT) ≥ 80 × 109 / L.
    2. Biochemical tests to meet the following criteria:

      • ①Total bilirubin (TBIL) ≤ 1.5 times the upper limit of normal (ULN);② Alanine aminotransferase (ALT) and aspartate aminotransferase AST ≤ 2.5 × ULN, such as liver metastasis, the ALT and AST ≤ 5×ULN;③ Serum creatinine (Cr) ≤ 1.5 × ULN or creatinine clearance (CCr) ≥ 60ml / min;
    3. Doppler ultrasound evaluation: left ventricular ejection fraction (LVEF) ≥ normal low (50%).
  • Women of childbearing age should agree that contraceptive measures (such as intrauterine devices, birth control pills or condoms) must be used within the study period and within 6 months after the end of the study; the serum or urine pregnancy test is negative within 7 days prior to the study For non-lactating patients; men should agree to patients who have contraindications during the study period and within 6 months after the end of the study period.

Exclusion Criteria:

  • Patients who had previously used Endostar injections;
  • Patients who have received antiangiogenic therapy or other targeted treatment for no more than 3 months, such as Endostar, Erlotinib, Sunitinib, Sorafenib, Avastin, Imatinib, Famitinib, Pazopanib and other drugs.
  • 5 years or present at the same time suffering from other malignant tumors. Cured cervix in situ cancer, non-melanoma skin cancer and superficial bladder tumors except. [Ta (non-invasive tumor), Tis (orthotopic carcinoma) and T1 (tumor infiltrating basement membrane)];
  • During the first 4 weeks of the group or during the study period, systemic anti-tumor therapy was planned, including cytotoxic therapy and immunotherapy. Intravenous radiotherapy (EF-RT) was performed 4 weeks prior to grouping or restricted radiotherapy was performed within 2 weeks prior to grouping to assess tumor lesions;
  • Due to any previous treatment caused by the CTC AE (4.0) level 1 or more of the mitigated toxicity, excluding hair loss;
  • Patients with symptoms or symptoms of control less than 2 months of brain metastases;
  • Any patient with severe and / or uncontrolled disease, including:

    1. Patients with poor blood pressure control. (Systolic blood pressure ≥ 160 mmHg, diastolic blood pressure ≥ 100 mmHg);
    2. Myocardial ischemia or myocardial infarction, arrhythmia (including QTC ≥480 ms) and ≥ 2 levels of congestive heart failure (NYHA classification)
    3. Active or uncontrollable serious infections (≥CTC AE Level 2 infection);
    4. Liver cirrhosis, decompensated liver disease, active hepatitis or chronic hepatitis to be treated with antiretroviral therapy;
    5. Renal failure requires hemodialysis or peritoneal dialysis;
    6. History of immunodeficiency, including HIV positive or other acquired, congenital immune deficiency disease, or a history of organ transplantation;
    7. Poor control of diabetes (fasting blood glucose (FBG)> 10mmol / L);
    8. Urine Urine Urine protein ≥ ++, and confirmed 24 hours urine protein> 1.0 g;
    9. Patients with a seizure and need treatment.
  • Significant surgical treatment, biopsy or traumatic injury was received within 28 days prior to the grouping;
  • Regardless of the severity of the presence of any signs of bleeding or medical history of patients; in the first 4 weeks before the group, any bleeding or bleeding events ≥ CTCAE3 patients, there is no healing wounds, ulcers or fractures;
  • Subluxation / venous thrombosis events occurred within 6 months before the group, such as cerebrovascular accident (including transient ischemic attack), deep vein thrombosis and pulmonary embolism;
  • Have a history of psychiatric abuse and can not quit or have mental disorders;
  • Four weeks before the group participated in other clinical trials of anti-tumor drugs;
  • According to the researcher's judgment, there are other comorbidities that seriously endanger the safety of the patient or affect the patient's completion of the study.

Sites / Locations

  • Tianjin Medical University Cancer Hospital & Institute

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Endostar & AIM regimen / GT regimen

Placebo & AIM regimen / GT regimen

Arm Description

Endostar & AIM regimen / GT regimen; Endostar 15mg, into 500ml 0.9% sodium chloride intravenous infusion of 3 ~ 4h, d1 ~ d14, 21-28 days for a cycle; AIM regimen is Pirarubicin (THP) + Ifosfamide (IFO), the specific dose is IFO 8-12g / m2, given 4-5 days; THP 75mg / m2, given 1-2 days; 21-28 days for a cycle; GT regimen is Docetaxel (TXT) + Gemcitabine (GEM), specific dose of Gemcitabine 1000mg / m2 (D1, D8) and Docetaxel 75mg / m2 (D8); 21-28 days for a cycle; Preferred AIM regimen, AIM regimen chemotherapy failure or can not tolerate anthracycline chemotherapy in patients with GT regimen.

Placebo + AIM regimen / GT regimen; Placebo is 500ml 0.9% sodium chloride, Intravenous 3 ~ 4h, d1 ~ d14, 21-28 days for a cycle; The chemotherapy regimen is the same as the experimental group.

Outcomes

Primary Outcome Measures

Progression-free survival (PFS)
PFS is defined as the length of time from random assignment to disease progression or to death resulting from any cause other than the progress.

Secondary Outcome Measures

Disease control rate(DCR)
Investigators will assess treatment response according to Response Evaluation Criteria in Solid Tumors 1.1(RECIST1.1)

Full Information

First Posted
April 17, 2017
Last Updated
December 23, 2019
Sponsor
Tianjin Medical University Cancer Institute and Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT03121833
Brief Title
Endostar Combined With Chemotherapy for Stage Ⅳ Soft Tissue Sarcoma
Official Title
Randomized, Double-blind, Placebo-controlled (2: 1), Multicenter Clinical Study (IIB) for the Treatment of Stage Ⅳ Soft Tissue Sarcoma With Recombinant Human Endostatin(Endostar) Combined With Chemotherapy
Study Type
Interventional

2. Study Status

Record Verification Date
December 2019
Overall Recruitment Status
Completed
Study Start Date
May 1, 2017 (Actual)
Primary Completion Date
December 20, 2019 (Actual)
Study Completion Date
December 20, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Tianjin Medical University Cancer Institute and Hospital

4. Oversight

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

5. Study Description

Brief Summary
This is a randomized, double-blind, placebo-controlled (2: 1), multicenter clinical phase II clinical trial evaluating the efficacy and safety of Endostar combined with chemotherapy for stage IV soft tissue sarcoma.
Detailed Description
The prognosis of sarcoma patients in stage IV is poor. For STS, the response rate of chemotherapy is only 20-35% and the median survival time is about 12 months. The 5 year survival rate is lower than 10% reported in several large-scale studies. Although chemotherapy plays a major role in the treatment of advanced STS, the classic chemotherapy agents are not curative. Combination chemotherapy or dose-dense regimens have largely failed to improve the response rates. Long-term using of cytotoxic drugs increased the risk of toxicity in patients. Endostatin is the strongest endogenous angiogenesis inhibitor, which inhibits vascular endothelial growth factor (VEGF) expression and then inhibits tumor angiogenesis . Endostar, is a novel recombinant human endostatin, with advantages of long half-life, stable and low cost. Recently, a study of Endostar combined with chemotherapy in the treatment of advanced soft tissue sarcoma indicated resulted in a higher clinical benefit response (CBR) and longer progression-free survival (PFS), with tolerable side effects. However this study included the patients with stage IIB-IV soft tissue sarcomas and did not include specific pathologic information. Thus this clinical trial is designed to compare the efficacy and safety of endostar combined with chemotherapy versus chemotherapy alone in stage IV patients with soft tissue sarcomas.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Soft Tissue Sarcoma, Adult, Stage IIB
Keywords
Endostar, Soft Tissue Sarcoma, Chemotherapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
A total of 150 cases, according to 2: 1 random into the group. Among them, 100 cases of Endostar combined chemotherapy group, 50 cases of placebo + chemotherapy group.
Masking
ParticipantInvestigator
Allocation
Non-Randomized
Enrollment
52 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Endostar & AIM regimen / GT regimen
Arm Type
Experimental
Arm Description
Endostar & AIM regimen / GT regimen; Endostar 15mg, into 500ml 0.9% sodium chloride intravenous infusion of 3 ~ 4h, d1 ~ d14, 21-28 days for a cycle; AIM regimen is Pirarubicin (THP) + Ifosfamide (IFO), the specific dose is IFO 8-12g / m2, given 4-5 days; THP 75mg / m2, given 1-2 days; 21-28 days for a cycle; GT regimen is Docetaxel (TXT) + Gemcitabine (GEM), specific dose of Gemcitabine 1000mg / m2 (D1, D8) and Docetaxel 75mg / m2 (D8); 21-28 days for a cycle; Preferred AIM regimen, AIM regimen chemotherapy failure or can not tolerate anthracycline chemotherapy in patients with GT regimen.
Arm Title
Placebo & AIM regimen / GT regimen
Arm Type
Placebo Comparator
Arm Description
Placebo + AIM regimen / GT regimen; Placebo is 500ml 0.9% sodium chloride, Intravenous 3 ~ 4h, d1 ~ d14, 21-28 days for a cycle; The chemotherapy regimen is the same as the experimental group.
Intervention Type
Drug
Intervention Name(s)
Endostar
Other Intervention Name(s)
Recombinant Human Endostatin Injection
Intervention Description
Recombinant Human Endostatin Injection
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
Placebo(for Endostar)
Intervention Description
500ml 0.9% sodium chloride
Intervention Type
Drug
Intervention Name(s)
AIM regimen / GT regimen
Intervention Description
"Pirarubicin (THP) + Ifosfamide (IFO)" / "Docetaxel (TXT) + Gemcitabine (GEM)"
Primary Outcome Measure Information:
Title
Progression-free survival (PFS)
Description
PFS is defined as the length of time from random assignment to disease progression or to death resulting from any cause other than the progress.
Time Frame
2 year
Secondary Outcome Measure Information:
Title
Disease control rate(DCR)
Description
Investigators will assess treatment response according to Response Evaluation Criteria in Solid Tumors 1.1(RECIST1.1)
Time Frame
2 year
Other Pre-specified Outcome Measures:
Title
Objective tumor response rate(ORR)
Description
ORR is defined as the percentage of subjects having achieved confirmed Complete Response + Partial Response as best overall response according to radiological assessments.
Time Frame
2 year
Title
Overall survival(OS)
Description
OS is defined as the length of time from random assignment to death or to last contact.
Time Frame
3 year
Title
Adverse Events(AEs)
Description
AEs are evaluated according to National Cancer Institute Common Terminology Criteria for Adverse Events v4.0.
Time Frame
2 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients volunteered to participate in this study, signed informed consent; Pathological diagnosis of stage Ⅳ of soft tissue sarcoma patients, clinical staging using the American Cancer Research Joint Commission (AJCC) TNM staging criteria. There is at least one extracranial measurable lesion based on CT or MRI. 18 to 75 years old; the patient's physical condition Karnofsky score ≧ 60 points; ECG, blood, liver and kidney function were no abnormalities; expected survival ≧ 6 months. Major organ function within 7 days prior to treatment, meeting the following criteria: Blood routine examination criteria (14 days without blood transfusion): ①hemoglobin (HB) ≥ 90g / L;② neutrophil absolute value (ANC) ≥ 1.5 × 109 / L;③ platelet (PLT) ≥ 80 × 109 / L. Biochemical tests to meet the following criteria: ①Total bilirubin (TBIL) ≤ 1.5 times the upper limit of normal (ULN);② Alanine aminotransferase (ALT) and aspartate aminotransferase AST ≤ 2.5 × ULN, such as liver metastasis, the ALT and AST ≤ 5×ULN;③ Serum creatinine (Cr) ≤ 1.5 × ULN or creatinine clearance (CCr) ≥ 60ml / min; Doppler ultrasound evaluation: left ventricular ejection fraction (LVEF) ≥ normal low (50%). Women of childbearing age should agree that contraceptive measures (such as intrauterine devices, birth control pills or condoms) must be used within the study period and within 6 months after the end of the study; the serum or urine pregnancy test is negative within 7 days prior to the study For non-lactating patients; men should agree to patients who have contraindications during the study period and within 6 months after the end of the study period. Exclusion Criteria: Patients who had previously used Endostar injections; Patients who have received antiangiogenic therapy or other targeted treatment for no more than 3 months, such as Endostar, Erlotinib, Sunitinib, Sorafenib, Avastin, Imatinib, Famitinib, Pazopanib and other drugs. 5 years or present at the same time suffering from other malignant tumors. Cured cervix in situ cancer, non-melanoma skin cancer and superficial bladder tumors except. [Ta (non-invasive tumor), Tis (orthotopic carcinoma) and T1 (tumor infiltrating basement membrane)]; During the first 4 weeks of the group or during the study period, systemic anti-tumor therapy was planned, including cytotoxic therapy and immunotherapy. Intravenous radiotherapy (EF-RT) was performed 4 weeks prior to grouping or restricted radiotherapy was performed within 2 weeks prior to grouping to assess tumor lesions; Due to any previous treatment caused by the CTC AE (4.0) level 1 or more of the mitigated toxicity, excluding hair loss; Patients with symptoms or symptoms of control less than 2 months of brain metastases; Any patient with severe and / or uncontrolled disease, including: Patients with poor blood pressure control. (Systolic blood pressure ≥ 160 mmHg, diastolic blood pressure ≥ 100 mmHg); Myocardial ischemia or myocardial infarction, arrhythmia (including QTC ≥480 ms) and ≥ 2 levels of congestive heart failure (NYHA classification) Active or uncontrollable serious infections (≥CTC AE Level 2 infection); Liver cirrhosis, decompensated liver disease, active hepatitis or chronic hepatitis to be treated with antiretroviral therapy; Renal failure requires hemodialysis or peritoneal dialysis; History of immunodeficiency, including HIV positive or other acquired, congenital immune deficiency disease, or a history of organ transplantation; Poor control of diabetes (fasting blood glucose (FBG)> 10mmol / L); Urine Urine Urine protein ≥ ++, and confirmed 24 hours urine protein> 1.0 g; Patients with a seizure and need treatment. Significant surgical treatment, biopsy or traumatic injury was received within 28 days prior to the grouping; Regardless of the severity of the presence of any signs of bleeding or medical history of patients; in the first 4 weeks before the group, any bleeding or bleeding events ≥ CTCAE3 patients, there is no healing wounds, ulcers or fractures; Subluxation / venous thrombosis events occurred within 6 months before the group, such as cerebrovascular accident (including transient ischemic attack), deep vein thrombosis and pulmonary embolism; Have a history of psychiatric abuse and can not quit or have mental disorders; Four weeks before the group participated in other clinical trials of anti-tumor drugs; According to the researcher's judgment, there are other comorbidities that seriously endanger the safety of the patient or affect the patient's completion of the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jilong Yang, M.D., Ph.D.
Organizational Affiliation
Tianjin Medical University Cancer Institute and Hospital
Official's Role
Study Chair
Facility Information:
Facility Name
Tianjin Medical University Cancer Hospital & Institute
City
Tianjin
State/Province
Tianjin
ZIP/Postal Code
300060
Country
China

12. IPD Sharing Statement

Plan to Share IPD
No

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Endostar Combined With Chemotherapy for Stage Ⅳ Soft Tissue Sarcoma

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