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
About this trial
This is an interventional treatment trial for Neurofibroma
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
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
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
Learn more about this trial
Evaluation of Percutaneous Cryotherapy in the Treatment of Plexiform Neurofibromas and Unresectable Neurofibromas in Neurofibromatosis Type 1
We'll reach out to this number within 24 hrs