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Second Line Therapy in Advanced Biliary Tract Cancer (BIT-2)

Primary Purpose

Biliary Tract Cancer

Status
Completed
Phase
Phase 2
Locations
Italy
Study Type
Interventional
Intervention
capecitabine and mitomycin
Capecitabine
Sponsored by
IRCCS San Raffaele
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Biliary Tract Cancer focused on measuring biliary tract cancer, advanced disease, chemotherapy

Eligibility Criteria

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

Inclusion Criteria:

  1. Signed and dated IRB/IEC-approved Informed Consent.
  2. Cytological or histological diagnosis of locally advanced or metastatic adenocarcinoma of the biliary tract (Ampulla of Vater, gallbladder, intra or extra-hepatic biliary ducts).
  3. Disease progressing after first-line chemotherapy with gemcitabine and platinum analogs (only one prior systemic therapy allowed).
  4. Age 18-75 years
  5. Karnofsky Performance Status > 50%
  6. Estimated life expectancy of at least 3 months.
  7. Negative pregnancy test (if female in reproductive years).
  8. Adequate bone marrow, liver and kidney function: leukocyte > 3500/mm3; absolute neutrophil count (ANC) > 1500/mm3; platelet count > 100000/mm3; hemoglobin > 10 g/dl; creatinine < 1.5 mg/dL; total bilirubin ≤ 1.5 x upper limit of normal range (ULN); SGOT e SGPT ≤ 2.5 ULN
  9. At the time of start of treatment, at least 2 weeks must have elapsed since completion of prior chemotherapy, minor surgery and radiotherapy (provided that no more than 25% of bone marrow reserve has been irradiated).
  10. Resolution of all acute toxic effects of any prior chemotherapy, surgery or radiotherapy to NCI CTC (Version 4.03) grade ≤ 1 for hematologic toxicities and ≤ 2 for non hematologic toxicities, with the exception of alopecia.
  11. Able and willing to comply with scheduled visits, therapy plans, and laboratory tests required in this protocol.

Exclusion Criteria:

  1. Previous or concurrent malignancies at other sites with the exception of surgically cured carcinoma in-site of the cervix and basal or squamous cell carcinoma of the skin and of other neoplasm without evidence of disease at least from 5 years.
  2. Known brain metastases.
  3. Previous second-line or adjuvant treatment.
  4. Concurrent treatment with other experimental drugs.
  5. Clinically significant cardiovascular disease (including myocardial infarction, unstable angina, symptomatic congestive heart failure, cardiac arrhythmia) ≤1 year prior to dosing.
  6. Clinically significant disease including: Cerebral Vascular Accident; other serious underlying medical condition(s) which could impair the ability of the patient to participate in the study.
  7. History of interstitial lung disease (eg, pneumonia or pulmonary fibrosis) or evidence of interstitial lung disease on baseline chest CT scan
  8. Known positive tests for human immunodeficiency virus (HIV) infection, active hepatitis B or hepatitis C
  9. Subject who is pregnant or breast feeding
  10. Woman or man of child-bearing potential not consenting to use adequate contraceptive precautions ie. double barrier contraceptive methods (e.g., diaphragm plus condom), or abstinence during the course of the study and for 6 months after the last study drug administration for women, and 1 month for men
  11. Presence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule

Sites / Locations

  • ASUR zona territoriale N. 6 FABRIANO
  • Fondazione Istituto San Raffaele G. Giglio
  • Azienda Ospedaliero Universitaria Ospedali Riuniti Umberto I - G.M. Lancisi - G Salesi
  • A.O. Ospedali Riuniti
  • Azienda Ospedaliero-Universitaria Policlinico S. Orsola-Malpighi
  • Fondazione Piemontese Per la Ricerca sul Cancro
  • Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi
  • Ospedale San Raffaele
  • Istituto Oncologico Veneto I.R.C.C.S.
  • Azienda Ospedaliero-Universitaria Pisana
  • Azienda Ospedaliera Regionale San Carlo
  • Istituto Nazionale dei Tumori Regina Elena
  • Ospedale Generale Provinciale
  • Azienda Ospedaliera Universitaria San Giovanni Battista di Torino
  • Azienda Ospedaliero Universitaria Santa Maria della Misericordia
  • Azienda Ospedaliera Universitaria Integrata

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

capecitabine

capecitabine plus mitomycin

Arm Description

oral capecitabine 2000 mg/m2 day 1-14 in two divided doses taken with food

oral capecitabine 2000 mg/m2 day 1-14 in two divided doses taken with food plus bolus IV infusion Mitomycin 6 mg/m2 day 1

Outcomes

Primary Outcome Measures

Progression Free Survival (PFS)
This is a multi-centre phase II, randomized study. Patients will be stratified based on disease site and stage. For the purpose of the study, PFS-6 rate will be considered the primary outcome measure. The maximum PFS-6 rate of low clinical interest is 15% and the minimum PFS-6 rate of interest is set to 35%. The target enrollment, using a type I error of 5% and a test power of 90%, will be estimated to be 26 patients per treatment arm. The regimen will be considered active if at least 8 out of first 26 evaluable patients are PFS-6.

Secondary Outcome Measures

Overall Survival (OS)
the time from the date of randomization to the date of death from any cause All patients will be followed for survival every 3 months up to 2 years after the end of treatment

Full Information

First Posted
February 3, 2012
Last Updated
February 24, 2016
Sponsor
IRCCS San Raffaele
Collaborators
Regione Lombardia
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1. Study Identification

Unique Protocol Identification Number
NCT01530503
Brief Title
Second Line Therapy in Advanced Biliary Tract Cancer
Acronym
BIT-2
Official Title
A Randomized Phase II Trial of Second Line Therapy in Advanced Biliary Tract Cancer: Capecitabine or Capecitabine Plus Mitomycin C
Study Type
Interventional

2. Study Status

Record Verification Date
February 2016
Overall Recruitment Status
Completed
Study Start Date
November 2011 (undefined)
Primary Completion Date
October 2013 (Actual)
Study Completion Date
October 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
IRCCS San Raffaele
Collaborators
Regione Lombardia

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to assess the therapeutic activity of capecitabine alone or in combination with mitomycin C as second-line therapy in patients with advanced/metastatic biliary adenocarcinoma in progression after gemcitabine and platinum compounds
Detailed Description
Biliary tract adenocarcinoma is an uncommon tumor with a poor prognosis and a median overall survival (OS) rarely exceeding 6 months. Less than 25% of patients are resectable at diagnosis and, even in this subset of patients, relapse rate is high. An improvement of OS and quality of life for patients receiving chemotherapy versus best supportive care was demonstrated in advanced disease. Recently, cisplatin and gemcitabine combination was identified as the new standard first-line chemotherapy, yielding a median progression free survival (PFS) and median OS of 8.5 and 11.7 months, respectively. Despite the outcome improvement, disease progression is a constant and approximately half of patients failing upfront treatment has a good performance status and are willing to undergo further treatment. No standard salvage chemotherapy regimen has been identified. Clinical trials are difficult to perform due to the rarity and heterogeneity of these tumors and to the lack of interest of the pharmaceutical industry. Fluoropyrimidines and mitomycin C have been considered the basis of palliative chemotherapy for a long time. The investigators decided to explore the activity, in terms of PFS, of capecitabine alone or combined with mitomycin C as second-line therapy in patients with pathological diagnosis of advanced biliary tract cancer and progressive disease after gemcitabine and cisplatin, by means of an open label randomized multicentric phase II trial.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Biliary Tract Cancer
Keywords
biliary tract cancer, advanced disease, chemotherapy

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
capecitabine
Arm Type
Experimental
Arm Description
oral capecitabine 2000 mg/m2 day 1-14 in two divided doses taken with food
Arm Title
capecitabine plus mitomycin
Arm Type
Experimental
Arm Description
oral capecitabine 2000 mg/m2 day 1-14 in two divided doses taken with food plus bolus IV infusion Mitomycin 6 mg/m2 day 1
Intervention Type
Drug
Intervention Name(s)
capecitabine and mitomycin
Other Intervention Name(s)
capecitabine, mitomycin
Intervention Description
oral capecitabine 2000 mg/m2 day 1-14 in two divided doses taken with food plus bolus IV infusion mitomycin C 6 mg/m2 day 1. Cycles will be repeated in both arms every 3 weeks till progression, unacceptable toxicity, medical decision or patient's refusal or for a maximum of 6 months
Intervention Type
Drug
Intervention Name(s)
Capecitabine
Intervention Description
oral capecitabine 2000 mg/m2 day 1-14 in two divided doses taken with food. Cycles will be repeated in both arms every 3 weeks till progression, unacceptable toxicity, medical decision or patient's refusal or for a maximum of 6 months
Primary Outcome Measure Information:
Title
Progression Free Survival (PFS)
Description
This is a multi-centre phase II, randomized study. Patients will be stratified based on disease site and stage. For the purpose of the study, PFS-6 rate will be considered the primary outcome measure. The maximum PFS-6 rate of low clinical interest is 15% and the minimum PFS-6 rate of interest is set to 35%. The target enrollment, using a type I error of 5% and a test power of 90%, will be estimated to be 26 patients per treatment arm. The regimen will be considered active if at least 8 out of first 26 evaluable patients are PFS-6.
Time Frame
6 month PFS
Secondary Outcome Measure Information:
Title
Overall Survival (OS)
Description
the time from the date of randomization to the date of death from any cause All patients will be followed for survival every 3 months up to 2 years after the end of treatment
Time Frame
median OS (up to 2 years)

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: Signed and dated IRB/IEC-approved Informed Consent. Cytological or histological diagnosis of locally advanced or metastatic adenocarcinoma of the biliary tract (Ampulla of Vater, gallbladder, intra or extra-hepatic biliary ducts). Disease progressing after first-line chemotherapy with gemcitabine and platinum analogs (only one prior systemic therapy allowed). Age 18-75 years Karnofsky Performance Status > 50% Estimated life expectancy of at least 3 months. Negative pregnancy test (if female in reproductive years). Adequate bone marrow, liver and kidney function: leukocyte > 3500/mm3; absolute neutrophil count (ANC) > 1500/mm3; platelet count > 100000/mm3; hemoglobin > 10 g/dl; creatinine < 1.5 mg/dL; total bilirubin ≤ 1.5 x upper limit of normal range (ULN); SGOT e SGPT ≤ 2.5 ULN At the time of start of treatment, at least 2 weeks must have elapsed since completion of prior chemotherapy, minor surgery and radiotherapy (provided that no more than 25% of bone marrow reserve has been irradiated). Resolution of all acute toxic effects of any prior chemotherapy, surgery or radiotherapy to NCI CTC (Version 4.03) grade ≤ 1 for hematologic toxicities and ≤ 2 for non hematologic toxicities, with the exception of alopecia. Able and willing to comply with scheduled visits, therapy plans, and laboratory tests required in this protocol. Exclusion Criteria: Previous or concurrent malignancies at other sites with the exception of surgically cured carcinoma in-site of the cervix and basal or squamous cell carcinoma of the skin and of other neoplasm without evidence of disease at least from 5 years. Known brain metastases. Previous second-line or adjuvant treatment. Concurrent treatment with other experimental drugs. Clinically significant cardiovascular disease (including myocardial infarction, unstable angina, symptomatic congestive heart failure, cardiac arrhythmia) ≤1 year prior to dosing. Clinically significant disease including: Cerebral Vascular Accident; other serious underlying medical condition(s) which could impair the ability of the patient to participate in the study. History of interstitial lung disease (eg, pneumonia or pulmonary fibrosis) or evidence of interstitial lung disease on baseline chest CT scan Known positive tests for human immunodeficiency virus (HIV) infection, active hepatitis B or hepatitis C Subject who is pregnant or breast feeding Woman or man of child-bearing potential not consenting to use adequate contraceptive precautions ie. double barrier contraceptive methods (e.g., diaphragm plus condom), or abstinence during the course of the study and for 6 months after the last study drug administration for women, and 1 month for men Presence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
stefano cereda, MD
Organizational Affiliation
Ospedale San Raffaele (Milan, Italy)
Official's Role
Principal Investigator
Facility Information:
Facility Name
ASUR zona territoriale N. 6 FABRIANO
City
Fabriano
State/Province
Ancona
Country
Italy
Facility Name
Fondazione Istituto San Raffaele G. Giglio
City
Cefalù
State/Province
Palermo
Country
Italy
Facility Name
Azienda Ospedaliero Universitaria Ospedali Riuniti Umberto I - G.M. Lancisi - G Salesi
City
Ancona
Country
Italy
Facility Name
A.O. Ospedali Riuniti
City
Bergamo
Country
Italy
Facility Name
Azienda Ospedaliero-Universitaria Policlinico S. Orsola-Malpighi
City
Bologna
Country
Italy
Facility Name
Fondazione Piemontese Per la Ricerca sul Cancro
City
Candiolo (Torino)
ZIP/Postal Code
10060
Country
Italy
Facility Name
Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi
City
Catania
Country
Italy
Facility Name
Ospedale San Raffaele
City
Milan
ZIP/Postal Code
20132
Country
Italy
Facility Name
Istituto Oncologico Veneto I.R.C.C.S.
City
Padova
Country
Italy
Facility Name
Azienda Ospedaliero-Universitaria Pisana
City
Pisa
Country
Italy
Facility Name
Azienda Ospedaliera Regionale San Carlo
City
Potenza
Country
Italy
Facility Name
Istituto Nazionale dei Tumori Regina Elena
City
Roma
Country
Italy
Facility Name
Ospedale Generale Provinciale
City
Saronno (VA)
Country
Italy
Facility Name
Azienda Ospedaliera Universitaria San Giovanni Battista di Torino
City
Torino
Country
Italy
Facility Name
Azienda Ospedaliero Universitaria Santa Maria della Misericordia
City
Udine
ZIP/Postal Code
33100
Country
Italy
Facility Name
Azienda Ospedaliera Universitaria Integrata
City
Verona
Country
Italy

12. IPD Sharing Statement

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Second Line Therapy in Advanced Biliary Tract Cancer

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