Nal-IRI With 5-fluorouracil (5-FU) and Leucovorin or Gemcitabine Plus Cisplatin in Advanced Biliary-tract Cancer

Biliary Tract Cancer Clinical Trial

— NIFE  

Official title:

Nal-IRI With 5-fluorouracil (5-FU) and Leucovorin or Gemcitabine Plus Cisplatin in Advanced Biliary-tract Cancer - An Open Label, Non-comparative, Randomized, Multicenter Phase II Trial

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT03044587
• Other study ID #: AIO-YMO/HEP-0315
• Secondary ID: 2016-002467-34O1
• Status: Active, not recruiting
• Phase: Phase 2
• Start date: January 24, 2018
• Est. completion date: January 2025

Study information

• Verified date: June 2023
• Source: AIO-Studien-gGmbH
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

AIO-YMO/HEP-0315 (NIFE) is an open label, non-comparative, randomized, multicenter phase II trial

Description:

The primary objective is to determine whether a combination of 5-FU and nal-IRI prolongs progression-free survival in patients with locally advanced or metastatic adenocarcinoma of the biliary tract

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 93
• Est. completion date: January 2025
• Est. primary completion date: January 1, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Written informed consent incl. participation in translational research and any locally-required authorization (EU Data Privacy Directive in the EU) obtained from the subject prior to performing any protocol-related procedures, including screening evaluations

2. Age = 18 years at time of study entry

3. Histologically confirmed, non-resectable, locally advanced or metastatic adenocarcinoma of the intrahepatic or extrahepatic biliary tract

4. Protocol-specific staging guidelines have to be observed and non-resectability has to be confirmed by local tumor board

5. Measurable or assessable disease according to RECIST 1.1

6. ECOG performance status 0-1

7. Life expectancy of more than 3 months

8. If applicable, adequately treated biliary tract obstruction before study entry with total bilirubin concentration = 2 x ULN

9. Adequate blood count, liver-enzymes, and renal function:

• White blood cell count = 3.5 x 10^6/mL
• Platelet count = 100 x 10^9/L (>100,000 per mm3)
• AST (SGOT)/ALT (SGPT) = 5 x institutional upper limit of normal
• Serum Creatinine = 1.5 x ULN and a calculated glomerular filtration rate = 30 mL per minute

10. Patients not receiving therapeutic anticoagulation must have an INR < 1.5 ULN and PTT < 1.5 ULN within 7 days prior to randomization. The use of full dose anticoagulants is allowed as long as the INR or PTT is within therapeutic limits (according to the medical standard in the institution) and the patient has been on a stable dose for anticoagulants for at least three weeks at the time of randomization

11. No prior palliative chemotherapy for biliary tract cancer

12. No adjuvant treatment within 6 months prior to study entry

13. Subject is willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations including follow up.

Exclusion Criteria:

1. Active uncontrolled infection, chronic infectious diseases, immune deficiency syndromes

2. Premalignant hematologic disorders, e.g. myelodysplastic syndrome

3. Clinically significant cardiovascular disease (incl. myocardial infarction, unstable angina, symptomatic congestive heart failure, serious uncontrolled cardiac arrhythmia) within 6 months before enrollment

4. Prior (>5 years) or concurrent malignancy (other than biliary-tract cancer) which either progresses or requires active treatment. Exceptions are: basal cell cancer of the skin, pre-invasive cancer of the cervix, T1a or T1b prostate carcinoma, or superficial bladder tumor [Ta, Tis and T1].

5. Pre-existing lung disease

6. History or clinical evidence of CNS metastases Exceptions are: Subjects who have completed local therapy and who meet both of the

following criteria:

1. are asymptomatic and

2. have no requirement for steroids 6 weeks prior to start of study treatment. Screening with CNS imaging (CT or MRI) is required only if clinically indicated or if the subject has a history of CNS metastases

7. History of hypersensitivity to any of the study drugs or any of the constituents of the products

8. Allogeneic transplantation requiring immunosuppressive therapy or other major immunosuppressive therapy

9. Severe non-healing wounds, ulcers or bone fractions

10. Evidence of bleeding diathesis or coagulopathy

11. Major surgical procedures, except open biopsy, nor significant traumatic injury within 28 days prior to randomization, or anticipation of the need for major surgical procedure during the course of the study except for surgery of central intravenous line placement for chemotherapy administration.

12. Medication that is known to interfere with any of the agents applied in the trial.

13. Female subjects who are pregnant, breast-feeding or male or female patients of reproductive potential who are not employing an effective method of birth control (failure rate of less than 1% per year). [Acceptable methods of contraception are: implants, injectable contraceptives, combined oral contraceptives, intrauterine pessary (only hormonal devices), sexual abstinence or vasectomy of the partner]. Women of childbearing potential must have a negative pregnancy test (serum ß-HCG) at Screening.

14. Known Gilbert-Meulengracht syndrome

15. Known chronic hypoacusis, tinnitus or vertigo

16. Any condition or comorbidity that, in the opinion of the investigator, would interfere with evaluation of study treatment or interpretation of patient safety or study results

17. Participation in another clinical study with an investigational product during the last 30 days before inclusion or 7 half-lifes of previously used trial medication, whichever is of longer duration.

18. Previous enrollment or randomization in the present study (does not include screening failure).

19. Any other chemotherapy at study start

20. Involvement in the planning and/or conduct of the study

21. Patient who might be dependent on the sponsor, site or the investigator

22. Patient who has been incarcerated or involuntarily institutionalized by court order or by the authorities.

23. Patients who are unable to consent because they do not understand the nature, significance and implications of the clinical trial and therefore cannot form a rational intention in the light of the facts.

Related Conditions & MeSH terms

• Adenocarcinoma
• Adenocarcinoma Metastatic
• Adenocarcinoma of the Biliary Tract
• Adenocarinoma Locally Advanced
• Bile Duct Neoplasms
• Biliary Tract Cancer
• Biliary Tract Neoplasms
• Carcinoma
• Carcinoma, Ductal
• Extrahepatic Bile Duct Carcinoma
• Intrahepatic Bile Duct Carcinoma
• Non-Resectable Hepatocellular Carcinoma

Intervention

Drug:
• Arm NaI-IRI + 5-FU + Leucovorin (Arm A)
Nal-IRI (80 mg/m2 as a 1.5 hour infusion), 5-FU (2400 mg/m2 as 46 hour infusion) and Leucovorin (400 mg/m2 as 0.5 hour infusion) Cycle q2w
• Arm Cisplatin + Gemcitabine (Arm B)
Cisplatin (25 mg/m2 as 1 hour infusion on D1, D8) and Gemcitabine (1000 mg/m2 as 0.5 hour infusion on D1, D8) Cycle q3w

Locations

Country	Name	City	State
Germany	Universitätsklinikum Ulm	Ulm

Sponsors (3)

Lead Sponsor	Collaborator
AIO-Studien-gGmbH	Institut für Klinisch-Onkologische Forschung der Krankenhaus Nordwest GmbH, Servier

Country where clinical trial is conducted

Germany, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Exploratory biomarkers analysis	cfDNA exome sequencing, transcriptome, miRNA-arrays prior to and after start of treatment and upon progress	approx. 54 months
Other	Establishment of Predictive/Prognostic biomarker profiles for advanced cholangiocarcinoma		approx. 54 months
Other	Tumor Evolution under systemic therapy		approx. 54 months
Primary	Progression-free survival [PFS]		approx. 25 months
Secondary	Overall progression free survival according to RECIST 1.1	Response Evaluation Criteria in Solid Tumors (RECIST 1.1.)	approx. 54 months
Secondary	3-years overall survival	3-years overall survival	approx. 36 months
Secondary	Disease control rate according to RECIST 1.1		approx. 54 months
Secondary	Objective tumor response rate (ORR) according to RECIST 1.1	Proportion of patients with an objective response according to RECIST 1.1	approx. 54 months
Secondary	Toxicity/Safety according to CTC-AE-criteria		approx. 54 months
Secondary	Health related quality of life	EORTC QLQ-BIL21	approx. 54 months
Secondary	Health related quality of life	EORTC QLQ-C30	approx. 54 months
Secondary	Health related quality of life	Hospital Anxiety and Depression Scale (HADS-D)	approx. 54 months
Secondary	Retrospective correlation of resectability in accordance with a central surgical board compared to local surgical review	Tumor resectability in accordance with a retrospective central surgical board compared to local surgical review	approx. 54 months
Secondary	Retrospective central radiological review		approx. 54 months

External Links

•   AIO - Working Group for Medical Oncology from the German Cancer Society
•   AIO-Studien-gGmbH