MGMT-NET: O6-methylguanine-DNA Methyltransferase (MGMT) Status in Neuroendocrine Tumors: Predictive Factor of Response to Alkylating Agents

Neuroendocrine Tumors Clinical Trial

— MGMT-NET  

Official title:

MGMT-NET: O6-methylguanine-DNA Methyltransferase (MGMT) Status in Neuroendocrine Tumors: Predictive Factor of Response to Alkylating Agents

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03217097
• Other study ID #: 69HCL17_0284
• Status: Completed
• Phase: N/A
• Start date: October 16, 2018
• Est. completion date: April 25, 2022

Study information

• Verified date: November 2022
• Source: Hospices Civils de Lyon
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Neuroendocrine tumors (NET) are rare but their incidence is growing. Alkylating agents (ALKY) are one of the main systemic treatments used, at least for advanced duodeno-pancreatic NETs, with a response rate of 30 to 40% and a median progression-free survival of 4 to 18 months. Chemotherapy is one of the few therapeutic weapons, along with everolimus, somatostatin analogs, and metabolic radiotherapy, for lung NETs, called typical and atypical carcinoids, even if the level of proof of efficacy for these treatments is lower than for duodeno-pancreatic NETs. Considering the available retrospective data, O6-Methylguanine-DNA methyltransferase (MGMT) appears to be a predictive factor of the response to ALKY. Oxaliplatin (OX) has demonstrated an interesting activity, with response rates between 17% and 30%. In a first retrospective study we showed that Gemox is effective in NET, and more recently that its activity is similar to that of ALKYs, but without being influenced by the MGMT status. Prospective studies are needed but our data suggests that ALKY should be offered first to patients with methylated MGMT tumors while Oxaliplatin-based chemotherapy should be offered first to patients with unmethylated MGMT tumors.

In this project, we wish to evaluate the contribution of the MGMT methylation, evaluated in the tumor, in predicting the Objective Response (OR) in patients treated with ALKY and to evaluate a treatment with alkylating agents versus Oxaliplatin in patients with a duodeno-pancreatic or lung or unknown primitive NET.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 116
• Est. completion date: April 25, 2022
• Est. primary completion date: January 31, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Age greater than or equal to 18 years;

• Patient presenting well-differentiated advanced grade 1-3 (locally/metastatic) duodeno-pancreatic or thoracic (lung or thymus) or unknown primitive NETs, not curable with surgery.

• Patients must have measurable disease using the RECIST v1.1 criteria;

• Indication for cytotoxic systemic chemotherapy validated by the dedicated Multidisciplinary Tumor Board;

• MRI or TAP CT scan with contrast agents within 4 weeks +/- 1 week before beginning of treatment;

• Tumor tissue available (fresh frozen or paraffin-embedded) in order to search for the methyl guanine methyltransferase (MGMT) status;

• Patients with childbearing potential should use effective contraception during the study and the following 6 months;

• Covered by a Healthcare System where applicable, and/or in compliance with the recommendations of the national laws in force relating to biomedical research;

• Subject able to understand and willing to sign a written informed consent document;

• Signed written informed consent obtained prior to any study-specific screening procedures.

Previous treatments such as surgery, radiofrequency ablation, transarterial liver embolization, somatostatin analogs, interferon, everolimus or other targeted therapy, peptide receptor radionuclide treatment (PRRT) and chemotherapy (platin-etoposide, folfiri, paclitaxel or docetaxel) are allowed.

Exclusion Criteria:

• Previous chemotherapy using Oxaliplatin or ALKY (streptozotocin, dacarbazin or temozolomide). Other chemotherapy (platin-etoposide, folfiri, paclitaxel or docetaxel) are allowed;

• Pregnant or breastfeeding;

• Men and women of childbearing age potential not using medically accepted contraceptive measures, as judged by the investigator;

• Contraindication to any drug contained in the chemotherapy regimen;

• Any significant disease which, in the investigator's opinion, excludes the patient from the study;

• Under any administrative or legal supervision.

Related Conditions & MeSH terms

• Neuroendocrine Tumors

Intervention

Drug:
• Oxaliplatin-based chemotherapy
The "oxaliplatin-based" group will receive gemox (gemcitabine-oxaliplatin, 1x/2 week); alternatively folfox (5 fluorouracil-leucovorin-oxaliplatin, 1x/2 week) or capox (capecitabine-oxaliplatin, 1x/3 week).
• Alkylating-based chemotherapy
The "alkylating-based" group will receive CapTem regimen (capecitabine and temozolomide, /4 week), alternatively LV5FU2 (folinic acid-5 fluorouracil)-dacarbazine (1x/2 week) or LV5FU2 (folinic acid-5-fluorouracil)-streptozotocine (1x/2 week).

Locations

Country	Name	City	State
France	Hôpital Sud - CHU Amiens	Amiens
France	CHU d'Angers	Angers
France	Hôpital Estaing, CHU de Clermont-Ferrand	Clermont-Ferrand
France	Hôpital Beaujon - APHP	Clichy
France	Hôpital François Mitterrand - CHU Dijon Bourgogne	Dijon
France	Centre Oscar Lambret	Lille
France	Hôpital Claude Hurriet - CHRU Lille	Lille
France	Hôpital Edouard Herriot - Hospices Civils de Lyon	Lyon
France	Hôpital Privé Jean Mermoz	Lyon
France	Institut Paoli Calmettes	Marseille
France	Hôpital Cochin - APHP	Paris
France	Hôpital Saint Louis - APHP	Paris
France	CH Annecy Genevois	Pringy
France	Hôpital Robert Debré - CHU Reims	Reims
France	Hôpital Nord - CHU Saint Etienne	Saint-Priest-en-Jarez
France	Institut de Cancérologie de la Loire	Saint-Priest-en-Jarez
France	Hôpital Rangueil - CHU Toulouse	Toulouse
France	Hôpital Trousseau - CHU Tours	Tours
France	Institut Gustave Roussy	Villejuif

Sponsors (1)

Lead Sponsor	Collaborator
Hospices Civils de Lyon

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Objective Response (OR) in patients treated with alkylating-based chemotherapy	Objective Response (OR) in NETs patients treated with alkylating-based chemotherapy according to O6-Methyl guanine methyltransferase (MGMT) methylation status. The evaluation of OR is evaluation of complete response (CR) or partial response (PR) assessed by CT scan TAP or MRI with injection using the RECIST v1.1 criteria by centralized reading carried out by an expert radiologist blinded to the results of the MGMT methylation (methylated or un-methylated).	3 months
Secondary	Objective Response (OR) in patients treated with oxaliplatin-based chemotherapy	Objective Response (OR) in NETs patients treated with oxaliplatin-based chemotherapy according to O6-Methyl guanine methyltransferase (MGMT) methylation status. The evaluation of OR is evaluation of complete response (CR) or partial response (PR) assessed by CT scan TAP or MRI with injection using the RECIST v1.1 criteria by centralized reading carried out by an expert radiologist blinded to the results of the MGMT methylation (methylated or un-methylated).	3 months
Secondary	Progression Free Survival (PFS) in patients treated with alkylating-based chemotherapy	Progression Free Survival (PFS) in patients treated with alkylating-based chemotherapy according to MGMT methylation status. Progression Free Survival (PFS) is defined as the time from random assignment in a clinical trial to disease progression (assessed by CT scan TAP or MRI with injection, using the RECIST v1.1 criteria by centralized reading carried out by an expert radiologist blinded to the results of the MGMT methylation) or death from any cause.	3 months
Secondary	Progression Free Survival (PFS) in patients treated with oxaliplatin-based chemotherapy	Progression Free Survival (PFS) in patients treated with oxaliplatin-based chemotherapy according to MGMT methylation status. Progression Free Survival (PFS) is defined as the time from random assignment in a clinical trial to disease progression (assessed by CT scan TAP or MRI with injection, using the RECIST v1.1 criteria by centralized reading carried out by an expert radiologist blinded to the results of the MGMT methylation) or death from any cause.	3 months
Secondary	Overall Survival (OS) in patients treated with alkylating-based chemotherapy	Overall Survival (OS) in patients treated with alkylating-based chemotherapy according to MGMT methylation status. Overall Survival (OS) is defined as the time from random assignment to the date of death due to any cause, or to the date of censoring at the last time the subject was known to be alive in intention-to-treat populations	3 months
Secondary	Overall Survival (OS) in patients treated with oxaliplatin-based chemotherapy	Overall Survival (OS) in patients treated with oxaliplatin-based chemotherapy according to MGMT methylation status. Overall Survival (OS) is defined as the time from random assignment to the date of death due to any cause, or to the date of censoring at the last time the subject was known to be alive in intention-to-treat populations	3 months
Secondary	Objective Response (OR) assessed by immunochemistry on tissue	Objective Response (OR) at 3 months assessed by RECIST v1.1 criteria in patients with unmethylated MGMT NETs and in patients with methylated MGMT NETs evaluated with immunochemistry (IHC) on tissue	3 months