Clinical trial NCT05066555: Circulating Tumor DNA Genotyping for Biological Monitoring of Patients Treated in the FIL-Rouge Clinical Trial
Official title: Circulating Tumor DNA Genotyping for Biological Monitoring of Patients with Advanced-stage Classical HL Receiving Upfront ABVD-based Chemotherapy. an Ancillary Study to the FIL-Rouge Phase III Trial
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Hodgkin Lymphoma
Keywords: Hodgkin Lymphoma
ABVD treatment
ancillary
ctDNA
cHL
FIL-Rouge
PFS
Response Rate
Lead sponsor: Fondazione Italiana Linfomi - ETS
Sponsor class: OTHER
First posted: 2021-10-04
Enrollment: 100
Sex: ALL
Minimum age (years): 18
Maximum age (years): 60
Standard ages: ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Eligibility criteria for participation in this study require:

* Enrollment in the FIL-Rouge clinical trial;
* Evidence of signed informed consent for the biological FIL-RougeBIO study.

Brief summary: Prospective, multicenter, non-interventional, biological study ancillary to FIL-Rouge clinical trial (NCT03159897) enrolling patients affected by Advanced-stage Hodgkin Lymphoma, ABVD-based upfront treatment in 19 centers in Italy part of Fondazione Italiana Linfomi.

Detailed description: The FIL-Rouge design provides an ideal environment for validating the liquid biopsy in Classical Hodgkin lymphoma (cHL), since one arm of the study will utilize a PET/CT-adapted strategy (Positron Emission Tomography/Computed Tomography)for treatment, while the second arm will be devoid of any PET/CT-adaptation of therapy. Also, estimating prospectively differences in residual disease between the two study arms of the FIL-Rouge will provide an important biologic tool to validate the concept of dose-intensification within the ABVD therapeutic platform.

This study aims at the prospective validation of the concept of the liquid biopsy as a biomarker for disease response assessment in cHL. The patients enrolled in the FIL-Rouge clinical trial at the centers participating in this study and consenting to the biological study FIL-RougeBIO will be considered for this study. After providing written informed consent, relevant patients will be evaluated for detecting cancer gene mutations in ctDNA (Circulating Tumor DNA) for measuring residual disease. All clinical data useful for data analyses of this study will derive from the FIL-Rouge clinical trial.

Given the non-interventional design of the study, project participants will not have immediate potential benefits.The enrollment in FIL-RougeBIO will parallel the original protocol until reaching the 500 programmed patients. The results of this study could benefit future patients with the same condition.

Eligibility criteria: Inclusion Criteria: FIL ROUGE INCLUSION CRITERIA

* Histologically confirmed classical HL
* Previously untreated disease
* Age 18-60 years
* Ann Arbor stage IIB with extranodal involvement and/or bulk, III and IV
* At least one target PET-avid bidimensionally assessable lesion
* Eastern Cooperative Oncology Group (ECOG) performance status (PS) \<= 2
* Adequate organ and marrow function as defined below:

  * Absolute neutrophil count \>1,0 x109/L, platelets \>75 x109/L
  * Total bilirubin \<2 mg/dl without a pattern consistent with Gilbert's syndrome
  * Aspartate Transaminase and Alanine Transaminase (AST/ALT) \<3 X institutional Upper Limits of Normality (ULN)
  * Creatinine within normal institutional limits or creatinine clearance \>50 mL/min/1.73 m2
* Females of childbearing must have a negative pregnancy test under medical supervision even if patients had been using effective contraception
* Life expectancy \> 6 months
* Able to adhere to the study visit schedule and other protocol requirements
* Signed (or legally acceptable representatives must sign) informed consent indicating that patients understand the purpose of and procedures required for the study and are willing to participate in the study.
* Access to PET-CT (Positron Emission Tomography/Computed Tomography) scans facilities qualified by FIL

Exclusion Criteria: FIL ROUGE EXCLUSION CRITERIA

* Nodular Lymphocyte Predominant HL
* Ann Arbor stage IIB without extranodal involvement and/or mediastinal bulky
* Prior chemotherapy or radiation therapy
* Pregnant or lactating females
* Known hypertension, cardiac arrhythmia, conduction abnormalities, ischemic cardiopathy, left ventricular hypertrophy or left ventricular ejection fraction (LVEF) ≤50% at echocardiography.
* Abnormal QTc interval prolonged (\>450 msec in males; \>470 msec in women)
* Diffusion lung capacity for CO (DLCO)and/or Forced expiratory volume in the 1st second (FEV1) tests \<50% of predicted not due to mediastinal compression or parenchymal lymphoma
* Known cerebral or meningeal disease (HL or any other etiology)
* Prior history of malignancies unless the patient has been free of the disease for five years. Exceptions include the following: basal cells carcinoma of the skin, squamous cell carcinoma of the skin, carcinoma in situ of the cervix, carcinoma in situ of the breast and prostate cancer with the TNM stage of T1a or T1b
* Uncontrolled infectious disease
* Human immunodeficiency virus (HIV) positivity or active infectious A, B or C hepatitis. HBsAg-negative patients with anti-HBc (Hepatitis B core) antibody and can be enrolled provided that Hepatitis B Virus (HBV)-DNA are negative and that antiviral treatment with nucleos(t)ide analogs is provided (Lamivudine)
* Uncompensated diabetes
* Refusal of adequate contraception
* Any medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with the completion of treatment.

Primary outcomes:
measure: Complete Response Rate (CRR)
timeFrame: The endpoint will be assessed from the beginning of the study up to 76 months
Secondary outcomes:
measure: Diagnostic accuracy of Circulating tumor DNA (ctDNA) analysis versus interim PET/CT (Positron Emission Tomography/Computed Tomography)
timeFrame: The endpoint will be assessed from the beginning of the study up to 76 months
measure: Progression Free Survival (PFS) with at least three years of follow up
timeFrame: The endpoint will be assessed from the beginning of the study up to 76 months
Other outcomes:
Locations:
city: Avellino
country: Italy
facility: Azienda Ospedaliera S.Giuseppe Moscati - S.C. Ematologia e Trapianto emopoietico
city: Bari
country: Italy
facility: IRCCS Istituto Tumori Giovanni Paolo II - U.O.C Ematologia
city: Brescia
country: Italy
facility: ASST Spedali Civili di Brescia - Ematologia
city: Milano
country: Italy
facility: ASST Grande Ospedale Metropolitano Niguarda - SC Ematologia
city: Napoli
country: Italy
facility: Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale - UOC Ematologia Oncologica
city: Pagani
country: Italy
facility: Presidio ospedaliero "A. TORTORA" - U.O. Onco-ematologia
city: Palermo
country: Italy
facility: A.O. Ospedali Riuniti Villa Sofia-Cervello - Divisione di Ematologia
city: Pavia
country: Italy
facility: IRCCS Policlinico S. Matteo di Pavia - Div. di Ematologia
city: Perugia
country: Italy
facility: Ospedale S. Maria della Misericordia - Ematologia
city: Pescara
country: Italy
facility: P.O. Spirito Santo di Pescara - UOS Dipartimentale - Centro di diagnosi e Terapia dei linfomi
city: Rimini
country: Italy
facility: Ospedale degli Infermi di Rimini - U.O. di Ematologia
city: Rozzano
country: Italy
facility: Istituto Clinico Humanitas - U.O. Ematologia
city: Torino
country: Italy
facility: A.O.U. Citta della Salute e della Scienza di Torino - S.C.Ematologia
Study officials:
affiliation: Dipartimento di Ematologia, Istituto Nazionale Tumori, Fondazione Pascale, IRCCS, Napoli, Italy
name: Antonio Pinto, MD
role: PRINCIPAL_INVESTIGATOR
References: