Clinical trial NCT02730416: Combination Chemotherapy With Nintedanib / Placebo in Endometrial Cancer
Official title: ENGOT-EN1/FANDANGO: A Randomized Phase II Trial of First-line Combination Chemotherapy With Nintedanib / Placebo for Patients With Advanced or Recurrent Endometrial Cancer
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Endometrial Cancer
Lead sponsor: Nordic Society of Gynaecological Oncology - Clinical Trials Unit
Sponsor class: OTHER
Collaborators: name: North Eastern German Society of Gynaecological Oncology
name: Belgian Gynaecological Oncology Group
name: ARCAGY/ GINECO GROUP
First posted: 2016-04-06
Enrollment: 146
Sex: FEMALE
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This study will evaluate the role of addition of an anti-angiogenic agent (Nintedanib/placebo) to conventional combination chemotherapy as concomitant and maintenance treatment in primary advanced or with first relapse of endometrial cancer.

Detailed description: This multicenter, prospective, double-blind, placebo-controlled, randomised phase 2 study is evaluating combination chemotherapy with nintedanib in patients with primary advanced stage (3C2 \& 4), or with first relapse of endometrial cancer.

Patients are stratified according to:

1. Stage of disease (stage 3C2 vs. stage 4 vs. recurrent disease)
2. Prior adjuvant chemotherapy (yes/no)
3. Disease status (Measurable disease vs. non-measurable /RECIST 1.1)

Patients are randomized to one of the two treatment arms 1:1 randomization:

* Arm A: Paclitaxel and Carboplatin (6 courses) and Nintedanib (until PD). (Experimental arm)
* Arm B: Paclitaxel and Carboplatin (6 courses) and Placebo (until PD) (Control Arm)

Primary endpoint is PFS. 148 patients to be enrolled.

Eligibility criteria: Inclusion Criteria:

1. Histological confirmed endometrial cancer. (FIGO 2009)

   1. Stage 3C 2
   2. Stage 4 A \& B
   3. Relapsed after adjuvant therapy for stage 1-3 disease
2. Patients may have undergone primary surgery.
3. Patients may have received adjuvant chemotherapy for stage 1 - 3.
4. Patients may have received vaginal brachytherapy
5. Patients may have received external beam radiotherapy. Patients who are to be enrolled for stage 3C2 diseases are allowed to receive external beam radiotherapy prior to trial entry.
6. Patients may have received hormonal treatment
7. Patients must have measurable disease or non-measurable disease on CT scan according to RECIST 1.1 outside irradiated field. For stage 3C2 disease patients without measureable or non-measureable disease are accepted.
8. Patients must give informed consent
9. ECOG performance status of 0 -1
10. Patients must have an adequate organ function
11. Life expectancy of at least 12 weeks
12. Patients must be fit to receive combination chemotherapy
13. Patient's age \>18 years
14. Patients with preserved reproductive capacity must have a negative pregnancy test (β-HCG test in urine or serum) prior to commencing study treatment

Exclusion Criteria:

1. Sarcomas, small cell carcinoma with neuroendocrine differentiation or non-epithelial cancers.
2. Concurrent cancer therapy
3. Previous Chemotherapy for stage 4 disease or for relapsed disease.
4. Previous treatment with anti-angiogenic/anti VEGF therapy including nintedanib.
5. Concurrent treatment with an investigational agent or participation in another clinical trial.
6. Treatment within 28 days prior to randomisation with any investigational drug, radiotherapy, immunotherapy, chemotherapy, hormonal therapy or biological therapy. Palliative radiotherapy may be permitted for symptomatic control of pain from bone metastases in extremities, provided that the radiotherapy does not involve target lesions, and the reason for the radiotherapy does not reflect progressive disease.
7. Major injuries or surgery within the past 21 days prior to start of study treatment with incomplete wound healing and/or planned surgery during the on-treatment study period.
8. Relapse within six months after adjuvant chemotherapy (treatment-free interval \< 182 days).
9. Previous malignant disease, except patients with other malignant disease, for which the patient has been disease-free for at least three years. Concurrent other malignant disease except for curatively treated carcinoma in situ of the cervix or basal cell carcinoma of the skin.
10. Active infection or other serious underlying medical condition, which might prevent the patient from receiving treatment or to be followed.
11. Evidence of significant medical illness, abnormal laboratory finding or psychiatric illness/social situation that would, in the Investigator's judgement, make the patient inappropriate for this study.
12. Known contraindications to VEGF directed therapy Target Disease Exceptions
13. Known uncontrolled hypersensitivity to the investigational drugs.
14. History of major thromboembolic event defined as:

    * Uncontrolled pulmonary embolism (PE)
    * Deep venous thrombosis (DVT)
    * Other related conditions, though patients with stable therapeutic anticoagulation for more than three months prior randomization are eligible for this study.
15. History of a cerebral vascular accident, transient ischemic attack or subarachnoid haemorrhage within the past 3 months.
16. History of clinically significant haemorrhage in the past 3 months.
17. Radiotherapy to the target lesion within the past 3 months prior to baseline imaging
18. Persistant grade 3 or 4 toxicity from previous chemotherapy and/or radiotherapy, except alopecia. Patients with ongoing ≥ Grade 2 neuropathy are to be excluded.
19. Active brain metastases (e.g. stable for \<4 weeks, no adequate previous treatment with radiotherapy, symptomatic, requiring treatment with anti-convulsants; dexamethasone therapy will be allowed if administered as stable dose for at least one month before randomisation).
20. Leptomeningeal disease
21. Significant cardiovascular diseases ( i.e. uncontrolled hypertension, unstable angina, history of infarction within the past 12 months prior to start of study treatment, congestive heart failure \> NYHA II, serious cardiac arrhythmia, pericardial effusion) See Appendix 12.
22. Pregnancy or breastfeeding. Patients with preserved reproductive capacity, unwilling to use a medically acceptable method of contraception for the duration of the trial and for 3 months afterwards.
23. Radiographic evidence of cavitating or necrotic tumours with invasion of adjacent major blood vessels.
24. Active or chronic hepatitis C and/or B infection
25. Known hypersensitivity to the trial drugs, or to their excipients.
26. Gastrointestinal disorders or abnormalities that would interfere with absorption of the study drug
27. Unable or unwilling to swallow tablets/capsules

Primary outcomes:
measure: PFS: Difference in months of Median Progression-Free Survival in experimental arm versus comparator arm
timeFrame: 36 months
Secondary outcomes:
measure: PFS in the sub-populations as described under stratification factors
timeFrame: 32 months
measure: PFS after consecutive treatment (PFS2). To be measured (in months) and reported
timeFrame: 48 months
measure: Disease Specific Survival (DSS)
timeFrame: 48 months
measure: TSST (Time to Second Subsequent Therapy)
timeFrame: 48 months
measure: TFST (Time to First Subsequent Therapy)
timeFrame: 48 months
measure: Overall Survival (OS)
timeFrame: 48 months
measure: Response Rate (RR).
timeFrame: 32 months
measure: Disease Control Rate (DCR)
timeFrame: 32 months
measure: Patient Related Outcomes (PROs)
timeFrame: 48 months
measure: Number of patients with Grade 3 through Grade 5 Adverse Events that are related to study drug.
timeFrame: 36 months
measure: Compliance in the two treatment arms
timeFrame: 32 months
Other outcomes:
Locations:
city: Aalst
country: Belgium
facility: Onze Lieve Vrouwziekenhuis
city: Bruxelles
country: Belgium
facility: Cliniques universitaires Saint-Luc
city: Edegem
country: Belgium
facility: Antwerp University Hospital
city: Gent
country: Belgium
facility: Ghent University Hospital
city: Leuven
country: Belgium
facility: University Hospitals Leuven
city: Odense
country: Denmark
facility: Odense Universitetshospital
state: Fyn
city: Aalborg
country: Denmark
facility: Aalborg Universitetshospital
state: Jylland
city: Vejle
country: Denmark
facility: Vejle Sygehus
state: Jylland
city: Copenhagen
country: Denmark
facility: Rigshospitalet
state: Sjaelland
city: Kuopio
country: Finland
facility: Kuopio University Hospital
city: Tampere
country: Finland
facility: Tampere University Hospital
city: Bordeaux
country: France
facility: Institute Bergonié
city: Caen
country: France
facility: Centre François Baclesse
city: Lille
country: France
facility: Centre Oscar Lambret
city: Lyon
country: France
facility: Léon Bérard Center
city: Marseille
country: France
facility: Institut Paoli Calmettes
city: Montpellier
country: France
facility: ICM (Cancer Institute of Montpellier)
city: Nice
country: France
facility: Centre Antoine Lacassagne
city: Paris
country: France
facility: Hospital Group Diaconesses Croix Saint-Simon
city: Plérin
country: France
facility: Private Hospital Of Côtes D'armor
city: Saint-Herblain
country: France
facility: Institut de Cancérologie de l'Ouest
city: Berlin
country: Germany
facility: Charité Campus Virchow Clinic
city: Chemnitz
country: Germany
facility: Klinik Chemnitz gGmbH
city: Dresden
country: Germany
facility: University Hospital Carl Gustav Carus Dresden
city: Essen
country: Germany
facility: Universitätsklinikum Essen
city: Essen
country: Germany
facility: Kliniken Essen Mitte
city: Frankfurt
country: Germany
facility: Center of Gynecology and Obstetrics
city: Hamburg
country: Germany
facility: Universitätsklinikum Hamburg-Eppendorf
city: Karlsruhe
country: Germany
facility: St. Vincentius-Kliniken gAG Frauenklinik mit Hebammenlehranstalt
city: Mainz
country: Germany
facility: Universitätsfrauenklinik Mainz
city: Rostock
country: Germany
facility: Universitätsfrauenklinik am Klinikum Südstadt Rostock
city: Ulm
country: Germany
facility: Universitätsfrauenklinik Ulm
city: Oslo
country: Norway
facility: Oslo University Hospital
city: Linköping
country: Sweden
facility: Linköping University Hospital
city: Lund
country: Sweden
facility: Skåne University Hospital
city: Stockholm
country: Sweden
facility: Karolinska University Hospital
city: Uppsala
country: Sweden
facility: Uppsala University Hospital
Study officials:
affiliation: NSGO
name: Mansoor R Mirza, MD
role: STUDY_CHAIR
References: