| E.1 Medical condition or disease under investigation |
| E.1.1 | Medical condition(s) being investigated |
| low and intermediate risk neuroblastoma |
| neuroblastoma a basso e intermedio rishio |
|
| E.1.1.1 | Medical condition in easily understood language |
| low and intermediate risk neuroblastoma |
| neuroblastoma a rischio basso e intermedio |
|
| E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
| MedDRA Classification |
| E.1.2 Medical condition or disease under investigation |
| E.1.2 | Version | 14.1 |
| E.1.2 | Level | PT |
| E.1.2 | Classification code | 10029260 |
| E.1.2 | Term | Neuroblastoma |
| E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
|
| E.1.3 | Condition being studied is a rare disease | Yes |
| E.2 Objective of the trial |
| E.2.1 | Main objective of the trial |
| To demonstrate through a randomisation between observation and chemotherapy that you can safely reduce treatment in a subgroup of L2 low risk patients (those without life threatening symptoms (LTS) and without any segmental chromosomal changes (SCA), i.e. study group 1) by giving less treatment than has been given historically while maintaining an excellent OS of 100%. |
| dimostrare che in pazienti con neuroblastoma a basso rischio, di stadio L2 secondo la stadiazione INRG, senza sintomi gravi e senza alterazioni cromosomiche segmentali (SCA) (gruppo terapeutico 1), è possibile ridurre l’entità del trattamento senza comprometterne l’andamento clinico, mantenendo l’eccellente sopravvivenza complessiva (SC) del 100%. Ciò attraverso una randomizzazione tra osservazione e un trattamento chemioterapico di entità inferiore rispetto a quello utilizzato storicamente. |
|
| E.2.2 | Secondary objectives of the trial |
| To maintain a 2 year EFS of at least 90% and an OS of at least 95% in L2 patients with LTS without SCA (study group 2) To maintain the 2 year EFS of 85% and an OS of at least 98% in Ms patients without SCA (study groups 4 and 5) To improve the 2 year EFS to at least 90% and maintain the OS of close to 100% in L2 patients with SCA (Study Group 3) and improve the 2 year EFS to over 70% in Ms patients with SCA (study group 6) To evaluate adherence to the protocol recommendations regarding LTS To reduce surgical morbidity by promoting strict adherence to IDRFs to determine surgical resectability To define the long term follow-up and natural history of the Stage L2 non-resected masses that have remained IDRF positive at the end of treatment (study groups 1-3). |
| § mantenere una EFS a 2 anni di almeno 90% ed una OS a 2 anni di almeno 95% in pazienti con neuroblastoma di stadio L2 con sintomi gravi ma senza SCA (gruppo terapeutico 2). mantenere una EFS di 85% a 2 anni ed una OS a 2 anni di almeno 98% in pazienti con neuroblastoma di stadio Ms senza SCA (gruppi terapeutici 4-5).§ migliorare la EFS a 2 anni almeno fino a 90% e mantenere la OS vicina al 100% in pazienti di stadio L2 con SCA (gruppo terapeutico 3) e migliorare la EFS a 2 anni a oltre 70% in pazienti di stadio Ms con SCA (gruppo terapeutico 6). § valutare l’aderenza alle raccomandazioni del protocollo riguardo ai sintomi gravi per la vita. § ridurre la morbilità chirurgica promuovendo una stretta aderenza ai “fattori di rischio definiti dall’imaging” nel determinare l’operabilità.§ definire il follow up a lungo termine e la storia naturale nei tumori di stadio L2 non operati |
|
| E.2.3 | Trial contains a sub-study | No |
| E.3 | Principal inclusion criteria |
| Inclusion criteria for the whole low risk group: informed consent and follow-up warranted; group assignment completed within 6 weeks from diagnosis; no prior chemotherapy or radiotherapy Biopsy proven neuroblastoma Tumour genomic profile obtained in a NRL according to guidelines MYCN non-amplified |
| · consenso informato e garanzia di follow-up; assegnazione del gruppo terapeutico entro 6 settimane dalla diagnosi; nessuna somministrazione di chemioterapia o radioterapia precedente· neuroblastoma accertato con diagnosi istologica· profilo genomico del tumore ottenuto in un laboratorio di riferimento nazionale· MYCN non amplificato |
|
| E.4 | Principal exclusion criteria |
| Diagnosis of ganglioneuroma or ganglioneuroblastoma intermixed |
| · Diagnosi di ganglioneuroma o di ganglioneuroblastoma intermixed |
|
| E.5 End points |
| E.5.1 | Primary end point(s) |
| To maintain a 2 year EFS of at least 90% and an OS of at least 95% in L2 patients with LTS without SCA (study group 2) To maintain the 2 year EFS of 85% and an OS of at least 98% in Ms patients without SCA (study groups 4 and 5) To improve the 2 year EFS to at least 90% and maintain the OS of close to 100% in L2 patients with SCA (Study Group 3) and improve the 2 year EFS to over 70% in Ms patients with SCA (study group 6) To evaluate adherence to the protocol recommendations regarding LTS To reduce surgical morbidity by promoting strict adherence to IDRFs to determine surgical resectability To define the long term follow-up and natural history of the Stage L2 non-resected masses that have remained IDRF positive at the end of treatment (study groups 1-3). |
| § dimostrare che in pazienti con neuroblastoma a basso rischio, di stadio L2 secondo la stadiazione INRG, senza sintomi gravi e senza alterazioni cromosomiche segmentali (SCA) (gruppo terapeutico 1), è possibile ridurre l’entità del trattamento senza comprometterne l’andamento clinico, mantenendo l’eccellente sopravvivenza complessiva (SC) del 100%. Ciò attraverso una randomizzazione tra osservazione e un trattamento chemioterapico di entità inferiore rispetto a quello utilizzato storicamente. |
|
| E.5.1.1 | Timepoint(s) of evaluation of this end point |
|
| E.5.2 | Secondary end point(s) |
| To maintain a 2 year EFS of at least 90% and an OS of at least 95% in L2 patients with LTS without SCA (study group 2) To maintain the 2 year EFS of 85% and an OS of at least 98% in Ms patients without SCA (study groups 4 and 5) To improve the 2 year EFS to at least 90% and maintain the OS of close to 100% in L2 patients with SCA (Study Group 3) and improve the 2 year EFS to over 70% in Ms patients with SCA (study group 6) To evaluate adherence to the protocol recommendations regarding LTS To reduce surgical morbidity by promoting strict adherence to IDRFs to determine surgical resectability To define the long term follow-up and natural history of the Stage L2 non-resected masses that have remained IDRF positive at the end of treatment (study groups 1-3). |
| § mantenere una EFS a 2 anni di almeno 90% ed una OS a 2 anni di almeno 95% in pazienti con neuroblastoma di stadio L2 con sintomi gravi ma senza SCA (gruppo terapeutico 2). mantenere una EFS di 85% a 2 anni ed una OS a 2 anni di almeno 98% in pazienti con neuroblastoma di stadio Ms senza SCA (gruppi terapeutici 4-5).§ migliorare la EFS a 2 anni almeno fino a 90% e mantenere la OS vicina al 100% in pazienti di stadio L2 con SCA (gruppo terapeutico 3) e migliorare la EFS a 2 anni a oltre 70% in pazienti di stadio Ms con SCA (gruppo terapeutico 6). § valutare l’aderenza alle raccomandazioni del protocollo riguardo ai sintomi gravi per la vita. § ridurre la morbilità chirurgica promuovendo una stretta aderenza ai “fattori di rischio definiti dall’imaging” nel determinare l’operabilità.§ definire il follow up a lungo termine e la storia naturale nei tumori di stadio L2 non operati |
|
| E.5.2.1 | Timepoint(s) of evaluation of this end point |
|
| E.6 and E.7 Scope of the trial |
| E.6 | Scope of the trial |
| E.6.1 | Diagnosis | No |
| E.6.2 | Prophylaxis | No |
| E.6.3 | Therapy | Yes |
| E.6.4 | Safety | Yes |
| E.6.5 | Efficacy | Yes |
| E.6.6 | Pharmacokinetic | No |
| E.6.7 | Pharmacodynamic | No |
| E.6.8 | Bioequivalence | No |
| E.6.9 | Dose response | No |
| E.6.10 | Pharmacogenetic | No |
| E.6.11 | Pharmacogenomic | No |
| E.6.12 | Pharmacoeconomic | No |
| E.6.13 | Others | No |
| E.7 | Trial type and phase |
| E.7.1 | Human pharmacology (Phase I) | No |
| E.7.1.1 | First administration to humans | No |
| E.7.1.2 | Bioequivalence study | No |
| E.7.1.3 | Other | No |
| E.7.1.3.1 | Other trial type description | |
| E.7.2 | Therapeutic exploratory (Phase II) | No |
| E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
| E.7.4 | Therapeutic use (Phase IV) | No |
| E.8 Design of the trial |
| E.8.1 | Controlled | Yes |
| E.8.1.1 | Randomised | Yes |
| E.8.1.2 | Open | Yes |
| E.8.1.3 | Single blind | No |
| E.8.1.4 | Double blind | No |
| E.8.1.5 | Parallel group | Yes |
| E.8.1.6 | Cross over | Yes |
| E.8.1.7 | Other | No |
| E.8.2 | Comparator of controlled trial |
| E.8.2.1 | Other medicinal product(s) | Yes |
| E.8.2.2 | Placebo | No |
| E.8.2.3 | Other | No |
| E.8.2.4 | Number of treatment arms in the trial | 2 |
| E.8.3 |
The trial involves single site in the Member State concerned
| No |
| E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
| E.8.4.1 | Number of sites anticipated in Member State concerned | 29 |
| E.8.5 | The trial involves multiple Member States | Yes |
| E.8.5.1 | Number of sites anticipated in the EEA | 17 |
| E.8.6 Trial involving sites outside the EEA |
| E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
| E.8.6.2 | Trial being conducted completely outside of the EEA | No |
| E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
|
| E.8.7 | Trial has a data monitoring committee | Yes |
| E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
| the conclusion of the study is after 5 years to start of tehe protocol, or alternatively when 150 patients were enrolled. |
| lo studio si conclude all'arruolamento di 150 pazienti o in alternativa dopo 5 anni DALL'INIZIO DALL'ATTIVAZIONE DEL PROTOCOLLO |
|
| E.8.9 Initial estimate of the duration of the trial |
| E.8.9.1 | In the Member State concerned years | 5 |
| E.8.9.1 | In the Member State concerned months | 0 |
| E.8.9.1 | In the Member State concerned days | 0 |
| E.8.9.2 | In all countries concerned by the trial years | 5 |
| E.8.9.2 | In all countries concerned by the trial months | 0 |
| E.8.9.2 | In all countries concerned by the trial days | 0 |