E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Node-negative stage I-II intermediate or high risk endometrial cancer |
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E.1.1.1 | Medical condition in easily understood language |
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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 | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10014738 |
E.1.2 | Term | Endometrial cancer stage I |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10014739 |
E.1.2 | Term | Endometrial cancer stage II |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To compare overall survival (OS) of patients treated with adjuvant chemotherapy or to observation in the endometriod adenocarcinoma subgroup.
Patients with medium and high-risk stage I and II endometrial cancers have, despite radical surgery, a rather high risk for progression.
Combination chemotherapy regimen of paclitaxel-carboplatin is proposed in this study, as this combination is effective and well tolerated.
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E.2.2 | Secondary objectives of the trial |
•Overall survival of whole study population •Disease Specific Survival (DSS) •Progression-Free Survival (PFS) •Toxicity (both acute and late) •Compliance •Quality of Life (QOL) and symptom control will be assessed using EORTC QLQ-C30 and EORTC-QLQ-EN34 •Rate of isolated pelvic relapse •Rate of isolated distant relapse •Rate of mix local and distant relapse
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
The specific translational research objectives are: 1. To evaluate the prognostic and predictive values of tumor biomarkers from tissue collected at the initial surgery for the clinical outcome to chemotherapy or observation (eg. PFS and OS). 2. To evaluate the prognostic and predictive values of tumor biomarkers from tissue collected at the initial surgery for certain parameters measured prior to/at study entry, such as a) relation to stage and grade of the disease; and b) presence of certain toxicities to chemotherapy. 3. To evaluate protein expression using immunohistochemical (IHC), and to analyze the obtained results with the purpose to develop a optimal classifier for selecting patients into sub-group for individual treatment strategies (responsible researcher: E Høgdall). 4. To evaluate prognostic or predictive markers, such as EGFR, KRAS, BRAF, NRAS, PIK3CA, PTEN, TP53 and FBXW7 with the purpose of a optimal characterization of patients with the purpose of future individual treatment strategies (responsible researcher: F Amant). 5. The Translational Research Steering Committee keeps the freedom to change the TR if new developments indicate more useful research can be done on these samples.
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E.3 | Principal inclusion criteria |
Target Population 1. Only node-negative patients are eligible: Histological confirmed endometrial carci-noma with no macroscopic remaining tumour after primary surgery and lymph-node negative disease, with one of the following postoperative FIGO 2009 stage and grade: a. Stage I grade 3 endometrioid adenocarcinoma b. Stage II endometrioid adenocarcinoma c. Stage I and II type 2 histology (clear cell, serous, squamous cell carcinoma, carcinosarcoma or undifferentiated carcinoma) Prior therapy 2. Patients have undergone hysterectomy (total abdominal hysterectomy, radical hysterectomy, laparoscopic or robotic hysterectomy) and bilateral salpingo-oopherectomy (BSO) and pelvic lymphadenectomy (LNE). 3. LNE: minimum 10 pelvic nodes (4 from each side) should be removed. Para-aortic LNE is optional. 3.a Patients who undergo sentinel lymph node biopsy (SLB) may be included if the surgeon performing the SLB has performed at least 20 cases of SLB for endome-trial cancer. In addition, for each patient, bilateral sentinel node must be identified or a side-specific pelvic lymphadenectomy must be performed if a SLN is not iden-tified in a hemi-pelvis. 4. Omentectomy strongly recommended in clear cell, serous or undifferentiated car-cinoma. 5. Surgery performed within 12 weeks of randomization. If the dates for hysterectomy and lymph node dissection are different, 12 weeks are counted from the last sur-gery, and in that case the gap between two surgeries should not exceed 8 weeks. Other inclusion criteria 6. Patients must give informed consent according to the rules and regulations of the individual participating centres. 7. Patients have not received any other anticancer therapy other than surgery for en-dometrial cancer. 8. Adjuvant vaginal brachytherapy is permitted in both arms. In chemotherapy arm, timing of VBT should not cause delay in chemotherapy delivery. 9. Patients must have a WHO performance status of 0-2 10. Patients must have an adequate bone-marrow, renal and hepatic function (WBC ≥3.0x109/L, neutrophils ≥1.5x109/L, platelets ≥100x109/L, total S-bilirubin <2 x up-per normal value, ALAT <2.5 x upper normal value, estimated GFR >50 ml/min (measured or calculated according to Cockroft-Gault, Jeliffe or Wright formula). Up to 5% deviation for hematological values and 10% deviation for s-bilirubin and ALAT are tolerated. 11. Life expectancy of at least 12 weeks. 12. Patients must be fit to receive combination chemotherapy. 13. Patient’s age >18 years. |
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E.4 | Principal exclusion criteria |
Target Disease Exceptions 1. Sarcomas or small cell carcinoma with neuroendocrine differentiation. Prohibited Treatments and/or Therapies 2. External Beam Radiotherapy. 3. Concurrent cancer therapy. 4. Concurrent treatment with an anticancer investigational agent or participation in another anticancer clinical trial. Other exclusion criteria 5. Previous or concurrent malignant disease except for patients with second malig-nancy who has been relapse free for ≥3 years, or patients with curatively treated carcinoma in situ of the cervix or basal cell carcinoma of the skin. 6. Active infection or other serious underlying medical condition, which might prevent the patient from receiving treatment or to be followed. 7. Whatever reasons which interferes with an adequate follow-up 8. Patients who are breast feeding must stop breast feeding before enrolment in the trial and must not do so during whole trial period, otherwise these patients are non-eligible. |
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E.5 End points |
E.5.1 | Primary end point(s) |
overall survival in the endometriod adenocarcinoma subgroup |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Survival is calculated from the date of randomization until the date of death. |
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E.5.2 | Secondary end point(s) |
• Overall survival in the whole study population • Disease Specific Survival (DSS) • Progression-Free Survival (PFS) • Toxicity (both acute and late) • Compliance • Quality of Life (QOL) • Rate of isolated pelvic relapse (central or pelvic wall) • Rate of isolated distant relapse • Rate of mix local and distant relapse |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Survival is calculated from the date of randomization until the date of death. The DSS is calculated from the date of randomization until the date of death caused by cancer, Patients who die of non-disease-related causes are censored at time of death. The PFS is calculated as time elapsed from date of randomization to date of progression or death of disease, whichever is the first registered event. Vaginal, pelvic and distant relapses will be registered. QoL will be registered during whole study period. Toxicity will be graded according to the Common Terminology for Adverse Events (CTCAE v4.0) |
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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) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
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 | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
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E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
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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
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 55 |
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 |
Austria |
Belgium |
Czech Republic |
Denmark |
France |
Germany |
Italy |
Netherlands |
Poland |
Portugal |
Spain |
Switzerland |
United Kingdom |
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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
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It is expected to include 240 patients in 3-4 years period and have overall survival available by another 3-4 years |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 8 |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 8 |