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    The EU Clinical Trials Register currently displays   44334   clinical trials with a EudraCT protocol, of which   7366   are clinical trials conducted with subjects less than 18 years old.   The register also displays information on   18700   older paediatric trials (in scope of Article 45 of the Paediatric Regulation (EC) No 1901/2006).

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    Summary
    EudraCT Number:2014-003930-17
    Sponsor's Protocol Code Number:1407
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2016-10-26
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2014-003930-17
    A.3Full title of the trial
    A RANDOMIZED PHASE III TRIAL COMPARING CONVENTIONAL-DOSE CHEMOTHERAPY USING PACLITAXEL, IFOSFAMIDE, AND CISPLATIN (TIP) WITH HIGH-DOSE CHEMOTHERAPY USING MOBILIZING PACLITAXEL PLUS IFOSFAMIDE FOLLOWED BY HIGH-DOSE CARBOPLATIN AND ETOPOSIDE (TI-CE) AS FIRST SALVAGE TREATMENT IN RELAPSED OR REFRACTORY GERM CELL TUMORS
    Ensayo aleatorizado fase III que compara la quimioterapia en dosis convencionales de paclitaxel, ifosfamida y cisplatino (TIP) con la quimioterapia de paclitaxel más ifosfamida como movilizador, seguido de carboplatino y etopóstido (TI-CE) a dosis altas como primer tratamiento de rescate en pacientes con tumores de células germinales en resistentes o en recaída.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A RANDOMIZED PHASE III TRIAL COMPARING CONVENTIONAL-DOSE CHEMOTHERAPY USING PACLITAXEL, IFOSFAMIDE, AND CISPLATIN (TIP) WITH HIGH-DOSE CHEMOTHERAPY USING MOBILIZING PACLITAXEL PLUS IFOSFAMIDE FOLLOWED BY HIGH-DOSE CARBOPLATIN AND ETOPOSIDE (TI-CE) AS FIRST SALVAGE TREATMENT IN RELAPSED OR REFRACTORY GERM CELL TUMORS
    Ensayo aleatorizado fase III que compara la quimioterapia en dosis convencionales de paclitaxel, ifosfamida y cisplatino (TIP) con la quimioterapia de paclitaxel más ifosfamida como movilizador, seguido de carboplatino y etopóstido (TI-CE) a dosis altas como primer tratamiento de rescate en pacientes con tumores de células germinales en resistentes o en recaída.
    A.3.2Name or abbreviated title of the trial where available
    TIGER
    A.4.1Sponsor's protocol code number1407
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT02375204
    A.5.4Other Identifiers
    Name:AllianceNumber:A031102
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorEuropean Organisation for Research and Treatment of Cancer
    B.1.3.4CountryBelgium
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportMovember
    B.4.2CountryAustralia
    B.4.1Name of organisation providing supportOrchid
    B.4.2CountryUnited Kingdom
    B.4.1Name of organisation providing supportEORTC
    B.4.2CountryBelgium
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationEuropean Organization for Research and Treatment of Cancer
    B.5.2Functional name of contact pointClinical Operations Department
    B.5.3 Address:
    B.5.3.1Street AddressAvenue E. Mounier 83/11
    B.5.3.2Town/ cityBrussels
    B.5.3.3Post code1200
    B.5.3.4CountryBelgium
    B.5.4Telephone number+3227741542
    B.5.5Fax number+3227741030
    B.5.6E-mailregulatory@eortc.be
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namePaclitaxel
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPACLITAXEL
    D.3.9.1CAS number 33069-62-4
    D.3.9.4EV Substance CodeSUB09583MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number6
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameIfosfamide
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNIFOSFAMIDE
    D.3.9.1CAS number 3778-73-2
    D.3.9.4EV Substance CodeSUB08125MIG
    D.3.10 Strength
    D.3.10.1Concentration unit g gram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameCarboplatin
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCarboplatin
    D.3.9.3Other descriptive nameCARBOPLATIN
    D.3.9.4EV Substance CodeSUB06614MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameEtoposide
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNEtoposide
    D.3.9.3Other descriptive nameETOPOSIDE
    D.3.9.4EV Substance CodeSUB07337MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 5
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameCisplatin
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCisplatin
    D.3.9.3Other descriptive nameCISPLATIN
    D.3.9.4EV Substance CodeSUB07483MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    progressive or recurrent germ cell tumor (measurable or non-measurable)
    tumor de células germinales en progresión o en recidiva (medible o no medible)
    E.1.1.1Medical condition in easily understood language
    progressive or recurrent germ cell tumor (measurable or non-measurable)
    tumor de células germinales en progresión o en recidiva (medible o no medible)
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 19.0
    E.1.2Level LLT
    E.1.2Classification code 10043338
    E.1.2Term Testicular malignant germ cell tumor NOS
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To compare the overall survival in patients treated with conventional-dose chemotherapy using the TIP regimen with high-dose chemotherapy (HDCT) plus ASCT using the TI-CE regimen as initial salvage treatment of patients with relapsed or refractory GCT.
    Comparar la supervivencia global de pacientes diagnosticados con un tumor de células germinales (TCG) recidivante o resistente tratado con quimioterapia en dosis convencionales (QTDC) utilizando la pauta TIP con pacientes tratados con quimioterapia en dosis altas (QTDA) más trasplante autólogo de células madre (TACM) utilizando la pauta TI-CE como tratamiento de rescate inicial.
    E.2.2Secondary objectives of the trial
    - To compare PFS of patients treated with initial salvage HDCT with TI-CE vs. initial salvage CDCT with TIP.
    - To compare FRR of patients treated with initial salvage HDCT with TI-CE vs. initial salvage CDCT with TIP
    - To compare toxicity, including treatment-related mortality, associated with high-dose chemotherapy and ASCT using TI-CE compared with conventional-dose chemotherapy using TIP as initial salvage treatment for patients with relapsed or refractory GCT
    - To prospectively evaluate the IPFSG scoring system as a predictor of outcome to initial salvage therapy in patients with relapsed or refractory GCT. In this trial, randomization will be stratified by a modification of their IPFSG category and we will prospectively evaluate whether or not actual outcomes vary by risk group in the appropriate manner (low risk patients have higher OS than high-risk group).
    - To evaluate the association between tumor marker decline rates of AFP and HCG with OS and PFS.
    ♦ Comparar la supervivencia libre de progression/tasa de respuesta de los pacientes tratados con QTDA de rescate inicial con TI-CE frente a QTDC de rescate inicial con TIP.
    ♦ Comparar la toxicidad, incluida la mortalidad, asociada a la quimioterapia en dosis altas y TACM utilizando TI-CE comparado con quimioterapia en dosis convencionales utilizando TIP como tratamiento de rescate inicial
    ♦ Evaluar prospectivamente el valor predictivo de la clasificación pronóstica del grupo de estudio internacional (International Prognostic Factors Study Group, IPFSG) del resultado del tratamiento de rescate de primera línea en pacientes con TCG recidivante o resistente. Se evaluará prospectivamente si los resultados reales por grupo varían de acuerdo a lo esperable .
    ♦ Evaluar la asociación del descenso de marcadores a la semana 9 respecto al valor basal, tanto de la alfa-fetoproteína como de la gonadotropina coriónica humana y la SSP y la SG en pacientes con niveles de marcadores elevados.
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    - Quality of Life Evaluation Objective: to compare the quality of life among patients ≥ 18 years treated with TIP vs. those treated with TI-CE using the EORTC quality of life instruments (EORTC QLQ-C30 and QLQ-TC26).
    - Pharmacogenomic Objective: to evaluate the association between specific germline polymorphisms and patient outcome to treatment.
    - Tumor Biology Objectives:
    A) To evaluate the frequency of aberrations in the RAS, PI3K, and p53 pathways among patients with refractory or relapsed GCT entering the study.
    B) To correlate aberrations in the RAS, PI3K, and p53 pathways with patient outcome overall and within each treatment arm.
    C) To characterize the range of other genetic aberrations (mutations and copy number gains and losses among 341 cancer-related genes) within relapsed and refractory GCT samples
    D) To establish a GCT biospecimen bank for future analysis.
    - La calidad de vida se evaluará utilizando el EORTC QLQ-C30, y el módulo para cáncer de testículo de la EORTC, QLQ-TC26.
    - Farmacogenómica: Se evaluará la asociación entre los polimorfismos específicos en la línea germinal y resultados.
    - Estudio correlativo de la biología tumoral:
    ♦ Determinar si alteraciones genéticas en las vías de reparación de RAS, PI3K, p53 y de ADN son pronósticos de la SSP y de la respuesta al tratamiento.
    ♦ Caracterizar la gama completa de aberraciones genéticas.
    ♦ Evaluar la frecuencia de las alteraciones en las vías de RAS, PI3K y p53, correlacionar estas aberraciones con el resultado, e identificar otras alteraciones genéticas potencialmente importantes.
    ♦ Establecer un banco de muestras para su análisis futuro en este grupo infrecuente de pacientes.
    E.3Principal inclusion criteria
    - Confirmation of GCT histology (both seminoma and nonseminoma) on pathologic review at the center of enrollment. Tumor may have originated in any primary site.
    - Must have evidence of progressive or recurrent GCT (measurable or non-measurable) following one line of cisplatin-based chemotherapy, defined as meeting at least one of the following criteria:
    * Tumor biopsy of new or growing or unresectable lesions demonstrating viable non-teratomatous GCT (enrollment on this study for adjuvant treatment after macroscopically complete resection of viable GCT is not allowed). In the event of an incomplete gross resection where viable GCT is found, patients will be considered eligible for the study.
    * Consecutive elevated serum tumor markers (HCG or AFP) that are increasing. Increase of an elevated LDH alone does not constitute progressive disease.
    * Development of new or enlarging lesions in the setting of persistently elevated HCG or AFP, even if the HCG and AFP are not continuing to increase.
    - Must have received 3-6 cycles of cisplatin-based chemotherapy as part of first-line (initial) chemotherapy. Prior POMBACE, CBOP-BEP, or GAMEC are allowed.
    - No more than one prior line of chemotherapy for GCT (other than the 1 cycle of salvage chemotherapy).
    - Must have adequate recovery from prior surgery (e.g., healed scar, resumption of diet, etc.).
    - Age ≥ 14 years (≥ 15 years in France, ≥ 16 years in Ireland, ≥ 18 years in Germany, Denmark, Switzerland, the Netherlands, Slovenia and Italy)
    - ECOG Performance Status 0 to 2
    - Male gender
    - Required Initial Laboratory Values:
    Absolute Neutrophil Count (ANC) ≥ 1,500/mm3
    Platelet Count ≥ 100,000/mm3
    Calc. Creatinine Clearance ≥ 50 mL/min
    Bilirubin ≤ 2.0 x upper limits of normal (ULN)
    AST/ALT ≤ 2.5 x upper limits of normal (ULN)
    - Negative Serology (antibody test) for the following infectious diseases:
    a. Human Immunodeficiency Virus (HIV) type 1 and 2
    b. Human T-cell Leukemia Virus (HTLV) type 1 and 2 (mandatory in US but optional in Canada and Europe)
    c. Hepatitis B surface antigen
    d. Hepatitis C antibody
    - Reproductive risk: patient must not father a baby while in this study. The treatment could affect sperm or semen. Therefore, patient and his partner must use an appropriate and effective contraceptive method during the study period and for approximately 6 months after taking the last dose of study drug. A highly effective method of birth control is defined as those which result in low failure rate (i.e. less than 1% per year) when used consistently.
    - Before patient registration/randomization, written informed consent must be given according to ICH/GCP, and national/local regulations.
    - Confirmaciónhistológica de TCG (tanto seminoma como no seminoma) en el centro de inscripción. El tumor puede haberse originado en cualquier sitio principal.
    - Evidencia de TCG en progresión o en recidiva (medible o no medible)
    Versión 3.0 / 11 de marzo del 2016
    tras una línea de quimioterapia a base de cisplatino, para lo que debe cumplirse al menos uno de los siguientes criterios:
    a) Biopsia tumoral de lesiones nuevas o en crecimiento, o irresecables que demuestren TCG viable no teratomatoso (no se permite la inscripción en este estudio para tratamiento adyuvante después de resección macroscópicamente completa del TCG viable). En el caso de una resección gruesa incompleta en la que se encuentre TCG viable, los pacientes serán considerados aptos para el estudio.
    b) Marcadores tumorales séricos elevados consecutivos (HCG o AFP) y en aumento. El sólo aumento de la LDH no constituye progresión de la enfermedad.
    c) Aparición de lesiones nuevas o en crecimiento en el escenario de HCG o AFP persistentemente elevados, aunque los HCG y AFP no aumenten.
    - Debe haber recibido de 3 a 6 ciclos de quimioterapia a base de cisplatino como parte de la quimioterapia de primera línea (inicial). Se permiten POMBACE, CBOP-BEP o GAMEC previos.
    - No más de una línea de quimioterapia previa para el TCG (distinto del ciclo 1 de quimioterapia de rescate en la sección 3.1 del protocolo).
    - Debe haberse recuperado correctamente de la cirugía anterior (p. ej., cicatrización adecuada, reanudación de la dieta, etc.).
    - ≥ 14 anos.
    - Estado funcional ECOG de 0 a 2 según.
    - Sexo masculino.
    Criterios analíticos para la entrada en el protocolo:
    RAN (recuento absoluto de neutrófilos) ≥1500/mm³.
    Plaquetas ≥100 000/mm³.
    Aclaramiento de creatinina calculado ≥50 ml/min.
    Bilirrubina ≤2 x límite superior de la normalidad (LSN).
    AST/ALT ≤2,5 x LSN, a menos que se deba a metástasis hepática, en cuyo caso pacientes con niveles hasta ≤5 x LSN son elegibles.
    - Serología negativa (prueba de anticuerpos) para las siguientes enfermedades infecciosas:
    a. Virus de la inmunodeficiencia humana (VIH) tipo 1 y 2
    b. Virus de la leucemia humana de células T (VLHCT) tipo 1 y 2 (obligatoria en EE. UU., pero opcional en Canadá y en Europa)
    c. Antígeno de superficie de la hepatitis B
    d. Anticuerpos de la hepatitis C
    -Riesgos para la reproducción: los pacientes no deben concebir un hijo mientras participan en este estudio. El tratamiento podría afectar al esperma o al semen. Por lo tanto, el paciente y su pareja deben usar un método anticonceptivo adecuado y eficaz durante el periodo del estudio y durante aproximadamente 6 meses después de que haya tomado la última dosis del fármaco del estudio. Un método anticonceptivo altamente eficaz se define como aquel que tiene una baja tasa de fallo (es decir, inferior al 1 % anual)
    Versión 3.0 / 11 de marzo del 2016
    cuando se usa de manera sistemática.
    - Antes del registro/la aleatorización del paciente, se debe dar el consentimiento informado por escrito conforme a las ICH/BPC y a las regulaciones nacionales/locales.
    E.4Principal exclusion criteria
    - Prior treatment with high-dose chemotherapy (defined as treatment utilizing stem cell rescue).
    - Prior treatment with TIP with the exception when given as a bridge to treatment on protocol for patients with rapidly progressive disease who cannot wait to complete the eligibility screening process. Only one cycle is allowed.
    - Concurrent treatment with other cytotoxic drugs or targeted therapies.
    - Radiation therapy (other than to the brain) within 14 days of day 1 of protocol chemotherapy except radiation to brain metastases, which must be completed 7 days prior to start of chemotherapy.
    - Previous chemotherapy within 16 days prior to enrollment except for bleomycin which cannot have been given within 5 days prior to enrollment.
    - Concurrent malignancy other than non-melanoma skin cancer, superficial noninvasive (pTa or pTis) TCC of the bladder, contralateral GCT, or intratubular germ cell neoplasia. Patients with a prior malignancy, but at least 2 years since any evidence of disease are allowed.
    - Late relapse with completely surgically resectable disease. Patients with late relapses (defined as relapse ≥ 2 years from the date of completion of the last chemotherapy regimen) whose disease is completely surgically resectable are not eligible. Patients with late relapses who have unresectable disease are eligible.
    - Large (≥ 2 cm) hemorrhagic or symptomatic brain metastases until local treatment has been administered (radiation therapy or surgery). Treatment may begin ≥ 7 days after completion of local treatment. Patients with small (< 2 cm) and asymptomatic brain metastases are allowed and may be treated with radiation therapy and/or surgery concurrently with Arm A or cycles 1 and 2 of Arm B if deemed medically indicated. Radiation therapy should not be given concurrently with high-dose carboplatin or etoposide.
    - Secondary somatic malignancy arising from teratoma (e.g., teratoma with malignant transformation) when it is actively part of the disease recurrence or progression.
    - Contraindications to the use of paclitaxel, ifosfamide, cisplatine, carboplatine and etoposide as per summary of product characteristics (SPC).
    - Sin tratamiento previo con quimioterapia de dosis alta (definida como tratamiento que utiliza el rescate de células progenitoras).
    - Sin tratamiento previo con TIP con la excepción de si se administra como puente para el tratamiento según el protocolo para pacientes con enfermedad que progresa rápidamente que no pueden esperar a completar el proceso de selección para determinar la aptitud. Solo se permite un ciclo.
    - Ausencia de tratamiento concurrente con otros fármacos citotóxicos o tratamientos dirigidos.
    - Sin radioterapia (aparte de la aplicada al cerebro) dentro de los 14 días previos al día 1 de la quimioterapia del protocolo, excepto la radiación de las metástasis cerebrales, que debe haber finalizado al menos 7 días antes del inicio de la quimioterapia.
    - Sin quimioterapia previa dentro de los 16 días previos a la inscripción, excepto bleomicina, que no se puede haber administrado dentro de los 5 días previos a la inscripción.
    - Sin neoplasia maligna concurrente distinta del cáncer de piel no melanoma, carcinoma de células transicionales (CCT) no invasivo (pTa o pTis) superficial de vejiga, TCG contralateral, o neoplasia intratubular de células germinales. Se permite a los pacientes con una neoplasia maligna previa, pero para quienes hayan transcurrido al menos 2 años desde cualquier evidencia de enfermedad.
    - Sin recidiva tardía con enfermedad completamente resecable quirúrgicamente. Los pacientes con recidivas tardías (definidas como recidiva ≥2 años desde la fecha de finalización de la última pauta de quimioterapia) cuya enfermedad es totalmente resecable quirúrgicamente no son aptos. Los pacientes con recidivas tardías que tengan enfermedad irresecable son aptos.
    - Sin metástasis cerebral sintomática o hemorrágica de gran tamaño (≥2 cm) hasta que se haya administrado el tratamiento local (radioterapia o cirugía). El tratamiento puede comenzar ≥7 días después de completar el tratamiento local. Los pacientes con metástasis cerebral asintomática y de tamaño pequeño (<2 cm) son aptos y pueden ser tratados con radioterapia y/o cirugía de forma concurrente con el grupo A o los ciclos 1 y 2 del grupo B, si se considera médicamente indicado. La radioterapia no se debe administrar de forma simultánea a la administración de carboplatino o etopósido en altas dosis.
    - Sin neoplasia maligna somática secundaria derivada de un teratoma (p. ej., teratoma con transformación maligna) cuando es parte activa de la recurrencia o la progresión de la enfermedad.
    - Ausencia de tratamiento concurrente con otros fármacos citotóxicos o tratamientos dirigidos. 3.6 Los pacientes no deben presentar contraindicaciones para el uso de paclitaxel, ifosfamida, cisplatino, carboplatino y etopósido conforme al resumen de características del producto (RCP). Los investigadores deben consultar los RCP de los tratamientos.
    E.5 End points
    E.5.1Primary end point(s)
    Overall survival (OS)
    Supervivencia global (SG)
    E.5.1.1Timepoint(s) of evaluation of this end point
    Overall survival will be assessed at every visit during treatment and during the visits at months 9, 12, 15, 18, 24, 36, 48 and 60 from randomization.
    Supervivencia global: se evaluará en cada visita a partir de la fecha de la aleatorización y durante las visitas a meses 9, 12, 15, 18, 24, 36, 48 y 60 desde la aleatorización.
    E.5.2Secondary end point(s)
    - Progression Free Survival (PFS)
    - Favorable Response Rate (FRR)
    - Treatment-related mortality
    - Toxicity
    - Comparar la supervivencia libre de progresión (SSP)
    - Comparar la tasa de respuesta (TR)
    - mortalidad relacionada con el tratamiento
    - toxicidad
    E.5.2.1Timepoint(s) of evaluation of this end point
    - PFS: will be assessed at each visit from the date of randomization to date of progression or death due to any cause, whichever occurs first
    - FRR: will be assessed 4 weeks after end of treatment
    - Treatment-related mortality: will be assessed at each visit during protocol chemotherapy until 30-days following end of treatment
    - Toxicity: will be assessed at each visit
    SSP: se evaluará en cada visita a partir de la fecha de la aleatorización hasta la fecha de progresión o muerte por cualquier causa, lo que ocurra primero
    - TR: se evaluará 4 semanas después de finalizar el tratamiento
    - La mortalidad relacionada con el tratamiento: se evaluará en cada visita durante la quimioterapia protocolo de hasta 30 días después de finalizar el tratamiento
    - Toxicidad: se evaluará en cada visita
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    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.8.4.1Number of sites anticipated in Member State concerned4
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA53
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    Belgium
    Canada
    Denmark
    France
    Germany
    Ireland
    Italy
    Netherlands
    Slovenia
    Spain
    Switzerland
    United Kingdom
    United States
    E.8.7Trial has a data monitoring committee No
    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
    End of study occurs when all of the following criteria have been satisfied:
    1. Thirty days after all patients have stopped protocol treatment
    2. The trial is mature for the analysis of the primary endpoint as defined in the protocol
    3. The database has been fully cleaned and frozen for this analysis
    There are no study specific procedures foreseen after the end of trial but patients may continue visits to their treating physician in the frame of standard of care.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years7
    E.8.9.1In the Member State concerned months7
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years10
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 Yes
    F.1.1Number of subjects for this age range: 29
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) Yes
    F.1.1.6.1Number of subjects for this age range: 29
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 378
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 13
    F.2 Gender
    F.2.1Female No
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations No
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception No
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state60
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 170
    F.4.2.2In the whole clinical trial 420
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    For patient in Arm A:
    • High dose chemotherapy or
    • Palliative chemotherapy regimens or
    • Surgical resection of residual masses

    For patients in arm B :
    • TIP or
    • VeIP or
    • Palliative chemotherapy regimens or
    • Surgical resection of residual masses

    No further therapy should be given on either arm regardless of the pathologic findings of resection (i.e., viable GCT) if a complete resection is performed).
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2017-05-18
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2017-04-05
    P. End of Trial
    P.End of Trial StatusOngoing
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