E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Hepatoblastoma and Hepatocellular Carcinoma. |
Hepatoblastooma ja hepatosellulaarinen karsinooma |
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E.1.1.1 | Medical condition in easily understood language |
Hepatoblastoma and Hepatocellular Carcinoma are types of liver cancer. |
Hepatoblastooma ja hepatosellulaarinen karsinooma ovat maksakasvaimia. |
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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 | 10062001 |
E.1.2 | Term | Hepatoblastoma |
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 | 21.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10019828 |
E.1.2 | Term | Hepatocellular carcinoma non-resectable |
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 | 21.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10019830 |
E.1.2 | Term | Hepatocellular carcinoma resectable |
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 | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
- To evaluate if the outcome with 4 cycles of treatment is not inferior to the outcome with 6 cycles of treatment, for patients with Low Risk HB, resectable tumours.
- To compare outcome and toxicity in patients with Intermediate Risk HB, treated with one of three treatment regimens: C5VD (cisplatin/5-fluorouracil/vincristine/doxorubicin), SIOPEL-3 high risk (cisplatin, carboplatin and doxorubicin) and cisplatin monotherapy.
- To compare the outcomes in patients with High Risk HB with metastatic disease, treated with one of two post induction treatments (carboplatin and doxorubicin alternating with carboplatin and etoposide, carboplatin and doxorubicin alternating with vincristine and irinotecan)
- to determine whether the addition of gemcitabine and oxaliplatin (GEMOX) to cisplatin, doxorubicin and sorafenib improves outcome in unresectable HCC patients
- to collect biology in all HB and HCC patients |
- selvittää, voidaanko hoitotulosten heikentymättä käyttää 4 sytostaattikuuria 6 sijaan potilailla, joilla on matalariski, leikattavissa oleva HB
- verrata hoitotuloksia ja haittavaikutuksia keskiriski HB -potilailla, joita hoidetaan yhdellä kolmesta erilaisesta hoito-ohjelmasta: C5VD (sisplatiini / 5-fluorourasiili / vinkristiini / doksorubisiini); SIOPEL-3 korkea riski (sisplatiini / karboplatiini / doxorubicin); sisplatiini-monoterapia
- verrata hoitotuloksia potilailla, joilla on metastasoinut korkeariski HB, ja joita hoidetaan yhdellä kahdesta induktio-hoidon jälkeisestä hoito-ohjelmasta: karboplatiini / doksorubisiini ja karboplatiini / etoposidi vuorotellen; karboplatiini / doksorubisiini ja vinkristiini / irinotekaani vuorotellen
- tutkia, parantaako gemsitabiinin ja oksaliplatiinin (GEMOX) lisääminen sisplatiini / doksorubisiini / sorafenibi -hoitoon leikkaushoitoon soveltumattomien HCC-potilaiden hoitotuloksia
- kerätä biologisia näytteitä kaikilta HB- ja HCC-potilailta |
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E.2.2 | Secondary objectives of the trial |
- to report event free survival in all patient groups
- to evaluate prognostic factors, including the following:
> to provide a comprehensive and highly validated panel of diagnostic and prognostic biomarkers
> to determine if paediatric HCC is a biologically different entity to adult HCC
> to validate prospectively a clinical risk stratification
> to develop genomic and/or biomarker analysis to predict children who may have an increased risk of developing toxicity with chemotherapy
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
For Trial Entry:
• Clinical diagnosis of HB or histologically defined diagnosis of HB or HCC.
• Age ≤30 years
• Written informed consent for trial entry
For Allocation/Randomisation to Treatment Group:
All Groups
• Written Informed Consent for trial treatment participation
• Patient assessed as fit to receive group specific treatment
• For females of child-bearing potential, a negative pregnancy test prior to trial entry is required. Any patient who is of reproductive age must agree to use adequate contraception for the duration of the trial.
Group A (no treatment arm)
At diagnosis:
• Resected Tumour.
• Patient meets Very Low Risk definition according to CHIC guidelines.
Group A1 – No treatment arm
• Central pathology review confirming WDF histology.
Group A2 - Treatment arm
• Central pathology review confirming non-WDF histology.
• Adequate renal function determined by:
o Serum creatinine in the normal range based on age appropriate local reference values or glomerular filtration rate (GFR) ≥60mL/min/1.73m2
• Adequate haematology/biochemistry:
o Absolute neutrophil count (ANC) >0.75 x 109/L
o Platelet count >75 x 109/L
o International normalised ratio(INR)/Prothrombin time (PT) <1.2x ULN for age-based local reference values
o K, Mg, Ca within normal range for age
Group B
• Patient meets Low Risk definition according to CHIC Guidelines
• Adequate renal function determined by:
o Serum creatinine in the normal range based on age appropriate local reference values or glomerular filtration rate (GFR) ≥60mL/min/1.73m2
• Adequate haematology/biochemistry:
o Absolute neutrophil count (ANC) >0.75 x 109/L
o Platelet count >75 x 109/L
o International normalised ratio(INR)/Prothrombin time (PT) <1.2x ULN for age-based local reference values
o K, Mg, Ca within normal range for age
Group C
• Patient meets Intermediate Risk definition according to CHIC Guidelines
• Adequate renal function determined by:
o Serum creatinine in the normal range based on age appropriate local reference values or glomerular filtration rate (GFR) ≥60mL/min/1.73m2
• Adequate cardiac function determined by:
o Shortening fraction ≥28% by local assessment method
o OR Ejection fraction ≥47% by local assessment method
• Adequate haematology/biochemistry:
o Absolute neutrophil count (ANC) >0.75 x 109/L
o Platelet count >75 x 109/L
o International normalised ratio(INR)/Prothrombin time (PT) <1.2x ULN for age-based local reference values
o K, Mg, Ca within normal range for age
Group D
• Patient meets High Risk definition according to CHIC Guidelines
• Adequate renal function determined by:
o Serum creatinine in the normal range based on age appropriate local reference values or glomerular filtration rate (GFR) ≥60mL/min/1.73m2
• Adequate cardiac function determined by:
o Shortening fraction ≥28% by local assessment method
o OR Ejection fraction ≥47% by local assessment method
• Adequate haematology/biochemistry:
o Absolute neutrophil count (ANC) >0.75 x 109/L
o Platelet count >75 x 109/L
o International normalised ratio(INR)/Prothrombin time (PT) <1.2x ULN for age-based local reference values
o K, Mg, Ca within normal range for age
Group E
At diagnosis:
• Patient has been diagnosed with HCC
• Tumour has been resected with negative margins
Group E1
• HCC secondary to underlying liver disease
Group E2
• HCC de novo, including fibrolamellar
• Adequate renal function determined by:
o Serum creatinine in the normal range based on age appropriate local reference values or glomerular filtration rate (GFR) ≥60mL/min/1.73m2
• Adequate cardiac function determined by:
o Shortening fraction ≥28% by local assessment method
o OR Ejection fraction ≥47% by local assessment method
• Adequate haematology/biochemistry:
o Absolute neutrophil count (ANC) >0.75 x 109/L
o Platelet count >75 x 109/L
o International normalised ratio(INR)/Prothrombin time (PT) <1.2x ULN for age-based local reference values
o K, Mg, Ca within normal range for age
Group F
• Patient diagnosed with HCC
• Tumour locally assessed as un-resectable, or metastatic HCC disease
• Adequate renal function determined by:
o Serum creatinine in the normal range based on age appropriate local reference values or glomerular filtration rate (GFR) ≥60mL/min/1.73m2
• Adequate cardiac function determined by:
o Shortening fraction ≥28% by local assessment method
o OR Ejection fraction ≥47% by local assessment method
• Adequate haematology/biochemistry: o Absolute neutrophil count (ANC) >0.75 x 109/L
o Platelet count >75 x 109/L
o International normalised ratio(INR)/Prothrombin time (PT) <1.2x ULN for age-based local reference values
o K, Mg, Ca within normal range for age
o Qt/QTc interval =/<450msec for males, =/<470msec for females |
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E.4 | Principal exclusion criteria |
• Any previous chemotherapy or currently receiving anti-cancer agents
• Recurrent disease
• Previously received a solid organ transplant
• Uncontrolled infection
• Unable to follow the protocol for any reason
• Second malignancy
• Pregnant or breastfeeding women
Treatment Group Specific Exclusion Criteria
Group C:
• Patients who have known deficiency of dihydropyrimidine dehydrogenase (DPD)
Group D:
• Chronic inflammatory bowel disease and/or bowel obstruction
• Concomitant use with St John’s Wort which cannot be stopped prior to start of trial treatment
Group F:
• Peripheral Sensitive Neuropathy with functional impairment
• Personal or family history of congenital long QT syndrome
• QT/QTc interval >450msec for men and >470msec for women (corrected measurement of QT according to BAZETT formula)
• Patients who are unable to swallow tablets , where an oral solution is not available or approved |
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E.5 End points |
E.5.1 | Primary end point(s) |
Event Free Survival (EFS) as defined as the time from randomisation (or registration into the trial for non-randomised patients) to the first failure event. Patients who have not had an event will be censored at their last follow-up date.
Failure events are:
• progression of existing disease or occurrence of disease at new sites,
• death from any cause prior to disease progression,
• diagnosis of a second malignant neoplasm.
Response in HCC is defined as complete (CR) or partial (PR) response according to RECIST version 1.1 criteria. The assessment will be performed after 3 cycles of PLADO, or 4 cycles of PLADO+S/GEMOx+S in Group F patients. Patients who are not assessable for response, e.g. because of early stopping of treatment or death, will be assumed to be non-responders. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Evaluation of EFS will be until first failure event.
Evaluation of Response in HCC will be until end of treatment. |
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E.5.2 | Secondary end point(s) |
Failure-Free Survival (FFS) is defined as per EFS (primary endpoint above) with the addition of failure to go to resection.
Overall Survival (OS) is defined as the time from randomisation (or registration for non-randomised patients) to death from any cause.
Toxicity will be recorded in relation to each cycle of randomised treatment and will be categorised and graded using Common Terminology Criteria for Adverse Events (CTCAE)
Chemotherapy-related cardiac, nephro- and oto- toxicity will be recorded in relation to each cycle of non-randomised treatment and will be categorised by CTCAE.
Hearing loss is defined as Grade 4 Boston grade oto-toxicity compared to baseline.
Best Response is defined as Complete Response (CR) or Partial Response (PR) and is defined in the protocol based on radiological (RECIST) response and AFP decline.Patients who are not assessable for response (e.g. because of early stopping of treatment or death) will be assumed to be non-responders.
Surgical resectability id defined as complete resection, partial resection or transplant following randomisation (or enrolement for non-randomised patients).
Adherence to surgical guidelines is defined as the local clinician's surgical decision to resect or not compared to the current SIOPEL surgical guidelines. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Evaluation of FFS will be until first failure event, including failure to resect.
Evaluation of OS and Best Response will be until the last follow up.
Evaluation of Toxicity and Chemotherapy-related toxicity will be until 30 days after End of Treatment.
Evaluation of Hearing Loss, Surgical resectability and Adherence to surgical guidelines will be until End of Treatment.
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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 | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | Yes |
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 | No |
E.8.1.6 | Cross over | No |
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 | 6 |
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 | 5 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 140 |
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 |
Belgium |
Czech Republic |
Finland |
France |
Germany |
Ireland |
Italy |
Netherlands |
Norway |
Poland |
Spain |
Sweden |
Switzerland |
United Kingdom |
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E.8.7 | Trial 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
|
The trial will remain open until the date of the the last patient's last visit. |
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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 | 2 |
E.8.9.1 | In the Member State concerned months | 2 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 6 |
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 |