E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
We will include patients with NET G3 in upto four different antitumoral therapies and NEC Ki67 low after failure of standard treatment with conventional chemotherapy. |
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E.1.1.1 | Medical condition in easily understood language |
Patients with neuroendocrine tumor of high-grade in upto four antitumoral treatment lines and neuroendocrine carcinoma with low proliferation rate after failure of standard treatment. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
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 |
Evaluate the efficacy of Cabozantinib treatment |
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E.2.2 | Secondary objectives of the trial |
Evaluate short- and long term efficacy of Cabozantinib treatment, evaluate necessary exposure time, assess quality-of-life during and after Cabozantinib treatment, and to assess general safety of Cabozantinib treatment
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Patient with histologically confirmed diagnosis of neuroendocrine neoplasia; 2. Tumor proliferation rate has to be > Ki67 20% and ≤ Ki67 60% (local assessment); 3. Male, female, or diverse patients aged > 18 years without upper age limit; 4. Patients with up to four different antitumoral therapies 5. At least one measurable tumor lesions in CT or MRI scan; 6. Newly diagnosed or progressive disease assessed per RECIST criteria 1.1; 7. Patients must have a performance status of ECOG 0-2; 8. Patients must have a life expectancy of more than 3 months; 9. Hb> 9 mg/dl; 10. platelets >80T/µl; 11. white blood cells >3T/μL; 12. total bilirubin <3mg/dl; 13. AST and ALT <4xN; 14. Serum creatinine <2mg/dl, eGFR >40mL/min/1.73m2; 15. BUN <5xN; 16. lipase <3xN; 17. albumin ≥2.8 g/dL; 18. PT/PTT ≤ 1.5 × ULN; 19. Urine protein:creatinine ration ≤ 1 (Note: if proteinuria < 2g/l and increased proteinuria is ruled out by an urine teststick the protein:creatinine ratio does not need to be determined); 20. Written informed consent obtained according to international guidelines and local laws; 21. Ability to understand the nature of the trial and the trial related procedures and to comply with them |
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E.4 | Principal exclusion criteria |
1. Patients with Mixed Neuroendocrine-Non-neuroendocrine Neoplasia (MINEN); 2. Patients with former treatment with TKI or VEGF receptor antagonist; 3. Patients with additional malignancy <5 years in medical history (exclusion: non-invasive skin cancer); 4. Patients with symptomatic brain metastases; 5. Patients with known HIV infection, acute and chronic-active hepatitis (type A, B or C) or another uncontrolled infection; 6. Patients with known hypersensitivity to Cabozantinib or contraindications for treatment with Cabozantinib according to Summary of Product Characteristics (SmPC); 7. Patients with class III or IV congestive heart failure; 8. Patients with prolonged QTc (for women more than 470 ms, for men 450 ms); 9. Patients with uncontrolled hypertension (despite anti-hypertensive medication RR >160/110 mmHg); 10. Patients with severely impaired lung function; 11. Patients with history of organ transplant (exclusion: cornea transplantation); 12. Patients with clinical apparent acute or chronic gastric ulceration; 13. Patients with history of hemophilia; 14. Patients with surgery at the GI tract within the last 12 weeks; 15. Patients with patients with uncontrolled inflammatory bowel disease; 16. Simultaneous participation in other interventional trials which could interfere with this trial; simultaneous participation in registry and diagnostic trials is allowed 17. Patient without legal capacity who is unable to understand the nature, significance and consequences of the trial; 18. Previous participation in this trial 19. concomitant use of therapeutic anticoagulation or strong CYP3A4 inducers or inhibitors (e.g. amiodarone); 20. Known or persistent abuse of medication, drugs or alcohol; 21. Person who is in a relationship of dependence/employment with the sponsor or the investigator; 22. Current or planned pregnancy, nursing period |
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E.5 End points |
E.5.1 | Primary end point(s) |
Disease control rate (DCR) (Complete Response, CR + Partial Response, PR + Stable Disease, SD) |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
6 months after treatment start |
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E.5.2 | Secondary end point(s) |
Disease control rate (DCR). Progression free survival (PFS) and overall survival (OS). Time on drug (TOD). EORTC QLQ-C30 Quality of Life Questionnaire monthly. Serious adverse events and adverse events, Data Safety Monitoring Board (DSMB) after 20 patients. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
3 and 12 months after treatment start. For the QoL: monthly for 12 months after treatment start and after 15 months |
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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 | No |
E.8.1.1 | Randomised | No |
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) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 1 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 1 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 16 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
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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End of trial defined as last patient last visit (LPLV) |
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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 | 4 |
E.8.9.1 | In the Member State concerned months | 3 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 4 |
E.8.9.2 | In all countries concerned by the trial months | 3 |