Liposarcoma, MyxoidPhase 1/2TRASTSNCT02275286
Trabectedin Plus Radiotherapy in Soft Tissue Sarcoma Patients
A Phase 1/2 study testing Trabectedin and Radiotherapy in people with Liposarcoma, Myxoid and Sarcoma, Soft Tissue, run by Grupo Espanol de Investigacion en Sarcomas at 17 sites in 3 countries.
Trial summary
Phase I-II trial that combines trabectedin plus radiotherapy for tumor reduction response measure in four cohorts of patients: Cohort A: Patients with diagnosis of non-operable or unresectable or not oncologically recommended metastasectomy of limited to lung metastases soft tissue sarcoma. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Liposarcoma, Myxoid, Sarcoma, Soft Tissue, Leiomyosarcoma
- What is being tested?
- Trabectedin and Radiotherapy
- Type of treatment
- Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 199 participants
- Where
- 17 sitesin 3 countries
- Study dates
- Nov 2014to Jun 2028
- Phase
- Phase 1/2
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- The patient must sign voluntarily the informed consent form before any study test is conducted that is not part of routine patient care.
- Aged equal or over 18.
- Patients must have a diagnostic of Soft Tissue Sarcoma with metastasis limited to lung, and not suitable for metastasectomy or surgery resection or not oncologically recommended metastasectomy.A centralized diagnostic will be performed, the tumor sample must be available and sent prior to inclusion.
- Disease distribution allows meeting with normal tissue constraints of radiation therapy. Radiation oncologist must confirm this point.
- Metastatic spread could be present in two organs at maximum (i.e. lungs and pelvic fosa).
- Those lesions considered for radiation therapy have to be considered as target lesions as well. (i.e. in a patient with nodules in lungs, those lesions selected for radiation therapy have to include at least the target lesions)
Show all 50Show fewer
- It is allowed that not all the lesions will be under radiation fields. As a general rule, it will be prioritized to select, as target-irradiating lesions, those with greater increase in size and those largest lesions. It should be discouraged to irradiate pulmonary lesions with infiltration of pleural serosa.
- Patients must have documentation of disease progression within 6 months prior to study entry.
- The patient must have been considered eligible for systemic chemotherapy. A maximum of two previous lines for advanced/metastatic disease are allowed as long as trabectedin has not been included.
- The following histological subtypes can be included:
- Undifferentiated pleomorphic sarcoma (previously, malignant fibrous histiocytoma) Leiomyosarcoma Angiosarcoma/ epithelial hemangioendothelioma Liposarcoma and its variants (well differentiated, dedifferentiated, myxoid/round cells, pleomorphic).
- Synovial sarcoma Fibrosarcoma and its variants (epithelial fibrosarcoma/low grade fibromyxoid sarcoma) Hemangiopericytoma/solitary fibroid tumor Neurogenic sarcoma (Malignant peripheral nerve sheath tumor, MPNST) Myxofibrosarcoma Epithelioid Sarcoma Unclassified sarcoma (spindle cell/epithelioid/pleomorphic/myxoid)
- Measurable disease, according to RECIST V 1.1 criteria
- Performance status ≤1 (ECOG).
- Adequate respiratory functions: FEV1 >1L; DLco > 40% (patients with pulmonary target lesions)
- Adequate bone marrow function (hemoglobin > 10 g/dl, leukocytes ≥ 3.000/mm3, neutrophils ≥ 1.500/mm3, platelets ≥ 100.000/mm3). Patients with plasma creatinine ≤ 1,6 mg/dl, transaminases ≤ 2.5 times the UNL, total bilirubin ≤ UNL, CPK ≤ 2.5 times UNL, alkaline phosphatase ≤ 2.5 times the UNL are acceptable. If the increase of alkaline phosphatase is > 2.5 times the UNL, then the alkaline phosphatase liver fraction and/or GGT must be ≤ UNL.
- Men or women of child bearing potential should be using an effective method of contraception before entry into the study and throughout the same and for 6 months after ending the study. Women of childbearing potential must have a negative urine pregnancy test before study entry.
- Normal cardiac function with a LVEF ≥ 50% by echocardiogram or MUGA.
- It should be performed HBV and HCV serologies prior to inclusion. If HbsAg is positive it is recommended to reject the existence of replicative phase (HbaAg+, DNA VHB+). If these were positives the inclusion is not recommended, remaining at investigators' discretion the preventive treatment with lamivudine. If a potential patient is positive for anti-HCV antibodies, presence of the virus should be ruled out with a qualitative PCR, or the patient should NOT be included in the study (if a qualitative PCR cannot be performed then patient will not be able to enter the study)
- Patient must have a Central Venous Catheter for treatment
- The patient must sign voluntarily the informed consent form before any study test is conducted that is not part of routine patient care.
- Age ≥18 years old.
- Pathological diagnosis of Myxoid Liposarcoma, deep located and more than 5 cm or superficial more than 10 cm. A centralized diagnostic will be performed to confirm that the patient can be included in the study.
- Tumor must be resectable and without evidence of regional or distal spread after adequate staging procedure. Tumor must be located in limbs or superficial trunk wall.
- Disease distribution allows meeting with normal tissue constraints of radiation therapy. Radiation oncologist must confirm this point.
- Measurable disease, according to RECIST V 1.1 criteria
- Performance status 0-1 (ECOG).
- Adequate bone marrow function (hemoglobin > 10 g/dL, leukocytes ≥ 3.000/mm3, neutrophils ≥ 1.500/mm3, platelets ≥ 100.000/mm3). Patients with plasma creatinine ≤ 1,6 mg/dL, transaminases ≤ 2.5 times the UNL, total bilirubin ≤ UNL, CPK ≤ 2.5 times UNL, alkaline phosphatase ≤ 2.5 times the UNL are acceptable. If the increase of alkaline phosphatase is > 2.5 times the UNL, then the alkaline phosphatase liver fraction and/or GGT must be ≤ UNL.
- Men or women of child bearing potential should be using an effective method of contraception before entry into the study and throughout the same and for 6 months after ending the study. Women of childbearing potential must have a negative urine pregnancy test before study entry.
- Normal cardiac function with a LVEF ≥ 50% by echocardiogram or MUGA.
- It should be performed HBV and HCV serologies prior to inclusion. If HbsAg is positive it is recommended to reject the existence of replicative phase (HbaAg+, DNA HBV+). If these were positives the inclusion is not recommended, remaining at investigators' discretion the preventive treatment with lamivudine. If a potential patient is positive for anti-HCV antibodies, presence of the virus should be ruled out with a qualitative PCR, or the patient should NOT be included in the study (if a qualitative PCR cannot be performed then patient will not be able to enter the study).
- Patient may have had one previous chemotherapy line.
- Patient must have a Central Venous Catheter for treatment.
- The patient must voluntarily sign the informed consent form before performing any study-specific test that is not part of the patient's usual care.
- Aged between 18 and 75 years.
- The following histological subtypes may be included in the cohort C:
- High grade leiomyosarcoma (G2-3), liposarcoma (G2-3), if at least 30% of the tumour is dedifferentiated, pleomorphic liposarcoma.
- The following histological subtypes may be included in the cohort D:
- Well differentiated liposarcoma (WD liposarcoma) and G2 dedifferentiated liposarcorcoma, if less than 30% of the tumour is dedifferentiated.
- A centralised diagnosis will be made to confirm that the patient can be included in the study.
- The tumour must be located in the retroperitoneum and it must be resectable and without evidence of regional or distal spread after the appropriate staging process. This point must be confirmed by the central surgeon reviewer.
- The location and size of the disease in the retroperitoneum must allow for compliance with radiotherapy limitations in healthy tissue. This point must be confirmed by the site's radiation oncologist and the central radiation oncologist reviewer.
- Measurable disease according to CHOI criteria for cohort C and RECIST V 1.1 criteria for cohort D.
- ECOG performance status 0-1.
- Adequate haematological parameters (haemoglobin >10 g/dl, leukocytes ≥3,000/mm3, neutrophils ≥1,500/mm3, platelets ≥100,000/mm3). Patients with plasma creatinine ≤1.6 mg/dl, transaminases ≤2.5 times the ULN, total bilirubin ≤ ULN, CPK ≤2.5 times ULN, alkaline phosphatase ≤2.5 times ULN are acceptable. If the increase in alkaline phosphatase is >2.5 times the ULN, the liver fraction of alkaline phosphatase and/or GGT should be ≤ULN.
- Fertile men or women must use an effective contraceptive method before starting the study, during the study and for 6 months following the conclusion thereof. Women of childbearing potential who participate in the study must undergo a pregnancy test before starting the study.
- Normal cardiac function with LVEF ≥50% by echocardiogram or MUGA.
- HBV and HCV serology must be performed before including the patient in the study. If HbsAg is positive, it is advisable to rule out a replicative phase (HbsAg*, DNA HBV+). If positive, the patient's inclusion in the trial is not recommended, and it is at the discretion of the investigator to administer preventive treatment with lamivudine. If a potential patient is positive to anti-HCV antibodies, the presence of the virus will be ruled out with a qualitative PCR, or the patient cannot be included in the study (if the qualitative PCR test cannot be performed on the patient, they cannot be included in the study).
- Patient may have had one previous chemotherapy line (cohort D only).
- The patient must have a central venous catheter for the administration of the treatment.
Who cannot join
- Previous treatment with trabectedin or previous treatment with radiotherapy (except if previous radiotherapy treatment plus planned study radiotherapy treatment allow tissues constrains)
- Performance status ≥ 2 (ECOG).
- Plasma bilirubin > UNL.
- Creatinine > 1.6 mg/dL.
- History of other neoplastic disease with less than 5 years free of disease with the exception of basal cell carcinoma or in situ cervical cancer adequately treated.
- Severe COPD or other severe pulmonary diseases.
Show all 47Show fewer
- Significant cardiovascular disease (for example, dyspnea > 2 NYHA)
- Significant systemic diseases grade 3 or higher on the NCI-CTCAE v4.03 scale, that limit patient availability, or according to investigator judgment may contribute significantly to treatment toxicity.
- Uncontrolled bacterial, mycotic or viral infections.
- Known positive test for infection by human immunodeficiency virus (HIV).
- Women who are pregnant or breast-feeding.
- Psychological, familial, social or geographic circumstances that limit the patient"s ability to comply with the protocol or informed consent.
- Patients participating in another clinical trial or receiving any other investigational product
- Patients who had participated in another clinical trial and/or had received any other investigational product in the last 30 days prior to inclusion.
- Histologies other than those described in inclusion criteria.
- Cohort B: ML
- Unresectable tumors (with limb sparing surgery)
- More than one previous chemotherapy treatment for local disease including trabectedin.
- Radiotherapy involving the tumoral bed.
- Performance status ≥ 2 (ECOG).
- Presence of metastases or lymph node involvement by the tumor.
- Location other than limb or superficial trunk wall.
- Plasma bilirubin > UNL.
- Creatinine > 1.6 mg/dL.
- History of other neoplastic disease with less than 5 years free of disease with the exception of basal cell carcinoma or in situ cervical cancer adequately treated.
- Significant cardiovascular disease (for example, dyspnea > 2 NYHA)
- Significant systemic diseases grade 3 or higher on the NCI-CTCAE v4.03 scale, that limit patient availability, or according to investigator judgment may contribute significantly to treatment toxicity.
- Uncontrolled bacterial, mycotic or viral infections.
- Known positive test for infection by human immunodeficiency virus (HIV).
- Women who are pregnant or breast-feeding.
- Psychological, familial, social or geographic circumstances that limit the patient"s ability to comply with the protocol or informed consent.
- Patients who had participated in another clinical trial and/or had received any other investigational product in the last 30 days prior to inclusion.
- Cohorts C and D: Retroperitoneum sarcoma
- Unresectable tumours.
- Location other than the retroperitoneum.
- Patients who have previously received systemic treatment with chemotherapy (trabectedin included). For cohort D, patients may have received one previous line of chemotherapy with any other agent.
- Patients who underwent prior local treatment for retroperitoneal sarcoma: surgery or radiotherapy in the tumour bed.
- ECOG performance status ≥2.
- Presence of metastasis or lymph node involvement of the tumour.
- Previous history of another neoplastic disease with less than 5 years free of disease except for basal cell carcinoma or properly treated in situ cervical cancer.
- Significant cardiovascular disease (e.g. dyspnoea >2 NYHA).
- A significant grade 3 or greater systemic disease on the NCI-CTCAE v4.03 scale, which may limit the availability of the patient or which, in the opinion of the investigator, may contribute to the toxicity caused by the study treatment.
- Uncontrolled viral, mycotic or bacterial infections.
- Known HIV-positive patients.
- Pregnant or breast-feeding women.
- Psychological, familial, social or geographical circumstances that limit the patient's ability to comply with the protocol or informed consent form.
- Patients who have participated in another clinical trial and/or have received another investigational product in the 30 days prior to inclusion in the trial.
Trial locations and contacts
17 sites in 3 countries. Contact the study team or a site near you to ask about taking part.
17 sites in 3 countries
Spain10 sites, 10 recruiting
- Recruiting
Hospital Sant Pau
Barcelona, Catalonia, 08041
Antonio Lopez-Posa, MD
- Recruiting
Hospital Vall d'Hebrón
Barcelona, 08035
Claudia Valverde, MD
- Recruiting
Hospital Puerta de Hierro
Madrid, 28006
Ricardo Cubedo, MD
- Recruiting
Hospital Universitario Gregorio Marañón
Madrid, 28007
Rosa Álvarez, MD, rosa.alvarez.al@gmail.com
- Recruiting
Hospital Uniersitario La Paz
Madrid, 28046
Andres Redondo, MD
- Recruiting
Jiménez Díaz Foundation University Hospital
Madrid
Javier Martín-Broto, MD, jmartin@atbsarc.org
- Recruiting
Hospital Son Espases
Palma de Mallorca, Mallorca, 07010
Pablo Luna, MD
- Recruiting
Hospital Universitario Canarias
San Cristóbal de La Laguna, Tenerife, 38320
Josefina Cruz, MD
- Recruiting
Hospital Virgen del Rocío
Seville, 41013
Irene Carrasco, MD, irenecg1990@gmail.com
- Recruiting
Hospital Miguel Servet
Zaragoza, Aragon, 50009
Javier Martínez-Trufero, MD
Italy5 sites, 5 recruiting
- Not yet recruiting
Centro di Referimento Ocologico
Aviano, 33081
Angela Buonadonna, MD
- Not yet recruiting
Istituto Ortopedico Rizzoli
Bologna, 40136
Stefano Ferrari, MD
- Recruiting
Candiolo Cancer Institute
Candiolo, 10060
Giovanni Grignani, MD
- Recruiting
Istituto Nazionale dei Tumori
Milan, 20133
Alessandro Gronchi, MD, alessandro.gronchi@istitutotumori.mi.it
- Not yet recruiting
Istituto Clinico Humanitas
Rozzano, Milan, 20089
Armando Santoro, MD
France2 sites, 2 recruiting
- Recruiting
Institut Bergonié
Bordeaux, 33000
Antoine Italiano, MD
- Recruiting
Centre Léon Berard
Lyon
Jean Yves Blay, MD
About this study
Official title: Phase I-II Prospective Trial, Multicenter, Open Label, Exploring the Combination of Trabectedin Plus Radiotherapy in Soft Tissue Sarcoma Patients
Phase I-II trial that combines trabectedin plus radiotherapy for tumor reduction response measure in four cohorts of patients:
Cohort A: Patients with diagnosis of non-operable or unresectable or not oncologically recommended metastasectomy of limited to lung metastases soft tissue sarcoma.
Read more
Cohort B: Patients with locally advanced resectable Myxoid Liposarcoma. Cohort C: Patients with retroperitoneal and resectable soft tissue sarcoma (liposarcoma and leiomyosarcoma).
Cohort D (Phase II only): Patients with well differentiated liposarcoma and G2 dedifferentiated liposarcoma (with less than 30% dedifferentiated component).
Phase I: escalating dose of 1.3 or 1.5 mg/m2. Phase I for cohort C: de-escalating dose of 1.5 or 1.3mg/m2 Radiotherapy for cohort A: 30Gy in 10 fractions (3Gy/fraction). Radiotherapy for cohort B: 45Gy in 25 fractions (1.8Gy/fraction). Radiotherapy for cohort C: 45Gy in 25 fractions (1.8Gy/fraction).
Radiotherapy for cohort D: 45Gy in 25 fractions (1.8Gy/fraction). A translational substudy is developed to analyse different biomarkers predictive value.
Cohorts A and B are closed to recruitment in 2023.
Read the detailed description
In this study investigators plan to measure tumor response (RECIST and Choi criteria) when administering trabectedin standard dose or inferior with simultaneous radiotherapy treatment. The hypothesis states that administering trabectedin at 1.3mg/m2 or ≤1.5mg/m2 plus Radiotherapy 30-45Gy shows synergic activity that turns into tumor shrinkage.
A phase I trial (dose escalation -or de-escalation for cohort C- level of 1.3 or 1.5 mg/m2) will provide the proper dose level to perform a phase II trial to measure RECIST and Choi response, progression free survival, overall survival and register safety and quality of life details.
Four cohorts are indicated for this trial:
Cohort A: Patients with diagnosis of non-operable or unresectable or not oncologically recommended metastasectomy of limited to lung metastases soft tissue sarcoma.
Cohort B: Patients with locally advanced resectable Myxoid Liposarcoma, Cohort C:Patients with retroperitoneal and resectable soft tissue sarcoma (liposarcoma and leiomyosarcoma).
Cohort D: Patients with well differentiated liposarcoma and G2 dedifferentiated liposarcoma (with less than 30% dedifferentiated component) Unlimited cycles of chemotherapy are considered to be beneficial for cohort A patients, whereas cohort B and C only 3 cycles are indicated. About radiotherapy treatment, 30Gy will be given to cohort A patients, whereas cohort B and C will receive 45Gy. TCs and MRI are selected for imaging purposes.
Phase I:
For cohorts A and B:Trabectedin at two dose escalation levels:
0 1.3 mg/m2 as a 24h I.V. infusion
1 1.5 mg/m2 as a 24h I.V. infusion
For cohort C:Trabectedin at two dose de-escalation levels:
0 1.5 mg/m2 as a 24h I.V. infusion
-1 1.3 mg/m2 as a 24h I.V. infusion
Administration of trabectedin with a portable pump, i.v infusion of 24h, in cycles of 3 weeks.
Premedication:
- 4 mg oral dexamethasone 24h and 12h before chemotherapy administration.
- 20 mg I.V. dexamethasone 30minutes before treatment.
- Ondansetron or analogue will also be given prior to trabectedin.
Pathology review, radiology review and radiotherapy review are performed to each patient.
Several biomarkers are selected to perform FFPE tumor assays in relation to prediction
- Conditions
- Liposarcoma, Myxoid, Sarcoma, Soft Tissue, Leiomyosarcoma, Liposarcoma, Pleomorphic Liposarcoma
- Being tested
- Trabectedin, Radiotherapy
- Keywords
- sarcoma
- Medical subject headings
- Liposarcoma, Myxoid, Sarcoma, Leiomyosarcoma, Liposarcoma
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
TrabectedinDrug
Also called Yondelis
Escalating or deescalating dose of 1.3 or 1.5mg/m2, i.v 24h, once every 3 weeks.
Cohort A: unlimited cycles. Cohort B: 3 cycles. Cohort C: 3 cycles. Cohort D: cycles of trabectedin will be provided and patients will subsequently be evaluated for surgery.
RadiotherapyRadiation
3D conformal radiotherapy (3D-CRT) or intensity modulated radiotherapy (IMRT) providing: Cohort A: 30Gy in 10 fractions (3Gy/fraction). Cohort B: 45Gy in 25 fractions (1.8Gy/fraction). Cohort C: 45Gy in 25 fractions (1.8Gy/fraction). Cohort D: 45Gy in 25 fractions (1.8Gy/fraction).
| Study group | Role | What they receive |
|---|---|---|
| Trabectedin+Radiotherapy | Experimental | Trabectedin 1.3 or 1.5mg/m2 and radiotherapy 30Gy or 45Gy. Receives: Drug: Trabectedin; Radiation: Radiotherapy |
What is being measured
The primary outcome is the main question the study is designed to answer.
Tumor size
Image tumor assessment: RECIST response for the combination of trabectedin plus radiation therapy in cohorts A and B. CHOI response for the combination of trabectedin plus radiation therapy in cohort C.
Measured: every 6 weeks for 24 months
Relapse-free survival.
In cohort D to improve 5-year relapse-free survival (RFS), decreasing the 5-year relapse percentage from 30% to 10% in patients with well differentiated liposarcoma with cellular component and dedifferentiated G2 retroperitoneal resected liposarcoma (20% increase in RFS).
Measured: 5 years.
Secondary outcomes (10)
Number and grade of adverse events
CTCAE v4.03 adverse events registration to evaluate safety
Measured: every 21 days until 30 days after last dose or during 25 months
Number of months without progression
Progression free survival (PFS)
Measured: 24 months
Number of months alive
Overall survival (OS)
Measured: 24 months
Tumor size
Image tumor assessment measured by Choi criteria.
Measured: every 6 weeks during 24 months (cohort A) or every 4months during 36 months (cohort B and C)
Questionnaire
QLQ-C30 EORTC questionnaire to evaluate patient quality of life
Measured: every 3 months during 24 months
Overall response rate (ORR)
Sum of complete responses, partial responses and stable diseases
Measured: every 6 weeks during 24 months
relapse free survival (RFS) at 3 years (cohorts C and D)
percentage of relapses from diagnosis at 3 years
Measured: After 3 year since last patient treatment initiation
relapse at 5 years (cohorts C and D)
number of months without relapse from treatment initiation until 5 years.
Measured: After 5 years since last patient treatment initiation
Tumor cells response to the treatment
Number of tumor necrotic cells
Measured: Week 11, at surgery
Predictive and prognostic biomarker
percentage of protein and RNA expression of FAS, Ca2+ and NER pathways in tumor samples obtained at baseline and at surgery (approx week 11)
Measured: Baseline and week 11 (at surgery)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted27 Oct 2014 (estimated)
- Study startNov 2014
- Primary completionJun 2028 (estimated)
- Study completionJun 2028 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for Liposarcoma, MyxoidStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 1/2
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 199 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Grupo Espanol de Investigacion en Sarcomas
- Sponsor type
- University, hospital or other
- Collaborators
- Centre Leon Berard, Italian Sarcoma Group
- Responsible party
- Sponsor
- Investigators
- Javier Martín-Broto, MD, Principal investigator, Jiménez Díaz Foundation University Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02275286
- Sponsor's protocol ID
- GEIS 37
- Acronym
- TRASTS
- Status last verified
- May 2023
- First submitted
- 17 Oct 2014
- Last updated
- 31 May 2023
- Results posted
- No
- Data monitoring committee
- No
- Individual data sharing
- No
Publications
Vatner R, James CD, Sathiaseelan V, Bondra KM, Kalapurakal JA, Houghton PJ. Radiation therapy and molecular-targeted agents in preclinical testing for immunotherapy, brain tumors, and sarcomas: Opportunities and challenges. Pediatr Blood Cancer. 2021 May;68 Suppl 2:e28439. doi: 10.1002/pbc.28439. Epub 2020 Aug 22.
PubMed 32827353Martin-Broto J, Hindi N, Lopez-Pousa A, Peinado-Serrano J, Alvarez R, Alvarez-Gonzalez A, Italiano A, Sargos P, Cruz-Jurado J, Isern-Verdum J, Dolado MC, Rincon-Perez I, Sanchez-Bustos P, Gutierrez A, Romagosa C, Morosi C, Grignani G, Gatti M, Luna P, Alastuey I, Redondo A, Belinchon B, Martinez-Serra J, Sunyach MP, Coindre JM, Dei Tos AP, Romero J, Gronchi A, Blay JY, Moura DS. Assessment of Safety and Efficacy of Combined Trabectedin and Low-Dose Radiotherapy for Patients With Metastatic Soft-Tissue Sarcomas: A Nonrandomized Phase 1/2 Clinical Trial. JAMA Oncol. 2020 Apr 1;6(4):535-541. doi: 10.1001/jamaoncol.2019.6584.
PubMed 32077895Gronchi A, Hindi N, Cruz J, Blay JY, Lopez-Pousa A, Italiano A, Alvarez R, Gutierrez A, Rincon I, Sangalli C, Perez Aguiar JL, Romero J, Morosi C, Sunyach MP, Sanfilippo R, Romagosa C, Ranchere-Vince D, Dei Tos AP, Casali PG, Martin-Broto J. Trabectedin and RAdiotherapy in Soft Tissue Sarcoma (TRASTS): Results of a Phase I Study in Myxoid Liposarcoma from Spanish (GEIS), Italian (ISG), French (FSG) Sarcoma Groups. EClinicalMedicine. 2019 Mar 11;9:35-43. doi: 10.1016/j.eclinm.2019.03.007. eCollection 2019 Mar.
PubMed 31143880
Study at a glance
From the registry record, last updated by the sponsor on 31 May 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Phase I-II Prospective Trial, Multicenter, Open Label, Exploring the Combination of Trabectedin Plus Radiotherapy in Soft Tissue Sarcoma Patients
- ClinicalTrials.gov ID
- NCT02275286
- Acronym / sponsor ID
- TRASTS / GEIS 37
- Conditions
- Liposarcoma, Myxoid, Sarcoma, Soft Tissue, Leiomyosarcoma, Liposarcoma, Pleomorphic Liposarcoma
- Keywords
- sarcoma
- Phase
- Phase 1/2
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 199 participants (estimated)
- Lead sponsor
- Grupo Espanol de Investigacion en SarcomasUniversity, hospital or other
- Collaborators
- Centre Leon Berard, Italian Sarcoma Group
- Study start
- Nov 2014 (actual)
- Primary completion
- Jun 2028 (estimated)
- Study completion
- Jun 2028 (estimated)
- First posted
- 27 Oct 2014 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Phase I-II trial that combines trabectedin plus radiotherapy for tumor reduction response measure in four cohorts of patients:
Cohort A: Patients with diagnosis of non-operable or unresectable or not oncologically recommended metastasectomy of limited to lung metastases soft tissue sarcoma.
Cohort B: Patients with locally advanced resectable Myxoid Liposarcoma. Cohort C: Patients with retroperitoneal and resectable soft tissue sarcoma (liposarcoma and leiomyosarcoma).
Cohort D (Phase II only): Patients with well differentiated liposarcoma and G2 dedifferentiated liposarcoma (with less than 30% dedifferentiated component).
Phase I: escalating dose of 1.3 or 1.5 mg/m2. Phase I for cohort C: de-escalating dose of 1.5 or 1.3mg/m2 Radiotherapy for cohort A: 30Gy in 10 fractions (3Gy/fraction). Radiotherapy for cohort B: 45Gy in 25 fractions (1.8Gy/fraction). Radiotherapy for cohort C: 45Gy in 25 fractions (1.8Gy/fraction).
Radiotherapy for cohort D: 45Gy in 25 fractions (1.8Gy/fraction). A translational substudy is developed to analyse different biomarkers predictive value.
Cohorts A and B are closed to recruitment in 2023.
Detailed description
In this study investigators plan to measure tumor response (RECIST and Choi criteria) when administering trabectedin standard dose or inferior with simultaneous radiotherapy treatment. The hypothesis states that administering trabectedin at 1.3mg/m2 or ≤1.5mg/m2 plus Radiotherapy 30-45Gy shows synergic activity that turns into tumor shrinkage.
A phase I trial (dose escalation -or de-escalation for cohort C- level of 1.3 or 1.5 mg/m2) will provide the proper dose level to perform a phase II trial to measure RECIST and Choi response, progression free survival, overall survival and register safety and quality of life details.
Four cohorts are indicated for this trial:
Cohort A: Patients with diagnosis of non-operable or unresectable or not oncologically recommended metastasectomy of limited to lung metastases soft tissue sarcoma.
Cohort B: Patients with locally advanced resectable Myxoid Liposarcoma, Cohort C:Patients with retroperitoneal and resectable soft tissue sarcoma (liposarcoma and leiomyosarcoma).
Cohort D: Patients with well differentiated liposarcoma and G2 dedifferentiated liposarcoma (with less than 30% dedifferentiated component) Unlimited cycles of chemotherapy are considered to be beneficial for cohort A patients, whereas cohort B and C only 3 cycles are indicated. About radiotherapy treatment, 30Gy will be given to cohort A patients, whereas cohort B and C will receive 45Gy. TCs and MRI are selected for imaging purposes.
Phase I:
For cohorts A and B:Trabectedin at two dose escalation levels:
0 1.3 mg/m2 as a 24h I.V. infusion
1 1.5 mg/m2 as a 24h I.V. infusion
For cohort C:Trabectedin at two dose de-escalation levels:
0 1.5 mg/m2 as a 24h I.V. infusion
-1 1.3 mg/m2 as a 24h I.V. infusion
Administration of trabectedin with a portable pump, i.v infusion of 24h, in cycles of 3 weeks.
Premedication:
- 4 mg oral dexamethasone 24h and 12h before chemotherapy administration.
- 20 mg I.V. dexamethasone 30minutes before treatment.
- Ondansetron or analogue will also be given prior to trabectedin.
Pathology review, radiology review and radiotherapy review are performed to each patient.
Several biomarkers are selected to perform FFPE tumor assays in relation to prediction
Study design
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Trabectedin+Radiotherapy | Experimental | Drug: Trabectedin, Radiation: RadiotherapyTrabectedin 1.3 or 1.5mg/m2 and radiotherapy 30Gy or 45Gy. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (50 listed)
- The patient must sign voluntarily the informed consent form before any study test is conducted that is not part of routine patient care.
- Aged equal or over 18.
- Patients must have a diagnostic of Soft Tissue Sarcoma with metastasis limited to lung, and not suitable for metastasectomy or surgery resection or not oncologically recommended metastasectomy.A centralized diagnostic will be performed, the tumor sample must be available and sent prior to inclusion.
- Disease distribution allows meeting with normal tissue constraints of radiation therapy. Radiation oncologist must confirm this point.
- Metastatic spread could be present in two organs at maximum (i.e. lungs and pelvic fosa).
Key exclusion criteria (47 listed)
- Previous treatment with trabectedin or previous treatment with radiotherapy (except if previous radiotherapy treatment plus planned study radiotherapy treatment allow tissues constrains)
- Performance status ≥ 2 (ECOG).
- Plasma bilirubin > UNL.
- Creatinine > 1.6 mg/dL.
- History of other neoplastic disease with less than 5 years free of disease with the exception of basal cell carcinoma or in situ cervical cancer adequately treated.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| TrabectedinAlso: YondelisEscalating or deescalating dose of 1.3 or 1.5mg/m2, i.v 24h, once every 3 weeks. Cohort A: unlimited cycles. Cohort B: 3 cycles. Cohort C: 3 cycles. Cohort D: cycles of trabectedin will be provided and patients will subsequently be evaluated for surgery. | Drug | Trabectedin+Radiotherapy |
| Radiotherapy3D conformal radiotherapy (3D-CRT) or intensity modulated radiotherapy (IMRT) providing: Cohort A: 30Gy in 10 fractions (3Gy/fraction). Cohort B: 45Gy in 25 fractions (1.8Gy/fraction). Cohort C: 45Gy in 25 fractions (1.8Gy/fraction). Cohort D: 45Gy in 25 fractions (1.8Gy/fraction). | Radiation | Trabectedin+Radiotherapy |
Primary outcome
Tumor size
Time frame: every 6 weeks for 24 months
Image tumor assessment: RECIST response for the combination of trabectedin plus radiation therapy in cohorts A and B. CHOI response for the combination of trabectedin plus radiation therapy in cohort C.
Relapse-free survival.
Time frame: 5 years.
In cohort D to improve 5-year relapse-free survival (RFS), decreasing the 5-year relapse percentage from 30% to 10% in patients with well differentiated liposarcoma with cellular component and dedifferentiated G2 retroperitoneal resected liposarcoma (20% increase in RFS).
10 secondary outcomes
Number and grade of adverse events
Time frame: every 21 days until 30 days after last dose or during 25 months
Number of months without progression
Time frame: 24 months
Number of months alive
Time frame: 24 months
Tumor size
Time frame: every 6 weeks during 24 months (cohort A) or every 4months during 36 months (cohort B and C)
Questionnaire
Time frame: every 3 months during 24 months
Overall response rate (ORR)
Time frame: every 6 weeks during 24 months
relapse free survival (RFS) at 3 years (cohorts C and D)
Time frame: After 3 year since last patient treatment initiation
relapse at 5 years (cohorts C and D)
Time frame: After 5 years since last patient treatment initiation
Tumor cells response to the treatment
Time frame: Week 11, at surgery
Predictive and prognostic biomarker
Time frame: Baseline and week 11 (at surgery)
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 31 May 2023.
- Derived from this study: PubMed 32827353Vatner R, James CD, Sathiaseelan V, Bondra KM, Kalapurakal JA, Houghton PJ. Radiation therapy and molecular-targeted agents in preclinical testing for immunotherapy, brain tumors, and sarcomas: Opportunities and challenges. Pediatr Blood Cancer. 2021 May;68 Suppl 2:e28439. doi: 10.1002/pbc.28439. Epub 2020 Aug 22.
- Derived from this study: PubMed 32077895Martin-Broto J, Hindi N, Lopez-Pousa A, Peinado-Serrano J, Alvarez R, Alvarez-Gonzalez A, Italiano A, Sargos P, Cruz-Jurado J, Isern-Verdum J, Dolado MC, Rincon-Perez I, Sanchez-Bustos P, Gutierrez A, Romagosa C, Morosi C, Grignani G, Gatti M, Luna P, Alastuey I, Redondo A, Belinchon B, Martinez-Serra J, Sunyach MP, Coindre JM, Dei Tos AP, Romero J, Gronchi A, Blay JY, Moura DS. Assessment of Safety and Efficacy of Combined Trabectedin and Low-Dose Radiotherapy for Patients With Metastatic Soft-Tissue Sarcomas: A Nonrandomized Phase 1/2 Clinical Trial. JAMA Oncol. 2020 Apr 1;6(4):535-541. doi: 10.1001/jamaoncol.2019.6584.
- Derived from this study: PubMed 31143880Gronchi A, Hindi N, Cruz J, Blay JY, Lopez-Pousa A, Italiano A, Alvarez R, Gutierrez A, Rincon I, Sangalli C, Perez Aguiar JL, Romero J, Morosi C, Sunyach MP, Sanfilippo R, Romagosa C, Ranchere-Vince D, Dei Tos AP, Casali PG, Martin-Broto J. Trabectedin and RAdiotherapy in Soft Tissue Sarcoma (TRASTS): Results of a Phase I Study in Myxoid Liposarcoma from Spanish (GEIS), Italian (ISG), French (FSG) Sarcoma Groups. EClinicalMedicine. 2019 Mar 11;9:35-43. doi: 10.1016/j.eclinm.2019.03.007. eCollection 2019 Mar.
- Individual participant dataSharing planned: No
Related trials for Liposarcoma, Myxoid
Active, not recruitingPhase 2
Testing Ipilimumab and Nivolumab Combination With or Without Cabozantinib in People >= 18 Years Old With Advanced Soft Tissue Sarcoma
Locally Advanced Extraskeletal Myxoid Chondrosarcoma, Locally Advanced Leiomyosarcoma
Not yet recruitingPhase 2
Testing the Anti-Cancer Drug, Brenetafusp (IMCF106C), in Rare Cancers
Metastatic Myxoid Liposarcoma, Metastatic Synovial Sarcoma
RecruitingPhase 1/2
A Study of Mirdametinib in Combination With Palbociclib in People With Liposarcoma
Well Differentiated Liposarcoma, Dedifferentiated Liposarcoma
RecruitingPhase 1
First-in-Human Trial of DS-2243a in Participants With Advanced Solid Tumors
Solid Tumors, Sarcoma
RecruitingEarly Phase 1
N-803 in Patients With Progressive Synovial Sarcoma and Myxoid/Round Cell Liposarcoma Previously Treated With Adoptive Cellular Therapy
Myxoid Liposarcoma, Round Cell Liposarcoma
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Javier Martín-Broto, MD principal investigator
Jiménez Díaz Foundation University Hospital
17 sites in 3 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 1/2 study testing Trabectedin and Radiotherapy in people with Liposarcoma, Myxoid and Sarcoma, Soft Tissue, run by Grupo Espanol de Investigacion en Sarcomas at 17 sites in 3 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 50 inclusion and 47 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 31 May 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 17 sites in Spain, Italy, France. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this combined phase mean?
Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Adriana Rojo (0034912866807, adriana.crc@grupogeis.org), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Tumor size (time frame: every 6 weeks for 24 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02275286, which also lists 3 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 May 2023.