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出境医 / 临床实验 / Impact of Tumour 1q Gain in French Pediatric and Young Adult Patients With Renal Tumours (UMBRELLA)

Impact of Tumour 1q Gain in French Pediatric and Young Adult Patients With Renal Tumours (UMBRELLA)

Study Description
Brief Summary:

French patients with nephroblastoma (Wilms tumour, WT) have been treated for > 40 years according to International Society of Paediatric Oncology (SIOP) protocols with currently 267 centres across 28 countries collaborating internationally within the SIOP Renal Tumour Study Group (RTSG).

Over the last decades more than 10,000 children have been prospectively enrolled in SIOP WT studies and trials. This has resulted in more standardised diagnostic procedures, improved risk stratification, and adjusted treatment recommendations for most renal tumours. The treatment of patients with renal tumours according to SIOP protocols include preoperative chemotherapy, surgery (tumour-nephrectomy + node-picking ± metastasectomy) followed by risk- and stage-based postoperative chemotherapy ± radiotherapy. Central pathology review is nowadays routinely performed in order to prevent misclassification of stage and histology risk group.

The current SIOP 2001 protocol has come to an end with as major achievement the scientific proof of omitting doxorubicin in stage II and III patients with as a consequence less risk of sequelae. Moreover, in the SIOP 2001 protocol, several tumour biological aspects have been assessed that seem to interfere with outcome (chromosomal gain of 1q, or loss of 1p and 16q, blastemal residual volume). Chromosomal 1q gain is considered to be present in 25-35% of patients with nephroblastoma with a negative impact on event-free survival (EFS) in retrospective analyses. These biological aspects will be studied prospectively as a primary objective in the new SIOP RTSG 2016 UMBRELLA protocol that integrates diagnostics, treatment and follow-up guidelines as well as several research projects.

The main mission of the International Society of Paediatric Oncology (SIOP) Renal Tumour Study Group (RTSG) is to increase survival and to reduce acute treatment toxicity and late effects in all children diagnosed with any renal tumour. In this context, SIOP RTSG is aiming to offer all these patients the same standardized high quality diagnostics and treatment, independent of the tumour type. The new SIOP RTSG 2016 integrated diagnostic and research UMBRELLA protocol serves as an entry for including all children with a renal tumour in the SIOP-RTSG centers, including prospective biomarker analyses. Subsequently, treatment is recommended according to the SIOP RTSG 2016 UMBRELLA treatment guidelines, which provides treatment strategies for all patients with Wilms tumour (WT) and other renal tumours. Central radiology review (CRR) has been proposed as a novel tool within the diagnostic UMBRELLA protocol in order to optimize the diagnostics and hence the treatment.

The definition of metastatic disease in WT remains difficult since pulmonary nodules may not always be of malignant origin. The differential diagnosis of a pulmonary lesion seen in a child with WT is broad. In addition to malignancy, it includes atelectasis, fibrosis, pneumonitis, subpleural lymph nodes, and other infectious or inflammatory lesions. In addition, the issue of "CT-only" nodules in WT and adequate treatment needs to be solved. In previous protocols, the treatment strategy was based on the diagnosis of pulmonary metastases (92% of all metastases) by conventional pulmonary X-ray. Patients with CT-only nodules (= nodules not visible on conventional X-ray) were supposed to be treated as having localized WT. However, retrospective analyses of SIOP series (Smets et al), showed that patients with CT-only nodules had a less favourable prognosis as compared to patients with truly localized disease with a 12% difference in three-year event-free survival.

The diagnostics of bilateral renal tumours (stage V) often is complicated since it may be difficult to distinguish true WT from nephroblastomatosis/ nephrogenic rests, a pre malignant renal (multifocal) anomaly, which may respond to preoperative chemotherapy. An optimal multi-disciplinary sequential diagnostic procedure is required in order to propose the best adapted therapeutic approach to preserve sufficient renal tissue.


Condition or disease Intervention/treatment Phase
Kidney Cancer Other: Radiologic Centralized Review Other: Tissue sample (tumor, sung, urine) Not Applicable

Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 510 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: Treatment for French Pediatric Patients With Renal Tumours According to the International SIOP Renal Tumour Study Group (RTSG) 2016 UMBRELLA Protocol Including Analysis of Tumour Chromosome 1q Gain and Central Radiology Review
Estimated Study Start Date : August 1, 2019
Estimated Primary Completion Date : August 1, 2026
Estimated Study Completion Date : August 1, 2026
Arms and Interventions
Arm Intervention/treatment
Experimental: children and young adults supported in one of SFCE's centers Other: Radiologic Centralized Review
The patient's imaging will be examined in one of the examination centers

Other: Tissue sample (tumor, sung, urine)
all the samples will be made during the patients care

Outcome Measures
Primary Outcome Measures :
  1. Impact of tumour chromosomal 1q gain on event-free survival (EFS) [ Time Frame: 5 years ]
    5-year EFS will be analyzed by Kaplan-Meier analysis in all patients with nephroblastoma. The impact of tumour 1gain on 5-year EFS will be analyzed statistically by log-rank analysis comparing those patients with 1q gain with patients withour 1q gain

  2. Impact of tumour chromosomal 1q gain on overall survival (OS) [ Time Frame: 5 years ]
    5-year OS will be analyzed by Kaplan-Meier analysis in all patients with nephroblastoma. The impact of tumour 1gain on 5-year OS will be analyzed statistically by log-rank analysis comparing those patients with 1q gain with patients withour 1q gain


Secondary Outcome Measures :
  1. Central radiology review [ Time Frame: 5 years ]
    Central radiology review will be proposed as a novel tool in order to optimize the diagnostics and hence the treatment of patients with renal tumours. As such it will impact the 5-year EFS and OS.

  2. Blastemal residual volume [ Time Frame: 5 years ]
    The impact of balstemal residual volume > 10 ml in the tumour on outcome will be compared to patients with < 10 ml of residual volume. It is anticipated that ther ewill be a statisticla difference in EFS and/or OS.


Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   up to 30 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Children, adolescents or young adults (up to and including 30 years) with primary or relapsed renal tumor diagnosed at a participating SIOP-RTSG center
  • Subject agreeing to participate

Exclusion Criteria:

  • Absence of informed consent
Contacts and Locations

Contacts
Layout table for location contacts
Contact: Arnauld VERSCHUUR 33(0)4 91 38 84 78 arnauld.verschuur@ap-hm.fr

Locations
Layout table for location information
France
Service d'Hématologie-Oncologie Pédiatrique - APHM
Marseille, France, 13354
Contact: Arnauld VERSCHUUR    33(0)4 91 38 84 78    arnauld.verschuur@ap-hm.fr   
Sponsors and Collaborators
Assistance Publique Hopitaux De Marseille
Investigators
Layout table for investigator information
Study Director: Jean-Olivier ARNAUD AP HM
Tracking Information
First Submitted Date  ICMJE June 12, 2019
First Posted Date  ICMJE July 2, 2019
Last Update Posted Date July 2, 2019
Estimated Study Start Date  ICMJE August 1, 2019
Estimated Primary Completion Date August 1, 2026   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: June 28, 2019)
  • Impact of tumour chromosomal 1q gain on event-free survival (EFS) [ Time Frame: 5 years ]
    5-year EFS will be analyzed by Kaplan-Meier analysis in all patients with nephroblastoma. The impact of tumour 1gain on 5-year EFS will be analyzed statistically by log-rank analysis comparing those patients with 1q gain with patients withour 1q gain
  • Impact of tumour chromosomal 1q gain on overall survival (OS) [ Time Frame: 5 years ]
    5-year OS will be analyzed by Kaplan-Meier analysis in all patients with nephroblastoma. The impact of tumour 1gain on 5-year OS will be analyzed statistically by log-rank analysis comparing those patients with 1q gain with patients withour 1q gain
Original Primary Outcome Measures  ICMJE Same as current
Change History No Changes Posted
Current Secondary Outcome Measures  ICMJE
 (submitted: June 28, 2019)
  • Central radiology review [ Time Frame: 5 years ]
    Central radiology review will be proposed as a novel tool in order to optimize the diagnostics and hence the treatment of patients with renal tumours. As such it will impact the 5-year EFS and OS.
  • Blastemal residual volume [ Time Frame: 5 years ]
    The impact of balstemal residual volume > 10 ml in the tumour on outcome will be compared to patients with < 10 ml of residual volume. It is anticipated that ther ewill be a statisticla difference in EFS and/or OS.
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Impact of Tumour 1q Gain in French Pediatric and Young Adult Patients With Renal Tumours
Official Title  ICMJE Treatment for French Pediatric Patients With Renal Tumours According to the International SIOP Renal Tumour Study Group (RTSG) 2016 UMBRELLA Protocol Including Analysis of Tumour Chromosome 1q Gain and Central Radiology Review
Brief Summary

French patients with nephroblastoma (Wilms tumour, WT) have been treated for > 40 years according to International Society of Paediatric Oncology (SIOP) protocols with currently 267 centres across 28 countries collaborating internationally within the SIOP Renal Tumour Study Group (RTSG).

Over the last decades more than 10,000 children have been prospectively enrolled in SIOP WT studies and trials. This has resulted in more standardised diagnostic procedures, improved risk stratification, and adjusted treatment recommendations for most renal tumours. The treatment of patients with renal tumours according to SIOP protocols include preoperative chemotherapy, surgery (tumour-nephrectomy + node-picking ± metastasectomy) followed by risk- and stage-based postoperative chemotherapy ± radiotherapy. Central pathology review is nowadays routinely performed in order to prevent misclassification of stage and histology risk group.

The current SIOP 2001 protocol has come to an end with as major achievement the scientific proof of omitting doxorubicin in stage II and III patients with as a consequence less risk of sequelae. Moreover, in the SIOP 2001 protocol, several tumour biological aspects have been assessed that seem to interfere with outcome (chromosomal gain of 1q, or loss of 1p and 16q, blastemal residual volume). Chromosomal 1q gain is considered to be present in 25-35% of patients with nephroblastoma with a negative impact on event-free survival (EFS) in retrospective analyses. These biological aspects will be studied prospectively as a primary objective in the new SIOP RTSG 2016 UMBRELLA protocol that integrates diagnostics, treatment and follow-up guidelines as well as several research projects.

The main mission of the International Society of Paediatric Oncology (SIOP) Renal Tumour Study Group (RTSG) is to increase survival and to reduce acute treatment toxicity and late effects in all children diagnosed with any renal tumour. In this context, SIOP RTSG is aiming to offer all these patients the same standardized high quality diagnostics and treatment, independent of the tumour type. The new SIOP RTSG 2016 integrated diagnostic and research UMBRELLA protocol serves as an entry for including all children with a renal tumour in the SIOP-RTSG centers, including prospective biomarker analyses. Subsequently, treatment is recommended according to the SIOP RTSG 2016 UMBRELLA treatment guidelines, which provides treatment strategies for all patients with Wilms tumour (WT) and other renal tumours. Central radiology review (CRR) has been proposed as a novel tool within the diagnostic UMBRELLA protocol in order to optimize the diagnostics and hence the treatment.

The definition of metastatic disease in WT remains difficult since pulmonary nodules may not always be of malignant origin. The differential diagnosis of a pulmonary lesion seen in a child with WT is broad. In addition to malignancy, it includes atelectasis, fibrosis, pneumonitis, subpleural lymph nodes, and other infectious or inflammatory lesions. In addition, the issue of "CT-only" nodules in WT and adequate treatment needs to be solved. In previous protocols, the treatment strategy was based on the diagnosis of pulmonary metastases (92% of all metastases) by conventional pulmonary X-ray. Patients with CT-only nodules (= nodules not visible on conventional X-ray) were supposed to be treated as having localized WT. However, retrospective analyses of SIOP series (Smets et al), showed that patients with CT-only nodules had a less favourable prognosis as compared to patients with truly localized disease with a 12% difference in three-year event-free survival.

The diagnostics of bilateral renal tumours (stage V) often is complicated since it may be difficult to distinguish true WT from nephroblastomatosis/ nephrogenic rests, a pre malignant renal (multifocal) anomaly, which may respond to preoperative chemotherapy. An optimal multi-disciplinary sequential diagnostic procedure is required in order to propose the best adapted therapeutic approach to preserve sufficient renal tissue.

Detailed Description Not Provided
Study Type  ICMJE Interventional
Study Phase  ICMJE Not Applicable
Study Design  ICMJE Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Condition  ICMJE Kidney Cancer
Intervention  ICMJE
  • Other: Radiologic Centralized Review
    The patient's imaging will be examined in one of the examination centers
  • Other: Tissue sample (tumor, sung, urine)
    all the samples will be made during the patients care
Study Arms  ICMJE Experimental: children and young adults supported in one of SFCE's centers
Interventions:
  • Other: Radiologic Centralized Review
  • Other: Tissue sample (tumor, sung, urine)
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Not yet recruiting
Estimated Enrollment  ICMJE
 (submitted: June 28, 2019)
510
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE August 1, 2026
Estimated Primary Completion Date August 1, 2026   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • Children, adolescents or young adults (up to and including 30 years) with primary or relapsed renal tumor diagnosed at a participating SIOP-RTSG center
  • Subject agreeing to participate

Exclusion Criteria:

  • Absence of informed consent
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE up to 30 Years   (Child, Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE
Contact: Arnauld VERSCHUUR 33(0)4 91 38 84 78 arnauld.verschuur@ap-hm.fr
Listed Location Countries  ICMJE France
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT04005820
Other Study ID Numbers  ICMJE 2018-44
Has Data Monitoring Committee No
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE Not Provided
Responsible Party Assistance Publique Hopitaux De Marseille
Study Sponsor  ICMJE Assistance Publique Hopitaux De Marseille
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Study Director: Jean-Olivier ARNAUD AP HM
PRS Account Assistance Publique Hopitaux De Marseille
Verification Date June 2019

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP

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