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出境医 / 临床实验 / Doxorubicin Eluting Intra-arterial Embolization for Aggressive Desmoid Fibromatosis

Doxorubicin Eluting Intra-arterial Embolization for Aggressive Desmoid Fibromatosis

Study Description
Brief Summary:
In this study Drug-eluting microbeads (DEB) loaded with Doxorubicin will be delivered into the target Desmoid Fibromatoses (DF) tissue via selective arterial embolization by angiographic technique. The objective of the study is to demonstrate the safety and efficacy of this treatment.

Condition or disease Intervention/treatment Phase
Desmoid Desmoid Fibromatosis of Skin Desmoid Neoplasm of Chest Wall Desmoid Tumor Caused by Somatic Mutation Aggressive Fibromatoses Fibromatosis Desmoid Desmoid Fibromatosis Procedure: Drug Eluting Bead Embolization (DEB) for Desmoid Fibromatosis Phase 2

Detailed Description:

Desmoid Fibromatoses (DF) are locally aggressive lesions associated with substantial morbidity and potentially mortality, due to invasion of adjacent neurovascular structures and vital organs. They have no potential for metastasis. Histologically, they are characterised by mature fibroblasts within a matrix of abundant fibrous stroma. While 5-15% of cases are seen in patients with Familial Adenomatous Polyposis (FAP) syndrome, the vast majority arise sporadically.

The etiology of Desmoids remains poorly understood and the therapeutic approaches in their management remain very diverse. For resectable lesions, surgery is recommended but reported cure rates range broadly from 12-80%. Systemic treatments range from non-steroidal anti-inflammatories and anti-estrogenic therapy to targeted tyrosine kinase inhibitors and cytotoxic chemotherapy, most commonly methotrexate, vinblastine and doxorubicin.

Doxorubicin is an anthracycline with demonstrated efficacy in treating desmoids at systemic IV doses of 50- 75mg/m2 over 3-4 week cycles. Extended use is limited by dose - dependent cardiotoxicity which can be seen in up to 36% of patients receiving doses in excess of 550mg/m2. Delayed cardiotoxicity is particularly common and less predictable among pediatric cancer survivors.

Selective trans-arterial chemo-embolization (TACE) is a method to achieve high tissue drug concentration with minimal systemic toxicity. Historically, this has been achieved by mixing doxorubicin with embolic agents such as lipiodol or gelatin sponge in the treatment of hepatocellular carcinoma (HCC).

Drug-eluting microbeads (DEB) ionically loaded with doxorubicin have shown sustained release in TACE target tissues with substantially lower serum drug concentrations when compared to lipiodol TACE.

The present study utilizes DEB's loaded with Doxorubicin delivered into the target DF tissue via selective arterial embolization by angiographic technique. This study follows a successful feasibility study.

Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 50 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Intervention Model Description: All patients
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Doxorubicin Eluting Intra-arterial Embolization for Aggressive Desmoid Fibromatosis
Actual Study Start Date : October 11, 2018
Estimated Primary Completion Date : October 2023
Estimated Study Completion Date : October 2025
Arms and Interventions
Arm Intervention/treatment
Experimental: Treatment
Doxorubin-eluting particle embolization for treatment of Desmoid Fibromatosis.
Procedure: Drug Eluting Bead Embolization (DEB) for Desmoid Fibromatosis

Delivery of Doxorubicin selectively into Desmoid Fibromatosis utilizing its vascular supply as a conduit, and ionic loading the doxorubicin onto embolized particles as the drug delivery vehicle.

Maximal dose is 75 mg/m2 and at least 50 mg. The bead size is 75-300 Mµ in a 2 CC syringe.


Outcome Measures
Primary Outcome Measures :
  1. Objective response rate of tumor size. [ Time Frame: At baseline ; 6-10 weeks after each treatment ]
    Response to treatment. Measured by change in tumor size according to RECIST (Response Evaluation Criteria in Solid Tumors) version 1.1 criteria.

  2. Objective response rate of tumor biological activity. [ Time Frame: At baseline ; 6-10 weeks after each treatment ]
    Response to treatment. Tumor biological activity measured by change in MRI T2 signal intensity.

  3. Patient reported outcomes. [ Time Frame: At baseline ; 6-10 weeks after each treatment ]

    Change in clinical symptoms measured by standard clinical patient questionnaires - EORTC QLQ-C30. (Quality of Life Questionnaire).

    All of the scales and single-item measures range in score from 0 to 100. A high scale score represents a higher response level. Thus a high score for a functional scale represents a high level of functioning, a high score for the global health status / QoL represents a high QoL. Similarly, a high score for a symptom scale represents a high level of symptomatology.



Secondary Outcome Measures :
  1. Adverse event profile (safety) [ Time Frame: At baseline ; 6-10 weeks ]
    Treatment safety measured by standard patient questionnaires and clinical evaluation using CTCAE (Common Terminology Criteria for Adverse Events) version 5.0.


Other Outcome Measures:
  1. Pharmacokinetics of Doxorubicin [ Time Frame: 5 minutes, 30 minutes, 1 hour, 12 hours, 24 hours after treatment procedure ]
    Measurements of blood Doxorubicin concentration (mg/ml) over time, after treatment.

  2. Exploratory biomarkers [ Time Frame: At baseline ; 6-10 weeks ]
    Immunohistochemistry assay assessing the staining pattern (marked as negative to mildly or strongly positive) for: beta-catenin, keratin, SMA (smooth muscle actin). Ki-67 staining will be scored by percentage.


Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   3 Years to 80 Years   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Age 3-80 years.
  2. Histologically confirmed diagnosis of Desmoids Fibromatosis.
  3. After at least one systemic treatment line. Standard first line systemic treatment may include: Methotrexate, Vinblastine, Doxorubicin, Liposomal Doxorubicin (Doxil), NSAIDS or hormonal treatment. If first line treatment is renounced, this treatment decision must be documented. Considering the trend of avoiding surgical treatment, the documentation must include that the treatment decision is not associated to the resectability of the tumor.
  4. Karnofsky performance status (PS)>50% for patients older than 16 years or Lansky PS >50% for patients under 16 years.
  5. At least one measurable lesion, with a long diameter of at least 30mm, with an anatomical location accessible for endovascular treatment.
  6. T2 signal increase on MRI.
  7. No evidence of prior treatment toxicity, adequate washout period after prior treatment:

    • 14 days after myelosuppressive chemotherapy treatment.
    • 7 days after GCSF (Granulocyte colony-stimulating factor), 14 days after Neulastim.
    • 7 days after targeted/biologic treatment.
  8. Female patients of childbearing potential must be willing to use an adequate method of contraception (hormonal, barrier or abstinence) for the treatment period and up to 90 days after the treatment completion.
  9. Willing and able to provide written informed consent for the trial.

Exclusion Criteria:

  1. Participation in another interventional study.
  2. Congestive heart failure, characterised by LVEF (Left Ventricular Ejection Fraction) < 50% or Shortening fracture < 27%.
  3. Previous treatment with anthracycline of a accumulative dose of more than 360 mg/m2.
  4. History of allergic reaction attributed to Doxil or doxorubicin treatment.
  5. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure (New York Heart Association Class III or IV), cardiac arrhythmia, or psychiatric illness, social situations that would limit compliance with study requirements.
Contacts and Locations

Contacts
Layout table for location contacts
Contact: Eldad Elnekave, MD +972-3-9377940 eldadel@clalit.org.il

Locations
Layout table for location information
Israel
Rabin Medical Center Recruiting
Petach-Tikva, Israel
Contact: Eldad Elnekave, MD       eldadel@clalit.org.il   
Sponsors and Collaborators
Rabin Medical Center
Tracking Information
First Submitted Date  ICMJE April 8, 2019
First Posted Date  ICMJE May 29, 2019
Last Update Posted Date May 30, 2019
Actual Study Start Date  ICMJE October 11, 2018
Estimated Primary Completion Date October 2023   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: May 28, 2019)
  • Objective response rate of tumor size. [ Time Frame: At baseline ; 6-10 weeks after each treatment ]
    Response to treatment. Measured by change in tumor size according to RECIST (Response Evaluation Criteria in Solid Tumors) version 1.1 criteria.
  • Objective response rate of tumor biological activity. [ Time Frame: At baseline ; 6-10 weeks after each treatment ]
    Response to treatment. Tumor biological activity measured by change in MRI T2 signal intensity.
  • Patient reported outcomes. [ Time Frame: At baseline ; 6-10 weeks after each treatment ]
    Change in clinical symptoms measured by standard clinical patient questionnaires - EORTC QLQ-C30. (Quality of Life Questionnaire). All of the scales and single-item measures range in score from 0 to 100. A high scale score represents a higher response level. Thus a high score for a functional scale represents a high level of functioning, a high score for the global health status / QoL represents a high QoL. Similarly, a high score for a symptom scale represents a high level of symptomatology.
Original Primary Outcome Measures  ICMJE
 (submitted: May 28, 2019)
  • Objective response rate of tumor size. [ Time Frame: At baseline ; 6-10 weeks after each treatment ]
    Response to treatment. Measured by change in tumor size according to RECIST (Response Evaluation Criteria in Solid Tumors) version 1.1 criteria.
  • Objective response rate of tumor biological activity. [ Time Frame: At baseline ; 6-10 weeks after each treatment ]
    Response to treatment. Tumor biological activity measured by change in MRI T2 signal intensity.
  • Patient reported outcomes. [ Time Frame: At baseline ; 6-10 weeks after each treatment ]
    Change in clinical symptoms measured by standard clinical patient questionnaires - EORTC QLQ-C30. (Quality of Life Questionnaire)
Change History No Changes Posted
Current Secondary Outcome Measures  ICMJE
 (submitted: May 28, 2019)
Adverse event profile (safety) [ Time Frame: At baseline ; 6-10 weeks ]
Treatment safety measured by standard patient questionnaires and clinical evaluation using CTCAE (Common Terminology Criteria for Adverse Events) version 5.0.
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures
 (submitted: May 28, 2019)
  • Pharmacokinetics of Doxorubicin [ Time Frame: 5 minutes, 30 minutes, 1 hour, 12 hours, 24 hours after treatment procedure ]
    Measurements of blood Doxorubicin concentration (mg/ml) over time, after treatment.
  • Exploratory biomarkers [ Time Frame: At baseline ; 6-10 weeks ]
    Immunohistochemistry assay assessing the staining pattern (marked as negative to mildly or strongly positive) for: beta-catenin, keratin, SMA (smooth muscle actin). Ki-67 staining will be scored by percentage.
Original Other Pre-specified Outcome Measures
 (submitted: May 28, 2019)
  • Pharmacokinetics of Doxorubicin [ Time Frame: 5 minutes, 30 minutes, 1 hour, 12 hours, 24 hours after treatment procedure ]
    Measurements of blood Doxorubicin concentration (mg/ml) over time, after treatment.
  • Exploratory biomarkers [ Time Frame: At baseline ; 6-10 weeks ]
    Immunohistochemistry assay for beta-catenin, keratin, SMA (smooth muscle actin), Ki-67 and apoptosis markers
 
Descriptive Information
Brief Title  ICMJE Doxorubicin Eluting Intra-arterial Embolization for Aggressive Desmoid Fibromatosis
Official Title  ICMJE Doxorubicin Eluting Intra-arterial Embolization for Aggressive Desmoid Fibromatosis
Brief Summary In this study Drug-eluting microbeads (DEB) loaded with Doxorubicin will be delivered into the target Desmoid Fibromatoses (DF) tissue via selective arterial embolization by angiographic technique. The objective of the study is to demonstrate the safety and efficacy of this treatment.
Detailed Description

Desmoid Fibromatoses (DF) are locally aggressive lesions associated with substantial morbidity and potentially mortality, due to invasion of adjacent neurovascular structures and vital organs. They have no potential for metastasis. Histologically, they are characterised by mature fibroblasts within a matrix of abundant fibrous stroma. While 5-15% of cases are seen in patients with Familial Adenomatous Polyposis (FAP) syndrome, the vast majority arise sporadically.

The etiology of Desmoids remains poorly understood and the therapeutic approaches in their management remain very diverse. For resectable lesions, surgery is recommended but reported cure rates range broadly from 12-80%. Systemic treatments range from non-steroidal anti-inflammatories and anti-estrogenic therapy to targeted tyrosine kinase inhibitors and cytotoxic chemotherapy, most commonly methotrexate, vinblastine and doxorubicin.

Doxorubicin is an anthracycline with demonstrated efficacy in treating desmoids at systemic IV doses of 50- 75mg/m2 over 3-4 week cycles. Extended use is limited by dose - dependent cardiotoxicity which can be seen in up to 36% of patients receiving doses in excess of 550mg/m2. Delayed cardiotoxicity is particularly common and less predictable among pediatric cancer survivors.

Selective trans-arterial chemo-embolization (TACE) is a method to achieve high tissue drug concentration with minimal systemic toxicity. Historically, this has been achieved by mixing doxorubicin with embolic agents such as lipiodol or gelatin sponge in the treatment of hepatocellular carcinoma (HCC).

Drug-eluting microbeads (DEB) ionically loaded with doxorubicin have shown sustained release in TACE target tissues with substantially lower serum drug concentrations when compared to lipiodol TACE.

The present study utilizes DEB's loaded with Doxorubicin delivered into the target DF tissue via selective arterial embolization by angiographic technique. This study follows a successful feasibility study.

Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 2
Study Design  ICMJE Allocation: N/A
Intervention Model: Single Group Assignment
Intervention Model Description:
All patients
Masking: None (Open Label)
Primary Purpose: Treatment
Condition  ICMJE
  • Desmoid
  • Desmoid Fibromatosis of Skin
  • Desmoid Neoplasm of Chest Wall
  • Desmoid Tumor Caused by Somatic Mutation
  • Aggressive Fibromatoses
  • Fibromatosis Desmoid
  • Desmoid Fibromatosis
Intervention  ICMJE Procedure: Drug Eluting Bead Embolization (DEB) for Desmoid Fibromatosis

Delivery of Doxorubicin selectively into Desmoid Fibromatosis utilizing its vascular supply as a conduit, and ionic loading the doxorubicin onto embolized particles as the drug delivery vehicle.

Maximal dose is 75 mg/m2 and at least 50 mg. The bead size is 75-300 Mµ in a 2 CC syringe.

Study Arms  ICMJE Experimental: Treatment
Doxorubin-eluting particle embolization for treatment of Desmoid Fibromatosis.
Intervention: Procedure: Drug Eluting Bead Embolization (DEB) for Desmoid Fibromatosis
Publications * Elnekave E, Atar E, Amar S, Bruckheimer E, Knizhnik M, Yaniv I, Dujovny T, Feinmesser M, Ash S. Doxorubicin-Eluting Intra-Arterial Therapy for Pediatric Extra-Abdominal Desmoid Fibromatoses: A Promising Approach for a Perplexing Disease. J Vasc Interv Radiol. 2018 Oct;29(10):1376-1382. doi: 10.1016/j.jvir.2018.04.009. Epub 2018 Jul 31.

*   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 Recruiting
Estimated Enrollment  ICMJE
 (submitted: May 28, 2019)
50
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE October 2025
Estimated Primary Completion Date October 2023   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  1. Age 3-80 years.
  2. Histologically confirmed diagnosis of Desmoids Fibromatosis.
  3. After at least one systemic treatment line. Standard first line systemic treatment may include: Methotrexate, Vinblastine, Doxorubicin, Liposomal Doxorubicin (Doxil), NSAIDS or hormonal treatment. If first line treatment is renounced, this treatment decision must be documented. Considering the trend of avoiding surgical treatment, the documentation must include that the treatment decision is not associated to the resectability of the tumor.
  4. Karnofsky performance status (PS)>50% for patients older than 16 years or Lansky PS >50% for patients under 16 years.
  5. At least one measurable lesion, with a long diameter of at least 30mm, with an anatomical location accessible for endovascular treatment.
  6. T2 signal increase on MRI.
  7. No evidence of prior treatment toxicity, adequate washout period after prior treatment:

    • 14 days after myelosuppressive chemotherapy treatment.
    • 7 days after GCSF (Granulocyte colony-stimulating factor), 14 days after Neulastim.
    • 7 days after targeted/biologic treatment.
  8. Female patients of childbearing potential must be willing to use an adequate method of contraception (hormonal, barrier or abstinence) for the treatment period and up to 90 days after the treatment completion.
  9. Willing and able to provide written informed consent for the trial.

Exclusion Criteria:

  1. Participation in another interventional study.
  2. Congestive heart failure, characterised by LVEF (Left Ventricular Ejection Fraction) < 50% or Shortening fracture < 27%.
  3. Previous treatment with anthracycline of a accumulative dose of more than 360 mg/m2.
  4. History of allergic reaction attributed to Doxil or doxorubicin treatment.
  5. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure (New York Heart Association Class III or IV), cardiac arrhythmia, or psychiatric illness, social situations that would limit compliance with study requirements.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 3 Years to 80 Years   (Child, Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE
Contact: Eldad Elnekave, MD +972-3-9377940 eldadel@clalit.org.il
Listed Location Countries  ICMJE Israel
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT03966742
Other Study ID Numbers  ICMJE RMC-0485-17
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
Product Manufactured in and Exported from the U.S.: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: No
Responsible Party Eldad Elnekave, MD, Rabin Medical Center
Study Sponsor  ICMJE Rabin Medical Center
Collaborators  ICMJE Not Provided
Investigators  ICMJE Not Provided
PRS Account Rabin Medical Center
Verification Date May 2019

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