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Cisplatin, Carboplatin and Etoposide or Temozolomide and Capecitabine in Treating Patients With Neuroendocrine Carcinoma of the Gastrointestinal Tract or Pancreas That Is Metastatic or Cannot Be Removed by Surgery

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ClinicalTrials.gov Identifier: NCT02595424
Recruitment Status : Recruiting
First Posted : November 3, 2015
Last Update Posted : December 22, 2020
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Eastern Cooperative Oncology Group ( ECOG-ACRIN Cancer Research Group )

Study Description
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Brief Summary:
This randomized phase II trial studies how well temozolomide and capecitabine work compared to standard treatment with cisplatin or carboplatin and etoposide in treating patients with neuroendocrine carcinoma of the gastrointestinal tract or pancreas that has spread to other parts of the body (metastatic) or cannot be removed by surgery. Drugs used in chemotherapy, such as temozolomide, capecitabine, cisplatin, carboplatin and etoposide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Certain types of neuroendocrine carcinomas may respond better to treatments other than the current standard treatment of cisplatin and etoposide. It is not yet known whether temozolomide and capecitabine may work better than cisplatin or carboplatin and etoposide in treating patients with this type of neuroendocrine carcinoma, called non-small cell neuroendocrine carcinoma.

Condition or disease Intervention/treatment Phase
Gastric Neuroendocrine Carcinoma Intestinal Neuroendocrine Carcinoma Pancreatic Neuroendocrine Carcinoma Drug: Capecitabine Drug: Carboplatin Drug: Cisplatin Drug: Etoposide Other: Laboratory Biomarker Analysis Drug: Temozolomide Phase 2

Detailed Description:

PRIMARY OBJECTIVES:

I. To assess the progression free survival (PFS) of platinum (cisplatin or carboplatin) and etoposide versus the PFS of temozolomide and capecitabine in patients with advanced G3 non-small cell gastroenteropancreatic neuroendocrine carcinomas.

SECONDARY OBJECTIVES:

I. To assess the response rate (RR) of platinum (cisplatin or carboplatin) and etoposide versus the RR of temozolomide and capecitabine in patients with advanced G3 non-small cell gastroenteropancreatic neuroendocrine carcinomas.

II. To assess the overall survival (OS) of platinum (cisplatin or carboplatin) and etoposide versus the OS of temozolomide and capecitabine in patients with advanced G3 non-small cell gastroenteropancreatic neuroendocrine carcinomas.

III. To evaluate the toxicities associated with the combination of temozolomide and capecitabine and the combination of platinum (cisplatin or carboplatin) and etoposide, respectively, in patients with advanced G3 non-small cell gastroenteropancreatic neuroendocrine carcinomas.

TERTIARY OBJECTIVES:

I. To assess the impact of each treatment regimen on PFS, RR and OS based on marker of proliferation Ki-67 index in patients with advanced G3 non-small cell gastroenteropancreatic neuroendocrine carcinomas. (Laboratory) II. To assess the prognostic significance of well differentiated versus poorly differentiated non-small cell gastroenteropancreatic neuroendocrine tumors in relationship to survival and response to treatment. (Laboratory) III. To assess the agreement in Ki-67 status between that reported by institutional pathologist and that reported by central pathology review. (Laboratory)

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM A: Patients receive capecitabine orally (PO) twice daily (BID) on days 1-14 and temozolomide PO once daily (QD) on days 10-14. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

ARM B: Patients receive cisplatin intravenously (IV) on days 1-3 or carboplatin IV on day 1. Patients also receive etoposide IV on days 1-3. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.

Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 126 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Randomized Phase II Study of Cisplatin and Etoposide Versus Temozolomide and Capecitabine in Patients With Advanced G3 Non-small Cell Gastroenteropancreatic Neuroendocrine Carcinomas
Actual Study Start Date : November 6, 2015
Estimated Primary Completion Date : January 1, 2024
Estimated Study Completion Date : January 1, 2029

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Experimental: Arm A (capecitabine, temozolomide)
Patients receive capecitabine PO BID on days 1-14 and temozolomide PO QD on days 10-14. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
 Drug: Capecitabine
Given PO

Other: Laboratory Biomarker Analysis
Correlative studies

Drug: Temozolomide
Given PO
Active Comparator: Arm B (cisplatin, carboplatin, etoposide)
Patients receive cisplatin IV on days 1-3 or carboplatin IV on day 1. Patients also receive etoposide IV on days 1-3. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
 Drug: Carboplatin
Given IV

Drug: Cisplatin
Given IV

Drug: Etoposide
Given IV

Other: Laboratory Biomarker Analysis
Correlative studies


Outcome Measures
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Primary Outcome Measures :
  1. PFS [ Time Frame: Time from randomization to documented progression or death without progression, assessed up to 1 year ]
    Kaplan-Meier estimates will be used for time-to-event distribution. PFS by arm will be compared using one-sided stratified log-rank tests. Stratified Cox?s proportional hazards models will be used to estimate hazard ratios.


Secondary Outcome Measures :
  1. Incidence of toxicity, graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 [ Time Frame: Up to 30 days after last dose of protocol therapy ]
    90% confidence intervals will be provided.

  2. OS [ Time Frame: Time from randomization to death from any cause, assessed up to 5 years ]
    Kaplan-Meier estimates will be used for time-to-event distribution. OS by arm will be compared using one-sided stratified log-rank tests. Stratified Cox?s proportional hazards models will be used to estimate hazard ratios.

  3. Response rate (complete response or partial response) by RECIST 1.1 [ Time Frame: Up to 5 years ]
    Analyzed using a Fisher?s exact test at a one-sided significance level of 0.10.


Other Outcome Measures:
  1. Ki-67 as a continuous measure assessed by immunohistochemistry (IHC) [ Time Frame: Baseline ]
    Will evaluate the interaction, if any, between Ki-67 as a continuous measure and treatment. Cox regression of logistic regression, as appropriate, will be used to identify whether the treatment effect varies by Ki-67 for PFS, OS, and RR.

  2. Ki-67 measured centrally [ Time Frame: Baseline ]
    Concordance between Ki-67 measured centrally versus registering institutions? pathology assessments will be investigated and reported. Intra-class correlation will be calculated to assess agreement amongst the two continuous measures.

  3. Ki-67 measured with registering institutions? pathology assessments [ Time Frame: Baseline ]
    Concordance between Ki-67 measured centrally versus registering institutions? pathology assessments will be investigated and reported. Intra-class correlation will be calculated to assess agreement amongst the two continuous measures.

  4. Optimal cutoff value in Ki-67 that defines patients with prolonged OS assessed by IHC [ Time Frame: Baseline ]
    Receiver operating characteristics analysis will be performed to first determine the optimal cutoff value in Ki-67 that defines patients with prolonged OS. For the series of Ki-67 values observed in the data, Youden?s index will be calculated and with the highest index the threshold that minimizes the false positive and false negative rates for best detecting prolonged OS will be identified. Optimal cutoff values of Ki-67 with respect to response to temozolomide and capecitabine, positive octreotide scans, and negative PET scans will also be determined in a similar manner.

  5. Prognostic significance of poorly differentiated non-small cell gastroenteropancreatic neuroendocrine tumors [ Time Frame: Baseline ]
    Will assess the prognostic significance of well differentiated versus poorly differentiated non-small cell gastroenteropancreatic neuroendocrine tumors in relationship to survival and response to treatment in a similar manner, via Cox proportional hazard models for time to event endpoint and logistic regression for objective response.

  6. Prognostic significance of well differentiated non-small cell gastroenteropancreatic neuroendocrine tumors [ Time Frame: Baseline ]
    Will assess the prognostic significance of well differentiated versus poorly differentiated non-small cell gastroenteropancreatic neuroendocrine tumors in relationship to survival and response to treatment in a similar manner, via Cox proportional hazard models for time to event endpoint and logistic regression for objective response.


Eligibility Criteria
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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients must have a locally advanced and unresectable or metastatic gastroenteropancreatic neuroendocrine carcinoma that is either known or suspected to be of gastrointestinal (GI) origin; primary tumors arising from the lung, gynecologic organs or prostate are not permitted
  • Patients must have pathologically/histologically confirmed tumor of non-small cell histology
  • Patients must have a Ki-67 proliferative index of 20-100% OR at least 10 mitotic figures per 10 high powered fields

  • Patients must have measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria; baseline measurements and evaluations of all sites of disease must be obtained within 4 weeks prior to randomization and must be acquired by multiphasic computed tomography (CT) or contrast magnetic resonance imaging (MRI)

    • NOTE: positron emission tomography (PET)-CT scans are allowed provided the CT portion of the exam is equivalent to a diagnostic CT scan and includes both oral and IV contrast
  • Patients may not have had any prior systemic treatment for this malignancy (for example chemotherapy or somatostatin analogues); prior palliative radiation is permitted but radiated lesions may not be used for measurement
  • Patients may not have received any of the protocol agents within 5 years prior to randomization
  • Any prior surgeries must have been completed at least 4 weeks prior to randomization
  • Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
  • Patients may not be receiving any other investigational agents while on study treatment
  • Patients may not be receiving Coumadin while on treatment; other anticoagulants are allowed
  • Leukocytes >= 3,000/mm^3
  • Absolute neutrophil count >= 1,500/mm^3
  • Hemoglobin >= 9 g/dL
  • Platelets >= 100,000/mm^3
  • Total bilirubin =< institutional upper limit of normal (ULN) or =< 1.5 X institutional ULN (if the patient has liver metastases)
  • Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 X institutional ULN or (=< 5 X institutional ULN if the patient has liver metastases)

  • Serum creatinine =< 1.5 X institutional ULN and creatinine clearance >= 60 ml/min

    • NOTE: creatinine clearance must be calculated using the Cockcroft-Gault equation
  • Patients must have a life expectancy of >= 12 weeks as determined clinically by the treating physician
  • Patients with brain metastases (either remote or current) or presence of carcinomatous meningitis are not eligible
  • Patients with known dihydropyrimidine dehydrogenase (DPD) deficiency will be excluded
  • Patients must NOT have active or uncontrolled infection, symptomatic heart failure, unstable angina pectoris, cardiac arrhythmia or a serious psychiatric illness/social situation that would limit compliance with study requirements
  • Patients with impaired decision making capacity may participate in the study if a legal authorized representative is available to consent
  • Patients must NOT have a history of allergic reactions attributed to compounds of similar chemical or biochemical composition to cisplatin, carboplatin, etoposide, temozolomide or capecitabine
  • Patients must NOT have absorption issues that would limit the ability to absorb study agents

  • Patients with a history of the following within =< 12 months of study entry are not eligible:

    • Arterial thromboembolic events
    • Unstable angina
    • Myocardial Infarction
  • Patients with symptomatic peripheral vascular disease are not eligible

  • Patients must NOT have previous or concurrent malignancy; exceptions are made for patients who meet any of the following conditions:

    • Non-melanoma skin cancer, in situ cervical cancer, superficial bladder cancer, or breast cancer in situ OR
    • Prior malignancy completely excised or removed and patient has been continuously disease free for > 5 years OR
    • Prior malignancy cured by non-surgical modalities and patient has been continuously disease free for > 5 years

  • Women must not be pregnant or breast-feeding

    • All females of childbearing potential must have a blood test or urine study within 2 weeks prior to randomization to rule out pregnancy
    • A female of childbearing potential is any woman, regardless of sexual orientation or whether they have undergone tubal ligation, who meets the following criteria: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)
  • Women of childbearing potential and sexually active males must be strongly advised to use an accepted and effective method of contraception or to abstain from sexual intercourse for the duration of their participation in the study
  • Patients must be able to swallow pills
  • Patients must be able to tolerate CT or magnetic resonance (MR) imaging including contrast agents as required for the treatment and the protocol
  • Patients who are known to have human immunodeficiency virus (HIV) or are on combination antiretroviral therapy are ineligible
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02595424


Locations
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Sponsors and Collaborators
ECOG-ACRIN Cancer Research Group
National Cancer Institute (NCI)
Investigators
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Principal Investigator: Jennifer Eads ECOG-ACRIN Cancer Research Group
More Information
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Responsible Party: ECOG-ACRIN Cancer Research Group
ClinicalTrials.gov Identifier: NCT02595424    
Other Study ID Numbers: EA2142
NCI-2015-00547 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
NCI-2015-00505
EA2142
EA2142 ( Other Identifier: ECOG-ACRIN Cancer Research Group )
EA2142 ( Other Identifier: CTEP )
U10CA180820 ( U.S. NIH Grant/Contract )
First Posted: November 3, 2015    Key Record Dates
Last Update Posted: December 22, 2020
Last Verified: December 2020
Additional relevant MeSH terms:
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Carcinoma
Carcinoma, Neuroendocrine
Carcinoma, Islet Cell
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Neuroendocrine Tumors
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Adenocarcinoma
Neoplasms, Nerve Tissue
Pancreatic Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Endocrine Gland Neoplasms
 Digestive System Diseases
Pancreatic Diseases
Endocrine System Diseases
Cisplatin
Carboplatin
Capecitabine
Etoposide
Temozolomide
Antineoplastic Agents
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents, Phytogenic
Topoisomerase II Inhibitors
Topoisomerase Inhibitors