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Efficacy and Safety of Lanreotide Autogel (ATG) in Combination With Temozolomide in Subjects With Thoracic Neuroendocrine Tumors. (ATLANT)

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ClinicalTrials.gov Identifier: NCT02698410
Recruitment Status : Completed
First Posted : March 3, 2016
Results First Posted : October 1, 2020
Last Update Posted : October 1, 2020
Sponsor:
Information provided by (Responsible Party):
Ipsen

Brief Summary:
The purpose of the protocol is to evaluate the efficacy and safety of Lanreotide ATG 120 mg in combination with Temozolomide in subjects with unresectable advanced neuroendocrine tumours of the lung or thymus as Disease Control Rate at 9 months.

Condition or disease Intervention/treatment Phase
Neuroendocrine Tumours Drug: Lanreotide (Autogel formulation) and Temozolomide Phase 2

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 40 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Efficacy and Safety of Lanreotide ATG 120 mg in Combination With Temozolomide in Subjects With Progressive Well Differentiated Thoracic Neuroendocrine Tumors. A Phase II, Multicentre, Single Arm, Open-label Trial.
Study Start Date : July 2016
Actual Primary Completion Date : February 8, 2019
Actual Study Completion Date : June 18, 2019


Arm Intervention/treatment
Experimental: Lanreotide (Autogel formulation) and Temozolomide

Lanreotide ATG 120 mg every 28 days, deep subcutaneous injection for a maximum of 48 weeks, for a total number of 12 injections.

Temozolomide 250 mg hard capsules, for 5 consecutive days every 28 days, oral route, for a maximum of 48 weeks.

Drug: Lanreotide (Autogel formulation) and Temozolomide



Primary Outcome Measures :
  1. Disease Control Rate (DCR) Assessed Locally at Month 9 [ Time Frame: Up to Month 9; for sensitivity analysis-2, up to 10.5 months ]
    Responders were participants who showed disease control according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria v 1.1 assessed locally by the investigator. The DCR was defined as complete response (CR), partial response (PR) or stable disease (SD) according to RECIST criteria v1.1. A sensitivity analysis-1 of local DCR was performed excluding participants withdrawn before 9 months with reason other than progressive disease (PD) or missing assessment and considering participants with PD prior or at 9 months as failures. In addition, a sensitivity analysis-2 was performed in order to consider assessments done between 7.5 and 10.5 months as 9 months assessments when 9-month assessment was missing using same methodology, i.e. considering PD prior or at 9 months and participants withdrawn with other or missing reasons as failures.


Secondary Outcome Measures :
  1. DCR Assessed Centrally at Month 9 [ Time Frame: Up to Month 9 ]
    The DCR was defined as SD, PR or CR according to RECIST criteria v1.1. A second set of the original computed tomography (CT) scan images were used for a centralized RECIST v1.1 assessment by an independent radiologist.

  2. Median Progression Free Survival (PFS) Assessed Locally and Centrally [ Time Frame: From Day 1 up to end of study, 52 weeks ]
    The PFS was defined as the time from the first treatment administration to disease progression according to RECIST criteria v 1.1 or death from any cause. The PFS was assessed locally by the investigator and centrally by an independent radiologist. The distribution of PFS times was estimated using the Kaplan-Meier method. The PFS of participants who were lost to follow-up and those who had not progressed at end of study were censored at the date of the last disease assessment.

  3. Median Time to Response (TTR) Assessed Locally and Centrally [ Time Frame: From Day 1 up to end of study, 52 weeks ]
    The TTR was defined as the time from first treatment administration to the first objective tumor response (PR or CR according to RECIST criteria v 1.1). The TTR was assessed locally by the investigator and centrally by an independent radiologist. The distribution of TTR was estimated using the Kaplan-Meier method. The TTR of participants who were lost to follow-up or died prior to any objective tumor response were censored at the date of the last disease assessment.

  4. Median Duration of Response (DOR) Assessed Locally and Centrally [ Time Frame: From Day 1 up to end of study, 52 weeks ]
    The DOR was defined as the time from onset of the first objective tumor response (PR or CR) to objective tumor progression (PD) according to RECIST criteria v 1.1. The DOR was assessed locally by the investigator and centrally by an independent radiologist.

  5. Median Time to Progression (TTP) Assessed Locally and Centrally [ Time Frame: From Day 1 up to end of study, 52 weeks ]
    The TTP was defined as the time from first treatment administration to the first objective tumor progression (PD) according to RECIST criteria v 1.1. The TTP was assessed locally by the investigator and centrally by an independent radiologist. The distribution of TTP times was estimated using the Kaplan-Meier method. The TTP of participants who were lost to follow-up, and those who had not progressed at end of study were censored at the date of the last disease assessment.

  6. Best Overall Response (BOR) Assessed Locally and Centrally [ Time Frame: From Day 1 up to end of study, 52 weeks ]
    The BOR was defined as the highest OR achieved by the participant from the time of first treatment until disease progression/recurrence or the end of study according to RECIST criteria v1.1 and was classified as: CR > PR > Non-CR/Non-progressive disease (NCR/NPD) > SD > PD > ND > not evaluable (NE). The BOR was assessed locally by the investigator and centrally by an independent radiologist. Percentages are based on the number of participants in the ITT/Safety population with non-missing observations.

  7. Objective Response Rate (ORR) Assessed Locally and Centrally at Months 9 and 12 [ Time Frame: Months 9 and 12 ]
    The ORR was defined as the percentage of participants with CR or PR according to RECIST criteria v1.1. The ORR was assessed locally by the investigator and centrally by an independent radiologist. The ORR was based on the participants with PD prior to 9 and 12 months with respectively PD at 9 and 12 months, and participants withdrawn before the assessment for reason other than PD or missing as failures.

  8. DCR Assessed Locally and Centrally at Month 12 [ Time Frame: Month 12 ]
    The DCR was defined as SD, PR or CR according to RECIST criteria v1.1. The DCR was assessed locally by the investigator and centrally by an independent radiologist.

  9. DCR Assessed Locally and Centrally at Month 9 by Carcinoid Type [ Time Frame: Up to Month 9 ]
    The influence of type of carcinoid [typical, atypical and undetermined carcinoid neuroendocrine tumors (NET)] on the local and central DCR at 9 months was analysed. Typical carcinoids were defined with absent foci of necrosis and mitotic count < 2 mitoses/2 millimeters^2 (mm^2); atypical carcinoids were defined with presence of foci of necrosis and/or 2 mitoses/2 mm^2 <= mitotic count <= 10 mitoses/2 mm^2; and carcinoid NET were defined as confirmed carcinoid without foci of necrosis and/or mitotic count reported. The DCR was assessed locally by the investigator and centrally by an independent radiologist.

  10. Percentage of Biochemical Responders According to Chromogranin A (CgA) Plasma Levels [ Time Frame: Baseline (Day 1) and Week 4, 12, 24, 36 and 52 ]
    Participants with baseline CgA plasma levels greater than the upper limit of normal (ULN) were assessed for a biochemical response. A biochemical responder was defined as a participant who had a decrease of CgA >= 50% compared to baseline, while biochemical SD was defined as a decrease < 50% or an increase <= 25% compared to baseline. Biochemical non-responders had an increase >25% compared to baseline. Baseline was defined as value at Day 1.

  11. Neuron-Specific Enolase (NSE) and CgA Biomarker Levels [ Time Frame: Baseline and Weeks 4, 12, 24, 36 and 52 ]
    The NSE and CgA levels were classified according to ULN as follows: < 1 ULN, 1-2 ULN and > 2 ULN. Baseline was defined as value at Day 1. Percentages are based on the number of participants in the ITT/Safety population who attended the visit with non-missing observations.

  12. Influence of Biomarkers Expression on Locally and Centrally Assessed PFS [ Time Frame: From Screening period (-4 weeks) up to Week 52 ]
    The following biomarkers were investigated: Immunohistochemistry assay human somatostatin receptors 2 (SSTR2) including human epidermal growth factor receptor 2 (HER-2) score [0, 1+, 2+, 3+ and positive (+ve) versus negative (-ve)]; hormone receptor score (H-score) (from 0 to 300 as quantitative variable and +ve versus -ve); immunoreactive score (IRS) score (from 0 to 12 and reference for hazard ratio was 0-1). Ki67 index (from 0% to 100% and reference for hazard ratio was 4%-25%). O^6-methylguanine-DNA methyltransferase (MGMT) expression including percentage of +ve nuclei stained and methylated sites and H-score (from 0 to 300 as quantitative variable). For all these categories, higher score indicates a higher expression of biomarkers. Carcinoid type (typical or NET) was also investigated. Prognostic value of biomarkers expression at screening on PFS were assessed locally and centrally using univariate cox proportional hazard models.

  13. Influence of Biomarkers Expression on Locally and Centrally Assessed ORR at Months 9 and 12 [ Time Frame: Screening period, Months 9 and 12 ]
    The following biomarkers were investigated: Immunohistochemistry assay SSTR2 including HER-2 score (0, 1+, 2+, 3+); H-score (from 0 to 300 as quantitative variable); IRS score (from 0 to 12). Ki67 index (from 0% to 100%). MGMT expression including percentage of +ve nuclei stained and methylated sites and H-score (from 0 to 300 as quantitative variable). For all these categories, higher score indicates a higher expression of biomarkers. Less than 5 OR (CR or PR) events were reported, therefore this analysis was not performed.

  14. Influence of Biomarkers Expression on Locally and Centrally Assessed DCR at Months 9 and 12 [ Time Frame: Screening period, Months 9 and 12 ]
    The following biomarkers were investigated: Immunohistochemistry assay SSTR2 including HER-2 score (0, 1+, 2+, 3+ and +ve versus -ve); H-score (from 0 to 300 as quantitative variable and +ve versus -ve); IRS score (from 0 to 12 and reference for odds ratio was 0-1). Ki67 index (from 0% to 100% and reference for odds ratio was 4%-25%). MGMT expression including percentage of +ve nuclei stained and methylated sites and H-score (from 0 to 300 as quantitative variable). For all these categories, higher score indicates a higher expression of biomarkers. Carcinoid type (typical or NET) was also investigated. Prognostic value of biomarkers expression at screening on DCR were assessed locally and centrally using univariate logistic regression models.

  15. Coefficient of Agreement Between Central and Local Assessment of Tumor Radiological Response at Month 9 [ Time Frame: Month 9 ]
    Differences between central radiology review and local investigator review were assessed according to the DCR status and the number of agreements and disagreements between the evaluators (central versus local) along with the p-values from the kappa test. A kappa statistic was used to evaluate the concordance between the central and the local review.



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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:

  • Histological documented unresectable advanced (locally or metastatic) well or moderately differentiated neuroendocrine tumors of the lung or thymus (typical and atypical carcinoids according to the World Health Organisation (WHO) 2004 criteria);
  • Imaging documented progression within 12 months before screening visit (V1), according to RECIST criteria v 1.1;
  • Measurable disease, as defined by RECIST criteria v 1.1, on a CT scan performed at screening visit (V1);
  • Octreoscan or Ga68-DOTA-TATE/TOC/NOC-PET-TC within 12 months before screening visit (V1);
  • Adequate liver, renal and bone marrow function.

Exclusion Criteria:

  • Poorly differentiated neuroendocrine carcinoma and mixed Neuroendocrine tumours (NET), according to WHO 2004 criteria
  • Neuroendocrine tumours other than lung or thymus
  • Non-neuroendocrine thymic neoplasm
  • Received a prior therapy with Peptide Receptor Radionuclide Therapy (PRRT) within 6 months prior to screening visit (V1)
  • Treated with systemic therapies (chemotherapy, interferon-alpha, somatostatin analogues, molecular target therapies) within 1 month prior to screening visit (V1)
  • Treated with a number of systemic therapy lines > 3 prior to screening visit (V1), and any of the following:

    1. for chemotherapy no more than 1 line prior to V1
    2. for somatostatin analogue no more than 1 line therapy, considered as treatment lasting more than 6 months, prior to V1 no therapy with Temozolomide (TMZ) prior to V1
    3. Received a prior therapy with Peptide Receptor Radionuclide Therapy (PRRT) within 6 months prior to screening visit (V1)
  • Received external palliative radiotherapy within the last 28 days prior to screening visit (V1)
  • Received locoregional therapies (Transarterial embolization, Transcatheter arterial chemoembolization, thermo-ablation with radio-frequency) and Selective internal radiotherapy within 3 months prior to screening visit (V1)
  • Presence of symptomatic brain metastasis
  • Subjects with symptomatic cholelithiasis at screening visit (V1)

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): NCT02698410


Locations
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Italy
Oncologia Medica - Istituto Oncologico del Mediterraneo - IOM
Viagrande, Catania, Italy, 95029
Unità Operativa di Oncologia Azienda Ospedaliera Spedali Civili di Brescia
Brescia, Italy, 25123
Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) S.r.l., IRCCS
Meldola, Italy, 47014
Unità Oncologia Medica Gastrointestinale e Tumori Neuroendocrini Istituto Europeo di Oncologia, IEO
Milan, Italy, 20141
Dipartimento di Endocrinologia e Oncologia Molecolare e Clinica , Università degli Studi
Napoli, Italy, 80131
Dipartimento di Oncologia Università di Torino Ospedale San Luigi Gonzaga
Orbassano, Italy, 10043
S.C di Oncologia Medica, Azienda Ospedaliera Universitaria di Perugia
Perugia, Italy, 06123
U.O. Oncologia - Azienda Ospedaliero-Universitaria Pisana Ospedale S. Chiara
Pisa, Italy, 56126
Oncologia Medica - Istituto Tumori Regina Elena San Gallicano
Roma, Italy, 00144
OUC di Oncologia- Azienda Ospedaliera Universitaria Integrata - Ospedale Borgo Roma
Verona, Italy, 37134
Sponsors and Collaborators
Ipsen
Investigators
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Study Director: Ipsen Medical Director Ipsen
  Study Documents (Full-Text)

Documents provided by Ipsen:
Study Protocol  [PDF] November 16, 2017
Statistical Analysis Plan  [PDF] May 4, 2020

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Responsible Party: Ipsen
ClinicalTrials.gov Identifier: NCT02698410    
Other Study ID Numbers: A-93-52030-325
2014-005579-10 ( EudraCT Number )
First Posted: March 3, 2016    Key Record Dates
Results First Posted: October 1, 2020
Last Update Posted: October 1, 2020
Last Verified: September 2020
Additional relevant MeSH terms:
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Neuroendocrine Tumors
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Nerve Tissue
Temozolomide
Lanreotide
Angiopeptin
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents