Trial Outcomes & Findings for Integrated Dose Escalation for Advanced, Localized Gynecologic Cancer (The IDEAL - GYN Trial) (NCT NCT01627288)

NCT ID: NCT01627288

Last Updated: 2021-02-08

Results Overview

Concurrent radiation therapy and chemotherapy is the standard of care for node positive cervical cancer. While there are several acceptable means to boost the disease in the low pelvis (i.e. brachytherapy, IMRT, or external beam), there is limited research into boosting gross disease in the pelvis or para-aortic region. This protocol is designed to determine the maximum tolerated dose of treating tumor bearing regions within the abdomen and pelvis, using an integrated boost technique and concurrent chemotherapy.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

12 participants

Primary outcome timeframe

During RT to 6 weeks post RT

Results posted on

2021-02-08

Participant Flow

Participant milestones

Participant milestones
Measure
Boost Radiation: Dose Level 1
2.4 Gy X 25 fractions = 60 Gy
Boost Radiation: Dose Level 2
2.6 Gy X 25 fractions = 65 Gy
Boost Radiation: Dose Level 3
2.8 Gy x 25 fractions = 70 Gy
Boost Radiation Dose Level 0
If the 2 dose limiting toxicities are documented at dose level 1, therapy will be de-escalated to Dose level 0 defined below. Dose level 0: 2.2 Gy X 25 fractions = 55 Gy
Overall Study
STARTED
3
3
6
0
Overall Study
COMPLETED
3
3
6
0
Overall Study
NOT COMPLETED
0
0
0
0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Integrated Dose Escalation for Advanced, Localized Gynecologic Cancer (The IDEAL - GYN Trial)

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Boost Radiation: Dose Level 1
n=3 Participants
2.4 Gy X 25 fractions = 60 Gy
Boost Radiation: Dose Level 2
n=3 Participants
2.6 Gy X 25 fractions = 65 Gy
Boost Radiation: Dose Level 3
n=6 Participants
2.8 Gy x 25 fractions = 70 Gy
Boost Radiation Dose Level 0
If the 2 dose limiting toxicities are documented at dose level 1, therapy will be de-escalated to Dose level 0 defined below. Dose level 0: 2.2 Gy X 25 fractions = 55 Gy
Total
n=12 Participants
Total of all reporting groups
Ethnicity (NIH/OMB)
Not Hispanic or Latino
3 Participants
n=5 Participants
3 Participants
n=7 Participants
6 Participants
n=5 Participants
0 Participants
n=4 Participants
12 Participants
n=21 Participants
Age, Categorical
<=18 years
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
0 Participants
n=21 Participants
Age, Categorical
Between 18 and 65 years
3 Participants
n=5 Participants
2 Participants
n=7 Participants
6 Participants
n=5 Participants
0 Participants
n=4 Participants
11 Participants
n=21 Participants
Age, Categorical
>=65 years
0 Participants
n=5 Participants
1 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
1 Participants
n=21 Participants
Sex: Female, Male
Female
3 Participants
n=5 Participants
3 Participants
n=7 Participants
6 Participants
n=5 Participants
0 Participants
n=4 Participants
12 Participants
n=21 Participants
Sex: Female, Male
Male
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
0 Participants
n=21 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
0 Participants
n=21 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
0 Participants
n=21 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
0 Participants
n=21 Participants
Race (NIH/OMB)
Asian
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
0 Participants
n=21 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
0 Participants
n=21 Participants
Race (NIH/OMB)
Black or African American
2 Participants
n=5 Participants
1 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
3 Participants
n=21 Participants
Race (NIH/OMB)
White
1 Participants
n=5 Participants
2 Participants
n=7 Participants
6 Participants
n=5 Participants
0 Participants
n=4 Participants
9 Participants
n=21 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
0 Participants
n=21 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
0 Participants
n=21 Participants
Region of Enrollment
United States
3 Participants
n=5 Participants
3 Participants
n=7 Participants
6 Participants
n=5 Participants
12 Participants
n=21 Participants

PRIMARY outcome

Timeframe: During RT to 6 weeks post RT

Concurrent radiation therapy and chemotherapy is the standard of care for node positive cervical cancer. While there are several acceptable means to boost the disease in the low pelvis (i.e. brachytherapy, IMRT, or external beam), there is limited research into boosting gross disease in the pelvis or para-aortic region. This protocol is designed to determine the maximum tolerated dose of treating tumor bearing regions within the abdomen and pelvis, using an integrated boost technique and concurrent chemotherapy.

Outcome measures

Outcome measures
Measure
Treatment Arm
n=12 Participants
Participants received increasing doses of Radiation at 12.4 Gy X 25 fractions = 60 Gy (N=3), 2.6 Gy X 25 fractions = 65 Gy (N=6), or 2.8 Gy x 25 fractions = 70 Gy (N=12).
Boost Radiation: Dose Level 1 (60 Gy)
Dose level 1 consists of a total 60Gy given in 2.4 Gy per fraction
Boost Radiation: Dose Level 2 (65)
Dose level 2 consists of a total 65Gy given in 2.6 Gy per fraction
Boost Radiation: Dose Level 3 (70Gy)
Dose level 3 consists of a total 70Gy given in 2.8 Gy per fraction
Maximum Tolerated Dose of Integrated Boost Radiation Therapy, Administered With IMRT Technique With Concurrent Chemotherapy (Cisplatin).
70 Gray (Gy)

SECONDARY outcome

Timeframe: 3 years following treatment

Local-regional control is defined as local control without any nodal recurrence.

Outcome measures

Outcome measures
Measure
Treatment Arm
n=12 Participants
Participants received increasing doses of Radiation at 12.4 Gy X 25 fractions = 60 Gy (N=3), 2.6 Gy X 25 fractions = 65 Gy (N=6), or 2.8 Gy x 25 fractions = 70 Gy (N=12).
Boost Radiation: Dose Level 1 (60 Gy)
n=3 Participants
Dose level 1 consists of a total 60Gy given in 2.4 Gy per fraction
Boost Radiation: Dose Level 2 (65)
n=3 Participants
Dose level 2 consists of a total 65Gy given in 2.6 Gy per fraction
Boost Radiation: Dose Level 3 (70Gy)
n=6 Participants
Dose level 3 consists of a total 70Gy given in 2.8 Gy per fraction
Time to Local-regional Control With Integrated Boost Radiation Therapy (TTLR)
1.5 years
Standard Deviation 0.1
NA years
Standard Deviation NA
the value could not be calculated due to no events
0.65 years
Standard Deviation NA
the value could not be calculated due to too few events
1.52 years
Standard Deviation 0.04

SECONDARY outcome

Timeframe: 3 years after treatment

Outcome measures

Outcome measures
Measure
Treatment Arm
n=12 Participants
Participants received increasing doses of Radiation at 12.4 Gy X 25 fractions = 60 Gy (N=3), 2.6 Gy X 25 fractions = 65 Gy (N=6), or 2.8 Gy x 25 fractions = 70 Gy (N=12).
Boost Radiation: Dose Level 1 (60 Gy)
n=3 Participants
Dose level 1 consists of a total 60Gy given in 2.4 Gy per fraction
Boost Radiation: Dose Level 2 (65)
n=3 Participants
Dose level 2 consists of a total 65Gy given in 2.6 Gy per fraction
Boost Radiation: Dose Level 3 (70Gy)
n=6 Participants
Dose level 3 consists of a total 70Gy given in 2.8 Gy per fraction
Time to Distant Recurrence (TTDR)
1.4 years
Standard Deviation 0.1
NA years
Standard Deviation NA
the value could not be calculated due to no events
1.2 years
Standard Deviation NA
the value could not be calculated due to too few events
1.29 years
Standard Deviation 0.22

SECONDARY outcome

Timeframe: 3 years after treatment

Outcome measures

Outcome measures
Measure
Treatment Arm
n=12 Participants
Participants received increasing doses of Radiation at 12.4 Gy X 25 fractions = 60 Gy (N=3), 2.6 Gy X 25 fractions = 65 Gy (N=6), or 2.8 Gy x 25 fractions = 70 Gy (N=12).
Boost Radiation: Dose Level 1 (60 Gy)
n=3 Participants
Dose level 1 consists of a total 60Gy given in 2.4 Gy per fraction
Boost Radiation: Dose Level 2 (65)
n=3 Participants
Dose level 2 consists of a total 65Gy given in 2.6 Gy per fraction
Boost Radiation: Dose Level 3 (70Gy)
n=6 Participants
Dose level 3 consists of a total 70Gy given in 2.8 Gy per fraction
Disease Free Survival (DFS)
1.3 years
Standard Deviation 0.1
0.85 years
Standard Deviation NA
the value could not be calculated due to too few events
1.05 years
Standard Deviation 0.23
1.34 years
Standard Deviation 0.2

SECONDARY outcome

Timeframe: 3 years after treatment

Outcome measures

Outcome measures
Measure
Treatment Arm
n=12 Participants
Participants received increasing doses of Radiation at 12.4 Gy X 25 fractions = 60 Gy (N=3), 2.6 Gy X 25 fractions = 65 Gy (N=6), or 2.8 Gy x 25 fractions = 70 Gy (N=12).
Boost Radiation: Dose Level 1 (60 Gy)
n=3 Participants
Dose level 1 consists of a total 60Gy given in 2.4 Gy per fraction
Boost Radiation: Dose Level 2 (65)
n=3 Participants
Dose level 2 consists of a total 65Gy given in 2.6 Gy per fraction
Boost Radiation: Dose Level 3 (70Gy)
n=6 Participants
Dose level 3 consists of a total 70Gy given in 2.8 Gy per fraction
Overall Survival (OS)
1.6 years
Standard Deviation 0.1
0.85 years
Standard Deviation NA
the value could not be calculated due to too few events
1.08 years
Standard Deviation NA
the value could not be calculated due to too few events
1.7 years
Standard Deviation NA
the value could not be calculated due to too few events

SECONDARY outcome

Timeframe: 6 weeks following treatment

Acute DLT will be defined based on the side effects inherent from radiation therapy for gynecologic cancers, including effects on bowel, bladder, and skin.Since integrated radiation dose escalation is unlikely to substantially affect the hematopoietic system, only non-hematologic, grade 3-4, acute toxicity will be considered the primary dose-limiting toxicity (acute DLT). Dose limiting toxicity will include any of the following during treatment or within 6 weeks of completion: Acute Grade 3-4 enteritis or proctitis, Acute Grade 3-4 bladder toxicity, Acute Grade 4 dermatologic toxicity.

Outcome measures

Outcome measures
Measure
Treatment Arm
n=12 Participants
Participants received increasing doses of Radiation at 12.4 Gy X 25 fractions = 60 Gy (N=3), 2.6 Gy X 25 fractions = 65 Gy (N=6), or 2.8 Gy x 25 fractions = 70 Gy (N=12).
Boost Radiation: Dose Level 1 (60 Gy)
n=3 Participants
Dose level 1 consists of a total 60Gy given in 2.4 Gy per fraction
Boost Radiation: Dose Level 2 (65)
n=3 Participants
Dose level 2 consists of a total 65Gy given in 2.6 Gy per fraction
Boost Radiation: Dose Level 3 (70Gy)
n=6 Participants
Dose level 3 consists of a total 70Gy given in 2.8 Gy per fraction
Number of Participants With Acute Dose Limiting Toxicities (DLT)
1 Participants
0 Participants
0 Participants
1 Participants

SECONDARY outcome

Timeframe: 3 years following treatment

Late DLTs will be defined at grade 3-4 GI or GU toxicity with onset after 6 weeks of treatment.

Outcome measures

Outcome measures
Measure
Treatment Arm
n=12 Participants
Participants received increasing doses of Radiation at 12.4 Gy X 25 fractions = 60 Gy (N=3), 2.6 Gy X 25 fractions = 65 Gy (N=6), or 2.8 Gy x 25 fractions = 70 Gy (N=12).
Boost Radiation: Dose Level 1 (60 Gy)
n=3 Participants
Dose level 1 consists of a total 60Gy given in 2.4 Gy per fraction
Boost Radiation: Dose Level 2 (65)
n=3 Participants
Dose level 2 consists of a total 65Gy given in 2.6 Gy per fraction
Boost Radiation: Dose Level 3 (70Gy)
n=6 Participants
Dose level 3 consists of a total 70Gy given in 2.8 Gy per fraction
Number of Participants With Late Dose Limiting Toxicities (DLT)
1 Participants
0 Participants
0 Participants
1 Participants

Adverse Events

Dose Level 1

Serious events: 2 serious events
Other events: 3 other events
Deaths: 1 deaths

Dose Level 2

Serious events: 0 serious events
Other events: 3 other events
Deaths: 1 deaths

Dose Level 3

Serious events: 1 serious events
Other events: 6 other events
Deaths: 1 deaths

Serious adverse events

Serious adverse events
Measure
Dose Level 1
n=3 participants at risk
Participants received increasing doses of Radiation at 12.4 Gy X 25 fractions = 60 Gy (N=3)
Dose Level 2
n=3 participants at risk
2.6 Gy X 25 fractions = 65 Gy (N=3),
Dose Level 3
n=6 participants at risk
2.8 Gy x 25 fractions = 70 Gy (N=6)
Gastrointestinal disorders
Nausea
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
0.00%
0/6 • 3 years
Gastrointestinal disorders
Rectal necrosis
0.00%
0/3 • 3 years
0.00%
0/3 • 3 years
16.7%
1/6 • 3 years
Gastrointestinal disorders
Vomiting
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
0.00%
0/6 • 3 years
Metabolism and nutrition disorders
Dehydration
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
0.00%
0/6 • 3 years
Metabolism and nutrition disorders
Hypokalemia
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
0.00%
0/6 • 3 years
Renal and urinary disorders
Urinary fistula
0.00%
0/3 • 3 years
0.00%
0/3 • 3 years
16.7%
1/6 • 3 years
Renal and urinary disorders
Urinary tract obstruction
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
0.00%
0/6 • 3 years

Other adverse events

Other adverse events
Measure
Dose Level 1
n=3 participants at risk
Participants received increasing doses of Radiation at 12.4 Gy X 25 fractions = 60 Gy (N=3)
Dose Level 2
n=3 participants at risk
2.6 Gy X 25 fractions = 65 Gy (N=3),
Dose Level 3
n=6 participants at risk
2.8 Gy x 25 fractions = 70 Gy (N=6)
Investigations
Lymphocyte count decreased
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
0.00%
0/6 • 3 years
Investigations
Neutrophil count decreased
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
16.7%
1/6 • 3 years
Investigations
Platelet count decreased
0.00%
0/3 • 3 years
0.00%
0/3 • 3 years
33.3%
2/6 • 3 years
Blood and lymphatic system disorders
Anemia
33.3%
1/3 • 3 years
33.3%
1/3 • 3 years
50.0%
3/6 • 3 years
Gastrointestinal disorders
Colitis
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
33.3%
2/6 • 3 years
Gastrointestinal disorders
Constipation
0.00%
0/3 • 3 years
33.3%
1/3 • 3 years
33.3%
2/6 • 3 years
Gastrointestinal disorders
Diarrhea
0.00%
0/3 • 3 years
66.7%
2/3 • 3 years
100.0%
6/6 • 3 years
Gastrointestinal disorders
Gastrointestinal disorders
0.00%
0/3 • 3 years
0.00%
0/3 • 3 years
16.7%
1/6 • 3 years
Gastrointestinal disorders
Hemorrhoiids
0.00%
0/3 • 3 years
33.3%
1/3 • 3 years
33.3%
2/6 • 3 years
Gastrointestinal disorders
Nausea
100.0%
3/3 • 3 years
66.7%
2/3 • 3 years
83.3%
5/6 • 3 years
Gastrointestinal disorders
Proctitis
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
0.00%
0/6 • 3 years
Gastrointestinal disorders
Rectal hemorrhage
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
0.00%
0/6 • 3 years
Gastrointestinal disorders
Rectal pain
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
0.00%
0/6 • 3 years
Gastrointestinal disorders
Salivary duct inflammation
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
0.00%
0/6 • 3 years
Gastrointestinal disorders
Vomiting
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
50.0%
3/6 • 3 years
General disorders
Edema limbs
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
16.7%
1/6 • 3 years
General disorders
Fatigue
100.0%
3/3 • 3 years
33.3%
1/3 • 3 years
66.7%
4/6 • 3 years
General disorders
Pain
66.7%
2/3 • 3 years
66.7%
2/3 • 3 years
66.7%
4/6 • 3 years
Infections and infestations
Upper respiratory infection
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
0.00%
0/6 • 3 years
Infections and infestations
ry tract infection
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
0.00%
0/6 • 3 years
Investigations
Weight loss
0.00%
0/3 • 3 years
0.00%
0/3 • 3 years
33.3%
2/6 • 3 years
Investigations
White blood cell decreased
66.7%
2/3 • 3 years
66.7%
2/3 • 3 years
50.0%
3/6 • 3 years
Metabolism and nutrition disorders
Anorexia
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
0.00%
0/6 • 3 years
Metabolism and nutrition disorders
Dehydration
0.00%
0/3 • 3 years
33.3%
1/3 • 3 years
16.7%
1/6 • 3 years
Metabolism and nutrition disorders
Hypokalemia
0.00%
0/3 • 3 years
33.3%
1/3 • 3 years
33.3%
2/6 • 3 years
Metabolism and nutrition disorders
Hyponatremia
0.00%
0/3 • 3 years
33.3%
1/3 • 3 years
33.3%
2/6 • 3 years
Musculoskeletal and connective tissue disorders
Avascular necrosis
0.00%
0/3 • 3 years
33.3%
1/3 • 3 years
0.00%
0/6 • 3 years
Musculoskeletal and connective tissue disorders
Muscle weakness upper limb
0.00%
0/3 • 3 years
33.3%
1/3 • 3 years
0.00%
0/6 • 3 years
Musculoskeletal and connective tissue disorders
Pain in extremity
0.00%
0/3 • 3 years
33.3%
1/3 • 3 years
0.00%
0/6 • 3 years
Renal and urinary disorders
Acute kidney injury
0.00%
0/3 • 3 years
33.3%
1/3 • 3 years
0.00%
0/6 • 3 years
Renal and urinary disorders
Cystitis noninfective
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
33.3%
2/6 • 3 years
Renal and urinary disorders
Renal and urinary disorders
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
16.7%
1/6 • 3 years
Renal and urinary disorders
Urinary frequency
33.3%
1/3 • 3 years
33.3%
1/3 • 3 years
16.7%
1/6 • 3 years
Renal and urinary disorders
Urinary incontinence
0.00%
0/3 • 3 years
33.3%
1/3 • 3 years
16.7%
1/6 • 3 years
Renal and urinary disorders
Urinary tract pain
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
0.00%
0/6 • 3 years
Renal and urinary disorders
Urinary urgency
66.7%
2/3 • 3 years
33.3%
1/3 • 3 years
16.7%
1/6 • 3 years
Reproductive system and breast disorders
Dyspareunia
0.00%
0/3 • 3 years
33.3%
1/3 • 3 years
66.7%
4/6 • 3 years
Reproductive system and breast disorders
Pelvic pain
33.3%
1/3 • 3 years
33.3%
1/3 • 3 years
16.7%
1/6 • 3 years
Reproductive system and breast disorders
Vaginal hemorrhage
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
0.00%
0/6 • 3 years
Reproductive system and breast disorders
Vaginismus
33.3%
1/3 • 3 years
0.00%
0/3 • 3 years
0.00%
0/6 • 3 years
Skin and subcutaneous tissue disorders
Skin and subcutaneous tissue disorders
0.00%
0/3 • 3 years
33.3%
1/3 • 3 years
16.7%
1/6 • 3 years
Skin and subcutaneous tissue disorders
Skin hyperpigmentation
0.00%
0/3 • 3 years
33.3%
1/3 • 3 years
0.00%
0/6 • 3 years
Vascular disorders
Hot flashes
0.00%
0/3 • 3 years
33.3%
1/3 • 3 years
0.00%
0/6 • 3 years
Vascular disorders
Lymphedema
0.00%
0/3 • 3 years
0.00%
0/3 • 3 years
16.7%
1/6 • 3 years
Vascular disorders
Thromboembolic event
0.00%
0/3 • 3 years
0.00%
0/3 • 3 years
16.7%
1/6 • 3 years

Additional Information

Jennifer Mewshaw, MS RN

Duke University Health System

Phone: (919) 668-5211

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place