European Low and Intermediate Risk Neuroblastoma Protocol
NCT ID: NCT01728155
Last Updated: 2023-09-08
Study Results
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Basic Information
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COMPLETED
PHASE3
685 participants
INTERVENTIONAL
2011-01-01
Brief Summary
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1\. LOW RISK STUDY
The Low Risk Study is proposed in order to:
* minimise the amount of treatment (chemotherapy and surgery) for all appropriate low risk patients, who in previous studies have been shown to have an excellent long-term outcome (as in the SIOPEN 99.1-2 infant neuroblastoma studies where the overall survival was greater than 97%(H. Rubie, JCO).
* improve the EFS and maintain the OS (overall survival) in L2 and Ms patients with a SCA(Segmental Cromosomal Aberration) genomic profile tumour (presence of any segmental chromosomal change (SCA)) by electively treating these patients with chemotherapy despite the absence of symptoms.
2\) INTERMEDIATE RISK STUDY
The Intermediate Risk Study is proposed in order to:
* reduce the amount of chemotherapy for differentiating histology INRG (International Neuroblastoma Risk Group) stage L2 NB and ganglioneuroblastoma nodular patients who in previous SIOPEN study have been shown to have an excellent long-term outcome;
* increase the amount of treatment (radiotherapy and 13-cis-RA (13-cis-Retinoic Acid) for poorly differentiated or undifferentiated histology INRG stage L2 NB or ganglioneuroblastoma nodular patients in order to improve the EFS registered in the previous SIOPEN study;
* improve the EFS (Event Free Survival) of MYCN (V-Myc myelocytomatosis viral related oncogene, NB derived ,avian )amplified INSS (International NB Staging System) stage 1 NB patients with the introduction of adjuvant treatment;
* maintain the very good results obtained in previous SIOPEN study for INRG stage M infants with a moderate treatment.
NEONATAL SUPRARENAL MASSES
The incidence of suprarenal tumours/masses has increased in the last decade due to the expanded use of prenatal ultrasonography in routine obstetric care and in the neonatal and early infancy care. The differential diagnosis of these masses ranges from benign (adrenal haemorrhage) to malignant processes (neuroblastoma, adrenal carcinoma). Knowledge on perinatal suprarenal masses, although based on a relatively large literature, is scattered amongst studies on very few cases with no methodical approach and often short follow up. Therefore, the optimal management of these masses has not been clearly defined. Neuroblastoma at this age is an intriguing entity with a very good prognosis in most cases. The SIOPEN Group, based on their results in the first multicenter European Trial for infants with neuroblastoma (INES) and the world-wide experience provided in the literature, is launching this European surveillance study (Multi-centre, non-blinded, one armed prospective trial) for these masses. Treatment: Observation
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Detailed Description
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The low risk group of patients includes NB patients without MYCN amplification with or without life threatening symptoms in the following clinical situations:
* Children aged ≤ 18 months with localised neuroblastoma associated with image defined risk factors precluding upfront surgery (stage INRG L2).
* Children aged ≤ 12 months with disseminated neuroblastoma without bone, pleura, lung or CNS (Central Nervous System) disease (stage INRG Ms)
2\) INTERMEDIATE RISK STUDY
The intermediate risk group of patients includes NB patients in the following clinical situations:
* Children aged \>18 months with localised neuroblastoma without MYCN amplification, associated with image defined risk factors precluding upfront surgery (stage INRG L2).
* Children aged ≤12 months with disseminated neuroblastoma involving bone, pleura, lung and/or CNS (stage INRG M), without MYCN amplification.
* Children with localised resected NB (stage INSS I) with MYCN amplification. NEONATAL SUPRARENAL MASSES
The incidence of suprarenal tumours/masses has increased in the last decade due to the expanded use of prenatal ultrasonography in routine obstetric care and in the neonatal and early infancy care. The differential diagnosis of these masses ranges from benign (adrenal haemorrhage) to malignant processes (neuroblastoma, adrenal carcinoma). Knowledge on perinatal suprarenal masses, although based on a relatively large literature, is scattered amongst studies on very few cases with no methodical approach and often short follow up. Therefore, the optimal management of these masses has not been clearly defined. Neuroblastoma at this age is an intriguing entity with a very good prognosis in most cases. The SIOPEN Group, based on their results in the first multicenter European Trial for infants with neuroblastoma (INES) and the world-wide experience provided in the literature, is launching this European surveillance study (Multi-centre, non-blinded, one armed prospective trial) for these masses. Treatment: Observation
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
NONE
Study Groups
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Group1
initial observation (chemotherapy is only given if there is subsequent progression)
No interventions assigned to this group
Group 1: chemotherapy
chemotherapy and surgery
chemotherapy
Group 2
chemotherapy and surgery
chemotherapy
Group 3
chemotherapy and surgery
chemotherapy
Group 4
Observation
No interventions assigned to this group
Group 5
chemotherapy
chemotherapy
Group 6
chemotherapy and surgery
chemotherapy
Group 7
chemotherapy and surgery
chemotherapy
Group 8
chemotherapy, surgery, radiotherapy and 13 cis-retinoic acid
chemotherapy
Group 9
chemotherapy, surgery, radiotherapy and 13 cis-retinoic acid
chemotherapy
Group 10
chemotherapy, surgery,
chemotherapy
Interventions
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chemotherapy
Eligibility Criteria
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Inclusion Criteria
* Biopsy proven neuroblastoma
* Tumour genomic profile obtained in a NRL according to guidelines
* MYCN non-amplified
\*age ≤ 18 months
\* age ≤ 12 months
* informed consent and follow-up warranted; group assignment completed within 6 weeks from diagnosis; no prior chemotherapy or radiotherapy
* Tumour material available for biological studies according to guidelines
* Biopsy proven neuroblastoma confirmed in a National Reference Laboratory (NRL)
\* MYCN amplified
* Histology: differentiating, poorly differentiated, undifferentiated neuroblastoma or ganglioneuroblastoma nodular
* MYCN non-amplified
* age \>18 months
* Any histology
* MYCN non-amplified
* age ≤ 12 months
* Age less than or equal to 90 days when the suprarenal mass is discovered.
* Suprarenal mass detected by ultrasound and/or MRI. The suprarenal mass may be cystic and/or solid, but IT CANNOT REACH THE MIDLINE AND should MEASURE ≤ 5 CM AT THE LARGEST DIAMETER.
* No regional involvement: MRI scan does not show evidence of positive ipsi/contralateral lymph nodes or other spread outside the suprarenal gland.
* No metastatic involvement.
* Frozen plasma available.
* Informed consent.
* Availability to do the adequate follow-up
Exclusion Criteria
* any metastatic site
* MYCN amplification
* age \> 18 months INRG Stage Ms
* bone, pleura/lung and/or CNS metastasis
* MYCN amplification
* age \> 12 months
2. INTERMEDIATE RISK STUDY
\* Diagnosis of ganglioneuroma or ganglioneuroblastoma intermixed
INRG Stage L1 and INSS stage 1:
* MYCN non-amplified
* INSS stages 2, 3, 4, 4s
INRG Stage L2:
* neuroblastoma NOS
* MYCN amplification.
* age ≤ 18 months
INRG Stage M:
* MYCN amplification
* age \> 12 months
3. NEONATAL SUPRARENAL MASSES
* Age older than 90 days.
* Suprarenal mass bigger than 5 cm.
* Regional involvement.
* Metastatic involvement.
* Inability to undertake mandatory diagnostic studies (biological markers, US, MRI, MIBG).
* Follow-up not guaranteed by parents/guardians.
90 Days
18 Years
ALL
No
Sponsors
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Instituto de Investigacion Sanitaria La Fe
OTHER
Responsible Party
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Principal Investigators
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Adela Cañete, MD, PhD
Role: STUDY_CHAIR
Hospital Universitari i Politècnic La Fe, Valencia, Spain
Gudrun Schleiermacher
Role: STUDY_CHAIR
Institut Curie
Kate Wheeler
Role: STUDY_CHAIR
Oxford: John Radcliffe Hospital, UK
Andrea di Cataldo
Role: STUDY_CHAIR
Policlinico Universitario, Italy
Vassilius Papadakis
Role: STUDY_CHAIR
Aghia Sophia Children's Hospital, Athens
Locations
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Monash Children's Hospital
Clayton, , Australia
Perth Children's Hospital
Nedlands, , Australia
Sydney Children's Hospital
Sydney, , Australia
PHO Med Uni Graz
Graz, , Austria
Department Kinder- und Jugendheilkunde
Innsbruck, , Austria
Landes-Frauen- und Kinderklinik Linz
Linz, , Austria
St. Anna Kinderspital
Vienna, , Austria
Univ Klinik für Kinder- und Jugendheilkunde
Vienna, , Austria
Hôpital Universitaire d'Anvers (UZA- Universitair Ziekenhuis Antwerpen)
Antwerp, , Belgium
Hôpital Universitaire des Enfants Reine Fabiola (HUDERF)
Brussels, , Belgium
UCL Clíniques Universitaires Saint - Luc
Brussels, , Belgium
Universitair Ziekenhuis Brussel
Brussels, , Belgium
Universitair Ziekenhuis Gent
Ghent, , Belgium
Universitair Ziekenhuis Leuven
Leuven, , Belgium
CHC- Clinique de l'Espérance à Liège
Liège, , Belgium
CHR de la Citadelle
Liège, , Belgium
Aarhus University Hospital
Aarhus, , Denmark
National State Hospital (Department of Pediatrics)
Copenhagen, , Denmark
University Hospital of Odense (H.C. Andersen Children´s Hospital)
Odense, , Denmark
Soroka Medical Center
Beersheba, , Israel
Rambam Health Care Campus
Haifa, , Israel
Schneider Children's Medical Center
Petah Tikva, , Israel
Ichilov Hospital Sourasky Medical Center
Tel Aviv, , Israel
Ospedale Pediatrico G. Salesi di Ancona (Centro Regionale Oncoematologia Pediatrica)
Ancona, , Italy
Azienda Ospedaliera - Universitaria Ospedale Policlinico Consorziale
Bari, , Italy
Azienda Ospedaliera Ospedali Riuniti di Bergamo
Bergamo, , Italy
Azienda Ospedaliero- Universitaria di Bologna- Policlinico S. Orsola - Malpighi
Bologna, , Italy
Azienda Ospedaliera Spedali Civili di Brescia
Brescia, , Italy
Ospedale Microcitemico
Cagliari, , Italy
Oncology Policlinico- Department of Hematology
Catania, , Italy
Azienda Ospedaliero-Universitaria di Ferrara- Oncoematologia Pediatrica
Ferrara, , Italy
Azienda Ospedaliero-Universitaria Ospedale Pediatrico Meyer
Florence, , Italy
Oncology Gaslini Children's Hospital of Genova- Department of Hematology
Genova, , Italy
Istituto Nazionale dei Tumori di Milano- Onco-ematologia Pediatrica
Milan, , Italy
Azienda Ospedaliero-Universitaria Policlinico di Modena- Onco-ematologia Pediatrica
Modena, , Italy
Azienda Ospedaliera Pediatrica Santobono Pausilipon
Napoli, , Italy
Sec. Università degli studi di Napoli - Policlinico
Napoli, , Italy
Azienda Ospedaliera-Universitaria di Padova- Clínica di Onco-ematologia Pediatrica
Padua, , Italy
Ospedale dei Bambini G. Di Cristina
Palermo, , Italy
Azienda Ospedaliero - Universitaria di Parma- Oncoematologia Pediatrica
Parma, , Italy
Fondazione IRCCS - Policlinico San Matteo - Oncoematologia Pediadrica
Pavia, , Italy
Azienda USL Di Pescara - U.O.C di Ematologia Clinica
Pescara, , Italy
Ospedale Infermi di Rimini - U.O. Pediatria
Rimini, , Italy
Ospedale Pediatrico Bambino Gesù- Oncoematologia pediatrica
Roma, , Italy
Ospedale Policlinico Universitario Agostino Gemelli
Roma, , Italy
Policlinico Umberto I
Roma, , Italy
Casa Sollievo della Sofferenza
San Giovanni Rotondo, , Italy
Azienda Ospedaliera Universitaria Senese - Clinica Pediatrica
Siena, , Italy
Azienda Sanitaria Ospedaliera O.I.R.M.- Sant' Anna
Torino, , Italy
Ospedale Cardinale G. Panico
Tricase, , Italy
Ospedale Infantile Burlo Garofolo ( U.O. Emato-Oncologia Pediatrica - Università degli studi di Trieste)
Trieste, , Italy
Policlinico G.B. Rossi- Oncoematologia Pediatrica
Verona, , Italy
Haukeland University Hospital
Bergen, , Norway
Oslo University Hospital, Rikshospitalet. (National coordinator)
Oslo, , Norway
University Hospital of Northern Norway
Tromsø, , Norway
St Olavs University Hospital
Trondheim, , Norway
Hospital de Sabadell
Sabadell, Barcelona, Spain
Hospital Universitario Montepríncipe
Boadilla del Monte, Madrid, Spain
Hospital Universitario de Canarias
San Cristóbal de La Laguna, Tenerife, Spain
Hospital General Universitario de Albacete
Albacete, , Spain
Hospital General Universitario de Alicante
Alicante, , Spain
Complejo Hospitalario Torrecárdenas
Almería, , Spain
Hospital Infanta Cristina
Badajoz, , Spain
Hospital de la Santa Creu i Sant Pau
Barcelona, , Spain
Hospital Materno Infantil Vall d'Hebron
Barcelona, , Spain
Hospital Universitario Cruces
Bilbao, , Spain
Hospital Universitario Reina Sofía
Córdoba, , Spain
Hospital Universitario Materno Infantil Virgen de las Nieves
Granada, , Spain
Hospital Materno Infantil de Jaén
Jaén, , Spain
Hospital Universitario 12 de Octubre
Madrid, , Spain
Hospital Universitario Infantil la Paz
Madrid, , Spain
Hospital Universitario Infantil Niño Jesús
Madrid, , Spain
Hospital Regional Universitario Carlos Haya - Hospital Materno Infantil
Málaga, , Spain
Hospital Universitario Virgen de la Arrixaca
Murcia, , Spain
Hospital Universitario Central de Asturias
Oviedo, , Spain
Hospital Virgen del Camino
Pamplona, , Spain
Hospital Universitario Donostia
San Sebastián, , Spain
Hospital Universitario de Santiago
Santiago de Compostela, , Spain
Hospital Universitario Virgen del Rocío
Seville, , Spain
Hospital Universitario Virgen Macarena
Seville, , Spain
Instituto de Investigacion Sanitaria La Fe
Valencia, , Spain
Hospital Clínic Universitari
Valencia, , Spain
Hospital Universitario Miguel Servet
Zaragoza, , Spain
Queen Silvia's Children's Hospital
Gothenburg, , Sweden
Linköping University Hospital
Linköping, , Sweden
Skåne University Hospital
Lund, , Sweden
Karolinska University Hospital
Stockholm, , Sweden
Norrlands University Hospital
Umeå, , Sweden
Uppsala Academic Children's Hospital
Uppsala, , Sweden
Kantonsspital Aarau
Aarau, , Switzerland
Universitäts-Kinderspital beider Basel
Basel, , Switzerland
Ospedale San Giovanni
Bellinzona, , Switzerland
Inselspital Bern
Bern, , Switzerland
HUG Hôpitaux Universitaires Genève
Geneva, , Switzerland
CHUV - Centre Hospitalier Universitaire Vaudois - Unité d'hémato-oncologie pédiatrique
Lausanne, , Switzerland
Luzerner Kantonsspital
Lucerne, , Switzerland
Ostschweizer Kinderspital
Sankt Gallen, , Switzerland
Universitäts-Kinderspital Zürich
Zurich, , Switzerland
Countries
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References
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