European Low and Intermediate Risk Neuroblastoma Protocol

NCT ID: NCT01728155

Last Updated: 2023-09-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

685 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-01-01

Brief Summary

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The European study, LINES 2009 (Low and Intermediate Risk Neuroblastoma European Study), groups together in a single protocol the treatment of all patients with "non high risk" neuroblastoma (NB), with stratification into two groups: low risk and intermediate risk. These two separate cohorts are included in one single protocol to enable patient data from these two groups to be entered into a common database, as the current prognostic classifications determining treatment may evolve further with subsequent more detailed molecular analysis of the tumours.

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

Detailed Description

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1\. LOW RISK STUDY

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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LOW AND INTERMEDIATE PAEDIATRIC NEUROBLASTOMA AND NEONATAL SUPRARENAL MASSES

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Group1

initial observation (chemotherapy is only given if there is subsequent progression)

Group Type NO_INTERVENTION

No interventions assigned to this group

Group 1: chemotherapy

chemotherapy and surgery

Group Type ACTIVE_COMPARATOR

chemotherapy

Intervention Type DRUG

Group 2

chemotherapy and surgery

Group Type EXPERIMENTAL

chemotherapy

Intervention Type DRUG

Group 3

chemotherapy and surgery

Group Type EXPERIMENTAL

chemotherapy

Intervention Type DRUG

Group 4

Observation

Group Type NO_INTERVENTION

No interventions assigned to this group

Group 5

chemotherapy

Group Type EXPERIMENTAL

chemotherapy

Intervention Type DRUG

Group 6

chemotherapy and surgery

Group Type EXPERIMENTAL

chemotherapy

Intervention Type DRUG

Group 7

chemotherapy and surgery

Group Type EXPERIMENTAL

chemotherapy

Intervention Type DRUG

Group 8

chemotherapy, surgery, radiotherapy and 13 cis-retinoic acid

Group Type EXPERIMENTAL

chemotherapy

Intervention Type DRUG

Group 9

chemotherapy, surgery, radiotherapy and 13 cis-retinoic acid

Group Type EXPERIMENTAL

chemotherapy

Intervention Type DRUG

Group 10

chemotherapy, surgery,

Group Type EXPERIMENTAL

chemotherapy

Intervention Type DRUG

Interventions

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chemotherapy

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* informed consent and follow-up warranted; group assignment completed within 6 weeks from diagnosis; no prior chemotherapy or radiotherapy
* 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

\* Diagnosis of ganglioneuroma or ganglioneuroblastoma intermixed INRG Stage L2

* 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.
Minimum Eligible Age

90 Days

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Instituto de Investigacion Sanitaria La Fe

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

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

Site Status

Perth Children's Hospital

Nedlands, , Australia

Site Status

Sydney Children's Hospital

Sydney, , Australia

Site Status

PHO Med Uni Graz

Graz, , Austria

Site Status

Department Kinder- und Jugendheilkunde

Innsbruck, , Austria

Site Status

Landes-Frauen- und Kinderklinik Linz

Linz, , Austria

Site Status

St. Anna Kinderspital

Vienna, , Austria

Site Status

Univ Klinik für Kinder- und Jugendheilkunde

Vienna, , Austria

Site Status

Hôpital Universitaire d'Anvers (UZA- Universitair Ziekenhuis Antwerpen)

Antwerp, , Belgium

Site Status

Hôpital Universitaire des Enfants Reine Fabiola (HUDERF)

Brussels, , Belgium

Site Status

UCL Clíniques Universitaires Saint - Luc

Brussels, , Belgium

Site Status

Universitair Ziekenhuis Brussel

Brussels, , Belgium

Site Status

Universitair Ziekenhuis Gent

Ghent, , Belgium

Site Status

Universitair Ziekenhuis Leuven

Leuven, , Belgium

Site Status

CHC- Clinique de l'Espérance à Liège

Liège, , Belgium

Site Status

CHR de la Citadelle

Liège, , Belgium

Site Status

Aarhus University Hospital

Aarhus, , Denmark

Site Status

National State Hospital (Department of Pediatrics)

Copenhagen, , Denmark

Site Status

University Hospital of Odense (H.C. Andersen Children´s Hospital)

Odense, , Denmark

Site Status

Soroka Medical Center

Beersheba, , Israel

Site Status

Rambam Health Care Campus

Haifa, , Israel

Site Status

Schneider Children's Medical Center

Petah Tikva, , Israel

Site Status

Ichilov Hospital Sourasky Medical Center

Tel Aviv, , Israel

Site Status

Ospedale Pediatrico G. Salesi di Ancona (Centro Regionale Oncoematologia Pediatrica)

Ancona, , Italy

Site Status

Azienda Ospedaliera - Universitaria Ospedale Policlinico Consorziale

Bari, , Italy

Site Status

Azienda Ospedaliera Ospedali Riuniti di Bergamo

Bergamo, , Italy

Site Status

Azienda Ospedaliero- Universitaria di Bologna- Policlinico S. Orsola - Malpighi

Bologna, , Italy

Site Status

Azienda Ospedaliera Spedali Civili di Brescia

Brescia, , Italy

Site Status

Ospedale Microcitemico

Cagliari, , Italy

Site Status

Oncology Policlinico- Department of Hematology

Catania, , Italy

Site Status

Azienda Ospedaliero-Universitaria di Ferrara- Oncoematologia Pediatrica

Ferrara, , Italy

Site Status

Azienda Ospedaliero-Universitaria Ospedale Pediatrico Meyer

Florence, , Italy

Site Status

Oncology Gaslini Children's Hospital of Genova- Department of Hematology

Genova, , Italy

Site Status

Istituto Nazionale dei Tumori di Milano- Onco-ematologia Pediatrica

Milan, , Italy

Site Status

Azienda Ospedaliero-Universitaria Policlinico di Modena- Onco-ematologia Pediatrica

Modena, , Italy

Site Status

Azienda Ospedaliera Pediatrica Santobono Pausilipon

Napoli, , Italy

Site Status

Sec. Università degli studi di Napoli - Policlinico

Napoli, , Italy

Site Status

Azienda Ospedaliera-Universitaria di Padova- Clínica di Onco-ematologia Pediatrica

Padua, , Italy

Site Status

Ospedale dei Bambini G. Di Cristina

Palermo, , Italy

Site Status

Azienda Ospedaliero - Universitaria di Parma- Oncoematologia Pediatrica

Parma, , Italy

Site Status

Fondazione IRCCS - Policlinico San Matteo - Oncoematologia Pediadrica

Pavia, , Italy

Site Status

Azienda USL Di Pescara - U.O.C di Ematologia Clinica

Pescara, , Italy

Site Status

Ospedale Infermi di Rimini - U.O. Pediatria

Rimini, , Italy

Site Status

Ospedale Pediatrico Bambino Gesù- Oncoematologia pediatrica

Roma, , Italy

Site Status

Ospedale Policlinico Universitario Agostino Gemelli

Roma, , Italy

Site Status

Policlinico Umberto I

Roma, , Italy

Site Status

Casa Sollievo della Sofferenza

San Giovanni Rotondo, , Italy

Site Status

Azienda Ospedaliera Universitaria Senese - Clinica Pediatrica

Siena, , Italy

Site Status

Azienda Sanitaria Ospedaliera O.I.R.M.- Sant' Anna

Torino, , Italy

Site Status

Ospedale Cardinale G. Panico

Tricase, , Italy

Site Status

Ospedale Infantile Burlo Garofolo ( U.O. Emato-Oncologia Pediatrica - Università degli studi di Trieste)

Trieste, , Italy

Site Status

Policlinico G.B. Rossi- Oncoematologia Pediatrica

Verona, , Italy

Site Status

Haukeland University Hospital

Bergen, , Norway

Site Status

Oslo University Hospital, Rikshospitalet. (National coordinator)

Oslo, , Norway

Site Status

University Hospital of Northern Norway

Tromsø, , Norway

Site Status

St Olavs University Hospital

Trondheim, , Norway

Site Status

Hospital de Sabadell

Sabadell, Barcelona, Spain

Site Status

Hospital Universitario Montepríncipe

Boadilla del Monte, Madrid, Spain

Site Status

Hospital Universitario de Canarias

San Cristóbal de La Laguna, Tenerife, Spain

Site Status

Hospital General Universitario de Albacete

Albacete, , Spain

Site Status

Hospital General Universitario de Alicante

Alicante, , Spain

Site Status

Complejo Hospitalario Torrecárdenas

Almería, , Spain

Site Status

Hospital Infanta Cristina

Badajoz, , Spain

Site Status

Hospital de la Santa Creu i Sant Pau

Barcelona, , Spain

Site Status

Hospital Materno Infantil Vall d'Hebron

Barcelona, , Spain

Site Status

Hospital Universitario Cruces

Bilbao, , Spain

Site Status

Hospital Universitario Reina Sofía

Córdoba, , Spain

Site Status

Hospital Universitario Materno Infantil Virgen de las Nieves

Granada, , Spain

Site Status

Hospital Materno Infantil de Jaén

Jaén, , Spain

Site Status

Hospital Universitario 12 de Octubre

Madrid, , Spain

Site Status

Hospital Universitario Infantil la Paz

Madrid, , Spain

Site Status

Hospital Universitario Infantil Niño Jesús

Madrid, , Spain

Site Status

Hospital Regional Universitario Carlos Haya - Hospital Materno Infantil

Málaga, , Spain

Site Status

Hospital Universitario Virgen de la Arrixaca

Murcia, , Spain

Site Status

Hospital Universitario Central de Asturias

Oviedo, , Spain

Site Status

Hospital Virgen del Camino

Pamplona, , Spain

Site Status

Hospital Universitario Donostia

San Sebastián, , Spain

Site Status

Hospital Universitario de Santiago

Santiago de Compostela, , Spain

Site Status

Hospital Universitario Virgen del Rocío

Seville, , Spain

Site Status

Hospital Universitario Virgen Macarena

Seville, , Spain

Site Status

Instituto de Investigacion Sanitaria La Fe

Valencia, , Spain

Site Status

Hospital Clínic Universitari

Valencia, , Spain

Site Status

Hospital Universitario Miguel Servet

Zaragoza, , Spain

Site Status

Queen Silvia's Children's Hospital

Gothenburg, , Sweden

Site Status

Linköping University Hospital

Linköping, , Sweden

Site Status

Skåne University Hospital

Lund, , Sweden

Site Status

Karolinska University Hospital

Stockholm, , Sweden

Site Status

Norrlands University Hospital

Umeå, , Sweden

Site Status

Uppsala Academic Children's Hospital

Uppsala, , Sweden

Site Status

Kantonsspital Aarau

Aarau, , Switzerland

Site Status

Universitäts-Kinderspital beider Basel

Basel, , Switzerland

Site Status

Ospedale San Giovanni

Bellinzona, , Switzerland

Site Status

Inselspital Bern

Bern, , Switzerland

Site Status

HUG Hôpitaux Universitaires Genève

Geneva, , Switzerland

Site Status

CHUV - Centre Hospitalier Universitaire Vaudois - Unité d'hémato-oncologie pédiatrique

Lausanne, , Switzerland

Site Status

Luzerner Kantonsspital

Lucerne, , Switzerland

Site Status

Ostschweizer Kinderspital

Sankt Gallen, , Switzerland

Site Status

Universitäts-Kinderspital Zürich

Zurich, , Switzerland

Site Status

Countries

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Australia Austria Belgium Denmark Israel Italy Norway Spain Sweden Switzerland

References

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The European Network for Cancer Research in Children and Adolescents (ENCCA) is a Network of Excellence Funded by the European Union's 7th Framework Programme (FP7): See WP10

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