International Penile Advanced Cancer Trial (International Rare Cancers Initiative Study)

NCT ID: NCT02305654

Last Updated: 2025-04-02

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

RECRUITING

Clinical Phase

PHASE3

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-05-12

Study Completion Date

2027-11-30

Brief Summary

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This is an international phase III trial, with a Bayesian design, incorporating two sequential randomisations. It efficiently examines a series of questions that routinely arise in the sequencing of treatment. The study design has evolved from lengthy international consultation that has enabled us to build consensus over which questions arise from current knowledge and practice. It will enable potential randomisation for the majority of patients with inguinal lymph node metastases and will provide data to inform future clinical decisions.

InPACT-neoadjuvant patients are stratified by disease burden as assessed by radiological criteria. Treatment options are then defined according to the disease burden strata. Treatment is allocated by randomisation. Patients may be allocated to one of three initial treatments:

A. standard surgery (ILND); B. neoadjuvant chemotherapy followed by standard surgery (ILND); or C. neoadjuvant chemoradiotherapy followed by standard surgery (ILND).

After ILND, patients are defined as being at low or high risk of recurrence based on histological interpretation of the ILND specimen. Patients at high risk of relapse are eligible for InPACT-pelvis, where they are randomised to either:

P. prophylactic PLND Q. no prophylactic PLND

Detailed Description

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Conditions

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Squamous Cell Carcinoma of the Penis, Usual Type

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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Arm A - Standard Surgery (ILND)

Part of randomisation 1.

The total treatment duration (Inguinal Lymph Node Dissection (ILND)) is estimated to be over 1 day for those patients allocated to Arm A - standard surgery.

Group Type ACTIVE_COMPARATOR

ILND - Inguinal Lymph Node Dissection

Intervention Type PROCEDURE

Surgery to remove the lymph nodes in the groin near to where the cancer first appeared.

Arm B - neoadjuvant chemotherapy

Part of randomisation 1.

Patients will receive up to 4 cycles of Paclitaxel, Ifosfamide, and Cisplatin (TIP).

Administration on an outpatient basis:

Paclitaxel 175 mg/m2, day 1, Ifosfamide 900 mg/m2, days 2-5, Cisplatin 15 mg/m2, days 1-5

Administration on an inpatient basis:

Paclitaxel 175 mg/m2, day 1, Ifosfamide 1200 mg/m2, days 1-3, Cisplatin 25 mg/m2, days 1-3

Group Type EXPERIMENTAL

Paclitaxel

Intervention Type DRUG

Dose 175mg/m2 as part of TIP regimen.

Ifosfamide

Intervention Type DRUG

Dose 900mg/m2 as part of TIP regimen.

Cisplatin

Intervention Type DRUG

Dose 15mg/m2 as part of TIP regimen (neoadjuvant chemotherapy arm) Dose 40mg/m2 for use concurrently with raditotherapy (chemoradiotherapy arm)

Arm C - neoadjuvant chemoradiotherapy

Part of randomisation 1.

Radiotherapy dose is 45Gy in 25 fractions over 5 weeks using 6-10 MV photons to all regions.

Concurrent cisplatin 40mg/m2 will be given weekly, subject to GFR\>45mls/min.

Group Type EXPERIMENTAL

Cisplatin

Intervention Type DRUG

Dose 15mg/m2 as part of TIP regimen (neoadjuvant chemotherapy arm) Dose 40mg/m2 for use concurrently with raditotherapy (chemoradiotherapy arm)

Intensity modulated radiation treatment (IMRT)

Intervention Type RADIATION

Treatment with very high energy X-rays (radiotherapy).

Arm P - prophylactic PLND

Part of randomisation 2.

Prophylactic pelvic lymph node dissection (PLND) - The total treatment duration is estimated to be over 1 day.

Patients who have NOT received neoadjuvant chemoradiotherapy will receive adjuvant chemoradiotherapy:

Cisplatin 40mg/m2 will be given weekly, subject to GFR\>45mls/min.

Groin: One or both groins may be boosted up to 54Gy in 25 fractions. An IMRT boost of up to 57 Gy can be given to recurrent or residual macroscopic tumour

Pelvis: the dose is limited to 45Gy unless IMRT is available. An IMRT boost of up to 54Gy in 25 fractions is applied to:

1. Any macroscopic tumour or pathological lymph nodes
2. Electively to external iliac nodes in patient with high disease burden

Patients who have had neoadjuvant chemoradiotherapy will have prophylactic PLND alone.

Group Type EXPERIMENTAL

Prophylactic PLND - pelvic lymph node dissection

Intervention Type PROCEDURE

Surgery to remove the lymph nodes deeper in the pelvis, further away from where the cancer first appeared, that are at high risk of harbouring cancer.

Arm Q - Surveillance no prophylactic PLND

no prophylactic PLND Part of randomisation 2.

For patients who have NOT received neoadjuvant chemoradiotherapy:

Groin: One or both groins may be boosted up to 54Gy in 25 fractions. An IMRT boost of up to 57 Gy can be given to recurrent or residual macroscopic tumour

Pelvis: the dose is limited to 45Gy unless IMRT is available. An IMRT boost of up to 54Gy in 25 fractions is applied to:

Any macroscopic tumour or pathological lymph nodes Electively to external iliac nodes in patient with high disease burden

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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ILND - Inguinal Lymph Node Dissection

Surgery to remove the lymph nodes in the groin near to where the cancer first appeared.

Intervention Type PROCEDURE

Paclitaxel

Dose 175mg/m2 as part of TIP regimen.

Intervention Type DRUG

Ifosfamide

Dose 900mg/m2 as part of TIP regimen.

Intervention Type DRUG

Cisplatin

Dose 15mg/m2 as part of TIP regimen (neoadjuvant chemotherapy arm) Dose 40mg/m2 for use concurrently with raditotherapy (chemoradiotherapy arm)

Intervention Type DRUG

Intensity modulated radiation treatment (IMRT)

Treatment with very high energy X-rays (radiotherapy).

Intervention Type RADIATION

Prophylactic PLND - pelvic lymph node dissection

Surgery to remove the lymph nodes deeper in the pelvis, further away from where the cancer first appeared, that are at high risk of harbouring cancer.

Intervention Type PROCEDURE

Other Intervention Names

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Taxol Mitoxana

Eligibility Criteria

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Inclusion Criteria

1. Written informed consent
2. Measurable disease as determined by RECIST (version 1.1) criteria;
3. Histologically-proven squamous cell carcinoma of the penis,
4. Stage:

* any T, N1 (i.e. a palpable mobile unilateral inguinal lymph node), M0 or;
* any T, N2 (i.e. palpable mobile multiple or bilateral inguinal lymph nodes), M0 or;
* any T, N3 (i.e. fixed inguinal nodal mass or any pelvic lymphadenopathy), M0
5. Performance Status ECOG 0, 1 or 2.

Exclusion Criteria

1. Pure verrucous carcinoma of the penis,
2. Nonsquamous malignancy of the penis,
3. Squamous carcinoma of the urethra,
4. Stage M1,
5. Previous chemotherapy or chemoradiotherapy,
6. Concurrent malignancy (other than SCC or Basal Cell Carcinoma of non-penile skin) that has required surgical or non-surgical treatment in the last 3 years.
Minimum Eligible Age

18 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

ECOG-ACRIN Cancer Research Group

NETWORK

Sponsor Role collaborator

Institute of Cancer Research, United Kingdom

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Steve Nicholson

Role: STUDY_CHAIR

Mid and South Essex NHS Foundation Trust

Curtis Pettaway

Role: STUDY_CHAIR

University of Texas M.D. Anderson Cancer Center ; 713-792-3250 ; [email protected]

Locations

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Los Angeles County-USC Medical Center

Los Angeles, California, United States

Site Status RECRUITING

USC / Norris Comprehensive Cancer Center

Los Angeles, California, United States

Site Status RECRUITING

Moffitt Cancer Center

Tampa, Florida, United States

Site Status RECRUITING

Grady Health System

Atlanta, Georgia, United States

Site Status ACTIVE_NOT_RECRUITING

Emory University Hospital/Winship Cancer Institute

Atlanta, Georgia, United States

Site Status RECRUITING

University of Chicago Comprehensive Cancer Center

Chicago, Illinois, United States

Site Status ACTIVE_NOT_RECRUITING

Mayo Clinic

Rochester, Minnesota, United States

Site Status RECRUITING

Ohio State University Comprehensive Cancer Center

Columbus, Ohio, United States

Site Status ACTIVE_NOT_RECRUITING

University of Oklahoma Health Sciences Center

Oklahoma City, Oklahoma, United States

Site Status ACTIVE_NOT_RECRUITING

Fox Chase Cancer Center

Philadelphia, Pennsylvania, United States

Site Status ACTIVE_NOT_RECRUITING

University of Texas M.D. Anderson Cancer Center

Houston, Texas, United States

Site Status RECRUITING

Velindre NHS Trust

Cardiff, , United Kingdom

Site Status RECRUITING

University Hospitals of Leicester NHS Trust

Leicester, , United Kingdom

Site Status RECRUITING

The Royal Marsden NHS Foundation Trust

London, , United Kingdom

Site Status ACTIVE_NOT_RECRUITING

St George's Hospital NHS Foundation Trust

London, , United Kingdom

Site Status RECRUITING

Norfolk and Norwich University Hospitals NHS Foundation Trust

Norwich, , United Kingdom

Site Status RECRUITING

Swansea Bay University Health Board

Swansea, , United Kingdom

Site Status ACTIVE_NOT_RECRUITING

Countries

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United States United Kingdom

Central Contacts

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UK - InPACT Senior Trial Manager

Role: CONTACT

02087224261

US/Canada - InPACT DA for EA8134

Role: CONTACT

(857)504-2900

Facility Contacts

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Anne Schuckman

Role: primary

(323)865-3700

Sia Daneshmand

Role: primary

(323)865-3700

Phil Spiess

Role: primary

(813)745-8343

Viraj Master

Role: primary

(404)778-4898

Lance Pagliaro

Role: primary

Stephen Boorjian /Jeffrey Karnes ([email protected])

Role: backup

(507)284-4015 / (507)266-9968

Curtis Pettaway

Role: primary

(713)792-3250

Dr James Barber

Role: primary

Dr Christopher Kent

Role: primary

Mr Nick Watkin

Role: primary

Mr Vivekanandan Kumar

Role: primary

Related Links

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Other Identifiers

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CRUK/13/005

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

13580965

Identifier Type: REGISTRY

Identifier Source: secondary_id

EA8134

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

IRCI004

Identifier Type: OTHER

Identifier Source: secondary_id

2015-001199-23

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

ICR CTSU/2014/10048

Identifier Type: -

Identifier Source: org_study_id

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