A Multi-institutional Study for Treatment of Children With Newly Diagnosed Hepatoblastoma Using a Modified PHITT Strategy

Shanghai Jiao Tong University

Status and phase

Enrolling

Phase 3

Conditions

Hepatoblastoma

Treatments

Procedure: Resection of pulmonary nodules

Drug: Consolidation (Carboplatin, Doxorubicin) -Group D1

Procedure: Biopsy

Drug: Block 1 to 3 (Cisplatin, Doxorubicin) Group D

Drug: Cisplatin, 5-Fluorouracil, Vincristine, Doxorubicin-Group C

Drug: mono CDDP-Group A2

Procedure: Primary surgery resection

Drug: Sodium Thiosulfate Injection

Procedure: Resection or transplant

Drug: mono CDDP- Group B

Drug: Consolidation (Carboplatin +Doxorubicin/Vincristine + Irinotecan)-Group D2

Study type

Interventional

Funder types

Other

Identifiers

NCT04478292

NCMC-SH-HEP-2020

Details and patient eligibility

About

A Phase 3 multi-institutional study for treatment of children with newly diagnosed hepatoblastoma using a modified Paediatric Hepatic International Tumour Trial (PHITT) strategy incorporating a randomized assessment of sodium thiosulfate as auditory protection for children with localized disease, and response adapted therapy for patients with metastatic disease

Full description

Primary aims:

Localized Disease: Groups B and C: To evaluate and validate the efficacy of sodium thiosulfate (STS) to reduce the hearing impairment caused by a cisplatin monotherapy in non-metastatic patients without adverse features (localized PRETEXT I-III tumors without positive VPEFR annotation factors) (Group B - treated with cisplatin mono-therapy) or with adverse features (localized PRETEXT I-III tumors with positive VPEFR annotation factors) (Group C - treated with regimen C5VD)
Metastatic Disease: Group D: To determine the 3-year Event-free survival (EFS) in patients with metastatic disease treated with International Society of Paediatric Oncology (SIOPEL 4) induction therapy followed by response adapted consolidation therapy.
To determine the 3-year EFS in patients with HB whose tumor is completely resected at diagnosis (Group A) and either receive no adjuvant chemotherapy (Group A1, completely resected well differentiated fetal (WDF) histology HB) or 2 cycles of standard dose cisplatin monotherapy (Group A2, completely resected non-well differentiated fetal histology HB)

Secondary aims:

To determine any impact of STS on chemotherapy response and survival in children with localized hepatoblastoma
To assess the feasibility of complete resection after 2 cycles of interval compressed lower dose cisplatin monotherapy (80 mg/m2/cycle) in non-metastatic patients and without adverse features
To assess the feasibility of complete resection after 2 cycles of C5VD in non-metastatic patients with adverse features.5. To determine the adherence to PRETEXT and Post-treatment extent of disease (POSTTEXT) based surgical guidelines
To determine the prognostic relevance in HB of a "small cell undifferentiated", tumor component, percentage of tumor necrosis in post chemotherapy specimens, and the relevance of a positive microscopic margin in resected HB specimens.
To determine the concordance between institutional, regional expert panel (prospective) and international expert panel (retrospective) review assessment of PRETEXT and POSTTEXT stage, and correlate with outcome variables.
To prospectively collect patient HB tumor, peripheral blood and urine specimens, for translational biology studies.

Enrollment

330 estimated patients

Sex

All

Ages

Under 18 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Performance Level Patients must have a performance status corresponding to ECOG scores 0, 1, or 2. Use Karnofsky for patients >16 years of age and Lansky for patients ≤16 years of age.
Diagnosis Patients must be newly diagnosed with histologically-proven primary pediatric HB
Emergent Treatment for HB In emergency situation when a patient meets all other eligibility criteria and has had baseline required observations, but is too ill to undergo a biopsy safely, the patient may be enrolled without a biopsy.
Prior Therapy Patients may have had surgical resection of the hepatic malignancy prior to enrollment. All other anti-cancer therapy for the current liver lesion is prohibited.
Organ Function Requirements

I) Adequate renal function defined as:

Creatinine clearance or radioisotope Glomerular Filtration Rate (GFR) ≥ 70 mL/min/1.73 m2

II) Adequate liver function defined as:

Total bilirubin ≤ 5 x upper limit of normal (ULN) for age, and Aspartate aminotransferase (AST) or Alanine transaminase (ALT) < 10 x upper limit of normal (ULN) for age.

III) Adequate pulmonary function defined as:

Normal pulmonary function tests (including DLCO) if there is clinical indication for determination (e.g. dyspnea at rest, known requirement for supplemental oxygen)

Exclusion criteria

Prior chemotherapy or tumor directed therapy expect for surgical resection of the hepatic malignancy (i.e. radiation therapy, biologic agents, local therapy (embolization, radiofrequency ablation, and laser)). Therefore, patients with a pre-disposition syndrome who have a prior malignancy are not eligible.
Patients who are currently receiving another investigational drug.
Patients who are currently receiving other anticancer agents.
Patients with uncontrolled infection.
Patients who previously received a solid organ transplant.

Trial design

Primary purpose

Treatment

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

None (Open label)

330 participants in 4 patient groups

Group A

Experimental group

Description:

* Group A1： tumor is completely resected at diagnosis and receives no adjuvant chemotherapy（well differentiated fetal \[WDF\] histology HB) ； * Group A2：tumor is completely resected followed by 2 cycles of standard dose cisplatin monotherapy （non-well differentiated fetal histology HB)

Treatment:

Drug: mono CDDP-Group A2

Procedure: Primary surgery resection

Group B

Experimental group

Description:

* Patients will be randomized to one of 2 arms: Arm CDDP or Arm CDDP plus STS. In each arm, patients will be stratified by resectablity after completion of 2 cycles of protocol therapy (6 cycles of standard dose cisplatin monotherapy with or without STS). All the patients in 2 arms will receive 6 cycles chemotherapy in total. * Resection of the primary tumor will be performed after completing the 2nd cycle of chemotherapy. * Those patients whose tumors after 2 cycles do not meet criteria for definitive surgical, 2nd resectablity evaluation will be scheduled after 4 cycles of chemotherapy.

Treatment:

Drug: mono CDDP- Group B

Procedure: Resection or transplant

Drug: Sodium Thiosulfate Injection

Procedure: Biopsy

Group C

Experimental group

Description:

* Patients in Group C will have locally advanced tumors including PRETEXT I-III tumors with a positive VPEFR annotation factor and all PRETEXT IV tumors. * Patients will be randomized to one of 2 arms: Arm C5VD or Arm C5VD plus STS. In each arm, patients will be stratified by resectablity after completion of 2 cycles of protocol therapy. All the patients in 2 arms will receive 6 cycles chemotherapy in total. * Resection of the primary tumor will be performed after completing the 2nd cycle of chemotherapy. * Those patients whose tumors after 2 cycles do not meet criteria for definitive surgical, 2nd resectablity evaluation will be scheduled after 4 cycles of chemotherapy.

Treatment:

Procedure: Resection or transplant

Drug: Sodium Thiosulfate Injection

Drug: Cisplatin, 5-Fluorouracil, Vincristine, Doxorubicin-Group C

Procedure: Biopsy

Group D

Experimental group

Description:

* These patients have metastatic disease, suspected HB patients ≥ 8 years of age, or have an AFP ≤ 100 at diagnosis. * Patients will receive initial chemotherapy according to the cisplatin-intensive SIOPEL-4 induction regimen. Resection (including transplant) of the primary tumor should be completed after induction Block 3, but primary tumor resection can be planned any time after completing induction therapy. * Following 3 blocks of induction chemotherapy, patients will be stratified into 2 risk groups: Group D1 includes patients who either have a chemotherapy-induced lung CR or are rendered a lung CR by surgical metastasectomy. These patients will have chemotherapy consolidation with carboplatin/doxorubicin. In Group D2, patients will have not yet achieved a lung CR at the end of induction Block 3. These patients will get intensified consolidation therapy of carboplatin/doxorubicin with vincristine/irinotecan. * Resection of pulmonary nodules should be considered in Group D2.

Treatment:

Drug: Consolidation (Carboplatin +Doxorubicin/Vincristine + Irinotecan)-Group D2

Procedure: Resection or transplant

Drug: Block 1 to 3 (Cisplatin, Doxorubicin) Group D

Procedure: Biopsy

Drug: Consolidation (Carboplatin, Doxorubicin) -Group D1

Procedure: Resection of pulmonary nodules