Stereotactic Body Radiotherapy in Patients With Rare Oligometastatic Cancers (OligoRARE)

NCT04498767 | Recruiting DMC

• 1 other identifier: EORTC 1945
• Study Type: interventional
• Target: 200
• Locations: 7 countries
• Sites: 13

Brief Summary

This is a randomized open-label multicentre Phase III superiority study of the effect of adding SBRT to the standard of care treatment on overall survival in patients with rare oligometastatic cancers. Patients will be randomized in a 1:1 ratio between current standard of care treatment vs. standard of care treatment + SBRT to all sites of known metastatic disease. The primary objective of this trial is to assess if the addition of stereotactic body radiotherapy (SBRT) to standard of care treatment improves overall survival (OS) as compared to standard of care treatment alone in patients with rare oligometastatic cancers.

Conditions

Gynecologic Cancer; Skin Cancer; Head and Neck Cancer; Sarcoma; Renal Cancer; Bladder Cancer; Upper Urinary Tract Carcinoma; Pancreatic Cancer; Hepatobiliary Cancer; Gastric Cancer; Small Bowel Cancer; Esophageal Cancer; Melanoma; Colon Cancer; Oligometastasis

Keywords

oligometastatic cancer; Stereotactic body radiotherapy; SBRT

Outcome Measures

Primary Outcomes (1)

• Overall survival

  Overall survival is the time interval from the date of randomization to the date of death whatever the cause of death. Patients who are alive are censored at the last date known to be alive.

  7.5 years from first patient in

Secondary Outcomes (8)

• Progression-free survival

  9 years from first patient in

• Disease-specific survival

  9 years from first patient in

• Time to disease progression

  9 years from first patient in

• Time to development of new metastatic lesions

  9 years from first patient in

• Time to development of polymetastatic disease

  9 years from first patient in

Study Arms (2)

Arm 1: Standard of Care + palliative RT

ACTIVE COMPARATOR

Radiotherapy for patients in the standard arm should follow the principles of palliative radiotherapy as per the individual institution, with the goal of alleviating symptoms or preventing imminent complications. Recommended dose fractionations in this arm will include 8 Gy in 1 fractions, 20 Gy in 5 fractions, and 30 Gy in 10 fractions. Patients in this arm should not receive stereotactic doses or radiotherapy boosts, unless there is a clearly known clinical benefit (e.g. stereotactic radiation to a new brain metastases when all disease is controlled on systemic therapy). Systemic therapy will be pre-specified based on the standard of care approach for that patient, and it may include cytotoxic, targeted, hormonal, or immunotherapy.

Radiation: Palliative RT

Arm 2: Standard of Care + SBRT

EXPERIMENTAL

The experimental arm consists of SBRT (and standard of care systemic therapy). Each lesion may be treated with 1, 3, or 5 SBRT fractions of 16-24 Gy, 24-33 Gy or 25-40 Gy, respectively, depending on the local practice and size \& location of oligometastases. Three-fraction regimens will deliver a fraction every second day, and five-fraction regimens are delivered daily. All treatments must be completed within 2 weeks (10 working days) in order to avoid delays in starting systemic therapy. Patients treated with prior or concomitant systemic therapy are eligible for this study. Use of chemotherapy regimens, targeted therapy or immunotherapy containing potent enhancers of radiation damage (e.g. gemcitabine, doxorubicin) can be postponed or interrupted for a duration of one month after radiation.

Radiation: Stereotactic body radiotherapy

Interventions

Stereotactic body radiotherapy RADIATION

Each lesion may be treated with 1, 3, or 5 SBRT fractions of 16-24 Gy, 24-33 Gy or 25-40 Gy, respectively, depending on the local practice and size \& location of oligometastases. Three-fraction regimens will deliver a fraction every second day, and five-fraction regimens are delivered daily. All treatments must be completed within 2 weeks (10 working days) in order to avoid delays in starting systemic therapy.

Also known as: SBRT

Arm 2: Standard of Care + SBRT

Palliative RT RADIATION

Radiotherapy for patients in the standard arm should follow the principles of palliative radiotherapy as per the individual institution, with the goal of alleviating symptoms or preventing imminent complications. Recommended dose fractionations in this arm will include 8 Gy in 1 fractions, 20 Gy in 5 fractions, and 30 Gy in 10 fractions. Patients in this arm should not receive stereotactic doses or radiotherapy boosts, unless there is a clearly known clinical benefit (e.g. stereotactic radiation to a new brain metastases when all disease is controlled on systemic therapy).

Arm 1: Standard of Care + palliative RT

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Histologically confirmed malignancy with metastatic disease detected on imaging. Biopsy of metastasis is preferred, but not required.
• Controlled primary tumour, defined as:
• at least 3 months since original tumour treated definitively, with no progression at primary site
• Total number of oligometastases of 1-5 including:
• All sites of disease can be safely treated based on the judgement of an experienced radiation oncologist
• ECOG score 0-2
• Life expectancy \> 6 months
• Age 18 or older
• Before patient randomization, written informed consent must be given according to ICH/GCP, and national/local regulations.

You may not qualify if:

• Primary cancer of prostate, breast, lung or colorectal
• Serious medical comorbidities precluding radiotherapy:
• These include interstitial lung disease in patients requiring thoracic radiation, Crohn's disease in patients where the GI tract will receive radiotherapy, or ulcerative colitis where the bowel will receive radiotherapy and connective tissue disorders such as lupus or scleroderma.
• For patients with liver metastases, moderate/severe liver dysfunction (Child Pugh B or C)
• Substantial overlap with a previously treated radiation volume. Prior radiotherapy in general is allowed, as long as the composite plan meets dose constraints herein. For patients treated previously with radiation, biological effective dose calculations should be used to equate previous doses to the tolerance doses listed in the RTQA Guidelines. All such cases should be discussed with one of the study coordinators
• Brain metastases only, without extra-cerebral metastases
• Malignant pleural effusion, malignant ascites, meningeal carcinomatosis and peritoneal carcinomatosis
• Maximum size of 6 cm for lesions outside the brain, except:
• Bone metastases over 5 cm may be included, if in the opinion of the local radiation oncologist it can be treated safely (e.g. rib, scapula, pelvis)
• Clinical or radiologic evidence of symptomatic spinal cord compression. Patients can be eligible if surgical resection has been performed, but the surgical site counts toward the total of up to 3 metastases.
• Metastatic disease that invades any of the following: GI tract (including oesophagus, stomach, small or large bowel), mesenteric lymph nodes, or disseminated skin metastases and lymphangiosis
• Pregnant or breast feeding women
• Any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before randomization in the trial

Sponsors & Collaborators

• European Organisation for Research and Treatment of Cancer - EORTC: lead
• Anticancer Fund, Belgium: collaborator
• Rising Tide Foundation: collaborator

Study Sites (13)

Institut Jules Bordet

Anderlecht, 1070, Belgium

RECRUITING

Universitair Ziekenhuis Gent

Ghent, 9000, Belgium

RECRUITING

Gasthuiszusters Antwerpen - Sint-Augustinus

Wilrijk, 2610, Belgium

RECRUITING

Centre Oscar Lambret

Lille, 59020, France

RECRUITING

Gustave Roussy

Villejuif, 94805, France

RECRUITING

Universitaets Krankenhaus Eppendorf - Universitaetsklinikum Hamburg-Eppendorf KE - University Cancer Center

Hamburg, Martinistrasse 52, DE 20246, Germany

RECRUITING

Istituto Europeo di Oncologia

Milan, 20141, Italy

RECRUITING

Medical University Of Gdansk

Gdansk, Mariana Smoluchowskiego 17, PL 80-214, Poland

RECRUITING

Maria Sklodowska-Curie Memorial Cancer Centre - Maria Sklodowska-Curie National Research Institute of Oncology

Warsaw, PL 02 781, Poland

RECRUITING

Inselspital

Bern, 3010, Switzerland

RECRUITING

UniversitaetsSpital Zurich

Zurich, 8091, Switzerland

RECRUITING

University Hospitals Birmingham NHS Foundation Trust (UHB) - UHB-Queen Elisabeth Medical Centre

Birmingham, B15 2TH, United Kingdom

RECRUITING

Royal Marsden Hospital - site: Chelsea, London

London, SW3 6JJ, United Kingdom

RECRUITING

MeSH Terms

Conditions

Skin Neoplasms; Head and Neck Neoplasms; Sarcoma; Kidney Neoplasms; Urinary Bladder Neoplasms; Pancreatic Neoplasms; Stomach Neoplasms; Esophageal Neoplasms; Melanoma; Colonic Neoplasms

Interventions

Radiosurgery

Condition Hierarchy (Ancestors)

Neoplasms by Site; Neoplasms; Skin Diseases; Skin and Connective Tissue Diseases; Neoplasms, Connective and Soft Tissue; Neoplasms by Histologic Type; Urologic Neoplasms; Urogenital Neoplasms; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Kidney Diseases; Urologic Diseases; Male Urogenital Diseases; Urinary Bladder Diseases; Digestive System Neoplasms; Endocrine Gland Neoplasms; Digestive System Diseases; Pancreatic Diseases; Endocrine System Diseases; Gastrointestinal Neoplasms; Gastrointestinal Diseases; Stomach Diseases; Esophageal Diseases; Neuroendocrine Tumors; Neuroectodermal Tumors; Neoplasms, Germ Cell and Embryonal; Neoplasms, Nerve Tissue; Nevi and Melanomas; Colorectal Neoplasms; Intestinal Neoplasms; Colonic Diseases; Intestinal Diseases

Intervention Hierarchy (Ancestors)

Radiotherapy; Therapeutics; Stereotaxic Techniques; Neurosurgical Procedures; Surgical Procedures, Operative; Investigative Techniques

Study Officials

• Matthias Guckenberger

  University of Zurich

  PRINCIPAL INVESTIGATOR

• Piet Ost

  Gasthuiszusters Antwerpen - Sint-Augustinus

  PRINCIPAL INVESTIGATOR

Central Study Contacts

EORTC HQ

CONTACT

+32 2 7744 1611; eortc@eortc.org

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: NETWORK
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 30, 2020
• First Posted: August 4, 2020
• Study Start: June 10, 2021
• Primary Completion (Estimated): August 1, 2028
• Study Completion (Estimated): February 1, 2030
• Last Updated: August 26, 2024

Record last verified: 2024-08

Locations

FR (2); BE (3); PL (2); DE (1); IT (1); CH (2); GB (2)