ICRA Randomised Controlled Trial

NCT07068464 | Not Yet Recruiting Phase 3 DMC

• 1 other identifier: vF_ICRA
• Study Type: interventional
• Target: 682
• Locations: 1 country
• Sites: 1

Brief Summary

The standard of care for advanced stage epithelial ovarian cancer is primary cytoreduction surgery with the aim of complete cytoreduction, followed by platinum and taxane-based chemotherapy and consideration of maintenance therapy (bevacizumab or Poly ADP-ribose polymerase (PARP)-inhibitor). Neoadjuvant chemotherapy before and after interval cytoreduction surgery has become an alternative approach as randomized controlled trials have demonstrated non-inferiority of this type of management over primary surgery. In these studies, neoadjuvant chemotherapy was restricted to three to four cycles. However, real-world clinical practice varies, with centres giving more than four pre-operative cycles. The decision to delay surgery is complex and influenced by multiple factors. These include poor performance status, radiological evidence of unresectable sites of disease, or insufficient surgical resources (either lack of surgical expertise operating room availability due to waiting lists) particularly when high complexity surgery is required to achieve complete cytoreduction. International disparities in access to surgical resources between high and low-middle income country settings also results in delays to surgery. Knowledge gap: There is a paucity of data in the setting of extended use of neoadjuvant chemotherapy (more than four cycles). Data on the role of delayed cytoreduction surgery post four cycles are controversial. While some data have shown survival to be similar to that of patients undergoing interval cytoreductive surgery after three cycles,6-12 others have reported poorer prognosis. Conflicting data are due to selection biases such as heterogeneous inclusion criteria, small sample sizes and retrospective study designs. Delaying surgery to after four cycles has the potential to reduce surgical complexity and post-operative morbidity, and increase rates of complete cytoreduction (an independent marker of survival). Our multi-centre, international, retrospective cohort study (GO SOAR2) of 2498 women from twenty-two centres across twelve countries with advanced stage ovary cancer, showed that interval cytoreduction surgery was associated with statistically significant greater overall survival in comparison to delayed cytoreduction surgery (HR 0.81, p=0.01) but was associated with a higher GO SOAR surgical complexity score and greater surgical morbidity. Our results indicate that early maximum effort cytoreduction surgery with complete cytoreduction in high volume centres with appropriate surgical skill mix and resources, is what is needed to increase overall survival for women with advanced stage ovarian cancer. We present the study design for a pragmatic phase III superiority randomised controlled trial comparing overall survival following interval and delayed cytoreductive surgery. Our hypothesis is that overall survival is greater following interval cytoreduction surgery when compared to delayed cytoreduction in women with stage III-IV epithelial ovarian cancer.

Conditions

Ovary Cancer

Keywords

surgery

Outcome Measures

Primary Outcomes (1)

• Overall survival

  Defined from date of diagnosis to date of death

  5 years

Secondary Outcomes (4)

• Progression free survival

  5 years

• Post-operative morbidity

  30 days post surgery

• Peritoneal cancer index (PCI) to assess intra-operative tumour burden and completeness of cytoreduction (CC)

  At the end of surgery.

• Quality of life as per EQ-5D-5L health-related quality of life questionnaire

  5 years

Study Arms (2)

interval cytoreduction surgery

ACTIVE COMPARATOR

interval cytoreduction surgery is defined as surgery after 3 cycles of carboplatin and paclitaxel neoadjuvant chemotherapy

Procedure: interval cytoreduction surgery

delayed cytoreduction surgery

EXPERIMENTAL

delayed cytoreduction surgery is defined as surgery after 6 cycles of carboplatin and paclitaxel neoadjuvant chemotherapy

Procedure: delayed cytoreduction surgery

Interventions

delayed cytoreduction surgery PROCEDURE

Delayed cytoreduction surgery is defined as cytoreduction surgery after six cycles of carboplatin and paclitaxel neoadjuvant chemotherapy.

delayed cytoreduction surgery

interval cytoreduction surgery PROCEDURE

Interval cytoreduction surgery is defined as cytoreduction surgery after three cycles of carboplatin-paclitaxel neoadjuvant chemotherapy.

interval cytoreduction surgery

Eligibility Criteria

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

You may qualify if:

• Women ≥18 years of age.
• Histologically confirmed high grade, serous, or endometrioid ovarian cancer, fallopian tube carcinoma, or primary peritoneal carcinoma.
• International Federation of Gynecologic Oncology (FIGO) 2014 stage IIIA-IVB unsuitable for complete primary cytoreductive surgery because disease unresectable. Assessment of unresectable disease must have been made by staging CT chest abdomen pelvis +/- diagnostic laparoscopy.
• Disease must be deemed resectable after three courses of neoadjuvant chemotherapy.
• Patient must be fit for cytoreduction surgery and chemotherapy.

You may not qualify if:

• Women undergoing primary and recurrent cytoreductive surgery.
• Mucinous, clear cell, carcinosarcoma, low-grade serous carcinoma, germ cell and sex cord stromal histopathologies.
• Synchronous malignancies.
• Unfit for surgery and or chemotherapy.
• Pregnant or breastfeeding women.
• Delivery of HIPEC at cytoreduction surgery.

Sponsors & Collaborators

• NHS Grampian: lead

Study Sites (1)

University College London Hospitals NHS Foundation Trust

London, NW1 2BU, United Kingdom

Location

MeSH Terms

Conditions

Ovarian Neoplasms

Condition Hierarchy (Ancestors)

Endocrine Gland Neoplasms; Neoplasms by Site; Neoplasms; Ovarian Diseases; Adnexal Diseases; Genital Diseases, Female; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Genital Neoplasms, Female; Urogenital Neoplasms; Genital Diseases; Endocrine System Diseases; Gonadal Disorders

Central Study Contacts

Faiza Gaba

CONTACT

+442034567890; faiza.gaba1@abdn.ac.uk

Study Design

• Study Type: interventional
• Phase: phase 3
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Dr

Study Record Dates

• First Submitted: July 7, 2025
• First Posted: July 16, 2025
• Study Start: January 31, 2026
• Primary Completion (Estimated): January 31, 2029
• Study Completion (Estimated): January 31, 2034
• Last Updated: July 16, 2025

Record last verified: 2025-06

Locations

GB (1)