LMS Study (GOG 0277)

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LMS Study (GOG 0277) A Phase III randomised trial of gemcitabine plus docetaxel followed by doxorubicin versus observation for uterus limited, high grade uterine leiomyosarcoma EudraCT Number: 2012-002852-17 Pharmacy Initiation Slides – Version 1.0 18 th March 2014. Study Organisation. - PowerPoint PPT Presentation

Text of LMS Study (GOG 0277)

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    LMS Study (GOG 0277)A Phase III randomised trial of gemcitabine plus docetaxel followed by doxorubicin versus observation for uterus limited, high grade uterine leiomyosarcomaEudraCT Number: 2012-002852-17

    Pharmacy Initiation Slides Version 1.0 18th March 2014

  • **Study OrganisationThis trial is an Intergroup Trial jointly conducted by Gynecologic Oncology Group (GOG) from USA, the EORTC Gynaecology Group, EORTC Soft Tissue Bone Sarcoma Group and National Cancer Research Network [NCRN] United Kingdom.

    In the UK the trial is being run under the auspices of the NCRN/NCRI Sarcoma and Gynaecology Clinical Study Groups with funding from Cancer Research UK.

    The Cancer Research UK Clinical Trials Unit, Glasgow (CTU) is co-ordinating the UK participation in the trial on behalf of NCRI/NCRN and NHS Greater Glasgow & Clyde (NHS GG&C).

    The EORTC is the sole legal Sponsor for participants in the European Union.

    UK Chief Investigator is Dr Helen Hatcher

    Trial co-ordination costs for UK participation in the trial are supported by a grant from Cancer Research UK. This is an academic trial and is part of the NCRN portfolio.

  • **Study Team in UKUK Chief Investigator:Dr Helen Hatcher

    Lead Pathologist UK:Professor Cyril Fisher

    Project Manager:Karen Carty

    Pharmacovigilance:Via EORTC

    UK Study Pharmacist:Dr Samantha Carmichael

    Quality Assurance Manager:Michaela Rodger

    Clinical Trial Co-ordinator:Diann Taggart

    Clinical Trial Monitor:Jan Graham

  • Pharmacy Initiation

    Protocol and treatment overview

    IMP Presentation

    LMS site file and documentation

    Site initiation process*

  • **Design and Study Objectives

    Design:

    Study is designed as a two arm, open label randomised phase III with an observation only control arm and experimental arm of multi-agent chemotherapy.

    Study Objectives

    Primary Objective:

    -To determine whether overall survival of patients with uterus-limited high grade leiomyosarcoma is superior among patients assigned to treatment with adjuvant gemcitabine plus docetaxel followed by doxurubicin compared to patients assigned to observationSecondary Objectives:

    -To determine whether treatment with adjuvant gemcitabine plus docetaxel followed by doxorubicin improves recurrence free survival of patients with uterus-limited high grade leiomyosarcoma compared to observation

    -To explore the impact of potential predictors of recurrence or death such as patient age, and institution reported tumour size, cervix involvement (yes or no) and mitotic rate

  • *Study PopulationStudy Population:

    - Patients with high risk uterine leiomyosarcoma

    - FIGO stage I (confined to corpus +/- cervix)

    - Patients require to have had at least a complete hysterectomy (including removal of cervix)

    - All patients must have no evidence of persistent or metastatic disease as documented by a post-resection CT of the chest/abdomen/pelvis or by CT chest + MRI abdomen/pelvis

  • **Inclusion Criteria (1)Patients will be eligible for the study if the following criteria are met:

    Patients with high risk uterine leiomyosarcoma, FIGO stage I (confined to corpus +/- cervix). Patients with known uterine serosa involvement are not eligible. Patients should have had, at least, a complete hysterectomy (including removal of the cervix). Bilateral salpingo-oophorectomy is not required.All patients must be no longer than 12 weeks (3 months) from surgical resection of cancer at the time of the enrollment on study. If a patient requires a second operation to complete her surgery, i.e. trachelectomy to remove the cervix and/or BSO, the 12 weeks may be counted from the time of the second operation.

    All patients must have no evidence of persistent or metastatic disease as documented by a post resection CT scan of the chest, abdomen and pelvis or by CT scan of chest + MRI of abdomen and pelvis. The post resection imaging should be performed within 4 weeks of registration/randomisation on study.

  • **Inclusion Criteria (2)

    Patients must have adequate:

    -Bone Marrow Function*-Renal Function*-Hepatic Function*-Neurologic Function*Patients with GOG performance status of 0 or 1; ECOG performance status of 0 or 1; or KPS > 80%

    Patients who have met the pre-entry requirements specified in section 7.0 of protocol

    *Refer to Section 3 of protocol

  • **Inclusion Criteria (3)

    Patients must have signed an approved informed consent.

    Patients must be a minimum of 18 years of age.

    Patients should be free of active infection requiring antibiotics (with the exception of an uncomplicated Urinary Tract Infection [UTI])

  • **Exclusion Criteria (1)

    Patients will be excluded from the study in the following circumstances:

    Patients who have had prior therapy with docetaxel or gemcitabine or doxorubicin at any time in their history.

    Patients with a history of other invasive malignancies present within the last 5 years, with the exception of non-melanoma skin cancer.

    Patients with a history of severe hypersensitivity reaction to taxotere (docetaxel) or other drugs formulated with polysorbate 80.

    Patients with GOG performance status of 2,3 or 4; or ECOG performance status of 2,3 or 4.

    Patients who are breast feeding

    Patients with a know history of congestive heart failure or cardiac ejection fraction.

  • **Exclusion Criteria (2)

    Patients with a history of prior whole pelvic radiation.

    Concurrent treatment with hormone replacement therapy is permitted at the discretion of the treating physician. Use of anti-hormonal agents (tamoxifen, medroxyprogesterone, aromatase inhibitors) is permitted at the discretion of the treating physician.

    Patients with recurrent uterine LMS

    Patients who are know to be HIV (human immunodeficiency virus) positive.

    Patients with gross residual or metastatic tumour findings following complete surgical treatment for uterine LMS

  • **Treatment and DurationTreatment:

    REGIMEN I:

    -Gemcitabine 900mg/m2 IV on days 1 and 8-Docetaxel 75mg/m2 IV on day 8-Filgrastim (GCSF) 5 micrograms/kg SC on days 9 to 15 or Pegfilgrastim 6mg SC day 9 or 10Every 21 days for 4 cycles followed by:

    -Doxorubicin 60mg/m2 IV on day 1-Filgrastim (GCSF) 5 micrograms/kg SC on days 2 to 8 or Pegfilgrastim 6mg SC on day 2 or 3optionalEvery 21 days for 4 cycles

    REGIMEN II:Observation only

  • **Duration of Study/ Study Visits

    Patients on REGIMEN 1 will receive therapy for a maximum of 8 cycles (4 cycles of gemcitabine + docetaxel, followed by 4 cycles of doxorubicin) or until disease recurrence or toxicity intervenes

    A patient is considered off study treatment when the patient has recurred or died, a non-protocol drug or therapy (directed at the disease) is initiated or all study therapy is totally discontinued

    Patients on the observation arm (REGIMEN II) are considered off study treatment at the end of 24 weeks from study entry.

    Patients who are considered off study treatment in both arms remain on study in terms of follow-up for evidence of recurrence and for survival status.

    Patients will be followed for recurrence with physical examination, history and imaging until recurrence, death or five years of follow-up is reached. If there is evidence of disease recurrence, patients will continue to be followed for survival for at least 5 years from study entry.

    Please refer to study protocol investigations tables for each arm of the study to ensure the correct observations and tests are performed at protocol specified time points.

  • **Treatment Modifications (REGIMEN I) -1

    Please refer to section 6.0 of the protocol for full details of treatment modifications/dose reductions/delays for haematological and non haematological toxicities for regimen 1 (Brief details in relation to treatment modifications are provided on these slides)Gemcitabine and Docetaxel Dose Level Definitions:

    Doxorubicin Dose Level Definitions:

    Patients who require a dose reduction because of a toxicity meeting criteria specified in protocol are permitted ONE dose reduction. If toxicity recurs of a severity that would require another dose reduction, a second dose reduction is NOT permitted. Instead, treatment with the regimen that caused the additional toxicity should be discontinued.

    Study drug 1 Level reductionInitial dose levelGemcitabine675mg/m2 over 70-90 minutes900mg/m2 over 90 minutesDocetaxel60mg/m275mg/m2

    Study drug1 level reductionInitial dose levelDoxorubicin45mg/m260mg/m2

  • **Treatment Modifications (REGIMEN I) -2

    Haematologic Toxicity during EITHER gemcitabine + docetaxel OR doxorubicin

    Initial treatment modifications will consist of cycle delay and/or dose reduction. Refer to section 6.2 in protocol for full details.

    The use of hematopoietic cytokines and protective reagents are restricted . Refer to section 6.2 for full details

  • *Treatment Modifications (REGIMEN I) -3In addition to the dose modifications listed previously Day 8 Gemcitabine and Docetaxel dose adjustments should be made according to the table below:

    Note: ANC (absolute neutrophil count) >1000/mcl = ANC 1.0 x 109/liter (L).Plt (platelets) 100,000/mcl = Plt 100 x 109/L.Dose reduction on Day 8 does not count as one of the two permitted protocol dose reductions for toxicity. The next cycle may be started at previous doses, provided that blood counts have recovered as detailed in 6.23 of protocol. If a dose reduction is required on Day 8 of a cycle, subsequent Day 8 doses should only be reduced in subsequent cycles if the criteria for reduction or omissi