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Boden A, Lusque A, Lodin S, Bourgouin M, Mauries V, Moreau C, Fabre A, Mounier M, Poublanc M, Caunes-Hilary N, Filleron T. Study protocol of the TEC-ORL clinical trial: a randomized comparative phase II trial investigating the analgesic activity of capsaicin vs Laroxyl in head and neck Cancer survivors presenting with neuropathic pain sequelae. BMC Cancer 2022; 22:1260. [PMID: 36471253 PMCID: PMC9720988 DOI: 10.1186/s12885-022-10348-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/19/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Neuropathic pain is common in cancer survivorship and is one of the most distressing symptoms for patients previously treated for head and neck cancer. Persistent neuropathic pain, when it is ongoing and uncontrolled, has a detrimental effect and erodes patients' quality of life. Patients treated for head and neck cancer are chronic opioid users to manage their post-treatment pain, which may entail an increased risk of addiction and overdose. We propose to evaluate the analgesic activity of high-concentration capsaicin patches for the treatment of head and neck cancer survivors presenting with neuropathic pain sequelae. METHODS TEC-ORL is a parallel, multicenter randomized comparative phase II study evaluating whether Capsaïcin patches (Qutenza®) reduce neuropathic pain when compared to Amitriptyline (Laroxyl®) in head and neck cancer survivors presenting with neuropathic pain sequelae. The primary efficacy outcome is the rate of patients with a pain reduction of at least two points at 9 months compared to baseline. Assuming that 5% of patients become lost to follow-up, 130 patients will need to be randomized to detect a 25% improvement (i.e., standard: 25%, experimental: 50%) using a one-sided chi-square test with an alpha of 0.05%. According to the recommendations for comparative phase II trials, the target differences and type I error rates are relaxed. Randomized patients will either be treated with a capsaicin 8% (Qutenza®) patch applied at three time intervals in the experimental arm or with Amitriptyline (Laroxyl®) (oral solution 40 mg/ml) taken for 9 months at the recommended daily dose of 25 mg to 75 mg in the control arm. DISCUSSION TEC-ORL is a randomized comparative phase II trial designed to comprehensively evaluate the analgesic activity of capsaicin compared to Laroxyl in Head and Neck Cancer survivors presenting with neuropathic pain sequelae. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04704453 Date of registration: 2021/01/13.
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Affiliation(s)
- Antoine Boden
- grid.417829.10000 0000 9680 0846Support Care Department, Institut Claudius Regaud IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse Cedex, France
| | - Amélie Lusque
- grid.417829.10000 0000 9680 0846Biostatistics & Health Data Science Unit, Institut Claudius Regaud, IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Sabrina Lodin
- grid.417829.10000 0000 9680 0846Clinical Trials Office, Institut Claudius Regaud, IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Marie Bourgouin
- grid.417829.10000 0000 9680 0846Support Care Department, Institut Claudius Regaud IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse Cedex, France
| | - Valérie Mauries
- grid.417829.10000 0000 9680 0846Support Care Department, Institut Claudius Regaud IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse Cedex, France
| | - Christelle Moreau
- grid.417829.10000 0000 9680 0846Biostatistics & Health Data Science Unit, Institut Claudius Regaud, IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Amandine Fabre
- grid.417829.10000 0000 9680 0846Clinical Trials Office, Institut Claudius Regaud, IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Muriel Mounier
- grid.417829.10000 0000 9680 0846Clinical Trials Office, Institut Claudius Regaud, IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Muriel Poublanc
- grid.417829.10000 0000 9680 0846Clinical Trials Office, Institut Claudius Regaud, IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Nathalie Caunes-Hilary
- grid.417829.10000 0000 9680 0846Support Care Department, Institut Claudius Regaud IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse Cedex, France
| | - Thomas Filleron
- grid.417829.10000 0000 9680 0846Biostatistics & Health Data Science Unit, Institut Claudius Regaud, IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse, France
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Filleron T, Le Guellec S, Chevreau C, Cabarrou B, Lesluyes T, Lodin S, Massoubre A, Mounier M, Poublanc M, Chibon F, Valentin T. Value of peri-operative chemotherapy in patients with CINSARC high-risk localized grade 1 or 2 soft tissue sarcoma: study protocol of the target selection phase III CHIC-STS trial. BMC Cancer 2020; 20:716. [PMID: 32736540 PMCID: PMC7395339 DOI: 10.1186/s12885-020-07207-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The value of chemotherapy in soft tissue sarcoma (STS) remains controversial. Several expert teams consider that chemotherapy provides a survival advantage and should be proposed in high-risk (HR) patients. However, the lack of accuracy in identifying HR patients with conventional risk factors (large, deep, FNCLCC grade 3, extremity STS) is an issue that cannot be neglected. For example, while the FNCLCC grading system is a powerful tool, it has several limitations. CINSARC, a 67-gene signature, has proved to be an additional independent factor for predicting metastatic spread and outperforms histological grade. Regardless of FNCLCC grade, CINSARC stratifies patients into two separate prognostic groups: one with an excellent prognosis (low-risk (LR) CINSARC) and the other with a worse outcome (HR-CINSARC) in terms of metastatic relapse. Here we evaluate the role of chemotherapy in grade 1-2 STS patients with HR-CINSARC and assess the prognostic value of CINSARC in patients treated with standard of care. METHODS CHIC is a parallel, randomized, open-label, multicenter study evaluating the effect on metastasis-free survival of adding perioperative chemotherapy to standard of care in patients with grade ½ STS sarcoma defined as HR by CINSARC. In this target selection design, 600 patients will be screened with CINSARC to randomize 250 HR-CINSARC patients between standard of care and standard of care plus chemotherapy (4 cycles of 3 weeks of intravenous chemotherapy with doxorubicin in combination with dacarbazine or ifosfamide according to histologic subtype). LR-CINSARC patients will be treated by standard of care according to the investigator. The primary endpoint is metastasis-free survival. Secondary endpoints include overall survival, disease-free survival and safety. Furthermore, the prognostic value of CINSARC will be evaluated by comparing LR-CINSARC patients to HR-CINSARC patients randomized in standard of care. DISCUSSION CHIC is a prospective randomized phase III trial designed to comprehensively evaluate the benefit of chemotherapy in HR-CINSARC patients and to prospectively validate the prognostic value of CINSARC in grade ½ STS sarcoma patients. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04307277 Date of registration: 13 March 2020.
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Affiliation(s)
- Thomas Filleron
- Biostatistics Unit, Institut Claudius Regaud, IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse Cedex, France
| | - Sophie Le Guellec
- Department of Pathology, Institut Claudius Regaud, IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
- INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
| | - Christine Chevreau
- Department of Medical Oncology, Institut Claudius Regaud IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Bastien Cabarrou
- Biostatistics Unit, Institut Claudius Regaud, IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse Cedex, France
| | - Tom Lesluyes
- INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
| | - Sabrina Lodin
- Clinical Trials Office, Institut Claudius Regaud, IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Angélique Massoubre
- Clinical Trials Office, Institut Claudius Regaud, IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Muriel Mounier
- Clinical Trials Office, Institut Claudius Regaud, IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Muriel Poublanc
- Clinical Trials Office, Institut Claudius Regaud, IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Frédéric Chibon
- Department of Pathology, Institut Claudius Regaud, IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
- INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
| | - Thibaud Valentin
- INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Department of Medical Oncology, Institut Claudius Regaud IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
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