An International Clinical Program for the Diagnosis and Treatment of Children With Ependymoma

  • STATUS
    Recruiting
  • End date
    Aug 24, 2026
  • participants needed
    480
  • sponsor
    Centre Leon Berard
Updated on 24 January 2021
Investigator
Pierre LEBLOND, MD
Primary Contact
CHU Clermont- Ferrand - H pital Estaing (0.0 mi away) Contact
+61 other location

Summary

The overall aim of this project is to improve the outcome of patients diagnosed with ependymoma by improving and harmonising the staging and the standard of care of this patient population and to improve the investigators understanding of the underlying biology thereby informing future treatment.

The program will evaluate new strategies for diagnosis (centralized reviews of pathology and imaging) and new therapeutic strategies in order to develop treatment recommendations.

Patients will be stratified into different treatment subgroups according to their age, the tumour location and the outcome of the initial surgery. Each subgroup will be studied in a specific randomised study to evaluate the proposed therapeutic strategies.

Stratum 1:

The aim of the stratum 1 is to evaluate the clinical impact of 16-week chemotherapy regimen with VEC-CDDP following surgical resection and conformal radiotherapy in terms of progression free survival in patients who are > 12 months and < 22 years at diagnosis, with completely removed intra cranial Ependymoma.

Stratum 2:

This stratum is designed as a phase II trial for patients who are > 12 months and < 22 years at diagnosis, with residual disease to investigate the possible activity of HD-MTX by giving to all patients the benefit of VEC chemotherapy whilst randomising half of patients to receive additional HD-MTX.

Patients will receive conformal radiotherapy (cRT). For patients who remain with a residual inoperable disease after induction chemotherapy and cRT, an 8 Gy boost of radiotherapy to the residual tumour will be delivered immediately after the end of the cRT.

Stratum 3 This stratum is designed as a phase II trial to evaluate the benefit of postoperative dose intense chemotherapy administered alone or in combination with valproate in children <12 months of age or those not eligible to receive radiotherapy .

Description

The Ependymoma Program is a comprehensive program to improve the accuracy of the primary diagnosis of ependymoma and explore different therapeutic strategies in children, adolescents and young adults, accordingly. This program is opened to all patients diagnosed with ependymoma below the age of 22 years.

It will include a centralised review of pre and post-operative imaging to assess the completeness of the resection.

It will also include a central review of pathology to confirm the histological diagnosis. The biological markers 1q gain, Tenascin C status, NELL2 and LAMA2, RELA-fusion and molecular subgroup by methylation array will be prospectively assessed for prospective evaluation of disease subgroups. Further biological evaluations will be coordinated within the linked BIOMECA study.

After surgery and central review of imaging and pathology, patients will be offered the opportunity to undergo second look surgery, if possible. Patients will be enrolled in one of 3 different strata according to the outcome of the initial surgical resection (residual disease vs no residual disease), their age or eligibility / suitability to receive radiotherapy. These 3 different strata correspond to 3 therapeutic strategies according to the patient status.

  1. Stratum 1 is designed as a randomised phase III study for patients who have had a complete resection, with no measurable residual disease (as confirmed by centrally reviewed MRI) and are > 12 months and < 22 years at diagnosis. Those patients will be randomised to receive conformal radiotherapy followed by either 16 weeks of chemotherapy with VEC-CDDP, or observation.
  2. Stratum 2 is designed as a randomised phase II study for patients who have inoperable measurable residual disease and who are > 12 months and < 22 years at diagnosis. Those patients will be randomised to two different treatment schedules of chemotherapy either with VEC or VEC+ high dose methotrexate (VEC +HD-MTX). After completion of the frontline chemotherapy, patients will be assessed for response (MRI) and will receive second look surgery when feasible. For those patients who remain unresectable with residual disease despite frontline chemotherapy and for whom second line surgery is not feasible, there will be a study of the safety of a radiotherapy boost of 8 Gy that will be administered to the residual tumour immediately after the completion of the conformal radiotherapy. Patients without evidence of residual disease after the chemotherapy and/or a second look surgery are not eligible for radiotherapy boost. All patients who have not shown progression under chemotherapy will receive, as maintenance therapy, a 16 week course of VEC -CDDP following completion of radiotherapy.
  3. Stratum 3 is designed as a randomised phase II chemotherapy study in children <12 months of age or those not eligible to receive radiotherapy. These patients will be randomised to receive a dose dense chemotherapy alternating myelosuppressive and relatively non-myelosuppressive drugs at 2 weekly intervals, with or without, the addition of the histone deacetylase inhibitor, valproate.

Registry: Patients that do not fulfil the inclusion criteria of one of the interventional strata will be enrolled and followed up via an observational study which will be analysed descriptively.

Details
Condition Childhood Ependymoma
Treatment Chemotherapy, 16 weeks of VEC + CDDP, VEC + HD-MTX, Chemotherapy + Valproate, Conformal radiotherapy, Conformal radiotherapy, VEC, conformal radiotherapy +/- boost
Clinical Study IdentifierNCT02265770
SponsorCentre Leon Berard
Last Modified on24 January 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Age > 12 months and < 22 years at time of study entry
Histologically confirmed WHO Grade II-III ependymoma by central pathological review
No metastasis on spinal MRI and on CSF cytology assessments
No previous radiotherapy
No previous chemotherapy (except steroids)
No co-existent unrelated disease at the time of study entry that would render the patient unable to receive chemotherapy
No medical contraindication to radiotherapy and chemotherapy
No signs of infection
Adequate bone marrow, liver and renal functions
Specific inclusion criteria for Stratum 1
No residual measurable ependymoma based on the central neuroradiological
review (R0-1-2)
Specific inclusion criteria for Stratum 2
Residual non reoperable measurable ependymoma based on the central
neuroradiological review (R3-4)
Inclusion criteria for Stratum 3
Children younger than 12 months at time of entry to study or any children ineligible to receive radiotherapy due to age at diagnosis, tumour location or clinician / parent decision and according to national criteria
Histologically confirmed WHO Grade II-III ependymoma by central pathological review
Adequate bone marrow, liver and renal functions
No previous chemotherapy and radiotherapy
No contraindication to chemotherapy
No co-existent unrelated disease at the time of study entry that would render the patient unable to receive chemotherapy
No signs of infection. Patients that do not fulfill the inclusion criteria of one of the interventional strata will be enrolled and followed up into an observational study and descriptive analysis will be performed

Exclusion Criteria

Tumour entity other than primary intracranial ependymoma
Primary diagnosis predating the opening of SIOP Ependymoma II
Patients with WHO grade I ependymoma including ependymoma variants: myxopapillary ependymomas and subependymomas,patients with spinal cord location of the primary tumour
Participation within a different trial for treatment of ependymoma
Contraindication to one of the IMP used according to the SmPCs
Concurrent treatment with any anti-tumour agents
Inability to tolerate chemotherapy
Unable to tolerate intravenous hydration
Pre-existing mucositis, peptic ulcer, inflammatory bowel disease ascites, or pleural effusion
Strata 1 and 2
Ineligible to receive radiotherapy
Patient for whom imaging remains RX despite all effort to clarify the MRI conclusion
Stratum 3
Pre-existing severe hepatic and/or renal damage
Family history of severe epilepsy
Presence of previously undiagnosed mitochondrial disorder detected by screening as part of trial
Elevated blood ammonium and lactate level 1.5 x upper limit of the normal
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