A 3 Arm Randomized Study on Health-related QoL of Elderly Patients With Advanced Soft Tissue Sarcoma (Tolerance)

  • End date
    Mar 1, 2027
  • participants needed
  • sponsor
    European Organisation for Research and Treatment of Cancer - EORTC
Updated on 4 October 2022


This is a multi-centre, open label, randomized phase 3 selection study (1:2:2 randomization).

After confirmation of the eligibility criteria, 185 patients will be randomized 1:2:2 to either the control arm (doxorubicin 60-75 mg/m² IV every 3 weeks) or experimental arm 1 (doxorubicin 12 mg/m2 IV every week) or experimental arm 2 (cyclophosphamide 100 mg orally BD plus prednisolone 10-20 mg orally on day 1 to day 7 of each 14 day cycle).

HRQoL assessment will be performed every 3 weeks during the first 12 weeks and every 12 weeks thereafter until month 12 after start of treatment.

Disease evaluation will be performed every 12 weeks until progression. The primary endpoint of the study is difference among the study arms in physical and role functioning at 12 weeks.

Condition Advanced Soft-tissue Sarcoma
Treatment prednisone, doxorubicin, Prednisolone, Cyclophosphamide Oral Product, Cyclophosphamide Oral Product
Clinical Study IdentifierNCT04780464
SponsorEuropean Organisation for Research and Treatment of Cancer - EORTC
Last Modified on4 October 2022


Yes No Not Sure

Inclusion Criteria

Histologically proven advanced unresectable or metastatic soft tissue sarcoma
Representative formalin fixed, paraffin embedded tumor blocks or a minimum of 10 unstained tissue slides, either from the primary tumor or a metastatic lesion, must be available for histological central review. Histological central review is not required before treatment start but it is mandatory to send at least 10 unstained tumor slides (blocks optional) at time of study entry. Local histopathological diagnosis will be accepted for entry into this trial
Age ≥ 65 years of age (patients between 65 and 69 years old are eligible if G8 score ≤ 14; patients ≥ 70 years old are eligible independent of G8 score)
WHO performance status 0 - 2
Life expectancy based on other significant morbidity of ≥ 6 months
Presence of measurable disease (according to RECIST 1.1), as confirmed by imaging within the 28 days prior to randomization. CT with IV contrast is the preferred imaging modality. In case of any contra-indications (medical or regulatory), it is allowed to perform a non-contrast CT + MRI
Progressive disease at entry based on RECIST 1.1
Patients amenable to receive doxorubicin according to investigator's assessment
Adequate haematological and organ function assessed prior to randomization
Haematological function
haemoglobin ≥ 9.0 g/dL or 5.6 mmol/L
absolute neutrophil count (ANC) ≥ 1.5 x 109/L
platelet count ≥ 100 x 109/L
Coagulation: partial thromboplastin time (PTT) ≤ 1.0 times upper limit of normal (1.0 x ULN) of institutional limits and prothrombin time (PT) ≤ 1.0 x ULN of institutional limits
Renal function: estimated glomerular filtration rate (eGFR) > 50 ml/min/m2 (calculated
by the MDRD formula in appendix E); no proteinuria ≥ grade 2 (CTCAE version
Hepatic function: bilirubin ≤ 1.0 x ULN of institutional limits, alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≤1.5 x ULN
If isolated elevated bilirubin <2 x ULN and Gilberts syndrome suspected, suggest repeating
bloods after food. If bilirubin improves to meet the criteria above this is acceptable
More severe persistent hepatic impairment of whatever cause would exclude the patient from
treatment till resolved
Cardiac function: clinically normal function based on the institutional lower limit of
normal for left ventricular ejection fraction (LVEF) as assessed either by multi-gated
acquisition scan (MUGA) or cardiac ultrasound and 12 lead electrocardiogram (ECG)
without clinically relevant abnormalities. Measurement should include investigator
assessment of a potential participant's risk for heart failure with a validated
clinical classification system, i.e. the New York Heart Association Functional
Classification. Only patients with NYHA class 1 and 2 according to appendix D are
Completion of EORTC QLQ-C30 and EORTC QLQ-ELD14 at baseline
Assessment of G8 geriatric screening tool
Assessment of Katz Index of Independence in Activities of Daily Living (ADL)
For men: agreement to remain abstinent (refrain from heterosexual intercourse) or use
contraceptive measures, and agreement to refrain from donating sperm, as defined
With female partners of childbearing potential, men must remain abstinent or use a
condom during the treatment period and for a period of 6 months after the last dose of
doxorubicin-based chemotherapy and for a period of 12 months after the last dose of
cyclophosphamide-based chemotherapy. Men must refrain from donating sperm during this
same period. Contraception should be considered for the female partners of
childbearing potential as well
With pregnant female partners, men must remain abstinent or use a condom during the
treatment period and for a period of 6 months after the last dose of doxorubicin-based
chemotherapy and for a period of 12 months after the last dose of
cyclophosphamide-based chemotherapy to avoid exposing the embryo
Before patient registration/randomization, written informed consent must be given
according to ICH/GCP, and national/local regulations including commitment to
completing questionnaires during the course of the study

Exclusion Criteria

Symptomatic or known brain metastasis
Any prior treatment with anthracyclines
Any prior systemic treatment for metastatic STS
Inability to swallow and/ or retain oral tablets
Rare hereditary galactose intolerance, Lapp lactase deficiency or glucose-galactose
Hypersensitivity to doxorubicin, cyclophosphamide, prednisolone or to any of their
metabolites or to any of their excipients
Uncontrolled severe illness, including but not limited to
Congestive heart failure
Angina pectoris
Acute inflammatory heart disease
Myocardial infarction within 1 year before randomization
Arterial hypertension defined as blood pressure ≥ 150/100 mm Hg despite optimal
medical therapy
Uncontrolled cardiac arrhythmia
Increased haemorragic tendency
Uncontrolled diabetes
Bone marrow aplasia
Active or uncontrolled infections among which those requiring systemic antibiotics or
antimicrobial therapy
Inflammation of the urinary bladder (interstitial cystitis) and/or obstructions of the
urine flow
Vaccination with live vaccines within 30 days prior to study entry
Patients with a prior or concurrent malignancy whose natural history or treatment has
the potential to interfere with the safety or efficacy assessment of the
investigational regimen are not eligible for this trial
Known contraindication to imaging tracer or contrast medium and contraindication to
Any psychological, familial, sociological or geographical condition potentially
hampering compliance with the study protocol and its active requirements (including
completion of questionnaires) and follow-up schedule; those conditions should be
discussed with the patient before randomization in the trial
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