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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT00033293
Registration number
NCT00033293
Ethics application status
Date submitted
9/04/2002
Date registered
27/01/2003
Date last updated
18/04/2023
Titles & IDs
Public title
Cyclophosphamide and Prednisone With or Without Immunoglobulin in Treating Abnormal Muscle Movement in Children With Neuroblastoma
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Scientific title
A Phase III Randomized Trial of Intravenous Gammaglobulin Therapy for Patients With Neuroblastoma Associated Opsoclonus-Myoclonus-Ataxia Syndrome Treated With Chemotherapy and Prednisone
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Secondary ID [1]
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NCI-2009-00399
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Secondary ID [2]
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ANBL00P3
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Localized Resectable Neuroblastoma
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Localized Unresectable Neuroblastoma
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Regional Neuroblastoma
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Stage 4 Neuroblastoma
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Stage 4S Neuroblastoma
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Condition category
Condition code
Cancer
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Neuroendocrine tumour (NET)
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Cancer
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Children's - Other
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Other interventions - Clinical Observation
Treatment: Drugs - Cyclophosphamide
Other interventions - Laboratory Biomarker Analysis
Treatment: Surgery - Magnetic Resonance Imaging
Treatment: Drugs - Prednisone
Treatment: Other - Therapeutic Immune Globulin
Experimental: Arm I (chemotherapy, immunoglobulin therapy) - Patients with intermediate-risk or high-risk neuroblastoma receive chemotherapy (including cyclophosphamide) according to the standard of care for the stage of primary neuroblastoma, beginning on day 0. Patients with low-risk neuroblastoma (and not receiving other chemotherapy) receive cyclophosphamide IV over 1 hour on day 0. Treatment repeats every 4 weeks for 6 courses in the absence of disease progression or unacceptable toxicity. All patients receive oral prednisone twice daily for 3 months and then every other day for 7-15 months.
Patients receive immune globulin IV on days -2 and -1, at weeks 4, 8, 12, 16, 20, and 24, and then at months 8, 10, and 12 after therapy. Treatment continues in the absence of disease progression or unacceptable toxicity. Patients with no response after 6 months go off treatment.
Active comparator: Arm II (chemotherapy, observation) - Patients with intermediate-risk or high-risk neuroblastoma receive chemotherapy (including cyclophosphamide) according to the standard of care for the stage of primary neuroblastoma, beginning on day 0. Patients with low-risk neuroblastoma (and not receiving other chemotherapy) receive cyclophosphamide IV over 1 hour on day 0. Treatment repeats every 4 weeks for 6 courses in the absence of disease progression or unacceptable toxicity. All patients receive oral prednisone twice daily for 3 months and then every other day for 7-15 months.
Patients do not receive immune globulin. Patients with unresponsive opsoclonus-myoclonus-ataxia syndrome after 2 months or progression after 6 months may cross over to arm I.
Other interventions: Clinical Observation
Undergo observation
Treatment: Drugs: Cyclophosphamide
Given IV
Other interventions: Laboratory Biomarker Analysis
Correlative studies
Treatment: Surgery: Magnetic Resonance Imaging
Correlative studies
Treatment: Drugs: Prednisone
Given orally
Treatment: Other: Therapeutic Immune Globulin
Given IV
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Intervention code [1]
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Other interventions
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Intervention code [2]
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Treatment: Drugs
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Intervention code [3]
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Treatment: Surgery
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Intervention code [4]
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Treatment: Other
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Number of Responders
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Assessment method [1]
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A multi-stage design followed by a test of proportions between the treatment arms (chemo vs. chemo + therapeutic immune globulin (IVIG)) will be performed. The first stage of the multi-stage design will also function as an early stopping rule for insufficient activity of chemotherapy in OMA.
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Timepoint [1]
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Changes from baseline to 2 months, 6 months, and 1 year
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Secondary outcome [1]
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Motor Coordination as Assessed by Neurological Examination and Vineland Adaptive Behavior Scale (VABS)
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Assessment method [1]
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The "best" score at the two time points will be used in this analysis. For a given patient, this "best" score will be used to calculate the change from baseline. The mean change from baseline for each treatment group will be calculated.
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Timepoint [1]
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Changes from baseline to the better of 6 months or 1 year
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Secondary outcome [2]
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Functional Outcome as Assessed by Age-appropriate Neuropsychological Testing
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Assessment method [2]
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The Bayley Scales of infant development mental scale "best" score of two time points will be used in the analysis. For a given patient, this score will be used to calculate the change from baseline.
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Timepoint [2]
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Changes from baseline to the better of 6 months or 1 year
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Secondary outcome [3]
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Biology of Neuroblastoma Associated Opsoclonus-myoclonus-ataxia (OMA) Syndrome Specifically by MRI Findings, Anti-neuronal Antibodies, Cerebrospinal Fluid (CSF) Findings and Tumor Biology
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Assessment method [3]
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Descriptive analyses on biologic variables will be performed
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Timepoint [3]
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At diagnosis, 6 months, 1 year, 5 and 10 years after diagnosis
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Secondary outcome [4]
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Long-term Prognosis for Neurologic Recovery by Neurological Examination
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Assessment method [4]
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A t-test will be performed on the results of each neurologic test, comparing patients who have had disappearance of anti-neural antibodies to patients whose anti-neural antibodies have not disappeared.
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Timepoint [4]
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At diagnosis and yearly for 10 years after diagnosis
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Secondary outcome [5]
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Tumor Outcome in Terms of Event-free Survival (EFS) Rate Defined as a Relapse or Progression of Neuroblastoma, a Second Malignancy, or Death
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Assessment method [5]
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EFS rate for neuroblastoma event from time of study enrollment.
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Timepoint [5]
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Up to 3 years
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Secondary outcome [6]
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Tumor Outcome in Terms of Overall Survival (OS) Rate
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Assessment method [6]
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OS rate from time of study enrollment.
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Timepoint [6]
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Up to 3 years
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Eligibility
Key inclusion criteria
* Newly diagnosed neuroblastoma (NBL) or ganglioneuroblastoma with tumor-associated opsoclonus-myoclonus-ataxia syndrome (OMA)
* Patients with NBL diagnosed within 6 months of OMA diagnosis AND patients with OMA diagnosed within 6 months of NBL diagnosis are eligible
* Must enroll on study within 4 weeks of diagnosis
* Presence of opsoclonus, myoclonus, and/or ataxia associated with neuroblastoma considered eligible
* Currently enrolled on COG neuroblastoma protocols: COG-ANBL00B1 or its successor
* Creatinine clearance or radioisotope GFR = 70 mL/min OR serum creatinine based on age/gender as follows:
* = 0.4 mg/dL (for patients 1 to 5 months of age)
* = 0.5 mg/dL (for patients 6 to 11 months of age)
* = 0.6 mg/dL (for patients 1 year of age)
* = 0.8 mg/dL (for patients 2 to 5 years of age)
* = 1.0 mg/dL (for patients 6 to 9 years of age)
* = 1.2 mg/dL (for patients 10 to 12 years of age)
* = 1.4 mg/dL (for female patients = 13 years of age)
* = 1.5 mg/dL (for male patients 13 to 15 years of age)
* = 1.6 mg/dL (for male patients = 16 years of age)
* No prior IV gamma globulin therapy
* No prior chemotherapy
* Concurrent chemotherapy allowed
* No prior prednisone or corticotropin
* Patients who have received = 14 days of steroids are eligible
* Concurrent surgery allowed
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Minimum age
No limit
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Maximum age
8
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
15/03/2004
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
31/12/2022
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Sample size
Target
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Accrual to date
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Final
53
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Recruitment in Australia
Recruitment state(s)
NSW,WA
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Recruitment hospital [1]
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The Children's Hospital at Westmead - Westmead
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Westmead Hospital - Westmead
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Princess Margaret Hospital for Children - Perth
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Recruitment postcode(s) [1]
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2145 - Westmead
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Recruitment postcode(s) [2]
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6008 - Perth
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Recruitment outside Australia
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United States of America
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Alabama
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Funding & Sponsors
Primary sponsor type
Other
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Name
Children's Oncology Group
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Address
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Name [1]
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National Cancer Institute (NCI)
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Ethics approval
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Summary
Brief summary
This randomized phase III trial is studying cyclophosphamide, prednisone, and immunoglobulin to see how well they work compared to cyclophosphamide and prednisone alone in treating patients with abnormal trunk muscle movements associated with neuroblastoma. Drugs used in chemotherapy, work in different ways to stop tumor cells from dividing so they stop growing or die. Steroid therapy decreases inflammation. Combining chemotherapy and steroid therapy with immunoglobulin may be effective in treating abnormal muscle movement associated with neuroblastoma.
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Trial website
https://clinicaltrials.gov/study/NCT00033293
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Trial related presentations / publications
de Alarcon PA, Matthay KK, London WB, Naranjo A, Tenney SC, Panzer JA, Hogarty MD, Park JR, Maris JM, Cohn SL. Intravenous immunoglobulin with prednisone and risk-adapted chemotherapy for children with opsoclonus myoclonus ataxia syndrome associated with neuroblastoma (ANBL00P3): a randomised, open-label, phase 3 trial. Lancet Child Adolesc Health. 2018 Jan;2(1):25-34. doi: 10.1016/S2352-4642(17)30130-X. Epub 2017 Nov 3.
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Public notes
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Contacts
Principal investigator
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Pedro A De Alarcon
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Children's Oncology Group
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Contact person for scientific queries
No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results are available at
https://clinicaltrials.gov/study/NCT00033293
Download to PDF