POP-UP: a Single-arm, Two-cohort Study: an 8-week Trimodal Pre-habilitation Program for Patients With Pancreatic Ductal Adenocarcinoma and Oesogastric (POP-UP)
Trimodal Peri Operative Prehabilitation for Upper Oesogastric and Pancreatic Cancer: A Multicenter, Two-cohort, Open-label, Single-arm POP-UP GERCOR Study
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
The POP-UP study aims to evaluate the feasibility of an 8-week trimodal pre/posthabilitation program (consisting of APA, nutritional assessment, and psychological support) with remote monitoring of the APA sessions and nurse coordination alongside perioperative triplet chemotherapy in patients with localized PDAC (resectable or borderline resectable tumor) or OGC (≥ cT2 or N+).
The prehabilitation program will be conducted during neoadjuvant chemotherapy and the 3-5 weeks prior to surgery for a total of 8 weeks before surgery. There will be a total of three prehabilitation hospital days during the prehabilitation program.
The preoperative prehabilitation will include:
- Once per month, a prehabilitation hospital-day with functional capacities assessment with validated tests made by a physiotherapist or an APA professional (according of center resources/functioning), medical and nurse assessment evaluating performance status, chemotherapy toxicity and tolerance, and nutritional assessment (according to the functioning of each center it will be made by these professionals -with university training on nutrition- or a dietician). A therapeutic training session on the adherence to the prehabilitation program will be done by the nurse (trained in therapeutic education).
- Weekly, an APA professional trainer will follow via using app (Activiti®) the APA home-based program. It will be based on the functional capacities assessment made during the prehabilitation hospital day. The exercise training program will consist of twice per week autonomy sessions, supervised and adapted by the APA professional, and once per week a guided session with the APA professional. The patient will have a total of 3 physical activity sessions per week.
- Once per week, the nurse practitioner (or case manager, according to center functioning) will evaluate the patient via a videoconference to assess the chemotherapy toxicity and tolerance and patient's weight modifications.
The posthabilitation program will start for a total of 8 weeks, one week after surgery discharge. The structure is the same as the prehabilitation program except for the follow of chemotherapy toxicity and tolerance that will be replaced by the follow of the surgical complications/consequences. There will be a total of three posthabilitation days at hospital during the posthabilitation program.
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Marie-Line GARCIA LARNICOL, MD
- Phone Number: +33 (01) 40 29 85 04
- Email: marie-line.garcia-larnicol@gercor.com.fr
Study Contact Backup
- Name: Eva Ester MOLINA BELTRAN
- Email: evaester.molinabeltran@curie.fr
Study Locations
-
-
-
Dijon, France
- Not yet recruiting
- Centre Hospitalier Universitaire Dijon Bourgogne
-
Contact:
- Olivier FACY, MD
-
Grenoble, France
- Not yet recruiting
- Institut Daniel Hollard - Groupe Hospitalier Mutualiste de Grenoble
-
Contact:
- Camille HERVE, MD
-
Lille, France
- Not yet recruiting
- Centre Hospitalier Universitaire de Lille
-
Contact:
- PIESSEN Guillaume, MD
-
Marseille, France
- Not yet recruiting
- Institut Paoli-Calmettes
-
Contact:
- Brice CHANEZ, MD
-
Marseille, France
- Not yet recruiting
- Hospital La Timone
-
Contact:
- Laetitia DAHAN, MD
-
Reims, France
- Not yet recruiting
- CHU de Reims
-
Contact:
- Olivier BOUCHE, MD
-
Rouen, France
- Not yet recruiting
- CENTRE HOSPITALIER UNIVERSITAIRE ROUEN - CHU Charles Nicolle
-
Contact:
- Lilian SCHWARZ, MD
-
Saint-Cloud, France
- Recruiting
- INSTITUT CURIE de SAint Cloud
-
Contact:
- Cindy NEUZILLET, MD
-
Saint-Herblain, France
- Not yet recruiting
- Institut de Cancerologie de L'Ouest Rene Gauducheau
-
Contact:
- Damien VANSTEENE, MD
-
St-Malo, France
- Not yet recruiting
- Groupe hospitalier Rance Emeraude (CHU Saint-Malo)
-
Contact:
- Anais BODERE, MD
-
Tours, France
- Not yet recruiting
- Centre Hospitalier Universitaire Tours - Hopital Trousseau
-
Contact:
- Thierry LECOMTE, MD
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Signed and dated patient informed consent form (ICF) and willingness to comply with all study procedures and availability for the study duration,
- Histologically or cytologically proven, localized PDAC or OGC,
- Indication to a neoadjuvant treatment with triplet chemotherapy for ≥ 4 cycles (8 weeks) validated by the multidisciplinary board, Note: Patient treated for PDAC, dose reduction of oxaliplatin or irinotecan is authorized.
- Age > 18 years; If aged ≥ 75 years: G8 score must be ≥ 14 and if < 14 validation of oncogeriatric specialist,
- Eastern Cooperative Oncology Group performance status (ECOG PS) of 0-1 at the inclusion visit,
- No prior treatment for PDAC or OGC before starting chemotherapy (FLOT or FOLFIRINOX),
- At least one measurable or evaluable lesion as assessed by Computerized Tomography scan or Magnetic resonance imaging according to RECIST 1.1 and feasibility of repeated radiological assessments,
- Adequate hematologic and end-organ function allowing the triple combination chemotherapy protocol,
- Registration in a national health care system (PUMa - Protection Universelle Maladie included).
Exclusion Criteria:
- Evidence of metastatic disease at imaging (validated in multidisciplinary team evaluation),
- Histology of other than adenocarcinoma,
- Any medical (including cardiovascular, respiratory, psychiatric, musculoskeletal, or neurological) condition contra-indicating exercise practice,
- Patients with medical contraindication to surgery due to general condition or comorbidities
- Pregnancy or breast-feeding,
- Patient under a legal protection regime (guardianship, curatorship, judicial safeguard) or administrative decision or incapable of giving his/her consent,
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Other: Cohort 1 and Cohort 2
Cohort 1 - Patients with PDAC Cohort 2 - Patients with OGC |
Cohort 1 - Prehabilitation program will be implemented during the last cycles of neoadjuvant chemotherapy (cycle 5 - cycle 6 or cycle 6 - cycle 8) and the weeks preceding surgery (planned 3-4 weeks after the last chemotherapy cycle) Cohort 2 - Prehabilitation program will be implemented during the last cycles of neoadjuvant chemotherapy (cycle 2 - cycle 4) and the weeks preceding surgery (planned 3-4 weeks after the last chemotherapy cycle) |
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
The feasibility of personalized, 8-week trimodal pre-habilitation program alongside perioperative triplet chemotherapy
Time Frame: 8 weeks
|
The success of pre-habilitation is defined by the achievement of the following three criteria:
|
8 weeks
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Success rate of APA, nutritional, and psychological interventions
Time Frame: 8 weeks
|
Evaluates completion and adherence of each intervention separately according to predefined success criteria.
Unit of Measure: Proportion of patients (%) achieving predefined success criteria
|
8 weeks
|
|
Overall survival (OS) assessment
Time Frame: up to 12 months after surgery
|
OS defined as time (months) between the date of inclusion and 12 months after surgery
|
up to 12 months after surgery
|
|
Disease-free survival (DFS) assessment
Time Frame: up to 12 months after surgery
|
DFS defined as the time (months) between the date inclusion and the date corresponding at 12 months after surgery
|
up to 12 months after surgery
|
|
Nurse intervention assessment
Time Frame: 8 weeks
|
The nurse intervention will be evaluated by: Unit of Measure: Number of alerts managed by nurses and oncologists, Weekly remote follow-up completion rate (%), Scheduled vs. completed prehabilitation/posthabilitation sessions (%), and Hospital days
|
8 weeks
|
|
G-CSF use and neutropenia assessment
Time Frame: 8 weeks
|
Hematologic support and neutropenia will be evaluated.
Unit of Measure: G-CSF prescription (yes/no), rate of grade ≥2 neutropenia (%)
|
8 weeks
|
|
Perioperative chemotherapy rate assessment
Time Frame: 8 weeks
|
Assessing completion of scheduled perioperative chemotherapy cycles in eligible patients.
Unit of Measure: Number/proportion of patients with planned vs received number of perioperative chemotherapy cycles.
|
8 weeks
|
|
Chemotherapy dose received
Time Frame: 8 weeks
|
Relative dose intensity will be measured.
Unit of Measure: Percentage of planned dose received (%)
|
8 weeks
|
|
Health-related quality of life assessment by EORTC QLQ-C30
Time Frame: Inclusion, week 4, week 8, week +1, week +5, Week +9, follow-up (up to 17 months)
|
HRQoL will be assessed by using the EORTC QLQ-C30 questionnaire at screening, once per month and at the end of intervention visit.
The EORTC QLQ-C30 is a cancer specific questionnaire assessing 15 HRQOL scales through 30-items; for each dimension, one score is generated according to the recommendations of the EORTC on a 0-100 scale in order that a high score represents a high functional level, a high Global QoL level, and a high symptomatic level.
|
Inclusion, week 4, week 8, week +1, week +5, Week +9, follow-up (up to 17 months)
|
|
Health-related quality of life assessment by EORTC QLQ-PAN26
Time Frame: Inclusion, week 4, week 8, week +1, week +5, Week +9, follow-up (up to 17 months)
|
The EORTC QLQ-PAN26 is a module specific to pancreatic cancer, to be used in conjunction to the EORTC QLQ-C30.
It contains 26 items.
As for the EORTC QLQ-C30, one score is generated for each score according to the recommendations of the EORTC on a 0-100 scale in order that a high score represents a high functional level and a high symptomatic level.
|
Inclusion, week 4, week 8, week +1, week +5, Week +9, follow-up (up to 17 months)
|
|
Health-related quality of life assessment by EORTC QLQ-OG25
Time Frame: Inclusion, week 4, week 8, week +1, week +5, Week +9, follow-up (up to 17 months)
|
The EORTC QLQ-OG25 is a module specific to esophago-gastric cancer to use in conjunction to the EORTC QLQ-C30.
It contains 25 items.
One score is generated for each score according to the recommendations of the EORTC on a 0-100 scale in order that a high score represents a high functional level and a high symptomatic level
|
Inclusion, week 4, week 8, week +1, week +5, Week +9, follow-up (up to 17 months)
|
|
Chemotherapy tolerance assessment
Time Frame: 8 weeks
|
The chemotherapy tolerance with the CTCAE V5.0 (Grade ≥ 3) will be evaluated.
Unit of Measure: Number and proportion of patients with Grade ≥3 toxicities (CTCAE v5.0) Toxicities requiring hospitalization, treatment delays, and dose reductions related to toxicity will also be assessed
|
8 weeks
|
|
Postoperative complications assessment
Time Frame: Surgery and postoperative period (up to 90 days post-surgery)
|
Major postoperative complications will be measured.
Unit of Measure: Number/proportion of patients with Clavien-Dindo Grade ≥3 complications - evaluates serious surgical complications requiring intervention under anesthesia, ICU care, or resulting in death.
|
Surgery and postoperative period (up to 90 days post-surgery)
|
|
Adherence to APA program assessment
Time Frame: Inclusion, week 4, week 8, week +1, week +5, week +9
|
Tracks patient participation in post-habilitation APA sessions and documents reasons for drop-out.
Unit of Measure: Number and proportion of patients completing sessions (%).
Adherence will also be evaluated using patient-reported outcomes collected through the Activiti® application and APA professional assessments, including the number of APA sessions performed and APA dose intensity.
|
Inclusion, week 4, week 8, week +1, week +5, week +9
|
|
Pancreatic function assessment
Time Frame: week 4, week 8, week +1, week +5, week +9, follow-up visits (up to 17 months), end of study (at 4 years)
|
Fecal elastase and pancreatic enzyme use will be assessed.
Unit of Measure: Levels of fecal elastase (µg/g) and pancreatic enzyme consumption (units/day).
|
week 4, week 8, week +1, week +5, week +9, follow-up visits (up to 17 months), end of study (at 4 years)
|
|
Surgical rate assessment
Time Frame: Surgery and postoperative period
|
Surgical rate will be assessed.
Unit of Measure: Number/proportion of patients with surgery
|
Surgery and postoperative period
|
|
Nutritional Status Assessment - Body composition
Time Frame: Inclusion, week 4, week 8, week +1, week +5, week +9, follow-up visits (up to 17 months), end of study (at 4 years)
|
Evaluating changes in skeletal muscle and fat mass to assess nutritional status during the prehabilitation program.
Outcome Measure: Skeletal muscle and adipose tissue areas.
Unit of Measure: cm² (cross-sectional area at L3 via TAP-CT or bioimpedance)
|
Inclusion, week 4, week 8, week +1, week +5, week +9, follow-up visits (up to 17 months), end of study (at 4 years)
|
|
Nutritional Status Assessment - weight and BMI
Time Frame: Inclusion, week 4, week 8, week +1, week +5, week +9, follow-up visits (up to 17 months), end of study (at 4 years)
|
Evaluating changes in body weight and BMI to monitor nutritional status.
Unit of Measure: kg (weight), kg/m² (BMI).
|
Inclusion, week 4, week 8, week +1, week +5, week +9, follow-up visits (up to 17 months), end of study (at 4 years)
|
|
Nutritional Status Assessment - Food intake
Time Frame: Inclusion, week 4, week 8, week +1, week +5, week +9, follow-up visits (up to 17 months), end of study (at 4 years)
|
Measuring dietary intake and eating behavior to assess nutritional status.
Unit of Measure: Simple Evaluation of Food Intake (SEFI) visual analog scale.
The score is reported using the SEFI visual analog scale, which ranges from 0 to 10, where higher scores indicate better food intake.
|
Inclusion, week 4, week 8, week +1, week +5, week +9, follow-up visits (up to 17 months), end of study (at 4 years)
|
|
Nutritional Status Assessment - Serum Albumin evaluation
Time Frame: Inclusion, week 4, week 8, week +1, week +5, week +9, follow-up visits (up to 17 months), end of study (at 4 years)
|
Evaluating nutritional status through Serum Albumin evaluation. Unit of Measure: g/L. Meaning: Higher albumin levels indicate better nutritional status and overall protein reserves. Interpretation: Good: Higher values (within normal laboratory range) Bad: Lower values (may indicate malnutrition or poor protein intake) |
Inclusion, week 4, week 8, week +1, week +5, week +9, follow-up visits (up to 17 months), end of study (at 4 years)
|
|
Nutritional Status Assessment - C-Reactive Protein (CRP) evaluation
Time Frame: Inclusion, week 4, week 8, week +1, week +5, week +9, follow-up visits (up to 17 months), end of study (at 4 years)
|
Evaluating inflammatory status through CRP levels. Unit of Measure: mg/L. CRP is a marker of inflammation. Lower CRP indicates lower inflammatory activity. Interpretation: Good: Lower values (normal or near-normal, minimal inflammation) Bad: Higher values (indicating active inflammation or possible infection) |
Inclusion, week 4, week 8, week +1, week +5, week +9, follow-up visits (up to 17 months), end of study (at 4 years)
|
|
Nutritional Status Assessment - Complete Blood Count (CBC) Parameters evaluation
Time Frame: Inclusion, week 4, week 8, week +1, week +5, week +9, follow-up visits (up to 17 months), end of study (at 4 years)
|
Description: Evaluating general health and nutritional status through CBC parameters (e.g., hemoglobin, hematocrit, leukocytes). Unit of Measure: Standard laboratory units (e.g., g/dL for hemoglobin, cells/µL for leukocytes). Meaning: CBC evaluates general health and nutritional status (e.g., hemoglobin for anemia, leukocytes for immune status). Interpretation: Good: Values within normal reference ranges Bad: Values outside normal ranges (e.g., low hemoglobin = anemia, abnormal leukocytes = possible infection or immune dysfunction) |
Inclusion, week 4, week 8, week +1, week +5, week +9, follow-up visits (up to 17 months), end of study (at 4 years)
|
|
Functional Status Assessment - Behavioral changes in physical activity (International Physical Activity Questionnaire [IPAQ-S])
Time Frame: Inclusion, week 4, week 8, week +1, week +5, week +9, follow-up visits (up to 17 months)
|
Assessing daily physical activity using IPAQ-S.
It is a 7-item questionnaire in which duration (hours and minutes per day), frequency (times per week), and intensity (walking, moderate and vigorous) of the previous 7 days will be collected.
Sedentary time (self-reported time spent sitting) in the same time period will be recorded (hours/min/day).Unit of Measure: MET-min/week and Minutes/day.
|
Inclusion, week 4, week 8, week +1, week +5, week +9, follow-up visits (up to 17 months)
|
|
Functional Status Assessment - 6-minute walk test
Time Frame: Inclusion, week 4, week 8, week +1, week +5, week +9
|
Assessing functional exercise capacity.
Outcome Measure: Walking distance (meters).
|
Inclusion, week 4, week 8, week +1, week +5, week +9
|
|
Functional Status Assessment - Handgrip strength
Time Frame: Inclusion, week 4, week 8, week +1, week +5, week +9
|
Assessing upper body muscle strength.
Unit of Measure: Kilograms (kg)
|
Inclusion, week 4, week 8, week +1, week +5, week +9
|
|
Functional Status Assessment - Sit-to-stand test (STS)
Time Frame: Inclusion, week 4, week 8, week +1, week +5, week +9
|
Measuring lower limb strength and functional capacity.
Unit of Measure: Repetitions per minute
|
Inclusion, week 4, week 8, week +1, week +5, week +9
|
|
Functional Status Assessment - Borg scale
Time Frame: Inclusion, week 4, week 8, week +1, week +5, week +9
|
Measuring subjective exertion during functional tests.
Unit of Measure: Score.
Score on the Borg scale ranges from 6 (no exertion) to 20 (maximal exertion).
Lower scores indicate lighter effort (better functional tolerance), higher scores indicate greater perceived exertion (more strain).
|
Inclusion, week 4, week 8, week +1, week +5, week +9
|
|
Functional Status Assessment - Balance
Time Frame: Inclusion, week 4, week 8, week +1, week +5, week +9
|
Measuring balance and stability.
Unit of Measure: Seconds
|
Inclusion, week 4, week 8, week +1, week +5, week +9
|
|
Functional Status Assessment - Time Up and Go (≥70 years)
Time Frame: Inclusion, week 4, week 8, week +1, week +5, week +9
|
Measuring mobility and fall risk in older patients.
Unit of Measure: Seconds
|
Inclusion, week 4, week 8, week +1, week +5, week +9
|
|
Hospital Anxiety and Depression Scale (HADS) assessment
Time Frame: Inclusion, week 4, week 8, week +1, week +5, week +9, follow-up visits (up to 17 months)
|
The HADS is a 14-item questionnaire assessing anxiety through 7 items and depression with 7-items.
One score is generated per dimension on a 0-21 scale with the sum of the corresponding items.
A score between 0 and 7 represents the absence of anxiety/depression.
More of 9 in HADS-anxiety (A) is considered as a presence of an anxiety disorder which needs the intervention of a psychologist (anxiety) and more of 7 in HADS-depression (D) is considered as a presence of depression disorder which needs the intervention of a psychiatrist (depression).
|
Inclusion, week 4, week 8, week +1, week +5, week +9, follow-up visits (up to 17 months)
|
Other Outcome Measures
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Exploratory outcome measure - Changes in imaging assessment
Time Frame: Baseline to preoperative assessment
|
Comparing baseline imaging with preoperative imaging to assess changes in body composition and tumor characteristics, stratified by completion of the prehabilitation program.
Unit of Measure: cm² for body composition, mm or cm³ for tumor size
|
Baseline to preoperative assessment
|
|
Exploratory outcome measure - Changes in tumor specimen
Time Frame: At surgery
|
Evaluating differences between baseline diagnostic biopsy and resected surgical specimen for each patient, stratified by completion of the prehabilitation program.
Unit of Measure: Pathologic features (categorical or qualitative).
|
At surgery
|
Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Principal Investigator: Cindy Neuzillet, MD, Institut Curie, Saint-Cloud
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- POP-UP G-128
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.