Three Versus Five Years of Adjuvant Imatinib as Treatment of Patients With Operable GIST

Three Versus Five Years of Adjuvant Imatinib as Treatment of Patients With Operable GIST With a High Risk for Recurrence: A Randomised Phase III Study

In this study, patients who have been diagnosed with gastrointestinal stromal tumor (GIST) and have been treated with adjuvant imatinib for 3 years after surgery will be randomly allocated in a 1:1 ratio to receive imatinib (Gleevec) for 2 more years (Arm A) or to stop imatinib (Arm B). The study participants are required to have histologically verified GIST with a high risk of GIST recurrence despite removal of all macroscopic GIST tissue at surgery and 3 years of adjuvant imatinib. The high risk of GIST recurrence is defined as one of the following: gastric GIST with mitotic count >10/50 high power fields (HPFs) of the microscope, non-gastric GIST with mitotic count >5/50 HPFs, or tumor rupture. Study participants allocated to Arm A will receive imatinib 400 mg/day for 24 months after the date of randomization. All study participants will be followed up using blood tests and computerized tomography (or MRI) of the abdomen. The computerized tomography examinations will be performed at 6 month intervals. A total of 300 patients will be entered to the study. The study hypothesis is that adjuvant imatinib given for a total of 5 years may prevent some of the GISTs to recur as compared to patients who receive adjuvant imatinib for 3 years, and there may be a difference in the rate of GIST recurrence between the two groups.

Study Overview

• Status: Active, not recruiting
• Conditions: Sarcoma
• Intervention / Treatment: Drug: Imatinib

Detailed Description

The study will accrue patients in several countries in the Europe.

• Study Type: Interventional
• Enrollment (Actual): 255
• Phase: Phase 3

Contacts and Locations

• Study Contact: Name: Heikki Joensuu, MD; Phone Number: 358 094711
• Study Contact Backup: Name: Raija Husa; Phone Number: 358 094711

Study Locations

• Finland
  • Helsinki, Finland, 00029
    • Helsinki University Central Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 100 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age ≥ 18 years.
• Morphological and immunohistological documentation of GIST (immunostaining for KIT and/or DOG-1 positive, or mutation of KIT or PDGFRA present in tumor tissue).
• Macroscopically complete surgical resection of GIST (either R0 or R1 resection).
• Mutation analysis of KIT and PDGFR genes has been carried out.
• A high risk of GIST recurrence; either gastric GIST with mitotic count >10/50 HPFs, or non-gastric GIST with mitotic count >5/50 HPFs, or tumor rupture.
• Eastern Cooperative Oncology Group performance status ≤ 2.
• Adequate organ function.
• Female patients of childbearing potential must have a negative pregnancy test within 14 days before initiation of study drug dosing. Postmenopausal women must have amenorrhea for at least 12 months to be considered of non-childbearing potential. Male and female patients of reproductive potential must agree to employ an effective barrier method of birth control throughout the study and for up to 3 months following discontinuation of study drug.
• Patient willing to be followed up at the study site regardless of the result of randomization.
• Patient has provided a written, voluntary informed consent prior to study-specific screening procedures.

Exclusion Criteria:

• Presence of distant metastases or local recurrence of GIST.
• Not willing to donate tumor tissue and/or blood samples for the study molecular studies.
• Presence of a substitution mutation at PDGFRA codon D842 (usually D842V).
• Administration of adjuvant imatinib longer than for 3 years is planned regardless of the result of randomization, or "life long" imatinib administration is planned.
• Prior adjuvant (+ neoadjuvant) therapy with imatinib mesylate for at least 35 months has not been completed, or the total duration of prior adjuvant (+ neoadjuvant) imatinib administration exceeds the total duration of 37 months.
• Neoadjuvant imatinib for a duration that exceeds 9 months.
• Longer than 4-week break during adjuvant imatinib administration.
• The dose of imatinib at completion of 3 years of adjuvant imatinib was 200 mg per day or less or greater than 800 mg per day.
• Patient has received any investigational anti-cancer agents during adjuvant imatinib or between completion of adjuvant imatinib and the date of randomization.
• Patient has been free of another malignancy for less than 5 years except if the other malignancy is not currently clinically significant nor requiring active intervention, or if the other malignancy is a basal cell skin cancer or a cervical carcinoma in situ. Recent existence of any other malignant disease is not allowed.
• Patient with Grade III/IV cardiac disease as defined by the New York Heart Association Criteria (i.e., congestive heart failure, myocardial infarction within 6 months of study entry).
• Female patients who are pregnant or breast-feeding.
• Severe and/or uncontrolled medical disease (i.e., uncontrolled diabetes, severe chronic renal disease, or active uncontrolled infection).
• Known diagnosis of human immunodeficiency virus (HIV) infection.
• Patient with a significant history of non-compliance to medical regimens or with inability to grant reliable informed consent.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Imatinib; Imatinib 400 mg/day for 24 months.	Drug: Imatinib; Imatinib 400 mg/day; Other Names: Gleevec
No Intervention: No imatinib; No further imatinib.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Recurrence-free survival	Time from the date of randomization to GIST recurrence or death.	5 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall survival	Time from the date of randomization to death.	5 years
GIST-specific survival	Time from the date of randomization to the date of death considered to be caused by GIST.	5 years
Adverse effects	Adverse effects considered to be related to the treatment.	5 years

Collaborators and Investigators

• Sponsor: Heikki Joensuu
• Collaborators: Scandinavian Sarcoma Group
• Investigators: Principal Investigator: Heikki Joensuu, Helsinki University Central Hospital

Study record dates

Study Major Dates

• Study Start: May 1, 2015
• Primary Completion (Estimated): May 1, 2026
• Study Completion (Estimated): May 1, 2033

Study Registration Dates

• First Submitted: April 7, 2015
• First Submitted That Met QC Criteria: April 7, 2015
• First Posted (Estimated): April 10, 2015

Study Record Updates

• Last Update Posted (Actual): November 9, 2023
• Last Update Submitted That Met QC Criteria: November 8, 2023
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neoplasms, Connective and Soft Tissue; Neoplasms by Histologic Type; Neoplasms; Sarcoma; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antineoplastic Agents; Protein Kinase Inhibitors; Imatinib Mesylate
• Other Study ID Numbers: SSGXXII