A Study on How to Safely Guide Surgery for Melanoma and Similar Skin Tumors in Children Using Pathology and Genetic Information
A Multi-Institutional Central Pathology and Molecular Risk-Based Stratification Study of Surgical Management for Melanoma, Atypical Spitz/Spitzoid Tumors, and Other Atypical Melanocytic Neoplasms in Pediatric Patients
Přehled studie
Postavení
Postavení
Podmínky
Podmínky
Intervence / Léčba
Intervence / Léčba
- Postup: Sbírka biovzorků
- Jiný: Pozorování pacienta
- Jiný: Fludeoxyglukóza F-18
- Postup: Radiografie hrudníku
- Postup: Biopsie sentinelové lymfatické uzliny
- Postup: Počítačová tomografie
- Postup: Re-Excision
- Postup: Magnetic Resonance Imaging
- Postup: Positron Emission Tomography
- Postup: Ultrasound Imaging
- Postup: Wide Local Excision
Detailní popis
PRIMARY OBJECTIVE:
I. To study the feasibility of central risk-based stratification of malignant and atypical cutaneous melanocytic tumors to guide primary surgical management.
SECONDARY OBJECTIVES:
I. To evaluate the adherence rate to protocol-assigned surgical management in children with newly diagnosed melanoma, atypical Spitz/Spitzoid tumors, and other atypical melanocytic neoplasms.
II. To evaluate the surgery-related adverse events profile for patients treated with narrow re-excision without sentinel lymph node biopsy versus wide local excision +/- sentinel lymph node biopsy per standard adult cutaneous melanoma guidelines.
III. To describe progression free survival (PFS) and overall survival (OS) in pediatric patients with melanoma, atypical Spitz/Spitzoid tumors, and other atypical melanocytic neoplasms.
EXPLORATORY OBJECTIVES:
I. To describe surgical reconstruction techniques for pediatric patients with atypical and malignant melanocytic tumors.
II. To describe the use of sentinel lymph node biopsy and rate of completion nodal dissection vs observation following positive sentinel lymph node including number of sentinel nodes sampled, size of largest metastatic nodal deposit, location of draining lymph node basin(s), number of lymph nodes resected at completion dissection.
III. To describe surgical complications of completion nodal dissection (from time of surgery to 90 days following surgery): wound dehiscence, seroma/hematoma, hemorrhage, infection, skin graft failure, necrosis of flap used for reconstruction, lymphocele, lymphedema, deep vein thrombosis.
IV. To evaluate the concordance between local treating center pathologic diagnosis and central pathology review diagnosis.
V. To analyze the molecular characterization of melanocytic tumors to identify molecular and immunohistochemical biomarkers correlating with known clinical prognostic factors and outcome.
VI. To determine the number of Children's Oncology Group (COG) institutions that open the study within 18 months of activation.
OUTLINE: Patients with not atypical pathology are assigned to the Observation Arm. Patients with atypical low-risk tumors are assigned to Treatment Arm A and patients with atypical high-risk tumors are assigned to Treatment Arm B.
OBSERVATION ARM: Patients undergo observation throughout the study.
TREATMENT ARM A: Patients may undergo narrow margin re-excision without sentinel lymph node biopsy.
After completion of study intervention, patients are followed every 6 months for 1 year then every year for up to 5 years.
TREATMENT ARM B: Patients undergo wide local excision with or without sentinel lymph node biopsy (SLNB) per standard guidelines. Patients may also undergo blood sample collection, chest x-ray, computed tomography (CT), magnetic resonance imaging (MRI), whole-body fludeoxyglucose F-18 (FDG) positron emission tomography (PET)/CT or PET/MRI, nodal basin ultrasound, and brain MRI on study.
After completion of study treatment, patients are followed every 3-6 months for years 1 and 2, every 6 months up to year 5.
Typ studie
Typ studie
Zápis (Odhadovaný)
Zápis
Fáze
Fáze
- Nelze použít
Kontakty a umístění
Studijní místa
-
-
California
-
Oakland, California, Spojené státy, 94611
- Nábor
- Kaiser Permanente-Oakland
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 877-642-4691
- E-mail: Kpoct@kp.org
-
Vrchní vyšetřovatel:
- Aarati V. Rao
-
-
Pennsylvania
-
Philadelphia, Pennsylvania, Spojené státy, 19104
- Nábor
- Children's Hospital of Philadelphia
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 267-425-5544
- E-mail: CancerTrials@email.chop.edu
-
Vrchní vyšetřovatel:
- Theodore W. Laetsch
-
Pittsburgh, Pennsylvania, Spojené státy, 15224
- Nábor
- Children's Hospital of Pittsburgh of UPMC
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 412-692-8570
- E-mail: jean.tersak@chp.edu
-
Vrchní vyšetřovatel:
- Brittani K. Seynnaeve
-
-
Tennessee
-
Knoxville, Tennessee, Spojené státy, 37916
- Nábor
- East Tennessee Childrens Hospital
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 865-541-8266
-
Vrchní vyšetřovatel:
- Susan E. Spiller
-
Memphis, Tennessee, Spojené státy, 38105
- Nábor
- Saint Jude Children's Research Hospital
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 888-226-4343
- E-mail: referralinfo@stjude.org
-
Vrchní vyšetřovatel:
- Alberto S. Pappo
-
-
Kritéria účasti
Kritéria způsobilosti
Kritéria způsobilosti
Věk způsobilý ke studiu
- Dítě
- Dospělý
Přijímá zdravé dobrovolníky
Popis
Inclusion Criteria:
- Patients ≤ 25 years old
- Newly diagnosed localized cutaneous melanoma, atypical Spitz/Spitzoid tumors, or other atypical melanocytic neoplasm by local institution pathology report
- Patients must have disease that is localized to the skin on clinical assessment. Note that staging imaging is not required for the determination of eligibility, but if obtained prior to enrollment, all imaging must be consistent with localized cutaneous disease
- Patients must have a performance status corresponding to Eastern Cooperative Oncology Group (ECOG) scores of 0, 1 or 2. Use Karnofsky for patients > 16 years of age and Lansky for patients ≤ 16 years of age
- Patients must not have received any prior chemotherapy, immunotherapy, targeted therapy, radiation, or surgical therapy for melanoma other than the permitted biopsy/excision of the lesion for which they are enrolling. Note that prior biopsies/surgery for other benign melanocytic lesions is permitted
Exclusion Criteria:
- Patients ≥ 18 years old with conventional adult-type melanoma are excluded. Note that patients 18-25 years old with atypical Spitz/Spitzoid tumors, or other atypical melanocytic neoplasms are eligible
- Patients with clinical evidence of metastatic disease such as palpable malignant adenopathy or symptomatic distant metastases are not eligible
- Patients who have undergone re-excision to achieve a negative margin or sentinel lymph node biopsy for the melanocytic neoplasm under study are not eligible. Note that this does not exclude patients who have undergone the permitted diagnostic biopsy/excision, including re-biopsy, of the lesion
Any of the following diagnoses
- Congenital nevi-associated proliferative nodules
- Agminated Spitz nevi/tumors
- Dysplastic nevus
- Combined nevus
- CRTC1::TRIM11 and/or MED15::ATF1 fused tumors (molecular testing is not required prior to enrollment)
Pre-existing conditions:
- Solid organ transplant recipients
- Known melanoma predisposition syndrome (i.e., patients with previously known pathogenic variants in moderate and high penetrance melanoma susceptibility genes [i.e., CDKN2A, CDK4, BAP1, POT1, TERT promoter, ACD, TERF2IP] or Xeroderma Pigmentosum). Note germline testing is not required prior to enrollment
- All patients and/or their parents or legal guardians must sign a written informed consent
- All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Léčba
- Přidělení: Nerandomizované
- Intervenční model: Paralelní přiřazení
- Maskování: Žádné (otevřený štítek)
Počet zbraní
Zbraně a zásahy
Skupina účastníků / ArmSkupina účastníků / Arm |
Intervence / LéčbaIntervence / Léčba |
|---|---|
|
Aktivní komparátor: Observation Arm (observation)
Patients undergo observation throughout the study.
|
Podstoupit pozorování
Ostatní jména:
|
|
Experimentální: Treatment Arm A (narrow margin)
Patients may undergo narrow margin re-excision without sentinel lymph node biopsy.
|
Undergo narrow margin re-excision
Ostatní jména:
|
|
Experimentální: Treatment Arm B (wide local excision, SLNB)
Patients undergo wide local excision with or without sentinel lymph node biopsy per standard guidelines.
Patients may also undergo blood sample collection, chest x-ray, CT, MRI, whole-body FDG PET/CT or PET/MRI, nodal basin ultrasound, and brain MRI on study.
|
Podstoupit odběr vzorku krve
Ostatní jména:
Vzhledem k FDG
Ostatní jména:
Proveďte rentgen hrudníku
Ostatní jména:
Podstoupit SLNB
Ostatní jména:
Podstoupit CT nebo FDG PET/CT
Ostatní jména:
Undergo MRI, PET/MRI or brain MRI
Ostatní jména:
Undergo whole body FDG PET/CT or PET/MRI
Ostatní jména:
Undergo nodal basin ultrasound
Ostatní jména:
Undergo wide local excision
Ostatní jména:
|
Co je měření studie?
Primární výstupní opatření
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Feasibility success rate
Časové okno: Within 8 weeks of enrollment
|
Will be defined as the proportion of patients for whom risk stratification can be returned to the treating institution based on pathology and molecular data obtained through rapid central review.
|
Within 8 weeks of enrollment
|
Sekundární výstupní opatření
Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Adherence to surgical treatment arm assignment
Časové okno: Up to 5 years
|
Will be defined as the proportion of patients who receive the specific protocol-assigned surgical management.
|
Up to 5 years
|
|
Incidence of grade 3-5 surgical adverse events
Časové okno: From the time of surgery up to 90 days postoperatively
|
Will be defined according to the Clavien-Dindo Classification.
Will be summarized descriptively by study arm.
Special attention will be given to the following surgical complications: wound dehiscence, seroma/hematoma, hemorrhage, infection, skin graft failure, necrosis of flap used for reconstruction, lymphocele, lymphedema, and deep vein thrombosis.
|
From the time of surgery up to 90 days postoperatively
|
|
Overall survival (OS)
Časové okno: From the date of enrollment to date of death due to any reason, assessed up to 5 years
|
The 2-year OS along with the confidence intervals will be estimated using the Kaplan-Meier survival curves for each study arm separately: observation arm, low-risk arm A, and high-risk arm B.
|
From the date of enrollment to date of death due to any reason, assessed up to 5 years
|
|
Progression-free survival (PFS)
Časové okno: From the date of enrollment to the earliest occurrence of relapse, disease progression/recurrence, secondary malignant neoplasm, or death due to any cause, assessed up to 5 years
|
The 2-year PFS along with the confidence intervals will be estimated using the Kaplan-Meier survival curves for each study arm separately: observation arm, low-risk arm A, and high-risk arm B.
|
From the date of enrollment to the earliest occurrence of relapse, disease progression/recurrence, secondary malignant neoplasm, or death due to any cause, assessed up to 5 years
|
Další výstupní opatření
Další výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Surgical reconstruction techniques for pediatric patients with atypical and malignant melanocytic tumors
Časové okno: Up to 5 years
|
The analysis will consist of a descriptive summary of the surgical reconstruction techniques utilized in this cohort.
Reconstruction techniques will be categorized as follows: primary closure; delayed primary closure; closure by secondary intention; autologous skin graft; skin graft, other material; local tissue flap; free flap with microvascular reconstruction; amputation; other.
Frequencies and percentages will be reported for each technique.
|
Up to 5 years
|
|
The proportion of patients who undergo sentinel lymph node biopsy (SLNB) among the eligible high-risk arm B patients
Časové okno: Up to 5 years
|
The proportion will be summarized.
Among patients with a positive SLNB, the rate of subsequent completion nodal dissection versus observation will be reported.
The number of sentinel nodes sampled, size of largest metastatic nodal deposit, location of draining lymph node basin(s), number of lymph nodes resected at completion dissection will be summarized using appropriate descriptive statistics.
|
Up to 5 years
|
|
Surgical complications of completion nodal dissection
Časové okno: From the time of surgery to 90 days following surgery
|
The occurrence of surgical complications including wound dehiscence, seroma or hematoma, hemorrhage, infection, skin graft failure, necrosis of flap used for reconstruction, lymphocele, lymphedema, and deep vein thrombosis will be summarized descriptively.
The incidence of each complication will be calculated, accompanied by 95% confidence intervals if there are sufficient patients.
|
From the time of surgery to 90 days following surgery
|
|
Concordance between local treating center pathologic diagnosis and central pathology review diagnosis
Časové okno: Up to 5 years
|
Will be assessed by comparing both the initial local treating center enrolling pathologic diagnosis (without incorporating molecular testing data) with the final central pathology review diagnosis, and final local diagnosis (with available molecular data incorporation) with the final central pathology review diagnosis.
Concordance will be defined as agreement between the local and central reviewer on the assigned diagnostic category.
Concordance rates will be reported as proportions with corresponding confidence intervals.
For discordant cases, additional descriptive analysis may explore the nature and direction of the discrepancies.
|
Up to 5 years
|
|
Molecular characterization of melanocytic tumors to identify molecular and immunohistochemical biomarkers correlating with known clinical prognostic factors and outcome
Časové okno: Up to 5 years
|
Will be addressed through descriptive and exploratory analyses of molecular and immunohistochemical (IHC) data collected from tumor samples.
The frequency and distribution of molecular alterations and IHC marker expression will be summarized.
Associations between individual biomarkers and known clinical prognostic factors, such as tumor Breslow depth, ulceration, increased mitotic index, high grade cytological atypia, clinical tumor diameter (> 1cm versus [vs.] ≤ 1 cm), diagnosis age (> 10 years vs. ≤ 10 years), will be evaluated using appropriate statistical methods (e.g., chi-square or Fisher's exact test for categorical variables, Wilcoxon rank-sum test for continuous variables).
If number of events permits, exploratory analyses will assess the relationship between biomarkers and PFS.
Kaplan-Meier curves may be used to illustrate differences in survival by biomarker status, and log-rank tests will assess statistical significance.
|
Up to 5 years
|
|
The number of Children's Oncology Group institutions that open the study within 18 months of activation
Časové okno: Within 18 months of protocol activation
|
The total number will be reported.
|
Within 18 months of protocol activation
|
Spolupracovníci a vyšetřovatelé
Sponzor
Sponzor
Vyšetřovatelé
Vyšetřovatelé
- Vrchní vyšetřovatel: Brittani K Seynnaeve, Children's Oncology Group
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Odhadovaný)
Začátek studia
Primární dokončení (Odhadovaný)
Primární dokončení
Dokončení studie (Odhadovaný)
Dokončení studie
Termíny zápisu do studia
První předloženo
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
První zveřejněno
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Poslední zveřejněná aktualizace
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Naposledy ověřeno
Více informací
Termíny související s touto studií
Další relevantní podmínky MeSH
- Novotvary podle místa
- Novotvary
- Novotvary podle histologického typu
- Kožní choroby
- Neuroektodermální nádory
- Novotvary, zárodečné buňky a embryonální
- Novotvary, nervová tkáň
- Neuroendokrinní nádory
- Nevi a melanomy
- Novotvary kůže
- Onemocnění kůže a pojivové tkáně
- Melanom
- Správa zdravotnických služeb
- Vyšetřovací techniky
- Metody
- Klinické laboratorní techniky
- Diagnostické techniky a postupy
- Diagnóza
- Chirurgické postupy, operativní
- Cytologické techniky
- Biopsie
- Cytodiagnosis
- Kvalita zdravotní péče
- Uhlohydráty
- Fyzické jevy
- Diagnostické techniky, chirurgické
- Techniky chemie, analytické
- Analýza spektra
- Elektromagnetické jevy
- Magnetické jevy
- Deoxyglukóza
- Deoxy cukry
- Posouzení výsledku, zdravotní péče
- Výsledek a posouzení procesů, zdravotní péče
- Elektromagnetické záření
- Záření
- Záření, ionizující
- Záření, neionizující
- Excize lymfatických uzlin
- Ultrazvukové vlny
- Zvuk
- Fluordeoxyglukóza F18
- Pozorování
- Manipulace se vzorkem
- Magnetická rezonanční spektroskopie
- Ostražité čekání
- Rentgenové paprsky
- Biopsie sentinelových lymfatických uzlin
- Šokové vlny s vysokou energií
Další identifikační čísla studie
Další identifikační čísla studie
- ARAR2421 (Jiný identifikátor: CTEP)
- U10CA180886 (Grant/smlouva NIH USA)
- NCI-2026-03776 (Identifikátor registru: CTRP (Clinical Trial Reporting Program))
Informace o lécích a zařízeních, studijní dokumenty
Studuje lékový produkt regulovaný americkým FDA
Studuje produkt zařízení regulovaný americkým úřadem FDA
produkt vyrobený a vyvážený z USA
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