Positionnement des marqueurs moléculaires en routine clinique pour la prise en charge des patients atteints de cancers/tumeurs surrénales (COMETE-CARE) (COMETE-CARE)
The adrenal cancer research network "COMETE" is federating French research on rare adrenal cancers. COMETE achieved major breakthroughs in the molecular characterization of adrenocortical carcinomas (ACC) and malignant pheochromocytomas/paragangliomas (MPP). Recently, COMETE successfully derived potential biomarkers for prognosis, theranostic and follow-up. Those biomarkers have been retrospectively validated. However the benefit for patients in real life conditions is not yet established.
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Main objective : to implement COMETE biomarkers as a routine standard of care for adrenal cancer.
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The primary end point is double :
- Proportion of biomarkers results provided within 3 months after surgery,
- The proportion of "informative" biomarkers, corresponding to markers passing quality controls and returning a value that is not in the grey zone of the measure.
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Secondary objective : to estimate the impact of COMETE biomarkers on patients management.
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Secondary endpoints :
- Proportion of patients with discrepant clinical and molecular markers ; for discrepancies, proportion of decisions impacted by biomarkers results
- Proportion of high risk patients for whom an actionable molecular target was identified
- Predictive value (positive and negative) of biomarkers to detect recurrences
- Molecular signatures of "extraordinary responders" to treatments (corresponding to the exceptional RECIST complete response, or to the >80% tumor reduction sutained for >6months)
- Correlation of molecular markers with morphological features (radiological and pathological) of the tumor
Aperçu de l'étude
Statut
Intervention / Traitement
Description détaillée
- Adult patients with a malignant adrenal tumor before initial surgery are proposed to participate to the study.
- Initial clinical management following current guidelines is applied, including clinical and morphological evaluation, hormone assays and adrenal surgery. A tumor sample from initial surgery , and a blood sample and a urine sample collected before surgery are included in the current research protocol. These samples are used to run prognostic molecular measurements, in order to classify patients as "low" or "high risk" of recurrence. For ACC samples, paraffin tumor samples will be sent to a centralized pathology facility, where 3' RNA sequencing will be performed on tumor RNA to classify tumors into previously established C1A/C1B prognostic classification. Circulating levels of miRNAs will be assayed from blood samples collected before surgery and used to classify tumors into prognostic categories as previously reported. Urine and plasma steroids profiles will be established using mass spectrometry to classify tumors into prognostic categories as previously reported. For MPP, molecular assays will include somatic genotyping, methylation assays and immunochemistry for the known recurrently altered genes, and used to classify tumors into prognostic categories as previously reported. These molecular results are returned by 3 months after surgery
- Patients follow-up is then performed following current guidelines, with repeated visits (each ~3 months for ACC and ~6 months for MPP), including clinical, morphological evaluation, and hormone assays. A blood and a urine sample will also be collected for the current research protocol. These samples will be used to run molecular measurements aiming at identifying early recurrence. For ACC, circulating levels of miRNAs and urine and plasma steroids profiles will be measured every 3 months to classify tumors into prognostic categories as previously reported. For MPP, circulating levels of miRNAs will be measured every 6 months to classify tumors into prognostic categories as previously reported
- For patients at high risk of recurrence, a molecular target will be searched by an extended genomic analysis of the tumor (exome sequencing and RNA sequencing), in search for molecular targets that may orient future treatments, if the disease recurs.
Type d'étude
Inscription (Estimé)
Phase
- N'est pas applicable
Contacts et emplacements
Coordonnées de l'étude
- Nom: Guillaume Assie, Pr
- Numéro de téléphone: 01 58 41 18 20
- E-mail: guillaume.assie@aphp.fr
Sauvegarde des contacts de l'étude
- Nom: Christelle AUGER, Chef de projet
- Numéro de téléphone: 01 71 76 07 53
- E-mail: christelle.auger@aphp.fr
Lieux d'étude
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Paris, France, 75014
- Recrutement
- GH Paris Centre, Assistance Publique - Hôpitaux de Paris
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Contact:
- Guillaume ASSIE, Pr
- Numéro de téléphone: 01 58 41 18 20
- E-mail: guillaume.assie@aphp.fr
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Contact:
- Christelle AUGER, Chef de projet
- Numéro de téléphone: 01 71 76 07 53
- E-mail: christelle.auger@aphp.fr
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Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria
- Patients 18 years of age and older
- Patients with an adrenal tumor who will be operated or have been operated in the last 2 months of a potentially malignant adrenocortical (ACC) (any tumor with density > 10 UH) or pheochromocytoma or paraganglioma (MPP) (any stage, any secretion)
- Patients affiliated with a social security regime
- Patients who have signed an informed consent
Exclusion Criteria
- Vulnerable populations : minors, pregnant or breastfeeding women, protected adults
- Patients on AME (state medical aid)
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Diagnostique
- Répartition: Non randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
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Autre: Patients with ACC
These patients will be followed up and proposed a search for targetable molecular alterations |
For patients with ACC : blood (30ml) sampling before surgery and every 3 months during 3 years after surgery for biobanking For patients with MPP : blood (30ml) sampling before surgery and every 6 to 12 months for MPP during 3 years after surgery for biobanking For patients with ACC : urine sampling before surgery and every 3 months during 3 years after surgery for biobanking For patients with MPP : urine sampling before surgery and every 6 to 12 months for MPP during 3 years after surgery for biobanking For patients with ACC and patients with MPP : tumor sample during surgery |
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Autre: Patients with MPP
These patients will be followed up and proposed a search for targetable molecular alterations |
For patients with ACC : blood (30ml) sampling before surgery and every 3 months during 3 years after surgery for biobanking For patients with MPP : blood (30ml) sampling before surgery and every 6 to 12 months for MPP during 3 years after surgery for biobanking For patients with ACC : urine sampling before surgery and every 3 months during 3 years after surgery for biobanking For patients with MPP : urine sampling before surgery and every 6 to 12 months for MPP during 3 years after surgery for biobanking For patients with ACC and patients with MPP : tumor sample during surgery |
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
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Baseline biomarkers results
Délai: Within 3 months after surgery
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Proportion of biomarkers and of informative biomarkers returned to physicians within 3 months after initial surgery |
Within 3 months after surgery
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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M3 biomarkers results
Délai: During follow-up (month 6)
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Proportion of biomarkers and of informative biomarkers returned to physicians within 3 months after M6 follow-up visit |
During follow-up (month 6)
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M6 biomarkers results
Délai: During follow-up (month 9)
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Proportion of biomarkers and of informative biomarkers returned to physicians within 3 months after M9 follow-up visit |
During follow-up (month 9)
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M9 biomarkers results
Délai: During follow-up (month 12)
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Proportion of biomarkers and of informative biomarkers returned to physicians within 3 months after M12 follow-up visit |
During follow-up (month 12)
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M12 biomarkers results
Délai: During follow-up (month 15)
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Proportion of biomarkers and of informative biomarkers returned to physicians within 3 months after M15 follow-up visit |
During follow-up (month 15)
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M15 biomarkers results
Délai: During follow-up (month 18)
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Proportion of biomarkers and of informative biomarkers returned to physicians within 3 months after M18 follow-up visit |
During follow-up (month 18)
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M18 biomarkers results
Délai: During follow-up (month 21)
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Proportion of biomarkers and of informative biomarkers returned to physicians within 3 months after M21 follow-up visit |
During follow-up (month 21)
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M21 biomarkers results
Délai: During follow-up (month 24)
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Proportion of biomarkers and of informative biomarkers returned to physicians within 3 months after M24 follow-up visit |
During follow-up (month 24)
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M24 biomarkers results
Délai: During follow-up (month 27)
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Proportion of biomarkers and of informative biomarkers returned to physicians within 3 months after M27 follow-up visit |
During follow-up (month 27)
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M27 biomarkers results
Délai: During follow-up (month 30)
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Proportion of biomarkers and of informative biomarkers returned to physicians within 3 months after M30 follow-up visit |
During follow-up (month 30)
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M30 biomarkers results
Délai: During follow-up (month 33)
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Proportion of biomarkers and of informative biomarkers returned to physicians within 3 months after M33 follow-up visit |
During follow-up (month 33)
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M33 biomarkers results
Délai: During follow-up (month 36)
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Proportion of biomarkers and of informative biomarkers returned to physicians within 3 months after M36 follow-up visit |
During follow-up (month 36)
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Collaborateurs et enquêteurs
Parrainer
Les enquêteurs
- Directeur d'études: Anne JOUINOT, Dr, APHP
Publications et liens utiles
Publications générales
- Assie G, Jouinot A, Fassnacht M, Libe R, Garinet S, Jacob L, Hamzaoui N, Neou M, Sakat J, de La Villeon B, Perlemoine K, Ragazzon B, Sibony M, Tissier F, Gaujoux S, Dousset B, Sbiera S, Ronchi CL, Kroiss M, Korpershoek E, De Krijger R, Waldmann J, Quinkler M, Haissaguerre M, Tabarin A, Chabre O, Luconi M, Mannelli M, Groussin L, Bertagna X, Baudin E, Amar L, Coste J, Beuschlein F, Bertherat J. Value of Molecular Classification for Prognostic Assessment of Adrenocortical Carcinoma. JAMA Oncol. 2019 Oct 1;5(10):1440-1447. doi: 10.1001/jamaoncol.2019.1558.
- Lenders JWM, Kerstens MN, Amar L, Prejbisz A, Robledo M, Taieb D, Pacak K, Crona J, Zelinka T, Mannelli M, Deutschbein T, Timmers HJLM, Castinetti F, Dralle H, Widimsky J, Gimenez-Roqueplo AP, Eisenhofer G. Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. J Hypertens. 2020 Aug;38(8):1443-1456. doi: 10.1097/HJH.0000000000002438.
- Jouinot A, Lippert J, Sibony M, Violon F, Jeanpierre L, De Murat D, Armignacco R, Septier A, Perlemoine K, Letourneur F, Izac B, Ragazzon B, Leroy K, Pasmant E, North MO, Gaujoux S, Dousset B, Groussin L, Libe R, Terris B, Fassnacht M, Ronchi CL, Bertherat J, Assie G. Transcriptome in paraffin samples for the diagnosis and prognosis of adrenocortical carcinoma. Eur J Endocrinol. 2022 Apr 21;186(6):607-617. doi: 10.1530/EJE-21-1228.
- Chabre O, Libe R, Assie G, Barreau O, Bertherat J, Bertagna X, Feige JJ, Cherradi N. Serum miR-483-5p and miR-195 are predictive of recurrence risk in adrenocortical cancer patients. Endocr Relat Cancer. 2013 Jul 5;20(4):579-94. doi: 10.1530/ERC-13-0051. Print 2013 Aug.
- Bancos I, Taylor AE, Chortis V, Sitch AJ, Jenkinson C, Davidge-Pitts CJ, Lang K, Tsagarakis S, Macech M, Riester A, Deutschbein T, Pupovac ID, Kienitz T, Prete A, Papathomas TG, Gilligan LC, Bancos C, Reimondo G, Haissaguerre M, Marina L, Grytaas MA, Sajwani A, Langton K, Ivison HE, Shackleton CHL, Erickson D, Asia M, Palimeri S, Kondracka A, Spyroglou A, Ronchi CL, Simunov B, Delivanis DA, Sutcliffe RP, Tsirou I, Bednarczuk T, Reincke M, Burger-Stritt S, Feelders RA, Canu L, Haak HR, Eisenhofer G, Dennedy MC, Ueland GA, Ivovic M, Tabarin A, Terzolo M, Quinkler M, Kastelan D, Fassnacht M, Beuschlein F, Ambroziak U, Vassiliadi DA, O'Reilly MW, Young WF Jr, Biehl M, Deeks JJ, Arlt W; ENSAT EURINE-ACT Investigators. Urine steroid metabolomics for the differential diagnosis of adrenal incidentalomas in the EURINE-ACT study: a prospective test validation study. Lancet Diabetes Endocrinol. 2020 Sep;8(9):773-781. doi: 10.1016/S2213-8587(20)30218-7. Epub 2020 Jul 23.
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Réel)
Achèvement primaire (Estimé)
Achèvement de l'étude (Estimé)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- APHP210350
- 2022-A00663-40 (Autre identifiant: ID-RCB Number)
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