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
Panoramica dello studio
Stato
Stato
Condizioni
Condizioni
Intervento / Trattamento
Intervento / Trattamento
- Procedura: Raccolta di campioni biologici
- Altro: Osservazione del paziente
- Altro: Fluodeossiglucosio F-18
- Procedura: Radiografia del torace
- Procedura: Biopsia del linfonodo sentinella
- Procedura: Tomografia computerizzata
- Procedura: Re-Excision
- Procedura: Magnetic Resonance Imaging
- Procedura: Positron Emission Tomography
- Procedura: Ultrasound Imaging
- Procedura: Wide Local Excision
Descrizione dettagliata
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.
Tipo di studio
Tipo di studio
Iscrizione (Stimato)
Iscrizione
Fase
Fase
- Non applicabile
Contatti e Sedi
Luoghi di studio
-
-
California
-
Oakland, California, Stati Uniti, 94611
- Reclutamento
- Kaiser Permanente-Oakland
-
Contatto:
- Site Public Contact
- Numero di telefono: 877-642-4691
- Email: Kpoct@kp.org
-
Investigatore principale:
- Aarati V. Rao
-
-
Pennsylvania
-
Philadelphia, Pennsylvania, Stati Uniti, 19104
- Reclutamento
- Children's Hospital of Philadelphia
-
Contatto:
- Site Public Contact
- Numero di telefono: 267-425-5544
- Email: CancerTrials@email.chop.edu
-
Investigatore principale:
- Theodore W. Laetsch
-
Pittsburgh, Pennsylvania, Stati Uniti, 15224
- Reclutamento
- Children's Hospital of Pittsburgh of UPMC
-
Contatto:
- Site Public Contact
- Numero di telefono: 412-692-8570
- Email: jean.tersak@chp.edu
-
Investigatore principale:
- Brittani K. Seynnaeve
-
-
Tennessee
-
Knoxville, Tennessee, Stati Uniti, 37916
- Reclutamento
- East Tennessee Childrens Hospital
-
Contatto:
- Site Public Contact
- Numero di telefono: 865-541-8266
-
Investigatore principale:
- Susan E. Spiller
-
Memphis, Tennessee, Stati Uniti, 38105
- Reclutamento
- Saint Jude Children's Research Hospital
-
Contatto:
- Site Public Contact
- Numero di telefono: 888-226-4343
- Email: referralinfo@stjude.org
-
Investigatore principale:
- Alberto S. Pappo
-
-
Criteri di partecipazione
Criteri di ammissibilità
Criteri di ammissibilità
Età idonea allo studio
- Bambino
- Adulto
Accetta volontari sani
Descrizione
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
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: Non randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Nessuno (etichetta aperta)
Numero di armi
Armi e interventi
Gruppo di partecipanti / ArmGruppo di partecipanti / Arm |
Intervento / TrattamentoIntervento / Trattamento |
|---|---|
|
Comparatore attivo: Observation Arm (observation)
Patients undergo observation throughout the study.
|
Sottoponiti all'osservazione
Altri nomi:
|
|
Sperimentale: Treatment Arm A (narrow margin)
Patients may undergo narrow margin re-excision without sentinel lymph node biopsy.
|
Undergo narrow margin re-excision
Altri nomi:
|
|
Sperimentale: 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.
|
Sottoponiti al prelievo di campioni di sangue
Altri nomi:
Dato FDG
Altri nomi:
Sottoponiti a una radiografia del torace
Altri nomi:
Sottoponiti a SLNB
Altri nomi:
Sottoporsi a TC o FDG PET/CT
Altri nomi:
Undergo MRI, PET/MRI or brain MRI
Altri nomi:
Undergo whole body FDG PET/CT or PET/MRI
Altri nomi:
Undergo nodal basin ultrasound
Altri nomi:
Undergo wide local excision
Altri nomi:
|
Cosa sta misurando lo studio?
Misure di risultato primarie
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Feasibility success rate
Lasso di tempo: 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
|
Misure di risultato secondarie
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Adherence to surgical treatment arm assignment
Lasso di tempo: 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
Lasso di tempo: 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)
Lasso di tempo: 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)
Lasso di tempo: 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
|
Altre misure di risultato
Altre misure di risultato
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Surgical reconstruction techniques for pediatric patients with atypical and malignant melanocytic tumors
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: Within 18 months of protocol activation
|
The total number will be reported.
|
Within 18 months of protocol activation
|
Collaboratori e investigatori
Sponsor
Sponsor
Investigatori
Investigatori
- Investigatore principale: Brittani K Seynnaeve, Children's Oncology Group
Studiare le date dei record
Studia le date principali
Inizio studio (Stimato)
Inizio studio
Completamento primario (Stimato)
Completamento primario
Completamento dello studio (Stimato)
Completamento dello studio
Date di iscrizione allo studio
Primo inviato
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Primo Inserito
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento pubblicato
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Termini MeSH pertinenti aggiuntivi
- Neoplasie per sede
- Neoplasie
- Neoplasie per tipo istologico
- Malattie della pelle
- Tumori neuroectodermici
- Neoplasie, cellule germinali ed embrionali
- Neoplasie, tessuto nervoso
- Tumori neuroendocrini
- Nevi e melanomi
- Neoplasie cutanee
- Malattie della pelle e del tessuto connettivo
- Melanoma
- Amministrazione dei servizi sanitari
- Tecniche investigative
- Metodi
- Tecniche di laboratorio clinico
- Tecniche e procedure diagnostiche
- Diagnosi
- Procedure chirurgiche, operative
- Tecniche citologiche
- Biopsia
- Citodiagnosi
- Qualità dell'assistenza sanitaria
- Carboidrati
- Fenomeni fisici
- Tecniche diagnostiche, chirurgiche
- Tecniche di chimica, analitiche
- Analisi dello spettro
- Fenomeni elettromagnetici
- Fenomeni magnetici
- Deossiglucosio
- Zuccheri di desossi
- Valutazione dei risultati, assistenza sanitaria
- Esito e valutazione del processo, assistenza sanitaria
- Radiazioni elettromagnetiche
- Radiazione
- Radiazione, ionizzante
- Radiazione, non ionizzante
- Escissione linfonodo
- Onde ad ultrasuoni
- Suono
- Fluorodesossiglucosio F18
- Osservazione
- Gestione dei campioni
- Spettroscopia di risonanza magnetica
- Aspetta vigile
- Raggi X.
- Biopsia linfonodo sentinella
- Onde d'urto ad alta energia
Altri numeri di identificazione dello studio
Altri numeri di identificazione dello studio
- ARAR2421 (Altro identificatore: CTEP)
- U10CA180886 (Sovvenzione/contratto NIH degli Stati Uniti)
- NCI-2026-03776 (Identificatore di registro: CTRP (Clinical Trial Reporting Program))
Informazioni su farmaci e dispositivi, documenti di studio
Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti
Studia un dispositivo regolamentato dalla FDA degli Stati Uniti
prodotto fabbricato ed esportato dagli Stati Uniti
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