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Non Functioning Pancreatic Endocrine TumorASPENNCT03084770

Asymptomatic Small Pancreatic Endocrine Neoplasms.

An observational study of Non Functioning Pancreatic Endocrine Tumor, run by IRCCS San Raffaele at 1 site in Italy.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

The aim of the study is to evaluate the most appropriate management of sporadic asymptomatic non-functioning pancreatic neuroendocrine neoplasms (NF-PNEN) ≤ 2 cm. P NF-PNEN management will be decided at the hospital and all therapeutics decision will be decided/coordinated by the treating physician. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Radiological imaging studies and Quality of Life Assessment
How many people
1,000 participants
Where
1 siteItaly
Study dates
1 Sep 2017to 31 Dec 2024
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Patients with a newly diagnosis (less thn 12 months) of non- functioning pancreatic endocrine neoplasia (NF-PNEN) ≤ 2 cm of diameter. Either patients submitted to surgery or in active surveillance can be enrolled. Patients with sindrome or genetics disorders are excluded from the study.

Who may be able to join

  • Age > 18 years
  • Individuals with asymptomatic sporadic NF-PNEN ≤ 2 cm
  • Diagnosis has to be proven by a positive fine-needle aspiration (FNA) or by the presence of a measurable nodule on high-quality imaging technique (CT or MR) that is positive at 68Gallium DOTATOC-PET scan or Octreoscan.
  • Patients who undergo surgery for NF-PNEN<2cm within 12 months. In these cases, diagnosis has to be proven by histological confirmation of NF-PNEN
  • Informed consent

Who cannot join

  • NF-PNEN > 2 cm of maximum diameter
  • Presence of genetic syndrome (MEN1, VHL, NF)
  • Presence of symptoms (specific symptoms suspicious of a clinical syndrome related to hypersecretion of bioactive compounds) or unspecific symptoms

Trial locations and contacts

1 site in 1 country.

Massimo Falconi, Professor contact

0039 022643 6046

falconi.massimo@hsr.it

Stefano Partelli, MD PhD contact

0039 022643 7697

partelli.stefano@hsr.it

Italy1 site, 1 recruiting
  • IRCCS San Raffaele Hospital

    Milan, 20132

    Massimo Falconi, Professor, 0039 0226436046, massimo.falconi@hsr.it

    Stefano Partelli, MD PhD, 0039 02 26437697, partelli.stefano@hsr.it

    Recruiting

Other trials in Italy

About this study

Official title: A Prospective Evaluation of the Management of Sporadic Asymptomatic Nonfunctioning Pancreatic Neuroendocrine Neoplasms ≤ 2 cm

The aim of the study is to evaluate the most appropriate management of sporadic asymptomatic non-functioning pancreatic neuroendocrine neoplasms (NF-PNEN) ≤ 2 cm. P NF-PNEN management will be decided at the hospital and all therapeutics decision will be decided/coordinated by the treating physician.

Patients will be either submitted to surgical resection or to active surveillance.

Read the detailed description

In the last decade a dramatic increase in diagnosis of small, incidentally discovered, NF-PNEN was observed. Various study indicates the safety of a conservative management for this lesion and the The European Neuroendocrine Tumor Society (ENETS) proposed a "wait and see" approach for small NF-PNEN.

Indications for surgery include the presence of a localized NF-PNEN in the absence of distant metastases as curative resection of these tumors is associated with favourable prognosis especially for low grade.

In the last decade a dramatic increase in diagnosis of small, incidentally discovered, NF-PNEN was observed.Moreover, other investigators observed a clear relationship between the tumor diameter and low risk of malignancy and systemic progression.

In particular, a tumor size ≤ 2 cm seems to be associated with a negligible risk of disease recurrence and with a very low incidence of aggressive features such as lymph node involvement.On this basis, the European Neuroendocrine Tumor Society (ENETS) proposed a "wait and see" approach for small NF-PNEN when incidentally discovered. Since then, various series evaluated the safety of a conservative management for small, sporadic, incidentally diagnosed, NF-PNEN.

After a median follow-up of 28-45 months, all the studies confirmed that an intensive surveillance for incidental and small NF-PNEN is safe in selected cases.

Nevertheless, available data are based only on retrospective series with a significant heterogeneity of inclusion criteria and different tumor diameter cut-off and the appropriate management of this entities (surveillance versus surgery) is still a matter of debate.

Being tested
Radiological imaging studies, Quality of Life Assessment
Keywords
NF-PNEN
Medical subject headings
Non functioning pancreatic endocrine tumor

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Radiological imaging studiesDiagnostic test

    Patients will be submitted to radiological imaging studies (CT scan and/or MRI and/ or 68Gallium PET/CT and/or Octreoscan and/or EUS+FNAand/or Octreoscan and/or EUS+FNA) at diagnosis, and then every 6 months for the first two years and yearly thereafter for five years in the absence of significant changes on imaging or symptoms appearance. Every 12 months (or 6 months for patients with Ki67> 2%) a high quality imaging (CT scan or MRI) is required.

  • Quality of Life AssessmentOther

    quality of life and the perceived burden of surveillance or follow-up after surgery for participants, will be investigated by administrating HADS questionnaire and EORTC QLQ-C30 (version 3) and EORTC QLQ-GI.NET21 Module.

Study groups in NCT03084770
Study groupRoleWhat they receive
Active surveillance groupAdvised surveillance strategy consists of imaging studies (MR or EUS or US), every 6 months for the first two years and yearly thereafter for five years in the absence of significant changes on imaging or symptoms appearance. During surveillance, a high-quality imaging technique (MRI or CT) is mandatory at least every 12 months. Determination of CgA during follow-up is at physician's discretion. During follow-up, the treating physician is responsible for patient management and decision-making.
Receives: Diagnostic Test: Radiological imaging studies; Other: Quality of Life Assessment
Surgical resection groupTiming and type of resection will be established by the treating physician. Follow up strategy after surgery consists of imaging studies (MR or CT), every 6 months for the first two years and yearly thereafter for five years. An high-quality imaging technique (MRI or CT) is mandatory at least every 12 months. Determination of CgA during follow-up is at physician's discretion. During follow-up, the treating physician is responsible for patient management and decision-making. Date of surgery does not change the timing of follow up which starts from the date of enrolment.
Receives: Diagnostic Test: Radiological imaging studies; Other: Quality of Life Assessment

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Disease/progression-free survival of NF-PNEN ≤ 2 cm

    The primary endpoint is disease/progression-free survival, defined as the time from study enrolment to the first evidence of progression (active surveillance group) or recurrence of disease (surgical resection group) or death from disease.

    Measured: From date of enrolment until the date of first documented progression or first evidence of recurrence, from 6 months up to 6 years.

Secondary outcomes (5)
  1. Frequency of NF-PNEN ≤ 2 cm

    The secondary end point is to evaluate the frequency of asymptomatic sporadic NF-PNEN ≤ 2 cm among overall sporadic NF-PNEN. Participating centers are required to give yearly the number of patients with NF-PNEN referred to their institution.

    Measured: 6 years

  2. Outcome of surgical intervention of NF-PNEN ≤ 2 cm

    Morbidity and mortality of patients submitted to surgical resection

    Measured: from the date of surgery to 1 months later the surgery

  3. Epidemiology of patients submitted to surgical intervention for NF-PNEN ≤ 2 cm

    Number of patients submitted to surgery andh type of surgical procedures.

    Measured: from the date of surgery, up to 6 years

  4. Evolution of NF-PNEN ≤ 2 cm

    NF-PNEN evolution, in terms of development of symptoms, tumour growth, development of distant metastases and secondary pancreatic duct dilatation.

    Measured: From date of enrolment until the date of first documented radiological evolution, from 6 months up to 6 years.

  5. Quality of Life of NF-PNEN ≤ 2 cm

    The perceived burden of surveillance or follow-up after surgery for participants, as assessed by questionnaires regarding attitude towards surveillance and general anxiety and depression (Hospital Anxiety and Depression scale, HADS). Quality of Life will be investigated, by filling in EORTC QLQ-C30 (version 3) and EORTC QLQ-GI.NET21 Module.

    Measured: from 6 months up to 6 years.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Mar 2017
  2. Study start1 Sep 2017
  3. Primary completion31 Aug 2024 (estimated)
  4. Study completion31 Dec 2024 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
1,000 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03084770
Sponsor's protocol ID
ASPEN
Acronym
ASPEN
Status last verified
Jan 2024
First submitted
6 Mar 2017
Last updated
18 Jan 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Falconi M, Eriksson B, Kaltsas G, Bartsch DK, Capdevila J, Caplin M, Kos-Kudla B, Kwekkeboom D, Rindi G, Kloppel G, Reed N, Kianmanesh R, Jensen RT; Vienna Consensus Conference participants. ENETS Consensus Guidelines Update for the Management of Patients with Functional Pancreatic Neuroendocrine Tumors and Non-Functional Pancreatic Neuroendocrine Tumors. Neuroendocrinology. 2016;103(2):153-71. doi: 10.1159/000443171. Epub 2016 Jan 5. No abstract available.

    PubMed 26742109
  • Jilesen AP, van Eijck CH, Busch OR, van Gulik TM, Gouma DJ, van Dijkum EJ. Postoperative Outcomes of Enucleation and Standard Resections in Patients with a Pancreatic Neuroendocrine Tumor. World J Surg. 2016 Mar;40(3):715-28. doi: 10.1007/s00268-015-3341-9.

    PubMed 26608956
  • Hashim YM, Trinkaus KM, Linehan DC, Strasberg SS, Fields RC, Cao D, Hawkins WG. Regional lymphadenectomy is indicated in the surgical treatment of pancreatic neuroendocrine tumors (PNETs). Ann Surg. 2014 Feb;259(2):197-203. doi: 10.1097/SLA.0000000000000348.

    PubMed 24253141
  • Kuo EJ, Salem RR. Population-level analysis of pancreatic neuroendocrine tumors 2 cm or less in size. Ann Surg Oncol. 2013 Sep;20(9):2815-21. doi: 10.1245/s10434-013-3005-7. Epub 2013 Jun 15.

    PubMed 23771245
  • Vagefi PA, Razo O, Deshpande V, McGrath DJ, Lauwers GY, Thayer SP, Warshaw AL, Fernandez-Del Castillo C. Evolving patterns in the detection and outcomes of pancreatic neuroendocrine neoplasms: the Massachusetts General Hospital experience from 1977 to 2005. Arch Surg. 2007 Apr;142(4):347-54. doi: 10.1001/archsurg.142.4.347.

    PubMed 17438169
  • Crippa S, Partelli S, Zamboni G, Scarpa A, Tamburrino D, Bassi C, Pederzoli P, Falconi M. Incidental diagnosis as prognostic factor in different tumor stages of nonfunctioning pancreatic endocrine tumors. Surgery. 2014 Jan;155(1):145-53. doi: 10.1016/j.surg.2013.08.002.

    PubMed 24646958
  • Birnbaum DJ, Gaujoux S, Cherif R, Dokmak S, Fuks D, Couvelard A, Vullierme MP, Ronot M, Ruszniewski P, Belghiti J, Sauvanet A. Sporadic nonfunctioning pancreatic neuroendocrine tumors: prognostic significance of incidental diagnosis. Surgery. 2014 Jan;155(1):13-21. doi: 10.1016/j.surg.2013.08.007. Epub 2013 Nov 12.

    PubMed 24238123
  • Bettini R, Partelli S, Boninsegna L, Capelli P, Crippa S, Pederzoli P, Scarpa A, Falconi M. Tumor size correlates with malignancy in nonfunctioning pancreatic endocrine tumor. Surgery. 2011 Jul;150(1):75-82. doi: 10.1016/j.surg.2011.02.022.

    PubMed 21683859
  • Haynes AB, Deshpande V, Ingkakul T, Vagefi PA, Szymonifka J, Thayer SP, Ferrone CR, Wargo JA, Warshaw AL, Fernandez-del Castillo C. Implications of incidentally discovered, nonfunctioning pancreatic endocrine tumors: short-term and long-term patient outcomes. Arch Surg. 2011 May;146(5):534-8. doi: 10.1001/archsurg.2011.102.

    PubMed 21576607
  • Cherenfant J, Stocker SJ, Gage MK, Du H, Thurow TA, Odeleye M, Schimpke SW, Kaul KL, Hall CR, Lamzabi I, Gattuso P, Winchester DJ, Marsh RW, Roggin KK, Bentrem DJ, Baker MS, Prinz RA, Talamonti MS. Predicting aggressive behavior in nonfunctioning pancreatic neuroendocrine tumors. Surgery. 2013 Oct;154(4):785-91; discussion 791-3. doi: 10.1016/j.surg.2013.07.004.

    PubMed 24074416
  • Partelli S, Gaujoux S, Boninsegna L, Cherif R, Crippa S, Couvelard A, Scarpa A, Ruszniewski P, Sauvanet A, Falconi M. Pattern and clinical predictors of lymph node involvement in nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs). JAMA Surg. 2013 Oct;148(10):932-9. doi: 10.1001/jamasurg.2013.3376.

    PubMed 23986355
  • Falconi M, Bartsch DK, Eriksson B, Kloppel G, Lopes JM, O'Connor JM, Salazar R, Taal BG, Vullierme MP, O'Toole D; Barcelona Consensus Conference participants. ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms of the digestive system: well-differentiated pancreatic non-functioning tumors. Neuroendocrinology. 2012;95(2):120-34. doi: 10.1159/000335587. Epub 2012 Feb 15. No abstract available.

    PubMed 22261872
  • Gaujoux S, Partelli S, Maire F, D'Onofrio M, Larroque B, Tamburrino D, Sauvanet A, Falconi M, Ruszniewski P. Observational study of natural history of small sporadic nonfunctioning pancreatic neuroendocrine tumors. J Clin Endocrinol Metab. 2013 Dec;98(12):4784-9. doi: 10.1210/jc.2013-2604. Epub 2013 Sep 20.

    PubMed 24057286
  • Lee LC, Grant CS, Salomao DR, Fletcher JG, Takahashi N, Fidler JL, Levy MJ, Huebner M. Small, nonfunctioning, asymptomatic pancreatic neuroendocrine tumors (PNETs): role for nonoperative management. Surgery. 2012 Dec;152(6):965-74. doi: 10.1016/j.surg.2012.08.038. Epub 2012 Oct 24.

    PubMed 23102679
  • Jung JG, Lee KT, Woo YS, Lee JK, Lee KH, Jang KT, Rhee JC. Behavior of Small, Asymptomatic, Nonfunctioning Pancreatic Neuroendocrine Tumors (NF-PNETs). Medicine (Baltimore). 2015 Jul;94(26):e983. doi: 10.1097/MD.0000000000000983.

    PubMed 26131843

Questions about this trial

What is this clinical trial studying?

An observational study of Non Functioning Pancreatic Endocrine Tumor, run by IRCCS San Raffaele at 1 site in Italy.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 18 Jan 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Massimo Falconi, Professor (0039 022643 6046, falconi.massimo@hsr.it), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Disease/progression-free survival of NF-PNEN ≤ 2 cm (time frame: From date of enrolment until the date of first documented progression or first evidence of recurrence, from 6 months up to 6 years.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03084770, which also lists 23 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Jan 2024.

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