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Ovarian CancerPhase 3EXPERTNCT04460807

Exemestane in Hormone Receptor Positive High Grade Ovarian Cancer

A Phase 3 study testing Exemestane in people with Ovarian Cancer, run by Ente Ospedaliero Ospedali Galliera at 47 sites in Italy.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

In this Italian, multicenter, randomized, double-blind, placebo controlled, phase III study the efficacy of exemestane will be evaluated in addition to the standard front line treatment in patients with hormone-receptor-positive high grade serous or endometrioid Epithelian Ovarian Cancer (EOC). Read more about this study

Who is it for?
Ages 18 years and older, women only
Conditions the study is for
Ovarian Cancer
What is being tested?
Exemestane
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
23 participants
Where
47 sitesItaly
Study dates
13 Feb 2020to 27 Apr 2023
Phase
Phase 3
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
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥18 years
  • Citologically or histologically confirmed high grade serous or endometrial epithelial ovarian cancer, including cancer of fallopian tube and peritoneum. For patients who are candidates for neoadjuvant chemotherapy, diagnosis must be documented via imaging or a core tissue (not fine needle aspiration) biopsy.
  • Disease stage IIB to IV according to FIGO classification. For patients who are candidates for neoadjuvant chemotherapy, stage IIB-IV should be documented via imaging or a core tissue (not fine needle aspiration) biopsy.
  • Patients must have completed a surgical debulking procedure, or be candidates for neoadjuvant chemotherapy. For patients enrolling after debulking surgery, randomization should occur at a maximum of 12 weeks and not before 4 weeks after surgery.
  • Immunoistochemically determined positivity (≥ 10%) for Progesterone and/or Estrogen receptor expression, including determination on cytology smears from ascitic fluid if surgery is differed.
  • Measurable or evaluable disease confirmed by radiological imaging, or histological proven ovarian cancer in the absence of postoperatively measurable or evaluable lesions
  • Eastern Cooperative Oncology Group - performance status (ECOG-PS) 0-2.
  • Written, informed consent obtained prior to any study-specific procedures.

Who cannot join

  • Previous systemic therapy for ovarian cancer.
  • Other malignancy within the last 5 years, except for adequately treated carcinoma in situ of the cervix or squamous carcinoma of the skin, or adequately controlled limited basal cell skin cancer.
  • Inadequate bone marrow, hepatic or renal functions, assessed within 7 days prior to randomization.
  • Treatment with hormonal contraceptives during the previous 3 months from diagnosis.
  • Concurrent comorbidities, which contraindicates the administration of chemotherapy, or endocrine therapy.
  • Pregnant or lactating patients.
  • Inability or unwillingness to swallow tablets.

Trial locations and contacts

47 sites in 1 country.

47 sites in 1 country

Italy47 sites
  • Azienda Sanitaria Locale CN2

    Alba, CN

  • AO SS Antonio e Biagio e Cesare Arrigo

    Alessandria, AL

  • CRO Centro di Riferimento Oncologico

    Aviano, PN

  • Ospedale Oncologico IRCCS Bari

    Bari, BA

  • Ospedale degli Infermi

    Biella, BI

  • Azienda Ospedaliero Universitaria Policlinico S.Orsola-Malpighi

    Bologna, BO

  • ASST degli Spedali Civili di Brescia

    Brescia, BS

  • Fondazione Poliambulanza

    Brescia, BS

  • AOU Cagliari, Policlinico Universitario

    Cagliari, CA

  • Fondazione del Piemonte per l'Oncologia - IRCCS

    Candiolo, TO

  • ARNAS Garibaldi

    Catania, CT

  • Azienda Ospedaliera per l'emergenza Cannizzaro

    Catania, CT

  • Ospedale Policlinico "SS. Annunziata"

    Chieti, CH

  • Ospedale Sant Anna di Como

    Como, CO

  • Azienda Ospedaliera S.Croce e Carle

    Cuneo, CN

  • Ospedale "degli Infermi"

    Faenza, RA

  • AULSS 1 Dolomiti - Ospedale "Santa Maria del Prato"

    Feltre, BL

  • ASL 3 Ospedale Villa Scassi

    Genova, GE

  • IRCCS AOU San Martino - IST

    Genova, GE

  • Medical Oncology Division, Ente Ospedaliero Ospedali Galliera

    Genova, 16128

  • Ospedale "Vito Fazzi"

    Lecce, LE

  • ASST Lecco - Ospedale "A. Manzoni"

    Lecco, LC

  • Ospedale "Umberto I"

    Lugo, RA

  • Ospedale di Manerbio

    Manerbio, BS

  • Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS

    Meldola, FC

  • Istituto Europeo di Oncologia (IEO)

    Milan, MI

  • AOU Policlinico di Modena

    Modena, MO

  • Ospedale di Mondovì CN1

    Mondovì, CN

  • UOS Oncologia Ginecologica, Ospedale S. Gerardo

    Monza, MB

  • Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale"

    Naples

  • Azienda Ospedaliero-Universitaria Maggiore della Carità

    Novara

  • A.R.N.A.S. Ospedali Civico Di Cristina Benfratelli

    Palermo, PA

  • Fondazione IRCCS Policlinico San Matteo

    Pavia, PV

  • Ospedale "Guglielmo da Saliceto"

    Piacenza, PC

  • Azienda Ospedaliero-Universitaria Pisana

    Pisa, PI

  • Azienda Ospedaliera Regionale San Carlo

    Potenza, PZ

  • Presidio Ospedaliero Unico Av3

    Province of Macerata, MC

  • Ospedale Santa Maria delle Croci

    Ravenna, RA

  • Azienda Ospedaliera Arcispedale Santa Maria Nuova

    Reggio Emilia, RE

  • Policlinico Umberto I, Università di Roma "La Sapienza"

    Roma, RM

  • Policlinico Universitario Fondazione Agostino Gemelli

    Roma, RM

  • Ospedale Casa Sollievo della Sofferenza

    San Giovanni Rotondo, FG

  • Azienda Ospedaliero Universitaria di Sassari

    Sassari, SS

  • ASST Valtellina e Alto Lario

    Sondrio, SO

  • AO Ordine Mauriziano

    Torino, TO

  • Azienda Ospedaliero-Universitaria Città della Salute e della Scienza - Ospedale Ostetrico Ginecologico Sant'Anna

    Torino, TO

  • Presidio Ospedaliero S. Andrea

    Vercelli, VC

Other trials in Italy

About this study

Official title: EXemestane in Progesterone and/or Estrogen Receptor Positive Epithelial Ovarian Cancer: A Randomized Phase III Trial, EXPERT

In this Italian, multicenter, randomized, double-blind, placebo controlled, phase III study the efficacy of exemestane will be evaluated in addition to the standard front line treatment in patients with hormone-receptor-positive high grade serous or endometrioid Epithelian Ovarian Cancer (EOC). The patients enrolled in the EXPERT trial will receive exemestane or placebo in addition to standard treatment. Patients and investigators will be blinded to study treatment.

The hypothesis underlying the proposed clinical trial is that exemestane added to standard first line therapy will significantly prolong median progression free survival (PFS).

Read the detailed description

Estrogen and Progesterone play a role in promoting EOC growth, metastasis, and progression. Recent data show that ER and PgR expression is frequent in high grade EOC and has prognostic significance. A large meta-analysis showed a clinical benefit with any endocrine treatment, and in particular for aromatase inhibitors (AIs), with a greatere benefit for ER+ and/or PgR+ patients and platinum sensitive tumors. Moreover, the analysis of a few randomized clinical trials (RCTs) showed a reduced mortality with endocrine therapy in EOC, suggesting that ER and PgR have a predictive role and that inhibition of their activation could therefore be a treatment option for EOC.

Exemestane is a well-tolerated and effective AI in endocrine sensitive breast cancer which inhibits the production of Estrogens by the adipose tissue in postmenopausal women.

In this Italian, multicentre, randomized, double-blind, placebo controlled, phase III study will be assessed the efficacy of exemestane versus placebo in addition to the standard front line treatment in patients with high grade serous or endometrioid EOC, IHC positive (≥ 10%) ER or PgR disease, stage IIB - IV according to the FIGO classification.

The primary objective of the study is to test the superiority of exemestane over placebo in addition to the standard front line treatment in terms of PFS.

Secondary Objectives are:

  1. to test whether the percent expression of ER and PgR is predictive of the effect of exemestane on PFS;
  2. to test whether the addition of exemestane to the standard front line treatment can prolong Overall Survival (OS);
  3. to evaluate objective response rate Overall Response Rate (ORR) of experimental treatment compared with the standard one;
  4. to assess whether the effect of exemestane is affected by the proliferative index Ki67;
  5. to evaluate the effect of exemestane on Quality of Life (QoL);
  6. to evaluate the compliance to the study treatment;
  7. to evaluate the safety profile of the experimental treatment compared with the standard one.

Study design: a total of 468 subjects (234 per Arm) will be randomized in a 1:1 ratio to receive either standard chemotherapy treatment plus exemestane (Experimental arm) or standard chemotherapy plus placebo (Control arm). Exemestane/placebo will be self-administered as a single oral tablet of 25 mg/day until disease progression, unacceptable toxicity or physician/patient decision to withdraw, whichever comes first. Radiological disease assessments and CA125 will be performed at baseline and every 4 months from randomization, until end of study or disease progression whichever comes first. Safety assessments will be performed at each cycle during standard chemotherapy treatment, then at each study visit, up to 30 days after the last Experimental Treatment administration.Quality of Life will be assessed by a menopause-specific questionnaire, administered to patients at baseline (T0), at 12 months (T1) and at disease progression (T2). For patients who have signed the specific informed consent, tissues and blood samples will be collected.

Conditions
Ovarian Cancer
Being tested
Exemestane, Placebo oral tablet
Keywords
exemestane, aromatase inhibitors, clinical trial, phase 3, receptors, estrogen, receptors, progesterone
Medical subject headings
Ovarian Neoplasms

What participants receive

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

  • ExemestaneDrug

    Also called Mestane

    Exemestane in addition to standard therapy, in Experimental arm.

  • Placebo oral tabletOther

    Placebo in addition to standard therapy, in Control arm.

Study groups in NCT04460807
Study groupRoleWhat they receive
ExemestaneExperimentalStandard chemotherapy: paclitaxel 175 mg/m2 + carboplatin AUC 5, on day 1 every 21 days ± bevacizumab 15mg/kg, on day 1 every 21 days. Chemotherapy will be administered for 6 cycles; Bevacizumab will be administered as up to a maximum of 22 cycles. Patients unfit for standard treatment can receive a weekly schedule of treatment or monotherapy with carboplatin alone. Neoadjuvant chemotherapy is allowed in patients unfit for primary elective surgery. + Exemestane: single oral tablet of 25 mg/day until disease progression, unacceptable toxicity or physician/patient decision to withdraw, whichever comes first.
Receives: Drug: Exemestane
PlaceboPlacebo comparatorStandard chemotherapy : paclitaxel 175 mg/m2 + carboplatin AUC 5, on day 1 every 21 days ± bevacizumab 15mg/kg, on day 1 every 21 days. Chemotherapy will be administered for 6 cycles; Bevacizumab will be administered as up to a maximum of 22 cycles. Patients unfit for standard treatment can receive a weekly schedule of treatment or monotherapy with carboplatin alone. Neoadjuvant chemotherapy is allowed in patients unfit for primary elective surgery. + Placebo: single oral tablet until disease progression, unacceptable toxicity or physician/patient decision to withdraw, whichever comes first.
Receives: Other: Placebo oral tablet

What is being measured

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

  1. Progression free survival (PFS)

    PFS id defined for each patient as the time from the date of randomization to the date of local or regional relapse, distant metastasis, second primary malignancy or death from any cause, whichever comes first. Patients not recurred, progressed or died while on study or lost to follow-up will be censored at their last disease assessment date.

    Measured: Up to 20 months

Secondary outcomes (7)
  1. Overall survival (OS)

    OS is defined for each patient as the time from the date of randomization to the date of death from any cause. Patients not reported as having died at the end of the study will be censored at the date they were last known to be alive.

    Measured: Up to 20 months

  2. Objective Response Rate (ORR)

    ORR is defined as the number of patients who will experience a complete or partial response divided by the number of patients randomized with at least one target lesion at baseline. Each patient will be assigned the best response ever recorded during the trial

    Measured: a CT-scan will be performed every 4 months. Up to 20 months from last patients randomized

  3. Quality of Life: Menopause Quality of Life (MENQoL) questionnaire

    The effect of study treatment will be assessed based on the MENQOL intervention questionnaire based on 29 items divided in four domains (vasomotor, physical, psychosocial and sexual), each scored from 1 to 8 (1 means no symptom, 2 presence of the symptoms but not bothersome, 3-8 an increasing grade of discomfort). Mean changes from the baseline domain scores between treatment arms will be evaluated.

    Measured: Up to 20 months

  4. Compliance - Number of administered cycles

    Number of administered cycles

    Measured: Up to 20 months

  5. Compliance - Reasons for discontinuation and treatment modification

    Number of patients for each reasons

    Measured: Up to 20 months

  6. Compliance - Dose intensity

    Number of tablets taken (i.e., number of tablets given-number of tablets returned)/number of tablets that should have been taken during the treatment period.

    Measured: Up to 20 months

  7. Safety (Adverse Events)

    Maximum toxicity grade experienced by each patient for each toxicity, proportion of patients experiencing grade 3-4 toxicity for each toxicity, type, frequency and nature of serious adverse events (SAEs).

    • Proportion of patients with at least one SAE.
    • Proportion of patients with at least one serious adverse drug reaction (SADR).

    Measured: Up to 20 months

Timeline

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

  1. First posted8 Jul 2020
  2. Study start13 Feb 2020
  3. Primary completion27 Apr 2023
  4. Study completion27 Apr 2023

Why it stopped: low accrual, COVID 19 emergency and the modification of the standard of care for ovarian cancer treatment

Resources

More details

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

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
23 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04460807
Sponsor's protocol ID
56UCS2017
Other IDs
2018-000693-30, 2018
Acronym
EXPERT
Status last verified
Feb 2024
First submitted
27 Apr 2020
Last updated
12 Feb 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Individual participant data that underlie the results reported in the primary publication of the trial will be shared (text, tables, figures, and appendices), after deidentification.

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Exemestane in people with Ovarian Cancer, run by Ente Ospedaliero Ospedali Galliera at 47 sites 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 8 inclusion and 7 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: stopped early, as of the sponsor's last update on 12 Feb 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 47 sites 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. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study was stopped early (reason given: low accrual, COVID 19 emergency and the modification of the standard of care for ovarian cancer treatment). Results are not available in the source record.

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

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Progression free survival (PFS) (time frame: Up to 20 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 12 Feb 2024.

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