This is an international phase III trial, with a Bayesian design, incorporating two sequential randomisations. It efficiently examines a series of questions that routinely arise in the sequencing of treatment. The study design has evolved from lengthy international consultation that has enabled us to build consensus over which questions arise from current knowledge and practice. It will enable potential randomisation for the majority of patients with inguinal lymph node metastases and will provide data to inform future clinical decisions. InPACT-neoadjuvant patients are stratified by disease burden as assessed by radiological criteria. Treatment options are then defined according to the disease burden strata. Treatment is allocated by randomisation. Patients may be allocated to one of three initial treatments: A. standard surgery (ILND); B. neoadjuvant chemotherapy followed by standard surgery (ILND); or C. neoadjuvant chemoradiotherapy followed by standard surgery (ILND). After ILND, patients are defined as being at low or high risk of recurrence based on histological interpretation of the ILND specimen. Patients at high risk of relapse are eligible for InPACT-pelvis, where they are randomised to either: P. prophylactic PLND Q. no prophylactic PLND
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
200
Surgery to remove the lymph nodes in the groin near to where the cancer first appeared.
Dose 175mg/m2 as part of TIP regimen.
Dose 900mg/m2 as part of TIP regimen.
Dose 15mg/m2 as part of TIP regimen (neoadjuvant chemotherapy arm) Dose 40mg/m2 for use concurrently with raditotherapy (chemoradiotherapy arm)
Treatment with very high energy X-rays (radiotherapy).
Surgery to remove the lymph nodes deeper in the pelvis, further away from where the cancer first appeared, that are at high risk of harbouring cancer.
Los Angeles County-USC Medical Center
Los Angeles, California, United States
RECRUITINGUSC / Norris Comprehensive Cancer Center
Los Angeles, California, United States
RECRUITINGMoffitt Cancer Center
Tampa, Florida, United States
RECRUITINGGrady Health System
Atlanta, Georgia, United States
ACTIVE_NOT_RECRUITINGEmory University Hospital/Winship Cancer Institute
Atlanta, Georgia, United States
RECRUITINGUniversity of Chicago Comprehensive Cancer Center
Chicago, Illinois, United States
ACTIVE_NOT_RECRUITINGMayo Clinic
Rochester, Minnesota, United States
RECRUITINGOhio State University Comprehensive Cancer Center
Columbus, Ohio, United States
ACTIVE_NOT_RECRUITINGUniversity of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, United States
ACTIVE_NOT_RECRUITINGFox Chase Cancer Center
Philadelphia, Pennsylvania, United States
ACTIVE_NOT_RECRUITING...and 7 more locations
Overall survival
The primary outcome measure that will be measured for all trial patients is survival time. This is defined in whole days as the time from the date of randomisation to the date of death from any cause; for those who have not been reported as dead at the time of analysis, the survival time will be censored at the date of last follow-up.
Time frame: up to 5 years
Disease specific survival time
Disease-specific survival time which is defined in whole days as the time from the date of randomisation to the date of death specifically from disease; for those who have not been reported as dead at the time of analysis, the survival time will be censored at the date of last follow-up and for those whose death is reported as non-disease specific then the survival time will be censored at date of death.
Time frame: up to 5 years
Number of patients experience a grade 3 or 4 toxicity
Time frame: up to 5 years
Disease-free survival time
Disease-free survival time (DFST) which is defined in whole days as the time from date of randomisation to the date of either locoregional recurrence, distant metastasis or death from disease, whichever occurs first; for those who have not been reported as experiencing any of these events, the DFST will be censored at the date last known to be alive and free of disease or date of non-disease-specific death. A supplementary exploratory outcome measure will also be calculated taking date of penectomy as the origin rather than date of randomisation. Subsidiary outcome measures will be * locoregional recurrence free survival time (LRFST). * distant metastases free survival time (DMFST). * A supplementary exploratory outcome measure will also be calculated taking date of penectomy as the origin for all these outcome measures rather than date of randomisation.
Time frame: up to 5 years
Occurrence of surgical complication
Time frame: up to 5 years
Is it possible to achieve pathological nodal assessment after chemotherapy
Feasibility of pathological nodal assessment after chemotherapy which is recorded as whether or not it was possible to achieve a pathological nodal assessment after chemotherapy.
Time frame: 12 weeks
Quality of life
Measured using the EORTC-QLQC30 and Lymphodema-QL
Time frame: Baseline, 3, 6, 9, 12, 18, 24 and 36 months
Occurrence of Pathological complete remission
Measured for all patients in InPACT-neoadjuvant: Absolute absence of disease on histological examination
Time frame: Time to complete remission after randomisation
Operability
Measured for all trial patients in InPACT-neoadjuvant. Operability which will be recorded as whether or not the planned inguinal node dissection was undertaken and the reasons if it did not occur.
Time frame: 2-6 weeks
Occurrence of Lower limb/scrotal oedema
Occurrence of Lower limb/scrotal oedema which is recorded as whether or not the patient experiences a lower limb or scrotal oedema
Time frame: up to 5 years
On-schedule delivery of neoadjuvant therapy
Feasibility of on-schedule delivery of neoadjuvant therapy
Time frame: After randomisation up to 12 weeks
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