Patients with inoperable metastatic or localized solid tumors who have an indication for parenteral nutrition will be enrolled and receive standard parenteral nutrition according to randomization using either 2/3-chamber bags or Eurotubes®, the latter either with or without reduced glucose. The main goal of the trial is to compare the frequency of self-administered parenteral nutrition at home (autonomy rate).
This is an open-label, randomized, multicenter, investigator-initiated, phase IV trial. A total number of 216 patients will be enrolled. Patients will be stratified according to ECOG (0-1 vs. 2 vs. 3), the modified Glasgow Prognostic Score (mGPS) (0-1 vs. 2) and whether the patient receives concurrent systemic anti-tumor treatment or not. In a first step, patients will be randomized in a 2:1 ratio to Arm A (Standard Parenteral Nutrition using Eurotubes®) or Arm B (Standard Parenteral Nutrition using 2/3-chamber bags). Patients in Arm A will be stratified again by the same criteria as listed above and randomized in a 1:1 ratio to Arm A-1 (Standard Low Glucose Parenteral Nutrition using Eurotubes®) or Arm A-2 (Standard Parenteral Nutrition using Eurotubes®). Within the study, the patient can receive PN for a maximum of 12 months after randomization as long as the PN is still indicated and deemed necessary by the investigator. Primary objective is to compare the frequency of self-administered parenteral nutrition at home (HPN). Main secondary objectives are to compare the incidence of catheter related infections (CRI), to compare the efficacy of parenteral nutrition (PN) in terms of body weight, C-reactive protein (CRP) and albumin levels, and overall survival (OS), to compare the Quality of life (QoL) by use of a modified HPN-PROQ questionnaire, to determine the frequency and duration of visits by the nursing service and to compare specified safety parameters. The HPN therapy plan determined at screening and any modifications and adjustments to this plan during the course of HPN treatment will be recorded. Anti-cancer treatment at the time of screening and any changes during the course of the HPN treatment period (e.g. type of treatment) will be documented. Monitoring of Adverse Events and medical device deficiencies will be performed at every visit. AEs will be graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI CTCAE) version 5.0. During the study the patient will maintain a study diary to document details of the administration of the HPN. A QoL questionnaire will be completed during regular study visits until EOT. After completion of study treatment, patients will enter the follow-up period. During this period, they will be followed approximately every 3 months for survival.
Study Type
7-,8- or 9-chamber bags for individualized parenteral nutrition compounding.
Premixed 2/3-chamber bags which are eventually completed with other supplements shortly before administration by infusion into the bag.
Berlin Spandau Vivantes Klinikum
Berlin, Germany
Evangelisches Klinikum Bethel gGmbh, Bielefeld
Bielefeld, Germany
Augusta Kranken-Anstalt gGmbH
Bochum, Germany
patients' autonomy
Rate of self-administered parenteral nutrition at home (autonomy rate), defined as administration without nursing service assistance, as documented within the patient's study diary and calculated as the number of patients with autonomy divided by the total number of patients in the respective arm. Autonomy - as relevant for the primary endpoint - is achieved if the patient self-administers 70% or more of her/his total administrations (Note: Help of family members or other personal caregivers accounts for self-administration).
Time frame: up to 1 year
Relative weight change
Relative weight change determined at baseline and during study visits approx. every four weeks after enrolment
Time frame: up to 1 year
Relative change of albumin and CRP
Relative change of albumin and CRP levels measured at baseline and during regular study visits
Time frame: up to 1 year
Overall survival
Overall survival (OS) defined as the time from randomization to death from any cause
Time frame: up to 4 years
Incidence and severity of adverse events
incidence and severity of adverse events according to CTCAE (Common Terminology Criteria for Adverse Events) Version 5.0 criteria as assessed every 4 weeks
Time frame: up to 12 months
Patient reported outcomes - Quality of life
Quality of life as measured by a modified HPN-PROQ questionnaire at baseline, at every visit and on EOT. For different types of questions, two scales are used, one is a 7-point-scale (range 1-7) with 1 meaning "very bad", 7 "excellent" and the numbers in between the respective intermediate states. The second scale measures 10 cm. The patients will have to put a cross on the line at the place which corresponds best to their state of the past week. 0 indicates "never" or "false" and 10 "daily" or "correct".
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OBSERVATIONAL
Enrollment
142
Praxis Braunschweig
Braunschweig, Germany
Uniklinikum Köln
Cologne, Germany
Krankenhaus Nordwest
Frankfurt, Germany
OncoResearch Lerchenfeld GmbH
Hamburg, Germany
Medizinische Hochschule Hannover
Hanover, Germany
NCT Heidelberg
Heidelberg, Germany
Universitätsklinikum Schleswig-Holstein
Lübeck, Germany
...and 5 more locations
Time frame: up to 12 months