ClinicalTrials.gg
TerminatedNCT03387592SENECAUpdated Mar 10, 2025

CAPTEM or FOLFIRI as SEcond-line Therapy in NEuroendocrine CArcinomas

A Phase 2 interventional study of CPT-11 and Calcio levofolinate in Neuroendocrine Carcinoma, sponsored by Istituto Romagnolo per lo Studio dei Tumori Dino Amadori IRST S.r.l. IRCCS. Terminated at 23 sites in Italy. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-03-10.

Sponsored by Istituto Romagnolo per lo Studio dei Tumori Dino Amadori IRST S.r.l. IRCCS · Phase 2, Interventional, and Treatment

Why this study was terminated
Efficacy endpoint not met according to first step of Briant-Day design

From the registry’s dates

  • Registered 9 months after the study started (first participant enrolled Mar 2017, registered Dec 2017).
Phase
Phase 2
Study type
Interventional
Enrollment
53
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

This is a randomized phase II non comparative study. Patients with metastatic Neuroendocrine Carcinomas (NEC) Grade 3, will be enrolled in the study and will be randomly assigned to receive FOLFIRI or CAPTEM as second line treatment. Disease control rate (DCR) and safety are primary objectives, secondary objectives are Disease control rate (OS), Progression Free Survival (PFS), quality of life and toxicity of subsequent line of therapy (after Progression Disease PD) with an observational purpose.

Read the detailed description

This is a multicenter randomized phase II non comparative study. Patients with metastatic NEC G3, will be enrolled in the study and will be randomly assigned to receive FOLFIRI or CAPTEM as second line treatment The primary objective is to assess DCR and the safety as co-primary objective. The secondary objectives are: OS, PFS, quality of life and toxicity of subsequent line of therapy (after Progression Disease PD) with an observational purpose.

The secondary exploratory objectives are the assessment of the impact of PET with gallium on PFS and the evaluation of biomarkers

Study treatment:

FOLFIRI regimen

  • Oxaliplatin (CPT-11) 180 mg/m2, given as 60 min. i.v. infusion on day 1 every 2 weeks followed by
  • Calcio levofolinate 200 mg/m2, given as a 2h i.v. infusion on days 1 every 2 weeks followed by
  • 5-Fluorouracil 400 mg/m2 given as bolus, and then 5-Fluorouracil 2400 mg/m2 given as a 48 h continuous infusion on day 1, every 2 weeks, until progression or for a maximum of 12 cycles

CAPTEM regimen Capecitabine 750 mg/m2 twice a day on days 1-14 in combination with temozolomide 200 mg/m2 daily on days 10-14, every 4 weeks, until progression or for a maximum of 6 cycles.

02

Conditions studied

  • Neuroendocrine Carcinoma

Keywords

  • Neuroendocrine Carcinoma
  • second line therapy
  • PET imaging
  • FOLFIRI
  • CAPTEM
03

In context

Carcinoma, Neuroendocrine

172 studies on the registry are indexed under Carcinoma, Neuroendocrine; 66 are open to participants now.

This study's enrollment of 53 is below the median of 60 across 144 interventional studies indexed under Carcinoma, Neuroendocrine.

Browse Carcinoma, Neuroendocrine studies →

Lead sponsor

Istituto Romagnolo per lo Studio dei Tumori Dino Amadori IRST S.r.l. IRCCS is the lead sponsor of 60 studies on the registry; 20 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  1. Histopathologic diagnosis of neuroendocrine carcinomas (GEP NEC and lung NEC), G3 with ki67 > 20%. Other rare sites of origin such as genitourinary or gynecological or larynx or unknown origin neuroendocrine carcinoma with Ki67 > 20% will be included.
  2. Male or Female, aged >=18 years.
  3. according to 1.1 criteria.
  4. Patients who already received a treatment for disease with platinum compound-based regimen chemotherapy (Cisplatin/Carboplatin and Etoposide, folfox4 or Capecitabine-Oxaliplatin).
  5. Previous treatments with immuno checkpoint-inhibitor and/or everolimus are permitted
  6. greater than 3 months
  7. (ECOG) performance status ≤ 2.
  8. Adequate haematological, liver and renal function:

    neutrophils > 2.0 x 109 /L, > 100 x 109 /L, > 10g/dL, total \< 1 Upper Normal Limit (UNL), (ASAT) and Alanine transaminase (ALAT) \< 2.5 x UNL or \< 5 x UNL in presence of liver metastases, alkaline phosphatase \< 2.5 x UNL; patients with ASAT or ALAT >1.5 x UNL associated with alkaline phosphatase >2.5 x UNL are not eligible.); creatinine \<1.5 UNL. In presence of borderline values, the calculated according to Cockcroft-Gault formula, 60 ML/min.

  9. If female of highly effective methods, according to guideline "Recommendation related to contraception and pregnancy testing in clinical trials", (2014_09_15 section 4.1) are mandatory. Highly effective birth control methods are required beginning at the screening visit and continuing until 6 months following last treatment with study drug. Negative serum pregnancy test for females of childbearing potential within 14 days of starting treatment. Male patient and his female partner who is of childbearing potential must use 2 acceptable methods of birth control (1 of which must include a condom as a barrier method of contraception) starting at screening and continuing throughout the study period and for 6 months after final study drug administration. Two acceptable methods of birth control thus include Condom (barrier method of contraception) and one of the following is required ( established use of oral, or injected or implanted hormonal method of contraception by the female partner; placement of an intrauterine device (IUD) or intrauterine system (IUS) by the female partner; additional barrier method like occlusive cap with spermicidal foam/gel/film/cream/suppository in the female partner; tubal ligation in the female partner; vasectomy or other procedure resulting in infertility (eg, bilateral orchiectomy), for more than 6 months.
  10. Written signed and dated before registration procedures, including expected cooperation of the patients for the treatment and follow-up, must be obtained and documented according to the local regulatory requirement.
  11. allowed if asymptomatic at study baseline. Whole brain irradiation or focal treatment for Central Nervous System (CNS) metastases are permitted.

Exclusion criteria

Exclusion Criteria:

  1. Ki67 index ≤ 20 %.
  2. Patients with NECs already treated with irinotecan regimen.
  3. Patients with a known to fluorouracil or calcium levofolinate or Irinotecan or their recipients.
  4. All acute toxic effects of any prior therapy (including surgery radiation therapy, chemotherapy) must have resolved to a grade \<= 1 according to National Cancer Institute Version 5.0 (CTCAE).
  5. minor than 3 months.
  6. performance status >2.
  7. Participation in another clinical trial with any agents within 30 days prior to study screening.
  8. Patients who have any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study such as:

    • unstable angina pectoris, symptomatic congestive heart failure, myocardial infarction within 6 months of start of study drug, serious uncontrolled cardiac arrhythmia or any other cardiac disease.
    • severely impaired lung function (spirometry and diffusing capacity of lung for carbon monoxide (DLCO) that is 50% of the normal predicted value and/or Oxygen saturation that is 88% or less at rest, in room air).
    • uncontrolled diabetes as defined by fasting serum glucose >1.5 x UNL.
    • any active (acute or chronic) or uncontrolled infections/disorders
  9. History of allergic reactions attributed to compounds of similar chemical or biologic composition.
  10. Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier
  11. Patients with uncontrolled or symptomatic will be excluded because they often develop progressive neurologic dysfunction that can be confounding of neurologic and other adverse events
  12. Other with a disease-free interval of less than 5 years (except non melanoma skin cancer or low grade superficial bladder cancer).
Terms in these criteria, in plain language(20)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Measurable disease

The amount of disease can be tracked with a defined measurement, so the study can see whether it shrinks or grows. It might be a tumour measured on a scan or, in some blood cancers such as myeloma, a marker measured in blood or urine.

The criteria or the study team say which measurement counts — having no tumour visible on a scan does not by itself rule you out.

RECIST

The standard rules for measuring tumours on CT or MRI scans, to tell whether a cancer is shrinking, stable or growing during treatment.

“Measurable disease per RECIST 1.1” usually means at least one tumour 10 mm or more at its longest on a CT scan, or a lymph node 15 mm or more across its short axis.

Line of therapy

A line of therapy is one course of treatment, which may combine several drugs. First-line is the first course given; second-line follows when that stops working or is not tolerated.

“Two prior lines” means two courses that count separately under the study’s rules — not simply two drugs. Ask the study team if you are unsure how yours are counted.

Metastases

Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.

Life expectancy

The study doctor’s estimate of how long someone is likely to live. Criteria use it so that people can stay in the study long enough for it to answer its question.

ECOG performance status

A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.

0
Fully active, no restrictions.
1
Limited in strenuous activity, but walking and able to do light work, such as housework or office work.
2
Walking and able to look after yourself, but unable to work; up and about more than half of waking hours.
3
Able to look after yourself only in part; in bed or a chair more than half of waking hours.
4
Unable to look after yourself at all; in bed or a chair all day.

Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

Hemoglobin (Hb)

The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

Creatinine clearance (CrCl)

How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Brain metastases

Cancer deposits in the brain from a cancer that started elsewhere in the body (CNS metastases include the spinal cord).

Studies differ: some leave out any brain metastases, some accept ones treated and stable for some weeks. Check what this study allows.

Hypersensitivity

An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.

CTCAE grade

The US National Cancer Institute’s scale of how severe an adverse event is — any unwanted medical event during a study, such as a symptom, an illness or an abnormal test result, whether or not a treatment caused it. Whether it did is judged separately.

1
Mild.
2
Moderate.
3
Severe.
4
Life-threatening.
5
Death due to the event.

“Side effects of earlier treatment resolved to grade 1 or less” means they have settled to mild or gone.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

Clinically significant

Judged by the study doctor to matter for your health or for the study. It is a doctor’s decision, so ask the study team if you are unsure whether something counts.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
53 participants (actual)

Study arms

  • Active comparator
    FOLFIRI regimen

    CPT-11 180 mg/m2, given as 60 min. i.v. infusion on day 1 every 2 weeks followed by Calcio levofolinate 200 mg/m2, given as a 2h i.v. infusion on days 1 every 2 weeks followed by 5-Fluorouracil 400 mg/m2 given as bolus, and then 5-Fluorouracil 2400 mg/m2 given as a 48 h continuous infusion on day 1, every 2 weeks, until progression or for a maximum of 12 cycles

    Drug: CPT-11 · Drug: Calcio levofolinate · Drug: 5-Fluorouracil

  • Experimental
    CAPTEM regimen

    Capecitabine 750 mg/m2 twice a day on days 1-14 in combination with Temozolomide 200 mg/m2 daily on days 10-14, every 4 weeks, until progression or for a maximum of 6 cycles

    Drug: Capecitabine · Drug: Temozolomide

Interventions

06

What researchers measure

Primary outcomes

  1. Disease Control Rate (DCR)

    DCR is defined as the percentage of patients who have achieved complete, partial response and stable disease lasting for at least 12 weeks. DCR will be evaluated using the new international criteria proposed by the Version 1.1 Response Evaluation Criteria in Solid Tumors (RECIST).

    Time frame: responses to treatment lasting at least 12 weeks up to 48 months of study period

  2. Incidence of treatment related adverse events

    Acute treatment related adverse events and late treatment related adverse events will be evaluated; the late treatment related adverse events is the adverse event that occurred after 30 days from the last treatment cycle. The adverse events will be evaluated according to CTCAE Version 5.0.

    Time frame: up to 60 months

Secondary outcomes

  1. Overall Survival (OS)

    Overall Survival (OS) is defined as the time from treatment start to the time of death from any cause. Subjects who are alive at the time of the final analysis or who have become lost to follow-up will be censored at their last known alive date.

    Time frame: up to 60 months

  2. Progression Free Survival (PFS)

    Progression free survival is defined as the time from the start treatment date to the date of first observation of documented disease progression or death due to any cause. Patients without tumor progression at the time of analysis will be censored at their last date of tumor evaluation.

    Time frame: up to 60 months

  3. Objective response rate (ORR)

    ORR is defined as the percentage of patients who have achieved complete and partial response for at least 12 weeks from therapy start.

    Time frame: responses to treatment lasting at least 12 weeks up to 60 months of study period

  4. Quality of Life Questionnaire (QLQ)

    Quality of life will be evaluated through validated standardized data collection forms from the EORTC QLQ-C30 questionnaire (quality of life questionnaire). Scoring of global health status, functional scales and symptom scales will be calculated according to EORTC QLQ-C30 Scoring Manual.

    Time frame: up to 60 months

  5. Evaluation of biomarkers

    testing for mutational status of Multiple endocrine neoplasia, type 1 (MEN1), death-domain-associated protein (DAXX), α thalassemia/mental retardation syndrome X-linked (ATRX) and Retinoblastoma 1 (RB-1) on primary tumors tissues and for miRNA on blood samples.

    Time frame: up to 60 months

07

Study locations

23 sites
  • Az. Osp. Ospedali Riuniti di Ancona
    Ancona, AN 60020, Italy
  • A.O.U. Policlinico di Bari
    Bari, BA 70124, Italy
  • IRCCS IST. Tumori Bari - Giovanni Paolo II
    Bari, BA 70124, Italy
  • Ospedale di Feltre
    Feltre, Belluno 32032, Italy
  • ASST Spedali Civili di Brescia
    Brescia, BS 25123, Italy
  • Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)
    Meldola, FC 47014, Italy
  • AOU Careggi
    Firenze, FI 50134, Italy
  • Istituto Europeo di Oncologia
    Milano, MI, Italy
  • Istituto Nazionale Tumori Milano
    Milano, MI, Italy
  • Azienda Ospedaliera-Universitaria di Modena
    Modena, MO, Italy
  • Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone"
    Palermo, PA 90127, Italy
  • Centro di Riferimento Oncologico di Aviano
    Aviano, Pordenone 33081, Italy
  • Ospedale Civile degli Infermi
    Faenza, RA, Italy
  • Policlinico Campus Biomedico Roma
    Roma, RM 00128, Italy
  • AOU San Luigi Gonzaga
    Orbassano, TO 10043, Italy
  • Azienda Ospedaliere Universitaria Integrata Verona
    Verona, VR 37134, Italy
  • Policlinico S. Orsola-Malpighi
    Bologna, 40138, Italy
  • Ospedale di Bolzano
    Bolzano, Italy
  • IRCCS "Saverio De Bellis"
    Castellana Grotte, Italy
  • Ospedale "Vito Fazzi"
    Lecce, Italy
  • Istituto Oncologico Veneto
    Padova, Italy
  • Azienda Ospedaliera-Universitaria di Parma
    Parma, Italy
  • Ospedale S.Chiara - AOU Pisana
    Pisa, Italy
08

References and documents

Publications

  • Bongiovanni A, Liverani C, Pusceddu S, Leo S, Di Meglio G, Tamberi S, Santini D, Gelsomino F, Pucci F, Berardi R, Lolli I, Bergamo F, Ricci S, Foca F, Severi S, Ibrahim T; SENECA Study Team Investigators. Randomised phase II trial of CAPTEM or FOLFIRI as SEcond-line therapy in NEuroendocrine CArcinomas and exploratory analysis of predictive role of PET/CT imaging and biological markers (SENECA trial): a study protocol. BMJ Open. 2020 Jul 19;10(7):e034393. doi: 10.1136/bmjopen-2019-034393. PubMed 32690499 ↗
09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Mar 10, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT03387592
Lead sponsor
Istituto Romagnolo per lo Studio dei Tumori Dino Amadori IRST S.r.l. IRCCS
Responsible party
Sponsor
First posted
Jan 2, 2018
Start date
Mar 6, 2017
Primary completion
Feb 28, 2022
Completion
Feb 28, 2022
Last update
Mar 10, 2025

Study contacts

Toni Ibrahim, MD
principal investigator · Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is terminated, as verified in Mar 2022. You cannot join it, but the record below documents what was studied.

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Studies of the drugs tested here: Capecitabine · Temozolomide

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