Intraperitoneal vs Intravenous Chemotherapy Following Neoadjuvant Chemotherapy in Ovarian Cancer
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| ClinicalTrials.gov Identifier: NCT00993655 |
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Recruitment Status :
Completed
First Posted : October 12, 2009
Results First Posted : August 10, 2017
Last Update Posted : August 28, 2023
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RATIONALE: Drugs used in chemotherapy, such as paclitaxel, carboplatin, and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) and giving them in different ways may kill more tumor cells. It is not yet known which combination chemotherapy regimen is more effective in treating patients with ovarian epithelial cancer, primary peritoneal cancer, and fallopian tube cancer.
PURPOSE: This randomized phase II trial is comparing the side effects of three combination chemotherapy regimens and to see how well they work in treating patients with stage IIB, stage IIC, stage III, or stage IV ovarian epithelial cancer, primary peritoneal cancer, or fallopian tube cancer.
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Fallopian Tube Cancer Metastatic Cancer Ovarian Cancer Peritoneal Cavity Cancer | Drug: carboplatin Drug: cisplatin Drug: paclitaxel | Phase 2 |
OBJECTIVES:
Primary
- To compare the efficacy of the selected IP chemotherapy regimen (Arm 3: IV paclitaxel and IP carboplatin plus day 8 IP paclitaxel) versus IV carboplatin plus paclitaxel (Arm 1) in patients with epithelial ovarian cancer optimally debulked at surgery following neoadjuvant intravenous chemotherapy. Nine month progressive rate post randomization is the primary endpoint for assessment of efficacy.
Secondary
- To compare IP plus IV chemotherapy versus IV carboplatin plus paclitaxel with respect to progression free survival and overall survival.
OUTLINE: This is a multicenter study. Patients are stratified according to cooperative group, residual disease (observable [e.g., macroscopic] disease that is evident at end of delayed primary debulking surgery vs no evidence of observable disease at end of delayed primary debulking surgery), reason for delayed primary debulking surgery at initial diagnosis (nonresectable disease vs other reasons), and timing of intraperitoneal catheter insertion (intra-operative catheter insertion vs post-operative insertion).
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Phase II: Patients are randomized to 1 of 3 treatment groups.
- ARM 1: Paclitaxel 135 mg/m2 intravenous day 1 plus Carboplatin AUC 5 if measured GFR or AUC6 if estimated GFR intravenous day 1; Paclitaxel 60 mg/m2 intravenous day 8. Cycles given Q 21 days x 3 cycles
- ARM 2: Paclitaxel 135 mg/m2 intravenous day 1 plus Cisplatin 75 mg/m2 intraperitoneal day 1; Paclitaxel 60 mg/m2 intraperitoneal day 8. Cycles given Q 21 days x 3 cycles (Phase II cisplatin arm closed to accrual on 2014-Feb-03)
- ARM 3: Paclitaxel 135 mg/m2 intravenous day 1 plus Carboplatin AUC 5 if measured GFR or AUC6 if estimated GFR intraperitoneal day 1; Paclitaxel 60 mg/m2 intraperitoneal day 8. Cycles given Q 21 days x 3 cycles.
Patients also receive carboplatin IP on day 1. Treatment repeats every 21 days for 3 courses in the absence of disease progression or unacceptable toxicity.
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Expanded Phase II: Patients are randomized to 1 of 2 treatment groups.
- Arm I: Patients receive paclitaxel and carboplatin as in phase II, arm I.
- Arm III: Patients receive paclitaxel and cisplatin as in phase II, arm II or paclitaxel and carboplatin as in phase II, arm III.
Patients complete quality of life questionnaires EORTC QLQ-C30, ovarian cancer module (EORTC QLQ-OV28), and FACT/GOG-Ntx at baseline, on day 1 of courses 2 and 3, at 3, 6 and 12 months after completion of study treatment, and then annually until disease progression, death, or initiation of second-line therapy.
After completion of study treatment, patients are followed at 6 weeks, every 3 months for 2 years, every 6 months for 2 years, and then annually until progression, death, or initiation of second-line therapy.
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 275 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Treatment |
| Official Title: | A Phase II Study of Intraperitoneal (IP) Plus Intravenous (IV) Chemotherapy Versus IV Carboplatin Plus Paclitaxel in Patients With Epithelial Ovarian Cancer Optimally Debulked at Surgery Following Neoadjuvant Intravenous Chemotherapy |
| Actual Study Start Date : | March 3, 2010 |
| Actual Primary Completion Date : | March 10, 2016 |
| Actual Study Completion Date : | July 11, 2016 |
| Arm | Intervention/treatment |
|---|---|
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Active Comparator: IV carboplatin + IV paclitaxel
ARM 1: Paclitaxel 135 mg/m2 intravenous day 1 plus Carboplatin AUC 5 if measured GFR or AUC6 if estimated GFR intravenous day 1; Paclitaxel 60 mg/m2 intravenous day 8. Cycles given Q 21 days x 3 cycles
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Drug: carboplatin
Carboplatin AUC 5 if measured GFR or AUC6 if calculated GFR intravenous or intraperitoneal. Drug: paclitaxel Paclitaxel 135 mg/m2 intravenous day 1 plus Paclitaxel 60 mg/m2 intraperitoneal or intravenously day 8. Cycles given Q 21 days x 3 cycles |
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Active Comparator: IP cisplatin + IV/IP paclitaxel
ARM 2: Paclitaxel 135 mg/m2 intravenous day 1 plus Cisplatin 75 mg/m2 intraperitoneal day 1; Paclitaxel 60 mg/m2 intraperitoneal day 8. Cycles given Q 21 days x 3 cycles (Phase II cisplatin arm closed to accrual on 2014-FEB-03)
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Drug: cisplatin
Cisplatin 75 mg/m2 intraperitoneal day 1 Drug: paclitaxel Paclitaxel 135 mg/m2 intravenous day 1 plus Paclitaxel 60 mg/m2 intraperitoneal or intravenously day 8. Cycles given Q 21 days x 3 cycles |
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Active Comparator: IP carboplatin + IV/IP paclitaxel
ARM 3: Paclitaxel 135 mg/m2 intravenous day 1 plus Carboplatin AUC 5 if measured GFR or AUC6 if estimated GFR intraperitoneal day 1; Paclitaxel 60 mg/m2 intraperitoneal day 8. Cycles given Q 21 days x 3 cycles
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Drug: carboplatin
Carboplatin AUC 5 if measured GFR or AUC6 if calculated GFR intravenous or intraperitoneal. Drug: paclitaxel Paclitaxel 135 mg/m2 intravenous day 1 plus Paclitaxel 60 mg/m2 intraperitoneal or intravenously day 8. Cycles given Q 21 days x 3 cycles |
- 9-month Progression Rate Post-randomization [ Time Frame: 9 months ]It is defined as proportion of patients who had progressed at or before 9 months after randomization, i.e., the time from the randomization to the date when the first observation of disease progression (earliest of the date when the first CA 125 meets progression definition and the date of first objective relapse or progression, defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions, recorded) has been documented or when death due to any cause has been observed was less than or equal to 9 months.
- Progression Free Survival [ Time Frame: During the study with median follow-up of 33 months ]Time from the day of randomization until the time when first observation of disease progression (earliest of the dates of first CA125 which meets progression definition and first objective relapse or progression defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions, has been documented or when death due to any cause has been observed.
- Overall Survival [ Time Frame: During the study with median follow-up of 33 months ]Time from the day of randomization to death from any cause.
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| Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
| Sexes Eligible for Study: | Female |
| Accepts Healthy Volunteers: | No |
DISEASE CHARACTERISTICS:
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Histologically confirmed ovarian epithelial, primary serous type peritoneal, or fallopian tube carcinoma
- Patients with ovarian cancer of the clear cell histology are eligible. Histologic confirmation is preferably by biopsy or limited excision prior to neo-adjuvant treatment. If the diagnosis prior to neo-adjuvant chemotherapy is based on cytology, histologic confirmation is required prior to randomization. Histologic confirmation can be obtained at the time of debulking surgery by intra-operative frozen section, thus permitting intra-operative randomization, or by final pathologic review of the resected specimen if randomization is to be performed following debulking surgery.
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Initial FIGO stage IIB-III disease
- Stage IV disease allowed provided the only criterion for stage IV disease is the presence of a pleural effusion confirmed to be associated with positive cytology for ovarian cancer
- Completed ≥ 3 but no more than 4 courses of platinum-based neoadjuvant chemotherapy prior to the first debulking surgery
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Meets the following criteria for surgical treatment prior to randomization:
- Initial Diagnosis: No debulking surgery was attempted or completed.
- The patient's first cytoreductive (debulking) surgery must be after neoadjuvant chemotherapy (Delayed Primary Debulking). The delayed primary debulking surgery must be completed no more than 4 weeks after commencing administering of the last cycle of neoadjuvant chemotherapy and must be completed no more than 6 weeks prior to randomization.
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Surgery will include total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy and any additional procedures required to achieve maximal cytoreduction with residual disease of 1 cm or less as assessed by the surgeon at the end of surgery.
- Delayed primary debulking surgery must be completed no more than 4 weeks after the last course of neoadjuvant chemotherapy and must be completed no more than 6 weeks prior to randomization
- Surgery will include total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and any additional procedures required to achieve maximal cytoreduction with residual disease of ≤ 1 cm as assessed by the surgeon at the end of surgery
- No borderline ovarian tumors (i.e., tumors of low malignant potential) alone
- No mucinous tumor
PATIENT CHARACTERISTICS:
- ECOG performance status 0-2
- Life expectancy ≥ 12 weeks
- Granulocyte count ≥ 1.5 x 10^9/L
- Platelet count ≥ 100 x 10^9/L
- Serum creatinine ≤ upper limit of normal (ULN) OR > ULN to ≤ 1.25 ULN provided measured creatinine clearance is > 60 mL/min
- Serum bilirubin normal
- AST/ALT ≤ 2.5 times ULN
- Fertile patients must use effective contraception
- Able (i.e., sufficiently fluent) and willing to complete the quality of life questionnaires
- Accessible for treatment and follow-up
- No history of other malignancy, except adequately treated nonmelanoma skin cancer, curatively treated carcinoma in situ of the cervix, or other solid tumors curatively treated with no evidence of disease for ≥ 5 years
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No uncontrolled atrial or ventricular arrhythmias including second or third degree heart block unless managed with implanted pacemaker
- Patients with a history of first degree heart block are eligible
- No documented myocardial infarction within the past 6 months preceding randomization (pretreatment ECG evidence only of infarct will not exclude patients)
- No diagnosis of bowel obstruction
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No serious illness or medical condition which would not permit the patient to be managed according to protocol including, but not limited to, any of the following:
- Prior allergic reactions to drugs containing cremophor or to compounds chemically related to cisplatin, paclitaxel, or carboplatin
- Symptomatic congestive heart failure within the past 6 months or other conditions which would lead to a contraindication of a high-volume saline diuresis
- History of significant neurologic or psychiatric disorder which would impair the ability to obtain consent
- Active uncontrolled infection
- Persistent peripheral neuropathy or hearing loss ≥ grade 2 resulting from prior therapy
- Extensive intraperitoneal adhesion intra- or post-operatively which would impede intraperitoneal treatment delivery
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- No prior therapy for ovarian cancer, except for neoadjuvant platinum-based chemotherapy and surgery
- No concurrent intraperitoneal adhesion barriers
- No other concurrent anticancer treatment, including cytotoxic agents, biological response modifiers, immunotherapy, anticancer hormone therapy, or investigational drug therapy
- No other concurrent experimental drugs or anticancer therapy
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00993655
Show 50 study locations
| Study Chair: | Helen J. Mackay, MD | Princess Margaret Hospital, Canada | |
| Study Chair: | Diane M. Provencher, MD, FRCS, FACOG | Hopital Notre-Dame du CHUM |
| Responsible Party: | Canadian Cancer Trials Group |
| ClinicalTrials.gov Identifier: | NCT00993655 |
| Other Study ID Numbers: |
OV21 CAN-NCIC-OV21 ( Registry Identifier: PDQ (NCI US Physician Data Query) ) UCL08/0379 ( Other Identifier: NCI ) GEICO-0902 ( Other Identifier: GEICO ) SWOG OV.21 ( Other Identifier: South West Oncology Group ) CDR0000655241 ( Other Identifier: PDQ ) |
| First Posted: | October 12, 2009 Key Record Dates |
| Results First Posted: | August 10, 2017 |
| Last Update Posted: | August 28, 2023 |
| Last Verified: | March 2020 |
| Individual Participant Data (IPD) Sharing Statement: | |
| Plan to Share IPD: | No |
| Studies a U.S. FDA-regulated Drug Product: | Yes |
| Studies a U.S. FDA-regulated Device Product: | No |
| Product Manufactured in and Exported from the U.S.: | No |
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peritoneal cavity cancer fallopian tube cancer stage II ovarian epithelial cancer stage III ovarian epithelial cancer |
stage IV ovarian epithelial cancer malignant pleural effusion ovarian clear cell cystadenocarcinoma ovarian clear cell tumor with proliferating activity |
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Ovarian Neoplasms Carcinoma, Ovarian Epithelial Fallopian Tube Neoplasms Endocrine Gland Neoplasms Neoplasms by Site Neoplasms Ovarian Diseases Adnexal Diseases Genital Diseases, Female Female Urogenital Diseases Female Urogenital Diseases and Pregnancy Complications Urogenital Diseases Genital Neoplasms, Female Urogenital Neoplasms Genital Diseases |
Endocrine System Diseases Gonadal Disorders Carcinoma Neoplasms, Glandular and Epithelial Neoplasms by Histologic Type Fallopian Tube Diseases Paclitaxel Carboplatin Antineoplastic Agents, Phytogenic Antineoplastic Agents Tubulin Modulators Antimitotic Agents Mitosis Modulators Molecular Mechanisms of Pharmacological Action |