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Carboplatin and Paclitaxel With or Without Bevacizumab After Surgery in Treating Patients With Recurrent Ovarian Epithelial Cancer, Primary Peritoneal Cavity Cancer, or Fallopian Tube Cancer
This study is currently recruiting participants.
Verified April 2011 by National Cancer Institute (NCI)

First Received on November 29, 2007.   Last Updated on April 2, 2011   History of Changes
Sponsor: Gynecologic Oncology Group
Collaborator: National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00565851
  Purpose

RATIONALE: Drugs used in chemotherapy, such as carboplatin and paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. It is not yet known whether combination chemotherapy is more effective when given with or without bevacizumab after surgery in treating patients with recurrent ovarian epithelial cancer, primary peritoneal cavity cancer, or fallopian tube cancer.

PURPOSE: This randomized phase III trial is studying giving carboplatin and paclitaxel together with or without bevacizumab after surgery to see how well it works in treating patients with recurrent ovarian epithelial cancer, primary peritoneal cavity cancer, or fallopian tube cancer.


Condition Intervention Phase
Fallopian Tube Cancer
Ovarian Cancer
Malignant Tumor of Peritoneum
Biological: bevacizumab
Drug: carboplatin
Drug: docetaxel
Drug: paclitaxel
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Primary Purpose: Treatment
Official Title: A Phase III Randomized Controlled Clinical Trial of Carboplatin and Paclitaxel Alone or in Combination With Bevacizumab (NSC #704865, IND #7921) Followed by Bevacizumab and Secondary Cytoreduction Surgery in Platinum-Sensitive, Recurrent Ovarian, Peritoneal Primary and Fallopian Tube Cancer

Resource links provided by NLM:


Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Overall survival [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Progression-free survival [ Designated as safety issue: No ]
  • Frequency and severity of adverse events [ Designated as safety issue: Yes ]

Estimated Enrollment: 660
Study Start Date: December 2007
Estimated Primary Completion Date: December 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Arm I
Patients receive paclitaxel IV over 3 hours or docetaxel IV over 1 hour and carboplatin over 30 minutes on day 1. Treatment repeats every 21 days.
Drug: carboplatin
Given IV
Drug: docetaxel
Given IV
Drug: paclitaxel
Given IV
Experimental: Arm II
Patients receive chemotherapy as in arm I and bevacizumab IV over 30-90 minutes on day 1. Treatment repeats every 21 days.
Biological: bevacizumab
Given IV
Drug: carboplatin
Given IV
Drug: docetaxel
Given IV
Drug: paclitaxel
Given IV

Detailed Description:

OBJECTIVES:

Primary

  • To determine if surgical secondary cytoreduction in addition to adjuvant chemotherapy comprising carboplatin and paclitaxel with or without bevacizumab increases the duration of overall survival of patients with recurrent platinum-sensitive ovarian epithelial cancer, primary peritoneal cavity cancer, or fallopian tube cancer.
  • To determine if the addition of bevacizumab to the second-line and maintenance phases of treatment increases the duration of overall survival relative to second-line paclitaxel and carboplatin alone in these patients.

Secondary

  • To determine if the addition of bevacizumab to the second-line and maintenance phase of treatment increases the duration of progression-free survival relative to second-line paclitaxel and carboplatin alone in these patients.
  • To prospectively determine the incidence of carboplatin and paclitaxel hypersensitivity in these patients undergoing retreatment with both agents as first recurrence therapy.
  • To determine if surgical secondary cytoreduction in addition to adjuvant chemotherapy increases quality of life (QOL) of patients with recurrent platinum-sensitive ovarian epithelial cancer or primary peritoneal cavity cancer, as measured by the FACT-O trial outcome index and Rand SF-36 physical functioning scale.
  • To determine if the addition of bevacizumab to the second-line and maintenance phases of treatment increases QOL relative to second-line paclitaxel and carboplatin alone in patients with recurrent platinum-sensitive ovarian epithelial cancer or primary peritoneal cavity cancer.

OUTLINE: This is a multicenter study. Patients are assigned to 1 of 2 treatment groups. Patients who are not candidates for surgical cytoreduction (i.e., those for whom complete cytoreduction in the estimation of the investigator is impossible or a medical infirmity precludes exploration and debulking) are eligible to receive chemotherapy after randomization. Patients who are eligible for surgery undergo abdominal exploration with cytoreduction and undergo tumor tissue collection and complete a quality of life questionnaire before and after surgery. All patients are then randomized to 1 of 2 treatment arms.

  • Arm I: Patients receive paclitaxel IV over 3 hours or docetaxel IV over 1 hour and carboplatin over 30 minutes on day 1.
  • Arm II: Patients receive chemotherapy as in arm I and bevacizumab IV over 30-90 minutes on day 1.

Treatment in both arms repeats every 21 days in the absence of disease progression or unacceptable toxicity. Patients with measurable disease achieving a clinical response (CR) receive 6-8 courses of therapy. Patients with stable disease or partial regression receive a maximum of 6 courses. Patients without measurable lesions as determined by a CT scan prior to initiating study treatment continue therapy for 6 courses or, if CA-125 normalizes, for 2 cycles beyond CA-125 normalization, whichever is greater. Patients in arm II then receive a maintenance regimen comprising bevacizumab IV over 30-90 minutes. Treatment with bevacizumab alone repeats every 3 weeks in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed periodically for 10 years.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Patients must have histologic diagnosis of ovarian epithelial carcinoma, primary peritoneal cavity carcinoma, or fallopian tube carcinoma

    • Recurrent disease* NOTE: *Patients with biochemical recurrence, by definition, are not eligible for surgical randomization and should be considered for the chemotherapy randomization alone.
  • The following histologic epithelial cell types** are allowed:

    • Serous adenocarcinoma
    • Endometrioid adenocarcinoma
    • Mucinous adenocarcinoma
    • Undifferentiated carcinoma
    • Clear cell adenocarcinoma
    • Mixed epithelial carcinoma
    • Transitional cell carcinoma
    • Malignant Brenner Tumor
    • Adenocarcinoma not otherwise specified NOTE: **Prior histologic diagnosis of borderline, low malignant potential (grade 0) epithelial carcinoma that was surgically resected and subsequently developed an unrelated, new invasive ovarian epithelial or primary peritoneal cavity cancer allowed provided the histological criteria for epithelial cell type is met
  • Patients with synchronous primary endometrial cancer or a past history of primary endometrial cancer are excluded, unless all of the following conditions are met:

    • Stage not greater than I-B
    • No more than superficial myometrial invasion
    • No vascular or lymphatic invasion
    • No poorly differentiated subtypes, including papillary serous, clear cell or other FIGO grade 3 lesions
  • Patients must have had a complete response to front-line platinum-taxane therapy (at least 3 cycles) and a treatment-free interval without clinical evidence of progressive disease lasting at least 6 months

    • Front-line therapy may have included a biologic agent (e.g., bevacizumab) but an interval of at least 6 months must have elapsed after completion of therapy
    • A complete response to front-line chemotherapy must include the following:

      • Negative physical exam
      • Negative pelvic exam
      • Normalization of CA125, if elevated at baseline
      • Negative radiographic assessment of disease
    • Front-line treatment may include maintenance therapy following complete clinical or pathological response provided recurrent disease is not identified earlier than 6 months following completion of all anticancer treatment

      • Patients receiving maintenance biological therapy or hormonal therapy are eligible provided their recurrence is documented more than 6 months from primary cytotoxic chemotherapy completion (includes maintenance chemotherapy) AND a minimum of 4 weeks has elapsed since their last infusion of biological therapy
      • Patients enrolled on GOG-0198 or patients receiving hormonal therapy for biochemical or non-measurable recurrence disease are eligible provided their recurrence is documented more than 6 months following the completion of primary cytotoxic chemotherapy AND a minimum of 4 weeks must have elapsed since their last exposure to hormonal therapy
  • Clinically evident measurable or nonmeasurable disease*** defined as at least one lesion that can be accurately measured in at least one dimension (longest dimension to be recorded)

    • Each lesion must be ≥ 20 mm when measured by conventional techniques, MRI or CT scan, or ≥ 10 mm when measured by spiral CT scan
    • Nonmeasurable disease defined by symptomatic ascites or pleural effusion
    • Patients with clinically evident measurable or nonmeasurable disease must also have any 1 of the following:

      • CA-125 > 2 times upper limit of normal
      • Histologic confirmation of recurrence in the absence of an elevated CA-125 and measurable disease NOTE: ***Patients with nonmeasurable, clinically-evident disease, by definition, are not eligible for surgical randomization and should be considered for the chemotherapy randomization alone.

PATIENT CHARACTERISTICS:

Inclusion criteria:

  • GOG performance status of 0, 1, or 2
  • Platelet count ≥ 100,000/mm^3
  • Absolute neutrophil count ≥ 1,500/mm^3
  • Creatinine (non-IDMS) ≤ 1.5 times upper limit of normal (ULN)
  • Total bilirubin ≤ 1.5 times ULN
  • SGOT/AST and alkaline phosphatase ≤ 2.5 times ULN (< 5.0 times ULN in the presence of liver metastasis)
  • Urine protein-to-creatinine ratio < 1.0 mg/dL
  • Signed an approved informed consent and authorization permitting release of personal health information
  • Patients with allergic (i.e., hypersensitivity) reactions to these chemotherapeutic agents are eligible if they were successfully retreated following a desensitization program or protocol

Exclusion criteria:

  • Patients who require parenteral hydration or nutrition and have evidence of partial bowel obstruction or perforation
  • Patients with uncontrolled infection
  • Patients with concurrent severe medical problems unrelated to the malignancy that would significantly limit full compliance with the study or expose the patient to extreme risk or decreased life expectancy
  • Patients with peripheral neuropathy ≥ grade 2
  • Patients with a history of allergic reactions to carboplatin and/or paclitaxel or chemically similar compounds
  • Patients with known hypersensitivity to Chinese hamster ovary cell products or other recombinant human or humanized antibodies
  • Patients of childbearing potential not practicing adequate contraception or patients who are pregnant or nursing
  • Patients with other invasive malignancies, with the exception of nonmelanoma skin cancer, or patients who had (or have) any evidence of the other cancer present within the past 5 years or whose previous cancer treatment contraindicates this protocol therapy
  • Patients with active bleeding or pathologic conditions that carry high risk of bleeding such as a known bleeding disorder, coagulopathy, or tumor involving major vessels
  • Patients with a history or evidence upon physical examination of CNS disease, including primary brain tumor, seizures not controlled with standard medical therapy, any brain metastases, or a history of stroke within the past 5 years
  • Patients with clinically significant cardiovascular disease including any of the following:

    • Significant cardiac conduction abnormalities (e.g., PR interval > 0.24 sec or 2nd or 3rd degree atrioventricular block)
    • Uncontrolled hypertension, defined as systolic blood pressure (BP) > 150 mm Hg or diastolic BP > 90 mm Hg
    • Myocardial infarction, cardiac arrhythmia, or unstable angina within the past 6 months
    • New York Heart Association grade II or greater congestive heart failure
    • Serious cardiac arrhythmia requiring medication
    • Grade II or greater peripheral vascular disease except episodes of ischemia < 24 hrs in duration that are managed non-surgically and without permanent deficit
    • History of cerebrovascular accident within the past 6 months
    • No significant traumatic injury within the past 28 days

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • No more than 1 prior regimen of chemotherapy (maintenance therapy is not considered a second regimen)
  • No prior radiotherapy to any portion of the abdominal cavity or pelvis
  • No prior chemotherapy for any other abdominal or pelvic tumor other than ovarian, fallopian tube, or primary peritoneal cancer
  • No major surgical procedure, open biopsy, or dental extractions or other dental surgery/procedure that results in an open wound within the past 28 days
  • No placement of vascular access device or core biopsy within the past 7 days
  • No concurrent immunotherapy or radiotherapy
  • No anticipation of need for major surgical procedure during the course of the study
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00565851

  Show 264 Study Locations
Sponsors and Collaborators
Gynecologic Oncology Group
Investigators
Study Chair: Robert L. Coleman, MD M.D. Anderson Cancer Center
Investigator: Scott M. Eisenkop, MD, FACOG Women's Cancer Center - Los Gatos
Investigator: Deborah K. Armstrong, MD Sidney Kimmel Comprehensive Cancer Center
Investigator: Thomas J. Herzog, MD Herbert Irving Comprehensive Cancer Center
Investigator: Paul Sabbatini, MD Memorial Sloan-Kettering Cancer Center
  More Information

Additional Information:
No publications provided

Responsible Party: Philip J. DiSaia, Gynecologic Oncology Group
ClinicalTrials.gov Identifier: NCT00565851     History of Changes
Other Study ID Numbers: CDR0000546714, GOG-0213
Study First Received: November 29, 2007
Last Updated: April 2, 2011
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
recurrent ovarian epithelial cancer
peritoneal cavity cancer
fallopian tube cancer
ovarian serous cystadenocarcinoma
ovarian endometrioid adenocarcinoma
ovarian mucinous cystadenocarcinoma
ovarian undifferentiated adenocarcinoma
ovarian clear cell cystadenocarcinoma
ovarian mixed epithelial carcinoma
Brenner tumor

Additional relevant MeSH terms:
Neoplasms
Ovarian Neoplasms
Peritoneal Neoplasms
Fallopian Tube Neoplasms
Neoplasms, Glandular and Epithelial
Endocrine Gland Neoplasms
Neoplasms by Site
Ovarian Diseases
Adnexal Diseases
Genital Diseases, Female
Genital Neoplasms, Female
Urogenital Neoplasms
Endocrine System Diseases
Gonadal Disorders
Abdominal Neoplasms
Digestive System Neoplasms
Digestive System Diseases
Peritoneal Diseases
Fallopian Tube Diseases
Neoplasms by Histologic Type
Docetaxel
Bevacizumab
Carboplatin
Paclitaxel
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators

ClinicalTrials.gov processed this record on May 22, 2012