Intraperitoneal Therapy For Ovarian Cancer With Carboplatin Trial (iPocc)

• Overall survival (OS) [ Time Frame: weekly during the protocl treatment, then every 3 months for the first 2 years, 6-month for the following 2 years, and once a year thereafter ] [ Designated as safety issue: Yes ]
• Tumor response (only patients with evaluable disease) [ Time Frame: every 2 cycles [after 2 cycles, after 4 cycles, after 6 cycles, (after 8 cycles)], the time of discontinuation of the protocol treatment and then at least annually during follow-up ] [ Designated as safety issue: No ]
• Adverse events [ Time Frame: weekly during the protocl treatment, then every 3 months for the first 2 years, 6-month for the following 2 years, and once a year thereafter ] [ Designated as safety issue: Yes ]
• Treatment completion rate [ Time Frame: After the last cycle of the protocol teatment ] [ Designated as safety issue: No ]
• Quality of Life (QOL) assessments [ Time Frame: baseline, after 3 cycles, 6 cycles, 36 week, 60 weeks and 84 weeks from the start of protocol treatment ] [ Designated as safety issue: No ]
• Cost-utility analysis [ Time Frame: baseline, after 3 cycles, 6 cycles, 36 week, 60 weeks and 84 weeks from the start of protocol treatment ] [ Designated as safety issue: No ]

• Overall survival (OS) [ Time Frame: weekly during the protocl treatment, then every 3 months for the first 2 years, 6-month for the following 2 years, and once a year thereafter ] [ Designated as safety issue: Yes ]
• Tumor response (only patients with evaluable disease) [ Time Frame: every 2 cycles [after 2 cycles, after 4 cycles, after 6 cycles, (after 8 cycles)], the time of discontinuation of the protocol treatment and then at least annually during follow-up ] [ Designated as safety issue: No ]
• Adverse events [ Time Frame: weekly during the protocl treatment, then every 3 months for the first 2 years, 6-month for the following 2 years, and once a year thereafter ] [ Designated as safety issue: Yes ]
• Treatment completion rate [ Time Frame: 2014/Apr ] [ Designated as safety issue: No ]
• Quality of Life (QOL) assessments [ Time Frame: baseline, after 3 cycles, 6 cycles, 36 week, 60 weeks and 84 weeks from the start of protocol treatment ] [ Designated as safety issue: No ]
• Cost-utility analysis [ Time Frame: baseline, after 3 cycles, 6 cycles, 36 week, 60 weeks and 84 weeks from the start of protocol treatment ] [ Designated as safety issue: No ]

The purpose of this study is:

Phase A: To confirm the feasibility of paclitaxel administered by intravenous (IV) infusion weekly plus concurrent carboplatin administered by intraperitoneal (IP) injection once every 3 weeks (dd-TCip therapy).

Phase B: To compare the efficacy and safety of the following two treatment regimens as first-line chemotherapy in women with epithelial ovarian, Fallopian tube or primary peritoneal cancer.

This is a randomized, multicenter international study. Patient are stratified according to Residual tumor diameter([0cm(No residual)] vs. [0cm＜residual＜1cm] vs. [1cm<residual<2cm] vs. [>2 cm]), FIGO stage(StageII vs. III vs. IV) and institution. Patient randomized to one of the treatment arms described below.

RegimenI(Standard treatment: dd-TCiv therapy): Paclitaxel administered by IV infusion weekly plus concurrent carboplatin administered by IV infusion once every 3 weeks

RegimenII(Study treatment: dd-TCip therapy): Paclitaxel administered by IV infusion weekly plus concurrent carboplatin administered by IP injection once every 3 weeks

The 3-week period (21 days) is 1 cycle. Protocol treatment basically comprises 6 cycles. IDS is allowed to be performed after 3, 4 or 5 cycles of the protocol treatment. In such cases, the protocol treatment must be restarted within 8 weeks after IDS. If IDS is performed, patients can receive up to 3 additional cycles of the protocol treatment after IDS. If interval debulking surgery (IDS) is performed after 3, 4 or 5 cycles, the patients can receive up to 3 additional cycles of the protocol treatment. A total of 6 to 8 cycles will be repeated.

The analysis of efficacy will be performed on all randomized subjects in accordance with the intention-to-treat (ITT) principle. In order to assess the robustness of the results, the same analyses will be done using all randomized subjects who satisfy the eligibility criteria. The analysis of safety will be performed on all subjects who have received at least one dose of study treatment.

• Epithelial Ovarian Cancer
• Fallopian Tube Cancer
• Primary Peritoneal Carcinoma

• Drug: Paclitaxel(intravenous) + Carboplatin(intravenous)

  Paclitaxel : 80mg/m2, IV infusion, Day1, 8, and 15

  Carboplatin: AUC=6.0, IV infusion, Day1

  A total of 6 to 8 cycles will be repeated.

• Drug: Paclitaxel(intravenous) + Carboplatin(intraperitoneal)

  Paclitaxel : 80mg/m2, IV infusion, Day1, 8, and 15

  Carboplatin: AUC=6.0, IP injection, Day1

  A total of 6 to 8 cycles will be repeated.

• Active Comparator: Regimen I (Standard treatment: dd−TCiv therapy)
  Paclitaxel administered by IV infusion weekly plus concurrent carboplatin administered by IV infusion once every 3 weeks
  Intervention: Drug: Paclitaxel(intravenous) + Carboplatin(intravenous)
• Experimental: Regimen II (Study treatment: dd-TCip therapy)
  Paclitaxel administered by IV infusion weekly plus concurrent carboplatin administered by IP injection once every 3 weeks
  Intervention: Drug: Paclitaxel(intravenous) + Carboplatin(intraperitoneal)

• Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002 Mar 1;20(5):1248-59.
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Inclusion Criteria:

1. Patients assumed to have a stageII−IV epithelial ovarian, fallopian tube, or primary peritoneal cancer as a pre-surgery diagnosis

2. Patients scheduled to undergo laparotomy

   *Both optimal and suboptimal patients will be eligible for the study (Suboptimal patients, as well as those who undergo only exploratory laparotomy, are eligible.)

3. ECOG Performance Status: 0-2
4. Patients who provide consent for placement of the IP port system, if randomized to Regimen II (Study treatment: dd-TCip therapy)
5. Patients expected to receive the first protocol treatment within 8 weeks after the comprehensive staging surgery

6. Lab data and clinical examination: Data within 28 days before the scheduled date of surgery

   • Neutrophil count ≧ 1,500 /mm3
   • Platelet count ≧ 100,000 /mm3
   • AST (GOT) ≦ 100 IU/L
   • ALT (GPT) ≦ 100 IU/L
   • Total bilirubin < 1.5 mg/dL
   • Serum Creatinine < 1.5 mg/dL
   • Electrocardiogram (ECG): Patients with normal ECG, Asymptomatic patients with abnormal ECGs not requiring medical intervention
   • Neuropathy(Both motor and sensory) ≦ Grade1 (CTCAE Version 4.0)
7. Patients expected to survive longer than 3 months from the start date of the protocol treatment
8. Patients aged 20 years and older at the time of tentative registration (with no upper age limit)
9. Patients who provide written informed consent for participation in this trial

Exclusion Criteria:

1. Patients assumed to have a borderline malignancy of the ovary, fallopian tube, or primary peritoneal cancer
2. Patients who have received previous chemotherapy or radiation therapy to treat the current disease
3. Patients who have a synchronous malignancy or who have been progression-free less than 5 years for a metachronous malignancy (Patients with basal and squamous cell carcinoma of the skin, as well as carcinoma in situ, and intramucosal carcinoma cured by local treatment, are eligible for the study)
4. Patients with serious medical complications, such as serious heart disease, cerebrovascular accidents, uncontrolled diabetes mellitus, uncontrolled hypertension, pulmonary fibrosis, interstitial pneumonitis, active bleeding, an active gastrointestinal ulcer, or a serious neurological disorder
5. Patients who have had a hypersensitivity reaction to polyoxyethylated or hydrogenated castor oil
6. Patients with a pleural effusion requiring continuous drainage
7. Patients with an active infection requiring antibiotics
8. Patients who are pregnant, nursing or of child-bearing potential
9. Patients with evidence upon physical examination of brain tumor and any brain metastases
10. Patients for whom completion of this study and/or follow-up is deemed inappropriate for any reason
11. Patients with any signs/symptoms of interstitial pneumonia