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Melphalan With or Without Tumor Necrosis Factor in Treating Patients With Locally Advanced Melanoma of the Arm or Leg
This study has been completed.
First Received: November 1, 1999   Last Updated: February 6, 2009   History of Changes
Sponsor: American College of Surgeons
Collaborator: National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00003789
  Purpose

RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Heating melphalan to several degrees above body temperature and infusing it only to the area around the tumor may kill more tumor cells. It is not yet known whether combining melphalan with tumor necrosis factor is more effective than melphalan alone in treating melanoma.

PURPOSE: Randomized phase III trial to compare the effectiveness of hyperthermic isolated limb perfusion of melphalan with or without tumor necrosis factor in treating patients who have locally advanced melanoma of the arm or leg.


Condition Intervention Phase
Melanoma (Skin)
Biological: recombinant tumor necrosis factor family protein
Drug: isolated limb perfusion
Drug: melphalan
Phase III

Study Type: Interventional
Study Design: Treatment, Randomized, Active Control
Official Title: A Randomized Phase III Trial of Hyperthermic Isolated Limb Perfusion and Melphalan With and Without Tumor Necrosis Factor in Patients With Localized Advanced Extremity Melanoma

Resource links provided by NLM:


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

Study Start Date: March 1999
Detailed Description:

OBJECTIVES:

  • Compare hyperthermic isolated limb perfusion with melphalan with or without tumor necrosis factor, in terms of response proportion for lesions in the perfusion field, in patients with locally advanced extremity melanoma.
  • Compare the local recurrence-free survival, improvement in regional symptoms related to tumor, and overall survival in patients treated with these regimens.
  • Compare the toxicity of these regimens in these patients.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to tumor burden (high vs low), prior reperfusion (melphalan vs other), regional nodal site (yes vs no), and participating center. Patients are randomized to one of two treatment arms.

  • Arm I: Patients undergo hyperthermic isolated perfusions of the lower limb by either the external iliac vessels or the common femoral vessels. Patients undergo perfusions of the upper extremity by the axillary artery and vein using an infraclavicular/axillary incision. Melphalan is introduced into the perfusion by slow injection over 5 minutes and allowed to remain for a total of 60 minutes.
  • Arm II: Patients undergo hyperthermic isolated perfusions as in arm I. Tumor necrosis factor is administered by slow injection into the arterial line and allowed to remain for a total of 90 minutes. Melphalan is introduced into the perfusion as in arm I and allowed to remain for a total of 60 minutes.

Patients are followed within 6 weeks, at 3, 6, and 12 months, every 6 months for 4 years, and then annually thereafter.

PROJECTED ACCRUAL: A total of 216 patients (108 per treatment arm) will be accrued for this study within 3 years.

  Eligibility

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

DISEASE CHARACTERISTICS:

  • Histologically proven locally advanced melanoma of an extremity

    • One or more evaluable in-transit metastases OR
    • All disease within the perfusion field of the extremity (with no local resection options short of amputation) OR
    • Disease outside of perfusion field (with no local resection options short of amputation) if all the following are true:

      • High tumor burden (more than 10 lesions or any single lesion greater than 3 cm)
      • Presence of pain, edema, skin breakdown, or decreased mobility
      • Greater than 80% of known tumor is within extremity perfusion field
      • Life expectancy more than 6 months
      • No brain metastases
  • At least 1 bidimensionally measurable lesion
  • Patients who received prior prophylactic isolated limb perfusion (ILP) must have 1 of the following:

    • Disease-free interval for at least 6 months after prior ILP with melphalan
    • Disease-free interval for at least 3 months after prior ILP with an agent other than melphalan
  • Patients who received prior therapeutic ILP must have 1 of the following:

    • Partial response of at least 3 months duration after prior ILP with melphalan
    • Stable response or disease progression after ILP without melphalan (performed at least 3 months prior to study)

PATIENT CHARACTERISTICS:

Age:

  • 18 and over

Performance status:

  • ECOG 0-2 OR
  • Zubrod 0-2

Life expectancy:

  • See Disease Characteristics

Hematopoietic:

  • Platelet count at least 100,000/mm^3
  • WBC greater than 2,500/mm^3
  • Hemoglobin greater than 9 g/dL

Hepatic:

  • Bilirubin less than 1.25 times ULN
  • AST and ALT less than 2 times ULN
  • Alkaline phosphatase less than 2 times ULN
  • Coagulation studies normal or within 1 second of upper limit of normal (ULN)

Renal:

  • Creatinine less than 1.5 mg/dL OR
  • Creatinine clearance greater than 50 mL/min
  • Calcium less than 12 mg/dL

Cardiovascular:

  • No severe peripheral vascular disease (claudication or other ischemic peripheral vascular disease [e.g., venous thrombosis or occlusive peripheral arterial disease])
  • No New York Heart Association class II-IV heart disease (congestive heart failure)
  • No uncontrolled or life-threatening cardiac arrhythmia
  • No myocardial infarction within the past year
  • No unstable angina
  • No symptomatic cerebral or carotid artery disease

Pulmonary:

  • No pulmonary embolism within the past year

Other:

  • Other prior malignancy allowed if completed curative therapy, disease-free for at least 5 years, and at low risk for recurrence
  • No active peptic ulcer disease within the past year
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • No known melphalan hypersensitivity
  • No known hypersensitivity to any component of tumor necrosis factor alpha formulation
  • No contraindications to ionotropic agents (e.g., dopamine or neosynephrine)
  • No concurrent infections uncontrolled with antibiotics
  • HIV negative

PRIOR CONCURRENT THERAPY:

Biologic therapy:

  • At least 1 month since prior biologic therapy

Chemotherapy:

  • See Disease Characteristics
  • At least 1 month since prior chemotherapy
  • At least 4 months since prior isolated limb perfusion

Endocrine therapy:

  • Not specified

Radiotherapy:

  • At least 1 month since prior radiotherapy

Surgery:

  • See Disease Characteristics
  • At least 12 months since prior coronary artery surgery or angioplasty
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00003789

Locations
United States, Illinois
Evanston Northwestern Health Care - Evanston Hospital
Evanston, Illinois, United States, 60201
University of Illinois Medical Center
Chicago, Illinois, United States, 60612
United States, Indiana
Indiana University Cancer Center
Indianapolis, Indiana, United States, 46202-5289
United States, Maryland
Sinai Hospital of Baltimore
Baltimore, Maryland, United States, 21215
Warren Grant Magnuson Clinical Center - NCI Clinical Studies Support
Bethesda, Maryland, United States, 20892-1182
United States, New York
Roswell Park Cancer Institute
Buffalo, New York, United States, 14263-0001
United States, North Carolina
Blumenthal Cancer Center at Carolinas Medical Center
Charlotte, North Carolina, United States, 28232-2861
Duke Comprehensive Cancer Center
Durham, North Carolina, United States, 27710
United States, Ohio
Charles M. Barrett Cancer Center at University Hospital
Cincinnati, Ohio, United States, 45219
United States, Pennsylvania
Abramson Cancer Center at University of Pennsylvania Medical Center
Philadelphia, Pennsylvania, United States, 19104-4283
United States, Texas
University of Texas - MD Anderson Cancer Center
Houston, Texas, United States, 77030-4009
United States, Utah
Latter Day Saints Hospital
Salt Lake City, Utah, United States, 84143
Sponsors and Collaborators
American College of Surgeons
Investigators
Study Chair: Douglas L. Fraker, MD Abramson Cancer Center of the University of Pennsylvania
  More Information

Additional Information:
Publications:
Study ID Numbers: CDR0000066929, ACOSOG-Z0020, NCI-03-C-0137
Study First Received: November 1, 1999
Last Updated: February 6, 2009
ClinicalTrials.gov Identifier: NCT00003789     History of Changes
Health Authority: United States: Federal Government

Keywords provided by National Cancer Institute (NCI):
stage III melanoma
recurrent melanoma

Additional relevant MeSH terms:
Melphalan
Neoplasms by Histologic Type
Molecular Mechanisms of Pharmacological Action
Immunologic Factors
Antineoplastic Agents
Neoplasms, Nerve Tissue
Physiological Effects of Drugs
Immunosuppressive Agents
Pharmacologic Actions
Melanoma
Neuroendocrine Tumors
Neuroectodermal Tumors
Neoplasms
Therapeutic Uses
Neoplasms, Germ Cell and Embryonal
Myeloablative Agonists
Nevi and Melanomas
Antineoplastic Agents, Alkylating
Alkylating Agents

ClinicalTrials.gov processed this record on November 27, 2009