Hyperthermic Intraperitoneal Oxaliplatin for Peritoneal Malignancies
RATIONALE: Drugs used in chemotherapy, such as oxaliplatin, leucovorin, and fluorouracil, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Hyperthermia therapy kills tumor cells by heating them to several degrees above normal body temperature. Peritoneal infusion of heated and nonheated chemotherapy drugs after surgery may kill more tumor cells.
PURPOSE: This phase I trial is studying the side effects and best dose of hyperthermic intraperitoneal oxaliplatin followed by intraperitoneal leucovorin and fluorouracil in treating patients with peritoneal cancer.
Peritoneal Cavity Cancer
Drug: leucovorin calcium
Procedure: cytoreductive surgery
|Study Design:||Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Phase I Hyperthermic Intraperitoneal Oxaliplatin for Peritoneal Malignancies|
- Maximum tolerated dose of hyperthermic intraperitoneal oxaliplatin [ Time Frame: 30 Days Post Treatment ]
- Changes in quality-of-life [ Time Frame: Baseline and at 4, 8, and 12 months ]Using the Functional Assessment of Cancer Therapy for Colorectal Cancer (FACT-C) and SF-36 (Quality of Life Evaluation in Dialysis Patients) questionnaires, the quality of life following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPC) will be reported and compared to the preoperative baseline.
- Overall survival [ Time Frame: 1 Year and 5 Years ]
- Time to Disease Progression [ Time Frame: Monthly ]
|Study Start Date:||October 2007|
|Study Completion Date:||September 2011|
|Primary Completion Date:||January 2010 (Final data collection date for primary outcome measure)|
Experimental: Hyperthermic Treatment
Patients receiving combination of hyperthermic intraperitoneal chemotherapy (HIPC) with oxaliplatin plus intraperitoneal 5-Fu and intraperitoneal leucovorin with peritoneal metastases.
Post-operative day 1 and day 2, 600mg/m^2 intraperitoneal (IP) held for 23 hours
Other Name: 5-FUDrug: leucovorin calcium
Day 0 200 mg/m^2 intraperitoneal held for 2 hoursDrug: oxaliplatin
Day 0 hyperthermic intraperitoneal oxaliplatin held for 30 minutes - assigned dose level: Levels 1 through 7 - 300 to 600 mg/m^2
Other Name: EloxatinProcedure: cytoreductive surgery
Day 0 Cytoreductive surgery is a systematic attempt to remove all or nearly all peritoneal nodules.
Other Name: conventional surgery
- To determine the safety and optimal dose of hyperthermic intraperitoneal oxaliplatin when administered during cytoreductive surgery and followed by intraperitoneal leucovorin calcium and fluorouracil in patients with peritoneal malignancies.
- To determine the outcome of cytoreductive surgery in these patients.
- To determine the time to disease progression and pattern of failure in patients treated with this regimen.
- To determine the 1 and 5 year survival in patients treated with this regimen.
- To compare quality-of-life pre- and post-surgery in these patients.
- To characterize total- and free-platinum pharmacokinetics in the plasma and total platinum in the intraperitoneal space at baseline, during, and after hyperthermic intraperitoneal chemotherapy (HIPC).
- To assess for the presence of genetic polymorphisms in the XDP and XRCC1 DNA repair genes.
- To assess tumor and normal tissue concentrations for total platinum obtained at baseline and immediately after HIPC.
- Cytoreductive Surgery: Patients undergo an exploratory laparotomy to remove all tumor nodules from all peritoneal surfaces prior to gastrointestinal anastomoses. An intraperitoneal drain is placed for postoperative intraperitoneal chemotherapy.
- Hyperthermic peritoneal chemotherapy (HIPC): After cytoreductive surgery, but before intestinal anastomosis, patients receive oxaliplatin into the abdomen cavity at approximately 1 liter/min at 41-42º C and held for 30 minutes at the maximum tolerated dose. A heat exchanger maintains the fluid temperature at 44-46º C to maintain the intraperitoneal temperature at 41-42º C. Patients may receive fluid challenges, furosemide, mannitol, or renal dose dopamine to maintain a brisk diuresis at the discretion of the anesthesiologist.
- Intraperitoneal chemotherapy: After HIPC, patients receive leucovorin calcium intraperitoneally through an intraperitoneal drain where it will remain for 2 hours and then drained. Patients then receive fluorouracil intraperitoneally through the intraperitoneal drain on day 1 and remain in the peritoneal fluid for 23 hours and then drained. The infusion will be repeated on day 2.
Blood samples are collected prior to surgery for pharmacogenetic studies and analyzed for the presence of genetic polymorphisms in the XPD and XRCC1 DNA repair genes and the GSTP1 and GSTM1 glutathione-S-transferase enzymes (i.e., XPD, Asp312Asn, XPD K751Q, XRCC1 Arg399GIn, XRCC1 Arg399Q, GSTP1 l105V, and GSTM1 DEL). Blood samples are also collected periodically for pharmacokinetic studies and analyzed for oxaliplatin concentrations. Normal and tumor tissue are collected periodically and analyzed for total platinum concentrations.
Quality of life is assessed at baseline and at 4, 8, and 12 months.
After completion of study treatment, patients are followed every 4 months for 2 years and then every 6 months for at least 5 years.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00625092
|United States, Minnesota|
|Masonic Cancer Center, University of Minnesota|
|Minneapolis, Minnesota, United States, 55455|
|Principal Investigator:||Todd M. Tuttle, MD||Masonic Cancer Center, University of Minnesota|