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Carboplatin/Pralatrexate in Recurrent Platinum-Sensitive Ovarian, Fallopian or Primary Peritoneal Cancer

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ClinicalTrials.gov Identifier: NCT01188876
Recruitment Status : Completed
First Posted : August 26, 2010
Results First Posted : January 19, 2018
Last Update Posted : January 19, 2018
Sponsor:
Collaborators:
Information provided by (Responsible Party):

Study Description
Brief Summary:
Pralatrexate is a type of antifolate drug which means is restrains the production of folic acid in the body. Folic acids are used by tumors to increase tumor cell growth and division. It is believed that reducing folic acid will hinder the rapid division of tumor cells, their growth and production. Carboplatin is an FDA approved chemotherapy drug for ovarian, fallopian tube and primary peritoneal cancer. Some antifolate drugs are used with other chemotherapy drugs to enhance cancer-fighting characteristics. It is believed that the study drug pralatrexate may improve the anti-tumor effect of carboplatin. In this research study we are looking for the highest dose of pralatrexate that can be given safely in combination with carboplatin.

Condition or disease Intervention/treatment Phase
Ovarian Cancer Fallopian Tube Cancer Peritoneal Cancer Drug: carboplatin Drug: pralatrexate Drug: Folic Acid Drug: Vitamin B12 Injection Phase 1 Phase 2

Detailed Description:
  • Since we are looking for the highest dose of the study drug that can be administered safely without severe or unmanageable side effects, not everyone who participates will receive the same dose of the study drug.
  • Each study cycle will last 28 days. On Day 1, participants will receive carboplatin intravenously. On Days 1 and 15 of each cycle they will receive pralatrexate intravenously. Participants will also be asked to take folic acid orally on a daily basis starting 7 days before the first dose of pralatrexate and continuing until 30 days after the last dose of pralatrexate. They will also receive a vitamin B12 injection no more than 10 weeks prior to the first dose of pralatrexate and every 8-10 weeks after the first dose of pralatrexate.
  • Participants will come to the clinic on Day 1 and 15 of each cycle and have the following tests/procedures performed: Medical history; Vital signs; Blood tests, assessment of the tumor (every two cycles) and an EKG (before the start of cycle 2).
  • In addition, during Cycle 1, participants will come to the clinic weekly for blood tests.
  • Pharmacokinetic (PK) blood samples (to monitor how the body absorbs and breaks down the study drug) will be done at the following time points during Cycle 1: Day 1-3 and Day 15-17.
  • Participants will be asked to take the study drugs for up to 6 cycles. They may continue beyond 6 cycles as long as there is evidence that the tumor is not growing and they are not experiencing any unacceptable side effects.

Study Design

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 50 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase I/II Study of Carboplatin and Pralatrexate in Patients With Recurrent Platinum-Sensitive Ovarian, Fallopian or Primary Peritoneal Cancer
Study Start Date : August 2010
Primary Completion Date : July 2016
Study Completion Date : July 2017

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Allergy
U.S. FDA Resources

Arms and Interventions

Arm Intervention/treatment
Experimental: Carboplatin/Pralatrexate Drug: carboplatin
Given intravenously on Day 1 of each 28-day cycle
Drug: pralatrexate
Given intravenously on Day 1 and Day 15 of each 28-day cycle.
Drug: Folic Acid
Given orally on a daily basis starting 7 days before the first dose of pralatrexate and continuing until 30 days after the last dose of pralatrexate.
Drug: Vitamin B12 Injection
Given vitamin B12 injection no more than 10 weeks prior to the first dose of pralatrexate and every 8-10 weeks after the first dose of pralatrexate.


Outcome Measures

Primary Outcome Measures :
  1. Maximum Tolerated Dose (MTD) [ Time Frame: 1 year ]
    The maximum tolerated dose of Pralatrexate in combination with Carboplatin in this patient population. The unit is given in milligrams per square meter of body surface area. MTD was determined using a standard 3 + 3 dose escalation cohort, where 3 participants were enrolled on the starting dose of 30 mg/m2 and if no dose limiting toxicities (DLT) were experienced after a full cycle, 3 additional participants were enrolled at the next highest dose level. Each increase in dose level escalated the dose of Pralatrexate by 15 mg/m2. If during any dose level, 1 patient out of 3 develops a DLT, then 3 additional patients will be added to that dose level. If 2 out of the 3 patients placed on any dose level experience a DLT, the preceding dose is considered MTD. If 1/6 has a DLT, the next higher dose level will commence accrual (unless at level +5 and then accrual to the Phase I portion will stop). If ≥ 2 of 6 patients have a DLT, then the preceding dose will be considered MTD.

  2. Best Overall Response [ Time Frame: 1 Year ]

    Summary of the best overall responses to treatment as assessed by RECIST (Response Evaluation Criteria In Solid Tumors).

    • Complete Response (CR): Disappearance of all target lesions
    • Partial Response (PR): At least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD
    • Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started
    • Progressive Disease (PD): At least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions


Secondary Outcome Measures :
  1. Overall Survival [ Time Frame: 6, 12, 18, and 24 months ]
    The number of participants still alive at the given time points. The duration of time is measured from the start of treatment until death due to any cause, participants are censored at the date of the last evaluation. The number participants surviving at 6, 12, 18, and 24 months is shown.

  2. Progression Free Survival [ Time Frame: 3 months, 6 months ]
    The number of participants alive and without disease progression at the given time-points. Time is measured from the start of treatment. Progression is defined as having at least a 20% increase in the sum of the longest diameter (LD) of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions.

  3. Treatment Related Adverse Events [ Time Frame: 1 Year ]
    Summary of the treatment related adverse events experienced by participants as assessed by Common Terminology Criteria for Adverse Events (CTCAE 4). Adverse events were assessed from the start of treatment until 30 days after the last dose of study drug.

  4. Maximum Concentration of Drug in Plasma (Cmax) [ Time Frame: Day 1 and Day 15 ]
    The maximum concentration of Pralatrexate at day 1 and 15 among phase 1 participants dosed at 105 milligrams per square meter of body surface area (mg/m2). The concentration is given in micrograms per milliliter.

  5. Area Under the Plasma Drug Concentration-Time Curve (AUC) [ Time Frame: Day 1 and Day 15 ]
    Area under the plasma drug concentration-time curve (AUC) for phase 1 participants that were dosed at 105 mg/m2. AUC represents the actual body exposure to drug after administration of a dose of the drug and is expressed in micrograms * hour per milliliter (ug*h/mL).


Eligibility Criteria

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients must be diagnosed with a platinum-sensitive recurrence of epithelial ovarian cancer, primary peritoneal cancer, or fallopian tube cancer.
  • The following histologic subtypes are eligible: papillary serous, endometrioid, mucinous, clear cell, adenocarcinomas, transitional, and mixtures of the above.
  • Patients must have at least one measurable lesion according to RECIST criteria via CT or MRI scan. CT of the chest should be performed if any known disease is present in the chest. Pleural effusions, ascites, bone metastases, CA125 tumor markers, and lesions located in previously radiated areas are not considered measurable.
  • Patients must have received a platinum-containing regimen at initial diagnosis.
  • ECOG Performance Status of 0, 1 or 2
  • Patients may have received up to 2 prior chemotherapy regimens in the recurrent cancer setting
  • 18 years of age or older
  • Life expectancy of greater than 12 weeks
  • Baseline laboratory values must meet what is outlined in the protocol
  • Patients must receive vitamin B12 and folic acid prior to starting treatment
  • Complete recovery from previous chemotherapy or biologic therapy
  • During the Phase II of the study, patients with significant ascites and/or pleural effusions will undergo consideration of drainage of these areas prior to starting carboplatin and pralatrexate.
  • Women of childbearing potential must have a negative pregnancy test within 7 days prior to initiating chemotherapy on trial and must agree to practice effective method of birth control during the study and for six months after their last treatment.
  • Patients must have a normal QTc interval

Exclusion Criteria:

  • Prior pelvic radiotherapy to greater than 25% of bone marrow
  • Any uncontrolled medical problem that in the opinion of the investigator would preclude safe administration of the study drugs.
  • Past history of bone marrow transplantation or stem cell support
  • Patient with known history of CNS metastasis is ineligible unless the patient has had treatment with surgery or radiation therapy, is neurologically stable, and does not require oral or intravenous corticosteroids or anticonvulsants.
  • A history of prior malignancy except for adequately treated carcinoma in situ of the uterine cervix, incidental stage I endometrial cancer, basal cell or squamous cell skin cancer, or breast cancer (invasive or ductal carcinoma in situ) for which the patient has been disease-free for at least three years.
  • Routine prophylactic use of G-CSF or GM-CSF within two weeks prior to study entry.
  • Clinically significant cardiac disease
  • Uncontrolled hypercalcemia or diabetes mellitus
  • Any signs of intestinal obstruction that interfere with bowel function and/or nutrition
  • Grade 2 or greater peripheral neuropathy
  • Participation in an investigational study within three weeks prior to study entry.
  • History of anaphylactic shock to prior platinum chemotherapy that would preclude safe administration of study carboplatin.
  • History of psychiatric disability or other central nervous system disorder as judged by the principal investigator that would be considered significant and that would preclude informed consent, safe administration of study medications and affecting ability to comply with study procedures.
  • Doses of ibuprofen in excess of 400mg QID.
  • Interval cytoreductive surgery planned for while subject is on-study.
  • Recurrence/progression within 6 months of receiving ay platinum regimen
  • Patients with either pleural effusions or ascites are not eligible for Phase I of the study
Contacts and Locations

Information from the National Library of Medicine

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): NCT01188876


Locations
United States, Massachusetts
Massachusetts General Hospital
Boston, Massachusetts, United States, 02114
Dana-Farber Cancer Institute
Boston, Massachusetts, United States, 02115
Sponsors and Collaborators
Massachusetts General Hospital
Dana-Farber Cancer Institute
Brigham and Women's Hospital
National Comprehensive Cancer Network
Investigators
Principal Investigator: Marcela G. del Carmen, MD, MPH Massachusetts General Hospital
More Information

Responsible Party: Marcela G. del Carmen, MD, MD, MPH, Massachusetts General Hospital
ClinicalTrials.gov Identifier: NCT01188876     History of Changes
Other Study ID Numbers: 10-113
First Posted: August 26, 2010    Key Record Dates
Results First Posted: January 19, 2018
Last Update Posted: January 19, 2018
Last Verified: December 2017

Keywords provided by Marcela G. del Carmen, MD, Massachusetts General Hospital:
carboplatin
recurrent
platinum sensitive
pralatrexate

Additional relevant MeSH terms:
Fallopian Tube Neoplasms
Peritoneal Neoplasms
Hypersensitivity
Genital Neoplasms, Female
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Fallopian Tube Diseases
Adnexal Diseases
Genital Diseases, Female
Abdominal Neoplasms
Digestive System Neoplasms
Digestive System Diseases
Peritoneal Diseases
Immune System Diseases
Vitamins
Folic Acid
Vitamin B 12
Hydroxocobalamin
Carboplatin
Vitamin B Complex
Aminopterin
Micronutrients
Growth Substances
Physiological Effects of Drugs
Antineoplastic Agents
Hematinics
Folic Acid Antagonists
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action