Treatment of Primary Peritoneal Carcinosis of Digestive Origin Using Cytoreductive Surgery and Hyperthermic Intraoperative Peritoneal Chemotherapy With Mitomycin C and Irinotecan

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01226550
Recruitment Status : Completed
First Posted : October 22, 2010
Last Update Posted : December 30, 2011
Information provided by (Responsible Party):
Hospices Civils de Lyon

Brief Summary:
This is an open, non-randomized, phase I-II, pilot study, which evaluates the combination of optimum cytoreductive surgery and hyperthermic intraoperative peritoneal chemotherapy (HIPEC) with mitomycin C (MMC) and irinotecan. The latter drug will be administered in escalating doses to patients with gastric, colorectal, appendicular, or primary peritoneal carcinosis (PC).

Condition or disease Intervention/treatment Phase
Peritoneal Carcinosis (PC) Procedure: cytoreductive surgery and HIPEC Phase 1 Phase 2

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 18 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Treatment of Primary Peritoneal Carcinosis of Digestive Origin Using Cytoreductive Surgery and Hyperthermic Intraoperative Peritoneal Chemotherapy With Mitomycin C and Irinotecan
Study Start Date : June 2007
Actual Primary Completion Date : April 2011
Actual Study Completion Date : April 2011

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U.S. FDA Resources

Arm Intervention/treatment
Experimental: cytoreductive surgery and HIPEC Procedure: cytoreductive surgery and HIPEC

The most complete cytoreductive surgery possible (ideally macroscopically complete) followed by a closed-abdomen hyperthermic intraoperative peritoneal chemotherapy (HIPEC), using a closed circuit connected to the self-regulating Cavitherm machine (EEC certified). This perfusion apparatus records temperature, flow, and pressure for 90 minutes at real temperature (42-43°C).

The dialysate is made up of peritoneal dialysis fluid containing 0.7 mg/kg of MMC and increasing doses of irinotecan added to the dialysate the last 30 minutes of the HIPEC.

Potentiation of irinotecan using an intravenous FUFOL perfusion at least 1hour before HIPEC (1st dose level: 10 mg/m² of folinic acid, then 200 mg/m² of 5-FU; 2nd dose level: 20 mg/m² of folinic acid, then 400 mg/m² of 5-FU).

Primary Outcome Measures :
  1. Morbidity rate [ Time Frame: 30 days postoperative ]
    postoperative complications (class III and IV, Common Terminology Criteria V3; National Cancer Institute)

Secondary Outcome Measures :
  1. Mortality rate [ Time Frame: 30 days postoperative ]
  2. Intraperitoneal and serumal concentration (pharmacokinetics) of mitomycine C, irinotecan, and its metabolites. [ Time Frame: per-HIPEC ]
    Plasma, peritoneal, and urinary values for MMC, irinotecan, SN-38, SN-38G, APC, and NPC.

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Ages Eligible for Study:   18 Years to 64 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patients with a peritoneal carcinosis (PC) either of digestive origin or primary: a colorectal or gastric carcinosis, a peritoneal pseudomyxoma or mesothelioma, or a primary carcinosis of the peritoneum regardless the number of prior treatment lines.
  • A PC and primary tumor considered to be resectable according to preoperative clinical and paraclinical data: absence of mesenteric retraction and absence of bladder invasion.
  • Patients in good general health (ASA ≤ 2).
  • Absence of cardiorespiratory failure (PaO2 > 60 mmHg in a stable condition, dyspnea ≤ NYHA stage 1, left ventricular ejection fraction > 60%.).
  • Prothrombin level >70 %, total bilirubin < 2 x the normal level, ASAT and ALAT < 2.5 x normal levels, and alkaline phosphatases < 5 x normal levels.
  • Creatinine clearance > 60 ml/min, polynuclear neutrophils > 1500/mm3, and a white blood cell count > 4000 /mm3.
  • Patients who give written, informed consent.
  • Patients affiliated with the French universal healthcare system.

Exclusion Criteria:

  • Patients with a PC with ovarian, mammary, biliary, pancreatic, or bronchial origin.
  • Evolutive patients after systemic chemotherapy.
  • Patients with a PC considered to be irresectable according to preoperative clinical and paraclinical data: mesenteric retraction or bladder invasion.
  • Patients in poor general health (ASA > 2).
  • Cardiorespiratory failure (dyspnea > NYHA stage 1, PaO2 < 60 mmHg in a stable condition)
  • Prothrombin level < 70 %.
  • Any brain abnormality showing on the head scan.
  • Signs of heart failure and especially left ventricular ejection fraction < 60% on the cardiac ultrasound.
  • Thrombocytopenia < 100 000 / mm3
  • Visceral metastases other than a single resectable liver metastasis.
  • Pregnancy or breast feeding.
  • Chronic inflammatory intestinal disease and/or an intestinal obstruction.
  • History of severe hypersensitivity to irinotecan hydrochloride trihydrate or one of the excipients of Campto.
  • Bilirubinemia > 3 times the normal upper limit
  • Yellow fever vaccine.
  • Prophylactic treatment with phenytoin.
  • Severe medullary insufficiency.

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 identifier (NCT number): NCT01226550

Service de Chirurgie Générale et Thoracique, Centre Hospitalier Lyon-Sud
Pierre Bénite Cedex, France, 69495
Sponsors and Collaborators
Hospices Civils de Lyon

Responsible Party: Hospices Civils de Lyon Identifier: NCT01226550     History of Changes
Other Study ID Numbers: 2004.368
First Posted: October 22, 2010    Key Record Dates
Last Update Posted: December 30, 2011
Last Verified: December 2011

Keywords provided by Hospices Civils de Lyon:
hyperthermic intraoperative peritoneal chemotherapy (HIPEC)
peritoneal carcinomatosis (PC)

Additional relevant MeSH terms:
Body Temperature Changes
Signs and Symptoms
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Antineoplastic Agents, Phytogenic
Antineoplastic Agents
Topoisomerase I Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Antibiotics, Antineoplastic
Alkylating Agents
Nucleic Acid Synthesis Inhibitors