Treatment of Malignant Peritoneal Mesothelioma (MESOTIP) (MESOTIP)
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| ClinicalTrials.gov Identifier: NCT03875144 |
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Recruitment Status :
Recruiting
First Posted : March 14, 2019
Last Update Posted : November 17, 2022
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MESOTIP is a randomized trial evaluating the association of PIPAC and systemic chemotherapy versus systemic chemotherapy alone as 1st-line treatment of Malignant Peritoneal Mesothelioma In this study, patients in the experimental arm will be treated by 4 PIPAC (Cisplatine+Doxorubicine) alternating with 6 cycles of standard intravenous chemotherapy (Cisplatine+Pemetrexed).
MESOTIP aim to show an improvement of the overall survival in the experimental arm.
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Peritoneal Mesothelioma Peritoneal Carcinomatosis | Procedure: PIPAC Drug: Cisplatin Drug: Pemetrexed | Phase 2 |
Malignant peritoneal mesothelioma (MPM) is a rare tumoral disease characterized by the diffuse involvement of the peritoneal serosa. The incidence of all mesotheliomas is estimated quite differently in various reports with the highest rates in industrialized countries. In France, the estimated incidence is 300 cases/year. Three types of malignant mesotheliomas are described in the WHO classification: epithelioid, sarcomatoid and biphasic.
The standard treatment of MPM is surgery. It has been shown that cytoreductive surgery (CRS) associated to hyperthermic intraperitoneal chemotherapy (HIPEC) improves prognosis resulting in a median overall survival of 29.5 months to 53 months and an 5 years overall survival rate ranging between 39 to 63%. Cytoreductive surgery should be complete or almost complete (CCR0/1) as macroscopic residual disease deteriorates prognosis.
However some patients are not eligible for surgery due to the locoregional extension of the disease. Although debulking surgery may still be considered, its results are less encouraging than CRS and HIPEC.
The neoadjuvant treatment combining Cisplatin and Pemetrexed became a routinely applied option for initially unresectable patients after the publication of an open-label study inspired by previous results of a randomized trial in pleural mesothelioma. This study showed a benefit in median survival of 5 months and an increase in the response rate of 10%. Ever since, other phase II studies were proposed but their benefit is still limited. Pleural mesothelioma which is more common and represents the model of choice for the treatment of peritoneal mesothelioma has also benefitted from phase III studies analyzing the addition of a targeted therapy (Bevacizumab) and phase II trials proposing immunotherapy.
By contrast, peritoneal mesothelioma was the setting of choice for testing intraperitoneal administration of chemotherapy either as early postoperative intraperitoneal chemotherapy (EPIC) or as neoadjuvant intraperitoneal chemotherapy. Both studies offered promising results showing a sensitivity of MPM to intraperitoneal administration.
Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) has recently been developed and shows interesting results in the neoadjuvant context of several peritoneal carcinomatoses while producing little toxicity. PIPAC is a modality of repeated administration of intraperitoneal chemotherapy during laparoscopy using aerosols at the pressure of the capnoperitoneum (12mmHg). Data from ex-vivo, in-vivo and human studies demonstrated a higher local drug bioavailability when compared to liquid IP chemotherapy. PIPAC was tested in the setting of malignant mesothelioma showing encouraging results.
In our study MESOTIP, patients in the experimental arm will be treated by 4 PIPAC (Cisplatine+Doxorubicine) alternating with 6 cycles of standard intravenous chemotherapy (Cisplatine+Pemetrexed).
Although retrospective reports showing the interest of PIPAC in the neoadjuvant setting for different peritoneal carcinomatosis origins were published, MESOTIP would be the first study to combine PIPAC to systemic chemotherapy in the first-line of treatment and to only include patients not eligible for surgical treatment and proposing a complete cytoreductive surgery associated to HIPEC for patients converted to resectability.
MESOTIP aim to show an improvement of the overall survival in the experimental arm.
| Study Type : | Interventional (Clinical Trial) |
| Estimated Enrollment : | 66 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Treatment |
| Official Title: | Phase II Multicenter Randomized Trial Evaluating the Association of PIPAC and Systemic Chemotherapy Versus Systemic Chemotherapy Alone as 1st-line Treatment of Malignant Peritoneal Mesothelioma |
| Actual Study Start Date : | August 14, 2020 |
| Estimated Primary Completion Date : | December 2022 |
| Estimated Study Completion Date : | December 2024 |
| Arm | Intervention/treatment |
|---|---|
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Experimental: association of PIPAC and systemic chemotherapy
4 PIPAC of Cisplatin 10.5mg/m² + Doxorubicin 2.1 mg/m² every 6 weeks alternating with standard intravenous chemotherapy for mesothelioma (Cisplatin 75mg/m² + Pemetrexed 500mg/m²)
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Procedure: PIPAC
Pressurized IntraPeritoneal Aerosol Chemotherapy of Cisplatin 10.5mg/m² + Doxorubicin 2.1 mg/m² every 6 weeks
Other Names:
Drug: Cisplatin standard intravenous chemotherapy for mesothelioma (Cisplatin 75mg/m² + Pemetrexed 500mg/m²) Drug: Pemetrexed standard intravenous chemotherapy for mesothelioma (Cisplatin 75mg/m² + Pemetrexed 500mg/m²) |
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Active Comparator: systemic chemotherapy alone
6 cycles of Cisplatin 75mg/m² + Pemetrexed 500mg/m²
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Drug: Cisplatin
standard intravenous chemotherapy for mesothelioma (Cisplatin 75mg/m² + Pemetrexed 500mg/m²) Drug: Pemetrexed standard intravenous chemotherapy for mesothelioma (Cisplatin 75mg/m² + Pemetrexed 500mg/m²) |
- overall survival [ Time Frame: from randomization of first patient until the database cut-off ]The overall survival is defined as the time from the date of randomization to the date of death from any cause
- Response to treatment using PFS [ Time Frame: week 10, week21,every 4 months during 2 years ]Progression free survival (PFS) defined as the time from the date of randomization to the date of any progression or death. PFS will be described with median PFS, 1 and 2y-PFS rate
- Adverse event [ Time Frame: during treatment ]Safety according to CTCAE v5.0. Complications related to PIPAC will also be defined according to CTCAE v5.0 as recent publications in the field of peritoneal carcinomatosis suggest that this classification is more reliable when compared with the Clavien Dindo classification for the peritoneal carcinomatosis surgery
- Feasibility of compliance [ Time Frame: Week 21 ]Feasibility rate of compliance defined as the percentage of patients who received 6 cycles of systemic chemotherapy and 4 PIPAC (for experimental arm).
- Conversion to resectability [ Time Frame: surgery ]Conversion to resectability rate defined as the percentage of patients eligible for cytoreductive surgery and HIPEC at the end of the treatment out of the total number of patients. Patients are eligible for surgery if preservation of at least 1.5 m of small bowel and of at least 2 m of lower gastrointestinal tube is feasible in case of complete cytoreduction.
- Quality of life evaluation [ Time Frame: baseline, week10, week21, FU every 4 months during 2 years ]Quality of life EORTC QLQ-C30 questionnaires according to EORTC Guidelines
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| Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Age ≥ 18 years
- PS (or WHO) <2
- Histologically-confirmed diagnosis of peritoneal malignant mesothelioma
- No previous line of treatment (both medical and surgical oncologic treatments) for this disease
- Peritoneal Carcinomatosis Index (PCI)>27 or at least 4 on the small bowel with serosal involvement contraindicating the cytoreductive surgery because of the impossibility to preserve a length >=1.5 m of uninvolved small bowel
- Written and dated informed consent
- Affiliated to the French national social security system
Exclusion Criteria:
- WHO performance status ≥ 2
- Any contraindication to chemotherapy and/or radiotherapy
- Any contraindication to repeated laparoscopy
- Symptomatic cardiac or coronary insufficiency
- Severe renal insufficiency
- Progressive active infection or any other severe medical condition
- Intestinal occlusion non responsive to medical treatment
- Other cancer treated within the last 2 years except in situ cervical carcinoma or basocellular/spinocellular carcinoma
- Pregnant or breast-feeding woman
- Previously operated patients where laparoscopy is not feasible
- Persons deprived of liberty or under guardianship or incapable of giving consent
- Any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol or follow-up schedule
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): NCT03875144
| Contact: Olivia SGARBURA, MD | 0467614586 ext +33 | Olivia.sgarbura@icm.unicancer.fr |
| France | |
| Institut réginal du Cancer de Montpellier | Recruiting |
| Montpellier, France, 34298 | |
| Contact: Olivia SGARBURA 0033467613102 olivia.sgarbura@icm.unicancer.fr | |
| Principal Investigator: | Olivia SGARBURA, MD | Institut régional du Cancer de Montpellier |
| Responsible Party: | Institut du Cancer de Montpellier - Val d'Aurelle |
| ClinicalTrials.gov Identifier: | NCT03875144 |
| Other Study ID Numbers: |
PROICM 2019-03 MES |
| First Posted: | March 14, 2019 Key Record Dates |
| Last Update Posted: | November 17, 2022 |
| Last Verified: | November 2022 |
| Individual Participant Data (IPD) Sharing Statement: | |
| Plan to Share IPD: | No |
| Studies a U.S. FDA-regulated Drug Product: | No |
| Studies a U.S. FDA-regulated Device Product: | No |
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Peritoneal mesothelioma PIPAC Surgical oncology Peritoneal Carcinomatosis |
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Mesothelioma Mesothelioma, Malignant Carcinoma Peritoneal Neoplasms Adenoma Neoplasms, Glandular and Epithelial Neoplasms by Histologic Type Neoplasms Neoplasms, Mesothelial Lung Neoplasms Respiratory Tract Neoplasms Thoracic Neoplasms Neoplasms by Site Pleural Neoplasms Lung Diseases |
Respiratory Tract Diseases Abdominal Neoplasms Digestive System Neoplasms Digestive System Diseases Peritoneal Diseases Cisplatin Doxorubicin Pemetrexed Antineoplastic Agents Antibiotics, Antineoplastic Topoisomerase II Inhibitors Topoisomerase Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Folic Acid Antagonists |