Extrapleural Pneumonectomy /Pleurectomy Decortication, IHOC Cisplatin and Gemcitabine With Amifostine and Sodium Thiosulfate Cytoprotection for Resectable Malignant Pleural Mesothelioma

January 19, 2017 updated by: Raphael Bueno, MD, Brigham and Women's Hospital

A Phase I Trial of Extrapleural Pneumonectomy/Pleurectomy Decortication, Intrathoracic/Intraperitoneal Hyperthermic (IOHC) Cisplatin and Gemcitabine With Intravenous Amifostine and Sodium Thiosulfate Cytoprotection for Patients With Resectable Malignant Pleural Mesothelioma

RATIONALE: After removal of visible cancer in the chest, chemotherapy drugs are used to kill or stop tumor cells from dividing, so that they stop growing or/and die. Cisplatin is currently used safely as in intra-operative treatment for malignant pleural mesothelioma. This study is aimed to determine if the addition of gemcitabine as a second intracavitary chemotherapy can be accomplished safely.

PURPOSE: This is a Phase I trial to study the efficacy of combination chemotherapy consisting of gemcitabine and cisplatin administered in the operating room and put into the chest and abdomen for one hour. We are also looking at the effects of heating the chemotherapy to a temperature of 42 degrees Celsius and the effect of cytoprotection agents: amifostine and sodium thiosulfate to counteract potential side effects of chemotherapy.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

  • This is a dose escalation study of gemcitabine with a fixed dose of cisplatin
  • Patients will undergo cytoreductive surgery, which entails the removal of the inner and outer lining of the lung (pleurectomy/decortication) with or without the lung itself (extrapleural pneumonectomy), including the lining overlying the pericardium and diaphragm. Resection of the pericardium and diaphragm are occasionally necessary to remove all visable tumor. This surgery is part of standard care for malignant pleural mesothelioma.
  • After surgery, a one hour lavage with heated cisplatin and or gemcitabine will be administered to the hemithorax (and abdominal regions if the diaphragm is no longer present).
  • Patients will remain hospitalized until they have recovered from surgery (usually 7-14 days).
  • Patients will return to the hospital during the first month after their surgery to be evaluated by the medical staff.
  • Dose escalation: 1) Three patients will be treated at the first dose level of gemcitabine. Labs will be monitored on a weekly basis, including a CBC, Chem-7, and LFT's. In the absence of developing dose-limiting toxicity (DLT) among the first 3 patients treated, dosages can be escalated. DLT will be defined as any grade 3 or higher renal toxicity, thrombocytopenia or other grade 3 toxicity not related to surgery 2) If none of these 3 patients have any toxicity, we will proceed to the next level of gemcitabine. 3) If DLT occurs in 1 of 3 patients at a given dose level, then 3 additional patients are added at that dose (for a total of 6 at this level)If no DLT occurs, we will proceed to the next level of gemcitabine. If DLT occurs in another patient, this dose is considered the maximum tolerated dose (MTD). 4) At any dose, 3 cases of DLT lead to discontinuation of recruitment at that dose and enrollment of 3 additional patients at a lower dose.

Study Type

Interventional

Enrollment (Actual)

141

Phase

  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Massachusetts
      • Boston, Massachusetts, United States, 02115
        • Brigham and Women's Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Histologically-proven diagnosis of stages I to III malignant mesothelioma of the pleura and negative mediastinal N2 lymph nodes (Malignancy is confined to the affected hemithorax)
  • Adequate organ function including the following: adequate cardiac function, pulmonary function, renal and hepatic function and bone marrow reserve
  • Adequate overall physical activity
  • Surgical candidate for cytoreductive surgery

Exclusion Criteria:

  • Extended disease outside the ipsilateral hemithorax as proven histologically, radiologically and/or intraoperatively
  • Have received chemotherapy and or radiation therapy within the last 3 years at the time of study entry
  • Serious concomitant systemic disorders
  • Second active primary malignancy (to exclude non- melanoma skin cancer)
  • Pregnancy at the time of the operation
  • Psychiatric or addictive disorder which would preclude obtaining informed consent

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: TREATMENT
  • Allocation: NON_RANDOMIZED
  • Interventional Model: SINGLE_GROUP
  • Masking: NONE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
EXPERIMENTAL: Extrapleural pneumonectomy (EPP)
This is dose escalation 3+3 study design. All the patients meet the eligibility criteria and then sign the informed consent. Then after they have completed their standard pre-operative evalutions were each brought to the operating room for this surgical resection. Regardless of the arm the subject is assigned to they all recieve surgical intervention (Extrapleural Pneumonectomy, Pleurectomy/Decortication, or Tumor Debulking), Amifostine, Cisplatin, Gemcitabine, and Sodium Thiosulfate
Procedure: Extrapleural pneumonectomy (EPP)
Resection of the lung, the lining of the lung (pleura), the covering of the heart (pericardium), and the muscle that separates the chest and abdomen (diaphragm)
Drug: Cisplatin
Given after the tumor is removed as a bath (perfusion) for one-hour
Other Names:
  • Platinol
Drug: gemcitabine
Given after the tumor is removed as a bath (perfusion) for one-hour
Other Names:
  • Gemzar
Drug: amifostine
Given intravenously before perfusion chemotherapy and then 2 hours after the first dose
Drug: sodium thiosulfate
Given intravenously immediately at the end of perfusion chemotherapy
EXPERIMENTAL: Pleurectomy/Decortication (P/DC)
This is dose escalation 3+3 study design. All the patients meet the eligibility criteria and then sign the informed consent. Then after they have completed their standard pre-operative evalutions were each brought to the operating room for this surgical resection. Regardless of the arm the subject is assigned to they all recieve surgical intervention (Extrapleural Pneumonectomy, Pleurectomy/Decortication, or Tumor Debulking), Amifostine, Cisplatin, Gemcitabine, and Sodium Thiosulfate
Drug: Cisplatin
Given after the tumor is removed as a bath (perfusion) for one-hour
Other Names:
  • Platinol
Drug: gemcitabine
Given after the tumor is removed as a bath (perfusion) for one-hour
Other Names:
  • Gemzar
Drug: amifostine
Given intravenously before perfusion chemotherapy and then 2 hours after the first dose
Drug: sodium thiosulfate
Given intravenously immediately at the end of perfusion chemotherapy
Procedure: Pleurectomy/Decortication
Resection of the lining of the lung (pleura), while the lung remains intact.
EXPERIMENTAL: Tumor Debulking (TD)
This is dose escalation 3+3 study design. All the patients meet the eligibility criteria and then sign the informed consent. Then after they have completed their standard pre-operative evalutions were each brought to the operating room for this surgical resection. Regardless of the arm the subject is assigned to they all recieve surgical intervention (Extrapleural Pneumonectomy, Pleurectomy/Decortication, or Tumor Debulking), Amifostine, Cisplatin, Gemcitabine, and Sodium Thiosulfate
Drug: Cisplatin
Given after the tumor is removed as a bath (perfusion) for one-hour
Other Names:
  • Platinol
Drug: gemcitabine
Given after the tumor is removed as a bath (perfusion) for one-hour
Other Names:
  • Gemzar
Drug: amifostine
Given intravenously before perfusion chemotherapy and then 2 hours after the first dose
Drug: sodium thiosulfate
Given intravenously immediately at the end of perfusion chemotherapy

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
To establish the maximally tolerated dose (MTD) of intraoperative Intrathoracic/Intraperitoneal hyperthermic gemcitabine and cisplatin combination modulated by amifostine and sodium thiosulfate in patients with malignant pleural mesothelioma.
Time Frame: 2 years
2 years

Secondary Outcome Measures

Outcome Measure
Time Frame
To determine and quantitate the safety of this combination in these patients by defining the dose limiting toxicity.
Time Frame: 2 years
2 years
To study the pharmacokinetics of gemcitabine and cisplatin combination administered in this way.
Time Frame: 2 years
2 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Brigham and Women's Hospital

Collaborators

Dana-Farber Cancer Institute

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

November 1, 2007

Primary Completion (ACTUAL)

November 1, 2011

Study Completion (ACTUAL)

June 1, 2015

Study Registration Dates

First Submitted

December 10, 2007

First Submitted That Met QC Criteria

December 10, 2007

First Posted (ESTIMATE)

December 11, 2007

Study Record Updates

Last Update Posted (ESTIMATE)

January 23, 2017

Last Update Submitted That Met QC Criteria

January 19, 2017

Last Verified

January 1, 2017

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 07-091

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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