Palliative Treatment With Liposomal Doxorubicin Plus Cisplatin for Patients With Malignant Pleural Mesothelioma

April 21, 2009 updated by: National Institute of Cancerología

"Phase II Study: Palliative Treatment With Liposomal Doxorubicin Plus Cisplatin for Patients With Malignant Pleural Mesothelioma "

Liposomal doxorubicin consists on doxorubicin encapsulated in liposomes that are composed of phosphatidylcholine and cholesterol. Liposomal doxorubicin can extravasate into tumors with abnormal vascular endothelium but may not penetrate normal tissues lowering its toxicity and increasing its efficiency. Combining Liposomal doxorubicin with cisplatin could be an effective new chemotherapy treatment for malignant pleural mesothelioma .

Hypothesis:

Liposomal doxorubicin combined with cisplatin could increase response rates to chemotherapy, progression free survival and overall survival in patients with malignant pleural mesothelioma.

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Detailed Description

Background:

Malignant pleural mesothelioma (MPM) is an invasive primary neoplasm associated with a rapid progression. It is usually diagnosed in the fifth to seventh decades of life, with a strong male predominance. 80% of the patients with MPM have a history of asbestos exposure. MPM develops only in 10% of the people with asbestos exposure, suggesting that other factors may be important in the development of this malignancy. MPM is classified into three pathological types: epithelial, sarcomatoid, and mixed. The epithelial type represents 50% of all the cases whether the sarcomatoid type the15%. Clinically the sarcomatoid type is related to a poorer prognosis compared with epithelial or mixed types MPM presents unique challenges with regard to diagnosis, staging, and treatment. Survival rates are approximately 6 months in patients without surgical treatment. 90% of the patients with MPM are not candidates for a surgical treatment because they arrived at advanced stages or with a poor lung function. In addition, surgery as a single modality has failed to improve survival, and several researches have explored the use of combined modality therapy incorporating radiation and chemotherapy. Given that the prognosis for patients with advanced MPM is poor regardless of the type of anticancer treatment, palliation of symptoms has been the primary goal. Chemotherapy remains the main palliative therapeutic modality, although either surgical intervention or local radiation therapy may be useful for the local control of pain or symptoms often associated with pleural fluid accumulation.

Most single chemotherapeutic agents have been tested in MPM obtaining response rates of < 20%. The impact of chemotherapy on the survival of patients with MPM remains uncertain. Platinum analogues have been extensively studied in MPM both single and combined regimens. There have been studies of patients with MPM treated with cisplatin 60 mg/m2 and doxorubicin 60 mg/m2 on day 1 with a 3 or 4 week interval demonstrating response rates of 20 to 25% with and overall survival of 10 months.

Liposomal doxorubicin (LD) consists on doxorubicin encapsulated in liposomes that are composed of phosphatidylcholine and cholesterol. LD can extravasate into tumors with abnormal vascular endothelium but may not penetrate normal tissues lowering its toxicity and increasing its efficiency. Combining LD with cisplatin could be an effective new chemotherapy treatment for MPM.

Objective:

Increase chemotherapy response rates, progression free survival and overall survival in patients with MPM treated with LD plus cisplatin as a palliative treatment for MPM.

Methods:

We conducted a prospective analytical study between September 2006 and April 2009. Thirty patients with epithelial, sarcomatoid or biphasic histological confirmed diagnosis of MPM from the Instituto Nacional de Cancerología and the Instituto Nacional de Enfermedades Respiratorias were included to receive LD 60mg/m2 plus cisplatin 80 mg/m2 every 4 weeks for 6 cycles. During the first cycle of chemotherapy, a scintigraphic image study was done with LD labeled with Tc-99m (LD-Tc-99m). The imaging study (SPECT/CT) was done 1h after administration to evaluate biodistribution and accumulation of LD-Tc-99m in tumoral tissue. Patients were evaluated by a surgeon after 2 cycles of chemotherapy, if surgery was not possible, chemotherapy continued until tumor progression. Clinical and biochemical evaluations were obtained before chemotherapy administration. An axial computed tomography was requested before chemotherapy and every 2 months in the first 6 months and every 4 months during following 2 years. Treatment response was according to RECIST criteria and toxicity was evaluated with National Cancer Institute Common Toxicity Criteria version 3.0. The statistical analysis was made using SPSS v.10 software. For descriptive purposes, continuous variables were summarized as arithmetic means, medians, and standard deviations; and categorical variables with 95% confidence intervals. Disease-free progression and over-all survival were evaluated by Kapplan-Meier.

Study Type

Interventional

Enrollment (Actual)

31

Phase

  • Phase 2

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

  • Mexico
    • Distrito Federal
      • Mexico city, Distrito Federal, Mexico, 14080
        • National Institute of Cancerología

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 to 80 years (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Patients with epithelial, sarcomatoid or biphasic histological confirmed diagnosis of MPM from the Instituto Nacional de Cancerología and the Instituto Nacional de Enfermedades Respiratorias
  • ECOG functional status 0 or 2
  • No renal function alteration (GFR >50%)
  • No hepatic function alteration
  • Leucocytes more than 2,000/mcl
  • Hemoglobin more than 10mg/dL
  • Platelets more than 100,000/mcl

Exclusion Criteria:

  • Patients who had received previous chemotherapy for MPM
  • Patients who do not accept the treatment

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: Liposomal doxorubicin
Thirty patients with MPM who received liposomal doxorubicin 60mg/m2 plus cisplatin 80 mg/m2 every 4 weeks for 6 cycles.
Drug: Liposomal doxorubicin

Liposomal doxorubicin 60 mg/m2 every 4 weeks for 6 cycles.

Thirty patients with epithelial, sarcomatoid or biphasic histological confirmed diagnosis of MPM from the Instituto Nacional de Cancerología and the Instituto Nacional de Enfermedades Respiratorias were included to receive LD 60mg/m2 plus cisplatin 80 mg/m2 every 4 weeks for 6 cycles.

Drug: Cisplatin

Cisplatin 80 mg/m2 every 4 weeks for 6 cycles.

Thirty patients with epithelial, sarcomatoid or biphasic histological confirmed diagnosis of MPM from the Instituto Nacional de Cancerología and the Instituto Nacional de Enfermedades Respiratorias were included to receive LD 60mg/m2 plus cisplatin 80 mg/m2 every 4 weeks for 6 cycles.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Progression free survival
Time Frame: 12 months
12 months
Over-all survival
Time Frame: 12 months
12 months

Collaborators and Investigators

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

Sponsor

National Institute of Cancerología

Investigators

  • Study Chair: Enrique Estrada Lobato, M.D., National Institute of Cancerología
  • Study Chair: Luis Alberto Medina Velázquez, PhD., Laboratorio de Enseñanza Virtual y Ciberpsicología. Facultad de Psicología. UNAM
  • Study Chair: Elena Arechaga Ocampo, PhD., National Institute of Cancerología
  • Study Chair: Victoria López Rodrígez, Q.F.B., National Institute of Cancerología
  • Study Chair: Luisa Geraldine Villanueva Rodríguez, M.D, National Institute of Canerología
  • Study Chair: Miguel Angel Ríos Trejo, M.D., National Institute of Cancerología

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.

General Publications

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

September 1, 2006

Primary Completion (ANTICIPATED)

April 1, 2009

Study Completion (ANTICIPATED)

June 1, 2009

Study Registration Dates

First Submitted

April 20, 2009

First Submitted That Met QC Criteria

April 21, 2009

First Posted (ESTIMATE)

April 22, 2009

Study Record Updates

Last Update Posted (ESTIMATE)

April 22, 2009

Last Update Submitted That Met QC Criteria

April 21, 2009

Last Verified

April 1, 2009

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CB/304/06
  • 007/024/OMI

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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