Cytoreductive Surgery and Intraperitoneal Chemotherapy for Stomach CAncer: a Feasibility Study (CISCA)

April 16, 2019 updated by: Richard van Hillegersberg

Rationale: For patients with peritoneal metastases of gastric origin, there is no consensus on the optimal treatment strategy. Several Asian and Western studies demonstrated hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CS) to result in a prolonged survival compared to palliative systemic treatment. Morbidity and mortality rates of HIPEC and CS appear to be acceptable. In the Netherlands, this treatment is not yet introduced, therefore patients with peritoneal metastases of gastric origin are precluded from surgery and will be treated with palliative chemotherapy or best support of care.

Objective: To assess the safety and feasibility of HIPEC and CS in Western patients with peritoneal metastases of gastric cancer, in terms of morbidity and mortality. Secondary objective is to determine the effect on survival and recurrence.

Study design: Mono centre prospective phase II single-arm feasibility study.

Study population: Western patients diagnosed with resectable (cT1-4b, N1-3) gastric cancer with clinical or pathologically proven peritoneal metastases without distant metastases.

Intervention: Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Cytoreductive Surgery (CS) with Cisplatin.

Main study parameters/endpoints: Primary outcome is the safety and feasibility of the intervention, measured by the percentage of overall surgical complications grade ≥3 as stated by the Common Terminology Criteria for Adverse Events. Secondary outcomes are intraoperative events, postoperative morbidity and mortality, postoperative recovery, including quality of life, and disease free- and overall survival.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The additional burden for the patient mainly consists of HIPEC and CS.Furthermore, patients will undergo additional staging in order to exclude unresectable disease, and neoadjuvant chemotherapy regimen (3 drugs) instead of a palliative chemotherapy regimen (2 drugs). Postoperative care and outpatient visits are performed according to current protocols on HIPEC and CS for colon cancer and nation-wide protocols on gastric cancer surgery. The study is associated with a high risk classification. As there is a potential survival benefit, a small chance for curation and possibly a higher quality of life, we consider the additional burden and risks justified. This study is designed as a one group study, which eliminates group relatedness.

Study Overview

Status

Terminated

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

3

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

  • Netherlands
      • Utrecht, Netherlands, 3584 CX
        • University Medical Center Utrecht

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 adenocarcinoma of the stomach.
  • Surgical resectable carcinoma (T1-4b, N1-3) (table 1)
  • Pathological proven peritoneal metastases
  • Peritoneal Cancer Index (PCI) ≤12
  • WHO performance status 0,1 or 2 and ASA 1-3
  • Age ≥ 18
  • Written informed consent

Exclusion Criteria:

  • Distant metastases other than peritoneal metastases
  • Siewert type I/II gastro-esophageal junction tumor 22.
  • Peritoneal carcinomatosis as a presentation of recurrent disease
  • Pregnancy

  • Any contraindication to cisplatin, e.g.

    • Hypersensitivity
    • HIV infection
    • inadequate bone marrow function (ANC <1.5x109/L or Platelets <100x109/L)
    • inadequate hepatic function (>1.5 x ULN, ALAT and ASAT >2.5 x ULN)
    • inadequate renal function (Creatinine clearance <50 ml/min)

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: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Study population
Drug: Perioperative chemotherapy
Perioperative chemotherapy
Procedure: Cytoreduction
Cytoreductive surgery
Drug: HIPEC
Hyperthermic intraperitoneal chemotherapy (HIPEC) with 100mg/m2 cisplatin

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Morbidity
Time Frame: From the day of surgery to hospital discharge or 30 days postoperative, whichever is last
Common Terminology Criteria for Adverse Events (CTCAE) ≥ grade 3
From the day of surgery to hospital discharge or 30 days postoperative, whichever is last
Mortality
Time Frame: From the day of surgery to 30 days postoperative
Postoperative mortality
From the day of surgery to 30 days postoperative

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Survival
Time Frame: Up to 5 years postoperative
Overall and disease free survival
Up to 5 years postoperative
Recovery
Time Frame: From the day of surgery to hospital discharge or 30 days postoperative, whichever is last
ICU stay, hospital stay
From the day of surgery to hospital discharge or 30 days postoperative, whichever is last
Quality of Life
Time Frame: Up to 5 years postoperative
EORTC-QLQ-C30 and EORTC-QLQ-STO22
Up to 5 years postoperative
Readmissions
Time Frame: Up to 30 days after hospital discharge
Readmissions after hospital discharge
Up to 30 days after hospital discharge

Collaborators and Investigators

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

Sponsor

Richard van Hillegersberg

Investigators

  • Principal Investigator: Richard van Hillegersberg, MD PhD, UMC Utrecht Cancer Center, Dep. of Surgery
  • Principal Investigator: Jelle P Ruurda, MD PhD, UMC Utrecht Cancer Center, Dep. of Surgery

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 (Actual)

August 1, 2017

Primary Completion (Actual)

April 23, 2018

Study Completion (Actual)

April 23, 2018

Study Registration Dates

First Submitted

April 4, 2017

First Submitted That Met QC Criteria

May 9, 2017

First Posted (Actual)

May 12, 2017

Study Record Updates

Last Update Posted (Actual)

April 17, 2019

Last Update Submitted That Met QC Criteria

April 16, 2019

Last Verified

April 1, 2019

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • NL58258.041.16
  • 2016-002595-27 (EudraCT Number)
  • 16-180/G-M (Other Identifier: Ethical Review Board Number)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

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.

Clinical Trials on Gastric Cancer

Clinical Trials on Perioperative chemotherapy

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Bulgaria

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

Subscribe