Cytoreductive Surgery and HIPEC in First or Secondary Platinum-resistant Recurrent Ovarian Epithelial Cancer (HIPOVA-01)

October 31, 2019 updated by: Hospices Civils de Lyon

Assessment of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in First or Secondary Platinum-resistant Recurrent Ovarian Epithelial Cancer

With 4,600 new cases in France in 2012, ovarian cancer is the seventh most common cancer in women and the fourth cause of mortality by cancer. Despite a high response rate to initial treatment, most patients will relapse within 2 years. No standard treatment has yet been established for patients with recurrent ovarian cancer.

Most patients with such recurrences are currently treated with new combinations of systemic chemotherapy. A repeated laparotomy with complete cytoreduction is also an option that several authors have used to obtain median survival rates of more than 30 months.

Twenty five percent of patients experiencing relapse present with platinum-resistant recurrence, occurring less than 6 months after chemotherapy completion. Recently, Pujade et al. showed that adding bevacizumab to chemotherapy significantly improves progression-free survival (PFS) in this subgroup of patients with poor prognoses (16.6 months versus 13.3 months in women treated with chemotherapy alone). Three case control studies have compared systemic chemotherapy and CRS (Cytoreduction Surgery) alone versus CRS plus HIPEC in patients with recurrent disease. They showed significantly improved results with the addition of HIPEC. In the French registry that included 474 patients with recurrence and peritoneal carcinomatosis, the median PFS was 13.8 months for platinum-resistant patients and 13 months for platinum-sensitive patients. Our hypothesis is that surgery would reduce the tumor burden and consequently the number of platinum-resistant tumor clones and that HIPEC would control the microscopic residual disease by increasing the tumor cell cytotoxicity.

We assume that adding a locoregional treatment to an "Aurelia-like" systemic treatment would improve the PFS. We aim to assess the benefit of adding surgery and HIPEC to the treatment of first or second platinum-resistant recurrence compared to chemotherapy + bevacizumab.

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Anticipated)

132

Phase

  • Phase 3

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

  • France
      • Besançon, France, 25030
        • Centre Hospitalier Universitaire Jean MINJOZ
      • Lille, France, 59000
        • Centre Oscar Lambret
      • Lille, France, 59067
        • CHRU Claude HURIEZ
      • Lyon, France, 69008
        • Centre Léon Bérard
      • Montpellier, France, 34298
        • Institut du Cancer de Montpellier
      • Nice, France, 06200
        • Centre Hospitalier Universitaire L'Archet II
      • Paris, France, 75015
        • Hôpital Européen Georges Pompidou - APHP
      • Pierre-Bénite, France
        • Centre Hospitalier Lyon Sud
      • Pierre-benite, France, 69495
        • Centre Hospitalier Lyon Sud
      • Poitiers, France, 86021
        • Centre Hospitalier Universitaire de Poitiers
      • Saint-Priest-en-Jarez, France, 42270
        • Institut de Cancerologie de La Loire
      • Saint-Priest-en-Jarez, France, 42270
        • Centre hospitalier universitaire de St Etienne
      • Saint-priest-en-jarez, France, 42270
        • Centre hospitalier universitaire de St Etienne
      • Strasbourg, France, 67200
        • Centre Hospitalier Universitaire Hautepierre
      • Vandœuvre-lès-Nancy, France, 54519
        • Institut de Cancérologie de Lorraine - Alexis Vautrin

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

14 years to 71 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • Histologically confirmed platinum-resistant Epithelial Ovarian Carcinoma (EOC)(clinical recurrence or persistence within 6 months of last treatment);
  • White blood cells >3,500/mm3, neutrophils ≥1,500/mm3, platelets ≥100,000/mm3;
  • Good renal function: serum creatinine values <1.5 mg/dl, creatinine clearance >60 ml/min;
  • Performance Status ≤2, Karnofsky Index ≥70%;
  • Serum bilirubin ≤1.5 x Upper limit of normal (UNL) 2 mg/dl;
  • Prior ovarian surgery before starting study treatment;
  • Covered by a Healthcare System, where applicable, and/or in compliance with the recommendations of the national laws in force relating to biomedical research;
  • Signed written informed consent obtained prior to any study-specific screening procedures.

Exclusion Criteria:

  • Platinum-refractory EOC (i.e progression under platinum containing chemotherapy);
  • Any prior malignancy not considered in complete remission for at least 2 years;
  • Pregnancy or breastfeeding;
  • Untreated central nervous system disease or symptomatic central nervous system metastasis, history or evidence of thrombotic or hemorrhagic disorders within 6 months before first study treatment;
  • Uncontrolled hypertension or active clinically significant cardiovascular disease;
  • Females of childbearing age not using medically accepted contraceptive measures, as judged by the investigator;
  • Contraindication to any drug contained in the chemotherapy regimen;
  • Known contraindication to cisplatin
  • Medical, geographical, sociological, psychological or legal conditions that would prevent the patient from completing the study or signing the informed consent;
  • Any significant disease which, in the investigator's opinion, excludes the patient from the study;
  • Under any administrative or legal supervision.

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: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Cytoreductive surgery combined with HIPEC
All patients will start with three cycles of CT-BEV 15 mg/kg, and will then be randomly. Then one cycle of monochemotherapy without bevacizumab is administered and followed by an interval CRS and HIPEC with postoperative chemotherapy and bevacizumab (CT-BEV - 15 mg/kg once every 3 weeks) until disease progression
Procedure: Cytoreductive surgery combined with HIPEC
Cytoreductive surgery combined with HIPEC (Cisplatin 70 mg/m2).
Active Comparator: Aurelia arm
Chemotherapy and bevacizumab (CT-BEV) once every 3 weeks from enrollment until disease progression
Drug: Chemotherapy and bevacizumab (CT-BEV)
Chemotherapy and bevacizumab (CT-BEV) 15 mg/kg once every 3 weeks from enrollment until disease progression (RECIST 1.1)

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Progression free survival
Time Frame: Change from baseline to 36 months
Progression will be based on RECIST V1.1 criteria performed on thoraco-abdominopelvic tomodensitometry (TDM ) assessed every 3 months. There is a follow-up period of 36 months.
Change from baseline to 36 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Overall survival
Time Frame: From the randomization to the death or 36 months end of follow-up
There is a follow-up period of 36 months.
From the randomization to the death or 36 months end of follow-up
Potential treatment-related mortality
Time Frame: During the first 60 postoperative days
Reported only in the experimental arm (cytoreductive surgery + HIPEC)
During the first 60 postoperative days
Potential treatment-related morbidity
Time Frame: During the first 60 postoperative days
Adverse events (AE) during the follow-up period: safety and tolerability will be assessed in terms of AEs, deaths, laboratory data, and vital signs. AEs will be described using MedDRA terms (version 18.0) and graded according to Common Terminology Criteria for Adverse Events (CTCAE version 5.0). These will be collected for all randomized patients.
During the first 60 postoperative days
Quality of life assessment
Time Frame: Baseline to 36 months end of follow-up
Quality of Life will be assessed using the Functional Assessment of Cancer Therapy-Ovarian (FACT-O) for all randomized patients.
Baseline to 36 months end of follow-up

Collaborators and Investigators

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

Sponsor

Hospices Civils de Lyon

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 (Anticipated)

November 30, 2019

Primary Completion (Anticipated)

November 30, 2022

Study Completion (Anticipated)

November 30, 2022

Study Registration Dates

First Submitted

May 11, 2017

First Submitted That Met QC Criteria

July 17, 2017

First Posted (Actual)

July 18, 2017

Study Record Updates

Last Update Posted (Actual)

November 1, 2019

Last Update Submitted That Met QC Criteria

October 31, 2019

Last Verified

October 1, 2019

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 69HCL17_0342

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

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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