Intraperitoneal and Intravenous Paclitaxel Chemotherapy With Oral Capecitabine for Gastric Adenocarcinoma With Peritoneal Carcinomatosis

A Phase II Study of Intraperitoneal and Intravenous Paclitaxel Chemotherapy With Oral Capecitabine for Gastric Adenocarcinoma With Peritoneal Carcinomatosis

Sponsors

Lead Sponsor: National Cancer Institute (NCI)

Source National Institutes of Health Clinical Center (CC)
Brief Summary

Background: Three-fourths of people diagnosed with gastric cancer will die from it. Researchers want to see if giving cancer drugs in a new way can help people live longer and delay the time it takes for the cancer to grow. Objective: To find a better way to treat advanced stomach cancer. Eligibility: People ages 18 and older with stomach cancer that has spread throughout their belly. Design: Participants will be screened with: Medical history Physical exam Blood, urine, and heart tests Scans Cancer sample: If they do not have one, they will have a biopsy. Tests of performance of normal activities Dietary assessment Participants will have a laparoscopy. Small cuts are made into their abdomen. A thin camera with a light is inserted. Small instruments are used to take biopsies. This will be repeated during the study to monitor the cancer. During the first laparoscopy, a port with a catheter attached will be put into the abdomen. Participants may also have an endoscopy: A thin tube with a camera is inserted through the mouth and into the stomach. The tube collects samples to monitor the cancer. Participants will get paclitaxel every 3 weeks through the abdominal port and through a small plastic tube in an arm vein. They will also take capecitabine by mouth twice daily for the first 15 days of a 21-day cycle. After participants finish 3 cycles, they will have scans to see how they are doing. They may get another course of therapy. Participants will have visits every 3 weeks during treatment. Then they will have follow-up visits for 5 years. Then they will keep in touch with researchers for the rest of their life.

Detailed Description

Background: - An estimated 28,000 cases of gastric adenocarcinoma are diagnosed annually in the U.S. - Peritoneal metastasis is a common finding at diagnosis, making curative surgical resection possible in an estimated 25% of patients. - Systemic chemotherapy is the recommended treatment for patients with metastatic gastric cancer to the peritoneal cavity, however selective use of cytoreductive surgery and intraperitoneal chemotherapy has been associated with improved overall survival. - Multiple chemotherapeutic agents and delivery systems have been described for intraperitoneal therapy, but no standard regimen exists. Objective: -Determine the progression free survival (PFS) in patients with peritoneal metastases from gastric cancer after repeated intraperitoneal chemotherapeutic infusion (IPC) and systemic paclitaxel administration with concomitant capecitabine therapy. Eligibility: - Histologically confirmed adenocarcinoma of the stomach. - Radiographic evidence of peritoneal carcinomatosis and/or sub-radiographic evidence of peritoneal carcinomatosis found at staging laparoscopy. - Medically fit for systemic chemotherapy and intraperitoneal chemotherapy. - Men and women agegreater than or equal to 18 years. Design: - Phase II, nonrandomized, open label study. - Patients will enroll in two cohorts: those with prior systemic chemotherapy and those who are treatment naive. - Patients will undergo staging laparoscopy and placement of peritoneal access port. - Intraperitoneal paclitaxel (60 mg/m^2 weekly), intravenous paclitaxel (80 mg/m2 weekly), and capecitabine (825 mg/m^2 twice daily for 14 days of each cycle) for 12 weeks. - Treatment response will be assessed with imaging and laparoscopy. - It is expected that 16-20 patients per year for total 4 years will be enrolled. The accrual ceiling is set at 74 patients.

Overall Status Recruiting
Start Date 2020-06-09
Completion Date 2027-01-30
Primary Completion Date 2026-05-30
Phase Phase 2
Study Type Interventional
Primary Outcome
Measure Time Frame
to determine progression free survival (PFS) in patients with peritoneal metastases from gastric cancer after repeated intraperitoneal chemotherapeutic infusion (IPC) and systemic paclitaxel administration with concomitant capecitabine therapy after 1 course (3 treatment cycles; 9 weeks)
Secondary Outcome
Measure Time Frame
intra-peritoneal progression free survival (iPFS) at intra-peritoneal progression
frequency of objective histopathologic response to therapy at end of each course (3 treatment cycles; 9 weeks)
distant (extra-peritoneal) disease free survival at extra-peritoneal progression
morbidity of this treatment strategy 4 years
overall survival death
Enrollment 74
Condition
Intervention

Intervention Type: Drug

Intervention Name: Paclitaxel

Description: Paclitaxel (IP and IV), Day 1 of each 3-week cycle: Paclitaxel IP - Intraperitoneal paclitaxel (60 mg/m2) will be diluted in 500 mL of 0.9% NS, to be infused as rapidly as tolerated once per 3-week cycle on Day 1. Paclitaxel IV - Intravenous paclitaxel (80 mg /m2) will be administered concomitantly over 3 hours, diluted in 100 to 250 ml of 0.9% NS once per 3-week cycle on Day 1.

Arm Group Label: 1/Arm 1

Intervention Type: Drug

Intervention Name: Capecitabine

Description: Day 1-15 of each 3-week cycle: oral capecitabine (825 mg /m2) to be taken twice a day starting the evening of Day 1 of each cycle until the morning of Day 15, followed by a 7-day rest period during each 3-week cycle.

Arm Group Label: 1/Arm 1

Intervention Type: Device

Intervention Name: BardPort Titanium Implanted Port withPeritoneal Catheter

Description: After peritoneal chemo infusion port is placed (Days 1-3, as dictated by clinical status), patients will begin intraperitoneal paclitaxel and intravenous paclitaxel (Day 1) followed by oral capecitabine on the evening of Day 1 to the morning of Day 15.

Arm Group Label: 1/Arm 1

Eligibility

Criteria:

-INCLUSION CRITERIA: 1. Patients must have histologically or cytologically confirmed gastric adenocarcinoma, including Siewert III gastroesophageal junction adenocarcinoma, confirmed by the NCI Laboratory of Pathology, and have provided a block or unstained slides of primary or metastatic tumor tissue or newly obtained fresh biopsy of a tumor lesion in case archival tissue sample is not available. 2. Patients may be treatment na(SqrRoot) ve or have received systemic chemotherapy prior to enrollment: - Trastuzumab allowed as prior treatment for HER2/neu over-expressing cancers as clinically indicated. - Last dose of chemotherapy at least 4 weeks prior to enrollment with recovery to Grade 1 from chemotherapy-related toxicities. 3. Radiographic evidence of peritoneal carcinomatosis and/or sub-radiographic evidence of peritoneal carcinomatosis found at staging laparoscopy. 4. Age >=18 years. Children under the age of 18 will not participate in this study as gastric cancer is rare in this population. 5. ECOG performance status <=1 6. Patients must have normal organ and marrow function as defined below: hemoglobin >=8.0 g/dL absolute neutrophil count >=1,000/mcL platelets >=100,000/mcL total bilirubin <=1.5 X institutional upper limit of normal AST(SGOT)/ALT(SGPT) <=2.5 X institutional upper limit of normal creatinine <1.5 mg/dl OR creatinine clearance >=60 mL/min/1.73 m^2 for patients with creatinine levels above institutional normal. 7. Physiologically able to undergo laparoscopy and systemic chemotherapy. 8. Ability of subject to understand and the willingness to sign a written informed consent document. 9. Previous exploratory laparotomy or laparoscopy with tissue biopsy or peritoneal lavage is permitted. 10. Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study treatment. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. 11. Patients must be co-enrolled in protocol 13C0176 (NCT01915225) and 17C0044 (NCT03027427) for sample collection. 12. HIV-positive patients may be considered for this study only after consultation with a NIAID physician. EXCLUSION CRITERIA: 1. Patients who are receiving any other investigational agents. 2. Previous cytoreductive surgery or intraperitoneal chemotherapy. 3. Disseminated extra-peritoneal or solid organ metastases: - Excludes greater omentum and ovarian metastases. - Radiographic signs or clinical symptoms consistent with malignant bowel obstruction. 4. History of allergic reactions attributed to compounds of similar chemical or biologic composition to Paclitaxel or Capecitabine or other agents used in study. 5. Previous treatment with paclitaxel or nab-paclitaxel resulting in progression of disease. 6. Existing peripheral neuropathy, Grade 3 or greater. 7. Past medical history of dihydropyrimidine dehydrogenase deficiency. 8. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. 9. Patients on therapeutic anticoagulation; Note: Prophylactic anticoagulation (i.e. intralumenal heparin) for venous or arterial access devices is allowed. 10. Pregnant women are excluded because paclitaxel and capecitabine can cause fetal harm when administered to pregnant women. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with paclitaxel and capecitabine, breastfeeding should be discontinued if the mother is treated with paclitaxel and capecitabine.

Gender:

All

Minimum Age:

18 Years

Maximum Age:

N/A

Healthy Volunteers:

No

Overall Official
Last Name Role Affiliation
Jeremy L Davis, M.D. Principal Investigator National Cancer Institute (NCI)
Overall Contact

Last Name: Cathleen E Hannah

Phone: (240) 858-7006

Email: [email protected]

Location
Facility: Status: Contact: National Institutes of Health Clinical Center For more information at the NIH Clinical Center contact National Cancer Institute Referral Office 888-624-1937
Location Countries

United States

Verification Date

2021-04-21

Responsible Party

Type: Sponsor

Keywords
Has Expanded Access No
Condition Browse
Number Of Arms 1
Arm Group

Label: 1/Arm 1

Type: Experimental

Description: IP and IV paclitaxel administration with concomitant oral capecitabine

Study Design Info

Allocation: N/A

Intervention Model: Single Group Assignment

Primary Purpose: Treatment

Masking: None (Open Label)

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