- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04329494
PIPAC for the Treatment of Peritoneal Carcinomatosis in Patients With Ovarian, Uterine, Appendiceal, Colorectal, or Gastric Cancer
Safety and Efficacy of Pressurized Intraperitoneal Aerosolized Chemotherapy (PIPAC) in Ovarian, Uterine, Appendiceal, Colorectal, and Gastric Cancer Patients With Peritoneal Carcinomatosis (PC)
Study Overview
Status
Conditions
- Peritoneal Carcinomatosis
- Stage IV Uterine Corpus Cancer AJCC v8
- Stage IVA Uterine Corpus Cancer AJCC v8
- Stage IVB Uterine Corpus Cancer AJCC v8
- Metastatic Malignant Solid Neoplasm
- Malignant Uterine Neoplasm
- Clinical Stage IV Gastric Cancer AJCC v8
- Metastatic Colorectal Carcinoma
- Stage IV Colorectal Cancer AJCC v8
- Stage IVA Colorectal Cancer AJCC v8
- Stage IVB Colorectal Cancer AJCC v8
- Stage IVC Colorectal Cancer AJCC v8
- Clinical Stage IVA Gastric Cancer AJCC v8
- Clinical Stage IVB Gastric Cancer AJCC v8
- Pathologic Stage IV Gastric Cancer AJCC v8
- Metastatic Gastric Carcinoma
- Postneoadjuvant Therapy Stage IV Gastric Cancer AJCC v8
- Stage IV Ovarian Cancer AJCC v8
- Stage IVA Ovarian Cancer AJCC v8
- Stage IVB Ovarian Cancer AJCC v8
- Metastatic Ovarian Carcinoma
- Metastatic Appendix Carcinoma
- Metastatic Malignant Neoplasm in the Peritoneum
- Stage IV Appendix Carcinoma AJCC v8
- Stage IVA Appendix Carcinoma AJCC v8
- Stage IVB Appendix Carcinoma AJCC v8
- Stage IVC Appendix Carcinoma AJCC v8
Detailed Description
PRIMARY OBJECTIVES:
I. To evaluate the safety of pressurized intraperitoneal aerosol chemotherapy (PIPAC) in 3 groups of patients: peritoneal carcinomatosis (PC) due to primary ovarian, uterine, or gastric carcinoma (Arm 1); PC due to primary colorectal or appendiceal carcinoma (Arm 2).
II. To evaluate safety of PIPAC and identify the maximum tolerated dose (MTD) of PIPAC with MMC in patients with PC due to colorectal or appendiceal carcinoma (Arm 3).
SECONDARY OBJECTIVES:
I. Ability to proceed to cytoreduction with/without hyperthermic intraperitoneal chemotherapy (HIPEC) (Arm 3 patients).
II. Efficacy will be assessed by:
Ia. Response Evaluation Criteria in Solid Tumors (RECIST), if available, version 1.1 via computed tomography (CT) scan at baseline (week 10, and 6 weeks after completing treatment; and at 18 weeks).
Ib. Peritoneal regression grading score (PRGS) via biopsy at each cycle (both pre-PIPAC and post-PIPAC peritoneal samples will be obtained).
Ic. Peritoneal carcinomatosis index (PCI) at the time of laparoscopy. II. Post-operative surgical complications by Claven-Dindo classification evaluated at 4, 10, and 16 weeks (4 weeks after each PIPAC).
III. Progression-free survival. IV. PIPAC technical failure rate. V. Patient-reported health state/quality of life and symptoms before treatment and at 6, 12, and 18 weeks as measured by the European Quality of Life Five Dimension Five Level Scale Questionnaire (EQ-5D-5L) and MD Anderson Symptom Inventory (MDASI).
VI. Functional status, as measured by the number of daily steps before and after treatments (Vivofit 4 wristband pedometer - Garmin Company).
EXPLORATORY OBJECTIVE:
I. Correlative/translational studies to characterize the tumor microenvironment, subclonal evolution, genomics, and pharmacokinetics of peritoneal tumors.
OUTLINE: Patients are assigned to 1 of 3 arms.
ARM I: Patients with ovarian, uterine, or gastric cancer, undergo PIPAC with doxorubicin intraperitoneally (IP), followed by cisplatin IP. Treatment repeats every 4-6 weeks for up to 3 cycles in the absence of disease progression or unacceptable toxicity.
ARM II: Patients with colorectal or appendiceal cancer undergo PIPAC with oxaliplatin IP. For cycles 2 and 3, patients receive leucovorin intravenously (IV) over 10 minutes and fluorouracil IV over 15 minutes 1-24 hours before undergoing PIPAC. Treatment repeats every 4-6 weeks for up to 3 cycles in the absence of disease progression or unacceptable toxicity.
ARM III: Patients with colorectal or appendiceal cancer who have undergo at least 4 months (or 8 cycles) of first-line standard of care chemotherapy but have not progressed on second line chemotherapy undergo PIPAC with mitomycin IP. Patients also receive standard of care irinotecan IV over 90 on day 1, leucovorin IV over 30 minutes on day 1, and fluorouracil IV on days 1-2 during weeks 2, 4, 8, 10, 14 and 16. Treatment repeats every 4-6 weeks for up to 3 cycles in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 12 weeks for up to 3 years.
Study Type
Enrollment (Estimated)
Phase
- Phase 1
Contacts and Locations
Study Locations
-
-
California
-
Duarte, California, United States, 91010
- Recruiting
- City of Hope Medical Center
-
Contact:
- Thanh H. Dellinger
- Phone Number: 626-218-1379
- Email: tdellinger@coh.org
-
Principal Investigator:
- Thanh H. Dellinger
-
-
Florida
-
Jacksonville, Florida, United States, 32224-9980
- Recruiting
- Mayo Clinic in Florida
-
Contact:
- Amit L. Merchea
- Phone Number: 904-953-2596
- Email: Merchea.AmitL@mayo.edu
-
Principal Investigator:
- Amit L. Merchea
-
-
New York
-
Greenlawn, New York, United States, 11740
- Recruiting
- Northwell Health Cancer Institute at Huntington
-
Contact:
- Richard L. Whelan
- Phone Number: 212-434-4860
- Email: rwhelan1@northwell.edu
-
Principal Investigator:
- Richard L. Whelan
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Documented informed consent of the participant and/or legally authorized representative
- Patients must have histologically confirmed ovarian, uterine, gastric, appendiceal or colorectal cancer with PC
- Prior IP chemotherapy is permitted
- Eastern Cooperative Oncology Group (ECOG) performance status (PS) =< 2
- Absolute neutrophil count (ANC) >= 1500/mm^3
- Platelets >= 100,000/mm^3
- Hemoglobin >= 9 g/dl
- Serum total bilirubin =< 1.5 x upper limit of normal (ULN)
- Alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) and aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) =< 2.5 x ULN, unless liver metastases (Arm 1) are present or unless patients is know to have chronic liver disease (hepatitis) in which case AST and ALT must be =< 5 x ULN
- Alkaline phosphatase =< 2 x ULN
- Serum creatinine (sCr) =< 1.5 x ULN, or creatinine clearance (Ccr) >= 40 ml/min as calculated by the Cockcroft-Gault formula
- No contraindications for a laparoscopy
- The peritoneal disease does not have to be measurable by RECIST 1.1 but needs to be visible on cross sectional imaging or diagnostic laparoscopy
- Patients must have progressed on at least one evidence-based chemotherapeutic regimen (Arm 1 and 2). For Arm 3, patients should have stable or responsive disease on at least 4 months first-line systemic chemotherapy
- For patients with a known history of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated
- Patients with a known history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load
Women of childbearing potential (WOCBP) and male patients with WOCBP partner must be using an adequate method of contraception to avoid pregnancy throughout the study and for up to 12 weeks after the last dose of investigational product in such a manner that the risk of pregnancy is minimized. WOCBP include any female who has experienced menarche and who has not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or is not postmenopausal. Post menopause is define as:
- Amenorrhea >= 12 consecutive months without another cause or
- For women with irregular menstrual periods and on hormone replacement therapy (HRT), a documented serum follicle stimulating hormone (FSH) level > 35 mIU/mL
- Women who are using oral contraceptives, other hormonal contraceptives (vaginal products, skin patches, or implanted or injectable products), or mechanical products such as an intrauterine device or barrier methods (diaphragm, condoms, spermicides) to prevent pregnancy, or are practicing abstinence or where their partner is sterile (e.g., vasectomy) should be considered to be of childbearing potential
INCLUSION TO PROCEED WITH PIPAC: Laparoscopy findings must meet all of the below criteria in order to proceed to PIPAC:
- PIPAC access is feasible
- There is room for aerosol therapy
- There is no evidence of impending bowel obstruction
- =< 5 L of ascites
- Not a candidate for cytoreduction and HIPEC
Exclusion Criteria:
Gastric and colorectal/appendiceal:
- Extra-peritoneal metastatic disease
- Arm 1 (ovarian, uterine, gastric): Previous treatment with maximum cumulative doses of doxorubicin, daunorubicin, epirubicin, idarubicin, and/or other anthracyclines and anthracenediones
- Arm 2 (colorectal/appendiceal): Known dihydropyrimidine dehydrogenase deficiency (DPD) deficiency
- Arm 2 (colorectal/appendiceal): Bowel obstruction requiring nasogastric tube, percutaneous endoscopic gastrostomy or exclusive total parenteral nutrition
- Arm 2 (colorectal/appendiceal): Prior unanticipated severe reaction or hypersensitivity to platinum based compounds
- Arm 2 (colorectal/appendiceal): Patients who have not recovered from adverse events due to prior anti-cancer therapy (i.e., have residual toxicities > grade 1), with the exception of alopecia, hearing loss, or non-clinically significant laboratory abnormalities. Grade 2 peripheral neuropathy is permitted
- Arm 2 (colorectal/appendiceal): Life expectancy of less than 6 months
- Arm 2 (colorectal/appendiceal): Chemotherapy or surgery within the last 4 weeks prior to enrollment (6 weeks for prior bevacizumab therapy). Five half-lives for other anti-cancer agents
- Arm 2 (colorectal/appendiceal): Previous anaphylactic reaction to the chemotherapy drug used
- Arm 2 (colorectal/appendiceal): Patients may not be receiving any other investigational or concurrent anti-cancer agents
- Arm 2 (colorectal/appendiceal): Ascites due to decompensated liver cirrhosis; portal vein thrombosis
- Arm 2 (colorectal/appendiceal): Simultaneous tumor debulking with gastrointestinal resection
- Arm 2 (colorectal/appendiceal): Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, severe myocardial insufficiency, recent myocardial infarction, severe arrhythmias, severe renal impairment, myelosuppression, or severe hepatic impairment
- Arm 2 (colorectal/appendiceal): Immunocompromised patients such as those with an immunosuppressive medication or a known disease of the immune system
- Arm 2 (colorectal/appendiceal): Involvement in the planning and conduct of the study
- Arm 2 (colorectal/appendiceal): Pregnancy
- Arm 2 (colorectal/appendiceal): Patients with psychiatric illness/social situations that would limit compliance with study requirements
- Arm 2 (colorectal/appendiceal): New York Heart Association (NYHA) class 3 or 4; myocardial infarction, acute coronary syndrome, diabetes mellitus with ketoacidosis or chronic obstructive pulmonary disease (COPD) requiring hospitalization in the preceding 6 months
- Arm 2 (colorectal/appendiceal): Major systemic infection requiring antibiotics 72 hours or less prior to the first dose of study drug
- Arm 2 (colorectal/appendiceal): Exclusive total parenteral nutrition
- Arm 2 (colorectal/appendiceal): Prior intra-abdominal aerosol chemotherapy
- Arm 3 (colorectal/appendiceal): Progression on first- AND second-line systemic therapy
- Arm 3 (colorectal/appendiceal): Hematologic toxicities requiring significant dose reductions while on systemic chemotherapy
- Arm 3 (colorectal/appendiceal): Intolerance to prior 5-FU at 2400mg/m^2 IV every 2 weeks or to irinotecan at 180mg/m^2. Intolerance is defined as the need of significant dose reduction or treatment interruption of > 1 week due to toxicity
- Arm 3 (colorectal/appendiceal): Known DPD deficiency
- Arm 3 (colorectal/appendiceal): Bowel obstruction requiring nasogastric tube, percutaneous endoscopic gastrostomy or exclusive total parenteral nutrition
- Arm 3 (colorectal/appendiceal): Patients who have not recovered from adverse events due to prior anti-cancer therapy (i.e., have residual toxicities > grade 1), with the exception of alopecia, hearing loss, or non-clinically significant laboratory abnormalities. Grade 2 peripheral neuropathy is permitted
- Arm 3 (colorectal/appendiceal): Life expectancy of less than 6 months
- Arm 3 (colorectal/appendiceal): Chemotherapy or surgery within the last 2 weeks prior to enrollment (6 weeks for prior bevacizumab therapy). Five half-lives for other anti-cancer agents
- Arm 3 (colorectal/appendiceal): Previous anaphylactic reaction to the chemotherapy drug used
- Arm 3 (colorectal/appendiceal): Patients may not be receiving any other investigational anti-cancer agents
- Arm 3 (colorectal/appendiceal): Ascites due to decompensated liver cirrhosis; portal vein thrombosis
- Arm 3 (colorectal/appendiceal): Simultaneous tumor debulking with gastrointestinal resection
- Arm 3 (colorectal/appendiceal): Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, severe myocardial insufficiency, recent myocardial infarction, severe arrhythmias, severe renal impairment, myelosuppression, or severe hepatic impairment
- Arm 3 (colorectal/appendiceal): Immunocompromised patients such as those with an immunosuppressive medication or a known disease of the immune system
- Arm 3 (colorectal/appendiceal): Involvement in the planning and conduct of the study
- Arm 3 (colorectal/appendiceal): Pregnancy
- Arm 3 (colorectal/appendiceal): Patients with psychiatric illness/social situations that would limit compliance with study requirements
- Arm 3 (colorectal/appendiceal): New York Heart Association (NYHA) class 3 or 4; myocardial infarction, acute coronary syndrome, diabetes mellitus with ketoacidosis or chronic obstructive pulmonary disease (COPD) requiring hospitalization in the preceding 6 months
- Arm 3 (colorectal/appendiceal): Major systemic infection requiring antibiotics 72 hours or less prior to the first dose of study drug
- Arm 3 (colorectal/appendiceal): Exclusive total parenteral nutrition
- Arm 3 (colorectal/appendiceal): Prior intra-abdominal aerosol chemotherapy
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Arm I (PIPAC, doxorubicin, cisplatin)
Patients with ovarian, uterine, or gastric cancer, undergo PIPAC with doxorubicin IP, followed by cisplatin IP.
Treatment repeats every 4-6 weeks for up to 3 cycles in the absence of disease progression or unacceptable toxicity.
|
Ancillary studies
Other Names:
Ancillary studies
Undergo biopsy
Other Names:
Given via PIPAC
Other Names:
Given via PIPAC
Other Names:
Undergo PIPAC
Other Names:
|
Experimental: Arm II (PIPAC, oxaliplatin, leucovorin, fluorouracil)
Patients with colorectal or appendiceal cancer undergo PIPAC with oxaliplatin IP.
For cycles 2 and 3, patients receive leucovorin IV over 10 minutes and fluorouracil IV over 15 minutes 1-24 hours before undergoing PIPAC.
Treatment repeats every 4-6 weeks for up to 3 cycles in the absence of disease progression or unacceptable toxicity.
|
Ancillary studies
Other Names:
Ancillary studies
Undergo biopsy
Other Names:
Given IV
Other Names:
Given IV
Other Names:
Undergo PIPAC
Other Names:
Given via PIPAC
Other Names:
|
Experimental: Arm III (PIPAC, mitomycin, FOLFIRI)
Patients with colorectal or appendiceal cancer who have undergo at least 4 months (or 8 cycles) of first-line standard of care chemotherapy but have not progressed on second line chemotherapy undergo PIPAC with mitomycin IP.
Patients also receive standard of care irinotecan IV over 90 on day 1, leucovorin IV over 30 minutes on day 1, and fluorouracil IV on days 1-2 during weeks 2, 4, 8, 10, 14 and 16.
Treatment repeats every 4-6 weeks for up to 3 cycles in the absence of disease progression or unacceptable toxicity.
|
Ancillary studies
Other Names:
Ancillary studies
Undergo biopsy
Other Names:
Given IV
Other Names:
Given IV
Other Names:
Given IV
Undergo PIPAC
Other Names:
Given via PIPAC
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Dose limiting toxicities
Time Frame: Up to 18 weeks
|
Assessed by Common Terminology Criteria for Adverse Events (CTCAE) version (v) 5.0.
Summarized by type (organ affected or laboratory determination), severity, time of onset, duration, probable association with the study treatment, and reversibility or outcome.
|
Up to 18 weeks
|
Incidence of adverse events
Time Frame: From day 1 of protocol therapy until week 18
|
Assessed using CTCAE v.5.0.
Summarized by grade and attribution.
Post-surgical complications will be assessed by Clavien-Dindo classification.
|
From day 1 of protocol therapy until week 18
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percentage of evaluable patients who have achieved complete response (CR), partial response (PR), or stable disease (SD)
Time Frame: At baseline, following the second cycle (week 10), and 6 weeks after completing treatment (at 18 weeks/off-study)
|
Assessed by Response Evaluation Criteria in Solid Tumors criteria version 1.1 via computed tomography (CT) scan.
The proportion of successes will be estimated by the number of successes divided by the total number of evaluable patients.
Confidence intervals for the true success proportion will be calculated according to the approach by Clopper and Pearson.
|
At baseline, following the second cycle (week 10), and 6 weeks after completing treatment (at 18 weeks/off-study)
|
Percentage of evaluable patients who have achieved CR, PR, or SD
Time Frame: At the time of laparoscopy (or CT imaging if laparoscopy is not planned during surgery)
|
Assessed by Peritoneal Carcinomatosis Index.
The proportion of successes will be estimated by the number of successes divided by the total number of evaluable patients.
Confidence intervals for the true success proportion will be calculated according to the approach by Clopper and Pearson.
|
At the time of laparoscopy (or CT imaging if laparoscopy is not planned during surgery)
|
Percentage of evaluable patients who have achieved a decrease in Peritoneal Regression Grading Score over successive biopsies
Time Frame: Up to 18 weeks
|
The proportion of successes will be estimated by the number of successes divided by the total number of evaluable patients.
Confidence intervals for the true success proportion will be calculated according to the approach by Clopper and Pearson.
|
Up to 18 weeks
|
Progression-free survival
Time Frame: Time from first pressurized intraperitoneal aerosolized chemotherapy (PIPAC) procedure, assessed up to 1 year
|
Described using the Kaplan-Meier method.
|
Time from first pressurized intraperitoneal aerosolized chemotherapy (PIPAC) procedure, assessed up to 1 year
|
Post-surgical complications
Time Frame: At 4 weeks after each PIPAC
|
Assessed by Clavien-Dindo classification.
Results will be strictly descriptive in nature.
|
At 4 weeks after each PIPAC
|
PIPAC technical failure rate
Time Frame: Up to 3 years
|
Up to 3 years
|
|
Functional status
Time Frame: Up to 18 weeks
|
Measured by the number of daily steps before and after treatments (Vivofit 4 wristband pedometer - Garmin Company).
|
Up to 18 weeks
|
Cytoreductive surgery rate (Arm 3)
Time Frame: Up to 18 weeks
|
Up to 18 weeks
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Thanh H Dellinger, MD, City of Hope Medical Center
- Principal Investigator: Mustafa Raoof, MD, City of Hope Medical Center
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Digestive System Diseases
- Neoplasms by Histologic Type
- Urogenital Neoplasms
- Neoplasms by Site
- Neoplasms, Glandular and Epithelial
- Peritoneal Diseases
- Genital Neoplasms, Female
- Uterine Diseases
- Endocrine System Diseases
- Ovarian Diseases
- Adnexal Diseases
- Gonadal Disorders
- Gastrointestinal Neoplasms
- Digestive System Neoplasms
- Gastrointestinal Diseases
- Stomach Diseases
- Endocrine Gland Neoplasms
- Colonic Diseases
- Intestinal Diseases
- Intestinal Neoplasms
- Rectal Diseases
- Abdominal Neoplasms
- Cecal Diseases
- Cecal Neoplasms
- Female Urogenital Diseases
- Female Urogenital Diseases and Pregnancy Complications
- Urogenital Diseases
- Genital Diseases
- Genital Diseases, Female
- Neoplasms
- Stomach Neoplasms
- Carcinoma
- Colorectal Neoplasms
- Ovarian Neoplasms
- Peritoneal Neoplasms
- Carcinoma, Ovarian Epithelial
- Uterine Neoplasms
- Appendiceal Neoplasms
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Nucleic Acid Synthesis Inhibitors
- Enzyme Inhibitors
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Protective Agents
- Alkylating Agents
- Topoisomerase II Inhibitors
- Topoisomerase Inhibitors
- Micronutrients
- Antibiotics, Antineoplastic
- Vitamins
- Topoisomerase I Inhibitors
- Antidotes
- Vitamin B Complex
- Cisplatin
- Fluorouracil
- Oxaliplatin
- Leucovorin
- Irinotecan
- Doxorubicin
- Liposomal doxorubicin
- Daunorubicin
- Mitomycins
- Mitomycin
Other Study ID Numbers
- 19184 (Other Identifier: City of Hope Medical Center)
- P30CA033572 (U.S. NIH Grant/Contract)
- NCI-2020-01254 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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