Combination Chemotherapy With or Without Surgery & Chemoradiotherapy in Patients With Malignant Pleural Mesothelioma

NCT ID: NCT00354393

Last Updated: 2025-07-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

9 participants

Study Classification

INTERVENTIONAL

Study Start Date

2002-08-31

Study Completion Date

2009-06-30

Brief Summary

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RATIONALE: Drugs used in chemotherapy, such as methotrexate, vinorelbine, and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving chemotherapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed. Radiation therapy uses high-energy x-rays to kill tumor cells. Cisplatin may also make tumor cells more sensitive to radiation therapy. Giving chemotherapy and radiation therapy after surgery may kill any tumor cells that remain after surgery.

PURPOSE: This phase II trial is studying how well giving combination chemotherapy with or without surgery and chemoradiotherapy works in treating patients with malignant pleural mesothelioma.

Detailed Description

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OBJECTIVES:

Primary

* Assess the response to induction combination chemotherapy comprising methotrexate, vinorelbine ditartrate, and cisplatin in patients with previously untreated malignant pleural mesothelioma.

Secondary

* Assess the tolerability and toxicity of this regimen in these patients.
* Determine relapse-free and overall survival of patients treated with induction combination chemotherapy with or without surgery and hemithoracic radiation.
* Assess the impact of induction combination chemotherapy on operability and surgical success.
* Evaluate the impact of these treatment regimens on quality of life.

OUTLINE:

* Induction chemotherapy: Patients receive MVP chemotherapy comprising cisplatin IV over 30-60 minutes on day 1 and vinorelbine ditartrate IV over 5-10 minutes and methotrexate IV over 5-30 minutes on days 8, 15, and 22. Treatment repeats every 28 days for 2 courses. Patients with unresectable disease may receive up to 2 additional courses of induction chemotherapy. Patients requiring palliative radiotherapy or who have progressive disease are removed from the study. Patients with resectable disease or sarcomatoid histology and T1-3, N1-2 disease with a complete or partial response to induction chemotherapy proceed to surgery.
* Surgery: Patients with extensive disease undergo palliative debulking pleurectomy and decortication and then are taken off study. All other patients undergo a thoracotomy with an extrapleural pneumonectomy and then proceed to chemoradiotherapy.
* Chemoradiotherapy: Beginning 6-10 weeks after surgery, patients undergo 3-dimensional conformal or intensity-modulated radiotherapy once daily, 5 days a week, for 6 weeks. Patients also receive cisplatin IV over 30-60 minutes on days 1 and 22. Patients with responding disease proceed to adjuvant chemotherapy.
* Adjuvant chemotherapy: Patients receive 2 additional courses of MVP chemotherapy as above.

Quality of life is assessed at baseline, after each course of induction chemotherapy, before surgery, and then every 3 months thereafter.

After completion of study therapy, patients are followed every 3 months.

PROJECTED ACCRUAL: A total of 36 patients will be accrued for this study.

Conditions

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Malignant Mesothelioma

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Induction Combination Chemotherapy

Induction chemotherapy: Patients get MVP chemo. Treatment repeats every 28 days for 2 courses.

Patients w/ unresectable disease may get up to 2 add'l courses of induction chemo. Patients requiring palliative radiotherapy or have PD are removed from study. Patients w/ resectable disease or sarcomatoid histology \& T1-3, N1-2 disease w/ a CR or PR to induction chemo go to surgery.

Surgery: Patients w/ extensive disease get palliative debulking pleurectomy and decortication \& are taken off study. Other patients undergo a thoracotomy w/ extrapleural pneumonectomy \& proceed to chemoradiotherapy.

Chemoradiotherapy: At 6-10 weeks post-op, patients get 3-dimensional conformal or intensity-modulated radiotherapy once daily, 5 days a week, for 6 weeks. Patients receive cisplatin IV over 30-60 minutes days 1 \& 22. Patients w/ responding disease proceed to adjuvant chemotherapy.

Adjuvant chemotherapy: Patients get 2 more courses of MVP chemotherapy

Group Type EXPERIMENTAL

Cisplatin

Intervention Type DRUG

Methotrexate

Intervention Type DRUG

Vinorelbine ditartrate

Intervention Type DRUG

Adjuvant therapy

Intervention Type PROCEDURE

Conventional surgery

Intervention Type PROCEDURE

Neoadjuvant Therapy

Intervention Type PROCEDURE

3-dimensional conformal radiation therapy

Intervention Type RADIATION

Intensity-modulated radiation therapy

Intervention Type RADIATION

Interventions

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Cisplatin

Intervention Type DRUG

Methotrexate

Intervention Type DRUG

Vinorelbine ditartrate

Intervention Type DRUG

Adjuvant therapy

Intervention Type PROCEDURE

Conventional surgery

Intervention Type PROCEDURE

Neoadjuvant Therapy

Intervention Type PROCEDURE

3-dimensional conformal radiation therapy

Intervention Type RADIATION

Intensity-modulated radiation therapy

Intervention Type RADIATION

Eligibility Criteria

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Inclusion Criteria

* Disease considered unresectable by any medical reason or if surgery was declined

PATIENT CHARACTERISTICS:

* ECOG performance status 0-1
* WBC ≥ 3,000/mm³
* Platelet count \> 100,000/mm³
* Creatinine ≤ 1.7 mg/dL
* Alkaline phosphatase \< 2 times normal
* AST \< 2 times normal
* Albumin \> 3 g/dL
* Bilirubin \< 2.0 mg/dL
* Patients must be available for and compliant with adequate long-term follow-up
* Not pregnant
* Negative pregnancy test
* Fertile patients must use effective contraception
* Patients with resectable disease must have adequate pulmonary function to undergo surgery and radiotherapy
* No other active malignancies

PRIOR CONCURRENT THERAPY:

* No prior surgical resection, radiation therapy, chemotherapy, or immunotherapy for this cancer
Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

The Cleveland Clinic

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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David J. Adelstein, MD

Role: STUDY_CHAIR

Case Comprehensive Cancer Center

Locations

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Case Comprehensive Cancer Center

Cleveland, Ohio, United States

Site Status

Countries

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United States

Other Identifiers

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P30CA043703

Identifier Type: NIH

Identifier Source: secondary_id

View Link

CASE-CCF-IRB-5179

Identifier Type: OTHER

Identifier Source: secondary_id

CASE-CCF-IRB-5179

Identifier Type: -

Identifier Source: org_study_id

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