Extrapleural Pneumonectomy /Pleurectomy Decortication, IHOC Cisplatin and Gemcitabine With Amifostine and Sodium Thiosulfate Cytoprotection for Resectable Malignant Pleural Mesothelioma

NCT ID: NCT00571298

Last Updated: 2017-01-23

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE1
• Total Enrollment: 141 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2007-11-30
• Study Completion Date: 2015-06-30

Brief Summary

RATIONALE: After removal of visible cancer in the chest, chemotherapy drugs are used to kill or stop tumor cells from dividing, so that they stop growing or/and die. Cisplatin is currently used safely as in intra-operative treatment for malignant pleural mesothelioma. This study is aimed to determine if the addition of gemcitabine as a second intracavitary chemotherapy can be accomplished safely.

PURPOSE: This is a Phase I trial to study the efficacy of combination chemotherapy consisting of gemcitabine and cisplatin administered in the operating room and put into the chest and abdomen for one hour. We are also looking at the effects of heating the chemotherapy to a temperature of 42 degrees Celsius and the effect of cytoprotection agents: amifostine and sodium thiosulfate to counteract potential side effects of chemotherapy.

Detailed Description

• This is a dose escalation study of gemcitabine with a fixed dose of cisplatin
• Patients will undergo cytoreductive surgery, which entails the removal of the inner and outer lining of the lung (pleurectomy/decortication) with or without the lung itself (extrapleural pneumonectomy), including the lining overlying the pericardium and diaphragm. Resection of the pericardium and diaphragm are occasionally necessary to remove all visable tumor. This surgery is part of standard care for malignant pleural mesothelioma.
• After surgery, a one hour lavage with heated cisplatin and or gemcitabine will be administered to the hemithorax (and abdominal regions if the diaphragm is no longer present).
• Patients will remain hospitalized until they have recovered from surgery (usually 7-14 days).
• Patients will return to the hospital during the first month after their surgery to be evaluated by the medical staff.
• Dose escalation: 1) Three patients will be treated at the first dose level of gemcitabine. Labs will be monitored on a weekly basis, including a CBC, Chem-7, and LFT's. In the absence of developing dose-limiting toxicity (DLT) among the first 3 patients treated, dosages can be escalated. DLT will be defined as any grade 3 or higher renal toxicity, thrombocytopenia or other grade 3 toxicity not related to surgery 2) If none of these 3 patients have any toxicity, we will proceed to the next level of gemcitabine. 3) If DLT occurs in 1 of 3 patients at a given dose level, then 3 additional patients are added at that dose (for a total of 6 at this level)If no DLT occurs, we will proceed to the next level of gemcitabine. If DLT occurs in another patient, this dose is considered the maximum tolerated dose (MTD). 4) At any dose, 3 cases of DLT lead to discontinuation of recruitment at that dose and enrollment of 3 additional patients at a lower dose.

Conditions

Malignant Pleural Mesothelioma

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Extrapleural pneumonectomy (EPP)

This is dose escalation 3+3 study design. All the patients meet the eligibility criteria and then sign the informed consent. Then after they have completed their standard pre-operative evalutions were each brought to the operating room for this surgical resection. Regardless of the arm the subject is assigned to they all recieve surgical intervention (Extrapleural Pneumonectomy, Pleurectomy/Decortication, or Tumor Debulking), Amifostine, Cisplatin, Gemcitabine, and Sodium Thiosulfate

Group Type: EXPERIMENTAL

Extrapleural pneumonectomy (EPP)

Intervention Type: PROCEDURE

Resection of the lung, the lining of the lung (pleura), the covering of the heart (pericardium), and the muscle that separates the chest and abdomen (diaphragm)

Cisplatin

Intervention Type: DRUG

Given after the tumor is removed as a bath (perfusion) for one-hour

gemcitabine

Intervention Type: DRUG

Given after the tumor is removed as a bath (perfusion) for one-hour

amifostine

Intervention Type: DRUG

Given intravenously before perfusion chemotherapy and then 2 hours after the first dose

sodium thiosulfate

Intervention Type: DRUG

Given intravenously immediately at the end of perfusion chemotherapy

Pleurectomy/Decortication (P/DC)

This is dose escalation 3+3 study design. All the patients meet the eligibility criteria and then sign the informed consent. Then after they have completed their standard pre-operative evalutions were each brought to the operating room for this surgical resection. Regardless of the arm the subject is assigned to they all recieve surgical intervention (Extrapleural Pneumonectomy, Pleurectomy/Decortication, or Tumor Debulking), Amifostine, Cisplatin, Gemcitabine, and Sodium Thiosulfate

Group Type: EXPERIMENTAL

Cisplatin

Intervention Type: DRUG

Given after the tumor is removed as a bath (perfusion) for one-hour

gemcitabine

Intervention Type: DRUG

Given after the tumor is removed as a bath (perfusion) for one-hour

amifostine

Intervention Type: DRUG

Given intravenously before perfusion chemotherapy and then 2 hours after the first dose

sodium thiosulfate

Intervention Type: DRUG

Given intravenously immediately at the end of perfusion chemotherapy

Pleurectomy/Decortication

Intervention Type: PROCEDURE

Resection of the lining of the lung (pleura), while the lung remains intact.

Tumor Debulking (TD)

This is dose escalation 3+3 study design. All the patients meet the eligibility criteria and then sign the informed consent. Then after they have completed their standard pre-operative evalutions were each brought to the operating room for this surgical resection. Regardless of the arm the subject is assigned to they all recieve surgical intervention (Extrapleural Pneumonectomy, Pleurectomy/Decortication, or Tumor Debulking), Amifostine, Cisplatin, Gemcitabine, and Sodium Thiosulfate

Group Type: EXPERIMENTAL

Cisplatin

Intervention Type: DRUG

Given after the tumor is removed as a bath (perfusion) for one-hour

gemcitabine

Intervention Type: DRUG

Given after the tumor is removed as a bath (perfusion) for one-hour

amifostine

Intervention Type: DRUG

Given intravenously before perfusion chemotherapy and then 2 hours after the first dose

sodium thiosulfate

Intervention Type: DRUG

Given intravenously immediately at the end of perfusion chemotherapy

Interventions

Extrapleural pneumonectomy (EPP)

Resection of the lung, the lining of the lung (pleura), the covering of the heart (pericardium), and the muscle that separates the chest and abdomen (diaphragm)

Intervention Type: PROCEDURE

Cisplatin

Given after the tumor is removed as a bath (perfusion) for one-hour

Intervention Type: DRUG

gemcitabine

Given after the tumor is removed as a bath (perfusion) for one-hour

Intervention Type: DRUG

amifostine

Given intravenously before perfusion chemotherapy and then 2 hours after the first dose

Intervention Type: DRUG

sodium thiosulfate

Given intravenously immediately at the end of perfusion chemotherapy

Intervention Type: DRUG

Pleurectomy/Decortication

Resection of the lining of the lung (pleura), while the lung remains intact.

Intervention Type: PROCEDURE

Other Intervention Names

Platinol; Gemzar

Eligibility Criteria

Inclusion Criteria

• Histologically-proven diagnosis of stages I to III malignant mesothelioma of the pleura and negative mediastinal N2 lymph nodes (Malignancy is confined to the affected hemithorax)
• Adequate organ function including the following: adequate cardiac function, pulmonary function, renal and hepatic function and bone marrow reserve
• Adequate overall physical activity
• Surgical candidate for cytoreductive surgery

Exclusion Criteria

• Extended disease outside the ipsilateral hemithorax as proven histologically, radiologically and/or intraoperatively
• Have received chemotherapy and or radiation therapy within the last 3 years at the time of study entry
• Serious concomitant systemic disorders
• Second active primary malignancy (to exclude non- melanoma skin cancer)
• Pregnancy at the time of the operation
• Psychiatric or addictive disorder which would preclude obtaining informed consent

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Dana-Farber Cancer Institute

OTHER

Sponsor Role: collaborator

Brigham and Women's Hospital

OTHER

Sponsor Role: lead

Responsible Party

Raphael Bueno, MD

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Raphael Bueno, MD

Role: PRINCIPAL_INVESTIGATOR

Brigham and Women's Hospital

Locations

Brigham and Women's Hospital

Boston, Massachusetts, United States

Countries

United States

Related Links

http://www.brighamandwomens.org/mesothelioma

Brigham and Women's Hospital, Mesothelioma and International Mesothelioma Program

Other Identifiers

07-091

Identifier Type: -

Identifier Source: org_study_id