Pemetrexed Maintenance in Patients With Urothelial Carcinoma Who Completed First Line Platinum-based Chemotherapy

NCT ID: NCT03193788

Last Updated: 2017-06-21

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

UNKNOWN

Clinical Phase

PHASE3

Total Enrollment

74 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-01-31

Study Completion Date

2020-06-30

Brief Summary

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This study aims to verify superiority of pemetrexed maintenance to observation for patient without disease progression after 1 st line cisplatin-based chemotherapy.

Detailed Description

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Patients with unresectable locally advanced, recurrent, or metastatic urothelial carcinoma of bladder, ureter, or renal pelvis who do not experience disease progression after 4 to 6 cycles of 1 st line chemotherapy administration.

After completion of 4-6 cycles, patients without disease progression on CT which is taken within 3 weeks after administration of the last chemotherapy will be randomized within 4 weeks after administration of the last chemotherapy to assign either maintenance group or observation group.

Pemetrexed 500 mg/m 2 mixed in normal saline 100 mL as a 10 minute IV infusion on day 1 of each 21 day cycle, with vitamin supplementation (folic acid 1000μg daily orally from 7 days prior to treatment initiation and vitamin B12 1000 μg IM 7 days prior to treatment initiation and then every 3 cycles). Thereafter, vitamin B12 can be injected on the same day of pemetrexed infusion. Dexamethasone 4 mg orally twice daily for 3 days beginning the day before treatment to minimize cutaneous reactions.

Treatment continues until occurrence of disease progression or intolerable toxicities upto maximum of 16 cycles.

Conditions

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Bladder Cancer Ureter Cancer Transitional Cell Carcinoma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

open label

Study Groups

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pemetrexed maintenance

Drug: Pemetrexed Maintenance therapy: 500 mg/m\^2, IV, on Day 1 of each 21-day cycle until progressive disease or treatment discontinuation.

Drug: folic acid 1000 μg daily orally from 7 days prior to treatment initiation until the end of treatment

Drug: vitamin B12 injection 1000 μg IM 7 days prior to treatment initiation and the every then every 3 cycles until the end of treatment

Drug: dexamethasone 4 mg twice orally for 3 days beginning the day before treatment until the end of treatment

Group Type EXPERIMENTAL

pemetrexed

Intervention Type DRUG

Pemetrexed 500 mg/m2mixed in normal saline 100 mL as a 10 minute IV infusion on day 1 of each 21 day cycle

Folic Acid

Intervention Type DRUG

folic acid 1000 μg daily orally from 7 days prior to treatment initiation until the end of treatment

Vitamin B12 Injection

Intervention Type DRUG

vitamin B12 1000 μg IM 7 days prior to treatment initiation and the end of treatment

Dexamethasone

Intervention Type DRUG

Dexamethasone 4 mg twice orally for 3 days beginning the day before treatment until the end of treatment to minimize cutaneous reactions

observation

observation group will be observed with best supportive care until progressive disease

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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pemetrexed

Pemetrexed 500 mg/m2mixed in normal saline 100 mL as a 10 minute IV infusion on day 1 of each 21 day cycle

Intervention Type DRUG

Folic Acid

folic acid 1000 μg daily orally from 7 days prior to treatment initiation until the end of treatment

Intervention Type DRUG

Vitamin B12 Injection

vitamin B12 1000 μg IM 7 days prior to treatment initiation and the end of treatment

Intervention Type DRUG

Dexamethasone

Dexamethasone 4 mg twice orally for 3 days beginning the day before treatment until the end of treatment to minimize cutaneous reactions

Intervention Type DRUG

Other Intervention Names

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Alimta Folvite FA-8 FaLessa Vitabee 12 decadron

Eligibility Criteria

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Inclusion Criteria

1. Histologically or cytologically confirmation urothelial cancer of bladder, ureter, or renal pelvis.
2. Patients must present with locally advanced, recurrent or metastatic disease not amenable to surgery, radiotherapy, or combined modality therapy with curative intent.
3. Patients who were administered 4-6 cycles of cisplatin-based first line chemotherapy \[GP (gemcitabine/cisplatin), classic MVAC (methotrexate/vinblastine/doxorubicin/cisplatin), or dose-dense MVAC\] and were planned to undergo regular surveillance
4. ce after confirmation of absence of disease progression on CT taken within 3 week after the administration of the last cycle of 1st line chemotherapy.
5. For patients with recurrent disease who received prior adjuvant or neoadjuvant chemotherapy with cisplatin-containing regimen, the last administration of previous treatment should be administered at least 6 months before start date of 1st line chemotherapy.
6. Measurable disease according RECIST criteria v 1.1.
7. Age 20 years or older
8. ECOG performance status 2 or better
9. Adequate bone marrow, hepatic, and renal function
10. Signed and dated informed consent of document indicating that the patient (or legally acceptable representative) has been informed of all pertinent aspects of the trial prior to enrollment

Exclusion Criteria

1. Prior systemic chemotherapy or immunotherapy for palliative aim before or after 1st line cisplatin-based chemotherapy. However, prior intravesical chemotherapy or immunotherapy is allowed.
2. Disease progression during or after 1st line cisplatin-based chemotherapy
3. Known CNS metastasis
4. Diagnosis of any serious secondary malignancy within the last 2 years, except for adequately treated basal cell or squamous cell carcinoma of skin, early gastric carcinoma, early stage thyroid carcinoma, insignificant prostate carcinoma, or in situ carcinoma of cervix uteri
5. Pregnancy or breast feeding.
6. Serious hypersensitivity reaction to pemetrexed.
7. Severe renal function impairment with creatinine clearance \<45 mL/min by standard Cockcroft-Gault formula or GFR measured by Tc99m-DPTA serum clearance method.
8. Other severe acute or chronic medical or psychiatric condition
Minimum Eligible Age

20 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Korean Cancer Study Group

OTHER

Sponsor Role collaborator

Asan Medical Center

OTHER

Sponsor Role lead

Responsible Party

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JLee

Associated Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jae-Lyun Lee, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Asan Medical Center

Locations

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Hallym University Medical Center, Hallym University College of Medicine

Anyang, , South Korea

Site Status RECRUITING

Keimyeong University Dongsan Medical Center

Daegu, , South Korea

Site Status RECRUITING

Fatima Hospital

Daegu, , South Korea

Site Status RECRUITING

Chungnam University Hospital

Daejeon, , South Korea

Site Status RECRUITING

National Health Insurance Service Ilsan Hospital

Goyang, , South Korea

Site Status RECRUITING

Hallym University Dongtan Sacred Heart Hospital

Hwaseong-si, , South Korea

Site Status RECRUITING

Gil Medical Center

Incheon, , South Korea

Site Status RECRUITING

Dong-A University Medical Center

Pusan, , South Korea

Site Status RECRUITING

Inje University Haeundae Paik Hospital

Pusan, , South Korea

Site Status RECRUITING

Pusan National University Hospital, Pusan National University School of Medicine

Pusan, , South Korea

Site Status RECRUITING

Asan Medical Center

Seoul, , South Korea

Site Status RECRUITING

Chung Ang University Hospital

Seoul, , South Korea

Site Status RECRUITING

Inje University Sanggye Paik Hospital

Seoul, , South Korea

Site Status RECRUITING

Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine

Seoul, , South Korea

Site Status RECRUITING

Korea University Anam Hospital

Seoul, , South Korea

Site Status RECRUITING

Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine

Seoul, , South Korea

Site Status RECRUITING

Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea

Seoul, , South Korea

Site Status RECRUITING

Yonsei Cancer Center

Seoul, , South Korea

Site Status RECRUITING

St. Vincent's Hospital, The Catholic University of Korea

Suwon, , South Korea

Site Status RECRUITING

Uijeongbu St Mary's hospital, Catholic university of Korea

Uijeongbu-si, , South Korea

Site Status RECRUITING

Pusan National University Yangsan Hospital

Yangsan, , South Korea

Site Status RECRUITING

Countries

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South Korea

Central Contacts

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Jae-Lyun Lee, MD, PhD

Role: CONTACT

82 2 3010 5977

MiRan Kim

Role: CONTACT

82 2 3010 5576

Facility Contacts

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Ho Young Kim

Role: primary

Jin Young Kim, MD

Role: primary

Jung Lim Lee

Role: primary

Hyo Jin Lee, MD, PhD.

Role: primary

Soo Jung Hong

Role: primary

Hyun Ae Jung

Role: primary

Inkeun Park, MD

Role: primary

Suee Lee

Role: primary

Il-Hwan Kim

Role: primary

Hyo Jung Kim

Role: primary

Jae-Lyun Lee, MD, PhD

Role: primary

82 2 3010 5977

Hee Joon Kim, MD

Role: primary

Byeong Seok Sohn

Role: primary

Yun-Gyoo Lee

Role: primary

Yoon Ji Choi

Role: primary

Bhum Suk Keam

Role: primary

Role: backup

In-Ho Kim

Role: primary

Sang Joon Shin

Role: primary

Byoung Yong Shim

Role: primary

Yoon Ho Ko

Role: primary

Kwonoh Park

Role: primary

References

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von der Maase H, Hansen SW, Roberts JT, Dogliotti L, Oliver T, Moore MJ, Bodrogi I, Albers P, Knuth A, Lippert CM, Kerbrat P, Sanchez Rovira P, Wersall P, Cleall SP, Roychowdhury DF, Tomlin I, Visseren-Grul CM, Conte PF. Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol. 2000 Sep;18(17):3068-77. doi: 10.1200/JCO.2000.18.17.3068.

Reference Type RESULT
PMID: 11001674 (View on PubMed)

Paz-Ares LG, de Marinis F, Dediu M, Thomas M, Pujol JL, Bidoli P, Molinier O, Sahoo TP, Laack E, Reck M, Corral J, Melemed S, John W, Chouaki N, Zimmermann AH, Visseren-Grul C, Gridelli C. PARAMOUNT: Final overall survival results of the phase III study of maintenance pemetrexed versus placebo immediately after induction treatment with pemetrexed plus cisplatin for advanced nonsquamous non-small-cell lung cancer. J Clin Oncol. 2013 Aug 10;31(23):2895-902. doi: 10.1200/JCO.2012.47.1102. Epub 2013 Jul 8.

Reference Type RESULT
PMID: 23835707 (View on PubMed)

Bellmunt J, Theodore C, Demkov T, Komyakov B, Sengelov L, Daugaard G, Caty A, Carles J, Jagiello-Gruszfeld A, Karyakin O, Delgado FM, Hurteloup P, Winquist E, Morsli N, Salhi Y, Culine S, von der Maase H. Phase III trial of vinflunine plus best supportive care compared with best supportive care alone after a platinum-containing regimen in patients with advanced transitional cell carcinoma of the urothelial tract. J Clin Oncol. 2009 Sep 20;27(27):4454-61. doi: 10.1200/JCO.2008.20.5534. Epub 2009 Aug 17.

Reference Type RESULT
PMID: 19687335 (View on PubMed)

Vaughn DJ, Broome CM, Hussain M, Gutheil JC, Markowitz AB. Phase II trial of weekly paclitaxel in patients with previously treated advanced urothelial cancer. J Clin Oncol. 2002 Feb 15;20(4):937-40. doi: 10.1200/JCO.2002.20.4.937.

Reference Type RESULT
PMID: 11844814 (View on PubMed)

Sweeney CJ, Roth BJ, Kabbinavar FF, Vaughn DJ, Arning M, Curiel RE, Obasaju CK, Wang Y, Nicol SJ, Kaufman DS. Phase II study of pemetrexed for second-line treatment of transitional cell cancer of the urothelium. J Clin Oncol. 2006 Jul 20;24(21):3451-7. doi: 10.1200/JCO.2005.03.6699.

Reference Type RESULT
PMID: 16849761 (View on PubMed)

Galsky MD, Moshier E, Krege S, Lin CC, Hahn N, Ecke T, Sonpavde G, Pond G, Godbold J, Oh WK, Bamias A. Posttreatment prognostic nomogram for patients with metastatic urothelial cancer completing first-line cisplatin-based chemotherapy. Urol Oncol. 2014 Jan;32(1):48.e1-8. doi: 10.1016/j.urolonc.2013.07.001. Epub 2013 Sep 18.

Reference Type RESULT
PMID: 24055428 (View on PubMed)

Other Identifiers

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KCSG GU16-05

Identifier Type: -

Identifier Source: org_study_id

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