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...

Date First Received: December 10, 2007
Last Updated: December 20, 2007
Verified by: Dana-Farber Cancer Institute, December 2007
Clinical Trial Phase: Phase 1 Start Date: November 2007
Overall Status: Recruiting
Estimated Enrollment: 36

Brief Summary

Official Title: Phase I Trial of Extrapleural Pneumonectomy, Intrathoracic/Intraperitoneal Hyperthermic (IOHC) Cisplatin and Gemcitabine With Intravenous Amifostine and Sodium Thiosulfate Cytoprotection for Patients With Resectable Malignant Pleural Mesothelioma.

Condition Keyword(s): Malignant Pleural Mesothelioma

Procedure: Extrapleural pneumonectomy (EPP)

Drug: cisplatin
Drug: gemcitabine
Drug: amifostine
Drug: sodium thiosulfate

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.

Study Type: Interventional

Study Design: Treatment, Non-Randomized, Open Label, Single Group Assignment, Safety Study

Detailed Clinical Trial Description

• This is a dose escalation study of gemcitabine with a fixed dose of cisplatin
  
  
• Patients will undergo surgery with Extrapleural Pneumonectomy, which entails the removal of the inner and outer lining of the lung (pleura) and the lung itself, 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.
  

Outcome Measures for this Clinical Trial

Primary: To establish the maximally tolerated dose (MTD) of intraoperative Intrathoracic/Intraperitoneal hyperthermic gemcitabine and cisplatin combination modulated by amifostine and sodium thiosulfate in patients with malignant pleural mesothelioma. 2 years

Secondary: To determine and quantitate the safety of this combination in these patients by defining the dose limiting toxicity. 2 years

To study the pharmacokinetics of gemcitabine and cisplatin combination administered in this way. 2 years

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 Extrapleural Pneumonectomy (EPP)

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

Clinical Trials Locations, Contact Details, and Sponsors

Lead Sponsor: Brigham and Women's Hospital
Brigham and Women's Hospital
Boston Massachusetts 02115 United States
Overall Clinical Trial Officials and Contacts
David J Sugarbaker, MD Principal Investigator Brigham and Women's Hospital

Overall Contact: David Sugarbaker, M.D. 617-732-5004 dsugarbaker@partners.org

Additional Information

Link to the current ClinicalTrials.gov record: http://clinicaltrials.gov/show/NCT00571298

Study ID Number: 07-091

ClinicalTrials.gov Identifier: NCT00571298

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Labels: ClinicalTrial