Malignant Mesothelioma
Conditions
Keywords
epithelial mesothelioma, sarcomatous mesothelioma, stage IA malignant mesothelioma, stage IB malignant mesothelioma, stage II malignant mesothelioma, stage III malignant mesothelioma
Brief summary
RATIONALE: Drugs used in chemotherapy, such as pemetrexed disodium 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. Giving radiation therapy after surgery may kill any tumor cells that remain after surgery. PURPOSE: This randomized phase II trial is studying how well giving pemetrexed disodium together with cisplatin followed by surgery with or without radiation therapy works in treating patients with malignant pleural mesothelioma.
Detailed description
OBJECTIVES: Primary * Evaluate the short-term outcomes and feasibility of neoadjuvant therapy with pemetrexed disodium and cisplatin followed by extrapleural pneumonectomy in patients with malignant pleural mesothelioma. * Evaluate the long-term outcomes and feasibility of postoperative hemithoracic radiotherapy in patients with R0 or R1 resection. Secondary * Determine the quality of life of these patients. * Identify predictive and prognostic markers in these patients. * Determine relapse-free or progression-free survival and overall survival of these patients. * Collect tissue and blood from these patients. OUTLINE: This is a randomized, multicenter study. Patients are stratified according to participating center, histology (sarcomatous or other vs epithelial or mixed histology), nodal status (N0-1 vs N2), and extent of disease (T1-2 vs T3). * Part 1 (neoadjuvant therapy and surgery): Patients receive pemetrexed disodium IV over 10 minutes and cisplatin IV over 2 hours on day 1. Treatment repeats every 21 days for 3 courses in the absence of disease progression or unacceptable toxicity. Within 8 weeks after completion of neoadjuvant therapy, patients without progressive disease undergo extrapleural pneumonectomy. * Part 2 : Patients achieving R0 or R1 resection proceed to part 2 of study treatment and are randomized to 1 of 2 treatment arms. Patients with R2 resection, disease progression, or symptomatic deterioration after treatment in part 1 are taken off study. * Arm I (no postoperative radiotherapy): Patients do not undergo radiotherapy. Quality of life is assessed at baseline and at 6, 10, 16, and 22 weeks after randomization. * Arm II (postoperative radiotherapy): Beginning within 10 weeks after surgery, patients undergo radiotherapy to the hemithoracic region 5 days a week for approximately 5 weeks in the absence of disease progression or unacceptable toxicity. Quality of life is assessed at baseline and at 4, 8, 14, and 20 weeks after initiation of radiotherapy. Patients undergo blood and tissue collection at registration and surgery for laboratory and biomarker analysis. After completion of study treatment, patients are followed periodically for up to 5 years after surgery. PROJECTED ACCRUAL: A total of 155 patients will be accrued for this study.
Interventions
DRUGCisplatin
Cisplatin 75 mg/m2 i.v. over approximately 2 hours on day 1 every 21 days
DRUGPemetrexed
Pemetrexed 500 mg/m2 i.v. over approximately 10 minutes on day 1 every 21 days
PROCEDURETherapeutic conventional surgery
Extrapleural pneumonectomy
RADIATIONRadiotherapy
CTV1 will receive 45 or 46 Gy. CTV2 will be treated up to a total dose of 55,9 to 56,2 Gy.
Sponsors
Swiss Cancer Institute
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 69 Years
Healthy volunteers
No
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically or cytologically confirmed malignant pleural mesothelioma * T1-3, N0-2, M0 disease according to International Mesothelioma Interest Group staging system * No obvious invasion of mediastinal structures by CT scan (e.g., heart, aorta, spine, esophagus) * No obvious widespread chest wall invasion * Resectable chest wall lesions allowed PATIENT CHARACTERISTICS: * WHO performance score 0-1 * Fit for neoadjuvant therapy, surgery, and postoperative radiotherapy * Creatinine clearance \> 60 mL/min * Hemoglobin ≥ 10.0 g/dL * WBC ≥ 3,500/mm³ * Absolute neutrophil count ≥ 1,500/mm³ * Platelet count ≥ 100,000/mm³ * Bilirubin ≤ 1.5 times upper limit of normal (ULN) * AST and ALT ≤ 1.5 times ULN * Alkaline phosphatase ≤ 1.5 times ULN * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception during and for up to 12 months after completion of study treatment * FEV\_1 ≥ 40% of predicted based on spirometry and lung perfusion scan, if necessary * No serious underlying medical condition that would preclude study requirements (e.g., active autoimmune disease or uncontrolled diabetes) * No known hypersensitivity against pemetrexed disodium, cisplatin, or other platinum-containing substances or any other components used for the preparation of the drugs * No restricted power of hearing (especially in the upper frequency range) * No acute infections PRIOR CONCURRENT THERAPY: * No prior chemotherapy * No treatment on another clinical trial within the past 30 days * No prior pleurectomy or lung resection * No prior radiotherapy of the lower neck, thorax, or upper abdomen * No aspirin, cyclooxygenase-2 inhibitors, or nonsteroidal anti-inflammatory agents for 5 days prior to, during, and for 2 days after pemetrexed disodium administration * No other concurrent experimental drugs or anticancer therapy * No concurrent drugs that would contraindicate study drugs * No concurrent vaccination against yellow fever
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Complete macroscopic resection (part 1) | After surgery (15 weeks after trial registration) |
| Loco-regional relapse-free survival (part 2) | From surgery until the first occurrence of loco-regional relapse |
Secondary
| Measure | Time frame |
|---|---|
| Operability (part 1) | Proportion of patients remaining operable after completing chemotherapy (9 weeks after trial registration) |
| Surgical complications (part 1) | Within 3 month after surgery |
| Reasons for non-randomization (part 1) | Reasons for non-randomization include macroscopic incomplete resection, patients' refusal or patient can not be subjected to RT within 10 weeks after surgery. |
| Relapse-free or progression-free survival (part 1) | From registration until progression/relapse (loco-regional or distant) or death |
| Adverse reaction to postoperative radiotherapy (part 2) | According to CTCAE |
| Response to neoadjuvant therapy (part 1) | Every 6 months in the follow-up until death for a maximum of 5 years |
| Feasibility of postoperative radiotherapy (part 2) | Proportion of patients receiving at least 90% of planned RT dose |
| Relapse-free survival (part 2) | From registration until progression/relapse (loco-regional or distant) or death |
| Psychological distress (quality of life) (part 2) | Until 22 weeks after treatment termination |
| Overall survival | From registration until death for all registered patients, and from randomization to death for all randomized patients. |
| Late toxicity (part 2) | Late toxicities occurring later than 6 weeks after the last RT fraction |
| Adverse drug reaction to neoadjuvant therapy (part 1) | According to CTCAE |
Countries
Germany, Switzerland
Outcome results
None listed