Skip to content

Alimta® Plus Cisplatin & Paclitaxel Given Intraperitonelly; First Line Tx Stage III Ovarian Cancer

Phase I Open Label Trial of Alimta® Plus Cisplatin and Paclitaxel Given Intraperitoneally (IP) as First Line Treatment for Women With Stage III Ovarian Cancer

Status
Completed
Phases
Phase 1
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00702299
Enrollment
15
Registered
2008-06-20
Start date
2007-09-30
Completion date
2012-10-31
Last updated
2016-01-01

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Fallopian Tube Cancer, Ovarian Cancer, Peritoneal Cavity Cancer

Keywords

stage III ovarian epithelial cancer, recurrent ovarian epithelial cancer, peritoneal cavity cancer, fallopian tube cancer

Brief summary

RATIONALE: Pemetrexed may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as cisplatin and paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving pemetrexed together with cisplatin and paclitaxel and giving them in different ways may kill more tumor cells. PURPOSE: This phase I trial is studying the side effects and best dose of intraperitoneal pemetrexed when given together with intraperitoneal cisplatin and paclitaxel in treating patients with stage III ovarian epithelial cancer, primary peritoneal cancer, or fallopian tube cancer.

Detailed description

OBJECTIVES: Primary * To determine the maximum-tolerated dose (MTD) of combination therapy comprising intraperitoneal (IP) pemetrexed disodium in combination with IP cisplatin and paclitaxel in patients with optimally debulked stage III ovarian epithelial cancer, primary peritoneal cancer, or fallopian tube cancer in relation to the percentage of patients completing at least 6 courses of treatment. * To determine the toxicity and the tolerability of this regimen in these patients. Secondary * To observe 80% of these patients progression free at 18 months after initiation of chemotherapy. * To determine, as an exploratory endpoint, the median overall survival of patients treated with this regimen. * To investigate the pharmacokinetics of this regimen at the determined MTD in these patients. * To conduct correlative studies on tumor tissue and blood from these patients. OUTLINE: This is a dose-escalation study of pemetrexed disodium. Patients receive pemetrexed disodium intraperitoneally (IP) on day 1, cisplatin IP on day 2, and paclitaxel IP on day 8. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. At least 10 patients are treated at the maximum-tolerated dose (MTD). Whole blood samples and tumor tissue specimens are obtained from patients at baseline and banked for future DNA, RNA, and protein studies related to prediction of disease progression and treatment resistance. Plasma and intraperitoneal fluid samples may also be collected from patients treated at the MTD for pharmacokinetic analysis of plasma concentrations of pemetrexed disodium by high-performance liquid chromatography (HPLC) or mass spectrometry-HPLC. After completion of study therapy, patients are followed periodically.

Interventions

DRUGcisplatin

IP cisplatin will be administered on day 2 of each cycle at 75mg per m2 and IP paclitaxel will be administered at 60mg per m2 on day 8 of each cycle. Courses will be repeated every 21 days for up to 6 cycles

DRUGpaclitaxel

IP cisplatin will be administered on day 2 of each cycle at 75mg per m2 and IP paclitaxel will be administered at 60mg per m2 on day 8 of each cycle. Courses will be repeated every 21 days for up to 6 cycles

DRUGpemetrexed disodium

Escalate doses in groups of 3 patients to 60mg per m2, 120 mg per m2, 500 mg per m2, 750 mg per m2, 1000 mg per m2

OTHERbiologic sample preservation procedure

Plasma samples will be collected on the 1st course at baseline, 30 minutes, 60 minutes, 2 hours, 4 hours, 6 hours (if possible) and 24 hours after the first IP Alimta® dose.

Sponsors

National Cancer Institute (NCI)
CollaboratorNIH
University of Arizona
Lead SponsorOTHER

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

DISEASE CHARACTERISTICS: * Histologically or pathologically confirmed ovarian epithelial carcinoma, primary peritoneal carcinoma, or fallopian tube carcinoma * Stage III disease * Meets 1 of the following criteria: * No prior treatment and no more than 6 months since primary surgery * Platinum-sensitive at second-look surgery with no prior cisplatin therapy * Must have been optimally debulked to less than 2-cm residual individual tumor plaques or, if suboptimally debulked at first surgery, had chemical debulking * No mixed Müllerian tumor or borderline ovarian tumor * No Central nervous system (CNS) or brain metastases PATIENT CHARACTERISTICS: * Gynecologic Oncology Group performance status 0-2 * White blood cell count(WBC) ≥ 3,500/mm³ * Platelet count ≥ 100,000/mm³ * Hemoglobin ≥ 9 g/dL * Serum bilirubin ≤ 2 times upper limit of normal (ULN) * Aspartate aminotransferase (AST)and alanine aminotransferase (ALT) ≤ 2.5 times upper limit of normal * Creatinine clearance ≥ 45 mL/min * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective barrier contraception during and for 3 months after discontinuation of study drug * No psychological, familial, sociological, or geographical conditions that do not permit medical follow-up or compliance with the study protocol * No unstable or preexisting major medical conditions, except cancer-related abnormalities * No medical life-threatening complications of their malignancies * No known severe and/or uncontrolled concurrent medical disease (e.g., uncontrolled diabetes, uncontrolled chronic renal or liver disease, active uncontrolled infection, or HIV) * No serious active uncontrolled infections * No inadequately controlled hypertension (defined as systolic blood pressure ≥ 150 mm Hg and/or diastolic blood pressure ≥ 100 mm Hg on antihypertensive medications) * No New York Heart Association grade II-IV congestive heart failure * No weight loss between 5 to ≤ 10% within the past 14 days that is not related to ascites or paracentesis * No prior hypertensive crisis or hypertensive encephalopathy * No myocardial infarction, cerebrovascular accident, transient ischemic attack, or unstable angina within the past 6 months * No evidence of uncontrollable nausea * No clinically significant or symptomatic peripheral vascular disease (e.g., aortic aneurysm or aortic dissection) * No history of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess * No pre-existing clinically significant hearing loss * No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer, cervical carcinoma in situ, or adequately treated stage I or II cancer from which the patient is in complete remission * No known hypersensitivity to any component of pemetrexed disodium * Able to take folic acid, vitamin B\_12, and dexamethasone according to protocol * No presence of third-space fluid that cannot be controlled by drainage * No inability to comply with study and/or follow-up procedures PRIOR CONCURRENT THERAPY: * See Disease Characteristics * May have received up to 4 courses of carboplatin and paclitaxel IV as neoadjuvant chemotherapy for advanced, unresectable disease * Concurrent low-dose aspirin therapy (i.e., 325 mg/day) allowed * Concurrent ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) with short elimination half-lives allowed provided ≥ 1 of the following criteria is met: * Creatinine clearance (CrCl) \> 80 mL/min (i.e., normal renal function) * CrCl 45-79 mL/min (i.e., mild to moderate renal insufficiency) AND NSAID dosing interrupted for a period of 2 days before, during, and 2 days after administration of pemetrexed disodium * Concurrent NSAIDs or salicylates with long half-lives (e.g., naproxen, piroxicam, diflunisal, or nabumetone) allowed provided NSAID dosing is interrupted for at least 5 days before, during, and 2 days after administration of pemetrexed disodium * No concurrent antineoplastic or antitumor agents not part of the study therapy (i.e., chemotherapy, radiotherapy, immunotherapy, or hormonal anticancer therapy) * No other concurrent investigational agents

Design outcomes

Primary

MeasureTime frameDescription
Maximum-tolerated Dose of Pemetrexed With a Day 2 i.p. Cisplatin (75 mg/m2) and Day 8 i.p. Paclitaxel (60 mg/m2)18 monthsIf none of the initial 3 patients on a dose level experienced a dose-limiting toxicity (DLT) after the first cycle of therapy, then the dose was escalated to the next level. If 2 or more patients on any dose level experienced a DLT, then the maximum tolerated dose would be determined to be the next lower dose level.
Patients That Completed at Least 6 Courses of Therapy of Pemetrexed Along With Day 2 i.p. Cisplatin (75 mg/m2) and Day 8 i.p. Paclitaxel (60 mg/m2)at the Determined Maximum Tolerated Dose18 monthsIf none of the initial 3 patients on a dose level experienced a dose-limiting toxicity (DLT) after the first cycle of therapy, then the dose was escalated to the next level. If 2 or more patients on any dose level experienced a DLT, then the Maximum Tolerance Dose (MTD) would be determined to be the next lower dose level.
Patients Experienced Grade >=3 Toxicity at Dose Level 5 (1,000 mg/m2 IP Pemetrexed)18 monthsToxicity was assessed by NCI Common Toxicity Criteria for Adverse Effects v3.0

Secondary

MeasureTime frameDescription
Progression-free Survival at 18 Months as Assessed by Cancer Antigen 12518 monthsProgression was evaluated with posttreatment CT scans and measured changes in cancer antigen 125 levels 6 months after the initiation of the treatment regimen, or within one month after discontinuation of treatment if stopped early. Cancer antigen 125 response in evaluable patients (N=13) was analyzed using the modified Gynecologic Cancer Intergroup (GCIG) criteria. There was one evaluable patient by Response Evaluation Criteria in Solid Tumors(RECIST) criteria
Overall SurvivalAverage Length of follow-up 788 days
Pharmacokinetics (Mean Cmax, ug/mL)for Different Dosages of Pemetrexed18 monthsCmax levels were found through plasma collected between 0.5 to 4 hours and at 24 hours after initiation of intraperitoneal administration

Countries

United States

Participant flow

Participants by arm

ArmCount
Receiving Treatment
Dose escalation of day 1 i.p. pemetrexed accrued three patients to each of five dose levels (60-1,000 mg/m2), along with day 2 i.p. cisplatin (75 mg/m2) and day 8 i.p. paclitaxel (60 mg/m2)
15
Total15

Baseline characteristics

CharacteristicReceiving Treatment
Age, Categorical
<=18 years
0 Participants
Age, Categorical
>=65 years
9 Participants
Age, Categorical
Between 18 and 65 years
6 Participants
Age, Continuous61.73 years
STANDARD_DEVIATION 9.76
Region of Enrollment
United States
15 participants
Sex: Female, Male
Female
15 Participants
Sex: Female, Male
Male
0 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
13 / 15
serious
Total, serious adverse events
5 / 15

Outcome results

Primary

Maximum-tolerated Dose of Pemetrexed With a Day 2 i.p. Cisplatin (75 mg/m2) and Day 8 i.p. Paclitaxel (60 mg/m2)

If none of the initial 3 patients on a dose level experienced a dose-limiting toxicity (DLT) after the first cycle of therapy, then the dose was escalated to the next level. If 2 or more patients on any dose level experienced a DLT, then the maximum tolerated dose would be determined to be the next lower dose level.

Time frame: 18 months

ArmMeasureValue (NUMBER)
Receiving TreatmentMaximum-tolerated Dose of Pemetrexed With a Day 2 i.p. Cisplatin (75 mg/m2) and Day 8 i.p. Paclitaxel (60 mg/m2)500 mg/m2
Primary

Patients Experienced Grade >=3 Toxicity at Dose Level 5 (1,000 mg/m2 IP Pemetrexed)

Toxicity was assessed by NCI Common Toxicity Criteria for Adverse Effects v3.0

Time frame: 18 months

ArmMeasureValue (NUMBER)
Receiving TreatmentPatients Experienced Grade >=3 Toxicity at Dose Level 5 (1,000 mg/m2 IP Pemetrexed)2 participants
Primary

Patients That Completed at Least 6 Courses of Therapy of Pemetrexed Along With Day 2 i.p. Cisplatin (75 mg/m2) and Day 8 i.p. Paclitaxel (60 mg/m2)at the Determined Maximum Tolerated Dose

If none of the initial 3 patients on a dose level experienced a dose-limiting toxicity (DLT) after the first cycle of therapy, then the dose was escalated to the next level. If 2 or more patients on any dose level experienced a DLT, then the Maximum Tolerance Dose (MTD) would be determined to be the next lower dose level.

Time frame: 18 months

ArmMeasureValue (NUMBER)
Receiving TreatmentPatients That Completed at Least 6 Courses of Therapy of Pemetrexed Along With Day 2 i.p. Cisplatin (75 mg/m2) and Day 8 i.p. Paclitaxel (60 mg/m2)at the Determined Maximum Tolerated Dose80.0 % of participants
Secondary

Overall Survival

Time frame: Average Length of follow-up 788 days

ArmMeasureValue (MEDIAN)
Receiving TreatmentOverall Survival680 Days
Secondary

Pharmacokinetics (Mean Cmax, ug/mL)for Different Dosages of Pemetrexed

Cmax levels were found through plasma collected between 0.5 to 4 hours and at 24 hours after initiation of intraperitoneal administration

Time frame: 18 months

ArmMeasureValue (MEAN)Dispersion
Receiving TreatmentPharmacokinetics (Mean Cmax, ug/mL)for Different Dosages of Pemetrexed25.1 ug/mLStandard Deviation 1.3
Pemetrexed Dose 750 mg/m2Pharmacokinetics (Mean Cmax, ug/mL)for Different Dosages of Pemetrexed39.3 ug/mLStandard Deviation 7.3
Pemetrexed Dose 1,000mg/m2Pharmacokinetics (Mean Cmax, ug/mL)for Different Dosages of Pemetrexed38.7 ug/mLStandard Deviation 11.2
Secondary

Progression-free Survival at 18 Months as Assessed by Cancer Antigen 125

Progression was evaluated with posttreatment CT scans and measured changes in cancer antigen 125 levels 6 months after the initiation of the treatment regimen, or within one month after discontinuation of treatment if stopped early. Cancer antigen 125 response in evaluable patients (N=13) was analyzed using the modified Gynecologic Cancer Intergroup (GCIG) criteria. There was one evaluable patient by Response Evaluation Criteria in Solid Tumors(RECIST) criteria

Time frame: 18 months

ArmMeasureValue (NUMBER)
Receiving TreatmentProgression-free Survival at 18 Months as Assessed by Cancer Antigen 12578.6 % of participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026