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Combination Chemotherapy With or Without Bevacizumab in Treating Patients With Malignant Mesothelioma

Primary Purpose

Advanced Malignant Mesothelioma, Epithelial Mesothelioma, Localized Malignant Mesothelioma

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
gemcitabine hydrochloride
cisplatin
bevacizumab
placebo
laboratory biomarker analysis
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Advanced Malignant Mesothelioma

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Histologically or cytologically confirmed malignant pleural or peritoneal mesothelioma that is not amenable to curative surgery Epithelial, sarcomatoid, or mixed subtype Evidence of gross unresectability, including, but not limited to, the following conditions: Direct extension into the chest wall Mediastinal or hilar lymphadenopathy Pulmonary or cardiac function that is inadequate to tolerate resection Sarcomatoid or mixed histology Pleural mesothelioma must be stage II or greater using the International Mesothelioma Interest Group staging system Measurable disease outside prior irradiation port At least 20 mm by conventional techniques OR at least 10 mm by spiral CT scan Pleural effusions and ascites are not considered measurable lesions Site in pleura, lung, liver, or retroperitoneum that can be assessed by MRI for evaluation of blood flow No obvious tumor involvement of major vessels by CT scan No known brain metastases Performance status - ECOG 0-1 More than 3 months WBC at least 3,000/mm^3 Absolute neutrophil count at least 1,500/mm^3 Platelet count at least 100,000/mm^3 No history of bleeding diathesis Bilirubin normal AST/ALT no greater than 2.5 times upper limit of normal INR no greater than 1.5 Creatinine no greater than 1.5 mg/dL Creatinine clearance at least 60 mL/min If 1+ or greater proteinuria on dipstick, then must have less than 500 mg of protein/24-hour urine collection No significant renal impairment See Disease Characteristics No history deep vein thrombosis No myocardial ischemia or infarction within the past 6 months No uncompensated coronary artery disease within the past 6 months No uncontrolled hypertension No symptomatic congestive heart failure No unstable angina pectoris within the past 6 months No cardiac arrhythmia No transient ischemic attack within the past 6 months No cerebrovascular accident within the past 6 months No other arterial thromboembolic event within the past 6 months No clinically significant peripheral artery disease See Disease Characteristics No history of pulmonary embolism No prior allergic reactions attributed to compounds of similar chemical or biologic composition to bevacizumab or other study agents No other active malignancy within the past 5 years except nonmelanoma skin cancer or carcinoma in situ of the cervix No ongoing or active infection No other concurrent uncontrolled illness that would preclude study participation No psychiatric illness or social situations that would preclude compliance Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No growth factors for 24 hours before, during, or for 24 hours after cytotoxic chemotherapy See Biologic therapy Prior intrapleural cytotoxic agents (including bleomycin) allowed No prior systemic cytotoxic chemotherapy See Disease Characteristics At least 4 weeks since prior radiotherapy and recovered See Disease Characteristics At least 6 weeks since prior major surgery At least 30 days since prior investigational drug No other concurrent investigational or commercial agents or therapies No concurrent combination antiretroviral therapy for HIV-positive patients

Sites / Locations

  • University of Chicago

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Arm I

Arm II

Arm Description

Patients receive gemcitabine IV over 30 minutes on days 1 and 8 and cisplatin IV over 30-60 minutes (beginning after gemcitabine infusion) and bevacizumab IV over 30-90 minutes (beginning after cisplatin infusion) on day 1. Treatment repeats every 3 weeks for 6 courses in the absence of disease progression or unacceptable toxicity. Patients who achieve stable disease (SD), complete response (CR), or partial response (PR) after the sixth course may receive bevacizumab as a single agent once every 3 weeks in the absence of disease progression or unacceptable toxicity.

Patients receive gemcitabine and cisplatin as in arm I and placebo IV over 30-90 minutes (beginning after cisplatin infusion) on day 1. Treatment repeats as in arm I. Patients who achieve SD, CR, or PR after the sixth course may receive placebo as a single agent once every 3 weeks in the absence of disease progression.

Outcomes

Primary Outcome Measures

Time to disease progression
The two treatment groups will be compared using a stratified logrank test. Kaplan-Meier time-to-event curves will be constructed for each treatment group. Median time-to-progression in each group and corresponding 95% confidence intervals will be derived using the method described in Brookmeyer and Crowley.

Secondary Outcome Measures

Complete response rate
Will be compared between groups using chi-square or Fisher exact tests, as appropriate.
Objective response rate (complete and partial response)
Will be compared between groups using chi-square or Fisher exact tests, as appropriate.
Rate of disease stabilization
Will be compared between groups using chi-square or Fisher exact tests, as appropriate.
Overall survival
Kaplan-Meier estimates of overall survival rates will be derived and compared between the two groups using a stratified log-rank test.
Incidence of adverse events graded according to NCI CTCAE version 3.0
Toxicity rates will be compared between the two groups via chi-square or Fisher exact tests.

Full Information

First Posted
December 7, 2001
Last Updated
February 10, 2014
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00027703
Brief Title
Combination Chemotherapy With or Without Bevacizumab in Treating Patients With Malignant Mesothelioma
Official Title
A Double Blind, Placebo Controlled Randomized Phase II Trial Of Gemcitabine And Cisplatin With Or Without The VEGF Inhibitor Bevacizumab (NSC #704865) In Patients With Malignant Mesotheloma
Study Type
Interventional

2. Study Status

Record Verification Date
December 2012
Overall Recruitment Status
Completed
Study Start Date
October 2001 (undefined)
Primary Completion Date
May 2006 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
This randomized phase II trial is to see if combination chemotherapy works better with or without bevacizumab in treating patients who have malignant mesothelioma. Drugs used in chemotherapy work in different ways to stop tumor cells from dividing so they stop growing or die. Monoclonal antibodies, such as bevacizumab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or deliver cancer-killing substances to them. It is not yet known if combination chemotherapy works better with or without bevacizumab in treating malignant mesothelioma.
Detailed Description
OBJECTIVES: I. Compare the time to progression of patients with malignant mesothelioma treated with gemcitabine and cisplatin with or without bevacizumab. II. Compare the objective response rate in patients treated with these regimens. III. Compare the toxicity of these regimens when administered to these patients. IV. Compare the median and overall survival of patients treated with these regimens. V. Assess plasma vascular endothelial growth factor and serum vascular cell adhesion molecule-1 levels before, during, and after study therapy as predictors of outcome in these patients. OUTLINE: This is a randomized, double-blind, placebo-controlled, multicenter study. Patients are stratified according to histology (epithelial vs other) and ECOG performance status (0 vs 1). Patients are randomized to one of two treatment arms. ARM I: Patients receive gemcitabine IV over 30 minutes on days 1 and 8 and cisplatin IV over 30-60 minutes (beginning after gemcitabine infusion) and bevacizumab IV over 30-90 minutes (beginning after cisplatin infusion) on day 1. Treatment repeats every 3 weeks for 6 courses in the absence of disease progression or unacceptable toxicity. Patients who achieve stable disease (SD), complete response (CR), or partial response (PR) after the sixth course may receive bevacizumab as a single agent once every 3 weeks in the absence of disease progression or unacceptable toxicity. ARM II: Patients receive gemcitabine and cisplatin as in arm I and placebo IV over 30-90 minutes (beginning after cisplatin infusion) on day 1. Treatment repeats as in arm I. Patients who achieve SD, CR, or PR after the sixth course may receive placebo as a single agent once every 3 weeks in the absence of disease progression.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Advanced Malignant Mesothelioma, Epithelial Mesothelioma, Localized Malignant Mesothelioma, Recurrent Malignant Mesothelioma, Sarcomatous Mesothelioma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
Double
Allocation
Randomized
Enrollment
106 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm I
Arm Type
Experimental
Arm Description
Patients receive gemcitabine IV over 30 minutes on days 1 and 8 and cisplatin IV over 30-60 minutes (beginning after gemcitabine infusion) and bevacizumab IV over 30-90 minutes (beginning after cisplatin infusion) on day 1. Treatment repeats every 3 weeks for 6 courses in the absence of disease progression or unacceptable toxicity. Patients who achieve stable disease (SD), complete response (CR), or partial response (PR) after the sixth course may receive bevacizumab as a single agent once every 3 weeks in the absence of disease progression or unacceptable toxicity.
Arm Title
Arm II
Arm Type
Experimental
Arm Description
Patients receive gemcitabine and cisplatin as in arm I and placebo IV over 30-90 minutes (beginning after cisplatin infusion) on day 1. Treatment repeats as in arm I. Patients who achieve SD, CR, or PR after the sixth course may receive placebo as a single agent once every 3 weeks in the absence of disease progression.
Intervention Type
Drug
Intervention Name(s)
gemcitabine hydrochloride
Other Intervention Name(s)
dFdC, difluorodeoxycytidine hydrochloride, gemcitabine, Gemzar
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
cisplatin
Other Intervention Name(s)
CACP, CDDP, CPDD, DDP
Intervention Description
Given IV
Intervention Type
Biological
Intervention Name(s)
bevacizumab
Other Intervention Name(s)
anti-VEGF humanized monoclonal antibody, anti-VEGF monoclonal antibody, Avastin, rhuMAb VEGF
Intervention Description
Given IV
Intervention Type
Other
Intervention Name(s)
placebo
Other Intervention Name(s)
PLCB
Intervention Description
Given IV
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Intervention Description
Correlative studies
Primary Outcome Measure Information:
Title
Time to disease progression
Description
The two treatment groups will be compared using a stratified logrank test. Kaplan-Meier time-to-event curves will be constructed for each treatment group. Median time-to-progression in each group and corresponding 95% confidence intervals will be derived using the method described in Brookmeyer and Crowley.
Time Frame
Time from randomization until the first evidence of progression, up to 9 years
Secondary Outcome Measure Information:
Title
Complete response rate
Description
Will be compared between groups using chi-square or Fisher exact tests, as appropriate.
Time Frame
Up to 6 months
Title
Objective response rate (complete and partial response)
Description
Will be compared between groups using chi-square or Fisher exact tests, as appropriate.
Time Frame
Up to 6 months
Title
Rate of disease stabilization
Description
Will be compared between groups using chi-square or Fisher exact tests, as appropriate.
Time Frame
Up to 6 months
Title
Overall survival
Description
Kaplan-Meier estimates of overall survival rates will be derived and compared between the two groups using a stratified log-rank test.
Time Frame
Up to 9 years
Title
Incidence of adverse events graded according to NCI CTCAE version 3.0
Description
Toxicity rates will be compared between the two groups via chi-square or Fisher exact tests.
Time Frame
Up to 9 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically or cytologically confirmed malignant pleural or peritoneal mesothelioma that is not amenable to curative surgery Epithelial, sarcomatoid, or mixed subtype Evidence of gross unresectability, including, but not limited to, the following conditions: Direct extension into the chest wall Mediastinal or hilar lymphadenopathy Pulmonary or cardiac function that is inadequate to tolerate resection Sarcomatoid or mixed histology Pleural mesothelioma must be stage II or greater using the International Mesothelioma Interest Group staging system Measurable disease outside prior irradiation port At least 20 mm by conventional techniques OR at least 10 mm by spiral CT scan Pleural effusions and ascites are not considered measurable lesions Site in pleura, lung, liver, or retroperitoneum that can be assessed by MRI for evaluation of blood flow No obvious tumor involvement of major vessels by CT scan No known brain metastases Performance status - ECOG 0-1 More than 3 months WBC at least 3,000/mm^3 Absolute neutrophil count at least 1,500/mm^3 Platelet count at least 100,000/mm^3 No history of bleeding diathesis Bilirubin normal AST/ALT no greater than 2.5 times upper limit of normal INR no greater than 1.5 Creatinine no greater than 1.5 mg/dL Creatinine clearance at least 60 mL/min If 1+ or greater proteinuria on dipstick, then must have less than 500 mg of protein/24-hour urine collection No significant renal impairment See Disease Characteristics No history deep vein thrombosis No myocardial ischemia or infarction within the past 6 months No uncompensated coronary artery disease within the past 6 months No uncontrolled hypertension No symptomatic congestive heart failure No unstable angina pectoris within the past 6 months No cardiac arrhythmia No transient ischemic attack within the past 6 months No cerebrovascular accident within the past 6 months No other arterial thromboembolic event within the past 6 months No clinically significant peripheral artery disease See Disease Characteristics No history of pulmonary embolism No prior allergic reactions attributed to compounds of similar chemical or biologic composition to bevacizumab or other study agents No other active malignancy within the past 5 years except nonmelanoma skin cancer or carcinoma in situ of the cervix No ongoing or active infection No other concurrent uncontrolled illness that would preclude study participation No psychiatric illness or social situations that would preclude compliance Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No growth factors for 24 hours before, during, or for 24 hours after cytotoxic chemotherapy See Biologic therapy Prior intrapleural cytotoxic agents (including bleomycin) allowed No prior systemic cytotoxic chemotherapy See Disease Characteristics At least 4 weeks since prior radiotherapy and recovered See Disease Characteristics At least 6 weeks since prior major surgery At least 30 days since prior investigational drug No other concurrent investigational or commercial agents or therapies No concurrent combination antiretroviral therapy for HIV-positive patients
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hedy Kindler
Organizational Affiliation
University of Chicago
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Chicago
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60637
Country
United States

12. IPD Sharing Statement

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Combination Chemotherapy With or Without Bevacizumab in Treating Patients With Malignant Mesothelioma

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