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A Phase II Trial of Neoadjuvant Laparoscopic Hyperthermic Intraperitoneal Chemotherapy (HIPEC) With Chemoradiation

Primary Purpose

Gastric Cancer, Stomach Cancer

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Paclitaxel
Carboplatin
Dexamethasone
Diphenhydramine
Famotidine
Palonosetron
3D conformal or intensity modulated radiotherapy
Surgical resection
Adjuvant Chemotherapy
Sponsored by
Icahn School of Medicine at Mount Sinai
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Gastric Cancer focused on measuring Phase II Trial, HIPEC, Chemoradiation

Eligibility Criteria

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

Inclusion Criteria:

  • Clinical diagnosis of gastric cancer post endoscopic ultrasound (EUS), staging must be T3/T4
  • N0/+, M0. EUS must have been done within 8 weeks of the protocol start.
  • Patient must plan to undergo surgical treatment.
  • ECOG Scale of Performance Status of 0-2
  • Adequate organ and marrow function (leukocytes ≥ 3000/mcl, absolute neutrophil count ≥ 1500, platelets ≥ 100,000/mcl, total bilirubin ≥ 1.5mg/dl (Gilbert's syndrome, then <3.0), AST(SGOT)/ALT(SPGT) ≤ 2.5 X institutional upper limit of normal, creatinine within normal institutional limits)
  • Women of child-bearing potential and men must agree to use adequate contraception prior to study entry, for the duration of study participation, and for 90 days following completion of therapy. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
  • Ability to understand and the willingness to sign a written informed consent.

Exclusion Criteria:

  • Subjects who have any previous treatment for their cancer.
  • Patients with known metastatic disease; this includes patients with clinically apparent or suspected metastasis to sites other than lymph nodes or peritoneal surfaces.
  • Subjects with early stage gastric cancer (Stage T1/T2 N0)
  • History of allergic reactions attributed to compounds of similar chemical or biological composition to any of the agents being used in this study, including but not limited to: Carboplatin, Taxol, 5-FU, Leucovorin, Mitomycin C.
  • Subjects who have received prior radiation to any portion of the abdominal cavity or pelvis are excluded.
  • Subjects who have had prior malignancies, except for cured non-melanoma skin cancer, or curatively treated in situ carcinoma of the cervix, or adequately treated malignancies for which there has been no evidence of activity for more than three years.
  • Patients must not be pregnant or nursing due to the potential for congenital abnormalities and the potential of this regimen to harm nursing infants.
  • Subjects with a condition that may interfere with the subjects' ability to understand the requirements of the study.
  • Known HIV, Hepatitis B, or Hepatitis C positive patients.
  • Patients with active coronary artery disease (defined as unstable angina or a positive cardiac stress test) will be excluded. Subjects with a history of coronary artery disease may be included if they have had a normal stress test within 30 days of enrollment.
  • Patients with restrictive or obstructive pulmonary disease that would limit study compliance or place the patient at unacceptable risk for participation in the study will be excluded.
  • Patients with a history of cerebrovascular disease that would limit study compliance or place the patient at unacceptable risk for participation in the study will be excluded.
  • Subjects with other concurrent severe medical problems unrelated to the malignancy that would significantly limit full compliance with the study, or places them at an unacceptable risk for participation in the study, will also be excluded.
  • Evidence of extensive intraperitoneal adhesions at the time of surgery which prohibits intraperitoneal therapy, as determined by the operating surgeon.
  • Patients with any condition that would precluded the ability to deliver appropriate IP therapy.
  • Patients with a life expectancy of less than 12 weeks will be excluded from this study.

Sites / Locations

  • Mount Sinai WestRecruiting
  • Mount Sinai St. Luke'sRecruiting
  • Icahn School of Medicine at Mount SinaiRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Patients With Local Regional Advanced Gastric Cancer

Arm Description

Patients with local regional advanced gastric cancer after at least 4 weeks post diagnostic laparoscopy and HIPEC, will receive all of the treatments described in the study protocol.

Outcomes

Primary Outcome Measures

Pathological Response
The pathological complete response (the lack of all signs of cancer in tissue samples), at the time of surgical resection. This will be determined using a four-category tumor regression score system that evaluates the response of the cancer cells to the treatment. RECIST - Complete Response (CR), Partial Response (PR) Progressive Disease (PD), and Stable Disease (SD)

Secondary Outcome Measures

Overall Survival (OS)
OS is defined as the time from the first dose of study treatment to the date of death (whatever the cause).
Disease-free Survival
The length of time after treatment ends that the patient survives without any signs or symptoms.
Peritoneal Disease-free Survival
The length of time after treatment ends that the patient survives without any peritoneal signs or symptoms.

Full Information

First Posted
March 12, 2020
Last Updated
December 7, 2021
Sponsor
Icahn School of Medicine at Mount Sinai
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1. Study Identification

Unique Protocol Identification Number
NCT04308837
Brief Title
A Phase II Trial of Neoadjuvant Laparoscopic Hyperthermic Intraperitoneal Chemotherapy (HIPEC) With Chemoradiation
Official Title
A Phase II Trial of Neoadjuvant Laparoscopic Hyperthermic Intraperitoneal Chemotherapy (HIPEC) With Chemoradiation (Carboplatin and Taxol) as First Line Treatment for Patients With Local Regional Advanced Gastric Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
December 2021
Overall Recruitment Status
Recruiting
Study Start Date
July 31, 2018 (Actual)
Primary Completion Date
August 2025 (Anticipated)
Study Completion Date
August 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Icahn School of Medicine at Mount Sinai

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Stomach cancer is the fifth most common digestive cancer and third main cause of death from cancer in the world. Modern management of Gastric cancer involves a multi-disciplinary approach involving surgical oncologists, medical oncologists, gastroenterologists and oncological radiologists. The most common clinical approach to Gastric adenocarcinoma is to begin with staging, which usually involves CT scan/ MRI combined with endoscopic US for more accurate T, N staging. Once the patient is deemed to have locally advanced gastric cancer (T3/T4,N0/+), a staging laparoscopy is recommended to rule out obvious or microscopic peritoneal metastatic disease. Additionally, neoadjuvant chemotherapy is initiated and followed by surgery +/- adjuvant radiation and chemotherapy.This protocol involves the addition of neoadjuvant HIPEC at the time of diagnostic laparoscopy as well as neoadjuvant radiation therapy for improved local and systemic control. The goal of this phase II clinical trial is to evaluate the efficacy of a multi-modality approach to treating patients with locally advanced Gastric cancer by incorporating diagnostic laparoscopy with HIPEC, neo-adjuvant chemo-radiotherapy, followed by surgical resection and adjuvant chemotherapy. The trial aims to assess this multi-modality approach in inducing pathological complete response; decreased rates of disease progression during neoadjuvant therapy; and increased overall, disease-free, and peritoneal disease-free survival.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Gastric Cancer, Stomach Cancer
Keywords
Phase II Trial, HIPEC, Chemoradiation

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Model Description
The study design involves a single arm of patients that will all receive the same treatment.
Masking
None (Open Label)
Allocation
N/A
Enrollment
29 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Patients With Local Regional Advanced Gastric Cancer
Arm Type
Experimental
Arm Description
Patients with local regional advanced gastric cancer after at least 4 weeks post diagnostic laparoscopy and HIPEC, will receive all of the treatments described in the study protocol.
Intervention Type
Drug
Intervention Name(s)
Paclitaxel
Intervention Description
50 mg/m2 given by intravenous infusion on days 1, 8, 15, 22 and 29.
Intervention Type
Drug
Intervention Name(s)
Carboplatin
Intervention Description
Carboplatin AUC = 2 given by intravenous infusion on days 1, 8, 15, 22 and 29.
Intervention Type
Drug
Intervention Name(s)
Dexamethasone
Intervention Description
All patients receiving Paclitaxel will receive institutional standard premedications, which include Dexamethasone (10 mg IVPB)
Intervention Type
Drug
Intervention Name(s)
Diphenhydramine
Intervention Description
All patients receiving Paclitaxel will receive institutional standard premedications, which include diphenhydramine (50mg IVP)
Intervention Type
Drug
Intervention Name(s)
Famotidine
Intervention Description
All patients receiving Paclitaxel will receive institutional standard premedications, which include Famotidine (20mg IVPB)
Intervention Type
Drug
Intervention Name(s)
Palonosetron
Intervention Description
All patients receiving Paclitaxel will receive institutional standard premedications, which include Palonosetron (0.25mg IVP)
Intervention Type
Radiation
Intervention Name(s)
3D conformal or intensity modulated radiotherapy
Other Intervention Name(s)
IMRT
Intervention Description
Treatment will be given 5 days per week. Photon beams >6 MV are required. Treatment may be delivered either by a 3D conformal technique or IMRT. IMRT via dynamically moving MLCs, step-and-shoot with a multileaf collimator, Rapid Arc, binary multileaf collimator, and tomotherapy are allowed. Proton therapy is not allowed.
Intervention Type
Procedure
Intervention Name(s)
Surgical resection
Intervention Description
Surgical resection will constitute subtotal or total gastrectomy (depending on tumor size and location) and D2 lymphadenectomy.
Intervention Type
Radiation
Intervention Name(s)
Adjuvant Chemotherapy
Intervention Description
The patient will begin adjuvant chemotherapy 4-12 weeks after surgery. The adjuvant chemotherapy will consist of FOLFOX every 2 weeks for 6 cycles (i.e. 3 months)
Primary Outcome Measure Information:
Title
Pathological Response
Description
The pathological complete response (the lack of all signs of cancer in tissue samples), at the time of surgical resection. This will be determined using a four-category tumor regression score system that evaluates the response of the cancer cells to the treatment. RECIST - Complete Response (CR), Partial Response (PR) Progressive Disease (PD), and Stable Disease (SD)
Time Frame
at time of surgical resection
Secondary Outcome Measure Information:
Title
Overall Survival (OS)
Description
OS is defined as the time from the first dose of study treatment to the date of death (whatever the cause).
Time Frame
6 years
Title
Disease-free Survival
Description
The length of time after treatment ends that the patient survives without any signs or symptoms.
Time Frame
6 years
Title
Peritoneal Disease-free Survival
Description
The length of time after treatment ends that the patient survives without any peritoneal signs or symptoms.
Time Frame
6 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Clinical diagnosis of gastric cancer post endoscopic ultrasound (EUS), staging must be T3/T4 N0/+, M0. EUS must have been done within 8 weeks of the protocol start. Patient must plan to undergo surgical treatment. ECOG Scale of Performance Status of 0-2 Adequate organ and marrow function (leukocytes ≥ 3000/mcl, absolute neutrophil count ≥ 1500, platelets ≥ 100,000/mcl, total bilirubin ≥ 1.5mg/dl (Gilbert's syndrome, then <3.0), AST(SGOT)/ALT(SPGT) ≤ 2.5 X institutional upper limit of normal, creatinine within normal institutional limits) Women of child-bearing potential and men must agree to use adequate contraception prior to study entry, for the duration of study participation, and for 90 days following completion of therapy. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately. Ability to understand and the willingness to sign a written informed consent. Exclusion Criteria: Subjects who have any previous treatment for their cancer. Patients with known metastatic disease; this includes patients with clinically apparent or suspected metastasis to sites other than lymph nodes or peritoneal surfaces. Subjects with early stage gastric cancer (Stage T1/T2 N0) History of allergic reactions attributed to compounds of similar chemical or biological composition to any of the agents being used in this study, including but not limited to: Carboplatin, Taxol, 5-FU, Leucovorin, Mitomycin C. Subjects who have received prior radiation to any portion of the abdominal cavity or pelvis are excluded. Subjects who have had prior malignancies, except for cured non-melanoma skin cancer, or curatively treated in situ carcinoma of the cervix, or adequately treated malignancies for which there has been no evidence of activity for more than three years. Patients must not be pregnant or nursing due to the potential for congenital abnormalities and the potential of this regimen to harm nursing infants. Subjects with a condition that may interfere with the subjects' ability to understand the requirements of the study. Known HIV, Hepatitis B, or Hepatitis C positive patients. Patients with active coronary artery disease (defined as unstable angina or a positive cardiac stress test) will be excluded. Subjects with a history of coronary artery disease may be included if they have had a normal stress test within 30 days of enrollment. Patients with restrictive or obstructive pulmonary disease that would limit study compliance or place the patient at unacceptable risk for participation in the study will be excluded. Patients with a history of cerebrovascular disease that would limit study compliance or place the patient at unacceptable risk for participation in the study will be excluded. Subjects with other concurrent severe medical problems unrelated to the malignancy that would significantly limit full compliance with the study, or places them at an unacceptable risk for participation in the study, will also be excluded. Evidence of extensive intraperitoneal adhesions at the time of surgery which prohibits intraperitoneal therapy, as determined by the operating surgeon. Patients with any condition that would precluded the ability to deliver appropriate IP therapy. Patients with a life expectancy of less than 12 weeks will be excluded from this study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Spiros Hiotis, MD, PhD
Phone
(212) 241-2891
Email
spiros.hiotis@mountsinai.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Spiros Hiotis, MD, PhD
Organizational Affiliation
Icahn School of Medicine at Mount Sinai
Official's Role
Principal Investigator
Facility Information:
Facility Name
Mount Sinai West
City
New York
State/Province
New York
ZIP/Postal Code
10019
Country
United States
Individual Site Status
Recruiting
Facility Name
Mount Sinai St. Luke's
City
New York
State/Province
New York
ZIP/Postal Code
10025
Country
United States
Individual Site Status
Recruiting
Facility Name
Icahn School of Medicine at Mount Sinai
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States
Individual Site Status
Recruiting

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

A Phase II Trial of Neoadjuvant Laparoscopic Hyperthermic Intraperitoneal Chemotherapy (HIPEC) With Chemoradiation

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