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Isolated Hepatic Perfusion With Melphalan in Treating Patients With Unresectable Colorectal Cancer That Has Metastasized to the Liver

Primary Purpose

Colorectal Cancer, Metastatic Cancer

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
isolated perfusion
melphalan
conventional surgery
Sponsored by
National Institutes of Health Clinical Center (CC)
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Colorectal Cancer focused on measuring recurrent colon cancer, stage IV colon cancer, recurrent rectal cancer, stage IV rectal cancer, liver metastases

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Histologically or cytologically confirmed colorectal cancer Metastatic disease limited to the parenchyma of the liver Patients with limited sites of extrahepatic disease AND who have dominant life-limiting disease in the liver are considered eligible provided the extrahepatic sites can be treated with local ablative measures (e.g., resection or external beam radiotherapy) No other evidence of unresectable extrahepatic disease by radiological studies Unresectable hepatic disease defined by > 3 sites of disease in the liver, bilobar disease, or tumor abutting major vascular or ductal structures making anatomic resection with liver function preservation impossible Measurable disease Refractory to prior first-line systemic chemotherapy Disease progression during or after completion of treatment with an irinotecan- or oxaliplatin-containing regimen for established hepatic metastases Treatment failure is defined as disease progression evidenced by tumor growth OR new lesions on imaging modalities OR increasing carcinoembryonic antigen (CEA) PATIENT CHARACTERISTICS: Age 18 and over Performance status ECOG 0-2 Life expectancy Not specified Hematopoietic Hematocrit > 27.0% Platelet count > 100,000/mm^3 WBC > 3,000/mm^3 Hepatic Bilirubin < 2.0 mg/dL PT ≤ 2 seconds of the upper limit of normal ALT and AST elevations secondary to metastatic disease allowed Chronic active hepatitis B or C allowed provided there is no evidence of cirrhosis on pathology, radiologic studies, or physical exam No history of veno-occlusive disease No biopsy proven cirrhosis No evidence of significant portal hypertension manifested by ascites, esophageal varices on endoscopy, or radiologic studies showing significant collateral vessels around the organs drained by the portal venous system No other liver condition that would preclude study therapy Renal Creatinine ≤ 1.5 mg/dL OR Creatinine clearance > 60 mL/min Cardiovascular LVEF ≥ 40% No ischemic cardiac disease No history of congestive heart failure Pulmonary Chronic obstructive pulmonary disease or other chronic pulmonary disease allowed provided pulmonary function test ≥ 50% of predicted Other Not pregnant or nursing Negative pregnancy test No active infection Weight > 30 kg PRIOR CONCURRENT THERAPY: Biologic therapy More than 4 weeks since prior biologic therapy for the malignancy and recovered Chemotherapy See Disease Characteristics More than 4 weeks since prior chemotherapy for the malignancy and recovered Endocrine therapy Not specified Radiotherapy See Disease Characteristics More than 4 weeks since prior radiotherapy for the malignancy and recovered Surgery See Disease Characteristics Other No concurrent immunosuppressive drugs No concurrent chronic anticoagulation therapy

Sites / Locations

  • Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office

Outcomes

Primary Outcome Measures

Response
Duration of response

Secondary Outcome Measures

Patterns of tumor recurrence (liver vs systemic)
Progression-free survival
Overall survival
Quality of life

Full Information

First Posted
August 4, 2004
Last Updated
May 11, 2012
Sponsor
National Institutes of Health Clinical Center (CC)
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00089401
Brief Title
Isolated Hepatic Perfusion With Melphalan in Treating Patients With Unresectable Colorectal Cancer That Has Metastasized to the Liver
Official Title
A Phase II Trial Of Isolated Hepatic Perfusion (IHP) With Melphalan For Subjects With Metastatic Unresectable Colorectal Cancers Of The Liver With Disease Refractory To First Line Systemic Chemotherapy
Study Type
Interventional

2. Study Status

Record Verification Date
May 2012
Overall Recruitment Status
Completed
Study Start Date
July 2004 (undefined)
Primary Completion Date
November 2006 (Actual)
Study Completion Date
March 2008 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
National Institutes of Health Clinical Center (CC)
Collaborators
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
RATIONALE: Drugs used in chemotherapy, such as melphalan, work in different ways to stop tumor cells from dividing so they stop growing or die. Giving chemotherapy drugs in different ways may kill more tumor cells. PURPOSE: This phase II trial is studying how well isolated hepatic perfusion with melphalan works in treating patients with unresectable colorectal cancer that has metastasized to the liver.
Detailed Description
OBJECTIVES: Primary Determine the response and duration of response in patients with unresectable colorectal cancer metastatic to the liver and refractory to first-line systemic chemotherapy treated with isolated hepatic perfusion with melphalan. Secondary Determine the pattern of recurrence (liver vs systemic) in patients treated with this regimen. Determine hepatic progression-free and overall survival in patients treated with this regimen. Determine the time to hepatic and systemic progression in patients treated with this regimen. Determine quality of life (QOL) in patients treated with this regimen. Correlate baseline QOL with length of survival in patients treated with this regimen. OUTLINE: Patients undergo a limited laparotomy to determine if extrahepatic disease that was not visualized during preoperative scanning is present. Patients found to have peritoneal seeding or unresectable extrahepatic metastatic disease not previously visualized on scans do not receive isolated hepatic perfusion (IHP). Remaining patients undergo IHP with melphalan and hyperthermia therapy. Liver perfusion continues for 1 hour. Quality of life is assessed at baseline, 6 weeks, and then every 3-4 months for 3 years. Patients are followed at 6 weeks, every 3-4 months for 3 years, and then every 6 months thereafter. PROJECTED ACCRUAL: A total of 30 patients will be accrued for this study within 3 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Colorectal Cancer, Metastatic Cancer
Keywords
recurrent colon cancer, stage IV colon cancer, recurrent rectal cancer, stage IV rectal cancer, liver metastases

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Masking
None (Open Label)
Enrollment
8 (Actual)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
isolated perfusion
Intervention Type
Drug
Intervention Name(s)
melphalan
Intervention Type
Procedure
Intervention Name(s)
conventional surgery
Primary Outcome Measure Information:
Title
Response
Title
Duration of response
Secondary Outcome Measure Information:
Title
Patterns of tumor recurrence (liver vs systemic)
Title
Progression-free survival
Title
Overall survival
Title
Quality of life

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically or cytologically confirmed colorectal cancer Metastatic disease limited to the parenchyma of the liver Patients with limited sites of extrahepatic disease AND who have dominant life-limiting disease in the liver are considered eligible provided the extrahepatic sites can be treated with local ablative measures (e.g., resection or external beam radiotherapy) No other evidence of unresectable extrahepatic disease by radiological studies Unresectable hepatic disease defined by > 3 sites of disease in the liver, bilobar disease, or tumor abutting major vascular or ductal structures making anatomic resection with liver function preservation impossible Measurable disease Refractory to prior first-line systemic chemotherapy Disease progression during or after completion of treatment with an irinotecan- or oxaliplatin-containing regimen for established hepatic metastases Treatment failure is defined as disease progression evidenced by tumor growth OR new lesions on imaging modalities OR increasing carcinoembryonic antigen (CEA) PATIENT CHARACTERISTICS: Age 18 and over Performance status ECOG 0-2 Life expectancy Not specified Hematopoietic Hematocrit > 27.0% Platelet count > 100,000/mm^3 WBC > 3,000/mm^3 Hepatic Bilirubin < 2.0 mg/dL PT ≤ 2 seconds of the upper limit of normal ALT and AST elevations secondary to metastatic disease allowed Chronic active hepatitis B or C allowed provided there is no evidence of cirrhosis on pathology, radiologic studies, or physical exam No history of veno-occlusive disease No biopsy proven cirrhosis No evidence of significant portal hypertension manifested by ascites, esophageal varices on endoscopy, or radiologic studies showing significant collateral vessels around the organs drained by the portal venous system No other liver condition that would preclude study therapy Renal Creatinine ≤ 1.5 mg/dL OR Creatinine clearance > 60 mL/min Cardiovascular LVEF ≥ 40% No ischemic cardiac disease No history of congestive heart failure Pulmonary Chronic obstructive pulmonary disease or other chronic pulmonary disease allowed provided pulmonary function test ≥ 50% of predicted Other Not pregnant or nursing Negative pregnancy test No active infection Weight > 30 kg PRIOR CONCURRENT THERAPY: Biologic therapy More than 4 weeks since prior biologic therapy for the malignancy and recovered Chemotherapy See Disease Characteristics More than 4 weeks since prior chemotherapy for the malignancy and recovered Endocrine therapy Not specified Radiotherapy See Disease Characteristics More than 4 weeks since prior radiotherapy for the malignancy and recovered Surgery See Disease Characteristics Other No concurrent immunosuppressive drugs No concurrent chronic anticoagulation therapy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Steven K. Libutti, MD
Organizational Affiliation
NCI - Surgery Branch
Official's Role
Study Chair
Facility Information:
Facility Name
Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892-1182
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Isolated Hepatic Perfusion With Melphalan in Treating Patients With Unresectable Colorectal Cancer That Has Metastasized to the Liver

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