RATIONALE: Drugs used in chemotherapy, such as carboplatin, gemcitabine, 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 chemotherapy before surgery may make the tumor smaller
and reduce the amount of normal tissue that needs to be removed. Giving chemotherapy after
surgery may kill any tumor cells that remain after surgery. It is not yet known which
treatment regimen may kill more tumor cells.
PURPOSE: This randomized phase II trial is studying how well giving one of two chemotherapy
regimens containing carboplatin, gemcitabine, and paclitaxel works in treating patients
undergoing surgery for newly diagnosed primary stage IIIC or stage IV ovarian cancer,
fallopian tube cancer, or primary peritoneal cancer.
- To examine and compare the feasibility of two sequential neoadjuvant regimens in
patients with newly diagnosed, stage IIIC-IV ovarian or peritoneal carcinoma.
- To confirm the feasibility of extended sequential regimens offering 6+6 courses of
chemotherapy in patients presenting with inoperable disease.
- To establish the feasibility of biweekly paclitaxel with vs without gemcitabine
hydrochloride in the adjuvant phase, after carboplatin neoadjuvant induction.
OUTLINE: This is a multicenter study. Patients are stratified according to serum albumin (<
30 g/dL vs 30-35 g/dL vs > 35 g/dL), FIGO stage (stage IIIC vs stage IV), and histological
grade (well-differentiated [grade 1] vs moderately well-differentiated [grade 2] vs poorly
differentiated [grade 3]). Patients are randomized to 1 of 2 treatment arms.
- Neoadjuvant therapy:
- Arm I: Patients receive carboplatin IV over 1 hour and gemcitabine hydrochloride
IV over 30 minutes on days 1 and 8. Treatment repeats every 3 weeks for up to 6
courses in the absence of disease progression or unacceptable toxicity.
- Arm II: Patients receive carboplatin IV over 1 hour on day 1. Treatment repeats
every 3 weeks for up to 6 courses in the absence of disease progression or
In both arms, patients with disease progression are switched to adjuvant paclitaxel-based
chemotherapy. Patients with responding disease after switching regimens may undergo
debulking surgery at the investigator's discretion.
- Surgery: After completion of 6 courses of chemotherapy, all patients are evaluated for
surgery. Patients with questionable operability based on clinical or radiological
criteria are re-assessed laparoscopically. Patients judged to have disease that is
amenable to optimal debulking at laparotomy are recommended for debulking surgery.
Patients judged to have disease that is not amenable to optimal debulking are
reconsidered for surgery after they receive an additional 6 courses of chemotherapy.
Patients with disease progression after completion of 12 courses of chemotherapy
undergo laparotomy only if there is a clinically pressing need to palliate their
condition and if surgery offers some prospect of achieving this result (e.g.,
palliation for bowel obstruction).
- Adjuvant therapy:
- Arm I: Patients receive paclitaxel IV over 3 hours on day 1. Treatment repeats
every 2 weeks for up to 6 courses in the absence of disease progression or
- Arm II: Patients receive paclitaxel IV over 3 hours and gemcitabine hydrochloride
IV over 30 minutes on day 1. Treatment repeats every 2 weeks for up to 6 courses
in the absence of disease progression or unacceptable toxicity.
Patients complete quality of life questionnaires at baseline, after completion of course 6
of neoadjuvant therapy, before course 7, and at the end of study treatment.
After completion of study therapy, patients are followed periodically for up to 10 years.
Allocation: Randomized, Masking: Open Label, Primary Purpose: Treatment
Drug : carboplatin, Drug : gemcitabine hydrochloride, Drug : paclitaxel
Study Arm Groups : Arm I, Arm II, Arm I, Arm II, Arm I, Arm II
See Interventions above
- Percentage of patients completing 12 courses of chemotherapy; null
- Toxicity; null; Quality of life as assessed by FACT-G, FACT-0, and FACT-T periodically; null; Objective response rate to the neoadjuvant phase of chemotherapy (i.e., first 6 courses) as assessed by CT scan, by laparoscopy, clinically, and by CA-125 level; null; Objective response rate following all 12 courses of treatment assessed clinically, by CT scan, and by CA-125 level; null; Progression-free survival, particularly at 34 weeks; null; Overall survival, particularly at 34 weeks; null; Rates of optimal and suboptimal interval debulking; null
Sorry, this information is not available
This is available on the Clinicaltrials.gov
18 Years - 75 Years
- DISEASE CHARACTERISTICS:
- - Clinically, radiologically, and histologically confirmed diagnosis of 1 of the
- - Primary epithelial ovarian cancer
- - Primary peritoneal carcinoma
- - Ovarian carcinosarcoma
- - Fallopian tube carcinoma
- - Newly diagnosed, stage IIIC/IV disease with or without ascites
- - None of the following histologies allowed:
- - Mucinous
- - Classic clear cell
- - Micropapillary or microacinar borderline tumors with or without invasive
- - Unsuitable for primary debulking surgery, as defined by the following:
- - Laparoscopic or other minor surgical-staging procedures
- - Supplementary clinical and radiological assessments
- - Presenting with factors affecting suitability for successful complete resection and
- necessarily prompting laparoscopic assessment, including any of the following:
- - CT scan or MRI evidence of peritoneal carcinomatosis, extensive mesenteric
- infiltration, diaphragmatic involvement, extensive retroperitoneal involvement,
- and cytologically verified malignant pleural effusion and/or ascites
- - Clinical evidence of ascites with radiological evidence of multisite disease
- - Clinical evidence of pelvic infiltration and radiological evidence of multisite
- - FIGO stage IV disease, including cervical/supraclavicular lymphadenopathy,
- intrahepatic parenchymal metastases, or cytologically confirmed malignant
- pleural effusion
- - No known brain metastases
- PATIENT CHARACTERISTICS:
- - ECOG performance status 0-3
- - Life expectancy ≥ 3 months
- - WBC > 3.0/mm³
- - Platelet count ≥ 100,000/mm³
- - ANC ≥ 1,500/mm³
- - AST and ALT < 2.5 times upper limit of normal (ULN)
- - Alkaline phosphatase < 2.5 times ULN
- - Bilirubin < 1.5 times ULN
- - Estimated glomerular filtration rate ≥ 30 mL/min
- - No diabetics, hypertensive smokers, or other patients with pre-existing occult
- neuropathic deficits
- - No poorly controlled, potentially serious medical conditions, including any of the
- - Cerebrovascular events within the past 12 months
- - Severe chronic respiratory conditions requiring prior hospitalization
- - Active infections
- - Poorly controlled seizures
- - Morbid psychiatric conditions likely to render treatment compliance with the
- protocol difficult
- - No other malignancy treated with chemotherapy or radiotherapy except nonmelanoma skin
- cancer or carcinoma in situ of the cervix
- - Prior malignancies disease-free for > 5 years not treated with chemotherapy
- - No other reasons likely to cause inability to comply with treatment schedule and
- - Fertile patients must use effective contraception
- PRIOR CONCURRENT THERAPY:
- - See Disease Characteristics
This is in the inclusion criteria above
A Randomised Feasibility Study of Extended Chemotherapy With Neoadjuvant Carboplatin, Then Surgery Followed by Adjuvant Paclitaxel and Gemcitabine Verses Neoadjuvant Gemcitabine and Carboplatin, Then Surgery, Followed by Adjuvant Paclitaxel
Not available for this trial
Sorry, this information is not available
Warwick Medical School