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A Phase II Study to Evaluate the Efficacy and Toxicity of Oxaliplatin in Combination With Gemcitabine as First and Second Line Therapy in Unknown Primary Cancer

Phase 2
18 Years
Not Enrolling
Unknown Primary Neoplasms

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Trial Information

A Phase II Study to Evaluate the Efficacy and Toxicity of Oxaliplatin in Combination With Gemcitabine as First and Second Line Therapy in Unknown Primary Cancer

Oxaliplatin is a chemotherapy drug that causes the death of cancer cells and other actively
dividing cells by interfering with Deoxyribonucleic acid (DNA) function. Gemcitabine
prevents cells from making DNA and Ribonucleic acid (RNA) that are necessary for cell
growth, thus disrupting the growth of the cancer cells, which causes the cancer cells to
start to die.

After the screening portion of the study, if you are eligible to begin study treatment, you
will come to M. D. Anderson at least every two weeks (14 days) for treatment. Each 14-day
period of treatment is called a "cycle" of therapy. You will receive at least 3 cycles of
therapy (6 weeks) unless side effects become intolerable or the disease progresses.

When you begin treatment, you will have a small tube (central venous line) inserted into a
large vein under the skin of the chest or through a vein in the arm for administration of
oxaliplatin and gemcitabine. The central venous line will remain in place the entire time
you are taking part in this study. Both drugs must be given at M. D. Anderson. On Day 1 of
each cycle, you will receive gemcitabine injected into a vein over 2 hours. On Day 2 of each
cycle you will receive oxaliplatin injected into a vein over 2 hours. This drug schedule
will be repeated every 2 weeks.

You will first be asked to fill out several questionnaires that deal with your quality of
life. These will help the researchers understand how the study drugs affect your quality of
life including your pain level, fatigue (tiredness) level, appetite, and ability to perform
everyday tasks, in spite of whether there is any shrinkage of the tumor. It will take about
30 minutes to an hour to complete the forms. You will also be asked to complete a
questionnaire (one time only) that asks questions about why you decided to take part in this

During the first cycle of therapy, blood (about 2 1/2 teaspoons) will be collected once a
week for routine tests. Before each new cycle of therapy, you will have a complete physical
exam, urine will be collected, and blood will be drawn (about 2 ½ teaspoons) for routine
tests. You will be asked to tell the study doctor about all medications you have taken since
you started taking the study drugs and any health problems that you may have experienced.
You will also have either computed tomography (CT) scans or an Magnetic resonance imaging
(MRI) of the tumor(s) every 6 weeks and at the end of the study.

All tests before each new cycle of treatment and when treatment stops must be done at M. D.
Anderson. Extra tests may be done during the study if your doctor feels it is necessary for
your care. Every 6 weeks for as long as you are on study, you will also be asked to fill out
the questionnaires that help study doctors understand your quality of life. It will take
about 30 minutes to an hour to complete the forms.

If you experience intolerable side effects, treatment may be delayed, stopped, or you may
receive smaller doses of the treatment. You may continue to receive treatment on this
study, unless the disease gets worse or you experience any intolerable side effects. If
this happens, you will be taken off the study and your doctor will discuss other treatment
options with you.

When you stop taking part in the study for any reason, you will have blood (about 3
teaspoons) collected for final routine tests. You will have one more physical exam and
either a CT scan or a MRI to check on the status of the disease. You will also be asked
once more to fill out the questionnaires that help assess your quality of life. It will
take about 30 minutes to an hour to complete the forms.

Once you stop receiving study treatment, you will be contacted by phone every three months
for the rest of your life to check on how you are doing and any symptoms you may be

This is an investigational study. Oxaliplatin is FDA approved for treatment of advanced
cancer of the colon or rectum, and gemcitabine is FDA approved for the treatment of advanced
cancer of the pancreas. However, the combination of the two drugs for treatment of cancers
with unknown primaries is still considered investigational. Up to 81 people will take part
in this study. All will be enrolled at M. D. Anderson.

Inclusion Criteria:

1. Age >/= 18 years old.

2. Signed informed consent/authorization is obtained prior to conducting any
study-specific screening procedures.

3. Patients should fulfill the criteria for UPC: no primary detected after a complete
evaluation which is defined as complete history and physical, detailed laboratory
examination, directed radiologic studies, symptom or sign directed invasive studies,
directed immunohistochemistry studies and serum tumor markers.

4. Previously untreated or has received no more than one prior chemotherapy regimen for
unknown primary cancer. If the patients are previously treated, they may not have had
previous exposure to gemcitabine or oxaliplatin. Prior exposure to cisplatin or
carboplatin is allowed for this study.

5. ECOG performance status must be 0-2 (Appendix A).

6. Adequate hepatic, renal and bone marrow function: Leukocytes >= 3,000/uL; Absolute
neutrophil count >= 1,500/uL; Platelets >= 100,000/uL; Total bilirubin <= 1.5 *
institutional upper limits of normal (ULN); AST (SGOT)/ALT (SGPT) <= 2.5 *
institutional ULN; Creatinine <= 1.5 mg/dL.

7. Women of childbearing potential are not excluded from this study; however all
participants (men and women) with reproductive potential must practice an effective
method of contraception while on this study in order to minimize risks to fetuses.

8. Patients may have received prior radiation treatment but the last fraction of
radiation treatment must have been completed at least 4 weeks prior to entry on this

9. Patients must have at least one measurable lesion as per the RECIST Criteria that can
be accurately measured in at least one dimension, with minimum lesion size equal to
or more than twice the thickness of the imaging study used. If radiation was
previously received, measurable disease must occur outside the previous radiation
field, unless disease progression has been documented.

10. Both men and women and members of all ethnic groups are eligible for this trial.

Exclusion Criteria:

1. In previously treated patients; patients should not have received gemcitabine or
oxaliplatin as one of the agents.

2. Uncontrolled intercurrent illness including, but not limited to, active infection,
symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmias
not well controlled with medication, myocardial infarction within the previous 6
months, or psychiatric illness/social situations that would limit compliance with
study requirements.

3. Patients with known brain metastases should be excluded from this clinical trial
because of their poor prognosis and because they often develop progressive
neurological dysfunction that would confound the evaluation of neurological and other
adverse events. A CT scan of the brain is not needed for eligibility and will be done
only if the patient presents with symptoms suggestive of brain metastases.

4. Patients who have had chemotherapy within 4 weeks (6 weeks for nitrosoureas or
mitomycin C) prior to entering the study or those who have not recovered from adverse
events due to agents administered more than 28 days earlier.

5. Patients may not be receiving any other investigational agents, or have participated
in any investigational drug study within 28 days preceding start of study treatment.

6. The teratogenic potential of this combination is currently unknown. Women who are
pregnant or lactating are excluded.

7. History of any other malignancy in the last 5 years, except patients with a prior
history of in situ cancer or basal or squamous cell skin cancer are eligible.

8. Peripheral neuropathy > grade 1.

9. Female patients with adenocarcinoma with axillary only nodes will be excluded from
the study.

Type of Study:


Study Design:

Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Participants' Response

Outcome Description:

Complete Response (CR): Disappearance of all target lesions; Partial Response (PR): At least 30% decrease in sum of longest diameter (LD) of target lesions, reference baseline sum LD; Progressive Disease (PD): At least 20% increase in sum of LD of target lesions, reference smallest sum LD recorded since treatment started or appearance of 1 or more new lesions; Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor increase to qualify for PD, reference smallest sum LD since treatment started.

Outcome Time Frame:

Response to treatment measured using Response Evaluation Criteria in Solid Tumors (RECIST) criteria with radiological evaluation at 6 weeks and reevaluated every 6 weeks.

Safety Issue:


Principal Investigator

Gauri R. Varadhachary, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

M.D. Anderson Cancer Center


United States: Institutional Review Board

Study ID:




Start Date:

February 2004

Completion Date:

January 2010

Related Keywords:

  • Unknown Primary Neoplasms
  • Unknown Primary Neoplasms
  • UPC
  • Unknown Primary Cancer
  • Questionnaire
  • Gemcitabine
  • Gemcitabine Hydrochloride
  • Gemzar
  • Oxaliplatin
  • Eloxatin
  • Gemox
  • Neoplasms
  • Neoplasms, Unknown Primary



U.T. M.D. Anderson Cancer Center Houston, Texas  77030