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A Cancer Research UK Randomised, Multicentre, Phase II Trial of the DNAhypomethylating Agent, 5-Aza-2'-Deoxycytidine (Decitabine) Given Intravenously in Combination With Carboplatin, Versus Carboplatin Alone Given 4 Weekly in Patients With Progressive, Advanced Ovarian Cancer


Phase 2
18 Years
N/A
Not Enrolling
Both
Fallopian Tube Cancer, Ovarian Cancer, Peritoneal Cavity Cancer

Thank you

Trial Information

A Cancer Research UK Randomised, Multicentre, Phase II Trial of the DNAhypomethylating Agent, 5-Aza-2'-Deoxycytidine (Decitabine) Given Intravenously in Combination With Carboplatin, Versus Carboplatin Alone Given 4 Weekly in Patients With Progressive, Advanced Ovarian Cancer


OBJECTIVES:

Primary

- To compare the response rate in patients with progressive, advanced ovarian epithelial
cancer, fallopian tube cancer, or primary peritoneal cancer who have methylated hMLH1
DNA in plasma treated with carboplatin with vs without decitabine.

Secondary

- To compare the response rate in all patients (regardless of methylation status) treated
with these regimens.

- To compare the progression-free survival and overall survival of patients treated with
these regimens.

- To compare the safety and tolerability of these regimens.

- To determine the feasibility of combining decitabine with carboplatin.

- To determine the incidence of hypersensitivity reactions to carboplatin.

- To study the relationship between peak plasma levels of decitabine and global or CpG
island specific methylation.

- To study the relationship between global and gene specific methylation in peripheral
blood mononuclear cells and response.

Tertiary

- To correlate the methylation status of genes associated with drug resistance detected
in plasma DNA with response.

- To determine the sensitivity and specificity of methylation of genes associated with
drug resistance detected in plasma DNA as a predictor of methylation status in tumor
cells isolated from ascites or tumor biopsy.

- To study methylation and expression of genes in tumor cells isolated from ascites or
tumor biopsy before and after treatment with decitabine and/or carboplatin.

- To investigate any correlation between methylation and expression of genes in surrogate
tissues, body fluids, or tumor cells and response or progression-free survival.

- To examine markers of cell death in plasma.

- To compare the methylation in tumor taken at the time of presentation vs at the time of
treatment.

OUTLINE: This is a multicenter study. Patients are stratified according to prior first-line
treatment (platinum alone vs platinum and taxane vs platinum and other combination), WHO
performance status (0 vs 1 vs 2), measurable disease criteria (RECIST criteria vs CA-125
criteria vs both), participating center, and the number of prior platinum-based regimens (1
vs 2). Patients are randomized to 1 of 2 treatment arms.

- Arm I: Patients receive carboplatin IV over 30-60 minutes on day 1.

- Arm II: Patients receive decitabine IV over 6 hours on day 1 and carboplatin IV over
30-60 minutes on day 8.

In both arms, treatment repeats every 28 days for up to 8 courses in the absence of disease
progression or unacceptable toxicity.

Patients undergo blood sample collection periodically for pharmacodynamic studies. Samples
are assessed for methylation of hMLH1 by methylation-specific PCR; global DNA methylation by
high performance liquid chromatography (HPLC) ; methylation of the MAGE-1A gene promoter by
methylation-specific PCR or bisulfite pyrosequencing; and markers of apoptosis by ELISA.
Pharmacokinetic studies of decitabine are also performed using blood samples from patients
randomized to arm II. Ascitic fluid and/or tumor tissue samples may also be collected for
pharmacodynamic studies.

After completion of study treatment, patients are followed at 28 days and then every 2
months thereafter.

Peer Reviewed and Funded or Endorsed by Cancer Research UK.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically or cytologically proven ovarian epithelial cancer, fallopian tube
cancer, or primary peritoneal cancer

- Progressive disease as defined by RECIST criteria and/or CA-125 criteria

- Advanced disease

- Previously treated with 1-2 prior platinum-containing regimen(s)

- Prior hormonal therapy does not count towards the prior treatment

- Responded to the most recent prior platinum-containing regimen(s) OR no evidence
of progression during platinum-containing therapy as documented by RECIST
criteria or CA-125 criteria (for patients with no macroscopic residual disease
after surgery who are not evaluable by CA-125)

- Disease relapse 6-12 months after completion of the most recent platinum-containing
therapy

- Patients who received two prior lines of treatment must have had ≥ 6 months
between their first and second lines of treatment

- Patients with disease progression, as defined by CA-125 criteria alone, within 6
months after completion of their last treatment are eligible provided study
treatment commences > 6 months after the last prior treatment

- Patients with disease progression, as defined by GCIG guidelines, within 12
months after completion of their last treatment are eligible provided study
treatment commences ≤ 14 months after the last prior treatment

- Measurable disease by RECIST criteria and/or CA-125 criteria

- Measurable lesions are defined as those that can be accurately measured in at
least one dimension (longest diameter to be recorded) as ≥ 20 mm by conventional
techniques (physical examination, CT scan, x-ray, or MRI) or as ≥ 10 mm by
spiral CT scan

- Patients with evaluable disease by CA-125 criteria are eligible provided CA-125
is ≥ 2 times upper limit of normal (ULN) within 2 weeks prior to initiating
study treatment

- Disease is not considered measurable if patient received prior mouse antibodies
or if there has been medical and/or surgical interference with the peritoneum or
pleura (e.g., paracentesis) within the past 28 days

- Ascites requiring therapeutic drainage allowed only if there is measurable disease by
RECIST criteria

- Ascites that do not require therapeutic drainage allowed even if disease is
evaluable by CA-125 criteria alone

PATIENT CHARACTERISTICS:

- WHO performance status 0-2

- Hemoglobin ≥ 10.0 g/dL

- WBC ≥ 3.0 x 10^9/L

- Neutrophil count ≥ 1.5 x 10^9/L

- Platelet count ≥ 100 x 10^9/L

- Bilirubin ≤ 30 μmol/L

- ALT and/or AST ≤ 2.5 times ULN (≤ 5 times ULN if due to tumor involvement of liver)

- EDTA/DTPA clearance ≥ 50 mL/min (uncorrected value)

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception for 4 weeks prior to, during, and
for 6 months after completion of study treatment

- No known hepatitis B, hepatitis C, or HIV positivity

- No non-malignant systemic disease, including active uncontrolled infection, that
would make the patient a high medical risk

- No other current malignancies, except adequately treated cone-biopsied in situ
carcinoma of the cervix or basal cell or squamous cell carcinoma of the skin

- Patients who have undergone potentially curative therapy for a prior malignancy
are eligible provided there is no evidence of disease for ≥ 5 years and the
patient is deemed to be at low risk for recurrence

- No intolerance to carboplatin (with a dose of ≥ AUC 5), as defined by any of the
following:

- Neutropenia or thrombocytopenia causing dose delay of > 4 days on more than 2
occasions

- Grade III or IV hypersensitivity reaction (not controlled by a desensitization
regimen)

- Hospitalization for confirmed febrile neutropenia (fever ≥ 38°C)

- Requirement for platelet transfusion

- No other condition that, in the investigator's opinion, would not make the patient a
good candidate for this study

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- Recovered from prior therapy (alopecia, grade 1 neuropathy, and certain grade 1
toxicities allowed)

- More than 28 days since prior maintenance therapy (e.g., erlotinib or bevacizumab)

- More than 4 weeks since prior radiotherapy, endocrine therapy, immunotherapy,
chemotherapy, biological therapy, or investigational agents

- More than 4 weeks since prior major thoracic and/or abdominal surgery and recovered

- No other concurrent anti-cancer therapy, including radiotherapy or investigational
drugs

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Response rate (partial response [PR] or complete response [CR]) in patients with methylated hMLH1 DNA in plasma as measured by RECIST criteria or CA-125 criteria

Safety Issue:

No

Principal Investigator

Stanley B. Kaye, MD, FRCP

Investigator Role:

Study Chair

Investigator Affiliation:

Royal Marsden NHS Foundation Trust

Authority:

Unspecified

Study ID:

CDR0000613805

NCT ID:

NCT00748527

Start Date:

July 2007

Completion Date:

Related Keywords:

  • Fallopian Tube Cancer
  • Ovarian Cancer
  • Peritoneal Cavity Cancer
  • fallopian tube cancer
  • stage III ovarian epithelial cancer
  • stage IV ovarian epithelial cancer
  • recurrent ovarian epithelial cancer
  • peritoneal cavity cancer
  • Ovarian Neoplasms
  • Peritoneal Neoplasms
  • Fallopian Tube Neoplasms
  • Neoplasms, Glandular and Epithelial

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