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A Phase II Feasibility Trial of Induction Chemotherapy Followed by Extrapleural Pneumonectomy and Postoperative Radiotherapy in Patients With Malignant Pleural Mesothelioma


Phase 2
N/A
69 Years
Not Enrolling
Both
Malignant Mesothelioma

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Trial Information

A Phase II Feasibility Trial of Induction Chemotherapy Followed by Extrapleural Pneumonectomy and Postoperative Radiotherapy in Patients With Malignant Pleural Mesothelioma


OBJECTIVES:

Primary

- Determine the feasibility of neoadjuvant chemotherapy comprising pemetrexed disodium
and cisplatin followed by extrapleural pneumonectomy and high-dose postoperative
3D-conformal radiotherapy, in terms of 90-day progression-free survival, in patients
with malignant pleural mesothelioma.

Secondary

- Determine the toxicity of this regimen in these patients.

- Determine progression-free survival and overall survival of patients treated with this
regimen.

OUTLINE: This is a non-randomized, multicenter study.

- Neoadjuvant chemotherapy: Patients receive pemetrexed disodium IV over 10 minutes and
cisplatin IV over 2 hours on day 1. Treatment repeats every 3 weeks for up to 3 courses
in the absence of disease progression or unacceptable toxicity. Patients are evaluated
3 weeks after completion of neoadjuvant chemotherapy. Patients without disease
progression proceed to surgery.

- Extrapleural pneumonectomy: Within 21-56 days after completion of neoadjuvant
chemotherapy, patients undergo extrapleural pneumonectomy. Patients are evaluated 30
days after surgery. Patients without disease progression undergo high-dose 3D-conformal
radiotherapy.

- High-dose 3D-conformal radiotherapy: Beginning 30-84 days after surgery, patients
undergo high-dose 3D-conformal radiotherapy daily for 30 days.

After completion of study treatment, patients are followed on days 42 and 90, every 3 months
for 1 year, and then every 6 months thereafter.

PROJECTED ACCRUAL: A total of 52 patients will be accrued for this study.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed malignant pleural mesothelioma

- All subtypes allowed

- T1-3, N0-1, M0 disease

- No N2 or N3 involvement confirmed by mediastinoscopy within 21 days before study
entry

- No clinical invasion of mediastinal structures (e.g., heart, aorta, spine, esophagus)

- No wide-spread chest wall invasion except focal chest wall lesions

- No clinical or radiological evidence of shrinking hemithorax

- No clinically significant third-space fluid (e.g., pleural effusions or ascites) that
cannot be managed with thoracentesis or pleurodesis

PATIENT CHARACTERISTICS:

Age

- Under 70

Performance status

- WHO 0-1

Life expectancy

- Not specified

Hematopoietic

- WBC > 3,500/mm^3

- Absolute neutrophil count > 1,500/mm^3

- Platelet count > 100,000/mm^3

- Hemoglobin ≥ 11 g/dL

Hepatic

- AST and ALT < 1.5 times upper limit of normal (ULN)

- Bilirubin < 1.5 times ULN

- Alkaline phosphatase < 1.5 times ULN

Renal

- Creatinine clearance ≥ 60 mL/min

- Acceptable (predicted) post-radiotherapy renal function by semiquantitative isotope
renography, with a relative contribution of the contralateral kidney of ≥ 40%

Pulmonary

- See Disease Characteristics

Other

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception during and for 3 months after
completion of study treatment

- Deemed to be fit enough to undergo study treatment

- No preexisting sensory neurotoxicity > grade 1

- No uncontrolled infection

- No prior or concurrent melanoma, breast cancer, or hypernephroma

- No other malignancy within the past 5 years except carcinoma in situ of the cervix or
adequately treated basal cell skin cancer

- No psychological, familial, sociological, or geographical condition that would
preclude study compliance

PRIOR CONCURRENT THERAPY:

Biologic therapy

- No concurrent immunotherapy

- No concurrent routine use of colony-stimulating factors during neoadjuvant
chemotherapy

- Concurrent secondary prophylactic use allowed during neoadjuvant chemotherapy

- No concurrent secondary prophylactic use of colony-stimulating factors during
post-operative radiotherapy

Chemotherapy

- No prior chemotherapy for mesothelioma

Endocrine therapy

- No concurrent hormonal cancer therapy

Radiotherapy

- No prior radiotherapy to the lower neck, thorax, or upper abdomen

Surgery

- See Disease Characteristics

Other

- No other concurrent anticancer therapy

- No other concurrent experimental medications

- No nonsteroidal anti-inflammatory drugs or salicylates for 2 days before, during, and
2 days after administration of neoadjuvant chemotherapy (5 days before and 2 days
after for drugs with a long half-life [e.g., naproxen, piroxicam, diflunisal, or
nabumetone])

Type of Study:

Interventional

Study Design:

Allocation: Non-Randomized, Primary Purpose: Treatment

Outcome Measure:

Feasibility in terms of 90-day progression-free survival

Safety Issue:

No

Principal Investigator

Paul Van Schil, MD, PhD

Investigator Role:

Study Chair

Investigator Affiliation:

Universitair Ziekenhuis Antwerpen

Authority:

United States: Federal Government

Study ID:

EORTC-08031

NCT ID:

NCT00227630

Start Date:

July 2005

Completion Date:

Related Keywords:

  • Malignant Mesothelioma
  • epithelial mesothelioma
  • sarcomatous mesothelioma
  • localized malignant mesothelioma
  • recurrent malignant mesothelioma
  • Mesothelioma

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