Trial of High Dose Topotecan With Carboplatin in Patients With Relapsed Ovarian Carcinoma

NCT01177501 | Terminated Phase 1 DMC

• 1 other identifier: P 050603
• Study Type: interventional
• Target: 3
• Locations: 1 country
• Sites: 1

Brief Summary

The early relapse of ovarian cancer occurring within 6 months of chemotherapy including platinum regimen are called relapses 'platinum resistant' consecutively patients die quickly of their disease. For relapses occurring between 6 and 12 months, no recommendation occur and few studies are conducted. Therefore it seems interesting to develop a research on intensive chemotherapy using a combination of carboplatin (a drug widely used in most ovarian cancer) with Topotecan , use in a high dose protocol. Topotecan has demonstrated its efficacy in relapse ovarian cancer and its possible use in high doses, a recent study (ITOV01) have demonstrated the feasibility of dose escalation of topotecan monotherapy (MTD set at 9 mg / m² / dx 5 days). This project is a feasibility research of the combination of topotecan and carboplatin in a high dose escalation protocol for early ovarian cancer relapse occurring 6 to 12 months after conventional chemotherapy-based platinum salts.

Conditions

Ovarian Cancer; Relapses

Keywords

Ovarian cancer; Topotecan; Carboplatine; Higt dose chemotherapy

Outcome Measures

Primary Outcomes (1)

• Identification of the maximum tolerated dose (MTD) of topotecan at 6 weeks

  Evaluation of limiting toxicities (toxic death, grade IV non-hematopoietic or haematopoietic toxicity)of topotecan

  at 6 weeks after the first administration of topotecan

Secondary Outcomes (4)

• Pharmacokinetic of topotecan

  At 1 and 5 days after the first administration of topotecan

• Pharmacokinetic of carboplatin

  At 1 and 5 days after the first administration of topotecan

• The response to therapy

  From the first day of the administration of topotecan to 2 years

• The duration of response and the overall survival

  From the first day of the administration of topotecan to 2 years

Study Arms (1)

Topotecan

EXPERIMENTAL

Drug: Topotecan

Interventions

Topotecan DRUG

Six sequential doses established in the absence of limiting toxicity, as follows : 7.5 - 8.0 - 8.5 - 9.0 - 10.0 mg/m²

Topotecan

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: female
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Primary ovarian or tubal adenocarcinoma, or peritoneal carcinoma histologically proved
• Age between 18 and 65
• ECOG criteria £ 2
• Patients with first relapsed ovarian carcinoma without platinum-treatment since 6-12 months and after first-line therapy with platinum salt and taxanes together or successively
• Negative viral serology (HbS, HbC and HIV)
• Informed consent
• Patients with social security

You may not qualify if:

• Refractory (relapse \< 6 months) or sensitive (relapse \> 12 months) relapsed ovarian carcinoma
• Life expectancy \< 3 months
• Previous treatment with pelvic radiography
• Previous treatment with Topotecan or other topoisomer I inhibitor
• Non resolutive intestinal obstruction under symptomatic treatment
• Creatinine \> or equal at 1.25N and/or creatinine clearance \< or equal at 60 ml/mn
• Bilirubin \> 1.25N ; transaminase and alkaline phosphatase \> 2N (3N if hepatic metastases were present)
• Abnormal heart (ultrasound only) (FR \< 30%; FEVG \< 50%)
• White blood cells \< or equal at 4.0 x 109/L, Neutrophils \< or equal at 1.5 x 109/L, platelets \< or equal at 100 x 109/L
• Neuropathy: grade \> or equal at 2
• Epilepsy
• Symptomatic cerebral metastases
• Serious psychiatric pathology
• Uncontrolled serious infection
• Patient that already received peripheral blood stem cell support

Sponsors & Collaborators

• Assistance Publique - Hôpitaux de Paris: lead

Study Sites (1)

Frédéric Selle

Paris, 75020, France

Location

Related Publications (36)

• McGuire WP, Hoskins WJ, Brady MF, Kucera PR, Partridge EE, Look KY, Clarke-Pearson DL, Davidson M. Cyclophosphamide and cisplatin versus paclitaxel and cisplatin: a phase III randomized trial in patients with suboptimal stage III/IV ovarian cancer (from the Gynecologic Oncology Group). Semin Oncol. 1996 Oct;23(5 Suppl 12):40-7.

  PMID: 8941409 BACKGROUND

• Trimble EL, Adams JD, Vena D, Hawkins MJ, Friedman MA, Fisherman JS, Christian MC, Canetta R, Onetto N, Hayn R, et al. Paclitaxel for platinum-refractory ovarian cancer: results from the first 1,000 patients registered to National Cancer Institute Treatment Referral Center 9103. J Clin Oncol. 1993 Dec;11(12):2405-10. doi: 10.1200/JCO.1993.11.12.2405.

  PMID: 7902426 BACKGROUND

• Lotz JP, Bouleuc C, Andre T, Touboul E, Macovei C, Hannoun L, Lefranc JP, Houry S, Uzan S, Izrael V. Tandem high-dose chemotherapy with ifosfamide, carboplatin, and teniposide with autologous bone marrow transplantation for the treatment of poor prognosis common epithelial ovarian carcinoma. Cancer. 1996 Jun 15;77(12):2550-9. doi: 10.1002/(SICI)1097-0142(19960615)77:123.0.CO;2-R.

  PMID: 8640705 BACKGROUND

• Mulder PO, Willemse PH, Aalders JG, de Vries EG, Sleijfer DT, Sibinga CT, Mulder NH. High-dose chemotherapy with autologous bone marrow transplantation in patients with refractory ovarian cancer. Eur J Cancer Clin Oncol. 1989 Apr;25(4):645-9. doi: 10.1016/0277-5379(89)90199-5.

  PMID: 2653845 BACKGROUND

• Dauplat J, Legros M, Condat P, Ferriere JP, Ben Ahmed S, Plagne R. High-dose melphalan and autologous bone marrow support for treatment of ovarian carcinoma with positive second-look operation. Gynecol Oncol. 1989 Sep;34(3):294-8. doi: 10.1016/0090-8258(89)90161-3.

  PMID: 2670694 BACKGROUND

• Viens P, Maraninchi D, Legros M, Oberling F, Philip T, Herve P, Plagne R, Dufour P, Bergerat JP, Guastalla JP, et al. High dose melphalan and autologous marrow rescue in advanced epithelial ovarian carcinomas: a retrospective analysis of 35 patients treated in France. Bone Marrow Transplant. 1990 Apr;5(4):227-33.

  PMID: 2337735 BACKGROUND

• Shpall EJ, Clarke-Pearson D, Soper JT, Berchuck A, Jones RB, Bast RC Jr, Ross M, Lidor Y, Vanacek K, Tyler T, et al. High-dose alkylating agent chemotherapy with autologous bone marrow support in patients with stage III/IV epithelial ovarian cancer. Gynecol Oncol. 1990 Sep;38(3):386-91. doi: 10.1016/0090-8258(90)90079-z. No abstract available.

  PMID: 2121627 BACKGROUND

• Broun ER, Belinson JL, Berek JS, McIntosh D, Hurd D, Ball H, Williams S. Salvage therapy for recurrent and refractory ovarian cancer with high-dose chemotherapy and autologous bone marrow support: a Gynecologic Oncology Group pilot study. Gynecol Oncol. 1994 Aug;54(2):142-6. doi: 10.1006/gyno.1994.1183.

  PMID: 8063237 BACKGROUND

• Murakami M, Shinozuka T, Kuroshima Y, Tokuda Y, Tajima T. High-dose chemotherapy with autologous bone marrow transplantation for the treatment of malignant ovarian tumors. Semin Oncol. 1994 Feb;21(1 Suppl 1):29-32. No abstract available.

  PMID: 8153654 BACKGROUND

• Stiff PJ, McKenzie RS, Alberts DS, Sosman JA, Dolan JR, Rad N, McCloskey T. Phase I clinical and pharmacokinetic study of high-dose mitoxantrone combined with carboplatin, cyclophosphamide, and autologous bone marrow rescue: high response rate for refractory ovarian carcinoma. J Clin Oncol. 1994 Jan;12(1):176-83. doi: 10.1200/JCO.1994.12.1.176.

  PMID: 8270975 BACKGROUND

• Legros M, Dauplat J, Fleury J, Cure H, Suzanne F, Chassagne J, Bay JO, Sol C, Canis M, Condat P, Choufi B, Tavernier F, Glenat C, Chollet P, Plagne R. High-dose chemotherapy with hematopoietic rescue in patients with stage III to IV ovarian cancer: long-term results. J Clin Oncol. 1997 Apr;15(4):1302-8. doi: 10.1200/JCO.1997.15.4.1302.

  PMID: 9193321 BACKGROUND

• Stiff PJ, Bayer R, Kerger C, Potkul RK, Malhotra D, Peace DJ, Smith D, Fisher SG. High-dose chemotherapy with autologous transplantation for persistent/relapsed ovarian cancer: a multivariate analysis of survival for 100 consecutively treated patients. J Clin Oncol. 1997 Apr;15(4):1309-17. doi: 10.1200/JCO.1997.15.4.1309.

  PMID: 9193322 BACKGROUND

• Ledermann JA, Herd R, Maraninchi D, Viens P, Buclon M, Philip T, Cure H, Lotz JP, Chauvin F, Ferrante P, Rosti G. High-dose chemotherapy for ovarian carcinoma: long-term results from the Solid Tumour Registry of the European Group for Blood and Marrow Transplantation (EBMT). Ann Oncol. 2001 May;12(5):693-9. doi: 10.1023/a:1011136807190.

  PMID: 11432630 BACKGROUND

• Rowinsky EK, Grochow LB, Hendricks CB, Ettinger DS, Forastiere AA, Hurowitz LA, McGuire WP, Sartorius SE, Lubejko BG, Kaufmann SH, et al. Phase I and pharmacologic study of topotecan: a novel topoisomerase I inhibitor. J Clin Oncol. 1992 Apr;10(4):647-56. doi: 10.1200/JCO.1992.10.4.647.

  PMID: 1312588 BACKGROUND

• Rivory LP, Robert J. [Pharmacology of camptothecin and its derivatives]. Bull Cancer. 1995 Apr;82(4):265-85. French.

  PMID: 10846537 BACKGROUND

• Grochow LB, Rowinsky EK, Johnson R, Ludeman S, Kaufmann SH, McCabe FL, Smith BR, Hurowitz L, DeLisa A, Donehower RC, et al. Pharmacokinetics and pharmacodynamics of topotecan in patients with advanced cancer. Drug Metab Dispos. 1992 Sep-Oct;20(5):706-13.

  PMID: 1358575 BACKGROUND

• Creemers GJ, Bolis G, Gore M, Scarfone G, Lacave AJ, Guastalla JP, Despax R, Favalli G, Kreinberg R, Van Belle S, Hudson I, Verweij J, Ten Bokkel Huinink WW. Topotecan, an active drug in the second-line treatment of epithelial ovarian cancer: results of a large European phase II study. J Clin Oncol. 1996 Dec;14(12):3056-61. doi: 10.1200/JCO.1996.14.12.3056.

  PMID: 8955650 BACKGROUND

• Kudelka AP, Tresukosol D, Edwards CL, Freedman RS, Levenback C, Chantarawiroj P, Gonzalez de Leon C, Kim EE, Madden T, Wallin B, Hord M, Verschraegen C, Raber M, Kavanagh JJ. Phase II study of intravenous topotecan as a 5-day infusion for refractory epithelial ovarian carcinoma. J Clin Oncol. 1996 May;14(5):1552-7. doi: 10.1200/JCO.1996.14.5.1552.

  PMID: 8622071 BACKGROUND

• ten Bokkel Huinink W, Gore M, Carmichael J, Gordon A, Malfetano J, Hudson I, Broom C, Scarabelli C, Davidson N, Spanczynski M, Bolis G, Malmstrom H, Coleman R, Fields SC, Heron JF. Topotecan versus paclitaxel for the treatment of recurrent epithelial ovarian cancer. J Clin Oncol. 1997 Jun;15(6):2183-93. doi: 10.1200/JCO.1997.15.6.2183.

  PMID: 9196130 BACKGROUND

• Kaufmann SH, Peereboom D, Buckwalter CA, Svingen PA, Grochow LB, Donehower RC, Rowinsky EK. Cytotoxic effects of topotecan combined with various anticancer agents in human cancer cell lines. J Natl Cancer Inst. 1996 Jun 5;88(11):734-41. doi: 10.1093/jnci/88.11.734.

  PMID: 8637027 BACKGROUND

• Rowinsky EK, Kaufmann SH, Baker SD, Grochow LB, Chen TL, Peereboom D, Bowling MK, Sartorius SE, Ettinger DS, Forastiere AA, Donehower RC. Sequences of topotecan and cisplatin: phase I, pharmacologic, and in vitro studies to examine sequence dependence. J Clin Oncol. 1996 Dec;14(12):3074-84. doi: 10.1200/JCO.1996.14.12.3074.

  PMID: 8955652 BACKGROUND

• Miller AA, Hargis JB, Lilenbaum RC, Fields SZ, Rosner GL, Schilsky RL. Phase I study of topotecan and cisplatin in patients with advanced solid tumors: a cancer and leukemia group B study. J Clin Oncol. 1994 Dec;12(12):2743-50. doi: 10.1200/JCO.1994.12.12.2743.

  PMID: 7527456 BACKGROUND

• O'Reilly S, Fleming GF, Barker SD, Walczak JR, Bookman MA, McGuire WP 3rd, Schilder RJ, Alvarez RD, Armstrong DK, Horowitz IR, Ozols RF, Rowinsky EK. Phase I trial and pharmacologic trial of sequences of paclitaxel and topotecan in previously treated ovarian epithelial malignancies: a Gynecologic Oncology Group study. J Clin Oncol. 1997 Jan;15(1):177-86. doi: 10.1200/JCO.1997.15.1.177.

  PMID: 8996140 BACKGROUND

• Murren JR, Anderson S, Fedele J, Pizzorno G, Belliveau D, Zelterman D, Burtness BA, Tocino I, Flynn SD, Beidler D, Cheng YC. Dose-escalation and pharmacodynamic study of topotecan in combination with cyclophosphamide in patients with refractory cancer. J Clin Oncol. 1997 Jan;15(1):148-57. doi: 10.1200/JCO.1997.15.1.148.

  PMID: 8996136 BACKGROUND

• Schiller JH, Kim K, Hutson P, DeVore R, Glick J, Stewart J, Johnson D. Phase II study of topotecan in patients with extensive-stage small-cell carcinoma of the lung: an Eastern Cooperative Oncology Group Trial. J Clin Oncol. 1996 Aug;14(8):2345-52. doi: 10.1200/JCO.1996.14.8.2345.

  PMID: 8708727 BACKGROUND

• O'Reilly S, Rowinsky E, Slichenmyer W, Donehower RC, Forastiere A, Ettinger D, Chen TL, Sartorius S, Bowling K, Smith J, Brubaker A, Lubejko B, Ignacio V, Grochow LB. Phase I and pharmacologic studies of topotecan in patients with impaired hepatic function. J Natl Cancer Inst. 1996 Jun 19;88(12):817-24. doi: 10.1093/jnci/88.12.817.

  PMID: 8637048 BACKGROUND

• Saltz L, Sirott M, Young C, Tong W, Niedzwiecki D, Tzy-Jyun Y, Tao Y, Trochanowski B, Wright P, Barbosa K, et al. Phase I clinical and pharmacology study of topotecan given daily for 5 consecutive days to patients with advanced solid tumors, with attempt at dose intensification using recombinant granulocyte colony-stimulating factor. J Natl Cancer Inst. 1993 Sep 15;85(18):1499-507. doi: 10.1093/jnci/85.18.1499.

  PMID: 7689654 BACKGROUND

• Rowinsky EK, Grochow LB, Sartorius SE, Bowling MK, Kaufmann SH, Peereboom D, Donehower RC. Phase I and pharmacologic study of high doses of the topoisomerase I inhibitor topotecan with granulocyte colony-stimulating factor in patients with solid tumors. J Clin Oncol. 1996 Apr;14(4):1224-35. doi: 10.1200/JCO.1996.14.4.1224.

  PMID: 8648378 BACKGROUND

• Wall JG, Burris HA 3rd, Von Hoff DD, Rodriguez G, Kneuper-Hall R, Shaffer D, O'Rourke T, Brown T, Weiss G, Clark G, et al. A phase I clinical and pharmacokinetic study of the topoisomerase I inhibitor topotecan (SK&F 104864) given as an intravenous bolus every 21 days. Anticancer Drugs. 1992 Aug;3(4):337-45. doi: 10.1097/00001813-199208000-00004.

  PMID: 1330081 BACKGROUND

• van Warmerdam LJ, ten Bokkel Huinink WW, Rodenhuis S, Koier I, Davies BE, Rosing H, Maes RA, Beijnen JH. Phase I clinical and pharmacokinetic study of topotecan administered by a 24-hour continuous infusion. J Clin Oncol. 1995 Jul;13(7):1768-76. doi: 10.1200/JCO.1995.13.7.1768.

  PMID: 7602366 BACKGROUND

• Rowinsky EK, Adjei A, Donehower RC, Gore SD, Jones RJ, Burke PJ, Cheng YC, Grochow LB, Kaufmann SH. Phase I and pharmacodynamic study of the topoisomerase I-inhibitor topotecan in patients with refractory acute leukemia. J Clin Oncol. 1994 Oct;12(10):2193-203. doi: 10.1200/JCO.1994.12.10.2193.

  PMID: 7931489 BACKGROUND

• Kantarjian HM, Beran M, Ellis A, Zwelling L, O'Brien S, Cazenave L, Koller C, Rios MB, Plunkett W, Keating MJ, et al. Phase I study of Topotecan, a new topoisomerase I inhibitor, in patients with refractory or relapsed acute leukemia. Blood. 1993 Mar 1;81(5):1146-51.

  PMID: 8382970 BACKGROUND

• Lotz JP, Pautier P, Selle F, Viens P, Fabbro M, Lokiec F, Viret F, Gligorov J, Gosse B, Provent S, Ribrag V, Miclea JM, Dosquet C, Goetschel A, Cailliot C, Lefevre G, Geneve J, Lhomme C; Groupe d' Intensification des traitements des Tumeurs Ovariennes (ITOV Group). Phase I study of high-dose topotecan with haematopoietic stem cell support in the treatment of ovarian carcinomas: the ITOV 01 protocol. Bone Marrow Transplant. 2006 Apr;37(7):669-75. doi: 10.1038/sj.bmt.1705310.

  PMID: 16501591 BACKGROUND

• Prince HM, Rischin D, Quinn M, Allen D, Planner R, Neesham D, Gates P, Davison J. Repetitive high-dose topotecan, carboplatin, and paclitaxel with peripheral blood progenitor cell support in previously untreated ovarian cancer: results of a Phase I study. Gynecol Oncol. 2001 May;81(2):216-24. doi: 10.1006/gyno.2001.6121.

  PMID: 11330952 BACKGROUND

• Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer. 1981 Jan 1;47(1):207-14. doi: 10.1002/1097-0142(19810101)47:13.0.co;2-6.

  PMID: 7459811 BACKGROUND

• Cheung YK, Chappell R. Sequential designs for phase I clinical trials with late-onset toxicities. Biometrics. 2000 Dec;56(4):1177-82. doi: 10.1111/j.0006-341x.2000.01177.x.

  PMID: 11129476 BACKGROUND

MeSH Terms

Conditions

Ovarian Neoplasms; Recurrence

Interventions

Topotecan

Condition Hierarchy (Ancestors)

Endocrine Gland Neoplasms; Neoplasms by Site; Neoplasms; Ovarian Diseases; Adnexal Diseases; Genital Diseases, Female; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Genital Neoplasms, Female; Urogenital Neoplasms; Genital Diseases; Endocrine System Diseases; Gonadal Disorders; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Camptothecin; Alkaloids; Heterocyclic Compounds

Study Officials

• Frédéric Selle, MD

  Assistance Publique - Hôpitaux de Paris

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: August 6, 2010
• First Posted: August 9, 2010
• Study Start: April 1, 2009
• Primary Completion: March 1, 2012
• Study Completion: March 1, 2012
• Last Updated: November 19, 2012

Record last verified: 2012-11

Locations

FR (1)