Efficacy of Neoadjuvant Hyperthermic Intraperitoneal Chemotherapy in Advanced High-grade Serous Ovarian Cancer (the NHIPEC Trial)

NCT05246020 | Unknown Phase 2

• 1 other identifier: 2020-KY-050
• Study Type: interventional
• Target: 80
• Locations: 1 country
• Sites: 1

Brief Summary

Background: Neoadjuvant chemotherapy (NACT) is an important treatment option for patients with ovarian cancer. Although intravenous NACT can improve optimal resection rates and decrease surgical morbidity and mortality, these advantages do not translate into a survival benefit. Ovarian carcinoma is mainly confined to the peritoneal cavity, which makes it a potential target for hyperthermic intraperitoneal chemotherapy (HIPEC). Our previous study showed that HIPEC could be used in the neoadjuvant setting, which was named neoadjuvant HIPEC (NHIPEC). Since hyperthermia is an excellent chemosensitiser, we hypothesised that the combination of NHIPEC and intravenous NACT could show superior efficacy to intravenous NACT alone. Methods: This study is a single-centre, open-label, randomised (1:1 allocation ratio) phase 2 trial. A total of 80 patients will be randomly assigned into an experimental group (NHIPEC+intravenous NACT) or a control group (intravenous NACT). Patients in the experimental group will receive NHIPEC following laparoscopic evaluation, and four tubes will be placed via the laparoscopic ports, which will be used to administer NHIPEC. Then, perfusion with docetaxel (60-75 mg/m2) will be performed (43°C for 60 min, Day 0) followed by cisplatin (75 mg/m2, Day 1) infusion (43°C for 60 min) 24 hours later. After NHIPEC, two cycles of intravenous NACT will be given. Patients in the control group will receive three cycles of intravenous NACT. The primary endpoint is the proportion of patients who achieve a Chemotherapy Response Score (CRS) of 3 according to the CRS system. The secondary endpoints include progression-free survival, overall survival and the rates of complete resection and NHIPEC-related adverse events.

Conditions

Hyperthermic Intraperitoneal Chemotherapy; Neoadjuvant Chemotherapy

Keywords

HIPEC; Neoadjuvant chemotherapy; High-grade serous ovarian cancer

Outcome Measures

Primary Outcomes (1)

• chemotherapy response score(CRS) 3

  the proportion of chemotherapy response score 3, which means a better outcome

  At the end of cycle 3 NACT (each cycle is 21 days)

Secondary Outcomes (4)

• progression-free survival(PFS)

  From date of randomization until the date of first documented progression, assessed up to 3 years

• overall survival(OS)

  From date of randomization until the time of death from any cause, assessed up to 3 years

• Rate of R0 resection

  At the end of cycle 3 NACT (each cycle is 21 days),when IDS is conducted

• NHIPEC-related adverse effects

  during the procedure

Study Arms (2)

NHIPEC

EXPERIMENTAL

Treatment: Four tubes will be placed via the laparoscopic ports and HIPEC will be given within 24 hours after laparoscopic evaluation.

Procedure: HIPEC

Intravenous NACT

ACTIVE COMPARATOR

Drug:Three cycles of intravenous NACT will be given in this group. The regimen of intravenous NACT is docetaxel 60-75mg/m2 followed by carboplatin area under curve(AUC) 5 for a 21-day cycle.

Procedure: intravenous chemotherapy

Interventions

HIPEC PROCEDURE

Docetaxel (60-75mg/m2) perfusion solution will be infused into the peritoneal cavity through the tubes within 24 hours after the laparoscopic evaluation. Then, perfusate containing cisplatin (75 mg/m2) will be infused 24 hours later. NHIPEC will be administered at 43°C for a duration of 60min. Saline solution (3000mL) will be used to dissolve the drug, and it will be heated and circulated at a flow rate of 300-500 mL/min.

NHIPEC

intravenous chemotherapy PROCEDURE

Patients in the control group will receive three cycles of intravenous NACT. The regimen of intravenous NACT is docetaxel 60-75mg/m2 followed by carboplatin AUC 5 for a 21-day cycle.

Intravenous NACT

Eligibility Criteria

• Age: 17 Years - 70 Years
• Sex: female
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• International Federation of Gynecology and Obstetrics(FIGO) stage IIIC-IVA, HGSOC
• Patients with Fagotti score ≥8
• Adequate kidney function (blood creatinine 58-96 µmol/L)
• Adequate haematological function (haemoglobin ≥110g/L, leucocytes ≥4.0×109/L, neutrophils ≥2.0×109/L, platelets≥100×109/L)
• Adequate liver function (serum total bilirubin 3.4-22.2µmol/L, alanine aminotransferase (ALT) 7-40U/L, aspartate aminotransferase (AST) 13-35U/L, AST/ALT ≤1.5)
• World Health Organization(WHO) score 0-2

You may not qualify if:

• Patients who had received chemotherapy, radiotherapy or any kind of targeted therapy.
• Patients with complete intestine obstruction.
• Expected life span ≤8 weeks.
• Complicated with any other known malignancies.
• Patients with poor cardiopulmonary function, which would limit compliance with study requirements.

Sponsors & Collaborators

• Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University: lead

Study Sites (1)

Sun Yat-sen Memorial Hospital

Guangzhou, Other (Non U.s.), 510000, China

RECRUITING

MeSH Terms

Interventions

Hyperthermic Intraperitoneal Chemotherapy

Intervention Hierarchy (Ancestors)

Chemotherapy, Adjuvant; Combined Modality Therapy; Therapeutics; Drug Therapy; Hyperthermia, Induced

Study Officials

• Jing Li, Doctor

  Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

miaofang Wu, Doctor

CONTACT

+8613828494674; wmiaofang@mail.sysu.edu.cn

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: All tissue samples harvested during IDS will be subjected to H\&E expert pathological evaluation to confirm the diagnosis of high-grade serous ovarian cancer(HGSOC). Omental slides will be independently reviewed by two pathologists to determine those with the greatest amount of viable tumour, and one slide of each site will be selected. The two pathologists, who will be blinded to the written report and each other's results, will independently score each slide according to the CRS system.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: The eligible patients will be randomised into an experimental group (NHIPEC +intravenous NACT) or a control group (intravenous NACT). Patients in the NHIPEC experimental group will receive NHIPEC and two cycles of intravenous NACT, while patients in the control group will receive three cycles of intravenous NACT. All patients will undergo IDS within 4weeks after the last cycle of NACT.

Study Record Dates

• First Submitted: January 24, 2022
• First Posted: February 18, 2022
• Study Start: December 1, 2020
• Primary Completion: December 1, 2022
• Study Completion: December 1, 2024
• Last Updated: February 18, 2022

Record last verified: 2022-01

Data Sharing

• IPD Sharing: Will not share

Locations

CN (1)