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3-AP and External-Beam Radiation Therapy With or Without Cisplatin in Treating Patients With Gynecologic Cancer
This study is ongoing, but not recruiting participants.
Sponsors and Collaborators: Case Comprehensive Cancer Center
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00335998
  Purpose

RATIONALE: Drugs used in chemotherapy, such as 3-AP and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. 3-AP may also stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Radiation therapy uses high-energy x-rays to kill tumor cells. 3-AP and cisplatin may make tumor cells more sensitive to radiation therapy. Giving 3-AP and external-beam radiation therapy together with cisplatin may kill more tumor cells.

PURPOSE: This phase I trial is studying the side effects and best dose of 3-AP when given together with external-beam radiation therapy with or without cisplatin in treating patients with gynecologic cancer.


Condition Intervention Phase
Cervical Cancer
Endometrial Cancer
Ovarian Cancer
Vaginal Cancer
Vulvar Cancer
Drug: cisplatin
Drug: triapine
Procedure: brachytherapy
Procedure: flow cytometry
Procedure: immunoenzyme technique
Procedure: molecular diagnostic method
Procedure: pharmacological study
Procedure: radiation therapy
Phase I

MedlinePlus related topics: Cancer Ovarian Cancer Vaginal Cancer Vulvar Cancer
Drug Information available for: Cisplatin 3-Aminopyridine-2-carboxaldehyde thiosemicarbazone
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment
Official Title: Phase I Study of Intravenous Triapine (IND # 68338) in Combination With Pelvic Radiation Therapy With or Without Weekly Intravenous Cisplatin Chemotherapy for Locally Advanced Cervical, Vaginal, or Pelvic Gynecologic Malignancies

Further study details as provided by National Cancer Institute (NCI):

Estimated Enrollment: 24
Study Start Date: February 2006
Estimated Primary Completion Date: October 2006 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • Determine the maximum tolerated dose (MTD) of 3-AP when given in combination with external-beam pelvic radiotherapy with or without cisplatin in patients with cervical, vaginal, or pelvic gynecologic malignancies.
  • Determine the dose-limiting toxicity (DLT) of 3-AP in patients treated with these regimens.
  • Determine the safety and sequelae of these regimens in these patients.

Secondary

  • Evaluate 3-AP's targeted inhibition of ribonucleotide reductase through tumor tissue biopsy at pretreatment evaluation and during external beam radiotherapy.
  • Serially monitor methemoglobin levels during therapy.

OUTLINE: This is a multicenter, dose-escalation study of 3-AP. Patients are assigned to 1 of 2 treatment groups based on eligibility* to receive cisplatin (yes vs no).

NOTE: *Patients who refuse or are not candidates for cisplatin chemotherapy due to prior platinum adverse sensitivity, active neuropathy, or comobid illness, as determined by the treating physician, are eligible to receive 3-AP alone with pelvic radiotherapy.

  • Group 1: Patients undergo external-beam pelvic radiotherapy once daily on days 1-5, 8-12, 15-19, 22-26, and 29-33. Patients also receive 3-AP IV over 2 hours on days 1, 3, 5, 8, 10, 12, 15, 17, 19, 22, 24, 26, 29, 31, and 33 and cisplatin IV over 1½ hours on day 2, 9, 16, 23, and 30.
  • Group 2: Patients undergo external-beam pelvic radiotherapy and receive 3-AP as in group 1.

In both groups, patients undergo intracavitary or interstitial brachytherapy at least once weekly for 3-5 weeks during or after external-beam radiotherapy as per standard of care.

Cohorts of 3-6 patients in group 1 and 1-3 patients in group 2 receive escalating doses of 3-AP until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. At least 6 patients are treated at the MTD.

Patients undergo blood draws on days 1 and 10 before treatment with 3-AP and at 2, 4, 6, and 24 hours after starting treatment to assess methemoglobin levels and 3-AP plasma levels. Patients also undergo punch biopsy on days 1 and 10 to determine R2 protein levels by Western blot analysis, ribonucleotide reductase R2 protein levels by flow cytometry, and cytidine deoxyphosphate reductase assay.

After completion of study treatment, patients are followed periodically for up to 5 years.

PROJECTED ACCRUAL: A total of 24 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Pathologically confirmed diagnosis of 1 of the following:

    • Primary or recurrent locally advanced cervical, vaginal, or vulvar cancers not amenable to curative surgical resection
    • Recurrent or persistent ovarian epithelial or endometrial cancer meeting all of the following criteria:

      • Not amenable to curative surgical resection alone
      • Planning to undergo pelvic radiotherapy
      • Amenable to tumor biopsy through the vaginal canal
  • Patients with metastatic disease to extrapelvic sites are eligible provided pelvic radiotherapy is planned as the primary management of the site of pelvic disease
  • Measurable disease, defined as at least 1 unidimesionally measurable lesion ≥ 20 mm by conventional methods or ≥ 10 mm by spiral CT scan (for patients relapsing ≥ 4 weeks after prior initial surgery or chemotherapy)
  • No known brain metastases

PATIENT CHARACTERISTICS:

  • ECOG performance status (PS) 0-2 OR Karnofsky PS 50-100%
  • Life expectancy > 3 months
  • WBC ≥ 3,000/mm³
  • Absolute neutrophil count ≥ 1,500/mm³
  • Platelet count ≥ 100,000/mm³
  • Hemoglobin ≥ 10 g/dL
  • Bilirubin ≤ 2.0 mg/dL
  • AST and ALT ≤ 2.5 times upper limit of normal (ULN)
  • PT/aPTT ≤ 1.5 times ULN
  • Creatinine ≤ 2.0 mg/dL (for patients receiving 3-AP alone with pelvic radiotherapy)
  • Creatinine ≤ 1.5 mg/dL OR 1.5-1.9 mg/dL AND creatinine clearance ≥ 30 mL/min (for patients receiving cisplatin)
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must agree to use effective contraception
  • No other uncontrolled illness including, but not limited to, any of the following:

    • Ongoing or active infection
    • Symptomatic congestive heart failure
    • Unstable angina pectoris
    • Cardiac arrhythmia
    • Known inadequately controlled hypertension
    • Significant pulmonary disease, including dyspnea at rest
    • Requirement for supplemental oxygen
    • Poor pulmonary reserve
    • Proteinuria or clinically significant renal function impairment (baseline creatinine > 2 mg/dL)
    • Psychiatric illness or social situation that would preclude study compliance
  • No history of allergic reactions to study drugs or to compounds with similar chemical or biological composition to 3-AP
  • No poor vascular access that would preclude intravenous chemotherapies (e.g., due to hemodialysis)
  • No known glucose-6-phosphate dehydrogenase deficiency
  • No other prior malignancy unless in remission for ≥ 6 months and not currently being treated
  • No other active malignancy

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • Recovered from prior therapy
  • More than 4 weeks since prior chemotherapy (6 weeks for nitrosourea or mitomycin C)
  • More than 4 weeks since prior radiotherapy
  • No prior anticancer treatment that would preclude study participation
  • No prior low abdominal or pelvic radiotherapy that would preclude study treatment
  • No concurrent epoetin alfa
  • No concurrent antiretroviral treatment for HIV-positive patients
  • No other concurrent anticancer agents or therapies for this malignancy
  • No other concurrent investigational agents
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00335998

Locations
United States, Ohio
Case Comprehensive Cancer Center
Cleveland, Ohio, United States, 44106-5065
Geauga Regional Hospital
Chardonr, Ohio, United States, 44024
Lake/University Ireland Cancer Center
Mentor, Ohio, United States, 44060
Mercy Cancer Center at Mercy Medical Center
Canton, Ohio, United States, 44708
University Suburban Health Center
South Euclid, Ohio, United States, 44121
UHHS Chagrin Highlands Medical Center
Orange Villager, Ohio, United States, 44122
UHHS Westlake Medical Center
Westlaker, Ohio, United States, 44145
Southwest General Health Center
Middleburgh Heights, Ohio, United States, 44130
Sponsors and Collaborators
Case Comprehensive Cancer Center
Investigators
Study Chair: Timothy J. Kinsella, MD Case Comprehensive Cancer Center
  More Information

Clinical trial summary from the National Cancer Institute's PDQ® database  This link exits the ClinicalTrials.gov site

Study ID Numbers: CDR0000471217, CASE-1805, NCI-7336, CASE-110534
Study First Received: June 8, 2006
Last Updated: December 16, 2008
ClinicalTrials.gov Identifier: NCT00335998  
Health Authority: United States: Food and Drug Administration

Keywords provided by National Cancer Institute (NCI):
recurrent vaginal cancer
recurrent vulvar cancer
recurrent cervical cancer
recurrent endometrial carcinoma
recurrent ovarian epithelial cancer
stage III vulvar cancer
stage IV vulvar cancer
stage III vaginal cancer
stage IVA vaginal cancer
stage IVB vaginal cancer
stage III cervical cancer
stage IVA cervical cancer
stage IVB cervical cancer
stage III endometrial carcinoma
stage IV endometrial carcinoma
stage III ovarian epithelial cancer
stage IV ovarian epithelial cancer

Study placed in the following topic categories:
Ovarian cancer
Vaginal Neoplasms
Ovarian Neoplasms
Gonadal Disorders
Genital Neoplasms, Female
Vaginal cancer
Uterine Diseases
Endocrine System Diseases
Vaginal Diseases
Urogenital Neoplasms
Ovarian Diseases
Ovarian epithelial cancer
Recurrence
Carcinoma
Genital Diseases, Female
Endometrial Neoplasms
Cisplatin
Vulvar Neoplasms
Uterine Neoplasms
Endocrinopathy
Endometrial cancer
Vulvar Diseases
Vulvar cancer
Endocrine Gland Neoplasms

Additional relevant MeSH terms:
Neoplasms
Neoplasms by Site
Radiation-Sensitizing Agents
Antineoplastic Agents
Therapeutic Uses
Physiological Effects of Drugs
Pharmacologic Actions
Adnexal Diseases

ClinicalTrials.gov processed this record on January 16, 2009