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Sponsors and Collaborators: |
University of California, Irvine GlaxoSmithKline |
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Information provided by: | University of California, Irvine |
ClinicalTrials.gov Identifier: | NCT00314678 |
Clinically, there has been extensive experience with topotecan and cisplatin. Recently, several investigators have evaluated the combination of paclitaxel, cisplatin and topotecan. As expected, myelosuppression was the dose-limiting factor. Herben et al recently reported the results of a phase I trial using the combination of paclitaxel, cisplatin, and topotecan as first line therapy in advanced stage ovarian cancer. Interestingly, the authors could not achieve a dose of topotecan that would be considered "optimal" for the treatment of relapsed disease in a single-agent fashion. The inability to utilize a therapeutic dose when combined with either platinum or paclitaxel has been demonstrated in previous reports and affirms the bone marrow suppressive effect. The clinical response rate from this trial was reported as 86.7%.
Condition | Intervention | Phase |
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Epithelial Ovarian Cancer Primary Peritoneal Cancer |
Drug: Topotecan Drug: Cisplatin Drug: Paclitaxel |
Phase II |
Study Type: | Interventional |
Study Design: | Treatment, Non-Randomized, Open Label, Uncontrolled, Single Group Assignment, Safety/Efficacy Study |
Official Title: | Cisplatin Induction Followed by Paclitaxel Consolidation for the Treatment of Stage III and IV Epithelial Ovarian Cancer and Primary Peritoneal Cancer With In Vitro Correlates of Response |
Estimated Enrollment: | 40 |
Study Start Date: | September 2005 |
Study Completion Date: | April 2007 |
Malignant neoplasms of the ovary are the cause of more deaths than any other gynecologic cancer. Approximately 26,500 new cases are diagnosed each year in the United States, and about 14,500 deaths occur annually as a result of this disease. Clinicians continue to be frustrated by both the paucity of data concerning the etiologic factors in epithelial ovarian cancer and by the failure to achieve a significant reduction in mortality over the past several decades.
Since the introduction of cisplatin-based chemotherapy, no treatment has been shown to improve survival in subjects with advanced ovarian cancer until the incorporation of paclitaxel into primary therapy for this disease. In 1996, the Gynecologic Oncology Group (GOG) published the results of a large prospective, randomized trial of cisplatin and cyclophosphamide compared to cisplatin and paclitaxel. The cisplatin plus paclitaxel regimen was noted to be superior based on: 1) an overall improved response rate; 2) an increased clinical response rate (51% vs. 31%); 3) an increased rate of negative second look laparotomies; 4) an increase in median progression free survival; and importantly 5) an increased overall median survival (38 months vs. 24 months).
The GOG results were recently confirmed by the Canadian- European consortium randomized phase III trial (OV 10).
These large randomized trials established the combination of paclitaxel and cisplatin as the standard, first line therapy for women with advanced ovarian cancer following cytoreductive surgery. Although the majority of women with advanced ovarian cancer will demonstrate an objective response to this combination; the response is generally of limited duration. The five-year survival for advanced stage ovarian cancer is 20-40%. Consequently, there remains a need for an improved chemotherapeutic approach in the management of ovarian cancer.
Topotecan is a semi-synthetic analog of camptothecin, a topoisomerase inhibitor. It has been investigated in a number of phase II trials as salvage therapy for recurrent ovarian cancer. Overall response rates have ranged from 6% to 27%. In a randomized comparative trial of topotecan versus paclitaxel, overall response rates were 21% and 14% respectively. The median survival for topotecan was 63 weeks as compared to 53 weeks for paclitaxel.
Both drugs demonstrated higher response rates in platinum-sensitive tumors than platinum-resistant tumors. These data suggest that topotecan may be as active as paclitaxel, and partially non-cross resistant with cisplatin.
Topotecan may be a better agent than paclitaxel for use in combination with cisplatin for multiple reasons. First, Kern et al demonstrated that paclitaxel may antagonize the activity of cisplatin. Second, topotecan has been demonstrated to be synergistic with both cisplatin and paclitaxel in vitro. It has been demonstrated that topotecan can dramatically potentiate the effects of platinum, perhaps by its ability to inhibit repair of platinum-DNA adducts.
Clinically, there has been extensive experience with topotecan and cisplatin. Recently, several investigators have evaluated the combination of paclitaxel, cisplatin and topotecan. As expected, myelosuppression was the dose-limiting factor. Herben et al recently reported the results of a phase I trial using the combination of paclitaxel, cisplatin, and topotecan as first line therapy in advanced stage ovarian cancer. Interestingly, the authors could not achieve a dose of topotecan that would be considered "optimal" for the treatment of relapsed disease in a single-agent fashion. The inability to utilize a therapeutic dose when combined with either platinum or paclitaxel has been demonstrated in previous reports and affirms the bone marrow suppressive effect. The clinical response rate from this trial was reported as 86.7%.
Ages Eligible for Study: | 18 Years and older |
Genders Eligible for Study: | Female |
Accepts Healthy Volunteers: | No |
Eligible Subjects:
Eligible cell types include:
Serous adenocarcinoma Endometrioid adenocarcinoma Mucinous adenocarcinoma Undifferentiated carcinoma Clear cell adenocarcinoma Mixed epithelial carcinoma Transitional cell carcinoma Malignant Brenner's Tumor
Ineligible Subjects:
United States, California | |
Chao Family Comprehensive Cancer Center | |
Orange, California, United States, 92868 |
Principal Investigator: | John P Fruehauf, MD, PhD | Chao Family Comprehensive Cancer Center |
Study ID Numbers: | UCI 99-25 |
Study First Received: | April 12, 2006 |
Last Updated: | December 7, 2007 |
ClinicalTrials.gov Identifier: | NCT00314678 History of Changes |
Health Authority: | United States: Institutional Review Board |
Ovarian Peritoneal |
Ovarian Neoplasms Digestive System Neoplasms Gonadal Disorders Genital Neoplasms, Female Endocrine System Diseases Urogenital Neoplasms Antimitotic Agents Ovarian Diseases Ovarian Epithelial Cancer Abdominal Neoplasms Genital Diseases, Female Digestive System Diseases |
Radiation-Sensitizing Agents Cisplatin Paclitaxel Tubulin Modulators Peritoneal Diseases Ovarian Cancer Gastrointestinal Neoplasms Endocrinopathy Peritoneal Neoplasms Topotecan Antineoplastic Agents, Phytogenic Endocrine Gland Neoplasms |
Molecular Mechanisms of Pharmacological Action Gonadal Disorders Antineoplastic Agents Physiological Effects of Drugs Urogenital Neoplasms Ovarian Diseases Genital Diseases, Female Neoplasms by Site Cisplatin Therapeutic Uses Peritoneal Diseases Endocrine Gland Neoplasms Ovarian Neoplasms Digestive System Neoplasms |
Mitosis Modulators Genital Neoplasms, Female Endocrine System Diseases Antimitotic Agents Abdominal Neoplasms Pharmacologic Actions Adnexal Diseases Neoplasms Digestive System Diseases Radiation-Sensitizing Agents Paclitaxel Tubulin Modulators Peritoneal Neoplasms Antineoplastic Agents, Phytogenic |