Isolated Hepatic Perfusion With Melphalan Followed by Combination Chemotherapy in Treating Patients With Unresectable Liver Metastases From Colorectal Cancer
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Purpose
RATIONALE: Drugs used in chemotherapy, such as melphalan, leucovorin, oxaliplatin, and fluorouracil, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) and giving the drugs in different ways may kill more tumor cells.
PURPOSE: This phase II trial is studying how well isolated hepatic perfusion with melphalan followed by combination chemotherapy works in treating patients with unresectable liver metastases from colorectal cancer.
| Condition | Intervention | Phase |
|---|---|---|
|
Colorectal Cancer Metastatic Cancer |
Drug: FOLFOX regimen Drug: fluorouracil Drug: isolated perfusion Drug: leucovorin calcium Drug: melphalan Drug: oxaliplatin |
Phase 2 |
| Study Type: | Interventional |
| Study Design: | Masking: Open Label Primary Purpose: Treatment |
| Official Title: | A Phase II Trial of Isolated Hepatic Perfusion (IHP) and Systemic FOLFOX4 for Subjects With Metastatic Unresectable Colorectal Cancers of the Liver With ≥ 40% Hepatic Tumor Burden |
- Response and duration of response [ Designated as safety issue: No ]
- Patterns of recurrence [ Designated as safety issue: No ]
- Progression-free and overall survival [ Designated as safety issue: No ]
- Correlation of health-related quality of life with length of survival [ Designated as safety issue: No ]
| Study Start Date: | December 2004 |
OBJECTIVES:
Primary
- Determine the response and duration of response in patients with previously untreated unresectable liver metastases secondary to colorectal cancer treated with isolated hepatic perfusion with melphalan followed by leucovorin calcium, oxaliplatin, and fluorouracil.
Secondary
- Determine the patterns of recurrence (liver vs systemic) in patients treated with this regimen.
- Determine progression-free and overall survival of patients treated with this regimen.
- Correlate health-related quality of life with length of survival of patients treated with this regimen.
OUTLINE: Patients undergo exploratory laparotomy. Patients with evidence of carcinomatosis not previously visualized on scans but found on surgical exploration are removed from the study. All other patients then undergo isolated hepatic perfusion (IHP). Once IHP is established, melphalan is administered intra-arterially over 3-5 minutes and then circulated throughout the liver for 1 hour. Approximately 6-12 weeks later, patients receive systemic chemotherapy comprising oxaliplatin IV over 2 hours on day 1 and leucovorin calcium IV over 2 hours and fluorouracil IV continuously over 22 hours on days 1-2. Courses with systemic chemotherapy repeat every 14 days for up to 1 year in the absence of disease progression or unacceptable toxicity.
Quality of life is assessed at baseline, after laparotomy, after completion of systemic chemotherapy, and then every 6 months thereafter.
After completion of study treatment, patients are followed every 3 months for 1 year, every 3-4 months for 2 years, and then every 6 months until disease progression.
PROJECTED ACCRUAL: A total of 30 patients will be accrued for this study within 2-3 years.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
DISEASE CHARACTERISTICS:
Histologically or cytologically confirmed colorectal cancer
Metastatic disease limited to the parenchyma of the liver
No evidence of unresectable extrahepatic disease by preoperative radiology
- Limited extra-hepatic disease and dominant life-limiting liver disease allowed provided extra-hepatic sites are treatable by local ablative measures (e.g., surgical resection or external beam radiotherapy)
- At least 40% hepatic replacement by tumor by axial CT scan or MRI
Unresectable liver metastases, defined by 1 of the following:
- More than 3 sites of disease in the liver
- Bilobar disease
- Tumor abutting major vascular or ductal structures
- Measurable disease
- Previously untreated disease
PATIENT CHARACTERISTICS:
Age
- 18 and over
Performance status
- ECOG 0-2
Life expectancy
- Not specified
Hematopoietic
- Hematocrit > 27.0%
- WBC > 3,000/mm^3
- Platelet count > 100,000/mm^3
Hepatic
- Bilirubin < 2.0 mg/dL
- PT < 2 seconds above upper limit of normal
- Elevated transaminase levels allowed if due to liver metastases
- No cirrhosis by biopsy
No significant portal hypertension as manifested by any of the following:
- Ascites
- Esophageal varices by endoscopy
- Significant collateral vessels around the organs drained by the portal venous system by radiography
No chronic active hepatitis
- Hepatitis B and C surface antigen negative
- No history of veno-occlusive disease
Renal
- Creatinine ≤ 1.5 mg/dL OR
- Creatinine clearance > 60 mL/min
Cardiovascular
- No ischemic cardiac disease
- No history of congestive heart failure
- LVEF > 40% by echocardiogram or stress thallium scan (for patients with cardiac disease)
Pulmonary
- No chronic obstructive pulmonary disease or other chronic pulmonary disease
- Pulmonary function tests ≥ 50% of predicted (for patients with pulmonary disease)
Other
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- Weight > 30 kg
- No active infection
- No peripheral neuropathy ≥ grade 2
PRIOR CONCURRENT THERAPY:
Biologic therapy
- Not specified
Chemotherapy
- Prior adjuvant chemotherapy (including leucovorin calcium, oxaliplatin, and fluorouracil) allowed provided it was administered > 6 months before liver metastases were diagnosed
Endocrine therapy
- Not specified
Radiotherapy
- More than 4 weeks since prior radiotherapy for this malignancy and recovered
Surgery
- Not specified
Other
- No concurrent chronic anticoagulation therapy
- No concurrent immunosuppressive drugs
Contacts and Locations| United States, Maryland | |
| Warren Grant Magnuson Clinical Center - NCI Clinical Studies Support | |
| Bethesda, Maryland, United States, 20892-1182 | |
| Study Chair: | H. Richard Alexander, MD, FACS | NCI - Surgery Branch |
More Information
Additional Information:
No publications provided
| ClinicalTrials.gov Identifier: | NCT00103298 History of Changes |
| Obsolete Identifiers: | NCT00096889 |
| Other Study ID Numbers: | CDR0000409754, NCI-05-C-0025 |
| Study First Received: | February 7, 2005 |
| Last Updated: | February 6, 2009 |
| Health Authority: | United States: Federal Government |
Keywords provided by National Cancer Institute (NCI):
|
recurrent colon cancer stage IV colon cancer recurrent rectal cancer stage IV rectal cancer liver metastases |
Additional relevant MeSH terms:
|
Colorectal Neoplasms Neoplasm Metastasis Neoplasms Neoplasms, Second Primary Intestinal Neoplasms Gastrointestinal Neoplasms Digestive System Neoplasms Neoplasms by Site Digestive System Diseases Gastrointestinal Diseases Colonic Diseases Intestinal Diseases Rectal Diseases Neoplastic Processes Pathologic Processes |
Fluorouracil Melphalan Oxaliplatin Leucovorin Levoleucovorin Antimetabolites Molecular Mechanisms of Pharmacological Action Pharmacologic Actions Antimetabolites, Antineoplastic Antineoplastic Agents Therapeutic Uses Immunosuppressive Agents Immunologic Factors Physiological Effects of Drugs Vitamin B Complex |
ClinicalTrials.gov processed this record on May 21, 2013