Combination Chemotherapy and Peripheral Stem Cell Transplantation in Treating Patients With Stage III Ovarian Cancer

Gynecologic Oncology Group (GOG)

Status and phase

Terminated

Phase 2

Conditions

Stage III Ovarian Cancer

Primary Peritoneal Carcinoma

Ovarian Serous Cystadenocarcinoma

Undifferentiated Ovarian Carcinoma

Ovarian Mucinous Cystadenocarcinoma

Malignant Ovarian Mixed Epithelial Tumor

Ovarian Clear Cell Cystadenocarcinoma

Ovarian Endometrioid Adenocarcinoma

Treatments

Procedure: Peripheral Blood Stem Cell Transplantation

Drug: Cyclophosphamide

Biological: Filgrastim

Drug: Topotecan Hydrochloride

Drug: Paclitaxel

Drug: Carboplatin

Study type

Interventional

Funder types

NETWORK

NIH

Identifiers

NCT00004221

U10CA027469 (U.S. NIH Grant/Contract)

CDR0000067462

NCI-2012-02312 (Registry Identifier)

GOG-9903 (Other Identifier)

Details and patient eligibility

About

Phase II trial to study the effectiveness of combination chemotherapy and peripheral stem cell transplantation in treating patients who have undergone surgery for stage III ovarian cancer. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining chemotherapy with peripheral stem cell transplantation may allow the doctor to give higher doses of chemotherapy drugs and kill more tumor cells.

Full description

OBJECTIVES:

I. Determine the safety and feasibility of multiple courses of high dose carboplatin, paclitaxel, and topotecan as initial chemotherapy combined with autologous peripheral blood stem cell transplantation in patients with optimally debulked stage III ovarian or primary peritoneal carcinoma.

II. Determine the pathological complete response rate, disease free survival, and overall survival in patients treated with this regimen.

OUTLINE: This is a multicenter study.

Mobilization and harvest: Within 8 weeks of surgical debulking, patients receive cyclophosphamide IV over 1 hour, followed 4 hours later by paclitaxel IV over 24 hours. Patients receive filgrastim (G-CSF) subcutaneously (SQ) daily beginning 24 hours after completion of paclitaxel infusion and continuing until blood counts recover and autologous peripheral blood stem cells (PBSC) are harvested and selected for CD34+ cells.

High dose chemotherapy and transplantation (3 weeks after PBSC harvest): Patients receive paclitaxel IV over 24 hours beginning on day 1, immediately followed by carboplatin IV over 2 hours, immediately followed by topotecan IV over 24 hours. Patients receive G-CSF sub-cutaneously (SQ) daily beginning 24 hours after completion of topotecan infusion and continuing until blood counts have recovered for 2 days. One quarter of the PBSC are reinfused beginning 2 days after completion of topotecan infusion. Treatment repeats every 4 weeks for 4 courses in the absence of disease progression or unacceptable toxicity. Patients with radiographic and biochemical complete response undergo laparoscopy as second look surgery within 8 weeks of the last course of chemotherapy. If no evidence of disease is found during laparoscopy, then exploratory laparotomy must also be performed.

Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter or at time of recurrence until death.

Enrollment

12 patients

Sex

Female

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria:

Histologically proven optimally debulked stage III ovarian or primary peritoneal carcinoma
- Any of the following subtypes:
  - Serous adenocarcinoma
  - Mucinous adenocarcinoma
  - Clear cell carcinoma
  - Transitional cell carcinoma
  - Endometrioid adenocarcinoma
  - Undifferentiated adenocarcinoma
  - Mixed epithelial adenocarcinoma
  - Adenocarcinoma, not otherwise specified
No ovarian carcinoma of low malignant potential (borderline)
Concurrent superficial endometrial or cervical carcinoma allowed if ovarian carcinoma more life threatening or limiting
Must have undergone appropriate primary surgical staging and debulking for ovarian carcinoma and have less than 1 cm of residual disease
- No more than 8 weeks since prior surgical debulking
Must have Hickman catheter in place or be eligible for placement
No CNS involvement
Performance status - GOG 0 or 1
Absolute neutrophil count at least 1,500/mm^3
Platelet count at least 100,000/mm^3
Bilirubin no greater than 1.5 mg/dL
SGOT or SGPT no greater than 2 times upper limit of normal
No active hepatitis
Creatinine no greater than 1.5 mg/dL
Creatinine clearance at least 60 mL/min
No renal failure
Curatively treated ureteral obstruction allowed if above creatinine measurements met
No congestive heart failure
No myocardial infarction within the past 6 months
No significant arrhythmias requiring medication
No poorly controlled systolic or diastolic hypertension (diastolic blood pressure consistently greater than 100 mm Hg)
No significant nonneoplastic pulmonary disease
No other malignancy within the past 5 years except basal cell or squamous cell skin cancer or carcinoma in situ of the cervix
HIV negative
No other severe medical or psychiatric illness including, but not limited to the following:
- Acute infection
- Active peptic ulcer disease
- Uncontrolled diabetes mellitus
- Prior hospitalization for psychiatric illness, including severe depression or psychosis
- Concurrent alcohol or drug abuse
No prior chemotherapy for this malignancy
No radiotherapy to greater than 25% of bone marrow
See Disease Characteristics