Efficacy Study of Chemotherapy to Treat Ovarian Cancer Recurrence by Prolonging the Platinum Free Interval (MITO-8)

National Cancer Institute, Naples

Status and phase: Active, not recruiting; Phase 3

Conditions: Ovarian Cancer

Treatments: Drug: carboplatin; Drug: Gemcitabine; Drug: Topotecan; Drug: stealth liposomal doxorubicin; Drug: paclitaxel

Study type: Interventional

Funder types: Other

Identifiers

NCT00657878

2008-001755-22 (EudraCT Number)

MITO-8

Details and patient eligibility

About

This study aims to test the hypothesis that the artificial prolongation of the platinum-free interval with a non-platinum treatment will improve the effectiveness of overall therapy in patients with ovarian cancer progression occurring 6-12 months after first-line treatment with a platinum-derivative.

Full description

Ovarian cancer is the most deadly gynecologic cancer. Though many patients respond well initially to chemotherapy, most of them in time will suffer a relapse. Patients often receive multiple lines of chemotherapy for their recurrences, and the choice of chemotherapy depends largely on the time interval since the last therapy. Patients whose disease recurs longer than 12 months after a platinum containing treatment are considered to be platinum sensitive, and are candidates for retreatment with a platinum regimen.

Patients in whom disease recurs less than 6 months after a platinum containing treatment are considered platinum resistant or refractory, and are treated with a non platinum chemotherapy. The option of treatment is less clear for patients whose disease recurs between 6 and 12 months after platinum containing therapy. It is hypothesized that prolonging the interval since last platinum treatment by using a non platinum chemotherapy will result in better outcomes for these patients.

This study will evaluate if the experimental sequence of a non platinum based chemotherapy, followed at a later progression by a platinum based chemotherapy is superior, in terms of the effect on overall survival, to the standard inverse sequence of treatment.

Enrollment: 215 patients

Sex: Female

Volunteers: No Healthy Volunteers

Inclusion criteria

• Histological or cytological diagnosis of ovarian cancer
• Disease recurrence between 6 and 12 months after a first-line platinum based therapy
• Indication for chemotherapy, but no more than 2 previous lines of previous therapy
• Life expectancy of more than 3 months

Exclusion criteria

• Previous or concomitant malignant malignancy (excluding adequately treated baso-or squamocellular carcinoma of the skin and carcinoma in situ of the cervix)
• ECOG Performance Status at least 3
• Previous treatment with stealth liposomal doxorubicin
• Residual peripheral neuropathy Grade 3 or higher
• Heart disease (congestive heart failure, myocardial infarction within 6 months from study entry, atrioventricular block of any grade, severe arrhythmias)
• Neutrophils < 2000 x mm3, platelets < 100000 x mm3
• Inadequate renal function (creatinine no greater than 1.25 x normal values) or liver function (ALT or AST no greater than 1.25 x normal values)
• Present or suspected hemorrhagic syndromes
• Inability to comply with protocol and follow-up
• Inability to access study site for clinical visits
• Refusal of informed consent

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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215 participants in 2 patient groups

non platinum based chemotherapy

Experimental group

Description:

a non platinum based therapy (corresponding to stealth liposomal doxorubicin, or topotecan, or gemcitabine,or any other drug approved in clinical practice for the treatment of patients with ovarian cancer after previous platinum-based chemotherapy) followed by a platinum based chemotherapy at disease progression

Treatment:

Drug: stealth liposomal doxorubicin

Drug: carboplatin

Drug: paclitaxel

Drug: Topotecan

Drug: Gemcitabine

platinum based chemotherapy

Active Comparator group

Description:

platinum based chemotherapy (corresponding to the combination of carboplatin + paclitaxel, or carboplatin + gemcitabine for patients with significant but lower than grade 3 neuropathy at baseline) followed by a non platinum based chemotherapy at disease progression

Treatment:

Drug: stealth liposomal doxorubicin

Drug: carboplatin

Drug: paclitaxel

Drug: Topotecan

Drug: Gemcitabine