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6-Hour Oxaliplatin in Preventing Nerve Damage in Patients with Advanced or Metastatic Gastrointestinal Cancer

Status
Active
Cancer Type
Unknown Primary
Trial Phase
Phase II
Eligibility
18 Years and older, Male and Female
Study Type
Treatment
NCT ID
NCT03800693
Protocol IDs
Winship4468-18 (primary)
NCI-2018-02241
IRB00106610
Study Sponsor
Emory University Hospital/Winship Cancer Institute

Summary

This phase II trial studies how well giving oxaliplatin over 6 hours works in preventing nerve damage in patients with gastrointestinal cancer that has spread to other places in the body. Oxaliplatin can cause side effects such as nerve damage that may delay or reduce the dose of oxaliplatin. Giving oxaliplatin over a longer period of time (6 hours) may prevent or delay the development of nerve damage, which may keep patients on standard doses of chemotherapy longer, without having to delay treatment.

Objectives

PRIMARY OBJECTIVE:
I. To determine the effect of 2 versus 6-hour oxaliplatin infusion time on the difference in severity of sensory neuropathy as measured by patient reported outcome (PRO) scores on the European Organization for Research and Treatment of Cancer (EORTC) chemotherapy-induced peripheral neuropathy (CIPN-20) scale at the initiation of cycle 4.

SECONDARY OBJECTIVES:
I. Pharmacokinetic parameters of maximum concentration (Cmax), area under the curve (AUC), time of maximum concentration (tmax), clearance, and half life (t1/2) of platinum ultra-filtrate.
II. CIPN-20 sensory score changes over the duration of therapy as measured by a cumulative area-under-the curve score.
III. Clinical outcomes including duration of therapy, oxaliplatin dose reductions, delays in therapy, and overall dose intensity and delivery of oxaliplatin.
IV. Relationship between oxaliplatin Cmax, patient-reported acute neurotoxicity, and chronic neurotoxicity by CIPN-20 scores.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM I: Patients receive oxaliplatin intravenously (IV) and leucovorin IV over 2 hours on day 1. Patients also receive a lower dose of fluorouracil IV over 2-4 minutes followed by a higher dose IV continuous over 46 hours on day 1. Cycles repeat every 14 days in the absence of disease progression or unacceptable toxicity. Patients also undergo blood sample collection, computed tomography (CT) scans and/or magnetic resonance imaging (MRI) throughout the study.

ARM II: Patients receive oxaliplatin IV over 6 hours on day 1. Patients also receive leucovorin and fluorouracil as in arm I. Cycles repeat every 14 days in the absence of disease progression or unacceptable toxicity. Patients also undergo blood sample collection, CT scans and/or MRI throughout the study.

After completion of study treatment, patients are followed up at 1, 3, 6, 12, and 18 months.

Eligibility

  1. Age = 18 years
  2. Eastern Cooperative Oncology Group (ECOG) performance status 0-2
  3. Confirmed diagnosis of a gastrointestinal cancer
  4. Plan for 4 or more cycles of FOLFOX6 (fluorouracil [with leucovorin] and oxaliplatin) containing chemotherapy
  5. Histologically confirmed, measurable or evaluable disease. Patients should have at least one measurable lesion by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1
  6. Absolute neutrophil count (ANC) >= 1,500/uL (no white blood cell growth factors allowed to meet requirement)
  7. Platelets >= 75,000/uL (may be transfused up to 72 hours prior to day 1 to meet requirement)
  8. Hemoglobin >= 8 g/dL (may be transfused up to 72 hours prior to day 1 to meet requirement)
  9. Creatinine clearance > 30 mL/min by Cockcroft-Gault, to preserve similar dosing (85 mg/m^2) for analysis
  10. Total bilirubin =< 1.5 x upper limit of normal (ULN)
  11. Signed informed consent
  12. Adequate birth control when appropriate

Treatment Sites in Georgia

Emory Saint Joseph's Hospital


5665 Peachtree Dunwoody Road NE
Atlanta, GA 30342
www.emoryhealthcare.org

Emory University Hospital - Midtown


550 Peachtree Street NE
Atlanta, GA 30308
404-686-4411
www.emoryhealthcare.org

Winship Cancer Institute of Emory University


1365 Clifton Road NE
Building C
Atlanta, GA 30322
404-778-5180
winshipcancer.emory.edu

**Clinical trials are research studies that involve people. These studies test new ways to prevent, detect, diagnose, or treat diseases. People who take part in cancer clinical trials have an opportunity to contribute to scientists’ knowledge about cancer and to help in the development of improved cancer treatments. They also receive state-of-the-art care from cancer experts... Click here to learn more about clinical trials.
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