This randomized phase II trial is to see if combination chemotherapy works better with or without bevacizumab in treating patients who have malignant mesothelioma. Drugs used in chemotherapy work in different ways to stop tumor cells from dividing so they stop growing or die. Monoclonal antibodies, such as bevacizumab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or deliver cancer-killing substances to them. It is not yet known if combination chemotherapy works better with or without bevacizumab in treating malignant mesothelioma.
OBJECTIVES: I. Compare the time to progression of patients with malignant mesothelioma treated with gemcitabine and cisplatin with or without bevacizumab. II. Compare the objective response rate in patients treated with these regimens. III. Compare the toxicity of these regimens when administered to these patients. IV. Compare the median and overall survival of patients treated with these regimens. V. Assess plasma vascular endothelial growth factor and serum vascular cell adhesion molecule-1 levels before, during, and after study therapy as predictors of outcome in these patients. OUTLINE: This is a randomized, double-blind, placebo-controlled, multicenter study. Patients are stratified according to histology (epithelial vs other) and ECOG performance status (0 vs 1). Patients are randomized to one of two treatment arms. ARM I: Patients receive gemcitabine IV over 30 minutes on days 1 and 8 and cisplatin IV over 30-60 minutes (beginning after gemcitabine infusion) and bevacizumab IV over 30-90 minutes (beginning after cisplatin infusion) on day 1. Treatment repeats every 3 weeks for 6 courses in the absence of disease progression or unacceptable toxicity. Patients who achieve stable disease (SD), complete response (CR), or partial response (PR) after the sixth course may receive bevacizumab as a single agent once every 3 weeks in the absence of disease progression or unacceptable toxicity. ARM II: Patients receive gemcitabine and cisplatin as in arm I and placebo IV over 30-90 minutes (beginning after cisplatin infusion) on day 1. Treatment repeats as in arm I. Patients who achieve SD, CR, or PR after the sixth course may receive placebo as a single agent once every 3 weeks in the absence of disease progression.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
106
University of Chicago
Chicago, Illinois, United States
Time to disease progression
The two treatment groups will be compared using a stratified logrank test. Kaplan-Meier time-to-event curves will be constructed for each treatment group. Median time-to-progression in each group and corresponding 95% confidence intervals will be derived using the method described in Brookmeyer and Crowley.
Time frame: Time from randomization until the first evidence of progression, up to 9 years
Complete response rate
Will be compared between groups using chi-square or Fisher exact tests, as appropriate.
Time frame: Up to 6 months
Objective response rate (complete and partial response)
Will be compared between groups using chi-square or Fisher exact tests, as appropriate.
Time frame: Up to 6 months
Rate of disease stabilization
Will be compared between groups using chi-square or Fisher exact tests, as appropriate.
Time frame: Up to 6 months
Overall survival
Kaplan-Meier estimates of overall survival rates will be derived and compared between the two groups using a stratified log-rank test.
Time frame: Up to 9 years
Incidence of adverse events graded according to NCI CTCAE version 3.0
Toxicity rates will be compared between the two groups via chi-square or Fisher exact tests.
Time frame: Up to 9 years
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