To evaluate the safety of secondary chemotherapy induced thrombocytopenia (reduction in platelets which leads to bleeding) prophylaxis with romiplostim in ovarian cancer subjects receiving myelosuppressive (blood cell damaging) chemotherapy.It is anticipated that Romiplostim, when administered at an effective dose and schedule, will be a well-tolerated treatment for subjects experiencing chemotherapy-induced thrombocytopenia.
Chemotherapy of recurrent ovarian cancer leads to severe thrombocytopenia in a considerable proportion of the patients, requiring treatment delays or dose reductions, and placing the patient at a high risk of bleeding complications. The amount of thrombocytopenia is highly schedule-dependent. In platinum-sensitive ovarian cancer that relapsed more than 6 months after end of primary therapy, a platinum containing reinduction therapy - the combination of paclitaxel/carboplatin, gemcitabine/carboplatin or PLD/carboplatin - is recommended according to the current AGO guidelines or recent ASCO presentations. Especially the latter two regimens often induce severe and even dose-limiting myelosuppression, including thrombocytopenia. Therefore, prophylaxis, or at least secondary prophylaxis of this toxicity is an important goal of supportive therapy. The use of platelet transfusions is limited by cost, supply problems, and associated risks, such as transfusion reactions, transmission of infection, and alloimmunization and platelet refractoriness. In contrast to the situation for the red and white blood cell compartments, the implementation of growth factor treatment in order to ameliorate the therapy of thrombocytopenia and its complications, is yet very limited. Romiplostim is an active second-generation thrombopoietic agent without safety problems due to immunogenicity, which proved to be beneficial in the treatment of immune thrombocytopenic purpura and myelodysplastic syndromes. The rationale of this trial is to obtain evidence that romiplostim can improve platelet counts/recovery in the treatment of recurrent ovarian cancer. Due to the fact, that the expected occurrence of severe thrombocytopenia and its complications may heavily depend on the selection of patient and their characteristics such as actually chosen treatment schedule, tumor stage, extent of metastasis, pre-treatment etc. a phase II design comparing the results to historical data or expectations is insufficient. A simple within-group control design, comparing subsequent cycles of the same patients with or without the supportive experimental drug may also be flawed, as "spontaneous" improvements after obviously unchanged chemotherapy are often observed. With some regimens, the first cycle proves to be generally more toxic than later ones. On the other hand, regimens may result in cumulative myelosuppression. A design including a randomized doubleblind control group is therefore warranted, moreover, as platelet counts represent a sensitive and valid surrogate marker for a clinical benefit. The current study will employ a model of secondary prophylaxis. The enrolment of subjects with grade 3 and/or 4 thrombocytopenia will facilitate an assessment of the ability of romiplostim to impact thrombocytopenia at clinically significant levels, which warrant the administration of platelet transfusions, dose reduction, and dose delay.
Praxisklinik für Krebsheilkunde für Frauen Drs. Kittel /Klare / Wetzel
Berlin, Germany
Charité Campus Virchow-Klinikum Universitätsmedizin Berlin
Berlin, Germany
Ev. Waldkrankenhaus Spandau
Berlin, Germany
Grade 3 and 4 thrombocytopenia
Platelet Count (100 x 10\^9/L) will be measured and the rate will be compared by Treatment Group
Time frame: At the end of Cycle 1 (each cycle is 28 days)
Adverse events of grade 3/4
Determine the rate of AE between the experimental arm and the placebo arm.
Time frame: At the end of Cycle 4 (each cycle is 28 days)
Grade 3/4 thrombocytopenia
The rate of AE between the experimental arm and the placebo arm will be determined
Time frame: on days 8, 11 or 12, 15
Platelet Counts
The average platelet nadir in each treatment Group will be considered
Time frame: on days 8, 11 or 12, 15
Bleeding events
The proportion of patients suffering from grade 1, 2, 3, or 4 bleeding Events will be considered
Time frame: At the end of Cycle 8 (each cycle is 28 days)
Grade 1, 2, 3, or 4 thrombocytopenia (maximum NCI CTC grade by patient)
Determine the proportion of subjects in each treatment group
Time frame: At the end of Cycle 8 (each cycle is 28 days)
Grade 3/4 thrombocytopenia
The duration will be considered
Time frame: At the end of Cycle 8 (each cycle is 28 days)
Platelet transfusions
The number of subjects in each treatment Group will be considered
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Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
21
Gynäkologisches Zentrum
Bonn, Germany
Städtisches Klinikum Brandenburg
Brandenburg, Germany
Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche
Braunschweig, Germany
Klinikum Chemnitz GmbH
Chemnitz, Germany
Universitätsklinik Carl Gustav Carus der Technischen Universität Dresden
Dresden, Germany
Universitätsklinikum Jena
Jena, Germany
Universitätsklinikum Schleswig-Holstein Campus Kiel
Kiel, Germany
...and 3 more locations
Time frame: At the end of Cycle 8 (each cycle is 28 days)
Platelet counts
The platelet counts on study chemotherapy treatment cycles by treatment group will be considered.
Time frame: On day 22 of each Cycle till max. 8 Cycles (each cycle is 28 days)
Counts of CT cycles
The proportion of subjects able to receive all CT cycles on time by treatment group
Time frame: through study completion, an average of 8 month
ADR/SADR of romiplostim
Assess the reported ADR/SADR
Time frame: through study completion, an average of 8 month