This phase I trial tests the safety, side effects, and best dose of intraperitoneal oxaliplatin and fluorouracil in treating patients with colorectal cancer that has spread to the peritoneal cavity (peritoneal metastasis). Oxaliplatin is in a class of medications called platinum-containing antineoplastic agents. It damages the cell's DNA and may kill cancer cells. Fluorouracil stops cells from making DNA and it may kill cancer cells. Both oxaliplatin and fluorouracil are approved by the Food and Drug Administration to treat patients with colorectal cancer, however administration of these drugs directly into the area between the muscles and organs in the abdomen (intraperitoneal) for the treatment of peritoneal metastases is experimental. Giving oxaliplatin and fluorouracil directly into the peritoneal space may be a safe and effective way of treating patients with peritoneal metastases from colorectal cancer.
PRIMARY OBJECTIVES: I. Determine safety, tolerability, and maximally tolerated dose (MTD) of intraperitoneal (IP) fluorouracil (5FU)+oxaliplatin. II. Determine pharmacokinetics (PK) of IP 5FU+oxaliplatin both in blood and peritoneal fluid. SECONDARY OBJECTIVES: I. Determine tumor-cell intrinsic effects, modulation of the tumor immune microenvironment, and changes in the makeup of circulating immune cells in response to IP 5FU+oxaliplatin. II. Identify preliminary response from IP 5FU+oxaliplatin: assess the rate of conversion from unresectable to resectable (determined by peritoneal carcinomatosis index \[PCI\] decreasing to \< 20) and response rates by imaging criteria. OUTLINE: This is a dose-escalation study of 5FU and oxaliplatin followed by a dose-expansion study. Patients undergo placement of indwelling IP port for chemotherapy infusion. Patients receive oxaliplatin and 5FU over 1-2 hours via IP infusion on days 1 and 15 of each cycle. Cycles repeat every 4 weeks for up to 16 weeks in the absence of disease progression or unacceptable toxicity. Patients also undergo diagnostic laparoscopy, biopsy, computed tomography (CT)/magnetic resonance imaging (MRI), and collection of blood samples at screening and on study and undergo collection of IP fluid samples on study. After completion of study treatment, patients are followed up for 30 days. Patients with confirmed disease progression or who start a new anti-cancer therapy are followed up every 12 weeks until death, withdrawal of consent, or end of study.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
24
Undergo biopsy
Undergo collection of blood and IP fluid samples
Undergo CT
Undergo diagnostic laparoscopy
Given via IP infusion
Undergo MRI
Given via IP infusion
Undergo placement of indwelling IP port
Ohio State University Comprehensive Cancer Center
Columbus, Ohio, United States
RECRUITINGUT Southwestern/Simmons Cancer Center
Dallas, Texas, United States
RECRUITINGMaximum tolerated dose (MTD)
MTD will be determined based on isotonic regression. Specifically, the MTD will be selected as the dose for which the isotonic estimate of the toxicity rate is closest to the targeted dose limiting toxicities via Bayesian optimal interval software.
Time frame: Up to 1 year
Incidence of adverse events
Adverse events (AEs) will be classified and attributed using National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 and will be summarized within and across dose levels using descriptive statistics. The overall number and percentage of patients experiencing AEs and toxicities will be summarized and reported as across all event types. All patients who have received at least one dose of the therapeutic agents will be evaluable for toxicity and tolerability.
Time frame: Up to 30 days after completion of study treatment
Area under the curve
Will be computed using non-compartmental and compartmental methods. Will use graphical analyses as well as repeated measure models (linear or nonlinear mixed models, generalized estimating equations) to assess the pharmacokinetic markers in relation to clinical treatment outcomes, recognizing some inherent limitations due to sample size.
Time frame: At the end of Cycle 1 (each cycle is 28 days)
Clearance
Will be computed using non-compartmental and compartmental methods. Will use graphical analyses as well as repeated measure models (linear or nonlinear mixed models, generalized estimating equations) to assess the pharmacokinetic markers in relation to clinical treatment outcomes, recognizing some inherent limitations due to sample size.
Time frame: At the end of Cycle 1 (each cycle is 28 days)
Volume of distribution
Will be computed using non-compartmental and compartmental methods. Will use graphical analyses as well as repeated measure models (linear or nonlinear mixed models, generalized estimating equations) to assess the pharmacokinetic markers in relation to clinical treatment outcomes, recognizing some inherent limitations due to sample size.
Time frame: At the end of Cycle 1 (each cycle is 28 days)
Half-life
Will be computed using non-compartmental and compartmental methods. Will use graphical analyses as well as repeated measure models (linear or nonlinear mixed models, generalized estimating equations) to assess the pharmacokinetic markers in relation to clinical treatment outcomes, recognizing some inherent limitations due to sample size.
Time frame: At the end of Cycle 1 (each cycle is 28 days)
Tumor-cell intrinsic effects in response to IP 5FU+oxaliplatin
Samples obtained from baseline and after 4 cycles will be studied. Data collected will be descriptive and exploratory, and provide limited estimates of variability given the small sample sizes at each dose level. Results will be summarized using descriptive statistics (i.e., means, standard deviations, 95% confidence intervals for continuous variables, and frequencies for discrete data.
Time frame: Up to 16 weeks
Modulation of the tumor microenvironment in response to IP 5FU+oxaliplatin
Samples obtained from baseline and after 4 cycles will be studied. Data collected will be descriptive and exploratory, and provide limited estimates of variability given the small sample sizes at each dose level. Results will be summarized using descriptive statistics (i.e., means, standard deviations, 95% confidence intervals for continuous variables, and frequencies for discrete data.
Time frame: Up to 16 weeks
Changes in the makeup of circulating immune cells in response to IP 5FU+oxaliplatin
Samples obtained from baseline and after 4 cycles will be studied. Data collected will be descriptive and exploratory, and provide limited estimates of variability given the small sample sizes at each dose level. Results will be summarized using descriptive statistics (i.e., means, standard deviations, 95% confidence intervals for continuous variables, and frequencies for discrete data.
Time frame: Up to 16 weeks
Rate of conversion from unresectable to resectable
Resectable disease will be determined by peritoneal carcinomatosis index decreasing to \< 20. Will be summarized and 95% exact binomial confidence interval will be provided.
Time frame: At time of second laparoscopy, after 4 cycles of treatment (16 weeks)
Overall response rate
Will be evaluated using imaging criteria. Overall response rate (partial response + complete response) will be summarized and 95% exact binomial confidence interval will be provided.
Time frame: Up to 16 weeks
The Ohio State University Comprehensive Cancer Center
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