Using pressurized aerosol chemotherapy to treat advanced abdominal cancers

Safety and Efficacy of Pressurized Intraperitoneal Aerosolized Chemotherapy (PIPAC) in Ovarian, Uterine, Appendiceal, Colorectal, and Gastric Cancer Patients With Peritoneal Carcinomatosis (PC)

This study is testing a new way to deliver chemotherapy directly into the abdomen using a special aerosol spray to see if it helps people with advanced abdominal cancers feel better and have fewer side effects.

Quick facts

• Phase: Phase 1
• Study type: Interventional
• Enrollment: 49 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: City of Hope Medical Center (Academic / other)
• Drugs / interventions: bevacizumab, chemotherapy, doxorubicin
• Locations: 3 sites (Duarte, California and 2 other locations)
• Trial ID: NCT04329494 on ClinicalTrials.gov

What this trial studies

This phase I trial evaluates the safety and maximum tolerated dose of pressurized intraperitoneal aerosol chemotherapy (PIPAC) in patients with peritoneal carcinomatosis from ovarian, uterine, appendiceal, gastric, or colorectal cancers. The study involves administering chemotherapy drugs via a nebulizer during a minimally invasive laparoscopic procedure. Patients will be monitored for side effects, surgical complications, and treatment efficacy through various assessments, including imaging and quality of life questionnaires.

Who should consider this trial

Good fit: Ideal candidates include patients with histologically confirmed ovarian, uterine, gastric, appendiceal, or colorectal cancer with peritoneal carcinomatosis.

Not a fit: Patients with performance status greater than 2 or those with severe comorbidities may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could provide a new treatment option for patients with advanced abdominal cancers that have spread to the peritoneum.

How similar studies have performed: Other studies have shown promise with similar aerosol chemotherapy approaches, indicating potential for success in this novel application.

Eligibility criteria

Inclusion Criteria:

* Documented informed consent of the participant and/or legally authorized representative
* Patients must have histologically confirmed ovarian, uterine, gastric, appendiceal or colorectal cancer with PC
* Prior IP chemotherapy is permitted
* Eastern Cooperative Oncology Group (ECOG) performance status (PS) =\< 2
* Absolute neutrophil count (ANC) \>= 1500/mm\^3
* Platelets \>= 100,000/mm\^3
* Hemoglobin \>= 9 g/dl
* Serum total bilirubin =\< 1.5 x upper limit of normal (ULN)
* Alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase \[SGPT\]) and aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase \[SGOT\]) =\< 2.5 x ULN, unless liver metastases (Arm 1) are present or unless patients is know to have chronic liver disease (hepatitis) in which case AST and ALT must be =\< 5 x ULN
* Alkaline phosphatase =\< 2 x ULN
* Serum creatinine (sCr) =\< 1.5 x ULN, or creatinine clearance (Ccr) \>= 40 ml/min as calculated by the Cockcroft-Gault formula
* No contraindications for a laparoscopy
* The peritoneal disease does not have to be measurable by RECIST 1.1 but needs to be visible on cross sectional imaging or diagnostic laparoscopy
* Patients must have progressed on at least one evidence-based chemotherapeutic regimen (Arm 1 and 2). For Arm 3, patients should have stable or responsive disease on at least 4 months first-line systemic chemotherapy
* For patients with a known history of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated
* Patients with a known history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load
* Women of childbearing potential (WOCBP) and male patients with WOCBP partner must be using an adequate method of contraception to avoid pregnancy throughout the study and for up to 12 weeks after the last dose of investigational product in such a manner that the risk of pregnancy is minimized. WOCBP include any female who has experienced menarche and who has not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or is not postmenopausal. Post menopause is define as:

  * Amenorrhea \>= 12 consecutive months without another cause or
  * For women with irregular menstrual periods and on hormone replacement therapy (HRT), a documented serum follicle stimulating hormone (FSH) level \> 35 mIU/mL
  * Women who are using oral contraceptives, other hormonal contraceptives (vaginal products, skin patches, or implanted or injectable products), or mechanical products such as an intrauterine device or barrier methods (diaphragm, condoms, spermicides) to prevent pregnancy, or are practicing abstinence or where their partner is sterile (e.g., vasectomy) should be considered to be of childbearing potential
* INCLUSION TO PROCEED WITH PIPAC: Laparoscopy findings must meet all of the below criteria in order to proceed to PIPAC:

  * PIPAC access is feasible
  * There is room for aerosol therapy
  * There is no evidence of impending bowel obstruction
  * =\< 5 L of ascites
  * Not a candidate for cytoreduction and HIPEC

Exclusion Criteria:

* Gastric and colorectal/appendiceal:

  * Extra-peritoneal metastatic disease
* Arm 1 (ovarian, uterine, gastric): Previous treatment with maximum cumulative doses of doxorubicin, daunorubicin, epirubicin, idarubicin, and/or other anthracyclines and anthracenediones
* Arm 2 (colorectal/appendiceal): Known dihydropyrimidine dehydrogenase deficiency (DPD) deficiency
* Arm 2 (colorectal/appendiceal): Bowel obstruction requiring nasogastric tube, percutaneous endoscopic gastrostomy or exclusive total parenteral nutrition
* Arm 2 (colorectal/appendiceal): Prior unanticipated severe reaction or hypersensitivity to platinum based compounds
* Arm 2 (colorectal/appendiceal): Patients who have not recovered from adverse events due to prior anti-cancer therapy (i.e., have residual toxicities \> grade 1), with the exception of alopecia, hearing loss, or non-clinically significant laboratory abnormalities. Grade 2 peripheral neuropathy is permitted
* Arm 2 (colorectal/appendiceal): Life expectancy of less than 6 months
* Arm 2 (colorectal/appendiceal): Chemotherapy or surgery within the last 4 weeks prior to enrollment (6 weeks for prior bevacizumab therapy). Five half-lives for other anti-cancer agents
* Arm 2 (colorectal/appendiceal): Previous anaphylactic reaction to the chemotherapy drug used
* Arm 2 (colorectal/appendiceal): Patients may not be receiving any other investigational or concurrent anti-cancer agents
* Arm 2 (colorectal/appendiceal): Ascites due to decompensated liver cirrhosis; portal vein thrombosis
* Arm 2 (colorectal/appendiceal): Simultaneous tumor debulking with gastrointestinal resection
* Arm 2 (colorectal/appendiceal): Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, severe myocardial insufficiency, recent myocardial infarction, severe arrhythmias, severe renal impairment, myelosuppression, or severe hepatic impairment
* Arm 2 (colorectal/appendiceal): Immunocompromised patients such as those with an immunosuppressive medication or a known disease of the immune system
* Arm 2 (colorectal/appendiceal): Involvement in the planning and conduct of the study
* Arm 2 (colorectal/appendiceal): Pregnancy
* Arm 2 (colorectal/appendiceal): Patients with psychiatric illness/social situations that would limit compliance with study requirements
* Arm 2 (colorectal/appendiceal): New York Heart Association (NYHA) class 3 or 4; myocardial infarction, acute coronary syndrome, diabetes mellitus with ketoacidosis or chronic obstructive pulmonary disease (COPD) requiring hospitalization in the preceding 6 months
* Arm 2 (colorectal/appendiceal): Major systemic infection requiring antibiotics 72 hours or less prior to the first dose of study drug
* Arm 2 (colorectal/appendiceal): Exclusive total parenteral nutrition
* Arm 2 (colorectal/appendiceal): Prior intra-abdominal aerosol chemotherapy
* Arm 3 (colorectal/appendiceal): Progression on first- AND second-line systemic therapy
* Arm 3 (colorectal/appendiceal): Hematologic toxicities requiring significant dose reductions while on systemic chemotherapy
* Arm 3 (colorectal/appendiceal): Intolerance to prior 5-FU at 2400mg/m\^2 IV every 2 weeks or to irinotecan at 180mg/m\^2. Intolerance is defined as the need of significant dose reduction or treatment interruption of \> 1 week due to toxicity
* Arm 3 (colorectal/appendiceal): Known DPD deficiency
* Arm 3 (colorectal/appendiceal): Bowel obstruction requiring nasogastric tube, percutaneous endoscopic gastrostomy or exclusive total parenteral nutrition
* Arm 3 (colorectal/appendiceal): Patients who have not recovered from adverse events due to prior anti-cancer therapy (i.e., have residual toxicities \> grade 1), with the exception of alopecia, hearing loss, or non-clinically significant laboratory abnormalities. Grade 2 peripheral neuropathy is permitted
* Arm 3 (colorectal/appendiceal): Life expectancy of less than 6 months
* Arm 3 (colorectal/appendiceal): Chemotherapy or surgery within the last 2 weeks prior to enrollment (6 weeks for prior bevacizumab therapy). Five half-lives for other anti-cancer agents
* Arm 3 (colorectal/appendiceal): Previous anaphylactic reaction to the chemotherapy drug used
* Arm 3 (colorectal/appendiceal): Patients may not be receiving any other investigational anti-cancer agents
* Arm 3 (colorectal/appendiceal): Ascites due to decompensated liver cirrhosis; portal vein thrombosis
* Arm 3 (colorectal/appendiceal): Simultaneous tumor debulking with gastrointestinal resection
* Arm 3 (colorectal/appendiceal): Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, severe myocardial insufficiency, recent myocardial infarction, severe arrhythmias, severe renal impairment, myelosuppression, or severe hepatic impairment
* Arm 3 (colorectal/appendiceal): Immunocompromised patients such as those with an immunosuppressive medication or a known disease of the immune system
* Arm 3 (colorectal/appendiceal): Involvement in the planning and conduct of the study
* Arm 3 (colorectal/appendiceal): Pregnancy
* Arm 3 (colorectal/appendiceal): Patients with psychiatric illness/social situations that would limit compliance with study requirements
* Arm 3 (colorectal/appendiceal): New York Heart Association (NYHA) class 3 or 4; myocardial infarction, acute coronary syndrome, diabetes mellitus with ketoacidosis or chronic obstructive pulmonary disease (COPD) requiring hospitalization in the preceding 6 months
* Arm 3 (colorectal/appendiceal): Major systemic infection requiring antibiotics 72 hours or less prior to the first dose of study drug
* Arm 3 (colorectal/appendiceal): Exclusive total parenteral nutrition
* Arm 3 (colorectal/appendiceal): Prior intra-abdominal aerosol chemotherapy

Where this trial is running

Duarte, California and 2 other locations

• City of Hope Medical Center — Duarte, California, United States (Recruiting)
• Mayo Clinic in Florida — Jacksonville, Florida, United States (Recruiting)
• Northwell Health Cancer Institute at Huntington — Greenlawn, New York, United States (Recruiting)

Study contacts

• Principal investigator: Thanh H Dellinger, MD — City of Hope Medical Center

Conditions Clinical Stage IV Gastric Cancer AJCC v8; Clinical Stage IVA Gastric Cancer AJCC v8; Clinical Stage IVB Gastric Cancer AJCC v8; Malignant Uterine Neoplasm; Metastatic Appendix Carcinoma; Metastatic Colorectal Carcinoma; Metastatic Gastric Carcinoma; Metastatic Malignant Neoplasm in the Peritoneum