Temsirolimus, Carboplatin, and Paclitaxel as First-Line Therapy in Treating Patients With Newly Diagnosed Stage III-IV Clear Cell Ovarian Cancer
Condition: Ovarian Clear Cell Cystadenocarcinoma; Stage III Ovarian Cancer; Stage IV Ovarian Cancer
MeSH terms: Ovarian Neoplasms; Carcinoma, Ovarian Epithelial; Cystadenocarcinoma
Intervention: Carboplatin; Docetaxel; Laboratory Biomarker Analysis; Paclitaxel; Temsirolimus
Intervention description: Given IV; Given IV; Correlative studies; Given IV; Given IV
Intervention MeSH terms: Sirolimus; Paclitaxel; Docetaxel; Carboplatin; Albumin-Bound Paclitaxel; Temsirolimus; MTOR Inhibitors
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 90.0
Sex: Female
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      This phase II trial studies how well temsirolimus, carboplatin, and paclitaxel as first-line
      therapy works in treating patients with newly diagnosed stage III-IV clear cell ovarian
      cancer. Temsirolimus may stop the growth of tumor cells by blocking some of the enzymes
      needed for cell growth. Drugs used in chemotherapy, such as carboplatin and paclitaxel, work
      in different ways to stop the growth of tumor cells, either by killing the cells or by
      stopping them from dividing. Giving temsirolimus with combination chemotherapy may be an
      effective treatment for ovarian cancer.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients must have stage III or IV clear cell ovarian cancer; primary tumors must be
             at least 50% clear cell histomorphology in order to be eligible; in addition, the
             tumors should be negative for expression of Wilms tumor 1 (WT-1) antigen and estrogen
             receptor (ER) antigen by immunohistochemistry; appropriate tissue sections to confirm
             stage and histologic classification of cell type must be sent to Gynecologic Oncology
             Group (GOG) for central pathology review; immunohistochemical stained slides for ER
             and WT-1 antigen must be also be submitted to GOG for pathology review

          -  Patients who have met the pre-entry requirements

          -  Patients must have signed an approved informed consent and authorization permitting
             release of personal health information

          -  Patients with a GOG performance status of 0, 1, or 2

          -  Patients must be entered between 2 and 12 weeks after initial surgery; performed for
             the combined purpose of diagnosis, staging and cytoreduction

          -  Patients should be free of active infection requiring antibiotics (with the exception
             of uncomplicated urinary tract infection [UTI])

          -  Absolute neutrophil count >= 1,500/mcl

          -  Platelets >= 100,000/mcl

          -  Total bilirubin within normal institutional limits

          -  Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) =<
             2.5 times institutional upper limit of normal (< 5 times upper limit of normal [ULN]
             for subjects with liver metastases)

          -  Alkaline phosphatase =< 2.5 times institutional upper limit of normal (< 5 times ULN
             for subjects with liver metastases)

          -  Creatinine =< 1.5 x institutional upper limit of normal, grade 1 per CTCAE v. 4.0

          -  Cholesterol =< 350 mg/dL (fasting)

          -  Triglycerides =< 400 mg/dL (fasting)

          -  Albumin >= 3.0 g/dL

          -  Prothrombin time (PT) such that international normalized ratio (INR) is =< 1.5 (or an
             in-range INR, usually between 2 and 3, if a patient is on a stable dose of therapeutic
             warfarin for management of venous thrombosis including pulmonary thrombo-embolus)

          -  Partial thromboplastin time (PTT) < 1.2 times the upper limit of normal

          -  Neurologic function (sensory and motor) =< CTCAE grade 1

        Exclusion Criteria:

          -  Patients with a history of other invasive malignancies, with the exception of
             non-melanoma skin cancer, are excluded if there is any evidence of other malignancy
             being present within the last five years; patients are also excluded if their previous
             cancer treatment contraindicates this protocol therapy

          -  Patients who have received prior radiotherapy to any portion of the abdominal cavity
             or pelvis are excluded; prior radiation for localized cancer of the breast, head and
             neck, or skin is permitted, provided that it was completed more than five years prior
             to registration, and the patient remains free of recurrent or metastatic disease

          -  Patients who have received prior chemotherapy for any abdominal or pelvic tumor
             including neo-adjuvant chemotherapy for their clear cell ovarian cancer

          -  Patients with primary peritoneal and fallopian tube carcinoma are not eligible

          -  Previous treatment with an mTOR inhibitor (sirolimus, temsirolimus, everolimus),
             paclitaxel, or carboplatin

          -  Patients cannot be receiving enzyme-inducing antiepileptic drugs (enzyme-inducing
             antiepileptic drugs [EIAEDs]; e.g., phenytoin, carbamazepine, phenobarbital) nor any
             other cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4) inducer such as
             rifampin or St. John's Wort; use of agents that potently inhibit CYP3A4 (and hence may
             raise temsirolimus levels), such as ketoconazole, is discouraged, but not specifically
             prohibited; the appropriateness of use of such agents is left to physician discretion;
             strong CYP3A4 inhibitors are prohibited

          -  Patients receiving any investigational agents

          -  Patients with severely impaired lung function defined as a diffusion lung capacity for
             carbon monoxide (DLCO) =< 50% of the normal predicted value and/or oxygen (O2)
             saturation =< 88% at rest on room air

          -  Patients with symptomatic congestive heart failure of New York Heart Association class
             III or IV, unstable angina pectoris, symptomatic congestive heart failure, myocardial
             infarction =< 6 months of start of study drug, serious uncontrolled cardiac arrhythmia
             or any other clinically significant disease

          -  Patients with active bleeding or pathologic conditions that carry high risk of
             bleeding, such as known bleeding disorder, coagulopathy, or tumor involving major
             vessels

          -  Patients on maintenance corticosteroids are ineligible with the exception of short
             term use (fewer than 5 days)

          -  Patients with baseline requirement for oxygen

          -  Patients with serious concomitant illness which, in the opinion of the treating
             physician, will place patient at unreasonable risk from therapy on this protocol

          -  Patients who are pregnant or nursing; patients of childbearing potential must agree to
             use contraceptive measures during study therapy and for at least six months after
             completion of study therapies

          -  Patients with poorly controlled diabetes