Surgery and Heated Chemotherapy for Adrenocortical Carcinoma
Condition: Adrenocortical Carcinoma; Peritoneal Carcinomatosis
MeSH terms: Carcinoma; Peritoneal Neoplasms; Adrenocortical Carcinoma
Intervention: Cisplatin; Cytoreductive surgery; sodium thiosulfate
Intervention description: Patients who are successfully debulked will then undergo hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin.; Patients will undergo cytoreductive surgery to achieve a Completeness of Cytoreduction Score (CC) of 0 or 1.; sodium thiosulfate will be given to limit the toxicity of cisplatin
Intervention MeSH terms: Sodium thiosulfate
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 11.0
Sex: All
Minimum age: 18 Years
Maximum age: 99 Years
Healthy volunteers: No
Keywords: Synergy for Cisplatin and Hyperthermia; Rare Tumor; Poor Prognosis

Summary:

      Background:

      - Adrenocortical carcinoma (ACC) is a rare tumor of the adrenal gland. Few people who develop
      this disease live more than 5 years after being diagnosed. Those whose tumors have spread
      inside their abdomen may have an especially poor outcome. In these cases, traditional
      chemotherapy is not very effective. One possible new treatment is aggressive surgery with
      heated chemotherapy. This type of treatment has been more effective for other types of cancer
      in the abdomen. Researchers want to see this if approach can improve the outcomes of people
      with ACC.

      Objectives:

      - To test the safety and effectiveness of surgery and heated chemotherapy for ACC.

      Eligibility:

      - Individuals at least 18 years of age who have advanced ACC.

      Design:

        -  Participants will be screened with a physical exam and medical history. Blood samples
           will be collected. Heart function tests will be given. Imaging studies will be used to
           locate the surgical sites before the operation.

        -  Participants will have surgery to remove ACC tumor tissue. After the tumors have been
           removed, they will have heated chemotherapy with cisplatin. The heat may help weaken any
           remaining cancer cells and make them easier to destroy. It will also focus the treatment
           on the tumor sites, rather than the whole body.

        -  Participants will recover in the hospital for several days after surgery. They will have
           regular follow-up visits to monitor the outcome of the surgery.
    

Eligibility criteria:

        -  INCLUSION CRITERIA

          -  Histologically proven Adrenocortical carcinoma (ACC) with the majority of disease
             confined to the peritoneal cavity and resectable or amenable to radiofrequency
             ablation

          -  Disease evaluable by computed tomography (CT) or positron emission tomography (PET)
             imaging

          -  All disease should be deemed resectable based on imaging studies e.g.:

               -  Hepatic metastases (unilateral or bilateral less than or equal to 5 lesions, less
                  than or equal to 15 cm total diameter)

               -  Note: Hepatic lesions must be amenable to complete resection

               -  Primary peritoneal metastases (small disease load less than or equal to P2
                  disease) without massive ascites or intestinal obstruction

               -  Lung metastases (less than or equal to 3 unilateral/bilateral, 9 cm total
                  diameter)

               -  Note: lung lesions must be amenable to complete resection

               -  Note: Patients with both pulmonary and hepatic metastases will be enrolled at the
                  discretion of the principal investigator (PI)

               -  Note: In situations where resection to Completeness of Cytoreduction Score (CC) 0
                  or 1 is uncertain, patients may undergo diagnostic laparoscopy prior to
                  enrollment to determine feasibility of resection.

          -  Greater than or equal to 18 years of age

          -  Able to understand and sign the Informed Consent Document

          -  Clinical performance status of Eastern Cooperative Oncology Group (ECOG) less than or
             equal to 2

          -  Life expectancy of greater than three months

          -  Patients of both genders must be willing to practice birth control during and for four
             months after receiving chemotherapy

          -  Hematology:

               -  Absolute neutrophil count greater than 1500/mm^3 without the support of
                  Filgrastim.

               -  Platelet count greater than 75,000/mm^3.

               -  Hemoglobin greater than 8.0 g/dl.

          -  Chemistry:

               -  Serum creatinine less than or equal to 1.5 mg/dl unless the measured creatinine
                  clearance is greater than 60 mL/min/1.73 m2

               -  serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) within
                  5 times the upper limit of normal and a total serum bilirubin of less than 3
                  times the upper limit of normal, both of which define the upper limit of grade 2
                  treatment related toxicities.

               -  Prothrombin time (PT) within 2 seconds of the upper limit of normal
                  (international normalized ratio (INR) less than or equal to 1.8)

          -  Recovered from any toxicity to grade 2 or less from all prior chemotherapy,
             immunotherapy or radiotherapy and be at least 30 days past the date of their last
             treatment with the exception of mitotane which may be continued.

          -  Able to understand their disease and the exploratory nature of combining surgery and
             Heated Intraperitoneal Peritoneal Chemotherapy (HIPEC) for this histology.

        EXCLUSION CRITERIA

          -  Concomitant medical problems that would place the patient at unacceptable risk for a
             major surgical procedure.

          -  History of congestive heart failure and/or an left ventricular ejection fraction
             (LVEF) less than 40%

        Note: Patients at increased risk for coronary artery disease or cardiac dysfunction (e.g.,
        greater than 65yo, diabetes, history of hypertension, elevated low-density lipoproteins
        (LDL), first degree relative with coronary artery disease) will undergo full cardiac
        evaluation and will not be eligible if they demonstrate significant irreversible ischemia
        on stress thallium or an ejection fraction less than 40%.

        - Significant Chronic Obstructive Pulmonary Disease (COPD) or other chronic pulmonary
        restrictive disease with pulmonary function test (PFTs) indicating an forced expiratory
        volume 1 (FEV1) less than 50% or a Carbon monoxide diffusing capacity (DLCO) less than 40%
        predicted for age

        Note: Patients who have shortness of breath with minimal exertion or who are at risk for
        pulmonary disease (e.g., chronic smokers) will undergo pulmonary function testing and will
        not be eligible if their FEV1 is less than 50% of expected.

          -  Grade 2 or greater neuropathy

          -  Women of child-bearing potential who are pregnant or breastfeeding because of the
             potentially dangerous effects of the chemotherapy on the fetus or infant.

          -  Brain metastases or a history of brain metastases

          -  Childs B or C cirrhosis

          -  Evidence of severe portal hypertension by history, endoscopy, or radiologic studies

        Note: Any diagnosis of portal hypertension or clinical stigmata of such including but not
        limited to gastric or esophageal varices, umbilical vein varices or telangiectasias.

          -  Weight less than 30 kg

          -  Active systemic infections, coagulation disorders or other major medical illnesses of
             the cardiovascular, respiratory or immune system, myocardial infarction, cardiac
             arrhythmias, obstructive or restrictive pulmonary disease