Paclitaxel and Cisplatin or Topotecan With or Without Bevacizumab in Treating Patients With Stage IVB, Recurrent, or Persistent Cervical Cancer
Condition: Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Squamous Cell Carcinoma; Recurrent Cervical Carcinoma; Stage IVB Cervical Cancer
MeSH terms: Carcinoma; Uterine Cervical Neoplasms; Carcinoma, Adenosquamous; Recurrence
Intervention: Bevacizumab; Cisplatin; Laboratory Biomarker Analysis; Paclitaxel; Quality-of-Life Assessment; Questionnaire Administration; Topotecan Hydrochloride
Intervention description: Given IV; Given IV; Correlative studies; Given IV; Ancillary studies; Ancillary studies; Given IV
Intervention MeSH terms: Paclitaxel; Bevacizumab; Cisplatin; Albumin-Bound Paclitaxel; Topotecan; Antineoplastic Agents, Immunological; Endothelial Growth Factors; Antibodies; Immunoglobulins; Antibodies, Monoclonal; Immunoglobulin G
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 452.0
Sex: Female
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      This randomized phase III trial studies the side effects of paclitaxel when given together
      with cisplatin or topotecan with or without bevacizumab and to compare how well they work in
      treating patients with stage IVB, cervical cancer that has come back or is persistent. Drugs
      used in chemotherapy, such as paclitaxel, cisplatin, and topotecan, work in different ways to
      stop the growth of tumor cells, either by killing the cells, by stopping them from dividing,
      or by stopping them from spreading. Monoclonal antibodies, such as bevacizumab, may interfere
      with the ability of tumor cells to grow and spread. It is not yet known whether paclitaxel is
      more effective when given together with cisplatin or topotecan with or without bevacizumab in
      treating patients with cervical cancer.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients must have primary stage IVB, recurrent or persistent squamous cell carcinoma,
             adenosquamous carcinoma, or adenocarcinoma of the cervix which is not amenable to
             curative treatment with surgery and/or radiation therapy

          -  All patients must have measurable disease; measurable disease is defined as at least
             one lesion that can be accurately measured in at least one dimension (longest
             dimension to be recorded); each lesion must be >= 20 mm when measured by conventional
             techniques, including palpation, plain x-ray, computed tomography (CT), and magnetic
             resonance imaging (MRI), or >= 10 mm when measured by spiral CT; biopsy confirmation
             is required if the lesion(s) measures < 30 mm or if the treating physician determines
             it is clinically indicated; patients must have at least one "target lesion" to be used
             to assess response on this protocol as defined by Response Evaluation Criteria in
             Solid Tumors (RECIST); this lesion should be the one that was biopsied if one was
             performed; tumors within a previously irradiated field will be designated as
             "non-target" lesions unless progression is documented or a biopsy is obtained to
             confirm persistence at least 90 days following completion of radiation therapy

          -  Absolute neutrophil count (ANC) >= 1500/mcl

          -  Platelets >= 100,000/mcl

          -  Serum creatinine =< upper limit of normal (ULN) (Common Toxicity Criteria [CTC] grade
             0) or calculated creatinine clearance (Jeliffe formula) >= 60 ml/min

          -  Bilirubin =< 1.5 x institutional normal

          -  Serum glutamic oxaloacetic transaminase (SGOT) =< 2.5 x institutional normal

          -  Alkaline phosphatase =< 2.5 x institutional normal

          -  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

          -  Urine protein-creatinine ratio (UPC ratio) < 1.0

          -  Patients must have a GOG performance status of 0 or 1

          -  Patients must have recovered from the effects of surgery, radiation therapy, or
             chemoradiotherapy; at least six weeks must have elapsed from the last administration
             of chemoradiotherapy, and at least three weeks must have elapsed from the last
             administration of radiation therapy alone; at least six weeks must have elapsed from
             the time of any major surgical procedure prior to randomization

          -  Patients must have signed an approved informed consent and authorization permitting
             release of personal health information

          -  Patients must meet all of the pre-entry requirements, including baseline QOL
             questionnaire

          -  Patients must be free of active infection requiring antibiotics

        Exclusion Criteria:

          -  Patients with bilateral hydronephrosis which cannot be alleviated by ureteral stents
             or percutaneous drainage

          -  Patients previously treated with chemotherapy except when used concurrently with
             radiation therapy

               -  Patients who have received concurrent paclitaxel and/or concurrent topotecan with
                  radiation therapy are ineligible

          -  Patients with craniospinal metastases

          -  Patients with a concomitant malignancy other than non-melanoma skin cancer

          -  Patients with a prior invasive malignancy (except non-melanoma skin cancer) who have
             had any evidence of disease within the last 5 years or whose prior malignancy
             treatment contraindicates the current protocol therapy

          -  Patients with serious non-healing wound, ulcer, or bone fracture; this includes
             history of abdominal fistula, gastrointestinal perforation or intra-abdominal abscess
             for which an interval of 3 to 6 months must pass before study entry; in addition, the
             patient must have undergone correction (or spontaneous healing) of the
             perforation/fistula and/or the underlying process causing the fistula/perforation;
             patients with granulating incisions healing by secondary intention with no evidence of
             fascial dehiscence or infection are eligible but require weekly wound examinations

          -  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 with history or evidence upon physical examination of central nervous system
             (CNS) disease, including primary brain tumor, seizures not controlled with standard
             medical therapy, any brain metastases, or history of cerebrovascular accident (CVA,
             stroke), transient ischemic attack (TIA) or subarachnoid hemorrhage within six months
             of the first date of treatment on this study

          -  Patients with clinically significant cardiovascular disease; this includes:

               -  Uncontrolled hypertension, defined as systolic > 150 mm Hg or diastolic > 90 mm
                  Hg

               -  Myocardial infarction or unstable angina < 6 months prior to registration

               -  New York Heart Association (NYHA) grade II or greater congestive heart failure

               -  Serious cardiac arrhythmia requiring medication; this does not include
                  asymptomatic, atrial fibrillation with controlled ventricular rate

               -  CTCAE grade 2 or greater peripheral vascular disease (at least brief [< 24 hours
                  (hrs)]) episodes of ischemia managed non-surgically and without permanent
                  deficit)

               -  History of CVA within six months

          -  Patients with known hypersensitivity to Chinese hamster ovary cell products or other
             recombinant human or humanized antibodies

          -  Patients with or with anticipation of invasive procedures as defined below:

               -  Major surgical procedure, open biopsy or significant traumatic injury within 28
                  days prior to the first date of bevacizumab therapy

               -  Major surgical procedure anticipated during the course of the study; this
                  includes, but is not limited to abdominal surgery (laparotomy or laparoscopy)
                  prior to disease progression, such as colostomy or enterostomy reversal, interval
                  or secondary cytoreductive surgery, or second look surgery; please consult with
                  the study chair prior to patient entry for any questions related to the
                  classification of surgical procedures

               -  Core biopsy, within 7 days prior to randomization

          -  Patients who are pregnant or nursing; bevacizumab should not be administered to
             pregnant women; bevacizumab should not be administered to nursing women; patients of
             childbearing potential must agree to use contraceptive measures during study therapy
             and for at least six months after completion of bevacizumab therapy

          -  Patients who have received prior therapy with any anti-vascular endothelial growth
             factor (VEGF) drug, including bevacizumab

          -  Patients with clinical symptoms or signs of gastrointestinal obstruction and who
             require parenteral hydration and/or nutrition

          -  Patients with medical history or conditions not otherwise previously specified which
             in the opinion of the investigator should exclude participation in this study; the
             investigator should feel free to consult the Study Chair or Study Co-Chairs for
             uncertainty in this regard

          -  Patients with significant peripheral vascular disease

          -  Patients with pre-existing grade 2 or greater peripheral neuropathy