Clinical trial NCT01281800: Cisplatin With Alimta or Gemcitabine in Long Infusion for Mesothelioma
Official title: Cisplatin With Either Alimta or Gemcitabine in Long Infusion for Mesothelioma: A Randomised Phase II Trial (AGILI Trial)
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: PHASE2
Conditions: Mesothelioma
Lead sponsor: Institute of Oncology Ljubljana
Sponsor class: OTHER
Collaborators: name: Slovenian Research Agency
First posted: 2011-01-24
Enrollment: 72
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This is a randomised Phase II clinical trial to assess and compare efficacy and safety profile of cisplatin and pemetrexed against cisplatin and low-dose gemcitabine in long infusion.

Detailed description: Combination of pemetrexed and cisplatin is now considered the standard systemic treatment for mesothelioma. Three arguments against such a position are: 1. Pemetrexed in combination with cisplatin was registered for mesothelioma on the basis of superiority over cisplatin alone, a clearly suboptimal control arm; 2. Several Phase II trials of gemcitabine in standard doses or as low-dose in long infusion in combination with cisplatin have shown at least comparable activity; 3. Due to high cost, pemetrexed is not available to many patients in countries with limited health care resources. During the past five years, our research team in Ljubljana conducted a Phase II trial of low-dose gemcitabine (250 mg/m2) in 6-hours infusion and cisplatin for patients with mesothelioma. In an unselected population of patients including those in poor performance status, elderly, patients with advanced extrathoracic disease and patients in progression after previous chemotherapy, the response rate was 54%, and median survival was 16.5 months. On the basis of this favourable experience and in search of cost-effective treatment for mesothelioma, we here propose a randomised Phase II clinical trial to compare efficacy and safety profile of cisplatin and pemetrexed against cisplatin and low-dose gemcitabine in long infusion. The primary endpoints are response rate and time to progression; secondary endpoints are survival, toxicity and quality of life.

Eligibility criteria: Inclusion Criteria:

* histologically proven mesothelioma. While local histopathology exam is sufficient to register a patient for the trial, all biopsies will be subject to central review (please see Section 5.3.)
* no history of other malignancy; or in complete remission for \> 3 years if previously treated for other malignancy;
* chemo-naive;
* performance status ≥ 70% (Karnofsky); or ECOG 0 - 2 ;
* no peripheral neuropathy grade 2 or more (common toxicity criteria - CTC, NCI), unless mechanical in origin;
* no vascular disease grade 2 or more (NCI CTC ver.3);
* hemoglobin \> 100 g/L;
* neutrophils \> 2.0 g/L;
* platelets \> 100 x 109 /L;
* kidney function: creatinine within normal limits + ECC \> 60 mL/min; or ECC \> 100 mL/min;
* liver function: bilirubin \< 1.25 x UNL; AST/ALT \< 2 x UNL;
* cardiac compensation;
* no active infection or other serious concomitant disease;
* women are not pregnant
* patient's understanding of the disease and treatment and written informed consent.

Exclusion Criteria:

• significant medical co-morbidity

Primary outcomes:
measure: Progression free survival
timeFrame: CT measurement of disease will be performed after 2nd cycle of chemotherapy, at the end of the treatment and during follow up period up to progression (total average 8 months)
Secondary outcomes:
measure: Overall survival
timeFrame: Outcome measures will be assessed during average time period of 18 months from enrollment
Other outcomes:
Locations:
city: Ljubljana
country: Slovenia
facility: Institute of Oncology Ljubljana
Study officials:
affiliation: Institute of Oncology Ljubljana
name: Viljem Kovac, MD
role: PRINCIPAL_INVESTIGATOR
References: