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Gastric CancerCRS-IPNCT04547725

Complete Cytoreduction Followed by IP and Systemic Chemotherapies for Gastric Cancer With Peritoneal Carcinomatosis

A study testing CRS followed by IP and systemic chemotherapies in people with Gastric Cancer and Peritoneal Carcinomatosis, run by National Taiwan University Hospital at 1 site in Taiwan.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Background: Approximately 15% of gastric adenocarcinoma patients presents with peritoneal carcinomatosis (PC) at the first encounter and is regarded as an unresectable and end-stage disease. The recommended treatment with palliative chemotherapy alone yields a poor clinical efficacy. Read more about this study

Who is it for?
Ages 20 to 75 years
Conditions the study is for
Gastric Cancer, Peritoneal Carcinomatosis
What is being tested?
CRS followed by IP and systemic chemotherapies
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
48 participants
Where
1 siteTaiwan
Study dates
16 Sep 2020to 16 Sep 2028
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 20 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

[Inclusion criteria]

  1. Age 20 to 75 years old.
  2. Blood tests:
  3. White blood cells > 4,000/mm3, neutrophils > 1,500/mm3, platelets > 100,000/mm3.
  4. Serum creatinine < 1.5 mg/dl or creatinine clearance > 60 ml/min.
  5. Serum bilirubin < 2 mg/dl.
  6. Eastern Cooperative Oncology Group (ECOG) Performance Status = 0 or 1.
  7. Not legal incapacity.
  8. Newly diagnosed gastric adenocarcinoma, including Siewert III adenocarcinoma of the cardia, with limited peritoneal carcinomatosis (PCI ≤ 10) or positive peritoneal wash cytology (CY1/P0) .

[Exclusion criteria]

  1. Prior malignancy within 3 years or with detectable signs of recurrence.
  2. Newly diagnosed gastric adenocarcinoma having been treated by preoperative systemic or intraperitoneal chemotherapy.
  3. Presence of comorbidities, including liver cirrhosis (≥ Child B), decompensated heart failure (New York Heart Association [NYHA] Class III or IV congestive heart failure), poorly-controlled chronic obstructive pulmonary disease.
  4. ≥ American Society of Anesthesiologists Classification (ASA Class) Class 3.
  5. Pregnancy or breastfeeding.
  6. Intolerability of chemotherapeutic agents in this study:
  7. N-IPEC paclitaxel (all patients).
  8. Capecitabine or oxaliplatin (patients who receive CAPOX regimen).
  9. Cisplatin or 5-fluorouracil (patients who receive P-HDFL regimen).
  10. Distant metastases (e.g. liver, lung, bone) except for the peritoneum, intra-abdominal lymph node, and ovary.
  11. Extensive PC (PCI > 10).
  12. Siewert I or II adenocarcinoma of the cardia.
  13. Other patients inappropriate for this study in the opinion of the investigators.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Hung-Hsuan Yen, MD contact

0910012718

yhhdean@gmail.com

Taiwan1 site, 1 recruiting
  • National Taiwan University Hospital

    Taipei, 100

    I-Rue Lai, MDPHD, 0972651460, iruelai@gmail.com

    Recruiting

Other trials in Taiwan

About this study

Official title: Complete Cytoreductive Surgery With Combined Intraperitoneal and Systemic Chemotherapies for Gastric Adenocarcinoma Patients With Limited Peritoneal Carcinomatosis: an Open-label Two-stage Phase II Trial

Background: Approximately 15% of gastric adenocarcinoma patients presents with peritoneal carcinomatosis (PC) at the first encounter and is regarded as an unresectable and end-stage disease. The recommended treatment with palliative chemotherapy alone yields a poor clinical efficacy. Emerging evidences suggest the survival benefits of complete cytoreductive surgery (CRS) combined with normothermic intraperitoneal chemotherapy (N-IPEC) for gastric adenocarcinoma with limited PC.

Objective: To evaluate the 6-month disease control rate (DCR) of complete CRS combined with N-IPEC and systemic chemotherapy for gastric adenocarcinoma with limited PC.

Read more

Patients and methods: Patients having gastric adenocarcinoma with PCI ≤ 10 (Arm-A) or positive peritoneal wash cytology (CY1/P0) (Arm-B) will be enrolled. Patients with other distant metastasis, including brain, lung, liver, bone, will be excluded. All patients should undergo ≥ D2 gastrectomy and complete CRS followed by N-IPEC (paclitaxel] and systemic chemotherapy (high-dose fluorouracil and cisplatin [P-HDFL], or capecitabine and oxaliplatin [CAPOX]). N-IPEC (paclitaxel) will be administered in combination with systemic P-HDFL or CAPOX on day 1,8,15 or day 1,8 for each cycle, respectively. The disease status will be evaluated every 12 weeks based on the computed tomography scan, and the clinical evaluation (outpatient follow-up) will be performed every 2 weeks for whom receiving P-HDFL and every 3 weeks for whom receiving CAPOX. Patients will receive maximal 6 cycles N-IPEC with P-HDFL or 8 cycles N-IPEC with CAPOX. After N-IPEC is discontinued, P-HDFL or CAPOX will be continued alone until disease progression or death. The primary endpoint of this study is 6-month DCR, and the secondary endpoints include 6-month response rate for ascites, 1-year progression-free survival (PFS) and overall survival (OS), 3-year PFS and OS, and safety profiles. Based on Simon's minimax two-stage design, this trial will be carried out in two stages. In stage I, a total number of 13 (Arm-A) / 16 (Arm-B) patients is accrued. If there are ≤ 6 (Arm-A) / ≤ 14 (Arm-B) progression-free among these 13 (Arm-A) / 16 (Arm-B) patients, the study will be early stopped. Otherwise, additional 17 (Arm-A) / 2 (Arm-B) patients will be accrued in stage II, resulting in a total number sample size of 30 (Arm-A) / 18 (Arm-B).

Expected result: A ≥ 75% (Arm-A) / ≥ 95% (Arm-B) 6-month DCR could be achieved for gastric adenocarcinoma patients with limited PC (Arm-A) / with CY1P0 (Arm-B) via this treatment strategy (complete CRS + N-IPEC + P-HDFL or CAPOX) -i.e., if there are ≥ 21 (Arm-A) / ≥ 16 (Arm-B) progression-free among the 30 (Arm-A) / 18 (Arm-B) enrolled patients, we will reject the null hypothesis and claim that the treatment is promising.

Read the detailed description

Background: Approximately 15% of gastric adenocarcinoma patients presents with peritoneal carcinomatosis (PC) at the first encounter and is regarded as an unresectable and end-stage disease. The recommended treatment with palliative chemotherapy alone yields a poor clinical efficacy and long-term prognosis. Emerging evidences suggest the survival benefits of complete cytoreductive surgery (CRS) combined with intraperitoneal chemotherapy (IP) for gastric adenocarcinoma with limited PC. Previous studies focused on the CRS combined with hyperthermic IP chemotherapy (HIPEC); however, the high morbidity and mortality rates of HIPEC have raised a safety concern and limited the clinical application. The normothermic IP chemotherapy (N-IPEC), on the other hand, is a safer and gentler type of IP chemotherapy, and has gained in popularity and been evaluated in many recent clinical trials. The criteria for patient selection and standard protocol of complete CRS combined with N-IPEC and systemic chemotherapy remain to be determined. Moreover, treatment efficacy regarding this strategy is still suboptimal.

Objective: To evaluate the 6-month disease control rate (DCR) of complete CRS combined with N-IPEC (paclitaxel) and systemic chemotherapy (high-dose fluorouracil and cisplatin; [P-HDFL], or capecitabine and oxaliplatin [CAPOX]) for gastric adenocarcinoma patients with limited PC (peritoneal carcinomatosis index [PCI] ≤ 10) (Arm-A) or positive peritoneal wash cytology (CY1/P0) (Arm-B).

Patients and methods: Patients having resectable advanced gastric adenocarcinoma with limited PC (PCI ≤ 10) (Arm-A) or positive peritoneal wash cytology (CY1/P0) (Arm-B) will be enrolled. Patients with distant metastasis other than PC, including brain, lung, liver, bone, will be excluded. All patients should undergo D2 or more extensive gastrectomy and complete CRS followed by N-IPEC (paclitaxel) and systemic chemotherapy (P-HDFL or CAPOX). N-IPEC with paclitaxel 20 mg/m2 will be administered in combination with systemic P-HDFL or CAPOX on day 1,8,15 or day 1,8 for each cycle, respectively. Peritoneal cytology will be collected at the surgery and on day 1 of each treatment cycle. The disease status and ascites amount will be evaluated every 12 weeks based on the computed tomography scan, and the clinical evaluation (outpatient follow-up) will be performed every 2 weeks for whom receiving P-HDFL and every 3 weeks for whom receiving CAPOX. Patients will receive maximal 6 cycles N-IPEC with P-HDFL (total 18 courses of N-IPEC) or 8 cycles N-IPEC with CAPOX (total 16 courses of N-IPEC). After N-IPEC is discontinued, P-HDFL or CAPOX will be continued alone until disease progression or death. The primary endpoint of this study is 6-month DCR, and the secondary endpoints include 6-month response rate for ascites, 1-year progression-free survival (PFS) and overall survival (OS), 3-year PFS and OS, and safety profiles. Based on Simon's minimax two-stage design, this trial will be carried out in two stages. In stage I, a total number of 13 (Arm-A) / 16 (Arm-B) patients is accrued. If there are ≤ 6 (Arm-A) / ≤ 14 (Arm-B) progression-free among these 13 (Arm-A) / 16 (Arm-B) patients, the study will be early stopped. Otherwise, additional 17 (Arm-A) / 2 (Arm-B) patients will be accrued in stage II, resulting in a total number sample size of 30 (Arm-A) / 18 (Arm-B).

Expected result: A ≥ 75% (Arm-A) / ≥ 95% (Arm-B) 6-month DCR could be achieved for gastric adenocarcinoma patients with limited PC (Arm-A) / with CY1P0 (Arm-B) via this treatment strategy (complete CRS + N-IPEC + P-HDFL or CAPOX) -i.e., if there are ≥ 21 (Arm-A) / ≥ 16 (Arm-B) progression-free among the 30 (Arm-A) / 18 (Arm-B) enrolled patients, we will reject the null hypothesis and claim that the treatment is promising.

Being tested
CRS followed by IP and systemic chemotherapies
Keywords
gastric cancer, peritoneal carcinomatosis, cytoreductive surgery, intraperitoneal chemotherapy
Medical subject headings
Stomach Neoplasms, Peritoneal Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • CRS followed by IP and systemic chemotherapiesOther

    Complete cytoreductive surgery (CRS) + normothermic intraperitoneal chemotherapy (N-IPEC) + systemic chemotherapy

Study groups in NCT04547725
Study groupRoleWhat they receive
CRS-IP (Arm-A)ExperimentalStage IV gastric cancer with limited peritoneal carcinomatosis (peritoneal carcinomatosis index [PCI] ≤ 10)
Receives: Other: CRS followed by IP and systemic chemotherapies
CRS-IP (Arm-B)ExperimentalStage IV gastric cancer with positive peritoneal wash cytology (CY1/P0)
Receives: Other: CRS followed by IP and systemic chemotherapies

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. 6-month disease control rate

    The 6-month disease control rate is defined as the percentage of patients with no occurrence of radiological PD (per RECIST 1.1), clinical PD (based on investigator's judgement), or death from any cause, after 24 weeks (~ 6 months) from the beginning of combined IP and systemic chemotherapies.

    Measured: 6 months

Secondary outcomes (4)
  1. Progression-free survival (PFS)

    The 1-year and 3-year PFS, defined as the time from the date of enrollment until the date of PD or death from any cause, whichever is earliest, during the first and the first three years of the study, respectively.

    Measured: 3 years

  2. Overall survival (OS)

    The 1-year and 3-year OS, defined as the time from the date of enrollment until the date of death from any cause, during the first and the first three years of the study, respectively.

    Measured: 3 years

  3. 6-month response rate for ascites.

    The 6-month response rate for ascites: the percentage of patients with complete disappearance (CR-ascites) or a dramatic decrease in ascites (PR-ascites) at the time when the 6-month disease control rate is evaluated.

    Measured: 6 months

  4. Safety evaluation

    Safety endpoints, including surgery-related complications, toxicities of chemotherapy, and intraperitoneal port/catheter-related complications, will be evaluated throughout the treatment period (at every follow-up visit), and then 30 days and 90 days after the treatment period is discontinued.

    Measured: 9 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted14 Sep 2020
  2. Study start16 Sep 2020
  3. Primary completion16 Mar 2026 (estimated)
  4. Study completion16 Sep 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Single group
Model description
Complete cytoreductive surgery followed by intraperitoneal and systemic chemotherapies
Masking
None (open label)
Enrolment
48 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04547725
Sponsor's protocol ID
202006125RINC
Acronym
CRS-IP
Status last verified
Apr 2024
First submitted
2 Sep 2020
Last updated
16 Apr 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing CRS followed by IP and systemic chemotherapies in people with Gastric Cancer and Peritoneal Carcinomatosis, run by National Taiwan University Hospital at 1 site in Taiwan.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 16 Apr 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Taiwan. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Hung-Hsuan Yen, MD (0910012718, yhhdean@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

6-month disease control rate (time frame: 6 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Apr 2024.

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