Study of Intravenous and Intraperitoneal Paclitaxel and Oral Nilotinib for Peritoneal Carcinomatosis From Colorectal, Appendiceal, Small Bowel, Gastric, Cholangiocarcinoma, Breast, Ovarian, or Other Gynecologic Primary Cancer

NCT05185947Active, Not RecruitingPHASE2INTERVENTIONAL

Summary

Key Facts

Lead Sponsor

National Cancer Institute (NCI)

Enrollment

19

Start Date

2022-10-13

Completion Date

2025-01-27

Study Type

INTERVENTIONAL

Official Title

Phase II Study of Intravenous and Intraperitoneal Paclitaxel and Oral Nilotinib for Peritoneal Carcinomatosis From Colorectal, Appendiceal, Small Bowel, Gastric, Cholangiocarcinoma, Breast, Ovarian, or Other Gynecologic Primary Cancer

Interventions

PaclitaxelNilotinib

Conditions

Gynecologic CancerGynecologic NeoplasmsPeritoneal CarcinomatosisPeritoneal NeoplasmsOvarian CancerOvarian NeoplasmsColorectal CancerColorectal NeoplasmsAppendiceal CancerAppendiceal Neoplasms

Eligibility

Age Range

18 Years+

Sex

ALL

* INCLUSION CRITERIA:

In order to be eligible to participate in this study, an individual must meet all of the following criteria.

* Histological confirmation of peritoneal carcinomatosis from colorectal, appendiceal, small bowel, gastric, cholangiocarcinoma, breast, ovarian, or other gynecologic (i.e., endometrial, fallopian tube, primary peritoneal, cervical) primary by the Laboratory of Pathology, NCI.
* Participants must have been treated with at least one line of approved systemic chemotherapy, with demonstrated resistance or lack of response
* Measurable or evaluable disease as defined by RECIST v1.1. criteria and/or by Peritoneal Carcinomatosis Index (PCI)
* Participants must be assessed to not be candidates for cytoreductive surgery, with laparoscopically assessed PCI score thresholds as indicated below:

  --Primary Histology PCI Cutoff for Eligibility
  * Gastric Total Score \>= 10 (out of 39 possible points)
  * Others Total Score \>= 20 (out of 39 possible points)
  * Any Jejunoileal Score \>= 4 (out of 12 possible points)
* Age \>= 18 years
* ECOG performance status \<= 2 (Karnofsky \>= 60%).
* Participants must have adequate organ and marrow function as defined below:

  * Absolute neutrophil count \>= 1,000/mcL
  * Platelets \>= 100,000/mcL
  * Total bilirubin within \<= 1.5x institutional upper limit of normal (ULN)
  * AST (SGOT)/ ALT (SGPT) \<= 3x institutional ULN, or \<= 5.0x ULN in participants with liver metastases (only)
  * Serum potassium and magnesium greater than institutional lower limit of normal
  * Creatinine \<= 1.5 mg/dL or creatinine clearance \>= 60 mL/min/1.73 m\^2 for participants with creatinine levels above institutional normal calculated using eGFR
* Nursing (including breastfeeding) participant must agree to discontinue nursing.
* Individuals of child-bearing potential (IOCBP) must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation and for 90 days after last study treatment. Should an individual of child-bearing potential suspect to be pregnant while participating in this study, the individual should inform the treating physician immediately.
* Ability of participant to understand and the willingness to sign a written informed consent document.
* Participants must agree to co-enrollment on the tissue collection protocol 13C0176, Tumor, Normal Tissue and Specimens from Patients Undergoing Evaluation or Surgical Resection of Solid Tumors

EXCLUSION CRITERIA:

An individual who meets any of the following criteria will be excluded from participation in this study.

* Participants who are receiving any other investigational agents or who have received an investigational agent within 30 days prior to the start of study treatment.
* Participants with a history of allergic reactions attributed to compounds of similar chemical or biologic composition to study drugs.
* Participants who have received systemic (i.e., oral or intravenous) chemotherapy or other anti-cancer therapy (i.e., immunotherapy) within either 5 half-lives or within 30 days of the last dose of individual agent(s) administered prior to the start of study treatment, whichever is shorter.
* Participants who have undergone major abdominal surgery within the last 12 weeks prior to the start of study treatment.

Note: Exclusion of participants who have undergone major abdominal surgery within the last 12 weeks prior to start of study treatment is to allow for scar tissue formation from that surgery to stabilize. Participant ECOG performance status will be checked to account for prolonged or difficult recoveries from other types of major surgery that would appropriately influence eligibility assessment.

* Participants who have received previous intraperitoneal chemotherapy within the last 6 months prior to the start of study treatment
* Participants requiring the use of drugs known to prolong the QT interval or known to strongly inhibit CYP3A4, 2C8. Participants on such agents at the time of screening are permitted on study if an alternative that does not have the same pharmacokinetic interactions can be found.
* Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. Note: No subject will be excluded based on a social situation prior to consultation with the Department of Social Work.
* Pregnant individuals are excluded from this study.
* Participants with HIV who have detectable viral load, or whose ART contains QTc Prolonging Medications or CYP3A4 Inhibitors regardless of viral load. (NOTE: Participants with HIV who have an undetectable viral load and have been on stable doses of ART that does not prolong the QT interval or is a strong CYP3A4, 2C8 inhibitor are eligible).
* QTcF interval of \>= 450 msec at study entry, or congenital long QT syndrome.
* More than 3 liters of ascites present at initial laparoscopy, or history of more than two therapeutic paracentesis procedures, each yielding at least 1.5 liters of fluid, in the 30 days prior to initial laparoscopy, or confirmation of predominantly mucinous ascites at

the time of screening laparoscopy.

* Advanced hepatic failure, as indicated by Child-Pugh Class C cirrhosis.
* Sensory/motor neuropathy \>= Grade 2

Outcome Measures

Primary Outcomes

Evaluate efficacy of bidirectional chemotherapy using intraperitoneal and intravenous paclitaxel and oral nilotinib by calculating the rate of downstaging of peritoneal disease burden to become resectable, based on Peritoneal Carcinomatosis Inde...

Rate of downstaging- i.e., the fraction of participants who are successfully downstaged to resectable based on PCI and PI discretion. The fraction of participants who are successfully down-staged to resectable by use of chemotherapy will be reported along with a 95% confidence interval.

Time frame: baseline, every 9 weeks during treatment, and then every 3 months for 3 years

Secondary Outcomes

Measure overall survival (OS) and overall progression-free survival (PFS)

Kaplan-Meier method will be used; a 95% confidence interval will be reported on the median overall survival (OS) and overall progression-free survival (PFS).

Time frame: baseline, at peritoneal disease relapse from CR or peritoneal disease progression, or death, for up to 3 years after completion of therapy

Evaluate the peritoneal progression-free survival (pPFS) probability and the percentage of participants who become resectable by individual histologies

Peritoneal progression-free survival (pPFS) probability and the percentage of participants who become resectable will be evaluated by individual histologies; median peritoneal progression-free survival (pPFS) will be reported using the Kaplan-Meier method, along with a 95% confidence interval for each histology. The fraction who are able to be down-staged to resectable will be reported for each histology along with a 95% confidence interval.

Time frame: baseline, at peritoneal disease relapse from CR or peritoneal disease progression, for up to 3 years after completion of therapy

Evaluate safety and tolerability of therapy

Safety will be assessed by analyzing the type, grade and frequency of toxicities in addition to laboratory data and vital signs. Adverse events (AEs) will be assessed using CTCAE v.5.0

Time frame: on-going throughout treatment

Evaluate participants quality of life (QOL)

Outcomes from QOL will be reported using descriptive statistics, as well as comparing the results from before to after treatment: physical and mental health-related quality of life.

Time frame: baseline, every 9 weeks while on treatment, then every 3 months for 3 years after completion of study therapy

Determine peritoneal progression-free survival (pPFS)

Kaplan-Meier method will be used to evaluate peritoneal progression-free survival (pPFS); the median peritoneal progression-free survival (pPFS) will be reported along with a 95% two-sided confidence interval, to be done for all participants.

Time frame: baseline, at peritoneal disease relapse from CR or peritoneal disease progression, for up to 3 years after completion of therapy

Assess clinicopathologic response to therapy

Response rate by RECIST 1.1 and/or by PCI: the fractions with a clinical response will be reported for all participants along with a 95% confidence interval.

Time frame: baseline, every 9 weeks during treatment, and then every 3 months for 3 years

Locations

National Institutes of Health Clinical Center, Bethesda, United States