Ovarian Cancer Clinical Trial
Official title:
Phase I/II Trial of Sequential Paclitaxel/Ifosfamide Followed by Dose-Escalated, Dose-Intensive Carboplatin, Paclitaxel and Ifosfamide With Stem Cell Support in Cisplatin-Resistant Germ Cell Tumor Patients
RATIONALE: Drugs used in chemotherapy, such as paclitaxel, ifosfamide, and carboplatin, work
in different ways to stop the growth of tumor cells, either by killing the cells or by
stopping them from dividing. Giving more than one drug (combination chemotherapy) may kill
more tumor cells. An autologous peripheral stem cell transplant may be able to replace
blood-forming cells that were destroyed by chemotherapy. This may allow more chemotherapy to
be given so that more tumor cells are killed.
PURPOSE: This phase I/II trial is studying the side effects and best dose of ifosfamide when
given together with paclitaxel and carboplatin followed by an autologous stem cell
transplant and to see how well they work in treating patients with germ cell tumors that did
not respond to cisplatin.
OBJECTIVES:
- Determine the safety of paclitaxel and ifosfamide followed by dose-escalated,
dose-intensive paclitaxel, carboplatin, and ifosfamide with autologous peripheral blood
stem cell support in patients with cisplatin-resistant germ cell tumor. (Phase I)
- Determine the maximum tolerated dose of paclitaxel, carboplatin, and ifosfamide when
given with a high-dose treatment program in these patients. (Phase I)
- Determine the efficacy of this regimen when given as salvage therapy in the second-line
or third-line setting, in terms of complete response, in these patients. (Phase II)
OUTLINE: This is a phase I, dose-escalation study of paclitaxel, carboplatin, and ifosfamide
followed by a phase II, open-label study.
- Phase I:
- Paclitaxel, ifosfamide, and autologous peripheral blood stem cell (PBSC)
collection: Patients receive paclitaxel IV over 3 hours on day 1 and ifosfamide IV
over 2 hours on days 1-3. Patients undergo leukapheresis on days 11-13. Patients
also receive filgrastim (G-CSF) subcutaneously (SC) twice daily beginning on day 3
and continuing until leukapheresis is completed. Beginning on day 14 or 21,
patients may receive a second course of paclitaxel, ifosfamide, and G-CSF.
Patients may also undergo additional leukapheresis.
- Paclitaxel, carboplatin, ifosfamide, and autologous PBSC transplantation: Patients
receive paclitaxel IV over 3 hours, high-dose carboplatin IV over 30 minutes, and
ifosfamide IV over 4 hours on days 1-3. Patients also receive G-CSF SC beginning
on day 3 and continuing until blood counts recover. Patients undergo reinfusion of
autologous PBSCs on day 5. Treatment repeats every 21-28 days for 3 courses in the
absence of disease progression or unacceptable toxicity.
Cohorts of 3-6 patients receive escalating doses of paclitaxel, carboplatin, and ifosfamide
until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose
preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.
- Phase II: Patients receive treatment as in phase I with paclitaxel, carboplatin, and
ifosfamide at the MTD determined in phase I.
After completion of study treatment, patients are followed periodically for 1 year and then
annually thereafter.
;
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
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