Esophageal Cancer Clinical Trial
Hepatic Arterial Infusion of Melphalan With Hepatic Perfusion in Treating Patients With Unresectable Liver Cancer
Summary
RATIONALE: Hepatic arterial infusion uses a catheter to deliver anticancer substances directly into the liver. Drugs used in chemotherapy, such as melphalan, work in different ways to stop tumor cells from dividing so they stop growing or die. Giving drugs in different ways may kill more tumor cells.
PURPOSE: This phase II trial is studying how well giving an hepatic arterial infusion of melphalan together with hepatic perfusion works in treating patients with unresectable liver cancer.
Full Description
OBJECTIVES:
Primary
Determine the response rate and duration of response in patients with unresectable primary or metastatic liver cancer treated with intrahepatic arterial infusion of melphalan with venous filtration via peripheral hepatic perfusion.
Secondary
Determine the patterns of recurrence in patients treated with this regimen.
Determine progression-free and overall survival of patients treated with this regimen.
Evaluate the safety and tolerability of this regimen in these patients.
Assess the filter characteristics including melphalan pharmacokinetics and filtration of cytokines and clotting factors during and after treatment.
OUTLINE: Patients are stratified according to primary tumor histology (neuroendocrine tumor vs primary hepatic malignancy vs adenocarcinoma of gastrointestinal or other origin).
Patients undergo peripheral isolated hepatic perfusion in which a catheter is placed via the groin into the hepatic artery and another into the hepatic vein. Patients then receive melphalan as an intrahepatic arterial infusion over 15-30 minutes. Treatment repeats approximately every 3-8 weeks for up to 6 total infusions in the absence of disease progression or unacceptable toxicity.
Patients are followed every 3 months for 2 years, every 4 months for 1 year, and then periodically thereafter.
PROJECTED ACCRUAL: A total of 105 patients will be accrued for this study within 4-5 years.
Eligibility Criteria
DISEASE CHARACTERISTICS:
Histologically or cytologically confirmed hepatic malignancy
Unresectable disease
Disease predominantly in the parenchyma of the liver
One of the following primary tumor histologies:
Adenocarcinoma of gastrointestinal or other origin
Neuroendocrine tumor (except gastrinoma)
Primary hepatic malignancy (e.g., hepatocellular cancer or intra-hepatic cholangiocarcinoma)
Cutaneous or ocular melanoma (patients must have received prior regional melphalan therapy)
Hepatic metastases from colorectal tumors allowed provided patient has undergone prior first-line chemotherapy, including irinotecan or oxaliplatin
Limited unresectable extrahepatic disease on preoperative radiological studies allowed if life-limiting component of progressive disease is in the liver
Limited extrahepatic disease includes, but is not limited to, the following:
Up to 4 pulmonary nodules each < 1 cm in diameter
Retroperitoneal lymph nodes each < 3 cm in diameter
Less than 10 skin or subcutaneous metastases each < 1 cm in diameter
Asymptomatic bone metastases that have been or could be palliatively treated with external beam radiotherapy
Resectable solitary metastasis to any site
Hormone receptor status:
Not specified
PATIENT CHARACTERISTICS:
Age
16 and over
Sex
Male or Female
Menopausal status
Not specified
Performance status
ECOG 0-2
Life expectancy
Not specified
Hematopoietic
Platelet count ≥ 75,000/mm^3
Hematocrit > 27%
Absolute neutrophil count ≥ 1,300/mm^3
Hepatic
Bilirubin ≤ 2.0 mg/dL
PT ≤ 2 seconds of upper limit of normal (ULN)
AST and ALT ≤ 10 times ULN
No Childs class B or C cirrhosis
No portal hypertension by history, endoscopy, or radiologic studies
Renal
Creatinine ≤ 1.5 mg/dL OR
Creatinine clearance > 60 mL/min
Cardiovascular
No congestive heart failure
LVEF ≥ 40%
Pulmonary
No chronic obstructive pulmonary disease
FEV_1 ≥ 30% of predicted
DLCO ≥ 40% of predicted
Immunologic
No active infection
No severe allergic reaction to iodine contrast agent that is not controlled by premedication with antihistamines or steroids
No known hypersensitivity reaction to melphalan or heparin in the presence of a heparin induced thrombocytopenia (HIT) antibody
Other
Weight > 35 kg
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
No documented latex allergy
No evidence of intracranial abnormalities which would lead to risk for bleeding with anticoagulation (e.g., stroke or active metastasis)
No evidence of active ulcer disease
PRIOR CONCURRENT THERAPY:
Biologic therapy
More than 1 month since prior biologic therapy and recovered
Chemotherapy
See Disease Characteristics
More than 1 month since prior chemotherapy and recovered
Endocrine therapy
Premenopausal women (i.e., have had a period within the past 12 months) must be willing to undergo hormonal suppression during study treatment
Radiotherapy
See Disease Characteristics
More than 1 month since prior radiotherapy and recovered
Surgery
No prior Whipple resection
Other
Prior intrahepatic perfusion (with or without arterial infusion with floxuridine) or peripheral hepatic perfusion allowed provided the patient had a radiographic partial response of 3 months' duration after therapy
No concurrent immunosuppressive drugs
No concurrent chronic anticoagulation therapy
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There is 1 Location for this study
Bethesda Maryland, 20892, United States
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