E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Gastric cancer with peritoneal carcinomatosis or positive peritoneal cytology. |
Maagkanker met peritoneale metastasen of positieve peritoneale cytologie |
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E.1.1.1 | Medical condition in easily understood language |
Gastric cancer with metastasis located in the peritoneum or tumorcellen located in the abdominal fluid |
Maagkanker met buikvliesmetastasen of kankercellen in het buikvocht. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 16.0 |
E.1.2 | Level | HLT |
E.1.2 | Classification code | 10017812 |
E.1.2 | Term | Gastric neoplasms malignant |
E.1.2 | System Organ Class | 100000004856 |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 16.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10067093 |
E.1.2 | Term | Intraperitoneal hyperthermic chemotherapy |
E.1.2 | System Organ Class | 10042613 - Surgical and medical procedures |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
to study the safety, tolerability and feasibility of gastrectomy combined with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) after neoadjuvant systemic chemotherapy as primary treatment option for advanced gastric cancer with tumour positive peritoneal cytology (C+) and/or limited peritoneal carcinomatosis (P+). |
Om de veiligheid, verdraagbaarheid en de haalbaarheid van gastrectomie gecombineerd met cytoreductieve chirurgie en hypertherme intraperitoneale chemotherapie (HIPEC) na neoadjuvante systemische chemotherapie als primaire behandelingsoptie voor gevorderde maagkanker met tumor positieve peritoneale cytologie (C+) en / of een beperkte peritoneale metastasen (P+) te onderzoeken. |
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E.2.2 | Secondary objectives of the trial |
-to determine the maximum tolerated dose of intraperitoneal docetaxel in combination with a fixed dose regimen of intraperitoneal oxaliplatin in gastric cancer patients undergoing gastrectomy combined with CRS and HIPEC after neoadjuvant systemic chemotherapy with DOC or T-DOC in case of HER2-positive tumour -to investigate the pharmacokinetics of HIPEC after gastrectomy and CRS in patients with advanced gastric cancer and peritoneal dissemination -to study the effect of neoadjuvant systemic chemotherapy on peritoneal dissemination from gastric cancer (peritoneal cancer index before and after neoadjuvant chemotherapy). -to identify genetic profiles predictive of tumour response in patients with gastric cancer and peritoneal dissemination undergoing gastrectomy combined with CRS and HIPEC. -to determine the 2-year disease free and overall survival of advanced gastric cancer patients with tumour positive cytology and/or limited peritoneal carcinomatosis treated with CRS and HIPEC. |
-De maximale verdraagbare dosis van intraperitoneale docetaxel in combinatie met een vaste dosering van intraperitoneale oxaliplatine bij maagkanker patiënten die een gastrectomie gecombineerd met cytoreductieve chirurgie (CRS) en HIPEC na neoadjuvante systemische chemotherapie met DOC of T-DOC bij HER2-positieve tumor ondergaan. -Om de farmacokinetiek van HIPEC na gastrectomie en CRS bij patiënten met maagkanker en peritoneale verspreiding te onderzoeken. -Om het effect van neoadjuvante chemotherapie op peritoneale verspreiding van maagkanker (PCI vóór en na neoadjuvante chemotherapie) te bestuderen. -De genetische profielen voorspellend voor tumorrespons bij patiënten met maagkanker en peritoneale verspreiding die gastrectomie gecombineerd met CRS en HIPEC ondergaan te identificeren. -Om de 2-jaar ziektevrije en algehele overleving van maagkanker patiënten met een tumor positieve cytologie en/of een beperkte peritoneale metastasen behandeld met CRS en HIPEC te bepalen. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• Biopsy proven adenocarcinoma of the stomach (including tumours at the oesophagogastric junction provided that the bulk of the tumour is located in the stomach for which the intended surgical treatment is a gastric resection and not a resection of the oesophagus and cardia) • T3-T4 tumour based upon CT-scan and/or EUS results • Tumour positive peritoneal cytology and/or peritoneal carcinomatosis limited to the upper abdominal cavity (above the transverse colon) and/or at the most at one location in the lower abdominal cavity (e.g., Douglas’ pouch, ovarian metastasis, Sister Mary Joseph nodule) confirmed by diagnostic laparoscopy • Age ≥ 18 years • WHO performance status 0-1 • ASA classification I-III • Adequate bone marrow, hepatic and renal function, i.e., minimal acceptable laboratory values at start of the study inclusion: a. ANC ≥ 1.5 x 10^9 /L b. Platelet count ≥ 100 x 10^9 /L c. Serum bilirubin ≤ 1.5 x ULN, and ALAT and ASAT ≤ 2.5 x ULN d. Creatinine clearance ≥ 50 ml/min (measured or calculated by Cockcroft-Gault formula). • Wildtype for DPD*2A • Negative pregnancy test (urine/serum) for female patients of childbearing potential • Life expectancy ≥ 3 months allowing adequate follow up • Able and willing to undergo blood sampling for pharmacokinetics • Written informed consent |
• biopsie bewezen adenocarcinoom van de maag (waaronder tumoren op de oesophagogastric overgang op voorwaarde dat het merendeel van de tumor in de maag gelegen is en een maagresectie wordt uitgevoerd en niet een resectie van de slokdarm en cardia) • T3-T4 tumor op basis van CT-scan en / of EUS resultaten • Tumor positieve peritoneale cytologie en / of peritoneale metastasen beperkt tot de bovenste buikholte (boven de colon transversum) en / of hoogstens op een locatie in de onderste buikholte (bijvoorbeeld Douglas pouch, ovariale metastase, zuster Mary Joseph nodule) bevestigd door diagnostische laparoscopie • Leeftijd ≥ 18 jaar • WHO performance status 0-1 • ASA classificatie I-III • Adequate beenmerg-, lever- en nierfunctie, minimaal acceptabele laboratoriumwaarden bij aanvang van inclusie: a. ANC ≥ 1,5 x 10^9 / L b. Trombocyten ≥ 100 x 10^9 / L c. Serum bilirubine ≤ 1,5 x ULN, en ALAT en ASAT ≤ 2,5 x ULN d. Creatinineklaring ≥ 50 ml / min (gemeten of berekend door de Cockcroft-Gault formule). • Wildtype voor DPD * 2A • Negatieve zwangerschapstest (urine / serum) voor vrouwelijke patiënten die zwanger kunnen worden • De levensverwachting ≥ 3 maanden waardoor adequate follow-up • In staat en bereid om bloedafname voor farmacokinetiek ondergaan • Schriftelijke informed consent |
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E.4 | Principal exclusion criteria |
• Distant metastases (e.g., liver, lung, para-aortic lymph nodes) or small bowel dissemination • Signs of local irresectability • Recurrent gastric cancer • Metachronous peritoneal carcinomatosis • Prior treatment of gastric cancer with systemic anticancer therapy • Pregnancy, breast feeding or active pregnancy ambition • Unreliable contraceptive methods. Patients enrolled in this trial must agree to use a reliable contraceptive method throughout the study • Uncontrolled infectious disease or known Human Immunodeficiency Virus HIV-1 or HIV-2 type • A known history of hepatitis B or C with active viral replication • Recent myocardial infarction (< 6 months) or unstable angina. • Uncontrolled diabetes mellitus • Any medical condition not yet specified above that is considered to possibly, probably or definitely interfere with study procedures, including adequate follow-up and compliance and/or would jeopardize safe treatment • Known hypersensitivity for any of the applied chemotherapeutic agents and/or their solvents |
• Afstandsmetastasen (bv., lever-, long-, para-aortale lymfeklieren) of verspreiding dunne darm • Tekenen van lokale irresectabiliteit • Terugkerende maagkanker • Metachrone peritoneale carcinomatosis • Voor de behandeling van maagkanker met systemische therapie tegen kanker • Zwangerschap, borstvoeding of actieve zwangerschap ambitie • Onbetrouwbare anticonceptie. Patiënten die deelnemen aan deze studie moeten akkoord gaan met een betrouwbare anticonceptiemethode gedurende de studie • Ongecontroleerde infectieziekte of bekende Human Immunodeficiency Virus HIV-1 of HIV-2 Type • Een bekende geschiedenis van hepatitis B of C met actieve virale replicatie • Recent myocardinfarct (<6 maanden) of onstabiele angina. • Ongecontroleerde diabetes mellitus • Elke medische conditie nog niet boven gespecificeerd, die wordt beschouwd als mogelijk, waarschijnlijk of beslist verstorend voor deelname aan de studie procedures, met inbegrip van een adequate follow-up en / of wil veilige behandeling in gevaar brengen • Bekende overgevoeligheid voor een van de toegepaste chemotherapeutische middelen en / of de oplosmiddelen |
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E.5 End points |
E.5.1 | Primary end point(s) |
Treatment related toxicity (graded according to the NCI Common Toxicity Criteria version 4.0) |
Behandeling gerelateerde toxiciteit (beoordeeld door middel van de NCI Common Toxicity Criteria versie 4.0) |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
- postoperative morbidity and mortality - completion of the study protocol - pharmacokinetic parameters (systemic, intraperitoneal fluid concentrations of oxaliplatin and docetaxel) - cytoreductive completeness score - patterns of tumour recurrence - disease free and overall survival |
- Postoperatieve morbiditeit en mortaliteit - Afronding van het studie protocol - Farmacokinetische parameters (systemisch en intraperitoneaal vocht van oxaliplatin en docetaxel) - Cytoreductieve compleetheidsscore - Patronen terugkeer van de ziekte - Ziektevrije en totale overleving |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | Yes |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | Yes |
E.7.1.3.1 | Other trial type description |
Dose-escalation trial |
dosis-escalatie studie |
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E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 2 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 5 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |