Intraperitoneal Paclitaxel for the Treatment of Patients with Metastatic Appendiceal Adenocarcinoma

Inclusion Criteria

• Age 18 years and above. There will be no upper age restriction
• Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2
• Patients must have histologically confirmed diagnosis of unresectable locally metastatic appendiceal adenocarcinoma and have undergone less than four prior lines of systemic therapy
• Patients must have adequate nutrition and normal bowel motility and function as evidenced by: * Albumin > 3.0 * No recent history (within last 2 mos) of bowel obstruction that resolved spontaneously or with surgical intervention * No history of internal intestinal bypass or diverting enterostomy
• Leukocytes ≥ 3000/mcL
• Absolute neutrophil count ≥ 1,500/mcL
• Platelets ≥ 75,000/mcL
• Total bilirubin ≤ institutional upper limit of normal (ULN)
• Creatinine ≤ 1.5 X institutional ULN
• For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated
• Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load
• Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
• The effects of PTX on the developing human fetus are unknown. For this reason, and because taxane agents as well as other therapeutic agents used in this trial are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. (Refer to Pregnancy Assessment Policy MD Anderson Institutional Policy # CLN1114). This includes all female patients, between the onset of menses (as early as 8 years of age) and 55 years unless the patient presents with an applicable exclusionary factor which may be one of the following: * Postmenopausal (no menses in greater than or equal to 12 consecutive months) * History of hysterectomy or bilateral salpingo-oophorectomy * Ovarian failure (follicle stimulating hormone and estradiol in menopausal range, who have received whole pelvic radiation therapy) * History of bilateral tubal ligation or another surgical sterilization procedure Approved methods of birth control are as follows: hormonal contraception (i.e., birth control pills, injection, implant, transdermal patch, vaginal ring), intrauterine device (IUD), tubal ligation or hysterectomy, subject/partner post vasectomy, implantable or injectable contraceptives, and condoms plus spermicide. Not engaging in sexual activity for the total duration of the trial and the drug washout period is an acceptable practice; however periodic abstinence, the rhythm method, and the withdrawal method are not acceptable methods of birth control. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and 4 months after completion of paclitaxel administration.
• Ability to understand and the willingness to sign a written informed consent document
• English and non-English-speaking patients

Exclusion Criteria

• Active infection such as pneumonia or wound infections that would preclude protocol therapy
• Subjects with unstable angina or New York Heart Association (NYHA) grade II or greater congestive heart failure
• Subjects deemed unable to comply with study and/or follow-up procedures (i.e., cognitive impairment)
• Subjects with a known hypersensitivity to protocol systemic chemotherapy that was life-threatening, required hospitalization or prolongation of existing hospitalization, or resulted in persistent or significant disability or incapacity
• Previous surgery that would preclude safe diagnostic laparoscopy with port placement
• Features of patient’s peritoneal disease that might increase the risk of small bowel obstruction and/or small bowel perforation as determined by review of radiographs * Foreshortening of small bowel mesentery and likelihood for dense adhesive disease * Areas concerning for abscess and/or contained perforation * Areas concerning for enteric fistula
• Patients with history of chronic abdominal pain requiring routine use of narcotic pain medication
• Patients with large volume ascites requiring repeated paracenteses
• Patients who have not recovered from adverse events (AE) due to prior anti-cancer therapy (i.e., have residual toxicities > grade 1) with the exception of alopecia
• Patients who are receiving any other investigational agents
• Patients with metastases outside the peritoneal cavity, with exception of limited metastases to the thoracic cavity
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to PTX or other agents used in study
• Patients with psychiatric illness/social situations that would limit compliance with study requirements
• Patients who are pregnant