Evaluation of the Efficacy of Diuretics for Symptomatic Malignant Ascites Episodes in Advanced Stage of Cancer (DIASC)

• Status: Terminated
• Trial end date: 2018-12-24
• Target enrollment: 0
• Participant gender: All

Summary

While some authors recommend diuretics as the first treatment to initiate for symptoms caused by malignant ascites (MA), their prescription is variable. No randomized, controlled study has assessed their benefit in this context. According to literature, diuretics may bring relief in about 40% of cases, regardless of primary tumor.

The purpose of our study is to assess the effectiveness of diuretic treatment according to Serum Ascites Albumin Gradient (SAAG) measured before treatment. Judgment criteria is the time elapsed between recurrent MA that requires paracentesis. The investigators will also examine whether SAAG and serum levels of renin and aldosterone can predict symptom response to diuretics.

• Phase: Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Centre Oscar Lambret
• Collaborator: National Cancer Institute, France
• Treatments: Diuretics; Furosemide; Spironolactone

Criteria

Inclusion Criteria:

• Patients with advanced stage cancer

• First episode of malignant ascites

• Grade 2 or 3 ascites

• Clinically symptomatic ascites requiring paracentesis due to : abdominal pain or heaviness, dyspnoea, orthopnoea, nausea/vomiting, anorexia, early satiety, gastro-oesophageal reflux, lower limb and genital oedema

• Age ≥ 18 years

• Performance status ≤ 3

• Life expectancy ≥ 1 month

• Absence of contra-indication to diuretic treatment

• Patient regularly followed up by a palliative care or supportive care team

• Signed and dated informed consent

Exclusion Criteria:

• Hepatic disorders : cirrhosis, hepatitis, hepatocellular insufficiency, hepatic encephalopathy

• Non malignant ascites

• Hydroelectrolytic disorders: hyponatremia (< 130 mmol/L) or hyperkaliemia (> 5 mmol/L) or severe hypokaliemia (< 3 mmol/L)

• Functional acute renal insufficiency

• Urinary disorders : Obstruction in the urinary tract, Oliguria/anuria

• Chronic renal failure

• Patient unable to swallow

• Sulfamides allergy

• Hypersensitivity to spironolactone or to any of the excipients

• Hypersensitivity to furosemide or to any of the excipients

• Pregnant or breastfeeding women

• Patient under guardianship