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Pazopanib as Single Agent in Advanced NETs

This study is ongoing, but not recruiting participants.
Sponsor:
Information provided by (Responsible Party):
Grupo Espanol de Tumores Neuroendocrinos
ClinicalTrials.gov Identifier:
NCT01280201
First received: January 19, 2011
Last updated: July 1, 2013
Last verified: July 2013
  Purpose

The incidence of new diagnosed patients with NET of the digestive tract including carcinoid and pancreatic islet cells tumors ranges from 2 to 10 per 100,000 in the western Countries (Kulke M, Mayer R. N Engl J Med 340:858-868, 1999). Despite of the low incidence, the prevalence of these tumors is high because of their relatively long survival estimated in 35% at 5 years for those patients with well or moderate differentiated tumors (Yao JC, et al. J Clin Oncol. 2008;26:3063-3072). In fact, digestive NETs are the second most prevalent tumors derived from the digestive tract after colorectal carcinoma.

NETs are characterized by abundant vasculature, moreover VEGFR and VEGFR are overexpressed in 60-84% of the carcinoids and pancreatic islet cells NETs (Zhang et al. Cancer 2007;109:1478-1486). Other pro-angiogenic factors like the platelet derived growth factor (PDGFR) have been also involved in NET progression and development (Chaudhry A, et al.Cancer Res 1992;52:1006-12).

Pazopanib is an oral tyrosine kinase inhibitor of the VEGFR, PDGFR and KIT with a dual activity both as an antiangiogenic and also and anti-tumoral agent (Kumar et al. Mol Cancer Ther2007;6:2012-2021, Hurwitz et al. Clin Cancer Res 2009;15:4220-4227). Pazopanib seems to have a better toxicity profile versus the other antiangiogenic tyrosine kinase inhibitors and has already shown activity in several tumor types like renal cell carcinoma (Sternberg et al. J Clin Oncol 2009;27:abst. 5021), soft tissue sarcomas (Sleijfer et al. J Clin Oncol 2009;27:3126-32), hepatocellular carcinoma (Yau et al. J Clin Oncol 2009;27:abst. 3561), colorectal cancer (Brady et al. J Clin Oncol 2009;27:abst.4133), and thyroid cancers (Bible et al. J Clin Oncol 2009;27:abst. 3521).

The Spanish Group for Research in Neuroendocrine Tumors (GETNE) group is an active Member inside of the GENET group and has a large tradition in clinical trials in NETs. The investigators hypothesize that pazopanib may have at least as good activity and better safety profile than other VEGFR inhibitors in progressive advanced or metastatic NET tumors derived from the digestive tract.


Condition Intervention Phase
Advanced/Metastatic Neuroendocrine Tumors
Drug: Pazopanib
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase II, Open Label, Uncontrolled and Multicenter Trial of Pazopanib Given as a Single Agent in Patients With Progressive Advanced/Metastatic Neuroendocrine Tumors (NET): a Search for Activity, Safety, and Predictive Biomarkers

Resource links provided by NLM:


Further study details as provided by Grupo Espanol de Tumores Neuroendocrinos:

Primary Outcome Measures:
  • Clinical Benefit Rate at six months [ Time Frame: anticipated 3 years ] [ Designated as safety issue: No ]
    Defined as the percentage of patients with a confirmed CR or PR and SD as per RECIST 1.0 criteria at six months.


Secondary Outcome Measures:
  • Progression-Free Survival [ Time Frame: anticipated 3 years ] [ Designated as safety issue: No ]

    Defined as the time between the starting date of treatment and the earliest date of disease progression or death due to any cause.

    If the patient does not have a documented date of progression or death, then PFS will be censored at the date of last adequate assessment.


  • Radiological Objective Response Rate [ Time Frame: anticipated 3 years ] [ Designated as safety issue: No ]
    Defined as the sum of complete responses plus partial responses of the disease.

  • Duration of Response (DR) [ Time Frame: anticipated 3 years ] [ Designated as safety issue: No ]
    Defined, for the subset of patients with a confirmed CR o PR, as the time from first documented evidence of CR or PR until first documented disease progression or death due to any cause. The DR data will be censored the day after the last evaluation in those patients who did not present an objective tumoral progression and did not died during their participation in the trial. The DR will be assessed only in the subset of patients presenting objective response.

  • Time to Tumor Response (TTR) [ Time Frame: anticipated 3 years ] [ Designated as safety issue: No ]
    Defined as the time between the inclusion date until the first documentation of confirmed objective response.

  • Safety assessment criteria [ Time Frame: anticipated 3 years ] [ Designated as safety issue: Yes ]
    Security and tolerance to the study medication will be determined evaluating the type, incidence, severity, timing, seriousness and connections with the treatment of the reported adverse events, physical examinations and laboratory tests. Toxicity will be classified according to NCI-CTCAE v 4.0.

  • Biomarkers assessment [ Time Frame: anticipated 3 years ] [ Designated as safety issue: No ]

    To assess different related biomarkers and to correlate their variations with the clinical outcomes of the patients.

    Identify polymorphisms that could predict response of patients to pazopanib



Enrollment: 44
Study Start Date: December 2010
Estimated Study Completion Date: December 2013
Estimated Primary Completion Date: September 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Pazopanib Drug: Pazopanib
Single arm of pazopanib 800 mg (2x400mg) given once daily as a single agent.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Subjects must provide signed informed consent form prior to performance of study-specific procedures or assessments, and must be willing to comply with treatment and follow‑up.

    Procedures conducted as part of the subject's clinical routine (e.g., blood count, imaging study) and obtained prior to signing the consent form might be used for screening or baseline purposes provided these procedures have been conducted as specified in the protocol.

  2. Age ≥ 18 years.
  3. Diagnosis of pancreatic islet cell tumors, well differentiated gastrointestinal NETs, pulmonary carcinoids and well differentiated thymic carcinoids. Locally-advanced or metastatic disease documented as progressive by CT scan, MRI, or Octreoscan at baseline and within 12 months prior to baseline. The previous scans will be used to classify the patient as having progressive disease at baseline according to RECIST criteria. Octreoscan results may be used to document progressive disease at baseline, but not for RECIST determination during the study.
  4. ECOG performance status 0-1.
  5. Disease not amenable to surgery, radiation or combined modality therapy with curative intent.
  6. Presence of at least one dimensionally measurable target lesion for further evaluation according to RECIST 1.0 criteria (contrast enhancing lesion with the largest diameter > 1cm, based on CT or MRI scan done within 4 weeks before the start of treatment).
  7. Patients could have received treatment with somatostatin analogs, chemotherapy, anti-VEGF, and anti-mTOR agents previously to the entrance into this study if the final toxicity was grade ≤ 1.
  8. From patients who sign an informed consent form to donate biological samples: Tumor tissue must be provided for all available subjects at baseline and serum samples will be collected at baseline and at week 12 of treatment for biomarker analysis as defined at the biomarker section of this protocol.
  9. Adequate organ system function as follows:

    9.1.Hematologic system:

    • Absolute neutrophil count (ANC) ≥ 1.5 X 10^9/L
    • Hemoglobin (1) ≥ 9 g/dL (5.6 mmol/L)
    • Platelets ≥ 100 X 10^9/L
    • Prothrombin time (PT) or international normalized ratio (INR) ≤ 1.2 X upper limit of normal (ULN)
    • Partial thromboplastin time (PTT) ≤ 1.2 X ULN

    9.2.Hepatic system (2):

    • Total bilirubin ≤ 1.5 X ULN
    • AST and ALT ≤ 2.5 X ULN

    9.3.Renal system:

    • Serum creatinine ≤ 1.5 mg/dL (133 µmol/L),

    Or, if greater than 1.5 mg/dL:

    • Calculated creatinine clearance ≥ 50 mL/min

    (Note 1):"Subjects should not have had a transfusion within 7 days of screening assessment." (Note 2): "Concomitant elevations in bilirubin and AST/ALT above 1.0 x ULN are not permitted"

  10. A female is eligible to enter and participate in this study if she is of:

    10.1.Non-childbearing potential (i.e., physiologically incapable of becoming pregnant), including any female who has had:

    • A hysterectomy
    • A bilateral oophorectomy (ovariectomy)
    • A bilateral tubal ligation
    • Is post-menopausal

    10.2.Childbearing potential, including any female who has had a negative serum pregnancy test within 2 weeks prior to the first dose of study treatment, preferably as close to the first dose as possible, and agrees to use adequate contraception. GETNE acceptable contraceptive methods, when used consistently and in accordance with both the product label and the instructions of the physician, are as follow:

    • An intrauterine device with a documented failure rate of less than 1% per year.
    • Vasectomized partner who is sterile prior to the female subject's entry and is the sole sexual partner for that female.
    • Complete abstinence from sexual intercourse for 14 days before exposure to investigational product, through the dosing period, and for at least 21 days after the last dose of investigational product.
    • Double-barrier contraception (condom with spermicidal jelly, foam suppository, or film; diaphragm with spermicide; or male condom and diaphragm with spermicide).
    • Oral contraceptives
    • Female subjects who are lactating should discontinue nursing prior to the first dose of study drug and should refrain from nursing throughout the treatment period and for 14 days following the last dose of study drug.
  11. Life expectancy > 3 months.
  12. Able to swallow oral compound.
  13. Signed and dated informed consent document indicating that the patient has been informed of all pertinent aspects of the trial prior to enrollment.
  14. Willingness and ability to comply with scheduled visits, treatment plans, laboratory tests and other study procedures.

Exclusion Criteria:

  1. Diagnosis of any second malignancy within the last 5 years, except for adequately treated basal cell or squamous cell skin cancer, or in situ carcinoma of the cervix uteri.
  2. History or clinical evidence of central nervous system (CNS) metastases or leptomeningeal carcinomatosis, except for individuals who have previously-treated CNS metastases, are asymptomatic, and have had no requirement for steroids or anti-seizure medication for 6 months prior to first dose of study drug. Screening with CNS imaging studies (computed tomography [CT] or magnetic resonance imaging [MRI]) is required only if clinically indicated or if the subject has a history of CNS metastases.
  3. Clinically significant gastrointestinal abnormalities that may increase the risk for gastrointestinal bleeding including, but not limited to:

    3.1.Active peptic ulcer disease 3.2.Known intraluminal metastatic lesion/s with risk of bleeding 3.3.Inflammatory bowel disease (e.g. ulcerative colitis, Chrohn's disease), or other gastrointestinal conditions with increased risk of perforation 3.4.History of abdominal fistula, gastrointestinal perforation, or intra‑abdominal abscess within 28 days prior to beginning study treatment.

  4. Clinically significant gastrointestinal abnormalities that may affect absorption of investigational product including, but not limited to:

    4.1.Malabsorption syndrome 4.2.Major resection of the stomach or small bowel. 4.3.Active peptic ulcer disease 4.4.Known intraluminal metastatic lesion/s with risk of bleeding 4.5.Inflammatory bowel disease (e.g. ulcerative colitis, Chrohn's disease), or other gastrointestinal conditions with increased risk of perforation 4.6.History of abdominal fistula, gastrointestinal perforation, or intra‑abdominal abscess within 28 days prior to beginning study treatment.

  5. Presence of uncontrolled infection.
  6. Corrected QT interval (QTc) > 480 msecs using Bazett's formula.
  7. History of any one or more of the following cardiovascular conditions within the past 6 months:

    7.1.Cardiac angioplasty or stenting 7.2.Myocardial infarction 7.3.Unstable angina 7.4.Coronary artery bypass graft surgery 7.5.Symptomatic peripheral vascular disease 7.6.Class III or IV congestive heart failure, as defined by the New York Heart Association (NYHA)

  8. Poorly controlled hypertension [defined as systolic blood pressure (SBP) of ≥140 mmHg or diastolic blood pressure (DBP) of ≥ 90mmHg].
  9. History of cerebrovascular accident including transient ischemic attack (TIA), pulmonary embolism or untreated deep venous thrombosis (DVT) within the past 6 months.

    Note: Subjects with recent DVT who have been treated with therapeutic anti-coagulating agents for at least 6 weeks are eligible.

  10. Prior major surgery or trauma within 28 days prior to first dose of study drug and/or presence of any non-healing wound, fracture, or ulcer (procedures such as catheter placement not considered to be major).
  11. Evidence of active bleeding or bleeding diathesis.
  12. Known endobronchial lesions and/or lesions infiltrating major pulmonary vessels.
  13. Hemoptysis in excess of 2.5ml within 8 weeks of first dose of study drug.
  14. Any serious and/or unstable pre-existing medical, psychiatric, or other condition that could interfere with subject's safety, provision of informed consent, or compliance to study procedures.
  15. Unable or unwilling to discontinue use of prohibited medications list in Concomitant Medication Section for at least 14 days or five half-lives of a drug (whichever is longer) prior to the first dose of study drug and for the duration of the study.
  16. Treatment with any of the following anti-cancer therapies:

    • radiation therapy, surgery or tumor embolization within 28 days prior to the first dose of pazopanib, or
    • chemotherapy, immunotherapy, biological therapy, investigational therapy or hormonal therapy within 28 days prior to the first dose of pazopanib.
  17. Any ongoing toxicity from prior anti-cancer therapy that is > Grade 1 and/or that is progressing in severity, except alopecia.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01280201

Locations
Spain
Institut Català d'Oncologia L'Hospitalet
L'Hospitalet de Llobregat, Barcelona, Spain
Hospital Universitari Vall d'Hebron
Barcelona, Spain
Hospital Clínico San Carlos
Madrid, Spain
Hospital Universitario 12 de Octubre
Madrid, Spain
Hospital Universitario Ramón y Cajal
Madrid, Spain
Centro Integral Oncológico Clara Campal
Madrid, Spain
Hospital Universitario Virgen de la Victoria
Málaga, Spain
Hospital Universitari Son Espases
Palma de Mallorca, Spain
Hospital Universitario Virgen del Rocío
Sevilla, Spain
Hospital Clínico Universitario Lozano Blesa
Zaragoza, Spain
Sponsors and Collaborators
Grupo Espanol de Tumores Neuroendocrinos
Investigators
Study Chair: Enrique Grande Pulido, MD Grupo Espanol de Tumores Neuroendocrinos
  More Information

No publications provided

Responsible Party: Grupo Espanol de Tumores Neuroendocrinos
ClinicalTrials.gov Identifier: NCT01280201     History of Changes
Other Study ID Numbers: GETNE-1002, 2010-020749-28
Study First Received: January 19, 2011
Last Updated: July 1, 2013
Health Authority: Spain: Agencia Española de Medicamentos y Productos Sanitarios
Spain: Comité Ético de Investigación Clínica

Keywords provided by Grupo Espanol de Tumores Neuroendocrinos:
Neuroendocrine Tumors
Pazopanib
GETNE
Biomarkers

Additional relevant MeSH terms:
Neuroendocrine Tumors
Neoplasms
Neoplasms by Histologic Type
Neoplasms, Germ Cell and Embryonal
Neoplasms, Nerve Tissue
Neuroectodermal Tumors

ClinicalTrials.gov processed this record on November 25, 2014