Gemcitabine Plus Rapamycin Versus Gemcitabine to Treat Advanced Soft Tissue Sarcoma

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Grupo Espanol de Investigacion en Sarcomas
ClinicalTrials.gov Identifier:
NCT01684449
First received: June 30, 2011
Last updated: February 5, 2014
Last verified: February 2014
  Purpose

The soft tissue sarcomas (STS) constitute an infrequent group of malignant neoplasms of mesenchymal origin. In Spain, the approximate incidence is of 2 new cases per 100.000 inhabitants every year. In patients with metastatic STS, the average survival is very short, approximately 12 months. The systemic treatment of the metastatic disease has had a very limited development, with few satisfactory results. This facts reflect the urgent need to identify new active agents for treatment of these patients.

The molecular pathway of the serine/threonine kinase mammalian target of rapamycin (mTOR) plays a central role in the regulation of the proteins translation, cellular growth and metabolism (Meric-Bernstam F et al. 2009). Currently, the mTOR pathway is considered a relevant target for the development of anti-cancer drugs, as rapamycin. Preliminary results of some clinical trials suggest that mTOR inhibitors could have some clinical activity for different types of sarcoma, including STS (Chawla et al Proc.ASCO 2006; Schuetze et al. Proc.ASCO 2006).

Gemcitabine is a chemotherapy antimetabolite agent with a broad antitumoral spectrum. The activity of this drug to treat resistant sarcomas and its reduced toxicity make from gemcitabine an adequate candidate for its study in combination with new drugs addressed to molecular targets in the STS treatment.

Pre-clinical studies suggest that mTOR inhibitors could have a potential synergistic or additive effect with some chemotherapy agents. The combination of rapamycin and gemcitabine seems to be a reasonable strategy to explore for the STS treatment.


Condition Intervention Phase
Advanced Soft Tissue Sarcoma
Drug: Gemcitabine + Rapamycin
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase 1/2, Randomized, Multicenter, Prospective Study of Gemcitabine and Rapamycin (Sirolimus) Combination Versus Gemcitabine Only to Treat Advanced Soft Tissue Sarcoma

Resource links provided by NLM:


Further study details as provided by Grupo Espanol de Investigacion en Sarcomas:

Primary Outcome Measures:
  • Phase 1: Determination of dosage: Security and toxicity of the combination gemcitabine and rapamycin. [ Time Frame: 15 months ] [ Designated as safety issue: Yes ]
    Type, frequency, seriousness and relation with the treatment of the adverse events in patients treated with the investigational medicinal products.

  • Phase 2: Progression Free Survival [ Time Frame: 12 months ] [ Designated as safety issue: No ]
    Progression free survival rate at 3 months to compare the effectiveness of the the treatment.


Secondary Outcome Measures:
  • Phase 2: Overall Survival [ Time Frame: 12 months ] [ Designated as safety issue: No ]
    Overall survival rate of the patients included in the experimental arm.

  • Phase 2: Toxicity [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]
    Tolerance to the drugs combination of the patients treated with gemcitabine + sirolimus

  • Phase 1 and 2: Assessment of molecular biomarkers [ Time Frame: 36 months ] [ Designated as safety issue: No ]
    Assess, both in models of sarcomas induced in immunodeficient mice and tumor samples from patients enrolled in the trial, the predictive value of the response to combination therapy of certain molecular markers for survival and mTOR pathway.


Enrollment: 28
Study Start Date: January 2010
Study Completion Date: December 2013
Primary Completion Date: May 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Phase 2: Experimental Arm
Gemcitabine + rapamycin at recommended dose of Phase 1. Recommended dose is defined as, the dose one level below of the (MTD). Being MTD, the dose of the cohort in which a maximum of one patient of 6 has presented dose-limiting toxicity (DLT).
Drug: Gemcitabine + Rapamycin

Gemcitabine + rapamycin at recommended dose of Phase 1. Recommended dose is defined as, the dose one level below of the (MTD). Being MTD, the dose of the cohort in which a maximum of one patient of 6 has presented dose-limiting toxicity (DLT).

Every three weeks until disease progression or unacceptable toxicity. The treatment will last for 6 cycles if there is not progression or intolerable toxicity.

Additionally, there will be a pharmacokinetic study in a minimum of 9 patients treated with the drug combination.


  Eligibility

Ages Eligible for Study:   18 Years to 70 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Patients with anatomopathological diagnosis of metastatic or locally advanced unresectable soft tissue sarcoma (STS). Patients with the following STS types will be excluded: chondrosarcoma, Ewing's sarcoma and embryonal or alveolar rhabdomyosarcoma. In phase 1 it will be allowed to include patients having other types of advanced cancer which are resistant to the standard treatment and can benefit from any of the study drugs.
  2. Prior treatment with chemotherapy including doxorubicin and ifosfamide, or contraindication for its administration. The previous treatment with gemcitabine or inhibitors of mTOR is not allowed.
  3. Age ≥ 18 y ≤ 70 years.
  4. ECOG performance status: 0 - 1. In Phase 1 only patients with ECOG 0-1 will be enrolled.
  5. Disease measurable according to RECIST criteria. Proven relapsed disease.
  6. Adequate bone marrow function, defined as neutrophil count ≥ 1.500/mm^3 and platelets ≥ 100.000/mm^3.
  7. Adequate renal and hepatic function , defined as calculated creatinine clearance ≥ 60 ml/min, creatinine, total bilirubin, AST and/or ALT ≤ 1,5 times the upper limit of normal (ULN).
  8. Informed consent form signed by the patient prior to the beginning of the treatment.

Exclusion Criteria:

  1. History of previous cancer diagnosed or treated in the past 5 years except basal cell carcinoma, cervical carcinoma in situ or superficial bladder cancer.
  2. Presence of brain metastases.
  3. Active infection or other severe concomitant diseases.
  4. Concurrent treatment with other experimental drugs within 30 days prior to study entry.
  5. Pregnancy or breastfeeding.
  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: NCT01684449

Locations
Spain
H. Universitario de Canarias
Tenerife, Santa Cruz de Tenerife, Spain, 38320
H. Sant Pau
Barcelona, Spain, 08024
Institut Català d'Oncologia - Hospital Duran i Reynals
L'Hospitalet de Llobregat, Spain
Hospital Universitario 12 de Octubre
Madrid, Spain
H. La Paz
Madrid, Spain
Hospital Universitario Puerta de Hierro
Majadahonda, Spain
H. Son Espases
Mallorca, Spain
Instituto Valenciano de Oncología
Valencia, Spain
H. Universitario Miguel Servet
Zaragoza, Spain, 50009
Sponsors and Collaborators
Grupo Espanol de Investigacion en Sarcomas
Investigators
Study Chair: Xavier García del Muro Solans, MD GEIS
  More Information

No publications provided

Responsible Party: Grupo Espanol de Investigacion en Sarcomas
ClinicalTrials.gov Identifier: NCT01684449     History of Changes
Other Study ID Numbers: GEIS-24, 2009-017232-41
Study First Received: June 30, 2011
Last Updated: February 5, 2014
Health Authority: Spain: Agencia Española de Medicamentos y Productos Sanitarios
Spain: Comité Ético de Investigación Clínica

Keywords provided by Grupo Espanol de Investigacion en Sarcomas:
Soft tissue sarcoma
Gemcitabine
Rapamycin
Sirolimus
mTOR inhibitor
Molecular biomarkers

Additional relevant MeSH terms:
Sarcoma
Neoplasms, Connective and Soft Tissue
Neoplasms by Histologic Type
Neoplasms
Gemcitabine
Sirolimus
Everolimus
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Antineoplastic Agents
Therapeutic Uses
Antiviral Agents
Anti-Infective Agents
Enzyme Inhibitors
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Radiation-Sensitizing Agents
Antibiotics, Antineoplastic
Antifungal Agents
Anti-Bacterial Agents

ClinicalTrials.gov processed this record on July 24, 2014