Doxorubicin and Bortezomib in Treating Patients With Liver Cancer - Full Text View

Purpose

This phase II trial is studying how well giving doxorubicin together with bortezomib works in treating patients with liver cancer. Drugs used in chemotherapy, such as doxorubicin, work in different ways to stop tumor cells from dividing so they stop growing or die. Bortezomib may stop the growth of tumor cells by blocking the enzymes necessary for their growth. Giving doxorubicin together with bortezomib may kill more tumor cells.

Condition	Intervention	Phase
Adult Primary Hepatocellular Carcinoma Advanced Adult Primary Liver Cancer Localized Unresectable Adult Primary Liver Cancer Recurrent Adult Primary Liver Cancer	Drug: doxorubicin Drug: bortezomib	Phase 2


Study Type:	Interventional
Study Design:	Intervention Model: Single Group Assignment Masking: None (Open Label) Primary Purpose: Treatment
Official Title:	A Phase II Trial of Bortezomib Plus Doxorubicin in Hepatocellular Carcinoma

Resource links provided by NLM:

MedlinePlus related topics: Liver Cancer

Drug Information available for: Doxorubicin Doxorubicin hydrochloride Bortezomib

Genetic and Rare Diseases Information Center resources: Primary Liver Cancer

U.S. FDA Resources

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:

Objective Response Rate Measured by Response Evaluation Criteria In Solid Tumors (RECIST) [ Time Frame: assessed every 3 cycles while on treatment. After discontinuing treatment, assessed every 3 months for 2 years and then every 6 months for 1 year ]
Tumor response was measured by Response Evaluation Criteria In Solid Tumors (RECIST) v1.0. Objective response rate included complete response (disappearance of all tumor lesions) and partial response (At least a 30% decrease in the sum of the longest diameters of target lesions, taking as reference the baseline sum longest diameter.).

Secondary Outcome Measures:

Overall Survival [ Time Frame: assessed every 3 months for 2 years and then every 6 months for 1 year ]
Overall survival is defined as time from registration to death from any cause. Patients alive were censored at follow up. Analysis was conducted in the 38 eligible and treated patients.
Progression Free Survival [ Time Frame: assessed every 3 cycles while on treatment. After discontinuing treatment, assessed every 3 months for 2 years and then every 6 months for 1 year. ]
Time from registration to disease progression or death, whichever occurred earlier. Patients alive and progression-free were censored at last follow up. 36 eligible and treated patients were included in the analysis. The other 2 eligible and treated patients had no disease status information.


Enrollment:	42
Study Start Date:	March 2004
Study Completion Date:	August 2012
Primary Completion Date:	February 2011 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: Treatment (doxorubicin+bortezomib) Patients receive doxorubicin IV over 5-15 minutes on days 1 and 8. Patients also receive bortezomib at a dose of 1.3 mg/m^2 IV over 3-5 seconds on days 1, 4, 8, and 11. Treatment repeats every 21 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. Patients with no disease progression may continue to receive bortezomib alone in the absence of disease progression or unacceptable toxicity.	Drug: doxorubicin Given IV Other Names: doxorubicin hydrochloride ADM ADR Adria Adriamycin PFS Adriamycin RDF Drug: bortezomib Given IV Other Names: LDP 341 MLN341 VELCADE

Arms

Assigned Interventions

Experimental: Treatment (doxorubicin+bortezomib)

Patients receive doxorubicin IV over 5-15 minutes on days 1 and 8. Patients also receive bortezomib at a dose of 1.3 mg/m^2 IV over 3-5 seconds on days 1, 4, 8, and 11. Treatment repeats every 21 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. Patients with no disease progression may continue to receive bortezomib alone in the absence of disease progression or unacceptable toxicity.

Drug: doxorubicin

Given IV

Other Names:

doxorubicin hydrochloride
ADM
ADR
Adria
Adriamycin PFS
Adriamycin RDF

Drug: bortezomib

Given IV

Other Names:

LDP 341
MLN341
VELCADE

Detailed Description:

PRIMARY OBJECTIVES:

I. To evaluate the tumor response rate in patients with hepatocellular carcinoma (HCC).

SECONDARY OBJECTIVES:

I. To determine other parameters of antitumor effect including time to tumor progression and overall survival in HCC patients treated with bortezomib and doxorubicin.

II. To observe toxicity profile of bortezomib and doxorubicin in patients with hepatocellular carcinoma.

III. To evaluate proteasome 20S inhibition in tumor tissue (including proteins such as p21, p27, p53, Bax and Bcl-2 which are affected by proteasome 26S) and compare them to clinical parameters using biopsy specimens obtained from patients with HCC treated with bortezomib. (Withdrawn as of 03-2007)

IV. To measure phosphorylation of IkB in tumor tissue and compare to clinical parameters using biopsy specimens obtained from patients with HCC treated with bortezomib. (Withdrawn as of 03-2007)

V. To evaluate the effect of bortezomib on 26S proteasome activity in peripheral white blood cells (WBC's) and patient serum. Direct measurement of 26S proteasome activity as well as proteins affected by proteasome 26S and Nuclear factor kappa-B (NF-kB) will be analyzed. (Withdrawn as of 03-2007)

OUTLINE: This is a multicenter study.

Patients receive doxorubicin intravenously (IV) over 5-15 minutes on days 1 and 8. Patients also receive bortezomib IV over 3-5 seconds on days 1, 4, 8, and 11. Treatment repeats every 21 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. Patients with no disease progression may continue to receive bortezomib alone in the absence of disease progression or unacceptable toxicity.

Patients are followed every 3 months for 2 years and then every 6 months for 1 year.

PROJECTED ACCRUAL: A total of 40 patients will be accrued for this study within 13 months.

Eligibility


Ages Eligible for Study:	18 Years and older (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Patients must have microscopically confirmed hepatocellular carcinoma not amenable to curative resection; if patients have an isolated lesion in one lobe of the liver, a liver surgeon should determine resectability; central review is not required
Patients must have measurable disease as determined by Response Evaluation Criteria In Solid Tumors (RECIST) criteria, amenable to biopsy; patients are not mandated to allow biopsy, even though it is an important aspect of this clinical trial
Patients with history of malignancy treated within the past 5 years are not eligible; history of carcinoma-in-situ of cervix, squamous cell cancer of skin, basal cell cancer of skin, previously treated are allowed; others are excluded as recurrence of disease may confuse response rate and/or survival endpoints
Patients must have Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
Patients must not have had prior systemic chemotherapy for HCC; patients on antineoplastics for non-malignant diseases, such as methotrexate for rheumatoid arthritis, are allowed, providing patients have been off these agents for at least 4 weeks and all related toxicities have resolved to baseline
Patients may have had prior embolization without chemotherapy; patients who have had chemoembolization are not eligible; patients may have had radiofrequency (RF) ablation, cryosurgery or ethanol injection; patients must have documented progression with the involved lesion or at least one previously untreated lesion amenable to biopsy
Platelet count must be >= 100,000/mm^3 in absence of splenomegaly; platelet count must be >= 75,000/mm^3 with splenomegaly
Absolute neutrophil count (ANC) must be >= 1,500/mm^3 in absence of splenomegaly; ANC must be =< 1,000/mm^3 with splenomegaly
Alkaline phosphate (ALT) must be =< 5 x institutional upper limit of normal (ULN)
Aspartate aminotransferase (AST) must be =< 5 x institutional ULN
Bilirubin must be =< 2 mg/dl
Patients may not exhibit Child Pugh scale grade C cirrhosis
Serum creatinine=< 2.0 mg/dl
All females of childbearing potential must have a blood test or urine study within 2 weeks prior to registration to rule out pregnancy
Women of childbearing potential and sexually active males are strongly advised to use an accepted and effective method of contraception
Patients must not have known bleeding diathesis, international normalized ratio (INR) > 1.5 or Partial thromboplastin time (PTT) > 1.5 x institutional ULN (required due to biopsy portion of study); use of vitamin K or fresh frozen plasma to correct values just prior to biopsy or enrollment is not allowed are not eligible

Exclusion criteria:

Patients have baseline peripheral neuropathy > grade 1
Patients with history of untreated malignancy other than HCC
Patients have had prior use of octreotide or tamoxifen as therapy for HCC
Patients with known allergy to boron, mannitol or bortezomib
Women are pregnant or breast-feeding (due to the uncertain effects of bortezomib in the developing fetus and young infants)
Patients have an underlying medical condition that precludes safe participation in this clinical trial
Patients have psychiatric illness or continued substance abuse that may impair the ability to provide informed consent or prevent safe administration of bortezomib
Patients with ejection fraction (EF) < 50% measured by Echocardiography (ECHO) or Multiple gated acquisition (MUGA)
Patients on verapamil who cannot be switched to an alternative medication (due to the interaction with doxorubicin)

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: NCT00083226

Locations


United States, Massachusetts
Eastern Cooperative Oncology Group
Boston, Massachusetts, United States, 02215

Sponsors and Collaborators

National Cancer Institute (NCI)

Investigators


Principal Investigator:	Jordan Berlin	Vanderbilt-Ingram Cancer Center

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Ciombor KK, Feng Y, Benson AB 3rd, Su Y, Horton L, Short SP, Kauh JS, Staley C, Mulcahy M, Powell M, Amiri KI, Richmond A, Berlin J. Phase II trial of bortezomib plus doxorubicin in hepatocellular carcinoma (E6202): a trial of the Eastern Cooperative Oncology Group. Invest New Drugs. 2014 Oct;32(5):1017-27. doi: 10.1007/s10637-014-0111-8. Epub 2014 Jun 4.


Responsible Party:	National Cancer Institute (NCI)
ClinicalTrials.gov Identifier:	NCT00083226 History of Changes
Other Study ID Numbers:	NCI-2014-00654 NCI-2012-02952 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) ) E6202 ( Other Identifier: Eastern Cooperative Oncology Group ) U10CA021115 ( U.S. NIH Grant/Contract )
Study First Received:	May 14, 2004
Results First Received:	October 24, 2014
Last Updated:	October 24, 2014

Keywords provided by National Cancer Institute (NCI):


doxorubicin doxorubicin hydrochloride bortezomib hepatocellular carcinoma

Additional relevant MeSH terms:


Carcinoma Carcinoma, Hepatocellular Liver Neoplasms Neoplasms, Glandular and Epithelial Neoplasms by Histologic Type Neoplasms Adenocarcinoma Digestive System Neoplasms Neoplasms by Site Digestive System Diseases	Liver Diseases Doxorubicin Liposomal doxorubicin Bortezomib Antibiotics, Antineoplastic Antineoplastic Agents Topoisomerase II Inhibitors Topoisomerase Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on September 25, 2017