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Bortezomib and Topotecan in Treating Patients With Advanced Solid Tumors

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ClinicalTrials.gov Identifier: NCT00388089
Recruitment Status : Completed
First Posted : October 13, 2006
Last Update Posted : June 29, 2010
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by:
University of California, Davis

Study Description
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Brief Summary:

RATIONALE: Bortezomib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as topotecan, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving bortezomib together with topotecan may kill more tumor cells.

PURPOSE: This phase I trial is studying the side effects and best dose of bortezomib and topotecan in treating patients with advanced solid tumors.


Condition or disease Intervention/treatment Phase
Lung Cancer Unspecified Adult Solid Tumor, Protocol Specific Drug: bortezomib Drug: topotecan hydrochloride Other: flow cytometry Other: immunoenzyme technique Other: immunohistochemistry staining method Other: laboratory biomarker analysis Phase 1

Detailed Description:

OBJECTIVES:

Primary

  • Evaluate the safety and feasibility of bortezomib and topotecan hydrochloride in patients with advanced solid tumors.

Secondary

  • Determine the maximum tolerated dose (MTD) of bortezomib and topotecan hydrochloride in these patients.
  • Determine, preliminarily, the efficacy of this regimen in these patients.
  • Perform laboratory correlative studies on tumor tissue and blood samples from these patients to investigate potential predictors of response.
  • Obtain fresh tumor tissue for correlative studies from a subset of patients with small cell lung cancer treated at the MTD.

OUTLINE: This is a dose-escalation study.

Patients receive topotecan hydrochloride IV over 30 minutes followed by bortezomib IV on days 1, 8, and 15. Treatment repeats every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Patients with stable or responding disease may continue to receive bortezomib alone in the absence of disease progression or unacceptable toxicity.

Cohorts of 3-6 patients receive escalating doses of topotecan hydrochloride and bortezomib until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 6 patients experience dose-limiting toxicity.

Ten additional patients with small cell lung cancer are treated at the MTD. These patients undergo tumor biopsy at baseline and before the second course of therapy.

Tumor tissue is collected at baseline in all patients. Blood samples are collected at baseline, at the beginning of courses 2 and 3, and after completion of study treatment. Samples are examined for topoisomerase-1 levels by western blotting; BCL-2, BCL-xL, BAX, and p27 by immunohistochemistry; hypoxia-inducible factor-1, plasminogen-activator inhibitor 1, vascular endothelial growth factor, and osteopontin by immunoenzyme techniques; and NF-kB and p27 nuclear expression by flow cytometry.

After completion of study treatment, patients are followed for 30 days.

PROJECTED ACCRUAL: A total of 34 patients will be accrued for this study.

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 24 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase I Study of Weekly Bortezomib (VELCADE, PS-341) and Weekly Topotecan (HYCAMTIN) in Solid Tumor Patients With an Emphasis on Small Cell Lung Cancer (SCLC)
Study Start Date : December 2004
Actual Primary Completion Date : November 2007
Actual Study Completion Date : June 2008

Resource links provided by the National Library of Medicine


Arms and Interventions
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Intervention Details:
  • Drug: bortezomib
    Dose level A: 1 mg/m2; Dose level B: 1.3 mg/m2; Dose level C: 1.6 mg/m2; Dose level D: 1.6 mg/m2
    Other Name: PS-341, Velcade
  • Drug: topotecan hydrochloride
    Dose level A: 3 mg/m2; Dose level B: 3 mg/m2; Dose level C: 3 mg/m2; Dose level D: 4 mg/m2
    Other Name: Hycamtin
  • Other: flow cytometry
    No description
  • Other: immunoenzyme technique
    No description
  • Other: immunohistochemistry staining method
    No description
  • Other: laboratory biomarker analysis
    No description

Outcome Measures
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Primary Outcome Measures :
  1. Safety [ Time Frame: Monitored on an ongoing basis during the study ]
    If cumulative toxicities are seen in subsequent treatment cycles, a decision regarding modification or discontinuation of the study drug and/or patient enrollment will be made by the sponsor in conjunction with the investigator.


Secondary Outcome Measures :
  1. Toxicity [ Time Frame: On Day 8 and at beginning of subsequent cycles ]
    Toxicity will be evaluated based on the standard NCI CTC grading criteria version 3.0.

  2. Response rate [ Time Frame: At baseline and every 2 courses during treatment ]
    As assessed by RECIST criteria

  3. Best response [ Time Frame: From start of treatment until disease progression/recurrence ]
    Best response is determined from the sequence of objective status.

  4. Survival [ Time Frame: From registration to time of death due to any cause ]
    Patients will be followed for 30 days after removal from study treatment or until all treatment-related toxicities resolve to < grade 1.

  5. Progression-free survival [ Time Frame: From registration to the first observation of disease progression or death due to any cause ]
    If a patient has not progressed or died, progression-free survival is censored at the time of last follow-up.

  6. Topoisomerase levels as assessed by western blot and tumor tissue biopsy [ Time Frame: From pre-treatment to post-treatment ]
    The aim of these molecular correlates is to examine the relationship between these studies and the clinical response to treatment.

  7. NF-kB and BCL-2 family activity as assessed by immunohistochemistry [ Time Frame: From pre-treatment to post-treatment ]
    The aim of these molecular correlates is to examine the relationship between these studies and the clinical response to treatment.

  8. Loss of p27 as assessed by immunohistochemistry [ Time Frame: From pre-treatment to post-treatment ]
    The aim of these molecular correlates is to examine the relationship between these studies and the clinical response to treatment.

  9. Hypoxia-induced plasma proteins as measured by enzyme-linked immunosorbent assay (ELISA) [ Time Frame: From pre-treatment to post-treatment ]
    The aim of these molecular correlates is to examine the relationship between these studies and the clinical response to treatment.

  10. Shed tumor DNA in plasma [ Time Frame: From pre-treatment to post-treatment ]
    The aim of these molecular correlates is to examine the relationship between these studies and the clinical response to treatment.

  11. Biological activity of bortezomib as measured by flow cytometry [ Time Frame: From pre-treatment to post-treatment ]
    The aim of these molecular correlates is to examine the relationship between these studies and the clinical response to treatment.


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

DISEASE CHARACTERISTICS:

  • Histologically or cytologically confirmed advanced solid tumor, meeting 1 of the following criteria:

    • Disease progressed after ≥ 1 prior standard therapy regimen
    • Treatment-naive with no standard therapy of curative intent available
    • Not a candidate for standard therapy due to poor performance status

  • Patients with small cell lung cancer are enrolled after the maximum tolerated dose has been determined

    • Must have tumor accessible for biopsy

  • Measurable disease by RECIST criteria or evaluable disease (e.g., pleural effusion, ascites, or bone metastasis)

    • Disease in previously irradiated sites is considered measurable provided there is clear disease progression after radiotherapy

  • Asymptomatic brain metastasis treated by prior surgical resection or radiotherapy allowed if both of the following criteria are met:

    • Neurologically stable
    • Off steroids and anticonvulsants for ≥ 4 weeks

PATIENT CHARACTERISTICS:

  • Karnofsky performance status 60-100%
  • Life expectancy ≥ 3 months
  • Absolute neutrophil count ≥ 1,500/mm³
  • Platelet count ≥ 100,000/mm³
  • Creatinine clearance ≥ 40 mL/min
  • Bilirubin ≤ 1.5 times upper limit of normal (ULN)
  • AST and ALT ≤ 3.0 times ULN
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • No preexisting neuropathy ≥ grade 2 within the past 14 days
  • No hypersensitivity to bortezomib, boron, or mannitol
  • No myocardial infarction within the past 6 months
  • No New York Heart Association class III or IV heart failure
  • No uncontrolled angina, severe uncontrolled ventricular arrhythmias, or ECG evidence of acute ischemia or active conduction system abnormalities

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • Any number of prior chemotherapy regimens allowed
  • At least 4 weeks since prior chemotherapy and recovered
  • At least 2 weeks since prior radiotherapy and recovered
  • No prior topotecan hydrochloride or bevacizumab
  • At least 14 days since prior investigational drugs
  • No concurrent anticonvulsants metabolized by the cytochrome P450 pathway
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00388089


Locations
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United States, California
University of California Davis Cancer Center
Sacramento, California, United States, 95817
Sponsors and Collaborators
University of California, Davis
National Cancer Institute (NCI)
Investigators
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Study Chair: Angela Davies, MD University of California, Davis
More Information
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Responsible Party: Angela Davies, MD, University of California, Davis
ClinicalTrials.gov Identifier: NCT00388089    
Other Study ID Numbers: CDR0000505990
P30CA093373 ( U.S. NIH Grant/Contract )
UCDCC-157 ( Other Identifier: University of California, Davis - Cancer Center )
200412738 ( Other Identifier: University of California, Davis - IRB )
GSK-8531 ( Other Grant/Funding Number: GlaxoSmithKline )
MILLENNIUM-X05131 ( Other Grant/Funding Number: Millennium Pharmaceuticals )
First Posted: October 13, 2006    Key Record Dates
Last Update Posted: June 29, 2010
Last Verified: December 2007
Keywords provided by University of California, Davis:
unspecified adult solid tumor, protocol specific
extensive stage small cell lung cancer
recurrent small cell lung cancer
Additional relevant MeSH terms:
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Lung Neoplasms
Neoplasms
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Lung Diseases
Respiratory Tract Diseases
 Bortezomib
Topotecan
Antineoplastic Agents
Topoisomerase I Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action