Sorafenib in Treating Patients With Relapsed Chronic Lymphocytic Leukemia

This study has been terminated.
(Slow accrual)
Sponsor:
Information provided by (Responsible Party):
National Cancer Institute (NCI)
ClinicalTrials.gov Identifier:
NCT00303966
First received: March 15, 2006
Last updated: April 17, 2014
Last verified: January 2014
  Purpose

Sorafenib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the cancer. This phase II trial is studying how well sorafenib works in treating patients with relapsed chronic lymphocytic leukemia.


Condition Intervention Phase
Refractory Chronic Lymphocytic Leukemia
Stage I Chronic Lymphocytic Leukemia
Stage II Chronic Lymphocytic Leukemia
Stage III Chronic Lymphocytic Leukemia
Stage IV Chronic Lymphocytic Leukemia
Drug: sorafenib tosylate
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 Study of BAY 43-9006 in Relapsed Chronic Lymphocytic Leukemia

Resource links provided by NLM:


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

Primary Outcome Measures:
  • Objective Response Rate [ Time Frame: Up to week 25 ] [ Designated as safety issue: No ]
    Objective response is defined as a complete (CR) or partial (PR) remission. Complete remission is defined as no evidence of chronic lymphocytic leukemia (CLL) in marrow with normal hematopoiesis and no palpable lymphadenopathy. Partial remission is defined as improvement in blood counts from baseline with >50% reduction in lymph nodes on examination. These are definitions from the CLL International Working Group (IWG).

  • Time to Disease Progression [ Time Frame: Up to 5.5 years ] [ Designated as safety issue: No ]
    Time to disease progression will be defined as the time from treatment start until disease progression and will be evaluated using the Kaplan-Meier estimator. Those who do not progress will be censored at the time that they were last known to be progression free.

  • Overall Survival [ Time Frame: Up to 5.5 years ] [ Designated as safety issue: No ]
    Overall survival will be defined as time from the start of treatment until death from any cause and will be evaluated using the Kaplan-Meier estimator.


Secondary Outcome Measures:
  • Changes in Mean Microvessel Density From Baseline to Week 25 [ Time Frame: Baseline and week 25 ] [ Designated as safety issue: No ]
    Mean microvessel density will serve as a marker of angiogenesis (other markers includes hot spot density). Will be examined using random-effects linear models.

  • Changes in Vascular Endothelial Growth Factor (VEGF) From Baseline to Week 25 [ Time Frame: Baseline and week 25 ] [ Designated as safety issue: No ]
    Changes in VEGF levels (post-pretreatment) will be assessed. A negative value indicates a decrease with treatment.

  • Changes in Plasma Level of Interleukin-8 (IL-8) From Baseline to Week 25 [ Time Frame: Baseline and week 25 ] [ Designated as safety issue: No ]
    The change (post-pretreatment) will be calculated and tested using a paired t test. A negative value indicates a decrease with treatment.


Enrollment: 5
Study Start Date: November 2005
Study Completion Date: May 2011
Primary Completion Date: May 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Treatment (sorafenib tosylate)
Patients receive oral sorafenib twice daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.
Drug: sorafenib tosylate
Given orally
Other Names:
  • BAY 43-9006
  • BAY 43-9006 Tosylate Salt
  • BAY 54-9085
  • Nexavar
  • SFN

Detailed Description:

PRIMARY OBJECTIVES:

I. Determine the objective response rate in patients with recurrent chronic lymphocytic leukemia (CLL) treated with sorafenib.

II. Determine the toxicity in patients treated with sorafenib.

SECONDARY OBJECTIVES:

I. Correlate bone marrow angiogenesis, CLL tumor cell expression of vascular endothelial growth factor (VEGF), VEGF receptors (flt-1, KDR, flt-4 and neuropilin-1), basic fibroblast growth factor, and plasma interleukin-8 levels with response.

OUTLINE: This is a multicenter study.

Patients receive oral sorafenib twice daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.

PROJECTED ACCRUAL: Approximately 40 patients will be accrued for this study.

  Eligibility

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

Inclusion Criteria:

  • Histologically or cytologically confirmed chronic lymphocytic leukemia (CLL) by NCI-WG immunophenotype and blood criteria

    • Documentation of current or prior peripheral blood (PB) or bone marrow (BM) immunophenotype compatible with CLL

      • Patients who currently do not have > 5,000/mm³ absolute lymphocytosis are eligible if they have previously met PB lymphocytosis criteria and have a current immunophenotype documenting monoclonal B lymphocytosis morphologically and immunophenotypically compatible with CLL
  • Intermediate-risk (Rai stage I or II) or high-risk (Rai stage III or IV) disease, including any of the following:

    • Rai stage I disease with lymphocytosis and enlarged nodes
    • Rai stage II disease with lymphocytosis plus splenomegaly and/or hepatomegaly (nodes positive or negative)
    • Rai stage III disease with lymphocytosis plus anemia
    • Rai stage IV disease with lymphocytosis and thrombocytopenia
  • Must require treatment with active disease, experiencing disease related symptoms, or having deterioration of blood counts, meeting ≥ 1 of the following criteria:

    • Presence of ≥ 1 of the following disease-related symptoms:

      • Weight loss > 10% within the past 6 months
      • Extreme fatigue (i.e., ECOG performance status 2: cannot work or unable to perform usual activities)
      • Fever > 100.5°F for 2 weeks without evidence of infection
      • Night sweats without evidence of infection
    • Evidence of progressive marrow failure, as manifested by worsening of anemia (hemoglobin < 10 g/dL), thrombocytopenia (platelet count < 100,000/mm³), and/or neutropenia (neutrophil count < 2,000/mm³)
    • Massive (i.e., > 6 cm below left costal margin) or progressive splenomegaly or discomfort from splenomegaly
    • Massive nodes or clusters (i.e., > 10 cm in longest diameter), progressive adenopathy, or discomfort from lymphadenopathy
    • Deterioration of blood counts and/or progressive lymphocytosis, with an increase of ≥ 10% documented over a 2-month period OR an anticipated doubling time < 6 months
  • Relapsed disease

    • Must receive at least 1, but no more than 3, prior chemotherapy regimens with any cytotoxic agent or antibody therapy

      • No fludarabine refractory disease

        • Responded to prior fludarabine without relapse or disease progression for at least 6 months
  • Patients with a history of Coombs-positive hemolytic anemia are eligible provided recovery from treatment of hemolysis and off steroids
  • No stage 0 CLL
  • No known CNS involvement
  • Life expectancy > 6 months
  • ECOG performance status 0-2 OR Karnofsky performance status 70-100%
  • Absolute neutrophil count ≥ 1,000/mm³
  • Platelets ≥ 30,000/mm³
  • Bilirubin ≤ 2 mg/dL
  • AST/ALT ≤ 2.5 times upper limit of normal (ULN)
  • Creatinine ≤ 1.5 times ULN OR creatinine clearance ≥ 60 mL/min (for patients with creatinine levels above normal)
  • No currently active second malignancy
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patient must use effective contraception prior to and during study participation
  • No uncontrolled hypertension, defined as blood pressure (BP) > 150/100 mm Hg on 2 different measurements at least 1 day apart with either systolic or diastolic number meeting this definition

    • Patients may later enter the study, if they have achieved stable BP (i.e., < 140/90 mm Hg) on a regimen of ≤ 2 drugs after 6-8 weeks of therapy
  • No history of allergic reactions attributed to compounds of similar chemical or biologic composition to sorafenib
  • No uncontrolled intercurrent illness including, but not limited to, any of the following:

    • Symptomatic congestive heart failure
    • Unstable angina pectoris
    • Cardiac arrhythmia
    • Psychiatric illness or social situations that would limit compliance with the study requirements
  • No active infection requiring systemic antibiotics
  • No evidence of bleeding diathesis
  • No evidence of bowel perforation or obstruction risk
  • No swallowing dysfunction leading to difficulty taking the study drug
  • See Disease Characteristics
  • Recovered from prior therapy
  • At least 2 weeks since prior antibiotic therapy
  • At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C) or radiotherapy
  • At least 12 weeks since prior monoclonal antibody
  • Concurrent warfarin for anticoagulation allowed provided all of the following are met:

    • On a stable therapeutic dose
    • INR ≤ 3
    • No active bleeding or pathological condition that carries high-risk of bleeding
  • No prior MAPK signaling inhibitor agents or anti-angiogenesis agents
  • No concurrent combination anti-retroviral therapy for HIV-positive patients
  • No concurrent cytochrome P450 enzyme-inducing antiepileptic drugs (phenytoin, carbamazepine, or phenobarbital), rifampin, or Hypericum perforatum (St. John's wort)
  • No other concurrent investigational agents
  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: NCT00303966

Locations
United States, Illinois
University of Chicago Comprehensive Cancer Center
Chicago, Illinois, United States, 60637-1470
Sponsors and Collaborators
Investigators
Principal Investigator: Wendy Stock University of Chicago Comprehensive Cancer Center
  More Information

No publications provided

Responsible Party: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00303966     History of Changes
Other Study ID Numbers: NCI-2012-02688, 14194B, UCCRC-14194B, NCI-7071, CDR0000462339, N01CM62201
Study First Received: March 15, 2006
Results First Received: November 8, 2013
Last Updated: April 17, 2014
Health Authority: United States: Food and Drug Administration

Additional relevant MeSH terms:
Leukemia, Lymphoid
Leukemia, Lymphocytic, Chronic, B-Cell
Leukemia
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Leukemia, B-Cell
Sorafenib
Niacinamide
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Vitamin B Complex
Vitamins
Micronutrients
Growth Substances
Physiological Effects of Drugs

ClinicalTrials.gov processed this record on October 19, 2014