Vandetanib to Treat Women With Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

This study has been terminated.
(The study closed because of inadequate early activity.)
Sponsor:
Information provided by:
National Institutes of Health Clinical Center (CC)
ClinicalTrials.gov Identifier:
NCT00445549
First received: March 7, 2007
Last updated: May 22, 2012
Last verified: May 2012
  Purpose

Background:

  • Vandetanib is a drug that attacks a group of proteins on the surface of many cells, especially blood vessel cells and tumor cells.
  • Tumors require the development of new blood vessels in order to grow and spread.
  • In laboratory experiments, vandetanib slowed the growth of certain tumors and regulated their blood vessel growth.
  • In early clinical trials, some patients' tumors did not grow for a period of time while they were receiving vandetanib.

Objectives:

  • To determine whether vandetanib can cause tumors to shrink or stabilize in some patients with ovarian cancer, fallopian tube cancer or primary peritoneal cancer.
  • To determine, by tumor biopsy, if features of the tumor change with vandetanib treatment may predict if the tumor will likely respond to vandetanib.

Eligibility:

  • Women 18 years of age and older with ovarian, fallopian tube or primary peritoneal cancer that does not respond to standard treatment.

Design:

  • Patients take vandetanib daily, by mouth in 28-day cycles until their disease worsens or they develop unacceptable side effects.
  • Tumor biopsies (surgical removal of a sample of tumor tissue) are done before starting vandetanib treatment and after 6 weeks of treatment.
  • Patients are followed in the clinic every 4 weeks during treatment for a physical examination, blood tests, and review of laboratory studies and side effects.
  • Patients have a computed tomography (CT) scan every 8 weeks to monitor tumor growth and magnetic resonance imaging (MRI) before starting vandetanib treatment, on the third day after taking vandetanib and 6 weeks into treatment.
  • Patients quality of life is assessed with regularly scheduled questionnaires.

Condition Intervention Phase
Ovarian Neoplasms
Fallopian Tube Neoplasms
Peritoneal Neoplasms
Drug: Vandetanib
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase II Study of Clinical Activity and Proteomic Pathway Profiling of the Vascular Endothelial Growth Factor 2 (VEGFR2) Inhibitor, ZD6474 (Vandetanib) in Women With Relapsed or Refractory Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

Resource links provided by NLM:


Further study details as provided by National Institutes of Health Clinical Center (CC):

Primary Outcome Measures:
  • Number of Participants With Clinical Efficacy [ Time Frame: 24 weeks ] [ Designated as safety issue: No ]
    Defined as complete response (CR), partial response (PR), or disease stabilization lasting 6 months or longer per RECIST criteria. CR-total disappearance of all evaluable disease. PR->30% reduction in the sum of the longest diameters (LD) of target lesions. Stable disease (SD) is <30% decrease and <20% increase in the sum of the LD of all target lesions. See the protocol Link module for full RECIST criteria.


Secondary Outcome Measures:
  • The Number of Participants With Adverse Events [ Time Frame: 22 months ] [ Designated as safety issue: Yes ]
    Here are the total # of participants with adverse events. For the detailed list of adverse events, see the adverse event module.


Enrollment: 12
Study Start Date: January 2007
Study Completion Date: October 2009
Primary Completion Date: December 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Vandetanib treatment
300 mg daily oral dose, 28 day cycle
Drug: Vandetanib
300 mg daily dose, 28 day cycle
Other Names:
  • Zactima
  • ZD6474

Detailed Description:

Background:

  • Epithelial ovarian cancer requires neovascularization for growth and metastasis. Anti-angiogenesis agents have been shown to have promise in the treatment of recurrent disease. Expression of vascular endothelial growth factor 2 (VEGFR2) and epidermal growth factor receptor (EGFR) has been demonstrated in ovarian cancer specimens in stroma and tumor. Blocking autocrine and paracrine loops acting through these receptors may inhibit downstream phosphorylation targets in the mitogen activated protein kinase (MAPK) and AKT pathways, thereby influencing disease progression and patient outcome.
  • The multi-kinase inhibitor ZD6474 (vandetanib, AstraZeneca, Zactima) blocks angiogenesis by targeting VEGFR2, and shows in vitro activity against a number of other receptor tyrosine kinases including resonance energy transfer (RET), vascular endothelial growth factor 3 (VEGFR3) and EGFR.
  • Clinical efficacy of ZD6474 (vandetanib) in women with refractory or relapsed epithelial ovarian cancer is unknown, but preclinical data suggests potential value.
  • The maximum tolerated dose of ZD6474 (vandetanib) has been determined at 300mg/day, limited by the dose-responsive adverse effect of prolonged (Q wave, T wave)QT interval.

Objectives:

  • To assess the clinical activity (CR - complete response, PR - partial response, or disease stabilization) of the VEGFR2 inhibitor ZD6474 (vandetanib), 300mg/d, in women with ovarian, fallopian tube or primary peritoneal cancer.
  • To study target signal events: quantity and activation of VEGFR2, EGFR, AKT and extracellular signal-regulated kinases (ERK).

Eligibility:

  • Women with biopsy-proven epithelial ovarian, fallopian tube or primary peritoneal cancer that is relapsed and/or refractory to prior therapy.
  • Women must have measurable disease by NCI Response Evaluation Criteria in Solid Tumors (RECIST) criteria and a sentinel lesion adequate for core biopsy through percutaneous biopsy.
  • Women must have had no more than four prior treatment regimens.

Design:

  • Women will receive 300mg of ZD6474 (vandetanib) daily, orally in 28-day cycles until disease progression, excessive toxicity, or withdrawal from study.
  • Biopsy of tumor will be performed prior to starting ZD6474 (vandetanib) and after six weeks of treatment. The quantity of phosphorylated VEGFR2, EGFR, ERK and AKT in the biopsy tissue will be analyzed.
  • Clinical outcome and toxicity will be measured and correlated with target inhibition.
  • Women will also undergo serial imaging with dynamic contrast-enhanced MRI to estimate tumor blood flow.
  • Research blood samples will be taken to assess changes in circulating cytokine concentrations.
  • Quality of life will be assessed during treatment.
  Eligibility

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

Inclusion Criteria:

  • All patients 18 years and older with biopsy-proven epithelial ovarian, fallopian tube or primary peritoneal cancer that is relapsed or refractory to prior standard platinum-and taxane based therapy will be eligible.
  • Histopathologic diagnosis must be confirmed in the Laboratory of Pathology (LP), NCI. A block of the primary or later access to recut slides is required. If this is unavailable, a recent resection of a metastatic site is required for entry.
  • All patients must have measurable disease by NCI RECIST criteria and a sentinel lesion adequate for core biopsy through percutaneous biopsy.
  • Patients must have a performance status of Eastern Cooperative Oncology Group (ECOG) = 0, 1, or 2.
  • Patients must have good end organ function:
  • white blood cells (WBC) greater than 3000/mm(3)
  • absolute neutrophil count (ANC) greater than 1000/mm(3)
  • platelets greater than 150,000/mm(3)
  • serum creatinine less than 1.5 mg/dl
  • liver function tests (AST and ALT) within 2.5 times the upper limit of normal (ULN)
  • bilirubin less than 1.5 mg/dl
  • potassium between 4.0 and ULN (supplementation allowed)
  • magnesium (Mg) and calcium (Ca) within normal limits (supplementation allowed)
  • Systolic blood pressure less than 160 mm Hg and diastolic blood pressure less than 100 mm Hg (therapy permitted)
  • Patients must be at least 4 weeks from previous therapy (chemotherapy, hormonal therapy, and radiation therapy, alternative therapy or investigational agents). Carboplatin, must not have been received for at least 6 weeks prior to enrollment.
  • Patients must have received no more than 4 prior regimens for the treatment of ovarian cancer.
  • Patients must have recovered from any toxicity related to prior cancer therapy to NCI grade 1, except for peripheral neuropathy, which must have recovered to grade 2 or better.
  • Women of childbearing age and potential must agree to use adequate barrier contraception (interaction with oral contraceptives is unknown) prior to study entry, during therapy and for 3 months after completion of therapy.
  • Patients must be able to give written informed consent.
  • All eligible patients must be registered by contacting Central Registration personnel by fax at (301) 480-0757 between the hours of 8:30am and 5:00 pm, Monday through Friday.

Exclusion Criteria:

  • Evidence of severe or uncontrolled systemic disease or any concurrent condition which in the investigators opinion makes it undesirable for the patient to participate in the trial or which would jeopardize compliance with the protocol.
  • Evidence of central nervous system (CNS) involvement (patients with abnormal clinical exam or history will require a head CT or MRI.
  • History of cardiac disorders including:
  • Clinically significant cardiac event such as myocardial infarction, New York Heart Association (NYHA) classification of heart disease greater than or equal to 2 within 3 months of entry, or presence of cardiac disease that, in the opinion of the investigator,increases the risk of ventricular arrhythmia.
  • Uncontrolled arrhythmia (multifocal premature ventricular contractions (PVCs), bigeminy, trigeminy, ventricular tachycardia, or uncontrolled atrial fibrillation) which is symptomatic.
  • Previous history of medication-induced corrected QT interval (QTc) prolongation requiring discontinuation of that medication.
  • Congenital long (Q wave, T wave) QT syndrome, or 1st degree relative with unexplained early sudden cardiac death(less than 40 years of age).
  • Presence of left bundle branch block (LBBB).
  • QTc, corrected per automated electrocardiogram (ECG) standards, that is unmeasurable, or greater than or equal to 480 msec on screening ECG. If a patient has QTc greater than or equal to 480 msec on screening ECG, the screen ECG may be repeated twice (at least 24 hours apart). The average QTc from the three screening ECGs must be less than 480 msec in order for the patient to be eligible for the study.
  • Patients requiring any concomitant treatment with medication that may cause QTc prolongation or induce Torsades de Pointes will not be permitted to enter this study unless the agent can safely be changed to one not affecting QTc.
  • Patients requiring any concomitant treatment with medication that may inhibit (cytochrome p450 3A4) CYP3A4 will not be permitted to begin this study. If it is considered medically safe to discontinue such medication, the patient may become eligible once a sufficient amount of time after the last dose of such medications has elapsed to consider the drug adequately eliminated (at least 5 half lives of the drug).
  • Patients with active infection will not be eligible, but may become eligible once infection has resolved and they are at least 7 days from completion of antibiotics.
  • Patients with incomplete wound healing from previous surgery or injury will be ineligible. Patients must be at least 4 weeks from a major surgical procedure.
  • Women who are actively breast-feeding will be excluded.
  • Currently active diarrhea that is uncontrolled with medication (e.g. bulk agents or loperamide) that may affect the ability of the patient to absorb the ZD6474.
  • Previous or current malignancies within the last 5 years, with the exception of cervical carcinoma in situ curatively treated, ductal or lobular carcinoma in situ curatively treated and without ongoing therapeutic intervention.
  • No concomitant use of complementary or alternative medication or other agents (investigational or anti-cancer agents) will be allowed without approval of a principal investigator (PI) or associate investigator (AI). Every effort will be made to maximize patient safety and minimize changes in chronic medications.
  • Patients with a history of deep venous thrombosis or pulmonary embolism within the past 3 months or those patients requiring ongoing anticoagulation will be ineligible.
  • Patients with a history of gastrointestinal (GI) bleed or gross hematuria within the past 30 days will be ineligible.
  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: NCT00445549

Locations
United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike
Bethesda, Maryland, United States, 20892
Sponsors and Collaborators
Investigators
Principal Investigator: Elise C Kohn, M.D. National Cancer Institute, National Institutes of Health
  More Information

Additional Information:
RECIST  This link exits the ClinicalTrials.gov site

Publications:
Responsible Party: Elise C. Kohn, M.D., National Cancer Institute (NCI), National Institutes of Health (NIH)
ClinicalTrials.gov Identifier: NCT00445549     History of Changes
Other Study ID Numbers: 070061, 07-C-0061, 070061
Study First Received: March 7, 2007
Results First Received: June 30, 2011
Last Updated: May 22, 2012
Health Authority: United States: Federal Government

Keywords provided by National Institutes of Health Clinical Center (CC):
Ovarian
VEGFR2
EGFR
Angiogenesis
Tyrosine Kinase
Protein Phosphorylation
Vandetanib
Ovarian Cancer
Fallopian Tube Cancer
Peritoneal Cancer

Additional relevant MeSH terms:
Neoplasms
Peritoneal Neoplasms
Ovarian Neoplasms
Fallopian Tube Neoplasms
Abdominal Neoplasms
Neoplasms by Site
Digestive System Neoplasms
Digestive System Diseases
Peritoneal Diseases
Endocrine Gland Neoplasms
Ovarian Diseases
Adnexal Diseases
Genital Diseases, Female
Genital Neoplasms, Female
Urogenital Neoplasms
Endocrine System Diseases
Gonadal Disorders
Fallopian Tube Diseases

ClinicalTrials.gov processed this record on October 01, 2014