Sirolimus and Bevacizumab in Treating Patients With Liver Cancer That Cannot Be Removed by Surgery
RATIONALE: Sirolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Bevacizumab and sirolimus may also stop the growth of liver cancer by blocking blood flow to the tumor. Giving sirolimus together with bevacizumab may kill more tumor cells.
PURPOSE: This phase I trial is studying the side effects and best dose of sirolimus when given together with bevacizumab in treating patients with liver cancer that cannot be removed by surgery.
|Study Design:||Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||A Phase I Study of Rapamycin in Combination With Bevacizumab in Patients With Unresectable Hepatocellular Carcinoma|
- Dose-limiting toxicity [ Time Frame: 3 years ] [ Designated as safety issue: Yes ]
- Maximum tolerated dose [ Time Frame: 3 years ] [ Designated as safety issue: Yes ]
- Response rate (complete and partial response and stable disease) [ Time Frame: 3 years ] [ Designated as safety issue: No ]
- Progression-free survival [ Time Frame: 3 years ] [ Designated as safety issue: No ]
- Overall survival [ Time Frame: 3 years ] [ Designated as safety issue: No ]
- Distribution of p70S6K activity in peripheral blood mononuclear cells [ Time Frame: 3 years ] [ Designated as safety issue: No ]
- Correlation of p70S6K with tumor response [ Time Frame: 3 years ] [ Designated as safety issue: No ]
- Expression of tumor tissue biomarkers (PTEN, 4EBP-1, CD31, p70S6K, and vascular endothelial growth factor) [ Time Frame: 3 years ] [ Designated as safety issue: No ]
- Correlation of tumor biomarkers with response [ Time Frame: 3 years ] [ Designated as safety issue: No ]
- Best overall response (complete and partial response; stable and progressive disease) [ Time Frame: 3 years ] [ Designated as safety issue: No ]
- Change in DCE-CT scan assessment of angiogenesis [ Time Frame: 3 years ] [ Designated as safety issue: No ]
|Study Start Date:||December 2006|
|Primary Completion Date:||May 2011 (Final data collection date for primary outcome measure)|
Experimental: Phase I study of rapamycin and bevacizumab
Rapamycin (available as 1mg per tablet; Wyeth) will be given orally once in the morning before meal. The starting dose of rapamycin will be 1mg administered once daily. All doses of rapamycin will be preceded by an oral loading dose three times the maintenance dose on day 1. The dose of rapamycin will be increased at each dose level.
Bevacizumab (100mg/4ml; Roche) will start concurrently with rapamycin. It will be diluted in a total of 100ml of 0.9% sodium chloride given via intravenous injection. The first dose will be infused over 90 minutes. If the first infusion is tolerated without any adverse infusion-related events (fever and/or chills), the second infusion may be delivered over 60 minutes. If the 60- minute infusion is well tolerated, the subsequent doses may be delivered over 30 minutes.
|Drug: Rapamycin Drug: Bevacizumab|
- Determine the maximum tolerated dose of sirolimus used in combination with bevacizumab in patients with unresectable hepatocellular carcinoma.
- Determine the toxicity profile of this regimen in these patients.
- Determine the clinical activity of this regimen in these patients.
- Determine the pharmacokinetics of sirolimus in these patients.
- Determine the biologically active dose range of sirolimus in these patients.
- Correlate phosphorylated p70S6K activity with clinical response in patients treated with this regimen.
- Correlate PTEN, 4EBP-1, phosphorylated p70S6K, CD31, and vascular endothelial growth factor expression with clinical response in patients treated with this regimen.
- Correlate the degree of angiogenesis (as measured by DCE-CT scan) with drug levels and clinical response.
OUTLINE: This is a dose-escalation study of sirolimus.
Patients receive bevacizumab IV over 30-90 minutes once every 2 weeks and oral sirolimus once daily. Treatment continues for up to 6 months in the absence of disease progression or unacceptable toxicity.
Cohorts of 3-6 patients receive escalating doses of sirolimus until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Six additional patients receive treatment at the MTD.
Blood samples are collected from healthy participants to measure p70S6 kinase activity. Patients undergo blood sample collection at baseline and periodically during study for pharmacokinetic and p70S6K activity assessment. Samples are also analyzed by high-performance liquid chromatography and tandem mass spectrophotometry to determine peak drug concentrations. Patients without archived tumor samples undergo tumor tissue biopsy at baseline. Samples are analyzed for PTEN, 4E-BP1, vascular endothelial growth factor, epidermal growth factor, p70S6K, and CD31 by immunohistochemistry. Patients also undergo DCE-CT scan at baseline and on day 29 to assess angiogenesis.
After completion of study treatment, patients are followed for 52 weeks.
PROJECTED ACCRUAL: A total of 36 patients and 5 healthy participants will be accrued for this study.
|Johns Hopkins Singapore International Medical Centre|
|Singapore, Singapore, 308433|
|National Cancer Centre - Singapore|
|Singapore, Singapore, 169610|
|Principal Investigator:||Choo Su Pin, MD||National Cancer Centre, Singapore|
|Principal Investigator:||Toh Han Chong, MD, MBBS, MRCP||National Cancer Centre, Singapore|