Sunitinib in Treating Patients With Liver Cancer That Cannot Be Removed by Surgery

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Swiss Group for Clinical Cancer Research
ClinicalTrials.gov Identifier:
NCT00514228
First received: August 8, 2007
Last updated: June 25, 2012
Last verified: June 2012
  Purpose

RATIONALE: Sunitinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor.

PURPOSE: This phase II trial is studying how well sunitinib works in treating patients with liver cancer that cannot be removed by surgery.


Condition Intervention Phase
Liver Cancer
Drug: sunitinib malate
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: Continuous Sunitinib Treatment in Patients With Unresectable Hepatocellular Carcinoma A Multicenter Phase II Trial

Resource links provided by NLM:


Further study details as provided by Swiss Group for Clinical Cancer Research:

Primary Outcome Measures:
  • Progression-free survival [ Time Frame: at 12 weeks ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Objective response [ Time Frame: Objective response (CR+PR) to treatment will be determined. CR or PR is to be confirmed after a minimum of 4 weeks ] [ Designated as safety issue: No ]
  • Disease stabilization (DS) [ Time Frame: Disease stabilization (CR, PR or SD) under sunitinib treatment will be determined ] [ Designated as safety issue: No ]
  • Duration of DS [ Time Frame: Duration of DS (CR, PR or SD) will be calculated from the time that measurement criteria are met for the first time until documented tumor progression ] [ Designated as safety issue: No ]
  • Progression-free survival [ Time Frame: PFS will be calculated from registration until documented tumor progression or death, whichever occurs first. ] [ Designated as safety issue: No ]
  • Time to progression [ Time Frame: TTP will be calculated from registration until documented tumor progression or death due to tumor. ] [ Designated as safety issue: No ]
  • Overall survival [ Time Frame: OS will be calculated from registration until death ] [ Designated as safety issue: No ]
  • Adverse events as assessed by NCI CTCAE v3.0 [ Time Frame: All AEs will be assessed according to NCI CTCAE v3.0. ] [ Designated as safety issue: Yes ]
  • Serum alpha fetoprotein level [ Time Frame: Serum AFP levels will be measured during the therapy, if AFP is ≥ 1.5 x ULN at baseline. ] [ Designated as safety issue: No ]

Enrollment: 45
Study Start Date: July 2007
Study Completion Date: February 2009
Primary Completion Date: August 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Continuous sunitinib treatment Drug: sunitinib malate
  • Starting dose: 37.5 mg 3 x 12.5 mg capsule
  • Reduced dose: 25 mg 2 x 12.5 mg capsule
Other Name: Sutent

Detailed Description:

OBJECTIVES:

Primary

  • Demonstrate the antitumor activity of continuous sunitinib malate treatment in patients with unresectable hepatocellular carcinoma.

Secondary

  • Evaluate the safety of sunitinib malate treatment.
  • Measure serum cobalamin (i.e., vitamin B12) level during sunitinib malate treatment in order to investigate the relationship between sunitinib malate treatment and cobalamin deficiency.
  • Control the cobalamin deficiency by cobalamin replacement.
  • Investigate whether changes in tumor density could be used as a criterion for tumor response in future trials.

OUTLINE: This is a multicenter study.

Patients receive oral sunitinib malate once daily. Treatment continues in the absence of disease progression or unacceptable toxicity.

Patients undergo blood sample collection on day 1 of each course to assess serum cobalamin levels and correlation with sunitinib malate treatment. Patients are also assessed for changes in tumor density and correlation with response. Baseline CT scans are compared with scans performed at 6 and 12 weeks to evaluate changes in CT-scan density due to tumor necrosis and response.

After completion of study therapy, patients are followed at least every 3 months for up to 3 years.

  Eligibility

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

DISEASE CHARACTERISTICS:

Inclusion criteria:

  • Histologically, cytologically, or radiologically confirmed hepatocellular carcinoma (HCC) meeting 1 of the following criteria:

    • Localized, surgically unresectable disease

      • Candidates for radical surgery for locally advanced disease are excluded
    • Metastatic disease
  • Measurable disease, defined as ≥ 1 lesion, outside of pretreated areas, that can be measured in ≥ 1 dimension as ≥ 10 mm by spiral or multi-slice CT scan or MRI
  • Child-Pugh class A or mildly decompensated Child-Pugh class B liver dysfunction

Exclusion criteria:

  • Clinical ascites of any grade
  • Clinical symptoms or history of CNS metastases or leptomeningeal disease
  • Known fibrolamellar HCC or mixed cholangiocarcinoma and HCC

PATIENT CHARACTERISTICS:

Inclusion criteria:

  • WHO performance status 0-1
  • Hemoglobin ≥ 9.0 g/dL
  • Absolute neutrophil count ≥ 1,500/mm³
  • Platelet count ≥ 75,000/mm³
  • Bilirubin ≤ 2 times upper limit of normal (ULN)
  • ALT ≤ 7 times ULN
  • Albumin ≥ 2.5 g/dL
  • Creatinine clearance ≥ 40 mL/min
  • Quick test ≥ 50% (adequate coagulation)
  • Urine dipstick for proteinuria < 2+ OR ≤ 1 g of protein in 24-hour urine collection
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for 12 months after completion of study therapy

Exclusion criteria:

  • Pregnant or nursing
  • Encephalopathy
  • Malignancy within the past 5 years except for adequately treated cervical carcinoma in situ or localized nonmelanoma skin cancer
  • Hemorrhagic or thrombotic cerebrovascular event in the past 12 months
  • Documented variceal hemorrhage within the past 3 months
  • History or presence of clinically significant acute or unstable cardiovascular, cerebrovascular, renal, gastrointestinal, pulmonary, immunological (except for the presence of hepatitis B virus, hepatitis C virus, or cirrhosis), endocrine, or central nervous system disorders
  • Known HIV infection
  • Active infection requiring IV antibiotics
  • Arterial hypertension ≥ 150/100 mm Hg, despite therapy
  • Ongoing cardiac dysrhythmias ≥ grade 2
  • Atrial fibrillation of any grade
  • Prolongation of QTc > 500 msec in screening ECG or history of familial long QT syndrome
  • Inability to take oral medications
  • Psychiatric disorder precluding understanding of information of study-related topics, giving informed consent, or interfering with compliance for oral drug intake

PRIOR CONCURRENT THERAPY:

Inclusion criteria:

  • At least 4 weeks since prior surgery or liver-directed therapy (e.g., transarterial embolization/chemoembolization [limited to 5 treatments], radiofrequency ablation, cryoablation, radiotherapy, or percutaneous ethanol injection)

    • Previously treated lesions must remain separate from those to be measured in the present study
  • Low-dose anticoagulants for maintenance of patency of central venous access or prevention of deep vein thrombosis allowed

Exclusion criteria:

  • Prior systemic anticancer treatment for hepatocellular carcinoma
  • Prior organ transplantation
  • Treatment in a clinical study within the past 30 days
  • Concurrent full-dose anticoagulant or requirement for anticoagulant therapy
  • Concurrent experimental drugs or other anticancer therapy
  • Concurrent use or anticipated need for CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, voriconazole, erythromycin, clarithromycin, and protease inhibitors)
  • Concurrent CYP3A4 inducers (e.g., carbamazepine, continuous treatment with dexamethasone [> 2 mg/day for > 7 days], phenobarbital, phenytoin, rifampicin, and St John's wort)

    • Concurrent antacids allowed provided they are administered > 1 hour before or > 1 hour after study drug
  • Concurrent elective major surgery
  • Concurrent radiotherapy

    • Concurrent analgesic radiotherapy of nontarget lesions allowed
  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: NCT00514228

Locations
Switzerland
Kantonsspital - St. Gallen
St. Gallen, Switzerland, CH-9007
Sponsors and Collaborators
Swiss Group for Clinical Cancer Research
Investigators
Study Chair: Dieter Koeberle, MD Cantonal Hospital of St. Gallen
  More Information

Publications:
Responsible Party: Swiss Group for Clinical Cancer Research
ClinicalTrials.gov Identifier: NCT00514228     History of Changes
Other Study ID Numbers: SAKK 77/06, SWS-SAKK-77/06, EU-20750, EUDRACT-2007-003977-22, CDR0000560441
Study First Received: August 8, 2007
Last Updated: June 25, 2012
Health Authority: Switzerland: Swissmedic

Keywords provided by Swiss Group for Clinical Cancer Research:
adult primary hepatocellular carcinoma
localized unresectable adult primary liver cancer
advanced adult primary liver cancer
recurrent adult primary liver cancer

Additional relevant MeSH terms:
Liver Neoplasms
Carcinoma, Hepatocellular
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Digestive System Diseases
Liver Diseases
Adenocarcinoma
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Sunitinib
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Physiological Effects of Drugs
Growth Inhibitors

ClinicalTrials.gov processed this record on July 22, 2014