Selumetinib in Treating Patients With Biliary Cancer That Cannot Be Removed By Surgery

This study is ongoing, but not recruiting participants.
Sponsor:
Information provided by (Responsible Party):
National Cancer Institute (NCI)
ClinicalTrials.gov Identifier:
NCT00553332
First received: November 2, 2007
Last updated: April 1, 2013
Last verified: April 2013
  Purpose

This phase II trial is studying how well selumetinib works in treating patients with biliary cancer that cannot be removed by surgery. Selumetinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.


Condition Intervention Phase
Liver and Intrahepatic Biliary Tract Cancer
Recurrent Extrahepatic Bile Duct Cancer
Unresectable Extrahepatic Bile Duct Cancer
Drug: selumetinib
Other: laboratory biomarker analysis
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase 2 Study of AZD6244 in Biliary Cancers

Resource links provided by NLM:


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

Primary Outcome Measures:
  • Objective response rate (CR and PR) [ Time Frame: Every 8 weeks ] [ Designated as safety issue: No ]
    Response will be evaluated in this study using the new international criteria proposed by Response Evaluation Criteria in Solid Tumors (RECIST) committee. Only those patients who have measurable disease present at baseline, have received at least one cycle of therapy, and have had their disease re-evaluated will be considered evaluable for response. A Simon 2-stage minimax design, which minimizes the maximum sample size given specified alpha and beta error rates will be utilize.


Secondary Outcome Measures:
  • Toxicity profile of AZD6244 [ Time Frame: From the time of first treatment with AZD6244, assessed up to 4 weeks ] [ Designated as safety issue: Yes ]
    Toxicitity will be assessed using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v 3.0

  • Percentage of patients who are progression-free and alive [ Time Frame: Up to 6 months ] [ Designated as safety issue: No ]
    Progression will be evaluated in this study using the new international criteria proposed by RECIST committee

  • Overall survival [ Time Frame: Up to 12 months ] [ Designated as safety issue: No ]
  • RAS/RAF/MEK/ERK signaling pathway activation [ Time Frame: At baseline ] [ Designated as safety issue: No ]
  • Genetic mutations [ Time Frame: At baseline ] [ Designated as safety issue: No ]
  • Epigenetic silencing [ Time Frame: At baseline ] [ Designated as safety issue: No ]
  • Protein levels of RAS/RAF/MEK/ERK signaling pathway activation [ Time Frame: At baseline ] [ Designated as safety issue: No ]

Estimated Enrollment: 35
Study Start Date: November 2007
Primary Completion Date: January 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Treatment (enzyme inhibitor therapy)
Patients receive oral selumetinib twice daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Drug: selumetinib
Given orally
Other Names:
  • ARRY-142886
  • AZD6244
Other: laboratory biomarker analysis
Correlative studies

Detailed Description:

PRIMARY OBJECTIVES:

I. To evaluate the objective response rate (complete response [CR] and partial response [PR]) in patients with unresectable biliary carcinoma treated with AZD6244 (selumetinib).

SECONDARY OBJECTIVES:

I. To evaluate the toxicity profile of this drug in these patients. II. To evaluate the 6- and 12-month survival, 6-month progression-free survival, and overall survival rates of patients treated with this drug.

III. To correlate genetic mutations, epigenetic silencing, and/or protein levels of RAS/RAF/MEK/ERK signaling pathway activation with therapeutic efficacy of AZD6244 in these patients.

IV. To genotype tumors for the presence of RAS mutations (i.e., NRAS, KRAS, HRAS) and BRAF mutations (e.g., V600E) in biliary tumor samples from these patients.

V. To assess the presence of activation of the MEK1, MEK2, ERK, and/or Akt pathways in tumor samples from these patients.

VI. To assess the epigenetic alterations (i.e., methylation) affecting the level of gene/protein expression of RASSF1A, NORE1A, and NORE1B in tumor samples from these patients.

OUTLINE:

Patients receive oral selumetinib twice daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

Formalin fixed paraffin-embedded tissue blocks or fresh tissue samples are obtained from all patients prior to treatment. Tissue samples are analyzed by immunohistochemistry for the expression level of target proteins (MEK, p-MEK, ERK, p-ERK, Akt, p-AKT, RASSF1A, NORE1A and NORE1B); PCR for mutational status of target genes RAS, BRAF and EGFR); and in methylation-specific PCR for methylation of target gene promoters (promoters for RASSF1A, NORE1A and NORE1B). Samples are also analyzed by quantitative real-time PCR to compare methylation status. Fresh frozen tissue, when available, is evaluated by Western analysis to measure expression levels of target proteins.

After completion of study treatment, patients are followed up for 4 weeks.

  Eligibility

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

Inclusion Criteria:

  • Histologically confirmed biliary tract carcinoma

    • Surgically unresectable disease
  • Meets any of the following criteria for biliary cancers only:

    • Received ≤ 1 prior systemic anticancer therapy, including chemoembolization
    • Received prior cryotherapy, radiofrequency ablation, ethanol injection, transarterial chemoembolization, or photodynamic therapy AND meets the following criteria:

      • More than 6 weeks have elapsed since any of the prior therapy described above
      • Indicator lesion(s) must be outside the area of prior treatment OR must demonstrate clear evidence of disease progression if the only indicator lesion is inside the prior treatment area
      • Indicator lesion must have clearly distinct edges on CT scan
    • Prior radiotherapy with or without the use of a fluoropyrimidine as a radiosensitizer is allowed, provided more than 12 weeks have elapsed since treatment
  • Fresh or paraffin-embedded tissue from tumor blocks must be available for review
  • Measurable disease, defined as ≥ 1 unidimensionally measurable lesion > 20 mm by conventional techniques or > 10 mm by spiral CT scan
  • No known brain metastases
  • Life expectancy > 12 weeks
  • ECOG performance status (PS) 0-1 or Karnofsky PS 70-100%
  • ANC ≥ 1,500/μL
  • Platelet count ≥ 75,000/μL
  • Total bilirubin ≤ 2 times upper limit of normal(ULN)
  • AST or ALT ≤ 3 times ULN
  • Serum albumin ≥ 2.5 mg/dL
  • INR ≤ 1.5 (not receiving anticoagulation therapy)
  • Creatinine normal or creatinine clearance ≥ 60 mL/min
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile women must use effective contraception during and for four weeks after the last dose of AZD6244
  • Fertile men must use effective contraception during and for 16 weeks after the last dose of AZD6244
  • No significant traumatic injury within the past 3 weeks
  • No uncontrolled symptoms consistent with encephalopathy
  • No history of allergic reactions attributed to compounds of similar chemical or biologic composition to AZD6244 or its excipient, Captisol®
  • No QTc interval > 500 msecs or other factors that increase the risk of QT prolongation or arrhythmic events (e.g., hypokalemia or family history of long QT interval syndrome), including NYHA class III-IV heart failure
  • No other malignancy within the past 3 years, except adequately treated basal cell or squamous cell skin cancer or carcinoma in situ of the cervix
  • No refractory nausea and vomiting, chronic gastrointestinal disease (e.g., inflammatory bowel disease), or significant bowel resection that would preclude adequate absorption
  • No uncontrolled concurrent illness including, but not limited to, ongoing or active infection or psychiatric illness/social situation that would limit compliance with study requirements
  • No malignant hypertension within the past year
  • No prior sorafenib or MEK inhibitors
  • More than 4 weeks since prior chemotherapy, biologic therapy, or immunotherapy (6 weeks for nitrosoureas or mitomycin C) and recovered to ≤ grade 1 adverse events
  • No major surgery within the past 3 weeks
  • No other concurrent investigational agents
  • No concurrent requirement for medication that can prolong the QT interval
  • No concurrent combination antiretroviral therapy for HIV-positive patients
  • No concurrent consumption of grapefruit or grapefruit juice
  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: NCT00553332

Locations
United States, Florida
H. Lee Moffitt Cancer Center and Research Institute
Tampa, Florida, United States, 33612
United States, Georgia
Emory University
Atlanta, Georgia, United States, 30322
United States, Michigan
University of Michigan Cancer Center (UMCC) Research Base
Ann Arbor, Michigan, United States, 48109-0352
Wayne State University
Detroit, Michigan, United States, 48202
United States, North Carolina
University of North Carolina
Chapel Hill, North Carolina, United States, 27599
United States, Ohio
Ohio State University Medical Center
Columbus, Ohio, United States, 43210
United States, Tennessee
Vanderbilt University
Nashville, Tennessee, United States, 37232
Sponsors and Collaborators
Investigators
Principal Investigator: Tanios Bekaii-Saab Ohio State University
  More Information

No publications provided

Responsible Party: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00553332     History of Changes
Obsolete Identifiers: NCT01645644
Other Study ID Numbers: NCI-2009-00251, OSU 07056, OSU-07056, CDR0000573452, N01CM62208, N01CM62207
Study First Received: November 2, 2007
Last Updated: April 1, 2013
Health Authority: United States: Food and Drug Administration

Additional relevant MeSH terms:
Bile Duct Neoplasms
Biliary Tract Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Bile Duct Diseases
Biliary Tract Diseases
Digestive System Diseases

ClinicalTrials.gov processed this record on October 19, 2014