Trial of Tasigna (Nilotinib) 400 mg Twice Daily Alone or With Gleevec (Imatinib Mesylate) 400 mg Daily for Patients With Advanced Gastrointestinal Stromal Tumor (GIST)

This study has been terminated.
(Novartis is ending their research program for Nilotinib in GIST.)
Sponsor:
Collaborator:
Novartis
Information provided by:
Fox Chase Cancer Center
ClinicalTrials.gov Identifier:
NCT01089595
First received: January 28, 2010
Last updated: March 8, 2012
Last verified: March 2012
  Purpose

Patients with advanced GIST are treated with imatinib. This study seeks to look at a new therapeutic agent at the time of tumor progression following treatment with 600-800 mg daily of imatinib. The study is looking to see if Nilotinib (tasigna) alone or in combination with imatinib (gleevec) is more effective at controlling disease.


Condition Intervention Phase
GIST
Metastatic Disease
Drug: Nilotinib
Drug: Nilotinib with Imatinib
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Open Label Phase II Randomized Trial of Tasigna (Nilotinib) 400 mg Twice Daily Alone or in Combination With Gleevec (Imatinib Mesylate) 400 mg Daily for Patients With Advanced GIST That Have Progressed on High Dose Imatinib

Resource links provided by NLM:


Further study details as provided by Fox Chase Cancer Center:

Primary Outcome Measures:
  • Progression free survival [ Time Frame: 6 months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Response by Choi Criteria [ Time Frame: 6 months ] [ Designated as safety issue: No ]

Enrollment: 5
Study Start Date: February 2009
Study Completion Date: March 2012
Primary Completion Date: March 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Nilotinib
Nilotinib 400 mg po bid
Drug: Nilotinib
Nilotinib 400 mg po bid
Other Name: Tasigna
Active Comparator: Nilotinib + Imatinib
Nilotinib 400 mg BID with Imatinib 400 mg daily
Drug: Nilotinib with Imatinib
Nilotinib 400 mg po BID Imatinib 400 mg po daily
Other Names:
  • Tasigna
  • Gleevec

Detailed Description:

Resistance to imatinib does develop and represents a major clinical challenge. Mechanisms implicated in imatinib resistance include: target resistance due to new KIT or PDGFRA mutations or over expression of the KIT protein; target modulation due to activation of an alternate receptor tyrosine kinase protein with loss of KIT oncoprotein expression; functional resistance due to KIT or PDGFRA activation without a secondary mutation; and alterations in imatinib uptake by P-glycoprotein.

This study seeks to test nilotinib alone and nilotinib in combination with imatinib in patients that have progressed on imatinib.

Nilotinib is a new synthetic second-generation inhibitor of the BCR-ABL tyrosine kinase that competes for the ATP-bindings sites of BCR-ABL. A completed phase I trial assessed the activity of nilotinib alone and in combination with imatinib in patients that have progressed on imatinib in a population of patients with imatinib refractory and intolerant patients. There were rare responses, but stable disease was observed in grater than 50% of patients.

This study is aiming to treat patients with advanced or metastatic GIST who have disease progression on imatinib dose escalated up to 600 mg or greater. The rationale for exploring Nilotinib in this setting is to determine if it has therapeutic efficacy, with potentially less toxicity than the current standard of care for second line therapy. In addition, since it is not uncommon to see progression of some metastatic GIST lesions on imatinib, while others remain controlled, adding nilotinib may treat the progressing lesions while imatinib continues to control the areas without disease progression.

  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 GIST.
  • advanced/metastatic GIST.
  • experienced failure of prior treatment with imatinib 600-800 mg per day defined by progression of disease according to RECIST criteria during treatment. Radiographic evidence of PD on imatinib must be confirmed by the Investigator prior to enrollment.
  • May have focal progression of disease including a new enhancing nodular focus within a pre-existing tumor nodule; such a nodule should be considered measurable by standard RECIST criteria.
  • measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as >20 mm with conventional techniques or as >10 mm with spiral CT scan.
  • At least 4 weeks since prior therapy with imatinib & resolution of all acute toxic effects of the prior therapy or surgical procedure to grade ≤1.
  • Age >18 years.
  • ECOG performance status 0-2.
  • Normal organ and marrow function as defined below:

    • ANC >1,500/mcL
    • Platelets >100,000/mcL
    • Total bilirubin < or equal to 1.5 X ULN
    • AST(SGOT)/ALT(SGPT) < or equal to 2.5 X ULN OR < or equal to 5.0 X ULN if considered due to tumor
    • Amylase/Lipase < or equal to 1.5 X ULN
    • Alkaline Phosphatase < or equal to 2.5 X ULN or </= 5 X ULN if considered tumor related.
    • Potassium, magnesium, calcium, phosphorus, creatinine WNL prior to randomization
    • OR
    • Creatinine clearance of > 50 calculated by cockroft-gault formula
  • WOCBP must have negative pregnancy test within 7 days of first treatment and use appropriate contraception.
  • Ability to understand and willingness to sign a written informed consent document.

Exclusion Criteria:

  • Have received nilotinib or additional tyrosine kinase inhibitors or additional targeted therapies (except for imatinib).
  • May not be receiving any other investigational agents within 4 weeks before treatment.
  • Prior or concomitant malignancies (with a relapse in the last 5 years or requiring active treatment) other than GIST and with exception of previous or concomitant basal cell skin, previous cervical carcinoma in situ.
  • Impaired cardiac function, including any one of the following:

Complete left bundle branch block. Ventricular paced cardiac pacemaker. Congenital long QT syndrome or family history of long QT syndrome. History of or presence of symptomatic ventricular or atrial tachyarrhythmias. Clinically significant resting bradycardia (< 50 beats per minute). QTc > 480 msec on screening ECG (using the QTcF formula). If QTc > 480 msec and electrolytes are not within normal ranges (electrolytes should be corrected and then the patient rescreened for QTc).

Right bundle branch block plus left anterior hemiblock, bifascicular block. Myocardial infarction within 12 months prior to Visit 1. Other clinically significant heart diseases (e.g., unstable angina, congestive heart failure or uncontrolled hypertension).

Severe and/or uncontrolled concurrent medical disease that could cause unacceptable safety risks or compromise compliance with protocol e.g. impairment of GI function, or GI disease that may significantly alter absorption of study drugs; uncontrolled diabetes; active infections; psychiatric illness/social situation that would limit compliance with study requirements.

  • Inability to remain laying down in PET scanner for up to one hour.
  • Use of any medications that prolong the QT interval and CYP3A4 inhibitors if treatment cannot be either safely discontinued or switched to a different medication prior to starting study drug administration.
  • Major surgery ≤ 2 weeks prior to Visit 1 or who have not recovered from side effects of such surgery.
  • Known history of noncompliance to medical regimens or inability/unwillingness to return for scheduled visits, patients who are pregnant or breast feeding, patients unwilling or unable to comply with the requirements for the protocol.
  • Known chronic liver disease (i.e., chronic active, hepatitis, and cirrhosis).
  • Known diagnosis of HIV, currently taking combination antiretroviral therapy.
  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: NCT01089595

Locations
United States, Missouri
Siteman Cancer Center, Washington University School of Mediciine
St Louis, Missouri, United States, 63110
United States, North Carolina
Wake Forest University
Winston-Salem, North Carolina, United States, 27157-1082
United States, Pennsylvania
Fox Chase Cancer Center
Philadelphia, Pennsylvania, United States, 19111
Sponsors and Collaborators
Fox Chase Cancer Center
Novartis
Investigators
Principal Investigator: Margaret von Mehren, MD Fox Chase Cancer Center
  More Information

No publications provided

Responsible Party: Margaret von Mehren, MD, Fox Chase Cancer Center
ClinicalTrials.gov Identifier: NCT01089595     History of Changes
Other Study ID Numbers: FER-SAR-023
Study First Received: January 28, 2010
Last Updated: March 8, 2012
Health Authority: United States: Food and Drug Administration

Keywords provided by Fox Chase Cancer Center:
Imatinib Resistance
GIST
Advanced Disease
Nilotinib

Additional relevant MeSH terms:
Gastrointestinal Stromal Tumors
Neoplasm Metastasis
Digestive System Diseases
Digestive System Neoplasms
Gastrointestinal Diseases
Gastrointestinal Neoplasms
Neoplasms
Neoplasms by Histologic Type
Neoplasms, Connective and Soft Tissue
Neoplasms, Connective Tissue
Neoplastic Processes
Pathologic Processes
Imatinib
Antineoplastic Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Protein Kinase Inhibitors
Therapeutic Uses

ClinicalTrials.gov processed this record on October 21, 2014