Dovitinib for Imatinib/Sumitinib-failed Gastrointestinal Stromal Tumors (GIST) - Full Text View

Purpose

With discovery of KIT mutations and the advent of KIT tyrosine kinase inhibitor imatinib (GlivecTM, Novartis), there has been substantial improvement in overall survival in patients with advanced and/or metastatic gastrointestinal tumors (GIST). Recently, sunitinib (SuteneTM, Pfizer) showed activity as second-line therapy in GIST patients after failure with imatinib. However, virtually all patients will eventually progress or become intolerable after the first-line imatinib and the second-line sunitinib. Dovitinib (TKI258, Novartis) is a multi-kinase inhibitor. TKI258 is a potent inhibitor of the VEGFR 1, 2, and 3, FGFR1, 2 and 3, PDGFRβ, Kit, RET, TrkA, CSF 1R, and FLT3 with inhibitory concentration 50% (IC50s) of less than 40nM. Stem cell factor (SCF) also termed KIT ligand, or steel factor has been shown to modulate tumor angiogenesis. In cultured human endothelial cells and Kit expressing cancer cells, TKI258 inhibits VEGF- and SCF-stimulated mitogenesis. .

Condition	Intervention	Phase
Gastrointestinal Stromal Tumors	Drug: dovitinib	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:	A Phase II Trial of TKI258 in Patients With Metastatic or Advanced Gastrointestinal Stromal Tumors (GIST) After Failure to Imatinib and Sunitinib(CTKI258AKR01T)

Resource links provided by NLM:

Genetics Home Reference related topics: gastrointestinal stromal tumor

MedlinePlus related topics: Cancer

Drug Information available for: Imatinib Imatinib mesylate

U.S. FDA Resources

Further study details as provided by Asan Medical Center:

Primary Outcome Measures:

Disease control rate (DCR; response + stable disease) [ Time Frame: Up to 24 weeks ] [ Designated as safety issue: No ]
evaluated with abdominal and pelvic dynamic CT scan every 4 weeks for the initial 8 weeks, and then every 8 weeks, using RECIST version 1.0

Secondary Outcome Measures:

Overall response rate using both CT and PET scans [ Time Frame: Up to 24 weeks ] [ Designated as safety issue: No ]
PET scan will be performed at baseline and at 4 weeks of treatment. Choi criteria will be used for determination of response
Efficacy according to the primary mutation type [ Time Frame: Up to 24weeks ] [ Designated as safety issue: No ]
Correlation between efficacy results such as response, progression-free survival and overall survival, and primary mutation type including KIT exons 9, 11, 13, and 17 and PDGFRα exons 12 and 18.
Efficacy according to the concentrations of circulating growth factors [ Time Frame: Up to 24weeks ] [ Designated as safety issue: No ]
Correlation between efficacy results, such as response, progression-free survival, and overall survival andcirculating growth factors (including vascular endothelial growth factor, fibroblast growth factor, interleukin‐8, placental growth factor, and fibroblast growth factor23), and soluble receptors (including soluble form of membrane bound vascular endothelial growth factor receptor-1 and -2).
Number of participants with adverse events [ Time Frame: Monitoring of adverse events will be continued for at least 28 days following the last dose of study treatment. ] [ Designated as safety issue: Yes ]
Adverse events will be graded according to Common Terminology Criteria for Adverse events version 3.0
Progression-free survival [ Time Frame: Up to 3 years ] [ Designated as safety issue: Yes ]
Progression-free survival is defined as the time from the first treatment to the onset of progressive disease per RECIST criteria or to the date of death whichever comes first. For patients who do not experience progressive disease or death, the progression-free survival duration will be right censored on the last disease assessment date.
Overall survival [ Time Frame: Up to 3 years ] [ Designated as safety issue: No ]
Overall survival duration is calculated as time from the first treatment to the date of death. For patients who are still alive at the cut‐off date for statistical reporting, the overall survival duration will be right censored on the last known alive date.

Estimated Enrollment:	30
Study Start Date:	September 2011
Estimated Study Completion Date:	March 2013
Estimated Primary Completion Date:	September 2012 (Final data collection date for primary outcome measure)

Intervention Details:

dovitinib

TKI258 at 500 mg/day on a 5 days on/2 days off dosing schedule

Other Name: A phase II study of TKI258

Detailed Description:

It is well known that KIT and PDGFR which can be inhibited by TKI258 have a crucial role in the development and proliferation of GIST, and in general FGFR has an important role in angiogenesis and tumor proliferation in many cancers. We assume that TKI258 can be also effective in patients with GIST. The objective of this study is to evaluate the safety and activity of TKI258 given as salvage treatment for GIST after failure to standard imatinib and sunitinib.

Eligibility

Ages Eligible for Study:	20 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion criteria

Age 20 years or older
Histologically confirmed metastatic and/or advanced GIST with CD117(+), DOG-1(+), or mutation in KIT or PDGFRα gene
Failed (progressed and/or intolerable) after prior treatments for GIST, including at least both imatinib and sunitinib .
ECOG performance status of 0~2
Resolution of all toxic effects of prior treatments to grade 0 or 1 by NCI-CTCAE version 3.0
At least one measurable lesion as defined by RECIST version 1.0.
Adequate bone marrow, hepatic, renal, and other organ functions
- Neutrophil > 1,500/mm3
- Platelet > 75,000/mm3
- Hemoglobin > 8.0 g/dL
- Total bilirubin < 1.5 x upper limit of normal (ULN)
- AST/ALT < 2.5 x ULN (or < 5 x ULM in case of liver metastases)
- Creatinine < 1.5 x ULN
- Amylase, lipase < ULN
Electrolytes should be within normal limits.
Urine dipstick reading: Negative for proteinuria or, if documentation of +1 results for protein on dipstick reading, then total urinary protein ≤ 500 mg and measured creatinine clearance ≥ 50 mL/min/1.73m2 from a 24-hour urine collection
Life expectancy > 12 weeks
Women with reproductive potential must have a negative serum or urine pregnancy test
Washout period of previous TKIs or chemotherapy for more than 4 times the half life.
Provision of a signed written informed consent

Exclusion criteria

Women of child-bearing potential who are pregnant or breast feeding or adults of reproductive potential not employing an effective method of birth control.
Clinically significant cardiac disease (New York Heart Association, Class III or IV) or impaired cardiac function or clinically significant cardiac diseases,
Uncontrolled infection.
Diabetes mellitus (insulin dependent or independent disease, requiring chronic medication) with signs of clinically significant peripheral vascular disease.
Previous pericarditis; clinically significant pleural effusion in the previous months or current ascites requiring two or more interventions/month.
Known pre-existing clinically significant disorder of the hypothalamic-pituitary axis, adrenal or thyroid glands.
Prior acute or chronic pancreatitis of any etiology.
Acute and chronic liver disease and all chronic liver impairment.
Malabsorption syndrome or uncontrolled gastrointestinal toxicities with toxicity greater than NCI CTCAE grade 2.
Other severe, acute, or chronic medical or psychiatric condition or laboratory abnormality.
Treatment with any of the medications that have a potential risk of prolonging the QT interval or inducing Torsades de Points and the treatment cannot be discontinued or switched to a different medication prior to starting study drug.
Use of ketoconazole, erythromycin, carbamazepine, phenobarbital, rifampin, phenytoin and quinidine 2 weeks prior baseline.
Major surgery ≤ 28 days prior to starting study drug or who have not recovered from side effects of such therapy.
Known diagnosis of HIV infection .
History of another primary malignancy that is currently clinically significant or currently requires active intervention.
Patients with brain metastases as assessed by radiologic imaging
Alcohol or substance abuse disorder.
no other inhibitor of FGFR except sunitinib

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01440959

Contacts

Contact: Yoon-Koo Kang, Md, PhD	+82-2-3010-3230	ykkang@amc.seoul.kr
Contact: Min-Hee Ryu, MD, PhD	+82-2-3010-5935	miniryu@amc.seoul.kr

Locations

Korea, Republic of
Asan Medical Center, University of Ulsan College of Medicine	Recruiting
Seoul,, Korea, Republic of, 138-736
Contact: Yoon-Koo Kang, MD, PhD +82-2-3010-3230 ykkang@amc.seoul.kr
Contact: Min-Hee Ryu, MD,PhD +82-2-3010-5935 miniryu@amc.seoul.kr
Principal Investigator: Yoon-Koo Kang, MD, PhD

Sponsors and Collaborators

Asan Medical Center

Investigators

Principal Investigator:

Yoon-Koo Kang, MD, PhD

Asan Medical Center

More Information

No publications provided

Responsible Party:	Yoon-Koo Kang, Study Principal Investigator, Asan Medical Center
ClinicalTrials.gov Identifier:	NCT01440959 History of Changes
Other Study ID Numbers:	AMC1101
Study First Received:	September 8, 2011
Last Updated:	August 1, 2012
Health Authority:	Korea: Food and Drug Administration

Keywords provided by Asan Medical Center:

This is a single-center
prospective
single-arm
open-label phase II study

Additional relevant MeSH terms:

Gastrointestinal Stromal Tumors
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Digestive System Diseases
Gastrointestinal Diseases

Imatinib
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on May 16, 2013