Linsitinib in Treating Patients With Gastrointestinal Stromal Tumors

This study is ongoing, but not recruiting participants.
Sponsor:
Information provided by (Responsible Party):
National Cancer Institute (NCI)
ClinicalTrials.gov Identifier:
NCT01560260
First received: March 20, 2012
Last updated: September 16, 2014
Last verified: June 2014
  Purpose

This phase II trial studies how well linsitinib works in treating younger and adult patients with gastrointestinal stromal tumors. Linsitinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.


Condition Intervention Phase
Carney Complex
Chondrosarcoma
Gastrointestinal Stromal Tumor
Paraganglioma
Drug: linsitinib
Other: pharmacological study
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 Linsitinib (OSI-906) in Pediatric and Adult Wild Type Gastrointestinal Stromal Tumors

Resource links provided by NLM:


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

Primary Outcome Measures:
  • Response rate (CR or PR) using Response Evaluation Criteria in Solid Tumors guideline version 1.1 [ Time Frame: At 6 months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Clinical benefit rate defined as SD >= 9 months, PR or CR [ Time Frame: Up to 2 years ] [ Designated as safety issue: No ]
  • Response duration [ Time Frame: Up to 37 weeks ] [ Designated as safety issue: No ]
    Analyzed using Kaplan-Meier curves for the all treated and per protocol populations.

  • PFS [ Time Frame: Time from date of enrollment to time of progression or death due to any cause, assessed up to 37 weeks ] [ Designated as safety issue: No ]
    Analyzed using Kaplan-Meier curves for the all treated and per protocol populations.

  • OS [ Time Frame: Up to 37 weeks ] [ Designated as safety issue: No ]
    Analyzed using Kaplan-Meier curves for the all treated and per protocol populations.

  • Failure-free survival [ Time Frame: Up to 37 weeks ] [ Designated as safety issue: No ]
    Analyzed using Kaplan-Meier curves for the all treated and per protocol populations.

  • Time to progression [ Time Frame: Up to 2 years ] [ Designated as safety issue: No ]
    Evaluated using cumulative incidence.


Enrollment: 20
Study Start Date: March 2012
Primary Completion Date: December 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Treatment (linsitinib)
Patients receive linsitinib PO BID on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Drug: linsitinib
Given PO
Other Name: OSI-906
Other: pharmacological study
Correlative studies
Other Name: pharmacological studies
Other: laboratory biomarker analysis
Correlative studies

Detailed Description:

PRIMARY OBJECTIVES:

I. To determine the response rate to treatment with OSI-906 (linsitinib) in patients with advanced wild-type (WT) gastrointestinal stromal tumor (GIST).

SECONDARY OBJECTIVES:

I. To determine the clinical benefit rate (stable disease [SD] >= 9 months, partial response [PR], or complete response [CR]) in patients with advanced WT GIST treated with OSI-906.

II. To determine the response duration, progression free survival, and overall survival in patients with advanced WT GIST treated with OSI-906.

III. To determine the tolerability and adverse event profile of OSI-906 in patients with advanced GIST.

IV. To explore patterns of protein expression in serum and tumor tissues as predictors of response and progression-free survival (PFS) in advanced WT GIST treated with OSI-906.

V. To evaluate the metabolic response to OSI-906 using fludeoxyglucose F 18 (FDG)-positron emission tomography (PET).

VI. To determine if tumor metabolic response correlates with anatomic response and clinical benefit.

VII. To measure changes in tumor metabolism by FDG-PET qualitatively and semi-quantitatively with standard uptake value (SUV) and tumor body ratio (TBR) from baseline to first computed tomography (CT)-response evaluation and correlate the findings with size changes as defined by conventional cross-sectional imaging scans.

VIII. To investigate correlations between glucose, insulin, and candidate tumor tissue and blood biomarkers with FDG-PET metabolic response.

OUTLINE:

Patients receive linsitinib orally (PO) twice daily (BID) on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up for 30 days, every 12 weeks for 2 years, and then annually thereafter.

  Eligibility

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

Inclusion Criteria:

  • Patients must have histologically confirmed gastrointestinal stromal tumor (GIST) with confirmed genotype of wild-type in a Clinical Laboratory Improvement Amendments (CLIA) certified laboratory
  • Patients will be stratified into pediatric and adult cohorts; patients in the pediatric cohort (age at diagnosis =< 18 years OR diagnosis of Carney Triad or Carney-Stratakis Diad (paraganglioma, pulmonary chondroma) must have received at least sunitinib and have had progression on or intolerance to progression on therapy; patients in the adult cohort (age at diagnosis > 18 years AND no diagnosis of diagnosis of Carney Triad or Carney-Stratakis Diad) have had progression on or intolerance to imatinib therapy as documented by treating physician
  • Performance status: Eastern Cooperative Oncology Group (ECOG) 0-2
  • Patients must have measurable disease defined as lesions that can be measured in 2 dimensions by medical imaging techniques such as CT or magnetic resonance imaging (MRI); ascites, pleural fluid, and lesions seen on PET scan only are not considered measurable
  • White blood cells count >= 2.0 x 10^9/L (being >= 14 days off growth factors) OR
  • Absolute neutrophil count (ANC) >= 1.5 x 10^9/L (being >= 14 days off growth factors)
  • Platelet count >= 75 x 10^9/L
  • Total bilirubin =< 1.5 times the upper limit of normal for age
  • Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) (serum glutamate pyruvate transaminase [SGPT]/serum glutamic oxaloacetic transaminase [SGOT]) =< 3 x the upper limit of normal (ULN) for the reference lab (=< 5 x the ULN for the reference lab in the presence of known hepatic metastasis, adjusted for age)
  • Creatinine clearance > 70 ml/min/1.73m^2 or
  • Serum creatinine < 1.5 x ULN per age and gender
  • QT interval corrected using Frederica formula (QTcF) interval average of < 450 msec at baseline using the Frederica formula (QTcF)
  • No concomitant drugs that prolong the QTc interval
  • No significant cardiac disease
  • Fasting blood glucose < 150 mg/dL at baseline
  • Hemoglobin A1C (HbA1c) < 7% at screening
  • Patients or their legal representative must be able to read, understand and provide written informed consent to participate in the trial
  • Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately; women of childbearing potential must provide a negative pregnancy test (serum or urine) within 7days prior to registration
  • Patients with diabetes mellitus should have controlled disease on oral medications, defined as: no diabetic ketoacidosis (hyperglycemia, ketonuria, pH < 7.3 and bicarbonate < 15mEq/L) at the time of enrollment or within 30 days prior to enrollment and; no change in oral medications greater than 10% within 30 days prior to enrollment
  • Patient must be able to swallow to participate in the study
  • Signed informed consent

Exclusion Criteria:

  • Time elapsed from previous therapy must be >= 3 weeks except for prior tyrosine kinase inhibitor therapy which can be >= 7 days; patients must be recovered from the effects of any prior surgery, radiotherapy or systemic therapy
  • Patients who are receiving any other investigational agents or other anti-cancer therapies other than those administered in this study during protocol treatment
  • Patients with diabetes mellitus requiring insulin for control of their diabetes
  • Patients with a history of liver cirrhosis
  • Patients with known brain metastases should be excluded from this clinical trial
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to linsitinib (OSI-906)
  • While cytochrome P450 1A2 (CYP1A2) inhibitors/inducers are not specifically excluded, investigators should be aware that linsitinib (OSI 906) exposure may be altered by the concomitant administration of these drugs
  • While cytochrome P450 2C9 (CYP2C9) substrates are not specifically excluded, investigators should be aware that levels of drugs metabolized by CYP2C9 may be increased by the concomitant administration of linsitinib (OSI-906); caution should be used when administering CYP2C9 substrates to patients who are on study drug
  • Use of the potent CYP1A2 inhibitors ciprofloxacin and fluvoxamine are prohibited; other less potent CYP1A2 inhibitors/inducers are not excluded
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
  • Prior treatment with another kinase inhibitor targeting insulin-like growth factor 1 receptor (IGF-1R) pathway, including monoclonal antibodies targeting IGF-1R
  • Pregnant women are excluded from this study; breastfeeding should be discontinued if the mother is treated with linsitinib (OSI-906)
  • Fertile men and women of childbearing potential not employing an effective method of birth control throughout the trial and for 3 months after last study drug administration in both sexes; women of childbearing potential must have a negative pregnancy test (serum or urine) within the 7 days prior to study drug administration

    • NOTE: Women of childbearing potential include both pre-menopausal women and women within the first 2 years of the onset of menopause
    • NOTE: Effective methods of birth control includes: surgically sterile, barrier device (condom, diaphragm), contraceptive coil, abstinence; oral contraceptive pills (OCPs) alone are not considered an effective method
  • Known human immunodeficiency virus (HIV)-positive patients on combination antiretroviral therapy are ineligible
  • Use of drugs that have a known risk of causing Torsades de Pointes (TdP) are prohibited within 14 days prior to initiation of linsitinib (OSI-906)
  • Patients with a history of solid organ transplant are ineligible
  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: NCT01560260

Locations
United States, California
Stanford University Hospitals and Clinics
Stanford, California, United States, 94305
United States, Iowa
University of Iowa Hospitals and Clinics
Iowa City, Iowa, United States, 52242
United States, Maryland
National Institutes of Health
Bethesda, Maryland, United States, 20892
United States, Massachusetts
Dana-Farber Cancer Institute
Boston, Massachusetts, United States, 02115
United States, Michigan
Sarcoma Alliance for Research Through Collaboration
Ann Arbor, Michigan, United States, 48106
University of Michigan
Ann Arbor, Michigan, United States, 48109
United States, Oregon
Oregon Health and Science University
Portland, Oregon, United States, 97239
United States, Pennsylvania
Fox Chase Cancer Center
Philadelphia, Pennsylvania, United States, 19111
Sponsors and Collaborators
Investigators
Principal Investigator: Margaret von Mehren Sarcoma Alliance for Research through Collaboration
  More Information

No publications provided

Responsible Party: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT01560260     History of Changes
Other Study ID Numbers: NCI-2012-00708, NCI-2012-00708, CDR0000728619, SARC-022, SARC 022, SARC022, 8945
Study First Received: March 20, 2012
Last Updated: September 16, 2014
Health Authority: United States: Food and Drug Administration

Additional relevant MeSH terms:
Gastrointestinal Stromal Tumors
Chondrosarcoma
Paraganglioma
Carney Complex
Neoplasms, Connective Tissue
Neoplasms, Connective and Soft Tissue
Neoplasms by Histologic Type
Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Digestive System Diseases
Gastrointestinal Diseases
Sarcoma
Neuroendocrine Tumors
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms, Nerve Tissue
Myxoma
Heart Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Heart Diseases
Cardiovascular Diseases
Abnormalities, Multiple
Congenital Abnormalities
Skin Abnormalities

ClinicalTrials.gov processed this record on September 30, 2014