Ixabepilone in Treating Patients With Recurrent or Persistent Uterine Cancer

• Frequency of patients with objective tumor response [ Time Frame: Up to 5 years ] [ Designated as safety issue: No ]
• Frequency and severity of adverse events [ Time Frame: Up to 5 years ] [ Designated as safety issue: Yes ]

• Objective tumor response [ Designated as safety issue: No ]
• Frequency and severity of adverse events [ Designated as safety issue: Yes ]

• Duration of progression-free survival [ Time Frame: Up to 5 years ] [ Designated as safety issue: No ]
  Kaplan-Meier product limit estimates will be provided along with descriptive measures such as their median estimates.
• Duration of overall survival [ Time Frame: Up to 5 years ] [ Designated as safety issue: No ]
  Kaplan-Meier product limit estimates will be provided along with descriptive measures such as their median estimates.

• Progression-free survival [ Designated as safety issue: No ]
• Overall survival [ Designated as safety issue: No ]

This phase II trial is studying the side effects and how well ixabepilone works in treating patients with persistent or recurrent uterine cancer. Drugs used in chemotherapy, such as ixabepilone, work in different ways to stop the growth of tumor cells, either by killing the cells of by stopping them from dividing

PRIMARY OBJECTIVES:

I. To determine the response rate of patients with persistent or recurrent carcinosarcoma of the uterus treated with ixabepilone.

II. To determine the nature and degree of toxicity of this regimen in these patients.

SECONDARY OBJECTIVES:

I. To determine the duration of progression-free survival and overall survival of patients treated with this regimen.

TERTIARY OBJECTIVES:

I. To examine the expression of class III beta-tubulin in carcinosarcoma of the uterus.

II. To explore the association between class III beta-tubulin expression with response, progression-free survival, and overall survival in these patients.

OUTLINE: This is a multicenter study.

Patients receive ixabepilone IV over 3 hours on day 1. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.

Tumor tissue samples from prior surgery may be collected for class III beta-tubulin analysis by IHC.

After completion of study therapy, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.

• Recurrent Uterine Sarcoma
• Uterine Carcinosarcoma

• Drug: ixabepilone
  Given IV
  Other Names:

  • BMS-247550
  • epothilone B lactam
  • Ixempra
• Other: laboratory biomarker analysis
  Correlative studies

Inclusion Criteria:

• Histologically confirmed uterine carcinosarcoma

  • Persistent or recurrent disease refractory to curative or established treatments
  • Malignant mixed müllerian tumor
  • Homologous or heterologous type
• Progressive disease after local therapy

• Measurable disease defined as ≥ 1 lesion that can be accurately measured in ≥ 1 dimension (longest diameter to be recorded)

  • Each lesion must be ≥ 10 mm by CT scan, MRI, or caliper measurement by clinical exam OR ≥ 20 mm by chest X-ray
  • Lymph nodes must be ≥ 15 mm in short axis by CT scan or MRI

• Patient must have ≥ 1 "target lesion" to assess response

  • Tumors within a previously irradiated field will be designated as "non-target" lesions unless progression is documented or a biopsy is obtained to confirm persistence ≥ 90 days after completion of radiotherapy

• Patient must have had 1 prior chemotherapeutic regimen for management of carcinosarcoma that may have included chemotherapy, chemotherapy and radiotherapy, and/or consolidation/maintenance therapy

  • Chemotherapy administered in conjunction with primary radiation as a radio-sensitizer is counted as a systemic chemotherapy regimen
  • Patients who have not received a prior taxane therapy (e.g., paclitaxel or docetaxel) must receive a second regimen that includes a taxane
• Patients must not be eligible for a higher priority GOG or Rare Tumor protocol, if one exists
• ECOG performance status 0-2
• ANC ≥ 1,500/mm³
• Platelet count ≥ 100,000/mm³
• Creatinine ≤ 1.5 times upper limit of normal (ULN)
• Bilirubin ≤ 1.5 times ULN
• AST and ALT ≤ 3.0 times ULN
• Alkaline phosphatase ≤ 2.5 times ULN
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• Peripheral neuropathy (sensory and motor) ≤ grade 1
• No active infection requiring antibiotics except uncomplicated urinary tract infection
• No history of severe grade 3-4 hypersensitivity reaction to agents containing Cremophor® EL or its derivatives (e.g., polyoxyethylated castor oil)
• More than 3 years since other invasive malignancy except non-melanoma skin cancer
• No concurrent amifostine or other protective reagents
• Recovered from recent surgery, radiotherapy, or chemotherapy
• At least 1 week since prior hormonal therapy
• At least 3 weeks since any prior therapy directed at the malignant tumor, including biological and immunological agents

• One prior non-cytotoxic (biologic or cytostatic) regimen for management of recurrent or persistent disease that includes, but is not limited to, any of the following allowed:

  • Monoclonal antibodies
  • Cytokines
  • Small-molecule inhibitors of signal transduction

• More than 3 years since prior radiotherapy to any portion of the abdominal cavity or pelvis other than for uterine carcinosarcoma

  • Prior radiation for localized cancer of the breast, head and neck, or skin allowed provided the patient remains free of recurrent or metastatic disease

• No prior chemotherapy for any abdominal or pelvic tumor, other than for uterine carcinosarcoma, within the past 3 years

  • More than 3 years since prior adjuvant chemotherapy for localized breast cancer allowed provided patient has remained free of recurrent or metastatic disease
• No prior ixabepilone
• No prior cancer therapy that contraindicates study treatment