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Sunitinib Malate in Treating HIV-Positive Patients With Cancer Undergoing Highly Active Antiretroviral Therapy
This study is ongoing, but not recruiting participants.

First Received on April 29, 2009.   Last Updated on December 1, 2011   History of Changes
Sponsor: AIDS Malignancy Clinical Trials Consortium
Collaborator: National Cancer Institute (NCI)
Information provided by (Responsible Party): AIDS Malignancy Clinical Trials Consortium
ClinicalTrials.gov Identifier: NCT00890747
  Purpose

RATIONALE: Sunitinib malate may stop the growth of cancer cells by blocking blood flow to the cancer and by blocking some of the enzymes needed for cell growth.

PURPOSE: This phase I trial is studying the side effects of sunitinib malate in treating HIV-positive patients with cancer undergoing highly active antiretroviral therapy.


Condition Intervention Phase
Brain and Central Nervous System Tumors
Chronic Myeloproliferative Disorders
Kidney Cancer
Leukemia
Lymphoma
Lymphoproliferative Disorder
Multiple Myeloma and Plasma Cell Neoplasm
Myelodysplastic Syndromes
Myelodysplastic/Myeloproliferative Neoplasms
Nonneoplastic Condition
Unspecified Adult Solid Tumor, Protocol Specific
Drug: sunitinib malate
Other: liquid chromatography-tandem mass spectrometry
Other: mass spectrometry
Other: pharmacogenetic study
Phase 1

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase 1/Pharmacokinetic Study of Sunitinib in Patients With Cancer Who Also Have HIV and Are on HAART Therapy

Resource links provided by NLM:


Further study details as provided by AIDS Malignancy Clinical Trials Consortium:

Primary Outcome Measures:
  • Safety [ Time Frame: Baseline through 30 days post treatment ] [ Designated as safety issue: Yes ]
  • Pharmacological interactions [ Time Frame: Baseline through 30 days post treatment ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Efficacy [ Time Frame: 30 days post treatment ] [ Designated as safety issue: No ]
  • Alterations in antiretroviral drug pharmacokinetics due to sunitinib malate [ Time Frame: Baseline through 30 days post treatment ] [ Designated as safety issue: No ]
  • Alterations in immune parameters, including total leukocyte count, CD4 count, and viral load, during treatment with sunitinib malate [ Time Frame: Baseline through 30 days post treatment ] [ Designated as safety issue: No ]
  • Correlation of variations in genes involved in sunitinib malate absorption, metabolism, and elimination (e.g., CYP3A4, CYP3A5, ABCB1, and ABCG2) with drug pharmacokinetics [ Time Frame: Baseline through 30 days post treatment ] [ Designated as safety issue: No ]

Estimated Enrollment: 42
Study Start Date: August 2009
Estimated Study Completion Date: January 2012
Estimated Primary Completion Date: January 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Group 1 (NNRTI-based therapy)
Subjects will receive 50 mg/day of therapy for 4 weeks, followed by 2 weeks off of therapy (6-week cycle). At least six subjects will be treated at the starting dose for Group 1. Further, six (6) patients on efavirenz-containing regimens will be recruited to Group 1.
Drug: sunitinib malate
Sunitinib starting dose will be assigned by treatment arm and will be taken orally once daily for 4 weeks, followed by a 2 weeks off therapy (6-week cycle), for up to 8 cycles.
Other Name: Sutent
Other: liquid chromatography-tandem mass spectrometry
Pharmacokinetic analysis of sunitinib and SU012662 concentration in plasma samples.
Other: mass spectrometry
Pharmacokinetic analysis of antiretroviral agent concentration in plasma samples.
Other: pharmacogenetic study
DNA analysis to identify single nucleotide polymorphisms in the genes involved in sunitinib and ARV pharmacokinetics.
Experimental: Group 2 (non-ritonavir PI based therapy)
Planned accrual for Group 2 was up to six subjects treated at the starting dose of 50 mg/day of therapy for 4 weeks, followed by 2 weeks off of therapy (6-week cycle). Accrual to Group 2 was closed upon approval of Version 7.0 of the protocol.
Drug: sunitinib malate
Sunitinib starting dose will be assigned by treatment arm and will be taken orally once daily for 4 weeks, followed by a 2 weeks off therapy (6-week cycle), for up to 8 cycles.
Other Name: Sutent
Other: liquid chromatography-tandem mass spectrometry
Pharmacokinetic analysis of sunitinib and SU012662 concentration in plasma samples.
Other: mass spectrometry
Pharmacokinetic analysis of antiretroviral agent concentration in plasma samples.
Other: pharmacogenetic study
DNA analysis to identify single nucleotide polymorphisms in the genes involved in sunitinib and ARV pharmacokinetics.
Experimental: Group 3 (ritonavir PI-based therapy)
Dose escalation, phase I-like design with cohorts of three subjects enrolled on three different dose levels (25 mg/day, 37.5 mg/day, and 50 mg/day). Intra-patient dose escalations will be allowed.
Drug: sunitinib malate
Sunitinib starting dose will be assigned by treatment arm and will be taken orally once daily for 4 weeks, followed by a 2 weeks off therapy (6-week cycle), for up to 8 cycles.
Other Name: Sutent
Other: liquid chromatography-tandem mass spectrometry
Pharmacokinetic analysis of sunitinib and SU012662 concentration in plasma samples.
Other: mass spectrometry
Pharmacokinetic analysis of antiretroviral agent concentration in plasma samples.
Other: pharmacogenetic study
DNA analysis to identify single nucleotide polymorphisms in the genes involved in sunitinib and ARV pharmacokinetics.

Detailed Description:

OBJECTIVES:

Primary

  • To determine the safety of sunitinib malate in HIV-positive patients with cancer undergoing highly active antiretroviral therapy (HAART) containing protease inhibitors and/or non-nucleoside reverse transcriptase inhibitors.
  • To investigate the pharmacological interactions of sunitinib malate.

Secondary

  • To evaluate the efficacy of sunitinib malate in treating patients with non-AIDS-defining cancers.
  • To detect alterations in antiretroviral drug pharmacokinetics due to sunitinib malate.
  • To detect alterations in immune parameters, including total leukocyte count, CD4 count, and viral load, during treatment with sunitinib malate.
  • To correlate variations in genes involved in sunitinib malate absorption, metabolism, and elimination (e.g., CYP3A4, CYP3A5, ABCB1, and ABCG2) with drug pharmacokinetics.
  • To explore the potential for pharmacological interactions between sunitinib and newer antiretroviral agents such as integrase and CCR5 inhibitors.

OUTLINE: This is a multicenter study. Patients are stratified according to type of highly active antiretroviral therapy (non-nucleoside reverse transcriptase inhibitor-based therapy vs non-ritonavir protease inhibitor [PI]-based therapy vs ritonavir PI-based therapy).

Patients receive oral sunitinib malate once daily for 4 weeks. Courses repeat every 6 weeks in the absence of disease progression or unacceptable toxicity.

Blood samples are collected periodically for pharmacokinetic studies by liquid chromatography-tandem mass spectrometry (LC-MS/MS).

After completion of study therapy, patients are followed for at least 1 month.

  Eligibility

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

DISEASE CHARACTERISTICS:

  • Biopsy proven malignancy, including any of the following:

    • Metastatic renal cell carcinoma
    • Other solid tumor malignancy, including non-AIDS-defining or AIDS-defining malignancy, that has progressed after standard therapy and/or for which other curative options are not available
    • Hematologic malignancy for which effective standard therapy or other curative options are not available

      • No blast phase leukemia
  • Serologic documentation of HIV infection by ELISA, western blot, or other federally approved licensed HIV test
  • CD4 count > 50 cells/µL
  • Has been on stable antiretroviral therapy for ≥ 4 weeks that includes a protease inhibitor (PI)-based or non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen of ≥ 3 drugs

    • Not planning to change the regimen within 8 weeks after starting study drug
    • Patients on a highly-active antiretroviral therapy combination that include neither a PI nor a NNRT allowed

PATIENT CHARACTERISTICS:

  • Karnofsky performance status 70-100%
  • Life expectancy ≥ 3 months
  • Hemoglobin ≥ 8.0 g/dL
  • Absolute neutrophil count ≥ 1,500/mm³
  • Platelet count ≥ 100,000/mm³
  • Creatinine normal OR glomerular filtration rate > 60 mL/min
  • Total bilirubin ≤ 1.5 times upper limit of normal (ULN) (total bilirubin ≤ 3.5 mg/dL allowed if elevation is secondary to indinavir therapy AND direct bilirubin ≤ 1.5 times ULN; if the elevation is secondary to atazanavir therapy, then there is no limit on the total bilirubin if the direct bilirubin ≤ 1.5 times ULN)
  • AST and ALT ≤ 2.5 times ULN (≤ 5 times ULN for patients with liver metastases)
  • LVEF normal
  • QTc interval ≤ 500 msec
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective barrier contraception during and for up to 3 months after completion of study treatment
  • No concurrent active opportunistic infection
  • No gastrointestinal tract disease resulting in an inability to take oral medication or a requirement for IV alimentation
  • No active peptic ulcer disease
  • No clinically significant cardiovascular disease, including uncontrolled hypertension (i.e., diastolic blood pressure ≥ 100 mm Hg despite optimal medical therapy) or unstable angina
  • No myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass graft, cerebrovascular accident, transient ischemic attack, or pulmonary embolism within the past 6 months
  • No ongoing ventricular cardiac dysrhythmias ≥ NCI CTCAE grade 2
  • No history of serious ventricular arrhythmia (i.e., ventricular tachycardia or ventricular fibrillation ≥ 3 beats in a row)
  • No serious cardiac arrhythmia requiring medication
  • No psychiatric illness that would limit compliance with study requirements
  • No pre-existing thyroid abnormality that cannot be maintained with medication to keep thyroid-stimulating hormone levels within the normal range
  • No other severe and/or life-threatening medical disease

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • Recovered from prior therapy
  • No prior surgical procedures affecting absorption
  • More than 14 days since prior treatment for an acute infection or other serious medical illness
  • More than 2 weeks since prior antineoplastic therapy, including investigational drugs or standard therapy
  • More than 3 weeks since prior major surgery or radiotherapy
  • No concurrent known CYP3A4 inhibitors or inducers (including grapefruit juice or star fruit) other than antiretroviral drugs used to treat HIV infection
  • No concurrent agents with proarrhythmic potential (e.g., terfenadine, quinidine, procainamide, disopyramide, sotalol, probucol, bepridil, haloperidol, risperidone, indapamide, or flecainide)
  • No other concurrent therapies for the primary malignancy, including chemotherapy or biologic therapy
  • No other concurrent investigational drugs other than antiretroviral agents obtained through an expanded access protocol
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00890747

Locations
United States, California
Rebecca and John Moores UCSD Cancer Center
La Jolla, California, United States, 92093-0658
UCLA Clinical AIDS Research and Education (CARE) Center
Los Angeles, California, United States, 90095-1793
United States, District of Columbia
Lombardi Comprehensive Cancer Center at Georgetown University Medical Center
Washington, District of Columbia, United States, 20007
United States, Illinois
Northwestern Cancer Center
Chicago, Illinois, United States, 60611
United States, Massachusetts
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States, 02215
United States, Missouri
Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis
Saint Louis, Missouri, United States, 63110
United States, New York
Montefiore Medical Center
Bronx, New York, United States, 10467
Memorial Sloan-Kettering Cancer Center
New York, New York, United States, 10065
United States, Pennsylvania
Pennsylvania Oncology Hematology Associates, Incorporated - Philadelphia
Philadelphia, Pennsylvania, United States, 19106
United States, Washington
Virginia Mason Medical Center
Seattle, Washington, United States, 98101
Sponsors and Collaborators
AIDS Malignancy Clinical Trials Consortium
Investigators
Principal Investigator: John F. Deeken, MD Lombardi Cancer Research Center
  More Information

Additional Information:
No publications provided

Responsible Party: AIDS Malignancy Clinical Trials Consortium
ClinicalTrials.gov Identifier: NCT00890747     History of Changes
Other Study ID Numbers: CDR0000639703, U01CA121947, AMC-061
Study First Received: April 29, 2009
Last Updated: December 1, 2011
Health Authority: United States: Federal Government
United States: Food and Drug Administration
United States: Institutional Review Board

Keywords provided by AIDS Malignancy Clinical Trials Consortium:
HIV infection
stage IV renal cell cancer
recurrent renal cell cancer
unspecified adult solid tumor, protocol specific
accelerated phase chronic myelogenous leukemia
acute undifferentiated leukemia
adult acute myeloid leukemia with 11q23 (MLL) abnormalities
adult acute myeloid leukemia with inv(16)(p13;q22)
adult acute myeloid leukemia with t(15;17)(q22;q12)
adult acute myeloid leukemia with t(16;16)(p13;q22)
adult acute myeloid leukemia with t(8;21)(q22;q22)
atypical chronic myeloid leukemia, BCR-ABL negative
chronic myelomonocytic leukemia
chronic phase chronic myelogenous leukemia
mast cell leukemia
meningeal chronic myelogenous leukemia
progressive hairy cell leukemia, initial treatment
prolymphocytic leukemia
recurrent adult acute lymphoblastic leukemia
recurrent adult acute myeloid leukemia
recurrent adult T-cell leukemia/lymphoma
refractory chronic lymphocytic leukemia
refractory hairy cell leukemia
relapsing chronic myelogenous leukemia
secondary acute myeloid leukemia
stage III adult T-cell leukemia/lymphoma
stage III chronic lymphocytic leukemia
stage IV adult T-cell leukemia/lymphoma
stage IV chronic lymphocytic leukemia
T-cell large granular lymphocyte leukemia

Additional relevant MeSH terms:
Neoplasms
Carcinoma, Renal Cell
Kidney Neoplasms
Leukemia
Lymphoma
Lymphoma, Non-Hodgkin
Lymphoproliferative Disorders
Multiple Myeloma
Neoplasms, Plasma Cell
Plasmacytoma
Myelodysplastic Syndromes
Preleukemia
Myeloproliferative Disorders
Nervous System Neoplasms
Lymphoma, Large-Cell, Immunoblastic
Central Nervous System Neoplasms
Myelodysplastic-Myeloproliferative Diseases
Adenocarcinoma
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Urologic Neoplasms
Urogenital Neoplasms
Neoplasms by Site
Kidney Diseases
Urologic Diseases
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Hemostatic Disorders

ClinicalTrials.gov processed this record on May 24, 2012