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Efficacy and Safety of PD-0332991 in Patients With Advanced Gastrointestinal Stromal Tumors Refractory to Imatinib and Sunitinib (CYCLIGIST)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01907607
Recruitment Status : Completed
First Posted : July 25, 2013
Last Update Posted : February 7, 2020
Information provided by (Responsible Party):
Institut Bergonié

Brief Summary:

The treatment of advanced GIST patients is based on imatinib followed with sunitinib in case of resistance/intolerance. However, the median progression-free survival (PFS) on sunitinib is frequently short, and after failure with both imatinib and sunitinib, treatment remains controversial.

Previous studies on GISTs have linked 9p21 alterations to tumor progression (El-Rifai et al. 2000; Kim et al., 2000; Schneider-Stock et al., 2003; Schneider-Stock et al., 2005; Romeo et al. 2009; Haller et al., 2008) but the driver gene was not positively identified (CDKN2A, CDKN2B, or MTAP) (Astolfi et al., 2010; Belinsky et al., 2009; Perrone et al., 2005; Assamaki et al. 2007; Huang et al., 2009). A recent study has shown that homozygous 9p21 deletions target CDKN2A and more specifically p16INK4a 4. Most of the CINSARC genes are known to be under the transcriptional control of E2F. RB1 sequesters E2F, which is released from the complex upon RB1 phosphorylation by CDK4. CDK4 is, in turn, inhibited by p16INK4a. Hence, we hypothesize that alteration of the restriction point via deletion of p16INK4a (and more rarely of RB1: 20% of cases) gene in GISTs is likely to be a causative event that leads to the overexpression of CINSARC genes, which in turn induce chromosome instability and ultimately metastasis. Low p16INK4a expression was associated with response to PD-0332991 in several in vitro tumor model(Konecny et al. 2011; Katsumi et al. 2011; Finn et al. 2009). Considering our molecular data, we believed that PD-0332991 warrants clinical investigation in advanced gastrointestinal stromal tumors with alteration of p16INK4a. This alteration is detectable by comparative genomic hybridization which is a technique highly manageable in the context of routine clinical care and clinical trial.

Exploratory, one-arm, multicenter, phase II clinical trial based on twostage Simon's design

To assess the antitumor activity of PD-0332991 in terms of non-progression at 16 weeks (after centralized review) in patients with documented disease progression while on therapy with imatinib and sunitinib for unresectable and/or metastatic GIST.

This is a multicentre single-arm Phase II study evaluating the efficacy and safety of orally PD-0332991, 125 mg/day, 21 days on/7 days off, in patients with documented disease progression while on therapy with 2nd line sunitinib for unresectable and/or metastatic GIST. Indeed, the usual treatment for advanced Gastrointestinal Stromal Tumors Refractory to Imatinib and Sunitinib is best supportive care for which outcome data are already available (Demetri et al., 2012; Italiano et al., 2012). Sixty three patients will be included in 10 centres of the French Sarcoma Group over a period of 18 months of enrolment.

Patients will be evaluated at scheduled visits in up to three study periods:

  • Pre-treatment (PRE TT): from signature of informed consent to the first treatment by PD-0332991.
  • Treatment (TT): from the first treatment by PD-0332991 to the first 28 days following the last PD-0332991 administration.
  • Follow-up (FUP): after treatment discontinuation, all patients must be followed up for 28 days after the last dose of the study drug for safety assessment (AEs and/or SAEs).

Condition or disease Intervention/treatment Phase
Advanced Gastrointestinal Stromal Tumors Drug: PD-0332991 will be administrated orally, formulated as gelatin capsules of 100 mg and 25 mg respectively. Phase 2

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 29 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Efficacy and Safety of PD-0332991 in Patients With Advanced Gastrointestinal Stromal Tumors Refractory to Imatinib and Sunitinib: A Phase 2 Study
Actual Study Start Date : February 2014
Actual Primary Completion Date : December 2016
Actual Study Completion Date : February 2019

Arm Intervention/treatment
Experimental: PD-0332991

Adult patients with Advanced Gastrointestinal Stromal Tumors Refractory to Imatinib and Sunitinib.

PD-0332991 is formulated as gelatin capsules of 100 mg and 25 mg respectively.

Drug: PD-0332991 will be administrated orally, formulated as gelatin capsules of 100 mg and 25 mg respectively.

PD-0332991 dosed on a flat scale of 125 mg (1 capsule x 100 mg/day, 1 capsule x25 mg/day) will be administrated orally o.d on a 21 days on / 7 days off dosing schedule. One cycle is considered to consist of 4 weeks of PD-0332991 administration.

Patients should be instructed to administrate PD-0332991 with a sufficient amount of water at least 1 hour prior to a meal or at least 2 hours following a meal and to swallow the required number of capsules at approximately the same time on each day.

Primary Outcome Measures :
  1. Efficacy assessment of PD-0332991 [ Time Frame: 16 weeks ]
    Efficacy is assessed based on 4-month non progression. Non progression is defined as complete or partial response (CR, PR) or stable disease (SD), using the Response Evaluation Criteria in Solid Tumors (RECIST v1.1). Non-progression rate will be calculated as the number of alive and progression free patients divided by the number of eligible and assessable patients for the efficacy analysis. Eligible and assessable populations are described in corresponding section of protocol. As recommended by RECIST v1.1, all claimed response will be centrally reviewed by an expert of the study. The results of the centralized radiological review will be used for the analysis of the primary endpoint.

Secondary Outcome Measures :
  1. Objective response [ Time Frame: 16 weeks ]
    Objective response is defined as complete response (CR) or partial response (PR) according to RECIST v1.1

  2. Progression-free survival [ Time Frame: 16 weeks ]
    Progression-free survival is defined as the time from the first administration of treatment to progression (as per RECIST v1.1) or death of any cause, whichever occurs first

  3. Overall survival [ Time Frame: 16 weeks ]
    Overall survival is defined as the time from the first administration of treatment to death.

  4. Progression [ Time Frame: 16 weeks ]
    Progression will also be assessed using CHOI criteria

  5. Safety of PD-0332991 [ Time Frame: 16 weeks ]
    Safety of PD-0332991 will be assessed by the Common Terminology Criteria for Adverse Events (CTCAE), v4.0

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Male or female patients ≥ 18 years of age
  2. Histologically confirmed GIST of any anatomical location and confirmed by the RRePS Network ; positive immunohistochemical staining for c-KIT (CD117); or negative staining for KIT, but with either positive staining for DOG1 or an identified mutation of KIT or PDGFRA gene
  3. CDKN2A gene deletion assessed by array-comparative genomic hybridization (array-CGH)
  4. Unresectable and/or metastatic disease with documented progression according to modified RECIST criteria (see section of protocol) after 1st line imatinib and 2nd line sunitinib. Progression on the last line of treatment should be confirmed by central review with two radiological assessments identical (CT scans or MRI) obtained at less from 4 months interval within the 24 months before inclusion.
  5. At least one measurable GIST lesion according to RECIST (v1.1 Appendix 3). A previously irradiated lesion is eligible to be considered as a measurable lesion provided that there is objective evidence of progression of the lesion prior to starting PD-0332991.
  6. A performance status of 0, 1 or 2 according to the Eastern Cooperative Oncology Group (ECOG) scale(Appendix 1)
  7. Recovery from Grade 2 to 4 toxicity related to prior line of treatment assessed according to NCICTCAE v.4.0 (Appendix 2)
  8. Adequate bone marrow function as shown by:

    Blood absolute neutrophil count (ANC) ≥ 1.5 x 109/L

    1. Blood platelets ≥ 100 x 109/L
    2. Blood hemoglobin (Hgb) > 9 g/dL
  9. Adequate liver function as shown by:

    c. Serum or plasma ALT and AST ≤ 3.0 x ULN (regardless of the presence or absence of metastases) d. Serum or plasma total bilirubin: ≤ 1.5 x ULN (excepted for patients with Gilbert's syndrome)

  10. Adequate renal function as shown by serum creatinine ≤ 2 x ULN
  11. Patients who give a written informed consent obtained according to French and European regulations.
  12. Patients affiliated to the French Social Security

Exclusion Criteria:

  1. RB1 gene deletion assessed by array-comparative genomic hybridization (array-CGH)
  2. Patients who received anti-cancer drugs ≤ 5 days prior to starting PD-0332991
  3. Patients who are treated or planned to be treated concomitantly with other cytotoxic or antineoplastic treatments, such as chemotherapy, immunotherapy, biological response modifiers, or radiotherapy
  4. Patients with another primary malignancy within 2 years prior to starting the study drug, with the exception of adequately treated in-situ carcinoma of the uterine cervix, or completely excised (R0 resection) basal or squamous cell carcinoma of the skin
  5. Patients with a corrected QT interval using Bazett's formula (QTcB) > 470 msec.
  6. Current use or anticipated need for food or drugs that are known strong cytochrome P450 (CYP)3A4 inhibitors (i.e. grapefruit juice, verapamil, ketoconazole, miconazole, itraconazole, posaconazole, erythromycin, clarithromycin, tilithromycin, indinavir, saquinavir, ritonavir, nelfinavir, lopinavir, atazanavir, amprenavir, fosamprenavir, nefazodone, diltiazem, and delaviridine)
  7. Patients with impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of PD-0332991 (e.g. severe ulcerative diseases, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or extensive (>1m) small bowel resection, inability to swallow oral medications). Prior partial gastrectomy is not an exclusion criterion.
  8. Patients with prior complete gastrectomy
  9. Any of the following in the previous 6 months: myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass graft, symptomatic congestive heart failure, cerebrovascular accident, transient ischemic attack or symptomatic pulmonary embolism.
  10. Patients with any clinically significant medical or surgical condition which, according to investigators' discretion, should preclude participation

    1. i.e. active or uncontrolled infection, uncontrolled diabetes, active or chronic liver disease (cirrhosis, chronic active hepatitis or chronic persistent hepatitis)
    2. hepatitis B or C virus carriers with normal liver function tests, can be included
  11. Known diagnosis of human immunodeficiency virus (HIV) infection. HIV testing is not mandatory
  12. Patients who are currently receiving anticoagulation treatment with therapeutic doses :

    1. of warfarin or equivalent anticoagulant (e.g. high dose aspirin or clopidogrel or other)
    2. or have an INR >1.5. Treatment with acetylsalicyclic acid 100 mg daily or low molecular weight heparin (LMWH) is allowed
  13. Pregnant or breast-feeding women
  14. Women of child-bearing potential not employing two effective methods of birth control. Effective contraception must be used throughout the trial and 24 weeks after the end of PD-0332991 (e.g. condom with spermicidal jelly, foam suppository or film; diaphragm with spermicide; male condom and diaphragm with spermicide, oral, implantable, or injectable contraceptives). Women of child-bearing potential defined as sexually mature women who have not undergone a hysterectomy or who have not been naturally postmenopausal for at least 12 consecutive months (i.e. who has had menses any time in the preceding 12 consecutive months), must have a negative serum pregnancy test ≤ 21 days prior to starting study drug.
  15. Fertile males not willing to use contraception as stated above
  16. Patients unwilling or unable to comply with the protocol.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01907607

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Institut Bergonié
Bordeaux, Gironde, France, 33076
Centre Georges-Francois Leclerc
Dijon, France, 21079
Centre Oscar Lambret
Lille, France, 59020
Centre Léon Bérard
Lyon, France, 69373
Hôpital de la Timone - AP-HM
Marseille, France, 13385
Centre René Gauducheau
Nantes, France, 44805
Hôpital Saint-Antoine (AP-HP)
Paris, France, 75571
CHU de REIMS - Hôpital Robert Debré
Reims, France, 51092
Institut Gustave Roussy
Villejuif, France, 94800
Sponsors and Collaborators
Institut Bergonié
Additional Information:
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Institut Bergonié Identifier: NCT01907607    
Other Study ID Numbers: IB 2013-01
First Posted: July 25, 2013    Key Record Dates
Last Update Posted: February 7, 2020
Last Verified: February 2020
Keywords provided by Institut Bergonié:
Advanced Gastrointestinal Stromal Tumor Refractory to Imatinib and Sunitinib
Efficacy and safety
Adult patients
Additional relevant MeSH terms:
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Gastrointestinal Stromal Tumors
Neoplasms, Connective Tissue
Neoplasms, Connective and Soft Tissue
Neoplasms by Histologic Type
Gastrointestinal Neoplasms
Digestive System Neoplasms
Digestive System Diseases
Gastrointestinal Diseases
Antineoplastic Agents
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action