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A Phase I/Randomized Phase II Study of Cediranib (NSC#732208) Versus Placebo in Combination With Cisplatin and Pemetrexed in Chemonaive Patients With Malignant Pleural Mesothelioma

Description

Brief Summary
This randomized phase I/II trial is studying the side effects and best dose of cediranib maleate when given together with pemetrexed disodium and cisplatin and to see how well it works in treating patients with malignant pleural mesothelioma. Drugs used in chemotherapy, pemetrexed disodium and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Cediranib maleate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. Giving pemetrexed disodium and cisplatin together with cediranib maleate may kill more tumor cells.


Detailed Description
I. To establish the maximum tolerated dose (MTD) and the recommended phase II dose of cediranib maleate (cediranib) in combination with cisplatin and pemetrexed disodium (pemetrexed). (Phase I) II. To assess the safety and toxicity of the regimen. (Phase I) III. To assess whether cisplatin/pemetrexed plus cediranib as compared to cisplatin/pemetrexed plus placebo improves progression-free survival in patients with malignant pleural mesothelioma. (Phase II) IV. To compare overall survival in patients treated with cisplatin/pemetrexed plus cediranib to those treated with cisplatin/pemetrexed plus placebo. (Phase II) V. To assess the safety and toxicity profile of the regimen. (Phase II) VI. To assess response rate (confirmed and unconfirmed, complete and partial responses) and disease control rate (response or stable disease) in the subset of patients with measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) criteria. (Phase II) VII. To assess response rate and disease control rate using modified RECIST criteria for pleural tumors in the subset of patients with measurable disease by modified RECIST criteria for pleural tumors. (Phase II) VIII. To assess the rate of agreement between local and central pathology review of mesothelioma and its histologic subtypes. (Phase II) IX. To collect specimens for banking for use in future research studies. (Phase II) OUTLINE: This is a phase I dose-escalation study of cediranib maleate followed by a phase II study. PHASE I (CLOSED): Patients receive pemetrexed disodium intravenously (IV) over 10 minutes and cisplatin IV over 2 hours on day 1 and cediranib maleate orally (PO) once daily (QD) on days 1-21. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive cediranib maleate alone PO QD in the absence of disease progression or unacceptable toxicity. PHASE II: Patients are randomized to 1 of 2 treatment arms. ARM I: Patients receive pemetrexed disodium IV over 10 minutes and cisplatin IV over 2 hours on day 1 and cediranib maleate PO QD on days 1-21. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive cediranib maleate alone PO QD in the absence of disease progression or unacceptable toxicity. ARM II: Patients receive pemetrexed disodium and cisplatin as in arm I and placebo PO QD on days 1-21. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive placebo alone PO QD in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 6 months for 2 years and then at 3 years.

Phase

Phase 2 - takes the treatment one step further, assessing the activity of a particular therapy in a disease, often building upon leads from the Phase I trial. While patients are generally required to be previously untreated, participation in a Phase II trial doesn't usually preclude the patient from getting the standard treatment after they've received the investigational agent. At best they are allowed to get a new drug they wouldn't be able to get otherwise that may turn out to be better for their disease.

Inclusion and Exclusion Criteria

  • Inclusion Criteria:
  • Patient must have histologically or cytologically confirmed diagnosis of malignant pleural mesothelioma; surgical resection must not be planned
  • Patients must have measurable or non-measurable disease by both RECIST and modified RECIST criteria for pleural tumors as documented by computed tomography (CT) scan; examinations for assessment of measurable disease must have been completed within 28 days prior to registration; examinations for assessment of non-measurable disease must have been performed within 42 days prior to registration; all disease must be assessed and documented on the RECIST 1.1 and Modified RECIST Baseline Tumor Assessment Form
  • Patients must not have received any prior systemic therapy (chemotherapy or other biologic therapy) for their unresectable malignant pleural mesothelioma; prior systemic chemotherapy or biologic therapy is allowed as neoadjuvant or adjuvant treatment, disease has now recurred, and all systemic treatment was completed > 6 months prior registration; prior therapy must not have included cediranib
  • Patients may have received prior surgery (e.g., pleurectomy, pleurodeisis) provided at least 28 days have elapsed since surgery (thoracic or other major surgeries) and patients have recovered from all associated toxicities at the time of registration; there must be no anticipated need for major surgical procedures during protocol treatment
  • Patients may have received prior radiation therapy provided at least 28 days have elapsed since the last treatment and patients have recovered from all associated toxicities at the time of registration
  • Institutions must seek additional patient consent for the banking and future use of specimens
  • Patient must have Zubrod performance status 0-2
  • Absolute neutrophil count >= 1,500 mcl
  • Platelets >= 100,000/ml
  • Hemoglobin >= 9.0 g/dl (may be reached by transfusion)
  • Total bilirubin =< 1.5 x institutional upper limit of normal (IULN)
  • Serum glutamic oxaloacetic transaminase (SGOT) or serum glutamate pyruvate transaminase (SGPT) =< 2.5 x ULN (if liver metastases are present, SGOT or SGPT must be =< 5.0 x IULN)
  • Serum creatinine =< 1.5 x IULN
  • Calculated creatinine clearance >= 60 mL/min
  • Urine protein must be screened by urine analysis within 28 days prior to registration; patient must not have greater than +1 proteinuria on two consecutive dipsticks taken no less than 7 days apart; however, if the first urinalysis shows no protein, then a repeat urinalysis is not required
  • Patient must have an electrocardiogram (ECG) performed within 42 days prior to registration; patient must not have mean corrected QT (QTc) > 500 msec (with Bazett's correction) in screening electrocardiogram, or other significant ECG abnormality, New York Heart Association (NYHA) classification III or IV; patient must not require concurrent use of drugs or biologics with proarrhythmic potential
  • Patient must not be receiving any medication that may markedly affect renal function (e.g., vancomycin, amphotericin, pentamidine)
  • Patient must not have had clinically significant hemoptysis, defined as greater than 1 tablespoon of bright red blood, within one year prior to registration; although hemoptysis has not been associated with cediranib, it may be a class effect for anti-angiogenic agents and therefore a risk factor for this experimental agent
  • Patient must be able to swallow oral medications
  • Patients must not have known human immunodeficiency virus (HIV) infection
  • Patients must not be pregnant or nursing; women/men of reproductive potential must have agreed to use an effective contraceptive method; a woman is considered to be of "reproductive potential" if she has had menses at any time in the preceding 12 consecutive months; in addition to routine contraceptive methods, "effective contraception" also includes heterosexual celibacy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) defined as a hysterectomy, bilateral oophorectomy or bilateral tubal ligation; however, if at any point a previously celibate patient chooses to become heterosexually active during the time period for use of contraceptive measures outlined in the protocol, he/she is responsible for beginning contraceptive measures
  • Patient must have no plans to receive concurrent chemotherapy, hormonal therapy, radiotherapy, immunotherapy or any other type of therapy for treatment of cancer while on this protocol treatment
  • No other prior malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease free for five years

Sites

  • California

    • USC / Norris Comprehensive Cancer Center, Los Angeles, California, 90033
    • Los Angeles County-USC Medical Center, Los Angeles, California, 90033
    • Kaiser Permanente, Fresno, California, 93720
    • Kaiser Permanente-Modesto, Modesto, California, 95356
    • University of California Davis Comprehensive Cancer Center, Sacramento, California, 95817
    • University of California at Davis Cancer Center, Sacramento, California, 95817

  • Idaho

    • Saint Alphonsus Cancer Care Center-Boise, Boise, Idaho, 83706

  • Oregon

    • Providence Willamette Falls Medical Center, Oregon City, Oregon, 97045
    • Providence Newberg Medical Center, Newberg, Oregon, 97132
    • Clackamas Radiation Oncology Center, Clackamas, Oregon, 97015
    • Providence Milwaukie Hospital, Milwaukie, Oregon, 97222
    • SWOG, Portland, Oregon, 97239
    • Providence Saint Vincent Medical Center, Portland, Oregon, 97225
    • Western Oncology Research Consortium, Portland, Oregon, 97213
    • Providence Portland Medical Center, Portland, Oregon, 97213

  • Washington

    • Compass Oncology Vancouver, Vancouver, Washington, 98684
    • PeaceHealth Southwest Medical Center, Vancouver, Washington, 98664
    • Columbia Basin Hematology and Oncology PLLC, Kennewick, Washington, 99336
    • Kadlec Clinic Hematology and Oncology, Kennewick, Washington, 99336
    • Saint John Medical Center, Longview, Washington, 98632
    • Wenatchee Valley Medical Center, Wenatchee, Washington, 98801
    • Rockwood Clinic, Spokane, Washington, 99220
    • Cancer Care Northwest - Spokane South, Spokane, Washington, 99202
    • University of Washington Medical Center, Seattle, Washington, 98195
    • Evergreen Hematology and Oncology PS, Spokane, Washington, 99218
    • Highline Medical Center-Main Campus, Burien, Washington, 98166
    • Swedish Cancer Institute-Issaquah, Issaquah, Washington, 98029
    • Minor and James Medical PLLC, Seattle, Washington, 98104
    • The Polyclinic, Seattle, Washington, 98122
    • Group Health Cooperative-Seattle, Seattle, Washington, 98112
    • Harrison HealthPartners Hematology and Oncology-Bremerton, Bremerton, Washington, 98310
    • Swedish Medical Center-Ballard Campus, Seattle, Washington, 98107
    • Harrison HealthPartners Hematology and Oncology-Poulsbo, Poulsbo, Washington, 98370
    • Swedish Medical Center-Edmonds, Edmonds, Washington, 98026
    • Skagit Valley Hospital, Mount Vernon, Washington, 98274
    • Cancer Care Center at Island Hospital, Anacortes, Washington, 98221
    • PeaceHealth Saint Joseph Medical Center, Bellingham, Washington, 98225

  • Wyoming

    • Rocky Mountain Oncology, Casper, Wyoming, 82609

  • Montana

    • Montana Cancer Specialists, Missoula, Montana, 59802
    • Frontier Cancer Center and Blood Institute-Billings, Billings, Montana, 59102
    • Billings Clinic Cancer Center, Billings, Montana, 59107
    • Great Falls Clinic, Great Falls, Montana, 59405
    • Glacier Oncology PLLC, Kalispell, Montana, 59901

  • Texas

    • Southwest Oncology Group (SWOG) Research Base, San Antonio, Texas, 78245
    • M D Anderson Cancer Center, Houston, Texas, 77030

  • Arkansas

    • Highlands Oncology Group-Rogers, Rogers, Arkansas, 72758

  • Illinois

    • Central Illinois CCOP, Decatur, Illinois, 62526
    • Cancer Care Center of Decatur, Decatur, Illinois, 62526

  • Indiana

    • Saint Francis Hospital and Health Centers, Beech Grove, Indiana, 46107
    • Franciscan Saint Francis Health-Indianapolis, Indianapolis, Indiana, 46237
    • Reid Hospital and Health Care Services, Richmond, Indiana, 47374

  • Ohio

    • Wayne Hospital, Greenville, Ohio, 45331
    • Oncology Hematology Care Inc-Mercy West, Cincinnati, Ohio, 45211
    • Oncology Hematology Care Inc-Healthplex, Fairfield, Ohio, 45014
    • Oncology and Hematology Care Inc-Taft, Cincinnati, Ohio, 45219
    • Oncology Hematology Care Inc - Kenwood, Cincinnati, Ohio, 45236
    • Oncology Hematology Care Inc - Anderson, Cincinnati, Ohio, 45230
    • Oncology Hematology Care Inc-Blue Ash, Cincinnati, Ohio, 45242
    • Samaritan North Health Center, Dayton, Ohio, 45415
    • Good Samaritan Hospital - Dayton, Dayton, Ohio, 45406
    • Grandview Hospital, Dayton, Ohio, 45405
    • Upper Valley Medical Center, Troy, Ohio, 45373
    • Miami Valley Hospital, Dayton, Ohio, 45409
    • Kettering Medical Center, Kettering, Ohio, 45429

  • Kentucky

    • Oncology Hematology Care Inc-Crestview, Crestview Hills, Kentucky, 41017
    • University of Kentucky/Markey Cancer Center, Lexington, Kentucky, 40536
    • University of Kentucky, Lexington, Kentucky, 40536

  • Michigan

    • Sparrow Hospital, Lansing, Michigan, 48912
    • Allegiance Health, Jackson, Michigan, 49201
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