A Phase II Study of Sunitinib (SU11248; NSC 736511; IND 74019) in Patients With Recurrent Epithelial Ovarian, Fallopian Tube or Primary Peritoneal Carcinoma
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Histologically confirmed diagnosis of 1 of the following:
- Ovarian epithelial cancer
- Fallopian tube cancer
- Primary peritoneal cancer
- Advanced and/or metastatic disease incurable by standard therapies
- Must have received at least 1 but no more than 2 prior chemotherapy regimens* (1 must
have been platinum-containing) AND may be either platinum-sensitive or
platinum-resistant NOTE: *Switching from 1 platinum compound to another for reasons
of disease progression or failure to respond is considered a second regimen; the same
regimen given as first- and second-line therapy is also considered 2 regimens
- Measurable disease, defined as ≥ 1 unidimensionally measurable lesion ≥ 20 mm by
x-ray, physical exam, or nonspiral CT scan OR ≥ 10 mm by spiral CT scan
- Patients with CA125 as only evidence of disease are not eligible
- Measurable disease must be outside of a previously irradiated area
- Sole site of disease in a previously irradiated area is not allowed unless there
is evidence of disease progression or new lesions were documented in the
irradiated field
- No known brain metastases
PATIENT CHARACTERISTICS:
- ECOG performance status 0-1
- Life expectancy ≥ 12 weeks
- Granulocyte count ≥ 1,500/mm³
- Platelet count ≥ 100,000/mm³
- Bilirubin normal
- AST and ALT ≤ 2.5 times upper limit of normal
- Creatinine normal OR creatinine clearance ≥ 60 mL/min
- Calcium ≤ 3 mmol/L
- No other malignancy within the past 5 years except adequately treated nonmelanoma
skin cancer, curatively treated in situ cancer of the cervix, or other curatively
treated solid tumors
- No history of allergic reactions attributed to compounds of similar chemical or
biological composition to sunitinib malate
- No QTc prolongation, defined as QTc interval ≥ 500 msec, or other significant ECG
abnormalities
- No New York Heart Association (NYHA) class III-IV heart failure
- History of NYHA class II heart failure allowed provided both of the following
criteria are met:
- Asymptomatic with respect to cardiac function
- LVEF > lower limit of normal as assessed by MUGA at baseline
- No poorly controlled hypertension (systolic blood pressure [BP] ≥ 140 mm Hg or
diastolic BP ≥ 90 mm Hg)
- No myocardial infarction, cardiac arrhythmia, stable or unstable angina, or
symptomatic congestive heart failure within the past year
- No pulmonary embolism within the past year
- No cerebrovascular accident or transient ischemic attack within the past year
- No bowel obstruction or any other condition (e.g., gastrointestinal [GI] tract
disease resulting in an inability to take oral medication, requirement for IV
alimentation, or active peptic ulcer disease) that would impair ability to swallow
and retain sunitinib malate tablets
- No serious illness or medical condition, including, but not limited to, any of the
following:
- History of significant neurologic or psychiatric disorder that would preclude
study compliance
- Active uncontrolled infection
- Other medical conditions that would be aggravated by treatment
- Serious or nonhealing wound, ulcer, or bone fracture
- Abdominal fistula, GI perforation, or intra-abdominal abscess within the past 28
days
- No preexisting hypothyroidism unless euthyroid on medication
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- No more than 1 prior hormonal treatment for metastatic disease
- No prior surgical procedures affecting absorption
- No prior antiangiogenic agents or multitargeted tyrosine kinase inhibitors (e.g.,
bevacizumab, sorafenib, pazopanib, thalidomide, ZD6474, AMG 706, AZD2171, vatalanib,
or VEGF Trap)
- No prior anthracycline exposure or thoracic radiotherapy that included the heart in
the radiotherapy port, unless all of the following criteria are met:
- Asymptomatic with respect to cardiac function
- LVEF > lower limit of normal as assessed by MUGA at baseline
- At least 1 year since prior coronary/peripheral artery bypass graft or stenting
- At least 28 days since prior hormonal therapy
- At least 28 days since prior chemotherapy and recovered
- At least 28 days since prior radiotherapy and recovered
- Radiotherapy must have involved < 30% of functioning bone marrow
- At least 28 days since prior major surgery and recovered
- At least 7 days since prior and no concurrent CYP3A4 inhibitors, including any of the
following:
- Azole antifungals (e.g., ketoconazole, itraconazole, or miconazole)
- Erythromycin
- Diltiazem
- Verapamil
- HIV protease inhibitors (e.g., indinavir, saquinavir, ritonavir, atazanavir, or
nelfinavir)
- Delavirdine
- Clarithromycin
- At least 12 days since prior and no concurrent CYP3A4 inducers, including any of the
following:
- Rifampin
- Rifabutin
- Carbamazepine
- Phenobarbital
- Phenytoin
- Hypericum perforatum (St. John's wort)
- Efavirenz
- Tipranavir
- No concurrent agents with proarrhythmic potential, including any of the following:
- Terfenadine
- Quinidine
- Procainamide
- Disopyramide
- Sotalol
- Probucol
- Bepridil
- Haloperidol
- Risperidone
- Indapamide
- Flecainide
- No concurrent therapeutic coumarin-derivative anticoagulants (e.g., warfarin)
- Warfarin (≤ 2 mg/day) allowed for prophylaxis of thrombosis
- Concurrent low molecular weight heparin allowed provided INR ≤ 1.5
- No concurrent combination antiretroviral therapy for HIV-positive patients
- No other concurrent anticancer therapy or other investigational agents