A Phase I/II Study of Cisplatin and Radiation in Combination With Sorafenib in Cervical Cancer
- Patients must have biopsy-proven epithelial carcinoma of the cervix, T1B-3B, N0/1, M0
with visible or palpable disease and a decision to treat radically with radiotherapy
and concurrent cisplatin chemotherapy (RT-CT).
- ECOG performance status 0, 1 or 2 (Karnofsky>=60%)
- Life expectancy of greater than 12 weeks.
- Patients must have normal organ and marrow function as defined below:
- Leukocytes >3,000/mcL
- Absolute neutrophil count >1,500/mcL
- Platelets >100,000/mcL
- Hemoglobin > 9 g/dL
- Total bilirubin Within normal institutional limits
- AST(SGOT)/ALT(SGPT) <=2.5 X institutional upper limit of normal
- Creatinine Within normal institutional limits, or
- Creatinine clearance >60 mL/min/1.73 m2 for patients with creatinine levels
- No prior treatment for cervix cancer.
- The effects of sorafenib on the developing human fetus at the recommended therapeutic
dose are unknown. Although radical RT-CT for cervix cancer is not compatible with
survival of a developing fetus, women of child-bearing potential must agree to use
adequate contraception (hormonal or barrier method of birth control; abstinence)
prior to study entry and for the duration of study participation. Should a woman
become pregnant or suspect she is pregnant while participating in this study, she
should inform her treating physician immediately.
- No active malignancy at another site.
- Ability to understand and the willingness to sign a written informed consent document
- Patients may not be receiving any other investigational agents concurrently or within
4 weeks. Patients who have previous exposure to a raf-kinase inhibitor are excluded
- Patients with poorly controlled hypertension (systolic blood pressure of 140 mmHg or
higher, or diastolic blood pressure of 90 mmHg or higher) are ineligible.
- Patients with any condition that impairs their ability to swallow sorafenib tablets
are excluded (e.g. gastrointestinal tract disease resulting in an inability to take
oral medication or a requirement for IV alimentation, prior surgical procedures
affecting absorption, or active peptic ulcer disease).
- Bleeding disorders. Patients cannot be receiving therapeutic anticoagulation.
Prophylactic anticoagulation (ie. low dose warfarin) of venous or arterial access
devices is allowed provided that the requirements for PT, INR, or PTT are met.
- Patients with known brain metastases should be excluded because of their poor
prognosis and because they often develop progressive neurologic dysfunction that
would confound the evaluation of neurologic and other adverse events. These patients
would not be eligible for radical RT-CT for cervix cancer, but instead would be
treated for palliation.
- Patients with intercurrent cardiac dysfunction including, but not limited to,
symptomatic congestive heart failure, unstable angina pectoris, or cardiac arrhythmia
are excluded as are those with a history of ischemic heart disease including
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection or psychiatric illness/social situations that would limit compliance with
- Pregnant women are excluded from this study because sorafenib has the potential for
teratogenic or abortifacient effects as shown by the gross fetal malformations and
effects on embryo-fetal survival seen in reproductive toxicity studies in the rat.
Because there is an unknown but potential risk for adverse events in nursing infants
secondary to treatment of the mother with sorafenib, breastfeeding should be
discontinued if the mother is treated with sorafenib.
- HIV-positive patients on combination antiretroviral therapy are ineligible because of
the potential for pharmacokinetic interactions with sorafenib. In addition, these
patients are at increased risk of lethal infections when treated with
marrow-suppressive therapy. Appropriate studies will be undertaken in patients
receiving combination antiretroviral therapy when indicated.
- A decision to treat with extended-field pelvic and para-aortic radiotherapy,
specifically cases where the para-aortic field will extend cranial to the L3-4