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A Phase 2 Study of AZD6244 in Biliary Cancers

Phase 2
18 Years
Open (Enrolling)
Liver and Intrahepatic Biliary Tract Cancer, Recurrent Extrahepatic Bile Duct Cancer, Unresectable Extrahepatic Bile Duct Cancer

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Trial Information

A Phase 2 Study of AZD6244 in Biliary Cancers


I. To evaluate the objective response rate (complete response [CR] and partial response
[PR]) in patients with unresectable biliary carcinoma treated with AZD6244 (selumetinib).


I. To evaluate the toxicity profile of this drug in these patients. II. To evaluate the 6-
and 12-month survival, 6-month progression-free survival, and overall survival rates of
patients treated with this drug.

III. To correlate genetic mutations, epigenetic silencing, and/or protein levels of
RAS/RAF/MEK/ERK signaling pathway activation with therapeutic efficacy of AZD6244 in these

IV. To genotype tumors for the presence of RAS mutations (i.e., NRAS, KRAS, HRAS) and BRAF
mutations (e.g., V600E) in biliary tumor samples from these patients.

V. To assess the presence of activation of the MEK1, MEK2, ERK, and/or Akt pathways in tumor
samples from these patients.

VI. To assess the epigenetic alterations (i.e., methylation) affecting the level of
gene/protein expression of RASSF1A, NORE1A, and NORE1B in tumor samples from these patients.


Patients receive oral selumetinib twice daily on days 1-28. Courses repeat every 28 days in
the absence of disease progression or unacceptable toxicity.

Formalin fixed paraffin-embedded tissue blocks or fresh tissue samples are obtained from all
patients prior to treatment. Tissue samples are analyzed by immunohistochemistry for the
expression level of target proteins (MEK, p-MEK, ERK, p-ERK, Akt, p-AKT, RASSF1A, NORE1A and
NORE1B); PCR for mutational status of target genes RAS, BRAF and EGFR); and in
methylation-specific PCR for methylation of target gene promoters (promoters for RASSF1A,
NORE1A and NORE1B). Samples are also analyzed by quantitative real-time PCR to compare
methylation status. Fresh frozen tissue, when available, is evaluated by Western analysis to
measure expression levels of target proteins.

After completion of study treatment, patients are followed up for 4 weeks.

Inclusion Criteria:

- Histologically confirmed biliary tract carcinoma

- Surgically unresectable disease

- Meets any of the following criteria for biliary cancers only:

- Received ≤ 1 prior systemic anticancer therapy, including chemoembolization

- Received prior cryotherapy, radiofrequency ablation, ethanol injection,
transarterial chemoembolization, or photodynamic therapy AND meets the following

- More than 6 weeks have elapsed since any of the prior therapy described

- Indicator lesion(s) must be outside the area of prior treatment OR must
demonstrate clear evidence of disease progression if the only indicator
lesion is inside the prior treatment area

- Indicator lesion must have clearly distinct edges on CT scan

- Prior radiotherapy with or without the use of a fluoropyrimidine as a
radiosensitizer is allowed, provided more than 12 weeks have elapsed since

- Fresh or paraffin-embedded tissue from tumor blocks must be available for review

- Measurable disease, defined as ≥ 1 unidimensionally measurable lesion > 20 mm by
conventional techniques or > 10 mm by spiral CT scan

- No known brain metastases

- Life expectancy > 12 weeks

- ECOG performance status (PS) 0-1 or Karnofsky PS 70-100%

- ANC ≥ 1,500/μL

- Platelet count ≥ 75,000/μL

- Total bilirubin ≤ 2 times upper limit of normal(ULN)

- AST or ALT ≤ 3 times ULN

- Serum albumin ≥ 2.5 mg/dL

- INR ≤ 1.5 (not receiving anticoagulation therapy)

- Creatinine normal or creatinine clearance ≥ 60 mL/min

- Not pregnant or nursing

- Negative pregnancy test

- Fertile women must use effective contraception during and for four weeks after the
last dose of AZD6244

- Fertile men must use effective contraception during and for 16 weeks after the last
dose of AZD6244

- No significant traumatic injury within the past 3 weeks

- No uncontrolled symptoms consistent with encephalopathy

- No history of allergic reactions attributed to compounds of similar chemical or
biologic composition to AZD6244 or its excipient, Captisol®

- No QTc interval > 500 msecs or other factors that increase the risk of QT
prolongation or arrhythmic events (e.g., hypokalemia or family history of long QT
interval syndrome), including NYHA class III-IV heart failure

- No other malignancy within the past 3 years, except adequately treated basal cell or
squamous cell skin cancer or carcinoma in situ of the cervix

- No refractory nausea and vomiting, chronic gastrointestinal disease (e.g.,
inflammatory bowel disease), or significant bowel resection that would preclude
adequate absorption

- No uncontrolled concurrent illness including, but not limited to, ongoing or active
infection or psychiatric illness/social situation that would limit compliance with
study requirements

- No malignant hypertension within the past year

- No prior sorafenib or MEK inhibitors

- More than 4 weeks since prior chemotherapy, biologic therapy, or immunotherapy (6
weeks for nitrosoureas or mitomycin C) and recovered to ≤ grade 1 adverse events

- No major surgery within the past 3 weeks

- No other concurrent investigational agents

- No concurrent requirement for medication that can prolong the QT interval

- No concurrent combination antiretroviral therapy for HIV-positive patients

- No concurrent consumption of grapefruit or grapefruit juice

Type of Study:


Study Design:

Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Objective response rate (CR and PR)

Outcome Description:

Response will be evaluated in this study using the new international criteria proposed by Response Evaluation Criteria in Solid Tumors (RECIST) committee. Only those patients who have measurable disease present at baseline, have received at least one cycle of therapy, and have had their disease re-evaluated will be considered evaluable for response. A Simon 2-stage minimax design, which minimizes the maximum sample size given specified alpha and beta error rates will be utilize.

Outcome Time Frame:

Every 8 weeks

Safety Issue:


Principal Investigator

Tanios Bekaii-Saab

Investigator Role:

Principal Investigator

Investigator Affiliation:

Ohio State University


United States: Food and Drug Administration

Study ID:




Start Date:

November 2007

Completion Date:

Related Keywords:

  • Liver and Intrahepatic Biliary Tract Cancer
  • Recurrent Extrahepatic Bile Duct Cancer
  • Unresectable Extrahepatic Bile Duct Cancer
  • Bile Duct Neoplasms
  • Biliary Tract Neoplasms



H. Lee Moffitt Cancer Center and Research Institute Tampa, Florida  33612
Vanderbilt University Nashville, Tennessee  37232-6305
University of North Carolina Chapel Hill, North Carolina  27599
Emory University Atlanta, Georgia  30322
Wayne State University Detroit, Michigan  48202
Ohio State University Medical Center Columbus, Ohio  43210
University of Michigan Cancer Center (UMCC) Research Base Ann Arbor, Michigan  48109-0352