A Phase II Study of Sunitinib as a Second-line Treatment for Patients With Recurrent Small Cell Lung Cancer.
Chemotherapy is the primary treatment option for patients with small cell lung cancer,
leading to a 5-year survival of about 20% in limited disease (LD), and less than 5% in
extensive disease (ED). Although initial tumor response rate to chemotherapy is very high
(up to 96% for LD and up to 65% in ED), SCLC relapses in approximately 4 months in ED and 12
months in LD adn despite the administration of second-line chemotherapy, the overall median
survival of patients with limited and extensive disease is approximately 18 and 9 months,
respectively. In the setting of second-line therapy, response rates to chemotherapy range
between 15 and 25%, with median survival in the range of 4-6 months. Second-line therapeutic
options include cyclophosphamide, doxorubicin and vincristine (CAV) given every 3 weeks or
topotecan, which have similar response rates, time to progression and survival in the two
treatment arms (topotecan 24%, 13 and 24.7 weeks; CAV 18%, 12 and 22 weeks, respectively).
However, both treatments however have substantial toxicities, with 9% of patients on trial
withdrawing for toxicity reasons. Treatment-associated mortality was as high as 4.7%
(possibly and definitely related), and many patients required transfusion support. Thus,
while these treatments have acceptable activity second-line, more active and less toxic
treatments are required for this patient population.Tyrosine kinase inhibitors have become a
promising new class of anti-cancer agents owing to the importance of their targets in tumor
proliferation, survival (apoptosis), angiogenesis, motility, and metastasis Among the most
important receptor tyrosine kinases that regulate tumor angiogenesis are the vascular
endothelial growth factor receptor 2 (VEGFR2/Flk-1/KDR), PDGFR, and the fibroblast growth
factor (FGF) receptor family. These receptors belong to the split-kinase domain superfamily,
which also includes Kit, the receptor for stem cell factor (SCF). Kit is frequently
expressed in multiple hematologic and non-hematologic malignancies. It can also be activated
in an autocrine fashion by coexpression with SCF, as is the case in SCLC, where
approximately 70% of tumors and cell lines coexpress Kit and SCF at some level. Inhibition
of Kit using small molecule inhibitors results in growth inhibition of multiple SCLC cell
lines. Sunitinib, a novel small molecule receptor tyrosine kinase inhibitor with direct
antitumor as well as antiangiogenic activity via targeting the vascular endothelial growth
factor (VEGF), platelet-derived growth factor (PDGF), KIT, and FLT3 receptor tyrosine
kinases, which showed anti-tumor activity in mouse xenograft model of SCLC. Therefore, the
investigators will conduct a phase II trial to evaluate the efficacy and toxicity of
Sunitinib in patients with recurrent SCLC.-Single arm
-Sunitinib(50mg/day, 4weeks on, 2 weeks off) Repeat every 6 weeksTreatment will continue
until disease progression, unacceptable toxicity, or patients' refusal
Interventional
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Tumor response rate
The response rate will be determined by the number of patients with complete and partial responses according to RECIST criteria.
at 4week and every 8 weeks
No
Ji-Youn Han, M.D.,Ph.D.
Principal Investigator
National Cancer Center, Korea
South Korea: Korea Food and Drug Administration (KFDA)
NCCCTS-07-285
NCT00620347
March 2008
September 2012
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