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Phase I Study of the Pharmacokinetics and Pharmacodynamics of ZD6474 in Combination With Docetaxel in Advanced Solid Tumors


Phase 1
18 Years
N/A
Not Enrolling
Both
Breast Cancer, Head and Neck Cancer, Lung Cancer, Prostate Cancer, Unspecified Adult Solid Tumor, Protocol Specific

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Trial Information

Phase I Study of the Pharmacokinetics and Pharmacodynamics of ZD6474 in Combination With Docetaxel in Advanced Solid Tumors


OBJECTIVES:

Primary

- To investigate the differential biological effects in tumor tissues through
pharmacodynamic endpoints (percent inhibition of pERK, pKDR, and pEGFR) and their
correlation with pharmacokinetics of vandetanib in combination with docetaxel in
patients with advanced solid tumors.

- To correlate the pharmacodynamic endpoints with the pharmacokinetics of this
combination regimen in these patients.

- To recommend an optimal biological dose of this combination regimen for further
testing.

Secondary

- To correlate the pharmacokinetics with safety profiles of two dose levels of vandetanib
when given in combination with docetaxel.

- To investigate scientific correlates, including serum proteomics and microvessel
density (CD31) and cell death (TUNEL) using tumor tissue biopsy samples taken at
baseline and during treatment.

- To determine the objective response in patients with measurable disease at baseline.

OUTLINE: This is a multicenter study.

Patients receive docetaxel IV over 1 hour on day 1 and oral vandetanib once daily on days
1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable
toxicity. After 6 weeks of treatment, patients who experience clinical benefit but poor
tolerance to docetaxel may continue treatment with vandetanib alone.

Plasma samples are collected periodically for pharmacokinetic analysis, measurement of
vandetanib trough levels, serum biomarker analysis, and serum proteomics. Tumor tissue
samples are collected at baseline and once between days 36-38 for pharmacodynamic analysis.

After completion of study treatment, patients are followed up for up to 28 days.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically or cytologically confirmed advanced solid tumor, including, but not
limited to the following:

- Non-small cell lung cancer

- Metastatic breast cancer

- Hormone-refractory prostate cancer

- Locally recurrent or metastatic head and neck cancer (including thyroid origin)

- Disease for which no standard therapy exists

- Tumor amenable to biopsy

- Measurable or non-measurable disease

- Brain metastases allowed provided patient has undergone brain irradiation (whole
brain or gamma knife) AND the metastases have been clinically and radiologically
stable for ≥ 6 weeks after completion of irradiation

- Patients requiring corticosteroids or anticonvulsants for brain metastases must
be on a stable or decreasing dose of corticosteroids and seizure free for ≥ 28
days before study enrollment

PATIENT CHARACTERISTICS:

- Zubrod performance status 0-1

- ANC ≥ 1,500/mm^3

- Platelet count ≥ 100,000/mm^3

- SGOT or SGPT ≤ 2.5 times upper limit of normal (ULN)

- Bilirubin ≤ 1.5 times ULN

- PT/INR ≤ 1.1 times normal

- Serum creatinine ≤ 1.8 times ULN OR measured or estimated creatinine clearance > 50
mL/min

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception during and for ≥ 3 months after
completion of study treatment

- Willing to undergo two tumor biopsies and blood and tissue sample submission for
correlative laboratory studies

- No clinically significant cardiovascular event, including any of the following:

- Myocardial infarction or cerebrovascular accident within the past 3 months

- Unstable angina pectoris

- NYHA class II-IV heart disease within the past 3 months

- Symptomatic congestive heart failure

- Serious cardiac arrhythmia

- No history of cardiac disease that, in the investigator's opinion, increases the risk
of ventricular arrhythmia

- No history of arrhythmia that is symptomatic or requires treatment (CTCAE grade 3),
including any of the following:

- Multifocal premature ventricular contractions (PVCs)

- Bigeminy or trigeminy

- Ventricular tachycardia

- Uncontrolled atrial fibrillation

- Medically controlled atrial fibrillation allowed

- No asymptomatic sustained ventricular tachycardia

- No history of or evidence of any of the following on ECG:

- History of QTc prolongation as a result from other medication that required
discontinuation of that medication

- Congenital long QT syndrome

- First degree relative with unexplained sudden death under 40 years of age

- Presence of left bundle branch block

- QTc with Bazett's correction that is unmeasurable or ≥ 480 msec on screening ECG

- No uncontrolled hypertension, defined as consistent systolic BP > 160 mm Hg or
consistent diastolic BP > 100 mm Hg despite medical management

- No intractable nausea or vomiting

- No concurrent active diarrhea that may affect the ability to absorb or tolerate
vandetanib

- No gastrointestinal (GI) tract disease resulting in malabsorption syndrome or a
requirement for IV alimentation

- No uncontrolled inflammatory GI disease (e.g., Crohn's disease or ulcerative colitis)

- No history of allergic reactions attributed to docetaxel or compounds of similar
chemical or biological composition to vandetanib, including other quinazoline
compounds (e.g., gefitinib or erlotinib)

- No history of deep venous thrombosis or pulmonary embolism requiring therapeutic
anticoagulation

- No known HIV positivity

- No other concurrent uncontrolled illness, including, but not limited to the
following:

- Ongoing or serious active infection

- Psychiatric illness or social situation that would limit compliance with study
requirements

- Prior or concurrent malignancies of other histologies within the past 5 years allowed

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- Recovered from prior therapy (i.e., ≤ grade 2 alopecia and ≤ grade 1 toxicity from
all other adverse events)

- Prior docetaxel as monotherapy or in combination with other chemotherapeutic agents
allowed provided there is potential clinical benefit present, in the investigator's
opinion, from the combination of docetaxel and vandetanib

- No prior vandetanib

- No prior surgical procedures affecting absorption

- More than 14 days since prior drugs with a short half-life (e.g., sorafenib or
sunitinib) (approval by study coordinator required)

- More than 28 days since prior major surgery, chemotherapy, or radiotherapy

- More than 28 days since prior investigational agents

- More than 2 weeks since prior and no concurrent medications associated with a risk of
causing Torsades de Pointes

- No concurrent therapeutic anticoagulation (coumadin, warfarin, or low-molecular
weight heparin)

- Low-dose anticoagulation for indwelling catheter maintenance allowed

- No concurrent medication that may cause QTc prolongation

- No other concurrent chemotherapy, hormonal therapy, radiotherapy, immunotherapy, or
any other type of therapy for the treatment of cancer, except for the following:

- Luteinizing hormone-releasing hormone agonists

- Bisphosphonates

Type of Study:

Interventional

Study Design:

Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Pharmacodynamic parameters (percent inhibition of pERK, pKDR, and pEGFR)

Safety Issue:

No

Principal Investigator

Monica Mita, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Cancer Therapy and Research Center, Texas

Authority:

United States: Food and Drug Administration

Study ID:

CDR0000647578

NCT ID:

NCT00937417

Start Date:

September 2008

Completion Date:

Related Keywords:

  • Breast Cancer
  • Head and Neck Cancer
  • Lung Cancer
  • Prostate Cancer
  • Unspecified Adult Solid Tumor, Protocol Specific
  • unspecified adult solid tumor, protocol specific
  • recurrent non-small cell lung cancer
  • stage IV non-small cell lung cancer
  • stage IV breast cancer
  • recurrent squamous cell carcinoma of the hypopharynx
  • stage IV squamous cell carcinoma of the hypopharynx
  • recurrent squamous cell carcinoma of the larynx
  • recurrent verrucous carcinoma of the larynx
  • stage IV squamous cell carcinoma of the larynx
  • stage IV verrucous carcinoma of the larynx
  • recurrent adenoid cystic carcinoma of the oral cavity
  • recurrent mucoepidermoid carcinoma of the oral cavity
  • recurrent squamous cell carcinoma of the lip and oral cavity
  • recurrent verrucous carcinoma of the oral cavity
  • recurrent basal cell carcinoma of the lip
  • stage IV adenoid cystic carcinoma of the oral cavity
  • stage IV basal cell carcinoma of the lip
  • stage IV mucoepidermoid carcinoma of the oral cavity
  • stage IV squamous cell carcinoma of the lip and oral cavity
  • stage IV verrucous carcinoma of the oral cavity
  • recurrent metastatic squamous neck cancer with occult primary
  • recurrent lymphoepithelioma of the nasopharynx
  • recurrent squamous cell carcinoma of the nasopharynx
  • stage IV lymphoepithelioma of the nasopharynx
  • stage IV squamous cell carcinoma of the nasopharynx
  • recurrent lymphoepithelioma of the oropharynx
  • recurrent squamous cell carcinoma of the oropharynx
  • stage IV lymphoepithelioma of the oropharynx
  • stage IV squamous cell carcinoma of the oropharynx
  • recurrent esthesioneuroblastoma of the paranasal sinus and nasal cavity
  • recurrent inverted papilloma of the paranasal sinus and nasal cavity
  • recurrent midline lethal granuloma of the paranasal sinus and nasal cavity
  • recurrent squamous cell carcinoma of the paranasal sinus and nasal cavity
  • stage IV esthesioneuroblastoma of the paranasal sinus and nasal cavity
  • stage IV inverted papilloma of the paranasal sinus and nasal cavity
  • stage IV midline lethal granuloma of the paranasal sinus and nasal cavity
  • stage IV squamous cell carcinoma of the paranasal sinus and nasal cavity
  • recurrent salivary gland cancer
  • stage IV salivary gland cancer
  • anaplastic thyroid cancer
  • stage IV follicular thyroid cancer
  • insular thyroid cancer
  • stage IV papillary thyroid cancer
  • recurrent thyroid cancer
  • thyroid gland medullary carcinoma
  • recurrent prostate cancer
  • hormone-resistant prostate cancer
  • recurrent breast cancer
  • stage IV prostate cancer
  • male breast cancer
  • Breast Neoplasms
  • Head and Neck Neoplasms
  • Lung Neoplasms
  • Prostatic Neoplasms
  • Neoplasms

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