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A Phase 1 Study of AZD6244 in Combination With Cetuximab in Refractory Solid Tumors

Phase 1
18 Years
Open (Enrolling)
Recurrent Colon Cancer, Recurrent Rectal Cancer, Stage IVA Colon Cancer, Stage IVA Rectal Cancer, Stage IVB Colon Cancer, Stage IVB Rectal Cancer, Unspecified Adult Solid Tumor, Protocol Specific

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Trial Information

A Phase 1 Study of AZD6244 in Combination With Cetuximab in Refractory Solid Tumors


I. To determine the dose limiting toxicities and the maximum tolerated dose of AZD6244 in
combination with cetuximab in advanced, refractory solid tumors.

II. To assess for evidence of anti-tumor activity with this combination, per tumor
measurements using RECIST criteria.


I. To evaluate the pharmacokinetics of AZD6244 and cetuximab when administered

II. To evaluate the safety and tolerability of the combination of AZD6244 and cetuximab in
patients with K-RAS mutated metastatic colorectal cancer.


I. To assess the inhibition of the RAF/MEK/ERK pathway in peripheral blood mononuclear cells
secondary to treatment with AZD6244.

II. To evaluate the pharmacokinetics of AZD6244 in combination with cetuximab and the
relation to treatment side effects.

OUTLINE: This is a dose-escalation study of MEK inhibitor AZD6244.

Patients receive oral MEK inhibitor AZD6244 once or twice daily on days 1-28 and cetuximab
IV over 60 minutes on days 1, 8, 15, and 22. Courses repeat every 28 days in the absence of
disease progression or unacceptable toxicity.

Blood samples are collected at baseline and periodically during study for pharmacokinetic
and biomarker analyses.

After completion of study treatment, patients are followed up for 1 month or every 3 months
for 1 year.

Inclusion Criteria:

- In the dose escalation cohorts: Patients must have histologically confirmed
malignancy that is metastatic or unresectable and for which standard curative or
palliative measures do not exist or are no longer effective; histology can be based
on either the primary tumor or metastases

- In the MTD expansion cohort: Patients must have biopsy proven K-RAS mutant,
metastatic colorectal cancer that has progressed on at least 2 prior standard
therapies; K-RAS mutation status must be verified by a CLIA-certified laboratory
(NOTE: colorectal patients enrolled during the dose escalation portion do not need to
be K-RAS mutant in order to be eligible)

- Patients must be at least 4 weeks since prior chemotherapy, 6 weeks if the last
regimen included nitrosureas or mitomycin C; prior radiation is allowed as long as
the radiation was completed 4 weeks prior to study treatment and no more than 35% of
marrow irradiated

- ECOG performance status =< 2 (Karnofsky >= 60%)

- Life expectancy of greater than 3 months

- Leukocytes >= 3,000/mcL

- Absolute neutrophil count >= 1,500/mcL

- Platelets >= 100,000/mcL

- Total bilirubin within normal institutional limits

- AST(SGOT)/ALT(SGPT) =< 2.5 X institutional upper limit of normal (AST and ALT =< 5.0
X institutional upper limit of normal will be permitted if liver metastases are

- Creatinine =< 1.5 X institution upper limit of normal OR creatinine clearance >= 45
mL/min/1.73 m^2, as calculated by Cockroft-Gault formula, for patients with
creatinine levels above institutional normal

- Patients may have received prior cetuximab

- The effects of AZD6244 on the developing human fetus are unknown; for this reason and
because small molecule kinase inhibitors as well as other therapeutic agents used in
this trial are known to be teratogenic, women of child-bearing potential and men must
agree to use adequate contraception prior to study entry and for 16 weeks following
the last dose of study treatment. Acceptable methods of birth control include
implants, injectables, combined oral contraceptives, (which must all be combined with
barrier methods of contraception), some IUDs, sexual abstinence, and vasectomized
partner; should a woman become pregnant or suspect she is pregnant while
participating in this study, she should inform her treating physician immediately

- Ability to understand and the willingness to sign a written informed consent document

- Patients with brain metastases that have been treated and stable for 2 months will be
eligible for this study

- Subjects undergoing anti-coagulation therapy with LMWH and warfarin are eligible;
subjects receiving both warfarin and AZD6244 should have more frequent PT/INR

Exclusion Criteria:

- Patients who have had chemotherapy, radiotherapy or hormonal therapy within 4 weeks
(6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who
have not recovered (=< grade 1) from adverse events due to agents administered more
than 4 weeks earlier

- Concurrent treatment with an investigational agent other than the investigational
agent(s) used in this study OR treatment within 4 weeks of study entry with any
investigational agent(s) or device(s)

- Failure to recover fully (as judged by the investigator) from prior surgical

- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to AZD6244 or other agents used in study

- Patients taking high doses (more than recommended daily dose) of vitamin E will be
excluded; patients can discontinue use of high dose vitamin E prior to study entry to
be considered eligible

- Any condition (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) that impairs their ability to
swallow and retain AZD6244 capsules

- Patients with malabsorption syndrome, disease significantly affecting
gastrointestinal function, or resection of the stomach or small bowel are excluded;
subjects with ulcerative colitis, inflammatory bowel disease, or a partial or
complete small bowel obstruction are also excluded

- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, uncontrolled hypertension, prior
cardiomyopathy, LVEF < 50%, unstable angina pectoris, cardiac arrhythmia (i.e. atrial
fibrillation), or psychiatric illness/social situations that would limit compliance
with study requirements

- Pregnant women are excluded from this study because AZD6244 is a small molecule
kinase inhibitor with the potential for teratogenic or abortifacient effects; because
there is an unknown but potential risk for adverse events in nursing infants
secondary to treatment of the mother with AZD6244, breastfeeding should be
discontinued if the mother is treated with AZD6244; these potential risks may also
apply to other agents used in this study

- HIV-positive patients on combination antiretroviral therapy are ineligible because of
the potential for pharmacokinetic interactions with AZD6244; 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

- Patients who are serologically positive for Hepatitis B or C, or have a history of
liver disease, other forms of hepatitis or cirrhosis are ineligible

- Use of strong CYP1A2 or 3A4 inducers and/or inhibitors (for example, but not limited
to, ketoconazole, rifampicin, atazanavir, clarithromycin, indinavir, itraconazole,
nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, troleandomycin (TAO),
voriconazole, grapefruit or grapefruit juice, rifabutin, rifapentine, phenytoin,
carbamazepine, phenobarbital and St. John's Wort) is not permitted while on study or
within 7 days prior to study enrollment

Type of Study:


Study Design:

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

Outcome Measure:

MTD of selumetinib combined with cetuximab

Outcome Description:

Graded using the NCI Common Toxicity Criteria.

Outcome Time Frame:

28 days

Safety Issue:


Principal Investigator

William Schelman

Investigator Role:

Principal Investigator

Investigator Affiliation:

University of Wisconsin Medical School


United States: Food and Drug Administration

Study ID:




Start Date:

October 2012

Completion Date:

Related Keywords:

  • Recurrent Colon Cancer
  • Recurrent Rectal Cancer
  • Stage IVA Colon Cancer
  • Stage IVA Rectal Cancer
  • Stage IVB Colon Cancer
  • Stage IVB Rectal Cancer
  • Unspecified Adult Solid Tumor, Protocol Specific
  • Colonic Neoplasms
  • Rectal Neoplasms
  • Neoplasms



University of Wisconsin Hospital and ClinicsMadison, Wisconsin  53792-0001