Use of Individual PK-guided Sunitinib Dosing: A Feasibility Study in Patients With Advanced Solid Tumors
Sunitinib is an orally available inhibitor of vascular endothelial growth factor (VEGFR),
platelet-derived growth factor (PDGF), cytokine receptor (c-KIT), and receptor tyrosine
kinase (FLT-3) activity. Sunitinib is proven effective as single agent in several solid
tumor types and is approved for use in advanced renal cell cancer (RCC) and
imatinib-resistant or -intolerant gastrointestinal stromal tumors (GISTs). However, in a
large percentage of patients (30 and 50%), dose reductions are required because of multiple
grade 2 toxicities or due to grade 3 or 4 toxicities. Therefore, the currently used dosing
schedule is not optimal.
Recently, a dose-efficacy relation was established for sunitinib treatment. This large
meta-analysis of pharmacokinetic/pharmacodynamic data from studies performed in mRCC
patients, GIST patients and patients with solid tumors, clearly showed a relationship
between sunitinib exposure and efficacy and tolerability. Both time to progression (TTP) and
overall survival (OS) were significantly better for mRCC patients with high area under the
curve (AUC) compared to low AUC. This was not only observed for sunitinib exposure but also
for its active metabolite SU12662. In addition, there was a significant relationship between
exposure and probability of partial response (PR) or complete response (CR) in mRCC patients
(p=0.00001), indicating that a dose intensity in patients should be as high as possible.
Target plasma concentrations of sunitinib plus metabolite (N-desethyl sunitinib) are in the
range of 50 to 100 ng/mL, as deduced from pharmacokinetic (PK) / pharmacodynamic (PD)
preclinical data. Since the dose-efficacy relation for sunitinib treatment is solely
established in a retrospective (meta-) analysis from patients treated in several studies, we
propose to perform a prospective feasibility study in 30 patients with PK guided dosing of
sunitinib. If PK guided once-daily continuous sunitinib dosing is feasible, a RCT in mRCC
patients will be performed comparing PK guided dosing with a standard sunitinib dosing
schedule.
Interventional
Endpoint Classification: Safety Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Number of Participants with Adverse Events as a Measure of Safety and Tolerability
To determine the safety and feasibility of PK guided dosing of sunitinib, weekly physical examination, blood hematology and blood chemistry parameters in the first 2 cycles, and monthly thereafter, will guide the safety of the treatment.
During treatment with sunitinib Adverse Events will be recorded up to 30 days after treatment. Patient will remain on treatment untill the disease progression, 1 year in average
Yes
Neeltje Steeghs, Md, PhD
Principal Investigator
The Netherlands Cancer Institute
Netherlands: The Central Committee on Research Involving Human Subjects (CCMO)
M10PKS
NCT01286896
March 2011
December 2011
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