A Phase II Study Of BIBF 1120 as Second-line Treatment for Patients With Small Cell Lung Cancer
Chemotherapy is the primary treatment option for patients with small cell lung cancer
(SCLC), 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. 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 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.
The next generation of anti-angiogenic drugs aims to improve clinical efficacy by targeting
multiple angiogenic factors. This approach was validated by a recent analysis of BIBF 1120,
which inhibits vascular endothelial growth factor receptors (VEGFRs), platelet-derived
growth factor receptors (PDGFRs) and the fibroblast growth factor receptors (FGFRs). BIBF
1120 resulted in growth inhibition of tumours in syngeneic rats and human tumour xenografts
in nude mice. It also displayed a favourable cellular duration of action and pharmacodynamic
profile and was well-tolerated. These data complement early-phase clinical data suggesting
that BIBF 1120 might be an effective anti-angiogenic agent. Some preclinical studies have
showed that fibroblast growth factor-2 induces proliferation and chemoresistance in SCLC
cells. In addition, the selective fibroblast growth factor receptor (FGFR) inhibitor
PD173074 blocks H-510 and H-69 SCLC proliferation and clonogenic growth in a dose-dependent
fashion and prevents FGF-2-induced chemoresistance. BIBF1120 is a novel, orally available,
potent triple angiokinase inhibitor that predominantly blocks the FGFR in addition to
vascular endothelial growth factor (VEGF) and platelet-derived growth factor receptor
(PDGFR). Therefore, the investigators will conduct a phase II trial to evaluate the efficacy
of BIBF1120 in patients with recurrent SCLC.
Interventional
Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Overall response rate
To assess the efficacy of BIBF1120 as second-line treatment in patients with recurrent small cell lung caner
every 8 weeks
No
Ji-Youn Han, PhD.
Principal Investigator
National Cancer Center, Korea
South Korea: Korea Food and Drug Administration (KFDA)
NCCCTS-10-525
NCT01441297
December 2011
January 2014
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