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Phase I Study of Pemetrexed and Sorafenib in Advanced Malignancy


Phase 1
18 Years
N/A
Open (Enrolling)
Both
Unspecified Adult Solid Tumor

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Trial Information

Phase I Study of Pemetrexed and Sorafenib in Advanced Malignancy


PRIMARY OBJECTIVES:

I. To determine doses for the combination of pemetrexed (pemetrexed disodium) with sorafenib
(sorafenib tosylate) appropriate for Phase II study.

II. To gain additional safety and dosing experience with the combination of pemetrexed and
sorafenib at the recommended phase II dose (RP2D) (s) in a breast cancer expansion cohort.

SECONDARY OBJECTIVES:

I. To evaluate the safety, tolerance, and toxicity of the combination of pemetrexed and
sorafenib.

II. To observe antitumor effects of the combination. III. To assess the feasibility of
analyzing tissue staining of Beclin1 in biopsy specimens.

IV. To assess the feasibility of analyzing PDGFRb expression in biopsy specimens.

V. To assess the feasibility of analyzing pTEN expression in biopsy specimens. VI. To assess
the feasibility of analyzing ZMP levels (marker of AICART inhibition) in peripheral blood
mononuclear cells (PBMCs), collected before and after pemetrexed administration.

VII. To assess the feasibility of analyzing ZMP levels in circulating tumor cells (CTCs),
collected before and after pemetrexed administration.

VIII. To assess the feasibility of analyzing LC3A levels by immunohistochemistry (IHC) in
CTCs of patients, before and after pemetrexed administration.

OUTLINE: This is a dose-escalation study of pemetrexed disodium and sorafenib tosylate.

Patients receive pemetrexed disodium intravenously (IV) on day 1 every 2 weeks and sorafenib
tosylate orally (PO) twice daily (BID) for 4 weeks. Courses repeat every 4 weeks in the
absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up for 30 days.


Inclusion Criteria:



- Advanced solid tumor malignancy for which there is no potentially curative treatment;
in the breast cancer expansion cohort, patients must have a documented history of
invasive ductal or lobular cancer, unresponsive to at least 1 line of systemic
therapy in the metastatic setting; there is no limit to the number of prior lines of
therapy

- Performance status Eastern Cooperative Oncology Group (ECOG) equal or less than 2

- Aspartate aminotransferase (AST), alanine aminotransferase (ALT) =< 5 x upper
institutional limit (ULN)

- Total bilirubin =< 1.5 ULN

- Creatinine clearance (CrCl) >= 45 as measured by the standard Cockcroft-Gault
equation

- Prothrombin time (PT)/international normalized ratio (INR) =< 1.5 (if not due to
anticoagulants)

- White blood cell count (WBC) >= 3.0

- Absolute neutrophil count (ANC) >= 1.5

- Platelets >= 80,000

- Hemoglobin (Hgb) >= 8.5

- Prior toxicities are allowed as long as they are stable and would not interfere with
study drug toxicity assessment

- Measurable or evaluable disease by Response Evaluation Criteria In Solid Tumors
(RECIST) (v 1.1) criteria

- Ability to understand and the willingness to sign a written informed consent
document; a signed informed consent must be obtained prior to any study specific
procedures

- Women of childbearing potential must have a negative pregnancy test performed within
7 days prior to the start of treatment; women of childbearing potential and men must
agree to use a medically accepted form of birth control for the duration of study
participation; men must agree to use a medically accepted form of birth control for 2
months following completion of study treatment

Exclusion Criteria:

- Any investigational agent within 4 weeks or 5 half-lives, whichever is longer, of
first dose of study treatment

- Unwillingness or inability to take folic acid, vitamin B12 supplementation, or
dexamethasone

- Known or presumed intolerance of pemetrexed or sorafenib; unable to swallow
medication; suspected malabsorption

- Active illicit substance or alcohol abuse

- Contraindication to antiangiogenic agents, including:

- Pulmonary hemorrhage/bleeding event >= Grade 2 within 4 weeks or less prior to the
first dose of study drug

- Any other hemorrhage/bleeding event >= Grade 3 within 4 weeks or less prior to the
first dose of study drug

- Serious non-healing wound, ulcer, or bone fracture

- Thrombolic or embolic events such as a myocardial infarction, cerebrovascular
accident including transient ischemic attacks within the past 6 months

- Major cardiac dysfunction, such as uncontrolled angina, congestive heart failure with
New York Heart Association (NYHA) class III or higher, ventricular arrhythmias
requiring anti-arrhythmic therapy

- Systolic blood pressure > 160 mmHg or diastolic pressure > 100 mmHg despite optimal
medical management

- Inability to interrupt aspirin or other nonsteroidal anti-inflammatory agents for a 5
day period

- Serious uncontrolled infection > Common Terminology Criteria for Adverse Events
(CTCAE) (v 4) grade 2

- Uncontrolled metastatic brain disease

- Other condition(s) that in the opinion of the investigator might compromise the
objectives of the study

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Recommended phase 2 doses for the combination of pemetrexed disodium with sorafenib tosylate

Outcome Description:

Maximum doses of pemetrexed and sorafenib, which, when administered in combination are determined to be tolerable and will be tested in a Phase 2 trial for efficacy.

Outcome Time Frame:

2 years

Safety Issue:

Yes

Principal Investigator

Andrew Poklepovic

Investigator Role:

Principal Investigator

Investigator Affiliation:

Massey Cancer Center

Authority:

United States: Institutional Review Board

Study ID:

MCC-13874

NCT ID:

NCT01450384

Start Date:

October 2011

Completion Date:

October 2013

Related Keywords:

  • Unspecified Adult Solid Tumor
  • protocol specific

Name

Location

Virginia Commonwealth University/Massey Cancer Center Richmond, Virginia  23298