An Open-Label, Phase II Study of Cabozantinib (XL184) in Advanced Pancreatic Neuroendocrine and Carcinoid Tumors
- Locally unresectable or metastatic, histologically-confirmed, carcinoid or pancreatic
neuroendocrine tumor. Tumors must be considered well- or moderately-differentiated.
Patients with poorly differentiated neuroendocrine carcinoma or cell carcinoma are
excluded from the study.
- A tumor sample is required for enrollment (except for patients diagnosed > 7 years
- Must have measurable disease by RECIST criteria
- Must have evidence of progressive disease within 12 months of study entry
- Prior or concurrent therapy with somatostatin analogs is permitted. If on
somatostatin/octreotide, must be on a stable dose for at least two months.
- Age ≥ 18 years
- No major surgery or radiation in the prior 4 weeks prior to enrollment
- No prior therapy with cabozantinib
- ECOG Performance status ≤ 1
- Participants must have adequate organ and marrow function as defined below:
- Absolute neutrophil count > 1,500/mcL
- Platelets > 100,000/mcL
- Total bilirubin = 1.5X normal institutional limits
- AST (SGOT) and ALT (SGPT) =2.5x normal institutional limits, or < 5x if liver
metastases are present
- Creatinine = 1.5x normal institutional limits or creatinine clearance >
- Urine Protein:Creatinine ratio of <1
- Lipase < 1.5X upper limit of normal
- Serum Albumin ≥ 2.8 g/dl
- Sexually active subjects must agree to use medically accepted methods of birth
control during the course of the study and for 3 months following discontinuation of
study treatments (excluding women who are not of child bearing potential and men who
have been sterilized).
- Ability to understand and the willingness to sign a written informed consent
- Subjects receiving any other standard or investigational anticancer agents, with the
exception of somatostatin/octreotide therapy. If patients has received prior
cytotoxic chemotherapy, must be at least three weeks since last treatment before
first dose of study treatment.
- Major surgery or radiation treatment <4 weeks prior to enrollment. In addition,
cannot have received radiation to the thorax or gastrointestinal tract within three
months of the first dose of study treatment.
- Cannot have received radionuclide treatment within 6 weeks of first dose of study
- High grade or poorly differentiated neuroendocrine tumors
- Ongoing immunosuppression with systemic steroids or other immune modulator
- Presence of CNS metastatic disease
- Uncontrolled hypertension defined by SBP > 140 or DBP > 90 despite titration of anti
- No uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
arrhythmia other than chronic atrial fibrillation, or psychiatric illness/social
situations that would limit compliance with study requirements. Congestive heart
failure or symptomatic coronary artery disease within 3 months prior to enrollment
- Cerebrovascular accident within prior 6 months
- The subject has a history of clinically significant hematemesis or a recent history
of hemoptysis of > 2.5 mL of red blood or other signs indicative of pulmonary
hemorrhage or evidence of endobronchial lesion(s).
- The subject has a pulmonary lesion abutting or encasing a major blood vessel.
- Previous history of pulmonary embolism or deep venous thrombosis
- The subject requires concomitant treatment, in therapeutic doses, with anticoagulants
such as warfarin or Coumadin-related agents, heparin, thrombin or FXa inhibitors, and
antiplatelet agents (eg, clopidogrel). Low dose aspirin (≤ 81 mg/day), low-dose
warfarin (≤ 1 mg/day), and prophylactic Low Molecular Weight Heparin (LMWH) are
- At the time of screening, active peptic ulcer disease or active inflammatory bowel
disease (including ulcerative colitis or Crohn's disease), diverticulitis,
cholecystitis, symptomatic cholangitis, or appendicitis.
- History of abdominal fistula, gastrointestinal perforation, bowel obstruction,
gastric outlet obstruction, or intra-abdominal abscess within six months of study
- History of GI surgery within the past 28 days. If >28 days since GI surgery, must
have confirmation of complete healing before initiating treatment with study drug.
- Other disorders associated with a high risk of fistula formation, including PEG tube
placement within 3 months before the first dose of study therapy or concurrent
evidence of intraluminal tumor involving the trachea or esophagus.
- Other clinically significant disorders such as:
- Active infection requiring systemic treatment
- Serious non-healing wound/ulcer/bone fracture
- History of organ transplant
- Concurrent uncompensated hypothyroidism or thyroid dysfunction
- History of major surgery within 4 weeks or minor surgical procedures within one
week before randomization
- The subject has a corrected QT interval calculated by the Fridericia formula > 500ms
within 28 days before randomization.
- Severely impaired lung function
- Concurrent malignancy (other than non-melanoma skin cancer) diagnosed within the past
3 years or any currently active malignancy
- Pregnant women are excluded from this study due to the potential for teratogenic or
abortifacient effects. Because there is an unknown but potential risk of adverse
events in nursing infants secondary to treatment of the mother with the treatment
protocol, breastfeeding should be discontinued if the mother is treated on protocol.