A Phase II Study of PF-03446962 in Patients With Advanced Malignant Pleural Mesothelioma
- Patients must have histologically or cytologically confirmed malignant pleural
- Patients must have advanced and/or metastatic disease, incurable by standard
- All patients must have a tumour block from their primary or metastatic tumour
available and consent to release the block for correlative analyses.
Centre/pathologist must have agreed to the submission of the specimens in both Stage
I and II of accrual. For patients entered in Stage I of accrual, if no archival
tissue is available, patient must undergo a biopsy prior to registration.
- All patients entered in Stage II of accrual must have an accessible tumour lesion
(from primary or metastatic disease) for a fresh biopsy, which is formalin fixed and
paraffin embedded. These patients must consent to this biopsy for entry on the trial.
- Presence of clinically and/or radiologically documented disease. At least one site of
disease must be unidimensionally measurable as follows:
- Chest X-ray ≥ 20 mm CT scan (with slice thickness of ≤ 5 mm) ≥ 10 mm longest diameter
Physical exam (using calipers) ≥ 10 mm Lymph nodes by CT scan ≥ 15 mm measured in
short axis All radiology studies must be performed within 21 days prior to
registration (Exception: Within 28 days if negative).
- Age ≥ 18 years.
- Patients must have a life expectancy of at least 12 weeks.
- ECOG performance status 0 or 1. Performance Status 2 patients are eligible, if, in
the opinion of the investigator, they are suitable for inclusion in the study and are
likely to be compliant with the study procedures (in particular the recommendations
for supportive care and dose modification).
- Patients are eligible after first line cytotoxic chemotherapy has failed
- Patients must have received one, but no more than one, combination chemotherapy
regimen for advanced disease, which must have contained a platinum agent, and
treatment failure must have been documented
o Exchange of one chemotherapy agent for another within a combination chemotherapy
regimen due to toxicity (and not due to progressive disease) is not considered a new
regimen in the following circumstances
- Carboplatin is substituted for cisplatin due to nephrotoxicity or ototoxicity
- One agent in the combination regimen is changed due to hypersensitivity
occurring in the first cycle
- 28 days must have elapsed since last chemotherapy treatment (at least 6 weeks for
nitrosoureas or mitomycin C) and patient must have recovered from toxic effects.
Other Anti-Cancer Therapy:
• Patients may have received other non-cytotoxic investigational therapy; 28 days must
have elapsed since last treatment, such as anti-angiogenic or growth factor antagonists.
Patients may have had prior radiation therapy. A minimum of 28 days must have elapsed
between the end of radiotherapy and registration onto the study. Radiation must have
involved < 30% of functioning bone marrow and there must be measurable disease outside the
previously irradiated area (patients whose sole site of disease is in previously
irradiated area are ineligible) unless there is evidence of progression. progression, or
new lesions have been documented, in the irradiated field). [Exceptions may be made
however for low dose palliative radiotherapy].
Previous major surgery is permitted provided that it has been at least 28 days prior to
patient registration and that wound healing has occurred.
Laboratory requirements must be done within 7 days prior to registration) Hematology:
Granulocytes (ANC) ≥1.5 x 109/L Platelet s ≥100 x 109/L Chemistry: Bilirubin ≤ULN AST and
ALT ≤2.5 x ULN Calcium ≤3 mmol /L INR ≤1.5 x ULN Serum creatinine ≤ULN Or Creatinine
clearance ≥60 ml/min if creatinine is >ULN Creatinine clearance to be measured directly by
24 hour urine sampling or as calculated by Cockcroft Formula:Females: GFR=1.04 x(140-age)x
weight in kg serum creatinine in μmol/L; Males: GFR=1.23 x (140-age)x weight in kg serum
creatinine in μmol/L
- Patient consent must be appropriately obtained in accordance with applicable local
and regulatory requirements. Each patient must sign a consent form prior to
registration in the trial to document their willingness to participate.
- Patients must be accessible for treatment, response assessment and follow-up.
Patients registered on this trial must be treated and followed at the participating
centre. This implies there must be reasonable geographical limits (for example: 1 ½
hour's driving distance) placed on patients being considered for this trial.
Investigators must assure themselves the patients registered on this trial will be
available for complete documentation of the treatment, response assessment, adverse
events and follow up.
- In accordance with NCIC CTG policy, protocol treatment is to begin within 2 working
days of patient registration.
- Patients with a history of other malignancies, except: adequately treated
non-melanoma skin cancer, curatively treated in-situ cancer of the cervix, or other
solid tumours curatively treated with no evidence of disease for ≥5 years.
- Patients with known brain metastases. (A head CT is not necessary to rule out brain
metastases, unless there is clinical suspicion of CNS involvement). Patients with
known brain metastases will be excluded from this trial due to their poor prognosis
and their likelihood of developing progressive neurologic dysfunction that would
confound the evaluation of neurologic and other adverse events.
- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to PF-03446962.
- Patients receiving concurrent treatment with other anti-cancer therapy or other
investigational anticancer agents.
- Patients with any of the following cardiovascular findings are to be excluded:
- QTc prolongation ( defined as a mean QTc interval with Bazetts correction equal
to or greater than 470 msec) in screening ECG or history of familial long QT
syndrome. An ECG must be done within 14 days prior to registration.
- Patients with resting BP consistently higher than, systolic > 150 mmHg and/or
diastolic > 100 mmHg (in the presence or absence of a stable dose of
anti-hypertensive medication) or poorly controlled hypertension, history of
labile hypertension or poor compliance with anti-hypertensive medication.
- Patients who have experienced untreated and/or uncontrolled cardiovascular
conditions and/or have symptomatic cardiac dysfunction (unstable angina,
congestive heart failure, myocardial infarction within the previous year or
cardiac ventricular arrhythmias requiring medication, history of 2nd or 3rd
degree atrioventricular conduction defects). Patients with a significant cardiac
history even if controlled, should have a LVEF > 50%.
- History of pulmonary embolism within the past 12 months; exceptions may be made for
incidental pulmonary emboli found on routine scanning providing not within the past 6
- History of cerebrovascular accident (CVA) or transient ischemic attack within 12
months prior to study entry.
- Patients with overt bleeding from any site (> 30 ml bleeding/episode) within 3 months
of study entry are not eligible. No clinically relevant hemoptysis (> 5 ml fresh
blood) within 4 weeks prior to study entry is permitted. Patients with only flecks of
blood in sputum are permitted.
- Patients who require use of therapeutic doses of anticoagulants such as warfarin,
heparin or low molecular weight heparin (except for low doses for prophylaxis). INR
must be done within 7 days prior to registration.
- Patients with bowel obstruction or any condition or gastrointestinal tract disease
that would increase the risk for gastrointestinal perforation, including abdominal
fistula, gastrointestinal perforation, or intra-abdominal abscess within 28 days of
- Patients with serious illness or medical condition which would not permit the patient
to be managed according to the protocol including, but not limited to:
- History of significant neurologic or psychiatric disorder which would impair the
ability to obtain consent or limit compliance with study requirements;
- Active uncontrolled infection;
- Any other medical conditions that might be aggravated by treatment;
- Serious or non-healing wound, ulcer, or bone fracture.
- The following are exclusions for enrollment on the study:
- Pregnant or lactating women. (N.B.: All women of childbearing potential must
have a negative pregnancy test within 7 days prior to registration).
- Women must be post-menopausal, surgically sterile or use two reliable forms of
contraception while on study and for 6 months after discontinuing therapy. Men
must be surgically sterile or use a barrier method of contraception with
spermicide. Should a woman become pregnant or suspect she is pregnant while
participating in this study, she should inform her treating physician