A Cancer Research UK Phase I Dose Escalation Trial of Oral VEGFR and EGFR Inhibitor, Vandetanib in Combination With the Oral MEK Inhibitor, Selumetinib (VanSel-1) in Solid Tumours (Dose Escalation) and NSCLC (Expansion Cohort).
1. (Dose escalation cohorts) Histologically or cytologically proven solid tumour for
which no conventional therapy exists or is declined by the patient
2. (Expansion cohort only) Histologically or cytologically confirmed NSCLC patients
only, for which no conventional therapy exists or is declined by the patient.
- If only cytologically confirmed, baseline biopsy is mandatory for a patient to
- For NSCLC patients to be eligible for the expansion cohort they must have
- One prior line of chemotherapy
- Previous platinum based chemotherapy
- Also eligible are those patients who:
- are erlotinib resistant
- are untreated with erlotinib
- have been treated with docetaxel
3. (Expansion cohort only) Measurable disease according to RECIST criteria Version 1.0
4. Life expectancy of at least 12 weeks
5. World Health Organisation (WHO) performance status of 0-1 (Appendix 1)
6. Baseline LVEF > 50%
7. Haematological and biochemical indices within the ranges shown below. These
measurements must be performed within one week (Day -7 to Day -1) before the patient
goes on study.
Laboratory Test Value required
Haemoglobin (Hb) ≥ 9.0 g/dL
Absolute neutrophil count ≥ 1.5 x 109/L
Platelet count ≥ 100 x 109/L
Normal serum calcium (adjusted)* 2.15-2.55 mmol/L
Normal serum magnesium* 0.60-1.0 mmol/L
Normal serum potassium >4.0 mmol/L
Either: Serum bilirubin ≤1.5 x upper limit of normal (ULN) This
does not apply to patients with Gilbert‟s disease.
Or: Alanine amino-transferase (ALT) or ≤ 2.5 x ULN unless raised due to
aspartate amino-transferase (AST) liver metastases in which case up and
alkaline phosphatase (ALP) to 5 x ULN is permissible
Calculated creatinine clearance (using the Wright or C&G formula) > 50
Or: Isotope clearance measurement** ≥ 50 mL/min (uncorrected)
INR or aPTT < 1.5 x ULN
*or normal range according to the local laboratory
** Isotope clearance result to be used to confirm eligibility if calculated
C&G/Wright method results in GFR of = 50 mL/min.
8. 18 years or over
9. Ability to swallow and retain oral medications.
10. Written (signed and dated) informed consent and be capable of co-operating with
treatment, and follow-up
1. Radiotherapy (except for palliative reasons), endocrine therapy, immunotherapy or
chemotherapy during the previous 4 weeks (6 weeks for investigational medicinal
products) before treatment.
2. Patients who have been withdrawn from treatment with agents that target EGFR because
of unacceptable toxicity (prior treatment with these agents is allowed) and those
patients who have had EGFR dose reductions.
3. Prior treatment with any agent that targets MEK or VEGFR
4. Any prior exposure to RAS or RAF inhibitors
5. Ongoing toxic manifestations of previous treatments. Exceptions to this are alopecia
or certain Grade 1 toxicities, which in the opinion of the Investigator and the Drug
Development Office (DDO) should not exclude the patient.
6. Symptomatic brain metastases (patients must be stable for >3 months post RT
treatment) or spinal cord compression.
7. Patients with interstitial lung disease.
8. Pregnant or lactating women are excluded. Female patients with the ability to become
pregnant who have a negative serum or urine pregnancy test before enrollment and
agree to use two of the following three highly effective forms of combined
contraception (oral, injected or implanted hormonal contraception and condom, have a
intra-uterine device and condom, diaphragm with spermicidal gel and condom) for four
weeks before entering the trial, during the trial and for six months afterwards are
9. Male patients with partners of child-bearing potential (unless they agree to take
measures not to father children by using one form of highly effective contraception
[condom plus spermicide] during the trial and for six months afterwards). Men with
pregnant or lactating partners should be advised to use barrier method contraception
(e.g. condom plus spermicidal gel) to prevent exposure to the foetus or neonate.
10. Major surgery from which the patient has not yet recovered.
11. At high medical risk because of non-malignant systemic disease including active
12. Known to be serologically positive for Hepatitis B, Hepatitis C or Human
Immunodeficiency Virus (HIV).
13. Cardiac conditions as follows:
- Clinically significant cardiovascular event within 3 months prior to entry to
- Myocardial infarction
- Angina requiring use of nitrates more than once weekly
- Superior vena cava syndrome
- Class II/III/IV cardiac disease (New York Heart Association [NYHA])
- Presence of cardiac disease that in the opinion of the Investigator
increases the risk of ventricular arrhythmia.
- History of arrhythmia which is symptomatic or requires treatment (CTCAE 3),
symptomatic or uncontrolled atrial fibrillation despite treatment or
asymptomatic sustained ventricular tachycardia. Patients with atrial
fibrillation controlled by medication are permitted.
- Uncontrolled hypertension (BP > 160/100 despite optimal therapy)
- Prior or current cardiomyopathy
- Atrial fibrillation with heart rate > 100 bpm
- QTcB > or equal to 450 msec on screening ECG (Note: If a patient has a QTcB
interval > or equal to 450 msec on screening ECG, the screen ECG may be
repeated twice [at least 24 hours apart]. The average QTcB from the three
screening ECGs must be < 450 msec in order for the subject to be eligible for
- History of congenital long QT syndrome
- History of Torsade de Pointes (or any concurrent medication with a known risk of
inducing Torsades de Pointes. See Appendix 16.8)
14. Concomitant medications that are potent inducers of CYP3A4 function i.e. rifampicin,
rifabutin, phenytoin, carbamazepine, Phenobarbital and St John‟s Wort.
15. Any other condition which in the Investigator‟s opinion would not make the patient a
good candidate for the clinical trial (e.g. evidence of severe or uncontrolled
systemic disease or concurrent condition or that may affect ability to absorb oral
16. Current malignancies of other types, with the exception of adequately treated
cone-biopsied in situ carcinoma of the cervix uteri and basal or squamous cell
carcinoma of the skin. Cancer survivors, who have undergone potentially curative
therapy for a prior malignancy, have no evidence of that disease for five years or
more and are deemed at negligible risk for recurrence, are eligible for the trial.
17. If a participant plans to participate in another interventional clinical study,
whilst taking part in this Phase I study. Participation in an observational study
would be acceptable.
18. (Expansion cohort only) If the patient is unsuitable for administration of DCE-MRI
contrast material because of hypersensitivity or impaired renal function.