Phase I Study of TheraSphere and Everolimus Among Patients With Neuroendocrine Tumors and Liver Only or Liver Dominant Disease
Study Groups:
If patient is are found to be eligible to take part in this study, they will be assigned to
a dose level of everolimus based on when they joined this study. Up to 3 dose levels of
everolimus will be tested. Up to 6 participants will be enrolled at each dose level. The
first group of participants will receive the low dose level. Each new group will receive a
higher dose than the group before it, if no intolerable side effects were seen. If
intolerable side effects are seen, the dose may be lowered. This will continue until the
highest tolerable dose of everolimus is found. After that, 10 additional participants will
be enrolled at the highest tolerable dose that was found.
All participants will receive the same dose level of TheraSphere.
Study Drug Administration:
Each study cycle is 28 days.
On Day 1 of Cycle 1, 2 weeks before the TheraSphere procedure, patient will start taking
everolimus.
Patient will take 1-2 tablets of everolimus by mouth 1 time every day. Patient will take
the everolimus tablets with a glass of water in the morning at the same time every day. The
tablets should be swallowed whole and not chewed or crushed. The tablets may be taken
either always with or always without food.
If patient vomits after taking their dose, they should not take another tablet that day. It
is very important that patients take the tablets given to them just as the study doctor
tells them and that they do not miss any tablets. If patient does forget to take it one
day, they should not take any extra doses the next day. Instead, patient should contact
their doctor and ask for advice.
On the days of patient's study visits, they should take their dose of everolimus at the
clinic, not at home.
TheraSphere Administration:
About 2 weeks before the TheraSphere procedure, patient will have an angiogram. An
angiogram is an imaging test that uses contrast dye to help the doctor look at the body's
blood vessels. Patient will be given drugs by vein in their arm or hand to help them relax,
but patient will stay awake during the procedure. An area in patient's groin will be numbed
with anesthetic.
During the procedure, the doctor will insert a catheter into a blood vessel in patient's
groin that leads to their liver. Dye will be injected into the catheter, and a series of
x-rays will be taken that will allow the doctor to see the blood vessels in patient's liver.
At the end of the procedure, the catheter will be removed from patient's groin area. The
x-rays taken will be looked at by patient's doctor to plan for their TheraSphere procedure.
The angiogram procedure should take about 1½ to 3 hours.
On Day 15 of Cycle 1, patient will receive TheraSphere. Before the procedure, patient will
be given drugs by vein in their arm or hand to help them relax, but patient will stay awake
during the procedure. An area in patient's groin will be numbed with anesthetic. Patient
may ask the study staff for information about how the anesthesia drugs are given and their
risks.
The doctor will insert a catheter into a blood vessel in patient's groin that leads to their
liver. Based on the planning from patient's angiogram procedure, the doctor will guide the
catheter to the target blood vessel. Once the catheter is in the proper blood vessel, the
TheraSphere microspheres containing Y-90 will be injected into the catheter to reach the
tumor in the liver. After the TheraSphere microspheres are injected, the catheter will be
removed from patient's groin. The entire procedure will take about 1½ to 3 hours.
After receiving the TheraSphere microspheres, patient will stay in the recovery area for
several hours so that the staff can check patient for possible side effects. If patient has
any serious side effects, they may be admitted to the hospital to be checked on and for
treatment, if needed.
Study Visits:
Before all visits, patient must fast starting at midnight the night before.
On Day 1 of Cycle 1, if the tests have not been done in the last 5 days:
- Patient will have a physical exam, including measurement of their weight and vital
signs.
- Patient will be asked about any symptoms they may have had and any drugs they may be
taking.
- Patient's performance status will be recorded.
- Blood (about 4 tablespoons) will be drawn for routine tests and tumor marker testing.
- Urine will be collected for routine tests.
- If patient's doctor thinks it is needed, blood (about 2 teaspoons) will be drawn to
check for hepatitis B and/or C.
On Day 14 or 15 of Cycle 1:
- Patient will have a physical exam, including measurement of their weight and vital
signs.
- Patient will be asked about any side effects they may have had.
- Patient's performance status will be recorded.
- Blood (about 3 tablespoons) will be drawn for routine tests.
On Day 1 of Cycles 2 and beyond:
- Patient will have a physical exam, including measurement of their weight and vital
signs.
- Patient will be asked about any side effects they may have had and any drugs they may
be taking.
- Patient's performance status will be recorded.
- Blood (about 1 tablespoon) will be drawn for routine tests.
On Day 1 of Cycles 2 and 3 and every 3-6 weeks after that, blood (about 2 teaspoons) will be
drawn to check for hepatitis B and/or C if the doctor thinks it is needed.
On Day 1 of Cycles 2, 4, and every 3 cycles after that, blood (about 2 tablespoons) will be
drawn for tumor marker testing and additional routine tests.
On Day 1 of Cycles 4 and beyond, urine will be collected for routine tests.
On Day 1 of Cycle 4 and every 3 cycles after that, patient will have a CT scan, MRI, and/or
x-ray to check the status of the disease.
Length of Dosing:
Patient will receive TheraSphere on Day 15 of Cycle 1 and they may continue taking
everolimus for up to 12 cycles, as long as the doctor thinks it is in patient's best
interest. Patient will no longer be able to take everolimus if the disease gets worse, if
intolerable side effects occur, or if they are unable to follow study directions.
Patient's participation on the study will be over once they have completed the follow-up.
End-of-Dosing Visit:
Within 1 week after patient stops taking the study drug, the following tests and procedures
will be performed. Patient must fast starting at midnight the night before this visit.
- Patient will have a physical exam, including measurement of their weight and vital
signs.
- Patient will be asked about any side effects they may have had.
- Patient's performance status will be recorded.
- Blood (about 3 tablespoons) will be drawn for routine tests and tumor marker testing.
This blood draw will include a pregnancy test if patient can become pregnant.
- Urine will be collected for routine tests.
- Patient will have a CT scan, MRI, and/or x-ray to check the status of the disease.
Follow-up:
At least 1 time a week by phone or at the clinic for up to 30 days after patient's last
everolimus dose, the study staff will follow up with patient. Patient will be asked about
any side effects they may have had. The call should last about 10-15 minutes.
If patient left the study because of a side effect, they will continue to be contacted by
the study staff until the side effect has gone away or become stable.
This is an investigational study. Everolimus is commercially available and FDA approved to
treat advanced pancreatic NETs and other types of cancer. The combination of everolimus and
TheraSphere in this study is investigational.
TheraSphere is commercially available and FDA approved as a radiation treatment for liver
cancer. The use of TheraSphere in this study is investigational.
Up to 22 participants will be enrolled in this study. All will take part at MD Anderson.
Interventional
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Dose Limiting Toxicities (DLT) for Combination of TheraSphere and Everolimus
Dose limiting toxicity (DLT) defined as any toxicity occurring during the first 56 days of therapy with definite, possible or probable attribution to TheraSphere and/or Everolimus and meets CTCAE version 4.0 criteria.
56 days
Yes
Nageshwara V. Dasari, MBBS
Principal Investigator
M.D. Anderson Cancer Center
United States: Food and Drug Administration
2011-1205
NCT01864070
November 2013
Name | Location |
---|---|
University of Texas MD Anderson Cancer Center | Houston, Texas 77030 |