Islet Cell Tumor, Neuroendocrine Tumor
Conditions
Keywords
Carcinoid, Pancreatic, Metastatic, Neuroendocrine, Tumors, Hepatic, Artery, Embolization, Angiogenesis, Sunitinib, Malate, Sutent, Tyrosine, Kinase, Inhibitor
Brief summary
The purpose of this study is to decide if a medicine that slows growth of new blood vessels can be give after the embolization procedure to prevent or delay new growth of blood vessels to tumors.
Detailed description
This is a single-center, open-label, non-randomized, prospective phase II trial. Sutent treatment will be continued until disease progression, or excessive toxicity (as determined by treating physician or primary investigator), or until a maximum of eight cycles, whichever duration is shorter.
Interventions
DRUGSunitinib malate
Sunitinib malate (Sutent) at a dose of 37.5mg will be administered orally once daily on days 1-28 in a 42-day cycle. Treatment with Sutent will begin no sooner than seven days after the first hepatic artery embolization. Subsequent embolizations (if necessary) will be scheduled during scheduled Sutent treatment breaks. No fewer than seven days shall separate treatment with Sutent and scheduling of hepatic artery embolizations.
PROCEDUREHepatic Artery Embolizations
1-3 selective hepatic artery embolizations will be performed at approximately 5-week intervals, based on the extent of hepatic involvement with tumor.
Sponsors
Pfizer
H. Lee Moffitt Cancer Center and Research Institute
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Well-differentiated metastatic carcinoid tumors and pancreatic endocrine tumors with measurable liver metastases. * Resolution of all acute toxic effects of prior chemotherapy or radiotherapy or surgical procedures to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version 3.0 grade less than or equal to 1. * Adequate organ function as defined by the following criteria: 1. Serum aspartate transaminase (AST; serum glutamic oxaloacetic transaminase \[SGOT\]) and serum alanine transaminase (ALT; serum glutamic pyruvic transaminase \[SGPT\]) less than or equal to 2.5 x local laboratory upper limit of normal (ULN), or AST and ALT less than or equal to 5 x ULN if liver function abnormalities are due to underlying malignancy 2. Total serum bilirubin less than or equal to 1.5 x ULN 3. Absolute neutrophil count (ANC) greater than or equal to 1500/microL 4. Platelets greater than or equal to 100,000/microL 5. Hemoglobin greater than or equal to 9.0 g/dL 6. Serum calcium less than or equal to 12.0 mg/dL 7. Serum creatinine less than or equal to 1.5 x ULN 8. Prothrombin and activated partial thromboplastin time (PT and aPTT) less than or equal to 1.5 x ULN * Eastern Cooperative Oncology Group (ECOG) Performance Status less than or equal to 2 * Informed Consent: Patients must be aware of the nature of his/her disease process and must willingly give consent after being informed of the experimental nature of therapy, alternatives, potential benefits, side-effects, risks and discomforts.
Exclusion criteria
* Major surgery or radiation therapy within 4 weeks of starting the study treatment. * Prior hepatic artery embolization or chemoembolization. * Prior treatment with a tyrosine kinase inhibitor or a vascular endothelial growth factor (VEGF) inhibitor. * NCI CTCAE grade 3 hemorrhage within 4 weeks of starting the study treatment. * History of or known brain metastases, spinal cord compression, or carcinomatous meningitis, or evidence of symptomatic brain or leptomeningeal disease on screening computed tomography (CT) or magnetic Resonance imaging (MRI) scan. * Any of the following within the 6 months prior to study drug administration: myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass graft, symptomatic congestive heart failure, cerebrovascular accident or transient ischemic attack, or pulmonary embolism. * Ongoing cardiac dysrhythmias of NCI CTCAE grade greater than or equal to 2. * Prolonged corrected QT (QTc) interval on baseline electrocardiogram (EKG). * Hypertension that cannot be controlled by medications (\>150/100 mm Hg despite optimal medical therapy). * Pre-existing thyroid abnormality with thyroid function that cannot be maintained in the normal range with medication. * Known human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)-related illness or other active infection * Concurrent treatment on another clinical trial. Supportive care trials or non-treatment trials, e.g. Quality of Life (QOL), are allowed. * Concomitant use of ketoconazole and other agents known to induce CYP3A4. * Concomitant use of theophylline and phenobarbital and/or other agents metabolized by the cytochrome P450 system. * Ongoing treatment with therapeutic doses of Coumadin (low dose Coumadin up to 2 mg by mouth (po) daily for thrombo prophylaxis is allowed). * Pregnancy or breastfeeding. Female participants must be surgically sterile or be postmenopausal, or must agree to use effective contraception during the period of therapy. Female participants with reproductive potential must have a negative pregnancy test (serum or urine) prior to enrollment. Male participants must be surgically sterile or must agree to use effective contraception during the period of therapy. * Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or study drug administration, or may interfere with the interpretation of study results, and in the judgment of the investigator would make the patient inappropriate for entry into this study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Progression Free Survival (PFS) at 12 Months | 12 months | Kaplan-Meier analysis of PFS. Progression-free survival rate at 12 months after first embolization. PFS was defined as time from start of treatment until disease progression or death as a result of any cause. Response and progression endpoints refer specifically to hepatic metastases. Extrahepatic metastases were included for assessment of response and progression by RECIST version 1.0. Progressive Disease (PD): At least a 20% increase in the SLD of target lesions, taking as reference the smallest SLD recorded since the treatment started. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Overall Survival (OS) at One Year | 12 months | Overall survival at 12 months. OS was defined as time from start of treatment until death as a result of any cause, with patients censored at the date of last follow-up if still alive. |
| Number of Participants With Partial Radiographic Response | 12 months | Objective radiographic response rate. Response and progression endpoints refer specifically to hepatic metastases. Extrahepatic metastases were included for assessment of response and progression by RECIST version 1.0. Partial Response (PR): At least a 30% decrease in the sum of longest diameter (SLD) of target lesions, taking as reference the baseline SLD. |
| Number of Participants With Biochemical Response | 12 months | Biochemical response rate (\>50% reduction in tumor marker). Response and progression endpoints refer specifically to hepatic metastases. |
| Number of Participants Requiring Dose Reduction | 12 months | Treatment related toxicity. Participants requiring dose reductions of sunitinib to 25 mg due to side effects. |
| Percentage of Participants With Overall Survival (OS) at 4 Years | 48 months | Participant overall survival at 48 months. OS was defined as time from start of treatment until death as a result of any cause, with patients censored at the date of last follow-up if still alive. |
Countries
United States
Participant flow
Recruitment details
All patients seen at Moffitt Cancer Center with hepatic metastases from gastrointestinal neuroendocrine tumors were screened for eligibility to be enrolled in the study.
Participants by arm
| Arm | Count |
|---|---|
| Sunitinib Malate and Hepatic Artery Embolizations Sunitinib Malate and Selective Hepatic Artery Embolizations: Sunitinib malate (Sutent) at a dose of 37.5mg. 1-3 selective hepatic artery embolizations. | 39 |
| Total | 39 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 5 |
| Overall Study | had embolism, did not receive sunitinib | 3 |
| Overall Study | Physician Decision | 9 |
| Overall Study | Protocol Violation | 1 |
Baseline characteristics
| Characteristic | Sunitinib Malate and Hepatic Artery Embolizations |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 10 Participants |
| Age, Categorical Between 18 and 65 years | 29 Participants |
| Age, Customized | 61 years |
| Region of Enrollment United States | 39 participants |
| Sex: Female, Male Female | 21 Participants |
| Sex: Female, Male Male | 18 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 38 / 39 |
| serious Total, serious adverse events | 3 / 39 |
Outcome results
Primary
Percentage of Participants With Progression Free Survival (PFS) at 12 Months
Kaplan-Meier analysis of PFS. Progression-free survival rate at 12 months after first embolization. PFS was defined as time from start of treatment until disease progression or death as a result of any cause. Response and progression endpoints refer specifically to hepatic metastases. Extrahepatic metastases were included for assessment of response and progression by RECIST version 1.0. Progressive Disease (PD): At least a 20% increase in the SLD of target lesions, taking as reference the smallest SLD recorded since the treatment started.
Time frame: 12 months
Population: All participants
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sunitinib Malate and Hepatic Artery Embolizations | Percentage of Participants With Progression Free Survival (PFS) at 12 Months | 66 percentage of participants |
Secondary
Number of Participants Requiring Dose Reduction
Treatment related toxicity. Participants requiring dose reductions of sunitinib to 25 mg due to side effects.
Time frame: 12 months
Population: All participants
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sunitinib Malate and Hepatic Artery Embolizations | Number of Participants Requiring Dose Reduction | 16 participants |
Secondary
Number of Participants With Biochemical Response
Biochemical response rate (\>50% reduction in tumor marker). Response and progression endpoints refer specifically to hepatic metastases.
Time frame: 12 months
Population: All Participants
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sunitinib Malate and Hepatic Artery Embolizations | Number of Participants With Biochemical Response | 19 participants |
Secondary
Number of Participants With Partial Radiographic Response
Objective radiographic response rate. Response and progression endpoints refer specifically to hepatic metastases. Extrahepatic metastases were included for assessment of response and progression by RECIST version 1.0. Partial Response (PR): At least a 30% decrease in the sum of longest diameter (SLD) of target lesions, taking as reference the baseline SLD.
Time frame: 12 months
Population: All Participants
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sunitinib Malate and Hepatic Artery Embolizations | Number of Participants With Partial Radiographic Response | 28 participants |
Secondary
Percentage of Participants With Overall Survival (OS) at 4 Years
Participant overall survival at 48 months. OS was defined as time from start of treatment until death as a result of any cause, with patients censored at the date of last follow-up if still alive.
Time frame: 48 months
Population: All Participants
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sunitinib Malate and Hepatic Artery Embolizations | Percentage of Participants With Overall Survival (OS) at 4 Years | 59 percentage of participants |
Secondary
Percentage of Participants With Overall Survival (OS) at One Year
Overall survival at 12 months. OS was defined as time from start of treatment until death as a result of any cause, with patients censored at the date of last follow-up if still alive.
Time frame: 12 months
Population: All participants
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sunitinib Malate and Hepatic Artery Embolizations | Percentage of Participants With Overall Survival (OS) at One Year | 95 percentage of participants |