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AZD2171 to Treat Prostate Cancer

A Phase II Study of AZD2171 in Metastatic Androgen Independent Prostate Cancer

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00436956
Enrollment
59
Registered
2007-02-19
Start date
2006-10-16
Completion date
2014-02-05
Last updated
2018-10-09

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Prostate Cancer

Keywords

VEGF, Angiogenesis, Hormone-Refractory, Bone Metastases, Docetaxel-Resistant, Prostate Cancer

Brief summary

Background: * AZD2171 (Cediranib) is an experimental drug that inhibits formation of new blood vessels. * Tumors need new blood vessels to grow. Preventing the growth of new blood vessels with AZD2171 may inhibit tumor growth. Objectives: -To determine the effectiveness and side effects of AZD2171 in patients with prostate cancer that has metastasized (spread beyond the primary site). Eligibility: * Males 18 years of age and older with androgen-independent prostate cancer that has metastasized. * Patients must have received prior treatment with docetaxel. Design: Patients take one AZD2171 by mouth every day in 28-day treatment cycles and undergo the following procedures: * 1- to 2-day hospitalization at the start of the study for biopsies and blood measurements to determine the level of AZD2171 in the bloodstream. Blood is drawn immediately before the first dose, and 0.25 hr, 0.5 hr, 1 hr, 2 hr, 4 hr, 6 hr, 8 hr, 12 hr, 24 hr, and 48 hours after the dose is taken. * Blood tests before starting treatment and then monthly to determine the level of vascular endothelial growth factor receptor ( VEGFR), a protein involved in blood vessel formation. * Magnetic resonance imaging (MRI) scans once a month to evaluate blood flow. * Tumor biopsies (optional) both before and after the second and sixth treatment cycles. * Clinic visits every 4 weeks, including various routine and research blood tests, urine test and electrocardiogram. * Computed tomography (CT) scan of the chest, abdomen, and pelvis every 8 weeks * Bone scan every 8 weeks Patients record all doses of AZD2171 taken or missed in a pill diary. They record their blood pressure at least once daily in a blood pressure diary. Treatment may continue as long as the patient tolerates the AZD2171 and the cancer does not worsen. ...

Detailed description

Background: * AZD2171 (Cediranib) is an oral potent inhibitor of receptor tyrosine kinases which impact vascular endothelial growth factor-A (VEGF). * VEGF appears important in blood vessel formation and disease progression in prostate cancer. * No known effective therapy in patients with progressive androgen-independent prostate cancer after treatment with docetaxel. Objectives: * Primary objective of this study is to determine if AZD2171 is associated with a 30% 6 month probability of progression free survival in patients with metastatic androgen independent prostate cancer (AIPC) as determined by clinical and radiographic criteria. * Secondary objective of this study will be demonstration of biologic effect by the drug in the patient and on the tumor (when possible). Correlative studies will be conducted on serially obtained tissue biopsies and white blood cell collections. * Laboratory correlates will include elucidation of activation of components of the VEGFR2 and angiogenesis pathways and evaluation of endothelial cell adhesion molecules (released by damaged cells) using enzyme-linked immunosorbent assay (ELISA), pharmacogenetic analysis of kinase insert domain receptor (KDR) variants and single nucleotide polymorphisms, and pharmacokinetic characterization of AZD2171 activity. Eligibility: * Metastatic progressive androgen-independent prostate cancer. * Prior treatment with docetaxel. * May not have corrected QT interval (QTc ) greater than 470 msec or greater than 1+ proteinuria on 2 consecutive dipsticks no less than 1 week apart. Design: * Phase II trial with a two stage design. 12 patients enrolled in first cohort, if 2 or more are progression free at 6 months than enroll up to 35 evaluable patients. The ceiling will be set at 37 to allow for inevaluable patients. * Starting dose 20 mg QD (every day) for all patients. * Once two stage design is complete then prednisone 10 mg once per day will be given in combination with AZD2171. The total number of patients will be 23 for this portion of the protocol.

Interventions

PROCEDUREMagnetic Resonance Imaging (DCE-MRI)

Scans evaluate tumor tissue and blood flow.

20 mg oral daily for 28 days

DRUGPrednisone

10mg orally daily in combination with AZD2171 20mg daily.

Sponsors

National Cancer Institute (NCI)
Lead SponsorNIH

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* INCLUSION CRITERIA: 1. Patients must have histopathological confirmation of prostate cancer by the Laboratory of Pathology of the National Cancer Institute (NCI), Pathology Department of the National Naval Medical Center or Pathology Department of Walter Reed Army Medical Center prior to entering this study. Patients whose pathology specimens are no longer available may be enrolled in the trial if the patient has a clinical course consistent with prostate cancer and available documentation from an outside pathology laboratory of the diagnosis. In cases where original tissue blocks or archival biopsy material is available, all efforts should be made to have the material forwarded to the research team for use in correlative studies. 2. Patients must have metastatic progressive androgen-independent prostate cancer. There must be radiographic evidence of disease that has continued to progress despite hormonal agents. Progression requires that a measurable lesion is expanding, new lesions have appeared, and/or that prostatic specific antigen (PSA) is continuing to rise on successive measurements. Patients on flutamide must have disease progression at least 4 weeks after withdrawal. Patients on bicalutamide or nilutamide must have progression at least 6 weeks after withdrawal. 3. Patients must have received prior therapy with docetaxel for androgen-independent prostate cancer. Any number of prior treatments are acceptable. 4. Age greater than or equal to 18 years. 5. Life expectancy of greater than 3 months. 6. Eastern Cooperative Oncology Group (ECOG) performance status less than or equal to 2 (Karnofsky greater than or equal to 60%). 7. Patients must have normal organ and marrow function as defined below: Absolute neutrophil count greater than or equal to 1,500/mcL Platelets greater than or equal to 100,000/mcL Hemoglobin greater than or equal to 8 g/dL Total bilirubin within normal institutional limits (unless with clinical Gilbert's syndrome) Aspartate aminotransferase/serum glutamic oxaloacetic transaminase (AST(SGOT))/alanine aminotransferase/serum glutamic pyruvic transaminase (ALT(SGPT) less than or equal to 2.5 times institutional upper limit of normal Creatinine less than or equal to 1.5 times institutional upper normal institutional limits OR Creatinine clearance greater than 40 mL/min/1.3 m\^2 for patients with creatinin levels above institutional normal as calculated by the Cockcroft Gault formula. 8. Patients must have recovered from any acute toxicity related to prior therapy, including surgery. Toxicity should be less than or equal to grade 1 or returned to baseline. 9. All patients who have not undergone bilateral surgical castration must continue suppression of testosterone production by appropriate usage of gonadotropin releasing hormone (GnRH) agonists or antagonists. 10. Patients must not have other invasive malignancies (within the past three years with the exception of non-melanoma skin cancers or non-invasive bladder cancer). 11. AZD2171 has been shown to terminate fetal development in the rat, as expected for a process dependent on VEGF signaling. Enrolled patients must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, the duration of study participation and 3 months after the end of the treatment. 12. Ability to understand and the willingness to sign a written informed consent document. 13. Patients must have a blood pressure of less than 140/90 at the time of enrollment. Details of antihypertensive treatment, if required, will be left up to the primary care physician.

Exclusion criteria

1. Patients who have had chemotherapy, radiotherapy, or major surgery within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study. 2. Patients may not be receiving any agents not approved by the Food and Drug Administration (FDA) within the past four weeks. 3. Patients with known brain metastases should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events. 4. Mean QTc greater than 470 msec (with Bazett's correction) in screening electrocardiogram or history of familial long Q wave, T wave (QT) syndrome. 5. Greater than +1 proteinuria on two consecutive dipsticks taken no less than 1 week apart. 6. Uncontrolled intercurrent illness including, but not limited to hypertension, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. 7. Human immunodeficiency virus (HIV)-positive patients on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with AZD2171.

Design outcomes

Primary

MeasureTime frameDescription
Percent Probability of Participants With 6-month Progression-free Survival (PFS)6 monthsPFS is the proportion of subjects who progress or die by 6 months after the start of the combined therapy. PFS is determined by prostatic specific antigen (PSA) consensus criteria and the Response Evaluation Criteria in Solid Tumors (RECIST). PSA consensus criteria is defined as PSA decline of \>/= 50% or PSA progression. RECIST is defined as the following: Complete response (CR) is disappearance of all target lesions; partial response (PR) is at least a 30% decline in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD; and stable disease is neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for progressive disease ((PD) at least a 20% increase in the sum of the LD of target lesions, or the appearance of one or more lesions), taking as reference the smallest sum LD since the treatment started. Data is estimated and the probability of PFS as a function of time was determined using the Kaplan-Meier method.

Secondary

MeasureTime frameDescription
Number of Grade 2 Toxicities61.5 monthsHere is the number of Grade 2 (moderate) toxicities.
Number of Grade 3 Toxicities61.5 monthsHere is the number of Grade 3 (severe) toxicities.
Number of Participants With Adverse EventsDate treatment consent signed to date off study, approximately 61.5 monthsHere is the number of participants with adverse events. For a detailed list of adverse events, see the adverse event module.
Median Progression Free Survival (PFS)up to 14.9 months based on a Kaplan-Meier analysis.Time interval from start of treatment to documented evidence of disease progression.
Response Per the Response Evaluation Criteria in Solid Tumors (RECIST)Every 2 cycles (approximately 56 days)Response was evaluated by the RECIST. Complete response (CR) is disappearance of all target lesions. Partial response (PR) is at least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD. Progressive disease (PD)is at least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. Stable disease (SD) is neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started.
Median Overall Survival44 monthsTime from treatment start date until date of death or date last known alive.

Countries

United States

Participant flow

Participants by arm

ArmCount
All Participants - AZD2171 & Prednisone
This group combines participants who received 20 mg AZD2171 (Cediranib) orally daily (n=35), in addition to participants who received 20 mg AZD2171 (Cediranib) orally daily plus 10mg prednisone (n=23). One pt was not evaluable due to a cord compression on day 2 of therapy; was removed from the trial (n=1).
59
Total59

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyNot evaluable10

Baseline characteristics

CharacteristicAll Participants - AZD2171 & Prednisone
Age, Categorical
<=18 years
0 Participants
Age, Categorical
>=65 years
39 Participants
Age, Categorical
Between 18 and 65 years
20 Participants
Age, Continuous68.9 years
Race/Ethnicity, Customized
Afican-American
3 Participants
Race/Ethnicity, Customized
Asian
1 Participants
Race/Ethnicity, Customized
Hispanic
3 Participants
Race/Ethnicity, Customized
White
52 Participants
Region of Enrollment
United States
59 Participants
Sex: Female, Male
Female
0 Participants
Sex: Female, Male
Male
59 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
40 / 59
other
Total, other adverse events
56 / 59
serious
Total, serious adverse events
59 / 59

Outcome results

Primary

Percent Probability of Participants With 6-month Progression-free Survival (PFS)

PFS is the proportion of subjects who progress or die by 6 months after the start of the combined therapy. PFS is determined by prostatic specific antigen (PSA) consensus criteria and the Response Evaluation Criteria in Solid Tumors (RECIST). PSA consensus criteria is defined as PSA decline of \>/= 50% or PSA progression. RECIST is defined as the following: Complete response (CR) is disappearance of all target lesions; partial response (PR) is at least a 30% decline in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD; and stable disease is neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for progressive disease ((PD) at least a 20% increase in the sum of the LD of target lesions, or the appearance of one or more lesions), taking as reference the smallest sum LD since the treatment started. Data is estimated and the probability of PFS as a function of time was determined using the Kaplan-Meier method.

Time frame: 6 months

Population: One participant was not evaluable owing to the development of a cord compression on day 2 of therapy and was subsequently removed from the trial. Since the prednisone was added to relieve toxicity \& outcome data is based on response, the cohorts were analyzed together in terms of response. No suggestion prednisone significantly altered outcomes.

ArmMeasureValue (NUMBER)
All Participants - AZD2171 & PrednisonePercent Probability of Participants With 6-month Progression-free Survival (PFS)43.9 percent probability
Secondary

Median Overall Survival

Time from treatment start date until date of death or date last known alive.

Time frame: 44 months

ArmMeasureValue (MEDIAN)
All Participants - AZD2171 & PrednisoneMedian Overall Survival11.7 Months
20 mg AZD2171 + 10mg Prednisone DailyMedian Overall Survival9.9 Months
Secondary

Median Progression Free Survival (PFS)

Time interval from start of treatment to documented evidence of disease progression.

Time frame: up to 14.9 months based on a Kaplan-Meier analysis.

ArmMeasureValue (MEDIAN)
All Participants - AZD2171 & PrednisoneMedian Progression Free Survival (PFS)3.6 Months
20 mg AZD2171 + 10mg Prednisone DailyMedian Progression Free Survival (PFS)3.7 Months
Secondary

Number of Grade 2 Toxicities

Here is the number of Grade 2 (moderate) toxicities.

Time frame: 61.5 months

Population: Only 58 participants were evaluable for toxicity.

ArmMeasureGroupValue (NUMBER)
All Participants - AZD2171 & PrednisoneNumber of Grade 2 ToxicitiesHypertension17 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 2 ToxicitiesFatigue15 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 2 ToxicitiesAnorexia12 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 2 ToxicitiesWeight loss11 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 2 ToxicitiesHypothyroidism7 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 2 ToxicitiesDehydration8 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 2 ToxicitiesProlonged QTc8 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 2 ToxicitiesNausea7 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 2 ToxicitiesDiarrhea8 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 2 ToxicitiesHypoalbuminemia5 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 2 ToxicitiesProteinuria5 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 2 ToxicitiesElevated alkaline phosphatase4 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 2 ToxicitiesAspartate transaminase3 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 2 ToxicitiesVomiting4 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 2 ToxicitiesHyperbilirubinemia4 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 2 ToxicitiesMuscle weakness2 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 2 ToxicitiesMuscle weakness1 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 2 ToxicitiesHypertension8 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 2 ToxicitiesDiarrhea0 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 2 ToxicitiesFatigue4 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 2 ToxicitiesAspartate transaminase3 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 2 ToxicitiesAnorexia6 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 2 ToxicitiesHypoalbuminemia3 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 2 ToxicitiesWeight loss4 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 2 ToxicitiesHyperbilirubinemia1 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 2 ToxicitiesHypothyroidism6 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 2 ToxicitiesProteinuria3 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 2 ToxicitiesDehydration2 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 2 ToxicitiesVomiting2 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 2 ToxicitiesProlonged QTc2 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 2 ToxicitiesElevated alkaline phosphatase2 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 2 ToxicitiesNausea3 toxicities
Secondary

Number of Grade 3 Toxicities

Here is the number of Grade 3 (severe) toxicities.

Time frame: 61.5 months

Population: Only 58 participants were evaluable for toxicity.

ArmMeasureGroupValue (NUMBER)
All Participants - AZD2171 & PrednisoneNumber of Grade 3 ToxicitiesMuscle weakness3 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 3 ToxicitiesDiarrhea0 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 3 ToxicitiesHypothyroidism0 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 3 ToxicitiesHypoalbuminemia0 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 3 ToxicitiesAnorexia1 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 3 ToxicitiesProteinuria0 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 3 ToxicitiesDehydration3 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 3 ToxicitiesElevated alkaline phosphatase5 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 3 ToxicitiesHyperbilirubinemia1 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 3 ToxicitiesAspartate transaminase2 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 3 ToxicitiesProlonged QTc1 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 3 ToxicitiesVomiting1 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 3 ToxicitiesWeight loss2 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 3 ToxicitiesHypertension0 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 3 ToxicitiesNausea1 toxicities
All Participants - AZD2171 & PrednisoneNumber of Grade 3 ToxicitiesFatigue4 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 3 ToxicitiesNausea0 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 3 ToxicitiesVomiting0 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 3 ToxicitiesFatigue2 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 3 ToxicitiesAnorexia1 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 3 ToxicitiesWeight loss0 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 3 ToxicitiesHypothyroidism0 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 3 ToxicitiesDehydration3 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 3 ToxicitiesProlonged QTc1 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 3 ToxicitiesHyperbilirubinemia0 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 3 ToxicitiesDiarrhea0 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 3 ToxicitiesHypoalbuminemia0 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 3 ToxicitiesProteinuria0 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 3 ToxicitiesElevated alkaline phosphatase0 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 3 ToxicitiesAspartate transaminase0 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 3 ToxicitiesMuscle weakness1 toxicities
20 mg AZD2171 + 10mg Prednisone DailyNumber of Grade 3 ToxicitiesHypertension0 toxicities
Secondary

Number of Participants With Adverse Events

Here is the number of participants with adverse events. For a detailed list of adverse events, see the adverse event module.

Time frame: Date treatment consent signed to date off study, approximately 61.5 months

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
All Participants - AZD2171 & PrednisoneNumber of Participants With Adverse Events59 Participants
Secondary

Response Per the Response Evaluation Criteria in Solid Tumors (RECIST)

Response was evaluated by the RECIST. Complete response (CR) is disappearance of all target lesions. Partial response (PR) is at least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD. Progressive disease (PD)is at least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. Stable disease (SD) is neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started.

Time frame: Every 2 cycles (approximately 56 days)

Population: One patient was not evaluable owing to the development of a cord compression on day 2 of therapy and was subsequently removed from the trial. Out of 59 patients, 39 had measurable disease.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
All Participants - AZD2171 & PrednisoneResponse Per the Response Evaluation Criteria in Solid Tumors (RECIST)Not Evaluable1 Participants
All Participants - AZD2171 & PrednisoneResponse Per the Response Evaluation Criteria in Solid Tumors (RECIST)Confirmed Partial Response6 Participants
All Participants - AZD2171 & PrednisoneResponse Per the Response Evaluation Criteria in Solid Tumors (RECIST)Unconfirmed Partial Response1 Participants
All Participants - AZD2171 & PrednisoneResponse Per the Response Evaluation Criteria in Solid Tumors (RECIST)Complete Response0 Participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026