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Sunitinib in Treating Patients With Relapsed or Refractory Esophageal or Gastroesophageal Junction Cancer

A Mechanistic Radiographic and Biologic Phase 2 Single Agent Study of Sunitinib Malate in Relapsed/Refractory Esophageal and Gastroesophageal Cancers

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00702884
Enrollment
25
Registered
2008-06-20
Start date
2008-06-30
Completion date
2013-12-30
Last updated
2017-03-21

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

Conditions

Esophageal Cancer

Keywords

recurrent esophageal cancer, stage IIIA esophageal cancer, stage IIIB esophageal cancer, stage IIIC esophageal cancer, stage IV esophageal cancer

Brief summary

RATIONALE: Sunitinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. PURPOSE: This phase II trial is studying how well sunitinib works in treating patients with relapsed or refractory esophageal or gastroesophageal junction cancer.

Detailed description

OBJECTIVES: Primary * To determine the progression-free survival rate (complete response, partial response, and stable disease as defined by RECIST criteria \[Response Evaluation Criteria in solid Tumors\]) at 24 weeks in patients with relapsed or refractory esophageal or gastroesophageal junction cancer treated with sunitinib malate. Secondary * To explore the predictive role of a hybrid imaging protocol that combines PET/CT (Positron emission tomography) scan simultaneously with dynamic contrast-enhanced MRI. * Correlate quantitative changes in mean vessel density, alterations in tumor cell proliferation, and apoptosis in tumor biopsy specimens with clinical outcome in these patients. * To evaluate the objective response as defined by RECIST criteria, median overall survival, and median progression-free survival of these patients. * To evaluate the toxicities of sunitinib malate in these patients. OUTLINE: Patients receive oral sunitinib malate once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo blood and tumor tissue sample collection periodically for correlative laboratory studies. Tumor tissue samples are assessed by immunohistochemistry and TUNEL for detection and quantitation of mean vessel density, proliferating tumor cells, and apoptosis. Tumor tissue samples are also assessed by immunohistochemistry for MAPK levels. Blood samples are analyzed by ELISA for VEGF, PlGF, sVEGFR2, and sVEGFR3 levels. Patients also undergo PET/CT scan and dynamic contrast-enhanced MRI periodically for correlative studies. After completion of study treatment, patients are followed for at least 6 months.

Interventions

DRUGsunitinib malate

Sunitinib 37.5 mg daily for a 4 week cycle

Sponsors

Pfizer
CollaboratorINDUSTRY
Tony Bekaii-Saab
Lead SponsorOTHER

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

DISEASE CHARACTERISTICS: * Histologically confirmed esophageal or gastroesophageal junction carcinoma that is not amenable to curative surgery or other curative therapy * Advanced, relapsed or refractory disease * Measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as ≥ 20 mm by conventional techniques or as ≥ 10 mm by spiral CT scan * No known brain metastases PATIENT CHARACTERISTICS: * ECOG (Eastern Cooperative Oncology Group) performance status 0-1 * Life expectancy \> 12 weeks * WBC ≥ 3,000/μL * Absolute neutrophil count ≥ 1,500/μL * Platelet count ≥ 100,000/μL * Serum calcium ≤ 12.0 mg/dL * Total bilirubin normal * AST (aspartate aminotransferase) and ALT (Alanine Aminotransferase) ≤ 2.5 times upper limit of normal * Creatinine normal OR creatinine clearance ≥ 60 mL/min * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception prior to, during, and for 28 days after completion of study treatment * No history of allergic reactions attributed to compounds of similar chemical or biologic composition to sunitinib malate * No ongoing cardiac dysrhythmias ≥ grade 2, atrial fibrillation of any grade, or prolongation of the QTc (corrected QT interval) interval to \> 450 msec (for males) or \> 470 msec (for females) * No hypertension that cannot be controlled by medications (i.e., systolic/diastolic blood pressure \> 150/100 mm Hg despite optimal medical therapy) * No myocardial infarction, cardiac arrhythmia, stable/unstable angina, symptomatic congestive heart failure, or coronary/peripheral artery bypass graft or stenting within the past 12 months * No cerebrovascular accident or transient ischemic attack within the past 12 months * No pulmonary embolism within the past 12 months * No condition that would impair the ability to swallow and retain sunitinib malate tablets (e.g., gastrointestinal tract disease resulting in an inability to take oral medication or a requirement for IV alimentation, prior surgical procedures affecting absorption, or active peptic ulcer disease) * No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 28 days * No serious or nonhealing wound, ulcer, or bone fracture * No pre-existing thyroid abnormality that cannot be maintained in the normal range with medication * No concurrent uncontrolled illness including, but not limited to, ongoing or active infection or psychiatric illness/social situation that would limit compliance with study requirements PRIOR CONCURRENT THERAPY: * Recovered from prior therapy * At least 4 weeks since prior radiotherapy or major surgery * At least 4 weeks since prior chemotherapy (6 weeks for mitomycin C, carmustine, or alkylating agents) * No more than 6 prior courses of an alkylating agent * No more than 450 mg/m² of prior doxorubicin hydrochloride or 900 mg/m² of prior epirubicin hydrochloride * No more than 2 lines of prior therapy in the metastatic setting * No prior anti-VEGF monoclonal antibodies, such as bevacizumab or aflibercept * No prior tyrosine kinase inhibitors with similar targets (e.g., sorafenib tosylate or axitinib) * No other concurrent investigational agents * No concurrent therapeutic doses of coumarin-derivative anticoagulants, such as warfarin * Warfarin at doses of ≤ 2 mg daily are allowed for prophylaxis of thrombosis * Low molecular weight heparin allowed provided PT/INR (Prothrombin time and international normalized ratio) is ≤ 1.5 * No concurrent combination antiretroviral therapy for HIV-positive patients * No concurrent agents with proarrhythmic potential (e.g., terfenadine, quinidine, procainamide, disopyramide, sotalol, probucol, bepridil, haloperidol, risperidone, indapamide, and flecainide)

Design outcomes

Primary

MeasureTime frameDescription
Progression-free Survival Rateup to 24 weeksComplete response, partial response, and stable disease) as assessed by RECIST criteria at 24 weeks

Secondary

MeasureTime frameDescription
Median Overall Survival Timeup to 4 yearsThe median overall survival time will be reported using the 95% confidence intervals for the parameters.
Median Progression-free Survival Timeup to 4 yearsProgression free survival was measured as the time from start of treatment to the first measurement of tumor growth.
Overall Response Rateup to 4 yearsThe Overall Response Rate (ORR) was assessed using Partial Response + Complete Response for patients. Response and progression was evaluated in this study using the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0.
Change in Mean Vessel Densityup to 4 yearsQuantitative assessment of proliferating tumor cells, and apoptosis, of the laboratory and radiographic correlates, the analyses will be purely explorative.
Quantitative Assessment of Proliferating Tumor Cells and Apoptosisup to 4 yearsBiopsy sample taken from patients before and after treatment Apoptosis measures using the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay, which measures 3' nicked DNA. DNA is degraded in the early steps of apoptosis into low molecular weight (LMW) fragments and the production of single strand breaks in the high molecular weight DNA.Both of these features of apoptosis can be detected by labeling free 3'-OH termini with modified nucleotides, in our case this will be biotin-labeled dUTP. Terminal deoxynucleotidyl transferase (TdT) is an enzyme that labels blunt-ends of DNA breaks and can catalyze polymerization of nucleotides to free 3'-OH DNA ends in a template-independent manner. The newly incorporated nucleotides are detected by a secondary antibody, avidin-peroxidase. After substrate reaction, the stained cells can be detected and counted under a light microscope. Apoptotic cells will be fixed with formaldehyde which links LMW DNA
Frequency and Severity of Adverse Eventsup to 4 yearsThe National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 was utilized for adverse event reporting.

Countries

United States

Participant flow

Participants by arm

ArmCount
Sunitinib
Sunitinib 37.5 mg daily for a 4 week cycle sunitinib malate: Sunitinib 37.5 mg daily for a 4 week cycle
25
Total25

Baseline characteristics

CharacteristicSunitinib
Age, Customized61 years
Race/Ethnicity, Customized
Black
2 patients
Race/Ethnicity, Customized
White
23 patients
Region of Enrollment
United States
25 patients
Sex: Female, Male
Female
3 Participants
Sex: Female, Male
Male
22 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
25 / 25
serious
Total, serious adverse events
25 / 25

Outcome results

Primary

Progression-free Survival Rate

Complete response, partial response, and stable disease) as assessed by RECIST criteria at 24 weeks

Time frame: up to 24 weeks

ArmMeasureValue (MEDIAN)
SunitinibProgression-free Survival Rate7 weeks
Secondary

Change in Mean Vessel Density

Quantitative assessment of proliferating tumor cells, and apoptosis, of the laboratory and radiographic correlates, the analyses will be purely explorative.

Time frame: up to 4 years

Population: Insufficient tissue was available and the analysis for mean vessel density not performed

Secondary

Frequency and Severity of Adverse Events

The National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 was utilized for adverse event reporting.

Time frame: up to 4 years

ArmMeasureGroupValue (NUMBER)
SunitinibFrequency and Severity of Adverse EventsFatigue52 percentage of patients
SunitinibFrequency and Severity of Adverse EventsAnemia48 percentage of patients
SunitinibFrequency and Severity of Adverse EventsThrombocytopenia12 percentage of patients
SunitinibFrequency and Severity of Adverse EventsLeukopenia32 percentage of patients
Grade 3 Adverse EventsFrequency and Severity of Adverse EventsLeukopenia12 percentage of patients
Grade 3 Adverse EventsFrequency and Severity of Adverse EventsFatigue24 percentage of patients
Grade 3 Adverse EventsFrequency and Severity of Adverse EventsThrombocytopenia12 percentage of patients
Grade 3 Adverse EventsFrequency and Severity of Adverse EventsAnemia12 percentage of patients
Grade 4 Adverse EventsFrequency and Severity of Adverse EventsLeukopenia4 percentage of patients
Grade 4 Adverse EventsFrequency and Severity of Adverse EventsAnemia8 percentage of patients
Grade 4 Adverse EventsFrequency and Severity of Adverse EventsThrombocytopenia4 percentage of patients
Grade 4 Adverse EventsFrequency and Severity of Adverse EventsFatigue0 percentage of patients
Secondary

Median Overall Survival Time

The median overall survival time will be reported using the 95% confidence intervals for the parameters.

Time frame: up to 4 years

ArmMeasureValue (MEDIAN)
SunitinibMedian Overall Survival Time16.6 weeks
Secondary

Median Progression-free Survival Time

Progression free survival was measured as the time from start of treatment to the first measurement of tumor growth.

Time frame: up to 4 years

ArmMeasureValue (MEDIAN)
SunitinibMedian Progression-free Survival Time6.9 weeks
Secondary

Overall Response Rate

The Overall Response Rate (ORR) was assessed using Partial Response + Complete Response for patients. Response and progression was evaluated in this study using the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0.

Time frame: up to 4 years

Population: Durable Complete Response= PR + SD \> 10 weeks

ArmMeasureValue (NUMBER)
SunitinibOverall Response Rate10 patients
Secondary

Quantitative Assessment of Proliferating Tumor Cells and Apoptosis

Biopsy sample taken from patients before and after treatment Apoptosis measures using the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay, which measures 3' nicked DNA. DNA is degraded in the early steps of apoptosis into low molecular weight (LMW) fragments and the production of single strand breaks in the high molecular weight DNA.Both of these features of apoptosis can be detected by labeling free 3'-OH termini with modified nucleotides, in our case this will be biotin-labeled dUTP. Terminal deoxynucleotidyl transferase (TdT) is an enzyme that labels blunt-ends of DNA breaks and can catalyze polymerization of nucleotides to free 3'-OH DNA ends in a template-independent manner. The newly incorporated nucleotides are detected by a secondary antibody, avidin-peroxidase. After substrate reaction, the stained cells can be detected and counted under a light microscope. Apoptotic cells will be fixed with formaldehyde which links LMW DNA

Time frame: up to 4 years

Population: Analysis for tumor cells not performed due to insufficient samples available

Source: ClinicalTrials.gov · Data processed: Mar 8, 2026