Bladder Cancer, Transitional Cell Carcinoma
Conditions
Keywords
TCC, Zactima, docetaxel, ZD6474, taxotere
Brief summary
In this research study the investigators are looking to see if the combination of docetaxel plus Vandetanib is effective in the treatment of metastatic transitional cell carcinoma (TCC). Docetaxel is a chemotherapy drug that kills cancer cells that are dividing. It is widely used in TCC. Vandetanib is a drug that is believed to stop new blood vessels from forming around cancer cells. The combination of docetaxel and Vandetanib has been studied in people with lung cancer and found to be helpful in killing cancer cells. Thus, this study is looking at people with TCC, to see if the combination of docetaxel plus Vandetanib is better or worse then docetaxel alone.
Detailed description
* Because no one knows which of the study options is best, and all of the options are considered equally likely to work, participants will be randomized into one of two study groups: docetaxel plus Vandetanib or docetaxel plus placebo. * Each treatment cycle lasts three weeks during which time the participant will be taking Vandetanib or placebo once a day, every day. On Day 1 of each cycle (a cycle is 21 days), participants will receive docetaxel as an infusion through a vein in the arm over one hour. * On Day 1 of every cycle the following tests and procedures will be performed: physical exam and blood tests. On day 1 and on Day 8 of the first cycle only, participants will have an ECG. Every 6-9 weeks (every 2 to 3 cycles), the participants tumor will be assessed by x-ray, CT scan, bone scan, and/or MRI.
Interventions
DRUGDocetaxel
Given intravenously on Day 1 of each 21-day cycle
DRUGvandetanib
taken orally once a day, every day
DRUGPlacebo
Taken orally once a day every day
Sponsors
Brigham and Women's Hospital
Beth Israel Deaconess Medical Center
Massachusetts General Hospital
AstraZeneca
Dana-Farber Cancer Institute
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Histologically or cytologically confirmed TCC. Mixed histologies are allowed as long as the predominant histology is TCC. * Must have received chemotherapy treatment for TCC and have stage IV TCC at the time of study entry. 1-3 prior systemic chemotherapeutic or investigational treatment regimens for TCC are allowed. Patient with more regimens than the ones allowed may be included at the discretion of the Overall Principal Investigator if it is felt that the regimen has shown minimal activity and toxicity and will not influence prior or subsequent therapies. Specifically, participants must meet one or more of the following criteria: a) Progression after treatment with a regimen that includes a platinum salt (e.g. carboplatin or cisplatin) for Stage IV disease OR b) Disease recurrence within two years (from the date of last dose of chemotherapy or surgery until day the informed consent is signed) after neoadjuvant or adjuvant treatment with a regimen that includes a platinum salt. * Measurable or evaluable disease, as defined by RECIST. If all sites of measurable or evaluable disease have been irradiated, one site must have demonstrated growth after irradiation. * Adequate contraceptive method for subjects with reproductive potential (females with reproductive potential must have a negative serum pregnancy test within 7 days of study entry). * ECOG PS 0 or 1 * 18 years of age or older
Exclusion criteria
* History of treatment of TCC (in any setting-neoadjuvant, adjuvant or for metastatic disease) with docetaxel. Patients treated with prior paclitaxel (Taxol) are eligible. * History of treatment with a VEGF-axis active agent, including antibodies to VEGF, antibodies to VEGF receptors, or VEGF receptor tyrosine kinase inhibitors. * Laboratory results as outlined in the protocol * Evidence of uncontrolled systemic disease or any concurrent condition which in the Investigator's opinion makes it undesirable for the subject to participate in the trial or which would jeopardize compliance with the protocol * Clinically significant cardiac event such as myocardial infarction; NHYA classification of heart disease \>2 within three months before entry; or presence of cardiac disease that, in the opinion of the Investigator, increases the risk of ventricular arrhythmia * History of arrhythmia, bigeminy, trigeminy, ventricular tachycardia, or uncontrolled atrial fibrillation which is symptomatic or requires treatment (CTCAE Grade 3) or asymptomatic sustained ventricular tachycardia. Atrial fibrillation, controlled on medication is not excluded. * Previous history of QTc prolongation as a result from other medication that required discontinuation of that medication. * Congenital long QT syndrome or 1st degree relative with unexplained sudden death under 40 years of age. * Presence of left bundle branch block (LBBB) * QTc with Bazett's correction that is unmeasurable, or 480 msec or greater on screening ECG. If a subject has a QTc of 480msec or greater on screening ECG, the screen ECG may be repeated twice (at least 24 hours apart). The average QTc from the three screening ECGs must be \<480 msec in order for the subject to be eligible for the study. * Any concomitant medication that may cause QTc prolongation, induce Torsades de Pointes or induce CYP3A4 function. * Hypertension not controlled by medical therapy * Currently active diarrhea * Women who are currently pregnant or breast feeding * Receipt of any investigational agent, chemotherapy or radiation therapy within 21 days prior to Study Day 1 * Any unresolved non-hematologic toxicity greater than CTCAE grade 1 from previous anti-cancer therapy (other than alopecia). * Major surgery within 4 weeks, or incompletely healed surgical incision before starting study therapy. * Grade 2 or greater peripheral neuropathy * Previous or current malignancies within the last 3 years, with the exception of in situ carcinoma of the cervix, adequately treated carcinoma of the skin, small renal masses, and adequately treated localized prostate cancer. Other cancers that are highly likely to be cured (cure rate of 75% or greater) may be included at the discretion of the Overall Principal Investigator. * History of severe hypersensitivity reaction to drugs formulated with polysorbate 80.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Median Progression-Free Survival (PFS) | Disease evaluations occurred at week 6 and 12 and thereafter every 3 cycles/9 weeks on treatment and every 3 months in follow-up. Participants were followed until PD, death or lost to follow-up. Median survival follow-up was 12 months (range 1-26). | PFS based on the Kaplan-Meier method is defined as the time between randomization and documented disease progression (PD) per RECIST 1.0 criteria or death, or is censored at time of last disease assessment. Per RECIST 1.0 for target lesions, PD is at least a 20% increase in sum LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or appearance of new lesions. For non-target lesions, PD is the appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Grade 3-5 Toxicity Rate | Assessed each cycle throughout treatment from time of first dose and up to day 30 post-treatment. Median treatment duration for this study cohort approximated 2 cycles (range 1-31). | Grade 3-5 toxicity rate is the percentage of participants experiencing maximum grade of all toxicity types of grade 3-5 with any attribution on treatment during the randomized phase. |
| Median Overall Survival | Off treatment, patients were followed for survival information every 6 months (±1 month) until death,up to 2 years after discontinuing therapy, or until lost to follow-up. Median survival follow-up for the study cohort was 12 months (95% CI: 9-18 months). | Overall survival is defined from date of randomization to date of death or censored at the date the patient was last known alive. |
| Objective Response Rate | Disease evaluations occurred at week 6 and 12 and thereafter every 3 cycles/9 weeks on treatment. Median treatment duration for this study cohort approximated 2 cycles (range 1-31). | Objective response rate is defined as the percentage of participants who achieved a confirmed overall partial response (PR) or complete response (CR) using RECIST criteria on treatment during the randomized phase. Patients without measurable disease only at baseline are included, based on status of non-target lesions.Per RECIST 1.0 for target lesions, CR is complete disappearance of all target lesions and PR is at least a 30% decrease in the sum of longest diameter (LD) of target lesions, taking as reference baseline sum LD. To be assigned a status of CR or PR, changes in tumor measurements must be confirmed by repeat assessments performed no fewer than 4 weeks after the response criteria are first met. PR or better overall response assumes at a minimum incomplete response/stable disease (SD) for the evaluation of non-target lesions and absence of new lesions. |
Countries
United States
Participant flow
Recruitment details
Patients enrolled from February 2007 through May 2010.
Pre-assignment details
There were 7 cancelled patients who were randomized but did not receive treatment.
Participants by arm
| Arm | Count |
|---|---|
| Vandetanib & Docetaxel Docetaxel: Given intravenously on Day 1 of each 21-day cycle Vandetanib: taken orally once a day, every day | 70 |
| Placebo and Docetaxel Docetaxel: Given intravenously on Day 1 of each 21-day cycle Placebo: Taken orally once a day every day | 72 |
| Total | 142 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Randomized Phase | Brain Metastasis | 0 | 1 |
| Randomized Phase | Crossover Participants | 0 | 37 |
| Randomized Phase | Inadequate Labs | 1 | 1 |
| Randomized Phase | Physician Decision | 1 | 0 |
| Randomized Phase | Withdrawal by Subject | 2 | 1 |
Baseline characteristics
| Characteristic | Vandetanib & Docetaxel | Placebo and Docetaxel | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 38 Participants | 33 Participants | 71 Participants |
| Age, Categorical Between 18 and 65 years | 32 Participants | 39 Participants | 71 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 2 Participants | 1 Participants | 3 Participants |
| Race (NIH/OMB) Black or African American | 3 Participants | 0 Participants | 3 Participants |
| Race (NIH/OMB) More than one race | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 3 Participants | 4 Participants | 7 Participants |
| Race (NIH/OMB) White | 61 Participants | 67 Participants | 128 Participants |
| Sex: Female, Male Female | 22 Participants | 23 Participants | 45 Participants |
| Sex: Female, Male Male | 48 Participants | 49 Participants | 97 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 22 / 70 | 12 / 72 | 5 / 37 |
| serious Total, serious adverse events | 42 / 70 | 26 / 72 | 6 / 37 |
Outcome results
Primary
Median Progression-Free Survival (PFS)
PFS based on the Kaplan-Meier method is defined as the time between randomization and documented disease progression (PD) per RECIST 1.0 criteria or death, or is censored at time of last disease assessment. Per RECIST 1.0 for target lesions, PD is at least a 20% increase in sum LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or appearance of new lesions. For non-target lesions, PD is the appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions.
Time frame: Disease evaluations occurred at week 6 and 12 and thereafter every 3 cycles/9 weeks on treatment and every 3 months in follow-up. Participants were followed until PD, death or lost to follow-up. Median survival follow-up was 12 months (range 1-26).
Population: The analysis dataset is comprised of all eligible and treated patients.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Vandetanib and Docetaxel | Median Progression-Free Survival (PFS) | 2.56 months |
| Placebo and Docetaxel | Median Progression-Free Survival (PFS) | 1.58 months |
Comparison: The study was designed with 80% power to detect 60% improvement in median PFS from 18 to 28.8 weeks (Vandetanib+docetaxel/Placebo+docetaxel hazard ratio of 0.625) with the addition of Vandetanib while maintaining an overall significance level of 5% in a one-sided test. This assumed exponential distribution of events, accrual of 1.75 patients per week (7-8 patients per month) for 78 weeks with 34 weeks of additional follow-up (112 weeks total). Full information was 118 PFS events.p-value: 0.93995% CI: [0.69, 1.49]Log Rank
Secondary
Grade 3-5 Toxicity Rate
Grade 3-5 toxicity rate is the percentage of participants experiencing maximum grade of all toxicity types of grade 3-5 with any attribution on treatment during the randomized phase.
Time frame: Assessed each cycle throughout treatment from time of first dose and up to day 30 post-treatment. Median treatment duration for this study cohort approximated 2 cycles (range 1-31).
Population: The analysis dataset is comprised of all eligible and treated patients.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Vandetanib and Docetaxel | Grade 3-5 Toxicity Rate | 73 percentage of participants |
| Placebo and Docetaxel | Grade 3-5 Toxicity Rate | 57 percentage of participants |
Secondary
Median Overall Survival
Overall survival is defined from date of randomization to date of death or censored at the date the patient was last known alive.
Time frame: Off treatment, patients were followed for survival information every 6 months (±1 month) until death,up to 2 years after discontinuing therapy, or until lost to follow-up. Median survival follow-up for the study cohort was 12 months (95% CI: 9-18 months).
Population: The analysis dataset is comprised of all eligible and treated patients.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Vandetanib and Docetaxel | Median Overall Survival | 5.85 months |
| Placebo and Docetaxel | Median Overall Survival | 7.03 months |
p-value: 0.87395% CI: [0.81, 1.79]Log Rank
Secondary
Objective Response Rate
Objective response rate is defined as the percentage of participants who achieved a confirmed overall partial response (PR) or complete response (CR) using RECIST criteria on treatment during the randomized phase. Patients without measurable disease only at baseline are included, based on status of non-target lesions.Per RECIST 1.0 for target lesions, CR is complete disappearance of all target lesions and PR is at least a 30% decrease in the sum of longest diameter (LD) of target lesions, taking as reference baseline sum LD. To be assigned a status of CR or PR, changes in tumor measurements must be confirmed by repeat assessments performed no fewer than 4 weeks after the response criteria are first met. PR or better overall response assumes at a minimum incomplete response/stable disease (SD) for the evaluation of non-target lesions and absence of new lesions.
Time frame: Disease evaluations occurred at week 6 and 12 and thereafter every 3 cycles/9 weeks on treatment. Median treatment duration for this study cohort approximated 2 cycles (range 1-31).
Population: The analysis dataset is comprised of all eligible and treated patients.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Vandetanib and Docetaxel | Objective Response Rate | 7.1 percentage of participants |
| Placebo and Docetaxel | Objective Response Rate | 11.1 percentage of participants |
p-value: 0.56Fisher Exact
Post Hoc
Disease Control Rate
Disease control rate is defined as the percentage of participants with confirmed overall Stable Disease (SD) or better using RECIST 1.0 criteria which parallels absence of disease progression (PD) on treatment during the randomized phase. Per RECIST 1.0 for target lesions, PD is at least a 20% increase in sum LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or appearance of new lesions. For non-target lesions, PD is the appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions. Patients without measurable disease only at baseline are included, based on status of non-target lesions.
Time frame: Disease evaluations occurred at week 6 and 12 and thereafter every 3 cycles/9 weeks on treatment. Median treatment duration for this study cohort approximated 2 cycles (range 1-31).
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Vandetanib and Docetaxel | Disease Control Rate | 51 percentage of participants |
| Placebo and Docetaxel | Disease Control Rate | 42 percentage of participants |
p-value: 0.31Fisher Exact