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Sorafenib Tosylate and Erlotinib Hydrochloride in Treating Patients With Locally Advanced, Unresectable, or Metastatic Gallbladder Cancer or Cholangiocarcinoma

Phase II Study of Sorafenib (NSC-724772) and Erlotinib (NSC-718781) in Patients With Advanced Gallbladder Carcinoma or Cholangiocarcinoma

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01093222
Enrollment
40
Registered
2010-03-25
Start date
2010-04-30
Completion date
2014-09-30
Last updated
2015-06-30

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

Conditions

Extrahepatic Bile Duct Adenocarcinoma, Gallbladder Adenocarcinoma, Gallbladder Adenocarcinoma With Squamous Metaplasia, Hilar Cholangiocarcinoma, Recurrent Extrahepatic Bile Duct Carcinoma, Recurrent Gallbladder Carcinoma, Undifferentiated Gallbladder Carcinoma, Unresectable Extrahepatic Bile Duct Carcinoma, Unresectable Gallbladder Carcinoma

Brief summary

This phase II trial is studying how well giving sorafenib tosylate together with erlotinib hydrochloride works in treating patients with locally advanced, unresectable, or metastatic gallbladder cancer or cholangiocarcinoma. Sorafenib tosylate and erlotinib hydrochloride may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth or by blocking blood flow to the tumor.

Detailed description

OBJECTIVES: I. To assess the progression-free survival in patients with unresectable or metastatic gallbladder carcinoma or cholangiocarcinoma treated with the combination of sorafenib (sorafenib tosylate) and erlotinib (erlotinib hydrochloride). II. To assess the overall survival in patients with unresectable or metastatic gallbladder carcinoma or cholangiocarcinoma treated with the combination of sorafenib and erlotinib. III. To assess the objective response rate. IV. To assess the frequency and severity of toxicities. V. To collect specimens for banking for future research. OUTLINE: This is a multicenter study. Patients receive sorafenib tosylate orally (PO) twice daily and erlotinib hydrochloride PO once daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. After completion of study therapy, patients are followed up every 6 months for 3 years.

Interventions

DRUGErlotinib Hydrochloride

Given PO

DRUGSorafenib Tosylate

Given PO

Sponsors

National Cancer Institute (NCI)
Lead SponsorNIH

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

* Cytologically or pathologically confirmed gallbladder carcinoma or cholangiocarcinoma * No ampullary carcinoma * Locally advanced unresectable or distant metastatic disease * Measurable disease * Patients with biliary obstruction must have decompression of the biliary tree by ERCP and stenting or percutaneous drainage * No prior systemic treatment for metastatic or unresectable locally advanced disease * No known brain metastases * Zubrod performance status of 0-1 * Leukocyte count ≥ 3,000/mm\^3 * ANC ≥ 1,000/mm\^3 * Platelet count ≥100,000/mm\^3 * Total serum bilirubin ≤ 1.5 times upper limit of normal (ULN) * For patient who had decompression of the biliary tree within the past 14 days, stability of the bilirubin level needs to be confirmed with two measurements within 5 to 7 days of each other * Serum albumin ≥ 2.5 g/dL * AST and ALT ≤ 2.5 times ULN (≤ 5 times ULN for liver metastases) * Creatinine clearance ≥ 60 mL/min * Not pregnant or nursing * Fertile patients must agree to use effective contraception * No active biliary sepsis * No bleeding diathesis * No uncontrolled or clinically significant cardiovascular disease, including any of the following: * Myocardial infarction within the past 6 months * Uncontrolled angina within the past 6 months * NYHA class II-IV congestive heart failure * Grade 3 cardiac valve dysfunction * Cardiac arrhythmia not controlled by medication * History of stroke or transient ischemic attack within the past 6 months * History of arterial thrombotic event of any type in the past 6 months * No uncontrolled hypertension, as evidenced by systolic BP ≥ 150 mm Hg or diastolic BP ≥ 100 mm Hg, within the past 28 days * Must be able to swallow and tolerate oral medications * No gastrointestinal tract disease or prior abdominal surgery that results in an inability to absorb oral medication * No other prior malignancy except adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease-free within the past 3 years * No concurrent grapefruit or its juice * At least 6 months since 1 adjuvant or neoadjuvant regimen of chemotherapy, hormonal therapy, immunotherapy, radiotherapy (to \< 25% of bone marrow only), or chemoradiotherapy before documented recurrence or metastatic disease * No prior treatment with any antiangiogenic agent or any EGFR inhibitors for any reason * Concurrent multiple anti-hypertensive medications allowed * No plans to receive concurrent chemotherapy, hormonal therapy, radiotherapy, immunotherapy, or any other therapy, including herbal or alternative medications for treatment of cancer

Design outcomes

Primary

MeasureTime frameDescription
Progression-free SurvivalUp to 3 yearsFrom date of registration to date of first documentation of progression or symptomatic deterioration (as defined in protocol), or death due to any cause. Patients last known to be alive and progression free are censored at date of last contact.

Secondary

MeasureTime frameDescription
Overall SurvivalUp to 3 yearsFrom date of registration to date of death due to any cause. Patients last known to be alive are censored at date of last contact.
Objective ResponseUp to 3 yearsComplete response (CR) is complete disappearance of all target and non-target lesions, no new lesions and no disease related symptoms. Partial response (PR) is a greater than or equal to 30% decrease under baseline of the sum of diameters of all target measurable lesions. Confirmed response is two or more objective statuses of CR a minimum of four weeks apart documented before progression or symptomatic deterioration. Partial response is two or more objective statuses of PR or better a minimum of four weeks apart documented before progression or symptomatic deterioration. Unconfirmed CR is one objective status of CR documented before progression or symptomatic deterioration but not qualifying as CR or PR. Unconfirmed PR is one objective status of PR documented before progression or symptomatic deterioration but not qualifying as CR, PR or unconfirmed CR.
Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugUp to 3 yearsOnly adverse events that are possibly, probably or definitely related to study drug are reported.

Countries

United States

Participant flow

Participants by arm

ArmCount
Sorafenib and Erlotinib
Patients receive sorafenib tosylate 400 mg PO twice daily and erlotinib hydrochloride 100 mg PO once daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.
34
Total34

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyAdverse Event7
Overall StudyDeath2
Overall StudyIneligible6
Overall StudyNot protocol specified1
Overall StudyProgression/relapse24

Baseline characteristics

CharacteristicSorafenib and Erlotinib
Age, Continuous63 years
Chemotherapy, multiple agents
No
33 participants
Chemotherapy, multiple agents
Yes
1 participants
Current Status of Disease
Distant Metastatic
28 participants
Current Status of Disease
Locally Advanced
6 participants
Ethnicity (NIH/OMB)
Hispanic or Latino
4 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
30 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
Primary Cancer
Cholangiocarcinoma
20 participants
Primary Cancer
Gallbladder
14 participants
Prior Radiation Therapy
No
34 participants
Prior Radiation Therapy
Yes
0 participants
Prior Surgery
No
20 participants
Prior Surgery
Yes
14 participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
Race (NIH/OMB)
Asian
1 Participants
Race (NIH/OMB)
Black or African American
3 Participants
Race (NIH/OMB)
More than one race
0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
Race (NIH/OMB)
Unknown or Not Reported
2 Participants
Race (NIH/OMB)
White
28 Participants
Setting of Prior Chemotherapy
Adjuvant
1 participants
Setting of Prior Chemotherapy
Neoadjuvant
0 participants
Setting of Prior Chemotherapy
None
33 participants
Sex: Female, Male
Female
21 Participants
Sex: Female, Male
Male
13 Participants
Zubrod Performance Status
0
19 participants
Zubrod Performance Status
1
15 participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
33 / 34
serious
Total, serious adverse events
17 / 34

Outcome results

Primary

Progression-free Survival

From date of registration to date of first documentation of progression or symptomatic deterioration (as defined in protocol), or death due to any cause. Patients last known to be alive and progression free are censored at date of last contact.

Time frame: Up to 3 years

Population: Eligible patients who began protocol therapy

ArmMeasureValue (MEDIAN)
Sorafenib and ErlotinibProgression-free Survival2 months
Secondary

Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug

Only adverse events that are possibly, probably or definitely related to study drug are reported.

Time frame: Up to 3 years

Population: Eligible patients who received any treatment and were assessed for toxicity were included in the adverse event summaries. Any CTCAE v4.0 event of Grade 3 (severe), Grade 4 (life threatening), or Grade 5 (fatal) which were deemed to be related to protocol treatment are included.

ArmMeasureGroupValue (NUMBER)
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugAbdominal pain1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugAlanine aminotransferase increased4 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugAlkaline phosphatase increased3 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugAllergic reaction1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugAspartate aminotransferase increased3 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugBlood bilirubin increased2 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugDeath NOS1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugDehydration1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugDiarrhea3 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugErythema multiforme1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugFatigue1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugGastric perforation1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugHepatic failure1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugHepatic infection1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugHepatic necrosis1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugHypertension5 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugHypoalbuminemia1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugHypokalemia2 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugHypophosphatemia3 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugHypoxia1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugLymphocyte count decreased1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugMucositis oral1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugNausea1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugPain1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugPalmar-plantar erythrodysesthesia syndrome2 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugPlatelet count decreased1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugRash acneiform1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugRash maculo-papular1 Participants
Sorafenib and ErlotinibNumber of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study DrugThromboembolic event1 Participants
Secondary

Objective Response

Complete response (CR) is complete disappearance of all target and non-target lesions, no new lesions and no disease related symptoms. Partial response (PR) is a greater than or equal to 30% decrease under baseline of the sum of diameters of all target measurable lesions. Confirmed response is two or more objective statuses of CR a minimum of four weeks apart documented before progression or symptomatic deterioration. Partial response is two or more objective statuses of PR or better a minimum of four weeks apart documented before progression or symptomatic deterioration. Unconfirmed CR is one objective status of CR documented before progression or symptomatic deterioration but not qualifying as CR or PR. Unconfirmed PR is one objective status of PR documented before progression or symptomatic deterioration but not qualifying as CR, PR or unconfirmed CR.

Time frame: Up to 3 years

Population: Eligible patients who began protocol therapy

ArmMeasureValue (NUMBER)
Sorafenib and ErlotinibObjective Response6 percentage of participants
Secondary

Overall Survival

From date of registration to date of death due to any cause. Patients last known to be alive are censored at date of last contact.

Time frame: Up to 3 years

Population: Eligible patients who began protocol therapy

ArmMeasureValue (MEDIAN)
Sorafenib and ErlotinibOverall Survival6 months

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