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
Conditions
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
Given PO
Given PO
Sponsors
Study design
Eligibility
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
| Measure | Time frame | Description |
|---|---|---|
| Progression-free Survival | Up to 3 years | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | Up to 3 years | 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. |
| Objective Response | Up to 3 years | 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. |
| Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Up to 3 years | Only adverse events that are possibly, probably or definitely related to study drug are reported. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| 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 |
| Total | 34 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 7 |
| Overall Study | Death | 2 |
| Overall Study | Ineligible | 6 |
| Overall Study | Not protocol specified | 1 |
| Overall Study | Progression/relapse | 24 |
Baseline characteristics
| Characteristic | Sorafenib and Erlotinib |
|---|---|
| Age, Continuous | 63 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 type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 33 / 34 |
| serious Total, serious adverse events | 17 / 34 |
Outcome results
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
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sorafenib and Erlotinib | Progression-free Survival | 2 months |
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.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Abdominal pain | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Alanine aminotransferase increased | 4 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Alkaline phosphatase increased | 3 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Allergic reaction | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Aspartate aminotransferase increased | 3 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Blood bilirubin increased | 2 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Death NOS | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Dehydration | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Diarrhea | 3 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Erythema multiforme | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Fatigue | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Gastric perforation | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Hepatic failure | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Hepatic infection | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Hepatic necrosis | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Hypertension | 5 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Hypoalbuminemia | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Hypokalemia | 2 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Hypophosphatemia | 3 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Hypoxia | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Lymphocyte count decreased | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Mucositis oral | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Nausea | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Pain | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Palmar-plantar erythrodysesthesia syndrome | 2 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Platelet count decreased | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Rash acneiform | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Rash maculo-papular | 1 Participants |
| Sorafenib and Erlotinib | Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drug | Thromboembolic event | 1 Participants |
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
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sorafenib and Erlotinib | Objective Response | 6 percentage of participants |
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
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sorafenib and Erlotinib | Overall Survival | 6 months |