Advanced Colorectal Carcinoma, Bile Duct Cancer, Esophageal Cancer, Gall Bladder Cancer, Gastric Cancer, Metastatic Colorectal Carcinoma, Pancreatic Cancer, Small Bowel Adenocarcinoma, Stage II Colon Cancer, Stage III Colon Cancer, Stage III Rectal Cancer, Stage II Rectal Cancer, Stage IVA Colorectal Cancer AJCC v8, Stage IVB Colorectal Cancer AJCC v8, Stage IVC Colorectal Cancer AJCC v8, Stage IV Colorectal Cancer AJCC v8
Conditions
Brief summary
This phase Ib trial studies side effects and best dose of dasatinib in preventing oxaliplatin-induced peripheral neuropathy in patients with gastrointestinal cancers who are receiving FOLFOX regimen with or without bevacizumab. Drugs used in chemotherapy, such as leucovorin, fluorouracil, and oxaliplatin (FOLFOX regimen), work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. However, the buildup of oxaliplatin in the cranial nerves can result in damage or the nerves. Dasatinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Blocking these enzymes may reduce oxaliplatin-induced peripheral neuropathy.
Detailed description
PRIMARY OBJECTIVES: I. To determine the recommended phase 2 dose (RP2D) of dasatinib in combination with oxaliplatin and fluorouracil (5FU) (modified version 6 regimen of leucovorin, fluorouracil and oxaliplatin \[mFOLFOX6\]) with or without bevacizumab in patients with colon, rectal or other GI cancer, defined as the lowest intermittent dose of dasatinib that affects serum biomarkers of OCT2 without influencing the pharmacokinetic properties of oxaliplatin. II. To determine the toxicity profile (based on Chemotherapy-Induced Peripheral Neuropathy \[CIPN\]20 and Common Terminology Criteria for Adverse Events \[CTCAE\] version \[v.\] 5.0) of dasatinib in combination with oxaliplatin/5-FU/bevacizumab in patients with colorectal cancer or other GI cancer. SECONDARY OBJECTIVES: I. To evaluate the influence of dasatinib on the pharmacokinetics of oxaliplatin and vice versa in these patients. OUTLINE: This is a dose-escalation study of dasatinib. Patients receive oxaliplatin intravenously (IV) over 2 hours, leucovorin IV over 2 hours, fluorouracil slow IV push over 2-4 minutes followed by continuous infusion over 46 hours on days 1 and 15. Patients also receive dasatinib orally (PO) once daily (QD) on days 14, 15, and 28 of cycle 1 and day 1 of cycle 2. Patients may receive bevacizumab IV over 30 minutes on days 1 and 15. Treatment repeats every 28 days for up to cycle 3 day 1 in the absence of disease progression or unacceptable toxicity.
Interventions
BIOLOGICALBevacizumab
Given IV
DRUGDasatinib
Given PO
DRUGFluorouracil
Given IV
DRUGLeucovorin
Given IV
DRUGLeucovorin Calcium
Given IV
DRUGOxaliplatin
Given IV
OTHERQuality-of-Life Assessment
Ancillary studies
Sponsors
Anne Noonan
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Confirmed confirmed stage II, III or IV colon or rectal cancer and other gastrointestinal (GI) cancers (e.g. pancreas, esophagogastric, bile duct, small bowel cancers etc) who are candidates for mFOLFOX6, with or without bevacizumab therapy. Pathological confirmation of colon,rectal or other GI cancer is required. Patients may have had prior therapy for GI cancer. * Eastern Cooperative Oncology Group (ECOG) performance status =\< 2 * Absolute neutrophil count (ANC) \>= 1.5 x 10\^9/L * Platelets \>= 100 x 10\^9/L * International normalized ratio (INR) or prothrombin time (PT) =\< 1.5 x upper limit of normal (ULN) unless subject is receiving anticoagulant therapy as long as PT or partial thromboplastin time (PTT) is within therapeutic range of intended use of anticoagulants * Activated partial thromboplastin time (aPTT) =\< 1.5 x ULN unless subject is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants * Serum creatinine: =\< 1.5 x upper limit of normal (ULN), or measured or calculated creatinine clearance (estimated by Cockcroft-Gault formula or measured ) \>= 50 mL/min urine protein:creatinine (UPC) \< 2 * Total bilirubin =\< 2 x ULN * Aspartate aminotransferase (AST, serum glutamic oxaloacetic transaminase \[SGOT\]) and alanine aminotransferase (ALT, serum glutamate pyruvate transaminase \[SGPT\]) =\< 3 x ULN, unless evidence of liver metastases, then AST/alanine aminotransferase (ALT) =\< 5 x ULN * Blood pressure (if receiving bevacizumab): systolic blood pressure (SBP) \> 150 or diastolic blood pressure (DBP) \> 100 * Serum potassium and magnesium within the institution normal range. * Corrected QT (QTc) interval =\< 450 mSec * Women of child-bearing potential must agree to use adequate contraception prior to study entry, for the duration of study participation and for 3 months after completion of study treatment administration * Prior chemotherapy in the adjuvant or metastatic setting is allowed including prior exposure to oxaliplatin in the adjuvant setting for colorectal cancer or other GI cancer as long as neuropathy is grade 1 or less. * Pre-existing neuropathy is allowed as long as it is grade 1 or less.
Exclusion criteria
* Treatment with any other investigational agents within 4 weeks or 5 half-lives (whichever is longer) prior to the first dose of dasatinib * Gastrointestinal (GI) disease or impairment of GI function that is likely to significantly alter the absorption of dasatinib * Use of potent OCT2 and/or CYP3A4 inhibitors if treatment cannot be either safely discontinued or switched to a different medication prior to starting dasatinib * Concurrent cetuximab panitumumab or any other biological/targeted agent. * Uncontrolled inter-current illness including, but not limited to, ongoing or active infection, known human immunodeficiency virus (HIV) diagnosis if receiving combination antiretroviral therapy, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations, including psychotic disorders, dementia and substance use disorders, that would limit compliance with study requirements * Because there is an unknown potential risk for adverse events in nursing infants secondary to treatment of the mother with dasatinib and/or oxaliplatin, breastfeeding should be discontinued * Inability to understand and sign informed consent * Any other condition that in the opinion of the investigators would make the study therapy unsafe
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Recommended phase II dose (RP2D) of dasatinib | Up to 14 days | The RP2D will be defined as the lowest intermittent dose of dasatinib that affects serum biomarkers of OCT2 without influencing the pharmacokinetic properties of oxaliplatin. |
| Incidence of adverse events | At the end of Cycle 1 (cycle length is 28 days) | The dose-limiting toxicity and toxicity profile will be based using the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 and Chemotherapy-Induced Peripheral Neuropathy (CIPN) 20. Toxicity will be defined as adverse events deemed to be at least possibly related to dasatinib treatment. Adverse events and toxicities will be summarized by dose level, and will tabulate these events by type and severity. Will summarize the numbers of patients who required dose reductions in dasatinib or oxaliplatin and the cumulative doses received. The CIPN20 will be measured in these subjects, and will be summarized within and across dose levels, and will be used to support and inform assumptions for a subsequent phase 2 trial. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Dasatinib on pharmacokinetics (PK) of oxaliplatin | Baseline, days 1, 2, and 14 | Objective is to evaluate the influence of dasatinib on the pharmacokinetics of oxaliplatin and vice versa. Oxaliplatin PK will be measured at pre-dose, 1 hour, immediately prior to end of infusion of oxaliplatin, and 0.5, 1, 2, 4 hours after end of infusion on day 1; Dasatinib PK will be measured at pre-dose and 0.5, 1.5, 2.5, 3, 4.5, and 6.5 hours after taking dasatinib on day 14; PK of dasatinib and oxaliplatin will be measured on day 15 pre-dose of dasatinib, prior to starting oxaliplatin infusion, 1 hour after start of oxaliplatin infusion, immediately prior to end of infusion with oxaliplatin, and at 0.5, 1, 2, 4 hours after end of oxaliplatin infusion. PK parameters calculated using standard non-compartmental methods, and non-linear mixed effect models will be created to inform the use of limited-sampling strategies for subsequent confirmatory studies. Area Under the Curve \[AUC\] will be calculated for each drug Oxaliplatin - ug x h/ml and Dasatinib- ng x h/ml |
Countries
United States
Outcome results
None listed