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Bevacizumab and Erlotinib Hydrochloride in Treating Patients With Metastatic or Unresectable Biliary Tumors

Primary Purpose

Cholangiocarcinoma of the Extrahepatic Bile Duct, Cholangiocarcinoma of the Gallbladder, Gastrointestinal Cancer

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
erlotinib hydrochloride
bevacizumab
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cholangiocarcinoma of the Extrahepatic Bile Duct

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Criteria: Absolute neutrophil count >= 1,500/mm3 Histologically or cytologically confirmed cholangiocarcinoma or gallbladder carcinoma: Metastatic or surgically unresectable disease Measurable disease, defined as >= 1 lesion whose longest diameter can be accurately measured as >= 2.0 cm with conventional techniques or as > 1.0 cm with spiral CT scan: Spiral CT scan imaging must be used for pre- and post-treatment tumor measurements of lesions measuring >= 1.0 cm to < 2.0 cm Clinical lesions will only be considered measurable when they are superficial Lesions on chest x-ray are acceptable as measurable lesions when they are clearly defined and surrounded by aerated lung No ampulla of Vater tumors No evidence of CNS disease Life expectancy >= 3 months ECOG performance status 0-2 Platelet count >= 75,000/mm3 Total bilirubin =< 2 times ULN ALT and AST =< 2.5 times ULN Creatinine =< 2 mg/dL Albumin >= 2.5 g/dL Alkaline phosphatase =< 5 times ULN Urine protein:creatinine ratio < 1.0 OR 24-hour urine protein < 1000 mg No concurrent illness or medical condition, including any of the following: Impairment of gastrointestinal (GI) function or disease that may significantly alter the absorption of erlotinib hydrochloride Requirement for IV alimentation No concurrent illness or medical condition, including any of the following: Active peptic ulcer disease; Serious or nonhealing wound, ulcer, or bone fracture; GI bleed that required procedural intervention within the past 3 months No concurrent illness or medical condition, including any of the following: Abdominal fistula, GI perforation, or intra-abdominal abscess within the past 28 days Ongoing or active infection Symptomatic congestive heart failure Psychiatric illness or social situation that would limit study compliance No other malignancy within the past 3 years No abnormalities of the cornea Not pregnant or nursing Fertile patients must use effective contraception No clinically significant cardiovascular disease More than 4 weeks since prior chemotherapy or radiotherapy (6 weeks for nitrosoureas or mitomycin C) and recovered No significant traumatic injury within the past 28 days No prior systemic anticancer therapy for metastatic gallbladder or bile duct cancer More than 28 days since prior major surgery [Note: Insertion of a vascular access device is not considered major/minor surgery] More than 2 weeks since prior minor surgery [Note: Insertion of a vascular access device is not considered major/minor surgery] More than 7 days since prior core biopsy No concurrent major surgery No other concurrent chemotherapy, immunotherapy, radiotherapy, or any other therapy or supportive care considered investigational No concurrent enzyme-inducing antiepileptic drugs or any other CYP3A4 inducer, such as rifampin or Hypericum perforatum No concurrent combination antiretroviral therapy for HIV-positive patients No other concurrent investigational agents or other concurrent anticancer therapies No concurrent prophylactic hematopoietic colony-stimulating factors Concurrent full-dose anticoagulants allowed provided PT/INR is > 1.5 and both of the following criteria are met: In-range INR on a stable dose of oral anticoagulant OR on a stable dose of low molecular weight heparin AND (continued from above) No active bleeding or pathological condition that carries a high risk of bleeding (e.g., tumor involving major vessels, gastrointestinal ulcerations, or known varices)

Sites / Locations

  • Mayo Clinic

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Bevacizumab and Erlotinib Hydrochloride

Arm Description

Patients receive 5 mg/kg bevacizumab IV over 30-90 minutes on days 1 and 15 and 150 mg oral erlotinib hydrochloride daily on days 1-28. Courses repeat every 28 days in the absence of unacceptable toxicity or disease progression. Tumor tissue and blood specimens are collected periodically for correlative studies. Specimens are examined by immunohistochemistry for epidermal growth factor receptor (EGFR) and P-EGFR protein levels; AKT p-AKT, mitogen-activated protein kinase (MAPK) and P-MAPK protein levels; and vascular endothelial growth factor receptor (VEGFR)-1 and VEGFR-2 protein levels. EGFR mutations are detected by laser capture microdissection. Enzyme-linked immunosorbent assay is used to measure total and free serum VEGF levels.

Outcomes

Primary Outcome Measures

Number of Confirmed Tumor Responses.
Complete Response (CR): Disappearance of all target lesions. Partial Response (PR): At least a 30% decrease in the target lesions. A confirmed tumor response is defined to be either a Complete Response or a Partial Response noted as the objective status on 2 consecutive evaluations at least 4 weeks apart. Confirmed tumor responses will be evaluated using the first 6 cycles of treatment. All patients meeting the eligibility criteria who have signed a consent form and have begun treatment and had one post-baseline disease assessment will be evaluable for response. Forty-nine of the 53 eligible patients had at least one post-baseline disease assessment and were evaluable for this endpoint.

Secondary Outcome Measures

Survival Time
Estimated using the method of Kaplan-Meier (1958).
Time to Disease Progression
Estimated using the method of Kaplan-Meier (1958).
Duration of Response
Point estimates and 95% confidence intervals were calculated using the method of Duffy and Santner (1987).

Full Information

First Posted
July 26, 2006
Last Updated
May 12, 2014
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00356889
Brief Title
Bevacizumab and Erlotinib Hydrochloride in Treating Patients With Metastatic or Unresectable Biliary Tumors
Official Title
A Phase II Trial of Bevacizumab and Erlotinib in Patients With Advanced Biliary Tumors
Study Type
Interventional

2. Study Status

Record Verification Date
April 2013
Overall Recruitment Status
Completed
Study Start Date
May 2006 (undefined)
Primary Completion Date
October 2008 (Actual)
Study Completion Date
June 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This phase II trial is studying how well giving bevacizumab together with erlotinib hydrochloride works in treating patients with metastatic or unresectable biliary tumors. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Erlotinib hydrochloride may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Bevacizumab and erlotinib hydrochloride may also stop the growth of tumor cells by blocking blood flow to the tumor. Giving bevacizumab together with erlotinib hydrochloride may kill more tumor cells.
Detailed Description
PRIMARY OBJECTIVES: I. Evaluate the objective response rate in patients with metastatic or unresectable cholangiocarcinoma treated with bevacizumab and erlotinib hydrochloride. SECONDARY OBJECTIVES: I. Evaluate time to progression in these patients. II. Evaluate overall and progression-free survival of these patients. III. Evaluate the adverse events associated with this regimen. OUTLINE: This is an open-label, multicenter study. Patients receive bevacizumab intravenously (IV) over 30-90 minutes on days 1 and 15 and oral erlotinib hydrochloride daily on days 1-28. Courses repeat every 28 days in the absence of unacceptable toxicity or disease progression. After completion of study therapy, patients are followed periodically for up to 3 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cholangiocarcinoma of the Extrahepatic Bile Duct, Cholangiocarcinoma of the Gallbladder, Gastrointestinal Cancer, Recurrent Extrahepatic Bile Duct Cancer, Recurrent Gallbladder Cancer, Unresectable Extrahepatic Bile Duct Cancer, Unresectable Gallbladder Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
56 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Bevacizumab and Erlotinib Hydrochloride
Arm Type
Experimental
Arm Description
Patients receive 5 mg/kg bevacizumab IV over 30-90 minutes on days 1 and 15 and 150 mg oral erlotinib hydrochloride daily on days 1-28. Courses repeat every 28 days in the absence of unacceptable toxicity or disease progression. Tumor tissue and blood specimens are collected periodically for correlative studies. Specimens are examined by immunohistochemistry for epidermal growth factor receptor (EGFR) and P-EGFR protein levels; AKT p-AKT, mitogen-activated protein kinase (MAPK) and P-MAPK protein levels; and vascular endothelial growth factor receptor (VEGFR)-1 and VEGFR-2 protein levels. EGFR mutations are detected by laser capture microdissection. Enzyme-linked immunosorbent assay is used to measure total and free serum VEGF levels.
Intervention Type
Drug
Intervention Name(s)
erlotinib hydrochloride
Other Intervention Name(s)
CP-358,774, erlotinib, OSI-774
Intervention Description
Given orally, 150 mg, once daily.
Intervention Type
Biological
Intervention Name(s)
bevacizumab
Other Intervention Name(s)
anti-VEGF humanized monoclonal antibody, anti-VEGF monoclonal antibody, Avastin, rhuMAb VEGF
Intervention Description
Given IV, 5mg/kg on days 1 and 15 every cycle
Primary Outcome Measure Information:
Title
Number of Confirmed Tumor Responses.
Description
Complete Response (CR): Disappearance of all target lesions. Partial Response (PR): At least a 30% decrease in the target lesions. A confirmed tumor response is defined to be either a Complete Response or a Partial Response noted as the objective status on 2 consecutive evaluations at least 4 weeks apart. Confirmed tumor responses will be evaluated using the first 6 cycles of treatment. All patients meeting the eligibility criteria who have signed a consent form and have begun treatment and had one post-baseline disease assessment will be evaluable for response. Forty-nine of the 53 eligible patients had at least one post-baseline disease assessment and were evaluable for this endpoint.
Time Frame
After 6 courses of treatment. Each course lasts 28 days.
Secondary Outcome Measure Information:
Title
Survival Time
Description
Estimated using the method of Kaplan-Meier (1958).
Time Frame
From registration to death due to any cause, assessed up to 3 years
Title
Time to Disease Progression
Description
Estimated using the method of Kaplan-Meier (1958).
Time Frame
From registration to documentation of disease progression, assessed up to 3 years
Title
Duration of Response
Description
Point estimates and 95% confidence intervals were calculated using the method of Duffy and Santner (1987).
Time Frame
From the date at which the patient's objective status is first noted to be either a CR or PR to the date progression is documented, assessed up to 3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Criteria: Absolute neutrophil count >= 1,500/mm3 Histologically or cytologically confirmed cholangiocarcinoma or gallbladder carcinoma: Metastatic or surgically unresectable disease Measurable disease, defined as >= 1 lesion whose longest diameter can be accurately measured as >= 2.0 cm with conventional techniques or as > 1.0 cm with spiral CT scan: Spiral CT scan imaging must be used for pre- and post-treatment tumor measurements of lesions measuring >= 1.0 cm to < 2.0 cm Clinical lesions will only be considered measurable when they are superficial Lesions on chest x-ray are acceptable as measurable lesions when they are clearly defined and surrounded by aerated lung No ampulla of Vater tumors No evidence of CNS disease Life expectancy >= 3 months ECOG performance status 0-2 Platelet count >= 75,000/mm3 Total bilirubin =< 2 times ULN ALT and AST =< 2.5 times ULN Creatinine =< 2 mg/dL Albumin >= 2.5 g/dL Alkaline phosphatase =< 5 times ULN Urine protein:creatinine ratio < 1.0 OR 24-hour urine protein < 1000 mg No concurrent illness or medical condition, including any of the following: Impairment of gastrointestinal (GI) function or disease that may significantly alter the absorption of erlotinib hydrochloride Requirement for IV alimentation No concurrent illness or medical condition, including any of the following: Active peptic ulcer disease; Serious or nonhealing wound, ulcer, or bone fracture; GI bleed that required procedural intervention within the past 3 months No concurrent illness or medical condition, including any of the following: Abdominal fistula, GI perforation, or intra-abdominal abscess within the past 28 days Ongoing or active infection Symptomatic congestive heart failure Psychiatric illness or social situation that would limit study compliance No other malignancy within the past 3 years No abnormalities of the cornea Not pregnant or nursing Fertile patients must use effective contraception No clinically significant cardiovascular disease More than 4 weeks since prior chemotherapy or radiotherapy (6 weeks for nitrosoureas or mitomycin C) and recovered No significant traumatic injury within the past 28 days No prior systemic anticancer therapy for metastatic gallbladder or bile duct cancer More than 28 days since prior major surgery [Note: Insertion of a vascular access device is not considered major/minor surgery] More than 2 weeks since prior minor surgery [Note: Insertion of a vascular access device is not considered major/minor surgery] More than 7 days since prior core biopsy No concurrent major surgery No other concurrent chemotherapy, immunotherapy, radiotherapy, or any other therapy or supportive care considered investigational No concurrent enzyme-inducing antiepileptic drugs or any other CYP3A4 inducer, such as rifampin or Hypericum perforatum No concurrent combination antiretroviral therapy for HIV-positive patients No other concurrent investigational agents or other concurrent anticancer therapies No concurrent prophylactic hematopoietic colony-stimulating factors Concurrent full-dose anticoagulants allowed provided PT/INR is > 1.5 and both of the following criteria are met: In-range INR on a stable dose of oral anticoagulant OR on a stable dose of low molecular weight heparin AND (continued from above) No active bleeding or pathological condition that carries a high risk of bleeding (e.g., tumor involving major vessels, gastrointestinal ulcerations, or known varices)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
William Schelman
Organizational Affiliation
Mayo Clinic
Official's Role
Principal Investigator
Facility Information:
Facility Name
Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States

12. IPD Sharing Statement

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Bevacizumab and Erlotinib Hydrochloride in Treating Patients With Metastatic or Unresectable Biliary Tumors

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