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Bevacizumab and Erlotinib in Treating Patients With Metastatic Pancreatic Cancer That Did Not Respond to Previous Treatment With Gemcitabine

Primary Purpose

Pancreatic Cancer

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
bevacizumab
erlotinib hydrochloride
laboratory biomarker analysis
Sponsored by
University of California, San Francisco
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Pancreatic Cancer focused on measuring stage IV pancreatic cancer, adenocarcinoma of the pancreas, recurrent pancreatic cancer

Eligibility Criteria

18 Years - 120 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: Histologically or cytologically confirmed adenocarcinoma of the pancreas Documented extrapancreatic metastases Radiographically measurable disease not required Gemcitabine hydrochloride-refractory disease Has undergone 1-3 prior therapies for locally advanced or metastatic disease with ≥ 1 regimen containing gemcitabine hydrochloride (alone or in combination with other agents) Treatment given in the adjuvant setting (radiotherapy and/or chemotherapy, given either concurrently or systemically) does not count as prior therapy as long as progressive disease occurs > 6 months after completion of treatment No central nervous system (CNS) or brain metastases PATIENT CHARACTERISTICS: Eastern Cooperative Oncology Group (ECOG) performance status 0-1 Absolute neutrophil count ≥ 1,500/mm³ Platelet count ≥ 100,000/mm³ International Normalized Ratio (INR) ≤ 1.5 (except in patients receiving full-dose warfarin) Bilirubin ≤ 2.0 mg/dL Creatinine ≤ 2.0 mg/dL AST or ALT ≤ 2.5 times upper limit of normal (ULN) (5 times ULN if documented liver metastases) Hemoglobin ≥ 9 g/dL (transfusion or epoetin alfa allowed) No contact lense use during and for 14 days after completion of study treatment Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for ≥ 6 months after completion of study treatment No history of other disease, metabolic dysfunction, or physical examination or clinical laboratory finding that contraindicates use of an investigational drug or precludes study compliance No history of serious systemic disease, including any of the following: Myocardial infarction within the past 6 months Stroke within the past 6 months Uncontrolled hypertension (i.e., blood pressure > 150/100 mm Hg on medication) Unstable angina New York Heart Association class II-IV congestive heart failure Unstable symptomatic arrhythmia requiring medication Chronic atrial arrhythmia (i.e., atrial fibrillation or paroxysmal supraventricular tachycardia) allowed Peripheral vascular disease ≥ grade 2 No significant traumatic injury within the past 28 days No proteinuria (defined as urine protein:creatinine ratio ≥ 1.0 at screening) No clinically significant impairment of renal function No serious, nonhealing wound, ulcer, or bone fracture No evidence of bleeding diathesis or coagulopathy No history of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 6 months PRIOR CONCURRENT THERAPY: More than 28 days since prior major surgery or open biopsy More than 7 days since prior fine-needle aspiration or core biopsy No prior antiangiogenesis agent (e.g., bevacizumab or an oral vascular endothelial growth factor receptor small molecule inhibitor) given together with an agent that disrupts epidermal growth factor receptor signaling (e.g., cetuximab or erlotinib hydrochloride) for locally advanced or metastatic pancreatic cancer Prior treatment with either one of the above alone allowed More than 4 weeks since prior and no concurrent participation in another clinical trial No other concurrent antineoplastic or antitumor agents, including chemotherapy, radiotherapy, immunotherapy, or hormonal anticancer therapy No concurrent major surgery No other concurrent investigational agents

Sites / Locations

  • UCSF Helen Diller Family Comprehensive Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Bevacizumab Plus Erlotinib Hydrochloride

Arm Description

A treatment cycle is 21 days: bevacizumab 15 mg/kg as a 60-90 min infusion once every 21 days, with erlotinib hydrochloride 150 mg by mouth daily

Outcomes

Primary Outcome Measures

Overall Survival Rate at 6 Months
Number of participants alive at 6 months
Safety and Toxicity
Treatment associated toxicities. Adverse event assessments were performed on day 1 of each treatment cycle and at the end of treatment; the longest duration of treatment was 7 cycles (x 3 weeks)

Secondary Outcome Measures

Objective Response as Measured by RECIST Criteria
Participants experiencing objecting response, per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.
Time to Tumor Progression
Time to tumor progression (TTP) was defined as the time from initial therapy to the first objective documentation of tumor progression (for patients with measurable disease) or to the data of death, if death was ascribed to progression of disease.
Proportion of Patients With ≥ 25% Decline in Serum CA19-9 Biomarker

Full Information

First Posted
August 16, 2006
Last Updated
December 19, 2017
Sponsor
University of California, San Francisco
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1. Study Identification

Unique Protocol Identification Number
NCT00365144
Brief Title
Bevacizumab and Erlotinib in Treating Patients With Metastatic Pancreatic Cancer That Did Not Respond to Previous Treatment With Gemcitabine
Official Title
A Phase II Trial of Bevacizumab Plus Erlotinib for Patients With Metastatic Gemcitabine-Refractory Pancreatic Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
December 2017
Overall Recruitment Status
Completed
Study Start Date
February 2006 (undefined)
Primary Completion Date
January 2009 (Actual)
Study Completion Date
March 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of California, San Francisco

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: 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. Bevacizumab may also stop the growth of pancreatic cancer by blocking blood flow to the tumor. Erlotinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving bevacizumab together with erlotinib may kill more tumor cells. PURPOSE: This phase II trial is studying how well giving bevacizumab together with erlotinib works in treating patients with metastatic pancreatic cancer that did not respond to previous treatment with gemcitabine.
Detailed Description
OBJECTIVES: Primary Evaluate the 6-month overall survival rate in patients with gemcitabine hydrochloride-refractory metastatic pancreatic cancer treated with bevacizumab and erlotinib hydrochloride. Determine the safety and toxicity of this regimen in these patients. Secondary Evaluate the objective response rate in these patients. Evaluate time to tumor progression in these patients. Determine the efficacy of this regimen, in terms of the proportion of patients with ≥ 50% decline in carbohydrate antigen 19-9, also called cancer antigen 19-9 (CA19-9) biomarker, in these patients. Obtain sequential measurements of circulating tumor cells (micrometastases) and endothelial cells in serum and correlate these variables with clinical outcomes (in patients enrolled in UCSF site only). OUTLINE: This is an open-label, nonrandomized, multicenter study. Patients receive bevacizumab IV over 30-90 minutes on day 1 and oral erlotinib hydrochloride once daily on days 1-21. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo blood collection at baseline and periodically during study for biomarker/laboratory analysis, including the CA19-9 biomarker. Circulating tumor micrometastases and endothelial cells are also measured in patients enrolled in University of California San Francisco (UCSF) site. After completion of study treatment, patients are followed at 30 days and at 6 months. PROJECTED ACCRUAL: A total of 40 patients will be accrued for this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pancreatic Cancer
Keywords
stage IV pancreatic cancer, adenocarcinoma of the pancreas, recurrent pancreatic 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
36 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Bevacizumab Plus Erlotinib Hydrochloride
Arm Type
Experimental
Arm Description
A treatment cycle is 21 days: bevacizumab 15 mg/kg as a 60-90 min infusion once every 21 days, with erlotinib hydrochloride 150 mg by mouth daily
Intervention Type
Biological
Intervention Name(s)
bevacizumab
Intervention Type
Drug
Intervention Name(s)
erlotinib hydrochloride
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Primary Outcome Measure Information:
Title
Overall Survival Rate at 6 Months
Description
Number of participants alive at 6 months
Time Frame
6 months
Title
Safety and Toxicity
Description
Treatment associated toxicities. Adverse event assessments were performed on day 1 of each treatment cycle and at the end of treatment; the longest duration of treatment was 7 cycles (x 3 weeks)
Time Frame
21 weeks
Secondary Outcome Measure Information:
Title
Objective Response as Measured by RECIST Criteria
Description
Participants experiencing objecting response, per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.
Time Frame
21 weeks
Title
Time to Tumor Progression
Description
Time to tumor progression (TTP) was defined as the time from initial therapy to the first objective documentation of tumor progression (for patients with measurable disease) or to the data of death, if death was ascribed to progression of disease.
Time Frame
from initial therapy to the first objective documentation of tumor progression
Title
Proportion of Patients With ≥ 25% Decline in Serum CA19-9 Biomarker
Time Frame
21 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
120 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically or cytologically confirmed adenocarcinoma of the pancreas Documented extrapancreatic metastases Radiographically measurable disease not required Gemcitabine hydrochloride-refractory disease Has undergone 1-3 prior therapies for locally advanced or metastatic disease with ≥ 1 regimen containing gemcitabine hydrochloride (alone or in combination with other agents) Treatment given in the adjuvant setting (radiotherapy and/or chemotherapy, given either concurrently or systemically) does not count as prior therapy as long as progressive disease occurs > 6 months after completion of treatment No central nervous system (CNS) or brain metastases PATIENT CHARACTERISTICS: Eastern Cooperative Oncology Group (ECOG) performance status 0-1 Absolute neutrophil count ≥ 1,500/mm³ Platelet count ≥ 100,000/mm³ International Normalized Ratio (INR) ≤ 1.5 (except in patients receiving full-dose warfarin) Bilirubin ≤ 2.0 mg/dL Creatinine ≤ 2.0 mg/dL AST or ALT ≤ 2.5 times upper limit of normal (ULN) (5 times ULN if documented liver metastases) Hemoglobin ≥ 9 g/dL (transfusion or epoetin alfa allowed) No contact lense use during and for 14 days after completion of study treatment Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for ≥ 6 months after completion of study treatment No history of other disease, metabolic dysfunction, or physical examination or clinical laboratory finding that contraindicates use of an investigational drug or precludes study compliance No history of serious systemic disease, including any of the following: Myocardial infarction within the past 6 months Stroke within the past 6 months Uncontrolled hypertension (i.e., blood pressure > 150/100 mm Hg on medication) Unstable angina New York Heart Association class II-IV congestive heart failure Unstable symptomatic arrhythmia requiring medication Chronic atrial arrhythmia (i.e., atrial fibrillation or paroxysmal supraventricular tachycardia) allowed Peripheral vascular disease ≥ grade 2 No significant traumatic injury within the past 28 days No proteinuria (defined as urine protein:creatinine ratio ≥ 1.0 at screening) No clinically significant impairment of renal function No serious, nonhealing wound, ulcer, or bone fracture No evidence of bleeding diathesis or coagulopathy No history of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 6 months PRIOR CONCURRENT THERAPY: More than 28 days since prior major surgery or open biopsy More than 7 days since prior fine-needle aspiration or core biopsy No prior antiangiogenesis agent (e.g., bevacizumab or an oral vascular endothelial growth factor receptor small molecule inhibitor) given together with an agent that disrupts epidermal growth factor receptor signaling (e.g., cetuximab or erlotinib hydrochloride) for locally advanced or metastatic pancreatic cancer Prior treatment with either one of the above alone allowed More than 4 weeks since prior and no concurrent participation in another clinical trial No other concurrent antineoplastic or antitumor agents, including chemotherapy, radiotherapy, immunotherapy, or hormonal anticancer therapy No concurrent major surgery No other concurrent investigational agents
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Andrew Ko, MD
Organizational Affiliation
University of California, San Francisco
Official's Role
Study Chair
Facility Information:
Facility Name
UCSF Helen Diller Family Comprehensive Cancer Center
City
San Francisco
State/Province
California
ZIP/Postal Code
94115
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
20130876
Citation
Ko AH, Venook AP, Bergsland EK, Kelley RK, Korn WM, Dito E, Schillinger B, Scott J, Hwang J, Tempero MA. A phase II study of bevacizumab plus erlotinib for gemcitabine-refractory metastatic pancreatic cancer. Cancer Chemother Pharmacol. 2010 Nov;66(6):1051-7. doi: 10.1007/s00280-010-1257-5. Epub 2010 Feb 4.
Results Reference
result
Citation
Ko AH, Dito E, Schillinger B, et al.: A phase II study of bevacizumab (BEV) and erlotinib (ERL) in patients with gemcitabine (GEM)-refractory metastatic adenocarcinoma of the pancreas (PanCa). [Abstract] American Society of Clinical Oncology 2007 Gastrointestinal Cancers Symposium, 19 -21 January 2007, Orlando, Florida A-187, 2007.
Results Reference
result

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Bevacizumab and Erlotinib in Treating Patients With Metastatic Pancreatic Cancer That Did Not Respond to Previous Treatment With Gemcitabine

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