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Regorafenib in Patients With Metastatic and/or Unresectable Gastrointestinal Stromal Tumor

Primary Purpose

Gastrointestinal Stromal Tumor

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
regorafenib
Sponsored by
Suzanne George, MD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Gastrointestinal Stromal Tumor focused on measuring regorafenib, GIST

Eligibility Criteria

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

Inclusion Criteria:

  • At least 18 years of age at the time of study entry
  • Histologically confirmed metastatic and/or unresectable GIST with prior failure of both conventional tyrosine kinase inhibitors, imatinib and sunitinib.
  • Measurable disease per RECIST 1.1. A lesion in a previously irradiated area is eligible to be considered as measurable disease as long as there is objective evidence of progression of the lesion.
  • ECOG Performance Status 0 or 1
  • Adequate organ and marrow function as outlined in the protocol
  • Fully recovered from the acute effects of prior cancer therapy before initiation of study drug
  • Patients must be suitable for oral drug administration
  • Willingness to use effective means of birth control throughout the duration of clinical study and for at least 3 months after completion of study drug
  • Women of childbearing potential must have a negative pregnancy test performed within 7 days of the start of study drug administration

Exclusion Criteria:

  • Use of any unapproved tyrosine kinase inhibitors or investigational agents within 2 weeks or 6 half-lives of the agent, whichever is shorter, prior to receiving study drug
  • Participants who have had radiotherapy within 4 weeks prior to study entry
  • Major surgery, or significant traumatic injury within 4 weeks prior to study entry
  • Presence of symptomatic or uncontrolled brain or central nervous system metastases
  • Prior exposure to sorafenib
  • Prior exposure to regorafenib
  • Known or suspected allergy to the investigational agent or any agent given in association with this trial
  • Individuals with a history of a different malignancy, other than cervical cancer in situ, basal cell or squamous cell carcinoma of the skin, are ineligible, except if they have been disease-free for at least 5 years, and are deemed by the investigator to be at low risk for recurrence of that malignancy or other primary malignancy is neither currently clinically significant nor requiring active intervention
  • Clinically significant cardiac arrhythmias and/or patients who require anti-arrhythmic therapy (excluding beta blockers or digoxin)
  • History of clinically significant cardiac disease or congestive heart failure > NYHA class 2. Patients must not have unstable angina or new-onset angina within the last 3 months or myocardial infarction within the past 6 months
  • Hypertension as defined by systolic blood pressure 140-159 mmHg or diastolic blood pressure 90-99 mmHg; recurrent or persistent or symptomatic increase by > 20 mmHg (diastolic) or to systolic blood pressure greater than 140 mmHg or diastolic blood pressure greater than 90 mmHg if previously within normal limits, despite optimal medical management
  • Arterial or venous thrombotic or embolic events such as cerebrovascular accident (including transient ischemic attacks), deep vein thrombosis or pulmonary embolism within the 6 months before start of study medication
  • Ongoing infection of Grade 3 or higher
  • Patients with evidence of, or history of, bleeding diathesis. Any major hemorrhage or bleeding event of Grade 3 or higher within 4 weeks of start of study medication
  • Non-healing wound, ulcer or bone fracture
  • Renal failure requiring hemo-or peritoneal dialysis
  • Dehydration of Grade 2 or greater
  • Persistent proteinuria Grade 3 or higher
  • Known history of HIV infection or chronic hepatitis B or C
  • Uncontrolled intercurrent illness
  • Pregnant or lactating females

Sites / Locations

  • Massachusetts General Hospital
  • Dana-Farber Cancer Institute
  • Oregon Health Sciences University
  • Fox Chase Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Regorafenib

Arm Description

Regorafenib adminstered orally, 160 mg per day on days 1 through 21 of a 28 day cycle

Outcomes

Primary Outcome Measures

Clinical Benefit as Defined by the Composite of Complete Response, Partial Response and Stable Disease Lasting 16 Weeks or More Per RECIST 1.1 as a Measure of Disease Control
The composite of complete response, partial response, and stable disease lasting 16 weeks or more per RECIST 1.1 as a measure of disease control. This is for target lesions. Complete response is disappearance of all target lesions and partial response is >+30% decrease in the sum of the longest diameter of target lesions. Stable disease is neither shrinkage by greater than or equal to 30% of the sum of the longest diameter of target lesions or the increase of lesions by greater than or equal to 20% of the sum of the longest diameter of target lesions. Progressive disease is considered an increase of the sum of the longest diameter of target lesions by greater than or equal to 20%.

Secondary Outcome Measures

Progression-free Survival (PFS)
Progression-free survival is defined as the duration of time from start of study drug administration to time of objective disease progression or death due to any cause, whichever comes first. Progression is evaluated every 8 weeks using Response Criteria for Solid Tumors (RECIST) 1.1. Objective disease progression is defined as a 20% increase in the sum of the longest diameter of target lesion(s).

Full Information

First Posted
February 12, 2010
Last Updated
August 7, 2020
Sponsor
Suzanne George, MD
Collaborators
Brigham and Women's Hospital, Massachusetts General Hospital, Fox Chase Cancer Center, Oregon Health and Science University, Bayer
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1. Study Identification

Unique Protocol Identification Number
NCT01068769
Brief Title
Regorafenib in Patients With Metastatic and/or Unresectable Gastrointestinal Stromal Tumor
Official Title
A Multi-center Phase II Study Evaluating the Efficacy and Safety of Regorafenib in Patients With Metastatic and/or Unresectable Gastrointestinal Stromal Tumor (GIST), Resistent or Intolerant to at Least Imatinib and Sunitinib
Study Type
Interventional

2. Study Status

Record Verification Date
August 2020
Overall Recruitment Status
Completed
Study Start Date
February 2010 (Actual)
Primary Completion Date
June 2012 (Actual)
Study Completion Date
August 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Suzanne George, MD
Collaborators
Brigham and Women's Hospital, Massachusetts General Hospital, Fox Chase Cancer Center, Oregon Health and Science University, Bayer

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this research study is to determine the safety and activity of regorafenib in participants with advanced gastrointestinal stromal tumor (GIST) if the standard approved therapies, imatinib and sunitinib, have failed to control the disease. Regorafenib is a drug that blocks abnormally active signaling enzymes called "tyrosine kinases" which are important to the growth of GIST. This "tyrosine kinase inhibition" is similar to the way that both imatinib and sunitinib work; however, regorafenib blocks certain additional signaling pathways that are not blocked by imatinib or sunitinib. Regorafenib has been not been tested in GIST participants before this research study.
Detailed Description
In this research study, each planned "cycle" of the study lasts 4 weeks. In the first cycle, participants will come to the clinic on Days 1, 15 and 16. For cycles 2 through 4, they will come to the clinic on Days 1 and 15 of each cycle. For cycle 5 and beyond, they will come to the clinic on Day 1 of each cycle. Repeat tumor imaging will be performed at the end of every 2 cycles during study drug administration (e.g. end of cycles 2, 4, 6, etc.) During each cycle, participants will take regorafenib by mouth, once a day in the morning, for 3 weeks followed by one week during which you do not take regorafenib (the "rest period"). FDG-PET/CT (Positron Emission Tomography) scans are required as part of this study to monitor effects of the study drug on the participant's GIST. The first scan will take place before the first dose of study drug. If the first scan shows that the "tracer sugar" collection is increased in the participant's GIST, they will have up to 5 additional scans performed at different time points throughout their participation in this research study. Participants may continue to participate in this research study for as long as they do not have serious side effects or their disease does not get worse.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Gastrointestinal Stromal Tumor
Keywords
regorafenib, GIST

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Regorafenib
Arm Type
Experimental
Arm Description
Regorafenib adminstered orally, 160 mg per day on days 1 through 21 of a 28 day cycle
Intervention Type
Drug
Intervention Name(s)
regorafenib
Other Intervention Name(s)
Stivarga
Intervention Description
Taken orally, once a day in the morning for 3 weeks followed by a one week rest period
Primary Outcome Measure Information:
Title
Clinical Benefit as Defined by the Composite of Complete Response, Partial Response and Stable Disease Lasting 16 Weeks or More Per RECIST 1.1 as a Measure of Disease Control
Description
The composite of complete response, partial response, and stable disease lasting 16 weeks or more per RECIST 1.1 as a measure of disease control. This is for target lesions. Complete response is disappearance of all target lesions and partial response is >+30% decrease in the sum of the longest diameter of target lesions. Stable disease is neither shrinkage by greater than or equal to 30% of the sum of the longest diameter of target lesions or the increase of lesions by greater than or equal to 20% of the sum of the longest diameter of target lesions. Progressive disease is considered an increase of the sum of the longest diameter of target lesions by greater than or equal to 20%.
Time Frame
2 years
Secondary Outcome Measure Information:
Title
Progression-free Survival (PFS)
Description
Progression-free survival is defined as the duration of time from start of study drug administration to time of objective disease progression or death due to any cause, whichever comes first. Progression is evaluated every 8 weeks using Response Criteria for Solid Tumors (RECIST) 1.1. Objective disease progression is defined as a 20% increase in the sum of the longest diameter of target lesion(s).
Time Frame
From date of enrollment until date of first documented progression or date of death from any cause, whichever came first

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: At least 18 years of age at the time of study entry Histologically confirmed metastatic and/or unresectable GIST with prior failure of both conventional tyrosine kinase inhibitors, imatinib and sunitinib. Measurable disease per RECIST 1.1. A lesion in a previously irradiated area is eligible to be considered as measurable disease as long as there is objective evidence of progression of the lesion. ECOG Performance Status 0 or 1 Adequate organ and marrow function as outlined in the protocol Fully recovered from the acute effects of prior cancer therapy before initiation of study drug Patients must be suitable for oral drug administration Willingness to use effective means of birth control throughout the duration of clinical study and for at least 3 months after completion of study drug Women of childbearing potential must have a negative pregnancy test performed within 7 days of the start of study drug administration Exclusion Criteria: Use of any unapproved tyrosine kinase inhibitors or investigational agents within 2 weeks or 6 half-lives of the agent, whichever is shorter, prior to receiving study drug Participants who have had radiotherapy within 4 weeks prior to study entry Major surgery, or significant traumatic injury within 4 weeks prior to study entry Presence of symptomatic or uncontrolled brain or central nervous system metastases Prior exposure to sorafenib Prior exposure to regorafenib Known or suspected allergy to the investigational agent or any agent given in association with this trial Individuals with a history of a different malignancy, other than cervical cancer in situ, basal cell or squamous cell carcinoma of the skin, are ineligible, except if they have been disease-free for at least 5 years, and are deemed by the investigator to be at low risk for recurrence of that malignancy or other primary malignancy is neither currently clinically significant nor requiring active intervention Clinically significant cardiac arrhythmias and/or patients who require anti-arrhythmic therapy (excluding beta blockers or digoxin) History of clinically significant cardiac disease or congestive heart failure > NYHA class 2. Patients must not have unstable angina or new-onset angina within the last 3 months or myocardial infarction within the past 6 months Hypertension as defined by systolic blood pressure 140-159 mmHg or diastolic blood pressure 90-99 mmHg; recurrent or persistent or symptomatic increase by > 20 mmHg (diastolic) or to systolic blood pressure greater than 140 mmHg or diastolic blood pressure greater than 90 mmHg if previously within normal limits, despite optimal medical management Arterial or venous thrombotic or embolic events such as cerebrovascular accident (including transient ischemic attacks), deep vein thrombosis or pulmonary embolism within the 6 months before start of study medication Ongoing infection of Grade 3 or higher Patients with evidence of, or history of, bleeding diathesis. Any major hemorrhage or bleeding event of Grade 3 or higher within 4 weeks of start of study medication Non-healing wound, ulcer or bone fracture Renal failure requiring hemo-or peritoneal dialysis Dehydration of Grade 2 or greater Persistent proteinuria Grade 3 or higher Known history of HIV infection or chronic hepatitis B or C Uncontrolled intercurrent illness Pregnant or lactating females
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Suzanne George, MD
Organizational Affiliation
Dana-Farber Cancer Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Facility Name
Dana-Farber Cancer Institute
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Facility Name
Oregon Health Sciences University
City
Portland
State/Province
Oregon
ZIP/Postal Code
97239
Country
United States
Facility Name
Fox Chase Cancer Center
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19111
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
27371698
Citation
Ben-Ami E, Barysauskas CM, von Mehren M, Heinrich MC, Corless CL, Butrynski JE, Morgan JA, Wagner AJ, Choy E, Yap JT, Van den Abbeele AD, Solomon SM, Fletcher JA, Demetri GD, George S. Long-term follow-up results of the multicenter phase II trial of regorafenib in patients with metastatic and/or unresectable GI stromal tumor after failure of standard tyrosine kinase inhibitor therapy. Ann Oncol. 2016 Sep;27(9):1794-9. doi: 10.1093/annonc/mdw228. Epub 2016 Jul 1.
Results Reference
derived

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Regorafenib in Patients With Metastatic and/or Unresectable Gastrointestinal Stromal Tumor

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