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Phase I Clinical and Pharmacokinetic Study of Pazopanib in a Population of Frail Elderly Patients According SIOG Criteria (VOTRAGE)

Primary Purpose

Metastatic Cancer (Different Solid Tumour Types)

Status
Terminated
Phase
Phase 1
Locations
France
Study Type
Interventional
Intervention
Pazopanib
Sponsored by
Institut Claudius Regaud
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Cancer (Different Solid Tumour Types) focused on measuring Phase I, Pazopanib, Frail elderly patients, Pharmacokinetics

Eligibility Criteria

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

Inclusion Criteria:

  1. Subjects must provide written informed consent prior to performance of study-specific procedures or assessments, and must be willing to comply with treatment and follow up.
  2. Age ≥ to 75 years old
  3. Patient with metastatic cancer among renal cell carcinoma, non small cell lung cancer, pancreatic neuroendocrine cancer, sarcoma , ovarian cancer , thyroid cancer, bladder cancer or breast cancers, who cannot receive any treatment with curative intent.
  4. WHO PS ≤ 2,
  5. Life expectancy ≥ 3 months,
  6. Group 2 (vulnerable) according to SIOG classification,
  7. Adequate organ system function as defined in provided Table

Exclusion Criteria:

  1. Patient with a history of a prior malignancy with the exception of cervical intraepithelial neoplasia; basal cell carcinoma of the skin; adequately treated localized prostate carcinoma with PSA <1.0; or who has undergone potentially curative therapy with no evidence of that disease for five years, and who is deemed at low risk for recurrence by his/her treating physician,
  2. History or clinical evidence of central nervous system (CNS) metastases or leptomeningeal carcinomatosis, except for individuals who have previously-treated CNS metastases, are asymptomatic, and have had no requirement for steroids or anti-seizure medication for 6 months prior to first dose of study drug.
  3. Criteria of group 3 according to SIOG classification,
  4. Clinically significant gastrointestinal abnormalities that may increase the risk for gastrointestinal bleeding including, but not limited to:

    •Active peptic ulcer disease

    •Known intraluminal metastatic lesion/s with risk of bleeding

    •Inflammatory bowel disease (e.g. ulcerative colitis, crohn's disease), or other gastrointestinal conditions with increased risk of perforation

    •History of abdominal fistula, gastrointestinal perforation, or intra abdominal abscess within 28 days prior to beginning study treatment.

  5. Clinically significant gastrointestinal abnormalities that may affect absorption of investigational product including, but not limited to:

    •Malabsorption syndrome

    •Major resection of the stomach or small bowel.

  6. Presence of uncontrolled infection.
  7. Corrected QT interval (QTc) > 480 msecs using Bazett's formula
  8. Anti-coagulants treatment (preventive or curative)
  9. History of any one or more of the following cardiovascular conditions within the past 6 months:

    • Cardiac angioplasty or stenting

    • Myocardial infarction

    • Unstable angina

    • Coronary artery bypass graft surgery

    • Symptomatic peripheral vascular disease
    • Class III or IV congestive heart failure, as defined by the New York Heart Association (NYHA)
  10. Poorly controlled hypertension
  11. History of cerebrovascular accident including transient ischemic attack (TIA), pulmonary embolism or untreated deep venous thrombosis (DVT) within the past 6 months.
  12. Prior major surgery or trauma within 28 days prior to first dose of study drug and/or presence of any non-healing wound, fracture, or ulcer
  13. Evidence of active bleeding or bleeding diathesis.

14 Known endobronchial lesions and/or lesions infiltrating major pulmonary vessels

15. Hemoptysis in excess of 2.5 mL (or one half teaspoon) within 8 weeks of first dose of study drug.

16. Any serious and/or unstable pre-existing medical, psychiatric, or other condition that could interfere with subject's safety, provision of informed consent, or compliance to study procedures.

17. Unable or unwilling to discontinue use of prohibited medications list in Appendix 7 for at least 14 days or five half-lives of a drug (whichever is longer) prior to the first dose of study drug and for the duration of the study

18. Treatment with any of the following anti-cancer therapies:

  • radiation therapy, surgery or tumor embolization within 14 days prior to the first dose of pazopanib OR
  • chemotherapy, immunotherapy, biologic therapy, investigational therapy or hormonal therapy within 14 days or five half-lives of a drug (whichever is longer) prior to the first dose of pazopanib

    19. Any ongoing toxicity from prior anti-cancer therapy that is >Grade 1 and/or that is progressing in severity, except alopecia.

    20. Patient not affiliated with social system in France.

    21. Patient deprived of liberty or under guardianship

Sites / Locations

  • Hôpital Saint André
  • Centre François BACLESSE
  • Centre Léon BERARD
  • Institut Claudius REGAUD

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Pazopanib

Arm Description

Pazopanib : 3 dose levels are defined : 400, 600 and 800 mg per day.

Outcomes

Primary Outcome Measures

Dose limiting toxicity (DLT) incidence (according DLT definition) during the first treatment cycle with pazopanib (28 days)
The MTD (Maximum Tolerated Dose) is defined as the highest dose level for which 6 patients were treated with a maximum of 1 patient presenting a DLT during the first cycle of treatment

Secondary Outcome Measures

Safety and tolerability assessments using the descriptions and grading scales found in the CTCAE (Common Terminology Criteria for Adverse Events) version 4.0 NCI
Measure of Pazopanib plasma concentration during treatment period (objective : assessment of pharmacokinetics of Pazopanib in this population)
Plasma concentrations of pazopanib will be determined using a validated LC-MS-MS method -
Geriatric criteria measured by comprehensive geriatric assessment which evaluate medical, functional and psychosocial aspects of elderly patients
The impact of treatment on the geriatric assessment will be done using : G8 : screening test ADL: Activities Daily Living IADL: Instrumental Activities Daily Living MMSE: Mini-mental State Examination SPPB: Short Physical Performance Battery MNA: Mini-nutritional Assessment CAM: Confusion Assessment Method GDS-15: Geriatric Depression Scale CIRS-G: Cumulative Illness Rating Scale for Geriatrics,
Rate of objective response according to RECIST criteria
Tumor assessment will be performed at screening visit, every 2 cycles and at the end of study visit and anytime if clinically indicated

Full Information

First Posted
July 13, 2012
Last Updated
August 3, 2018
Sponsor
Institut Claudius Regaud
Collaborators
Novartis
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1. Study Identification

Unique Protocol Identification Number
NCT01642017
Brief Title
Phase I Clinical and Pharmacokinetic Study of Pazopanib in a Population of Frail Elderly Patients According SIOG Criteria
Acronym
VOTRAGE
Official Title
Phase I Clinical and Pharmacokinetic Study of Pazopanib in a Population of Frail Elderly Patients According SIOG Criteria
Study Type
Interventional

2. Study Status

Record Verification Date
August 2018
Overall Recruitment Status
Terminated
Why Stopped
Slow recruitment rate
Study Start Date
November 22, 2012 (Actual)
Primary Completion Date
September 2017 (Actual)
Study Completion Date
March 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Institut Claudius Regaud
Collaborators
Novartis

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This is an open-label, multicenter, non-randomized, phase 1 dose escalation clinical trial to determine the MTD (Maximal Tolerated Dose) of Pazopanib in a population of frail elderly patients, selected according to the International Society of Geriatric Oncology (SIOG)classification (Group 2). It is expected that a total number of 30 patients maximum will be enrolled in the study on 30 months : 18 months accrual - 12 months follow up. Eligible patients will be enrolled into a standard 3+3 design with a starting dose of Pazopanib administered orally at 400 mg per day, in 28-day cycles. Then, further dose levels will be explored. Toxicity of the schedule will be assessed during the first cycle. Patients will receive study medication until disease progression. After treatment discontinuation, patients will be followed during one year.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Cancer (Different Solid Tumour Types)
Keywords
Phase I, Pazopanib, Frail elderly patients, Pharmacokinetics

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
18 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Pazopanib
Arm Type
Experimental
Arm Description
Pazopanib : 3 dose levels are defined : 400, 600 and 800 mg per day.
Intervention Type
Drug
Intervention Name(s)
Pazopanib
Intervention Description
Pazopanib will be administered orally at the starting dose of 400 mg/day in 28-days cycles ; barring limiting toxicities the dose of pazopanib will escalate in several steps (a maximum of 3 dose levels are defined : 400, 600 and 800 mg/day). The pazopanib will be administered at the same dosa until disease progression.
Primary Outcome Measure Information:
Title
Dose limiting toxicity (DLT) incidence (according DLT definition) during the first treatment cycle with pazopanib (28 days)
Description
The MTD (Maximum Tolerated Dose) is defined as the highest dose level for which 6 patients were treated with a maximum of 1 patient presenting a DLT during the first cycle of treatment
Time Frame
7.5 years
Secondary Outcome Measure Information:
Title
Safety and tolerability assessments using the descriptions and grading scales found in the CTCAE (Common Terminology Criteria for Adverse Events) version 4.0 NCI
Time Frame
7.5 years
Title
Measure of Pazopanib plasma concentration during treatment period (objective : assessment of pharmacokinetics of Pazopanib in this population)
Description
Plasma concentrations of pazopanib will be determined using a validated LC-MS-MS method -
Time Frame
.8 time points (cycle 1 Day 1), 3 time points (cycle 1 D15) and 1 pre dose time point each day 1 of the following cycles (over a period of 7.5 years for measures in all patients)
Title
Geriatric criteria measured by comprehensive geriatric assessment which evaluate medical, functional and psychosocial aspects of elderly patients
Description
The impact of treatment on the geriatric assessment will be done using : G8 : screening test ADL: Activities Daily Living IADL: Instrumental Activities Daily Living MMSE: Mini-mental State Examination SPPB: Short Physical Performance Battery MNA: Mini-nutritional Assessment CAM: Confusion Assessment Method GDS-15: Geriatric Depression Scale CIRS-G: Cumulative Illness Rating Scale for Geriatrics,
Time Frame
7.5 years
Title
Rate of objective response according to RECIST criteria
Description
Tumor assessment will be performed at screening visit, every 2 cycles and at the end of study visit and anytime if clinically indicated
Time Frame
7.5 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects must provide written informed consent prior to performance of study-specific procedures or assessments, and must be willing to comply with treatment and follow up. Age ≥ to 75 years old Patient with metastatic cancer among renal cell carcinoma, non small cell lung cancer, pancreatic neuroendocrine cancer, sarcoma , ovarian cancer , thyroid cancer, bladder cancer or breast cancers, who cannot receive any treatment with curative intent. WHO PS ≤ 2, Life expectancy ≥ 3 months, Group 2 (vulnerable) according to SIOG classification, Adequate organ system function as defined in provided Table Exclusion Criteria: Patient with a history of a prior malignancy with the exception of cervical intraepithelial neoplasia; basal cell carcinoma of the skin; adequately treated localized prostate carcinoma with PSA <1.0; or who has undergone potentially curative therapy with no evidence of that disease for five years, and who is deemed at low risk for recurrence by his/her treating physician, History or clinical evidence of central nervous system (CNS) metastases or leptomeningeal carcinomatosis, except for individuals who have previously-treated CNS metastases, are asymptomatic, and have had no requirement for steroids or anti-seizure medication for 6 months prior to first dose of study drug. Criteria of group 3 according to SIOG classification, Clinically significant gastrointestinal abnormalities that may increase the risk for gastrointestinal bleeding including, but not limited to: •Active peptic ulcer disease •Known intraluminal metastatic lesion/s with risk of bleeding •Inflammatory bowel disease (e.g. ulcerative colitis, crohn's disease), or other gastrointestinal conditions with increased risk of perforation •History of abdominal fistula, gastrointestinal perforation, or intra abdominal abscess within 28 days prior to beginning study treatment. Clinically significant gastrointestinal abnormalities that may affect absorption of investigational product including, but not limited to: •Malabsorption syndrome •Major resection of the stomach or small bowel. Presence of uncontrolled infection. Corrected QT interval (QTc) > 480 msecs using Bazett's formula Anti-coagulants treatment (preventive or curative) History of any one or more of the following cardiovascular conditions within the past 6 months: • Cardiac angioplasty or stenting • Myocardial infarction • Unstable angina • Coronary artery bypass graft surgery Symptomatic peripheral vascular disease Class III or IV congestive heart failure, as defined by the New York Heart Association (NYHA) Poorly controlled hypertension History of cerebrovascular accident including transient ischemic attack (TIA), pulmonary embolism or untreated deep venous thrombosis (DVT) within the past 6 months. Prior major surgery or trauma within 28 days prior to first dose of study drug and/or presence of any non-healing wound, fracture, or ulcer Evidence of active bleeding or bleeding diathesis. 14 Known endobronchial lesions and/or lesions infiltrating major pulmonary vessels 15. Hemoptysis in excess of 2.5 mL (or one half teaspoon) within 8 weeks of first dose of study drug. 16. Any serious and/or unstable pre-existing medical, psychiatric, or other condition that could interfere with subject's safety, provision of informed consent, or compliance to study procedures. 17. Unable or unwilling to discontinue use of prohibited medications list in Appendix 7 for at least 14 days or five half-lives of a drug (whichever is longer) prior to the first dose of study drug and for the duration of the study 18. Treatment with any of the following anti-cancer therapies: radiation therapy, surgery or tumor embolization within 14 days prior to the first dose of pazopanib OR chemotherapy, immunotherapy, biologic therapy, investigational therapy or hormonal therapy within 14 days or five half-lives of a drug (whichever is longer) prior to the first dose of pazopanib 19. Any ongoing toxicity from prior anti-cancer therapy that is >Grade 1 and/or that is progressing in severity, except alopecia. 20. Patient not affiliated with social system in France. 21. Patient deprived of liberty or under guardianship
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Loïc MOUREY, PhD
Organizational Affiliation
Institut Claudius Regaud
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hôpital Saint André
City
Bordeaux
ZIP/Postal Code
33075
Country
France
Facility Name
Centre François BACLESSE
City
Caen
ZIP/Postal Code
14076
Country
France
Facility Name
Centre Léon BERARD
City
Lyon
ZIP/Postal Code
69008
Country
France
Facility Name
Institut Claudius REGAUD
City
Toulouse
ZIP/Postal Code
31052
Country
France

12. IPD Sharing Statement

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Phase I Clinical and Pharmacokinetic Study of Pazopanib in a Population of Frail Elderly Patients According SIOG Criteria

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