Efficacy of Rechallenge With Sunitinib in Metastatic Pancreatic Neuroendocrine Tumor Previously Failed to Sunitinib (RESUNET)
Primary Purpose
Pancreatic Neuroendocrine Tumour Metastatic
Status
Completed
Phase
Phase 2
Locations
Spain
Study Type
Interventional
Intervention
Sunitinib
Sponsored by
About this trial
This is an interventional treatment trial for Pancreatic Neuroendocrine Tumour Metastatic focused on measuring Sunitinib
Eligibility Criteria
Inclusion Criteria:
- Subjects > 18 years old and able to give their informed consent.
- Patients diagnosed with Neuroendocrine Tumor of pancreatic origin and histologically confirmed, G1/2 according to the World Health Organization (WHO) classification (Ki67 <20% and/or mitotic count >20 mitoses x 10 HPF).
- Metastatic disease progression in the 12 months prior to baseline visit documented by CT, MRI or Octreoscan.
- Progression to prior treatment with sunitinib administered for metastatic disease and have received at least 1 line and no more than 2 lines of subsequent systemic treatment.
- Measurable disease according to the following criteria RECIST version 1.1
- No disease that can be treated with surgery, radiotherapy or combined treatment with curative intent.
- Eastern Cooperative Oncology Group (ECOG) 0-2.
- Pretreatment with somatostatin analogues, chemotherapy, anti-VEGF (vascular endothelial growth factor) and mTOR (mammalian target of rapamycin) inhibitors prior to participation in the study is allowed.
- Adequately controlled blood pressure (BP) <150/90 mmHg.
- Hematologic Function: - Absolute neutrophil count >1500 / microliter (uL) - Platelets >100,000 / uL - Hemoglobin >5.6 mmol / L (9 g / dL)
- Liver function: total bilirubin < 1.5 x upper limit of normal (ULN), unless unconjugated hyperbilirubinemia or Gilbert syndrome. - Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) < 2.5 x ULN (< 5 times in case of liver metastases).
- Renal function: calculated creatinine clearance according to Cockcroft-Gault > 30 ml / min.
- Blood coagulation: prothrombin time (PT) or International Normalized Ratio (INR) < 1.2 x ULN.
- Proteinuria <2+ urine dipstick. If > 2+ proteinuria, urinary protein <1 g / 24 h.
- Life expectancy> 3 months.
- Patient able to swallow the study drug and comply with the monitoring requirements of the study. - Women of childbearing potential must present a negative pregnancy test. Women of childbearing potential must agree to use contraception.
- Men whose partners are women of childbearing potential must use effective contraception.
Exclusion Criteria:
- Neuroendocrine tumors of pancreatic origin G3 according to WHO classification.
- Patients who received 3 or more lines of systemic treatment.
- Major surgery or trauma within 4 weeks prior to the first dose of sunitinib.
- Radiation therapy or tumor embolization within 2 weeks prior to the first dose of sunitinib.
- Chemotherapy, immunotherapy, biologic therapy or investigational therapy within the previous 2 weeks or 5 half-lives of the drug last received before the start of the first dose of sunitinib treatment.
- Prior treatment with high-dose chemotherapy that required hematopoietic rescue.
- Immunosuppressive therapy or prolonged treatment with corticosteroids concomitantly administered in the previous 3 months.
- Resolution to grade <2 (CTCAE according V4.03) of all previous related toxicities except alopecia treatments.
- Any ongoing toxicity from prior anti-cancer therapy that is >Grade 1 (according CTCAE V4.03) and/or that is progressing in severity, except alopecia.
- Treatment with potent inhibitors or inducers of CYP3A4 or known to prolong the QT interval in the previous 7 days.
- Prior radiotherapy to more than 25% of the bone marrow - Presence of uncontrolled metastatic brain disease, spinal cord compression, meningeal carcinomatosis or leptomeningeal disease.
- Any gastrointestinal malabsorption disorder or any other condition that, at investigator's criteria, may affect the absorption of sunitinib or increase the risk of bleeding or perforation.
- Presence of any non-healing wound or ulcer.
- Grade III/IV diarrhea in the screening period.
- Diagnosis of any second malignancy within the last 5 years, except for adequately treated basal cell or squamous cell skin cancer, or in situ carcinoma of the cervix uteri.
- Clinically significant cardio/cerebrovascular disease in the 6 months prior to treatment.
- Cardiac arrhythmias (NCI CTCAE version 4.0 grade >2), atrial fibrillation of any grade that requires medical treatment.
- Corrected QT interval (QTcF) > 180 msec.
- Active hemoptysis in the past 6 weeks.
- Evidence of active bleeding or bleeding diathesis.
- Presence of endobronchial lesions and/or lesions that infiltrate large vessels.
- Current treatment with acenocoumarol at therapeutic doses.
- Known HIV infection.
- Presence of uncontrolled active infection.
- Pregnant or breastfeeding women.
- Previous allergic reaction to components structurally similar to sunitinib or any of the excipients.
- Inability to discontinue any prohibited concomitant medication.
- Any illness (medical or psychiatric) or reason, in the investigator's opinion, that interferes with the patient's ability to participate.
Sites / Locations
- Hospital Universitario Central de Asturias
- Hospital Universitario Valle de Hebrón
- Hospital Reina Sofía
- Hospital Universitario Donostia
- Hospital Ramón y Cajal
- Hospital Universitario 12 de Octubre
- Hospital General Universitario J.M. Morales Meseguer
- Complejo Hospitalario Regional Virgen Del Rocío
- Instituto Valenciano de Oncología
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Sunitinib
Arm Description
Sunitinib 37.5 mg/day
Outcomes
Primary Outcome Measures
6 months progression free survival
Time form start of treatment to progression disease
Secondary Outcome Measures
Overall survival
Time form start of treatment to death
Progression free survival
Time form start of treatment to progression disease
Response duration
Time from first response to progression disease
Overall response rate
Complete response + partial response
Incidence of Adverse Events
Number of adverse events per patient
Full Information
NCT ID
NCT02713763
First Posted
March 16, 2016
Last Updated
March 3, 2020
Sponsor
Grupo Espanol de Tumores Neuroendocrinos
Collaborators
Pfizer, Apices Soluciones S.L.
1. Study Identification
Unique Protocol Identification Number
NCT02713763
Brief Title
Efficacy of Rechallenge With Sunitinib in Metastatic Pancreatic Neuroendocrine Tumor Previously Failed to Sunitinib
Acronym
RESUNET
Official Title
Phase II Study to Evaluate Efficacy of Rechallenge With Sunitinib in Patients With Metastatic Pancreatic Neuroendocrine Tumor (pNETs) Well Differentiated G1/2 Advanced or Metastatic Who Previously Failed to Sunitinib.
Study Type
Interventional
2. Study Status
Record Verification Date
March 2020
Overall Recruitment Status
Completed
Study Start Date
February 14, 2017 (Actual)
Primary Completion Date
October 23, 2019 (Actual)
Study Completion Date
October 23, 2019 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Grupo Espanol de Tumores Neuroendocrinos
Collaborators
Pfizer, Apices Soluciones S.L.
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
The therapeutic goals in the management of pancreatic neuroendocrine tumors (pNET) are the control of symptoms and tumor growth control in order to improve patient survival.
In recent years, data from two phase III studies with targeted therapies, sunitinib and everolimus, have broadened the possibilities for treatment of patients with neuroendocrine tumors of the pancreas.
Unfortunately, patients progress and development of new active drugs and evaluating the best treatment approach is decisive.
Given the lack of data comparing the activity of different treatment strategies, final decisions are based on medical experience and consensus of experts. In this context, different questions are still unanswered, as which is the best sequence of treatment and if all patients can benefit from all available drugs.
Neuroendocrine pancreatic tumors are highly vascularized tumors in which cells may be dependent on this pathway for growth throughout the entire history of the tumor and in which inhibition of this pathway is crucial. On the other hand, this aspect has not been endorsed by the population of patients with pNET who have previously failed treatment with sunitinib.
In this scenario the investigators will assess retreatment with sunitinib to evaluate the activity of this drug in the context of therapeutic rescue in patients with metastatic pNET.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pancreatic Neuroendocrine Tumour Metastatic
Keywords
Sunitinib
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
11 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Sunitinib
Arm Type
Experimental
Arm Description
Sunitinib 37.5 mg/day
Intervention Type
Drug
Intervention Name(s)
Sunitinib
Other Intervention Name(s)
Sutent
Intervention Description
Sunitinib 37.5 mg/day
Primary Outcome Measure Information:
Title
6 months progression free survival
Description
Time form start of treatment to progression disease
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Overall survival
Description
Time form start of treatment to death
Time Frame
2 years
Title
Progression free survival
Description
Time form start of treatment to progression disease
Time Frame
12 months
Title
Response duration
Description
Time from first response to progression disease
Time Frame
12 months
Title
Overall response rate
Description
Complete response + partial response
Time Frame
12 months
Title
Incidence of Adverse Events
Description
Number of adverse events per patient
Time Frame
12 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Subjects > 18 years old and able to give their informed consent.
Patients diagnosed with Neuroendocrine Tumor of pancreatic origin and histologically confirmed, G1/2 according to the World Health Organization (WHO) classification (Ki67 <20% and/or mitotic count >20 mitoses x 10 HPF).
Metastatic disease progression in the 12 months prior to baseline visit documented by CT, MRI or Octreoscan.
Progression to prior treatment with sunitinib administered for metastatic disease and have received at least 1 line and no more than 2 lines of subsequent systemic treatment.
Measurable disease according to the following criteria RECIST version 1.1
No disease that can be treated with surgery, radiotherapy or combined treatment with curative intent.
Eastern Cooperative Oncology Group (ECOG) 0-2.
Pretreatment with somatostatin analogues, chemotherapy, anti-VEGF (vascular endothelial growth factor) and mTOR (mammalian target of rapamycin) inhibitors prior to participation in the study is allowed.
Adequately controlled blood pressure (BP) <150/90 mmHg.
Hematologic Function: - Absolute neutrophil count >1500 / microliter (uL) - Platelets >100,000 / uL - Hemoglobin >5.6 mmol / L (9 g / dL)
Liver function: total bilirubin < 1.5 x upper limit of normal (ULN), unless unconjugated hyperbilirubinemia or Gilbert syndrome. - Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) < 2.5 x ULN (< 5 times in case of liver metastases).
Renal function: calculated creatinine clearance according to Cockcroft-Gault > 30 ml / min.
Blood coagulation: prothrombin time (PT) or International Normalized Ratio (INR) < 1.2 x ULN.
Proteinuria <2+ urine dipstick. If > 2+ proteinuria, urinary protein <1 g / 24 h.
Life expectancy> 3 months.
Patient able to swallow the study drug and comply with the monitoring requirements of the study. - Women of childbearing potential must present a negative pregnancy test. Women of childbearing potential must agree to use contraception.
Men whose partners are women of childbearing potential must use effective contraception.
Exclusion Criteria:
Neuroendocrine tumors of pancreatic origin G3 according to WHO classification.
Patients who received 3 or more lines of systemic treatment.
Major surgery or trauma within 4 weeks prior to the first dose of sunitinib.
Radiation therapy or tumor embolization within 2 weeks prior to the first dose of sunitinib.
Chemotherapy, immunotherapy, biologic therapy or investigational therapy within the previous 2 weeks or 5 half-lives of the drug last received before the start of the first dose of sunitinib treatment.
Prior treatment with high-dose chemotherapy that required hematopoietic rescue.
Immunosuppressive therapy or prolonged treatment with corticosteroids concomitantly administered in the previous 3 months.
Resolution to grade <2 (CTCAE according V4.03) of all previous related toxicities except alopecia treatments.
Any ongoing toxicity from prior anti-cancer therapy that is >Grade 1 (according CTCAE V4.03) and/or that is progressing in severity, except alopecia.
Treatment with potent inhibitors or inducers of CYP3A4 or known to prolong the QT interval in the previous 7 days.
Prior radiotherapy to more than 25% of the bone marrow - Presence of uncontrolled metastatic brain disease, spinal cord compression, meningeal carcinomatosis or leptomeningeal disease.
Any gastrointestinal malabsorption disorder or any other condition that, at investigator's criteria, may affect the absorption of sunitinib or increase the risk of bleeding or perforation.
Presence of any non-healing wound or ulcer.
Grade III/IV diarrhea in the screening period.
Diagnosis of any second malignancy within the last 5 years, except for adequately treated basal cell or squamous cell skin cancer, or in situ carcinoma of the cervix uteri.
Clinically significant cardio/cerebrovascular disease in the 6 months prior to treatment.
Cardiac arrhythmias (NCI CTCAE version 4.0 grade >2), atrial fibrillation of any grade that requires medical treatment.
Corrected QT interval (QTcF) > 180 msec.
Active hemoptysis in the past 6 weeks.
Evidence of active bleeding or bleeding diathesis.
Presence of endobronchial lesions and/or lesions that infiltrate large vessels.
Current treatment with acenocoumarol at therapeutic doses.
Known HIV infection.
Presence of uncontrolled active infection.
Pregnant or breastfeeding women.
Previous allergic reaction to components structurally similar to sunitinib or any of the excipients.
Inability to discontinue any prohibited concomitant medication.
Any illness (medical or psychiatric) or reason, in the investigator's opinion, that interferes with the patient's ability to participate.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Enrique Grande
Organizational Affiliation
MD Anderson Cancer Center MADRID
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hospital Universitario Central de Asturias
City
Oviedo
State/Province
Asturias
ZIP/Postal Code
33011
Country
Spain
Facility Name
Hospital Universitario Valle de Hebrón
City
Barcelona
ZIP/Postal Code
08035
Country
Spain
Facility Name
Hospital Reina Sofía
City
Córdoba
ZIP/Postal Code
14004
Country
Spain
Facility Name
Hospital Universitario Donostia
City
Donostia/San Sebastián
ZIP/Postal Code
20014
Country
Spain
Facility Name
Hospital Ramón y Cajal
City
Madrid
ZIP/Postal Code
28034
Country
Spain
Facility Name
Hospital Universitario 12 de Octubre
City
Madrid
ZIP/Postal Code
28041
Country
Spain
Facility Name
Hospital General Universitario J.M. Morales Meseguer
City
Murcia
ZIP/Postal Code
30008
Country
Spain
Facility Name
Complejo Hospitalario Regional Virgen Del Rocío
City
Sevilla
ZIP/Postal Code
41013
Country
Spain
Facility Name
Instituto Valenciano de Oncología
City
Valencia
ZIP/Postal Code
46009
Country
Spain
12. IPD Sharing Statement
Learn more about this trial
Efficacy of Rechallenge With Sunitinib in Metastatic Pancreatic Neuroendocrine Tumor Previously Failed to Sunitinib
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