Evaluating Efficacy of Tivozanib (AV-951) in Biliary Tract Cancers

This is an interventional treatment trial for Cholangiocarcinoma focused on measuring CCA, FOTIVDA, pan-vascular endothelial growth factor receptor (VEGFR) inhibitor, XPO7, Ste-20 like kinase (SLK) Read More

• INCLUSION CRITERIA:

  1. Patients with histologically or cytologically confirmed cholangiocarcinoma by the NCI Laboratory of Pathology. Archival tumor sample may be used but if archival tissue is not available or is not adequate, tissue biopsy will be required.
  2. Patients must have cholangiocarcinoma that is not amenable to resection.
  3. Patients must have had prior treatment with 1st line chemotherapy.
  4. Disease must be measurable by Response Evaluation Criteria in Solid Tumors (RECIST) criteria Version 1.1.

  5. Age >=18 years.

     NOTE: Because no dosing or adverse event data are currently available on the use of tivozanib in subjects < 18 years of age, children are excluded from this study, but may be eligible for future pediatric trials.

  6. ECOG performance status <= 1
  7. If the patient has liver disease; Child Pugh Class A.

  8. Adequate organ and marrow function as defined below:

     • Hemoglobin >= 9.0 g/dL
     • Absolute neutrophil count >= 1,000/mcL
     • Platelets >= 75,000/mcL
     • Total bilirubin <= 2 X institutional upper limit of normal (ULN)
     • AST(SGOT)/ALT(SGPT) <= 5 X institutional ULN
     • Creatinine clearance >= 60 mL/min/1.73 m^2 calculated by calculated using eGRF in the clinical lab
     • Serum Albumin (g/L) > 35

     • Alkaline phosphatase** <= 2.5 x ULN

       **unless bony metastases present

     • INR < 1.7

  9. Negative serum or urine pregnancy test at screening for women of childbearing potential (WOCBP).

     NOTE: WOCBP is defined as any female who has experienced menarche and who has not undergone successful surgical sterilization or who is not postmenopausal. WOCBP must have a negative pregnancy test (HCG blood or urine) during screening.

  10. Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and 1 month after completion of treatment.
  11. Ability of subject to understand and the willingness to sign a written informed consent document.
  12. Ability and willingness to co-enroll on the tissue collection protocol 13C0176, "Tumor, Normal Tissue and Specimens from Patients Undergoing Evaluation or Surgical Resection of Solid Tumors".

EXCLUSION CRITERIA:

1. Chemotherapy, small molecule or radiation therapy within 2 weeks prior to administration of first dose of study drug.
2. Prior treatment with Tivozanib.
3. Any history of elevations of both total serum bilirubin > 2X ULN AND AST or ALT > 3X ULN, unless related to common bile duct obstruction and treated adequately with a stent.
4. History of hepatic encephalopathy within past 12 months or requirement for medications to prevent or control encephalopathy (e.g., no lactulose, rifaximin, etc. if used for purposes of hepatic encephalopathy).
5. Inadequate recovery from any prior surgical procedure or major surgical procedure within 4 weeks prior to administration of first dose of study drug.
6. Patients with previous malignant disease other than the target malignancy within the last 3 years with the exception of basal or squamous cell carcinoma of the skin, cervical carcinoma in situ or thyroid carcinoma.
7. Current active second primary malignancy, other than skin carcinoma (basal or squamous cell carcinoma) or differentiated thyroid carcinoma.
8. History of allergic reactions or known or suspected hypersensitivity attributed to compounds of similar chemical or biologic composition to tivozanib.

9. Patients with uncontrolled intercurrent illness including, but not limited to, ongoing or active infection requiring systemic therapy (see exceptions below), or psychiatric illness/social situations that would limit compliance with study requirements

   • Human immunodeficiency virus (HIV)-infected patients on effective anti- retroviral therapy with undetectable viral load within 6 months are eligible for this trial.
   • For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable and on suppressive therapy, if indicated.
   • Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load.
10. Significant cardiovascular disease, including: Active clinically symptomatic left ventricular failure, uncontrolled hypertension, myocardial infarction, severe angina, or unstable angina within 6 months prior to administration of first dose of study drug, history of serious ventricular arrhythmia, cardiac arrhythmias requiring anti-arrhythmic medications.
11. Uncontrolled hypertension, i.e., blood pressure (BP) of >= 150/90 mmHg; patients who have a history of hypertension controlled by medication must be on a stable dose of antihypertensive therapy such that there has been no increase in hypertensive medications or dosage (for at least 30 days) and meet all other inclusion criteria.
12. Significant hematologic, gastrointestinal, thromboembolic, vascular, bleeding, or coagulation disorders.
13. GI Bleeding (e.g., esophageal varices or ulcer bleeding) within 12 months. (Note: For patients with a history of GI bleeding for more than 12 months or assessed as high risk for esophageal variceal by the Investigator, adequate endoscopic therapy according to institutional standards is required.)
14. Clinically meaningful ascites defined as ascites requiring non-pharmacologic intervention (e.g., paracentesis) to maintain symptomatic control, within 6 months prior to the first scheduled dose. Subjects on stable doses of diuretics for ascites for >= 2 months are eligible.
15. Main portal vein thrombosis (Vp4) as documented on imaging. (VP4 is defined as portal vein thrombosis in the main trunk of the portal vein or a portal vein branch contralateral to the primarily involved lobe (or both).)
16. Complex biliary obstruction requiring bile duct stents at more than one level of the biliary tree or external biliary drainage.
17. Recurrent episodes of cholangitis (>1) in the preceding 3 months prior to enrollment.
18. Therapeutic anti-coagulation or anti-platelet therapy with the exception of low molecular weight heparin or aspirin.
19. Pregnant or lactating women. Pregnant women are excluded from this study because based on findings in animals and its mechanism of action, tivozanib can cause fetal harm when administered to a pregnant woman. In animal reproduction studies, administration of tivozanib to pregnant rats caused adverse developmental outcomes including embryo- fetal mortality. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with tivozanib, breastfeeding should be discontinued if the mother is treated with tivozanib. These potential risks may also apply to other agents used in this study.

20. Treatment with systemic hormonal therapy within 3 weeks prior to start of protocol therapy, with the exception of:

    • Hormonal therapy for appetite stimulation or contraception
    • Nasal, ophthalmic, inhaled and topical steroid preparations
    • Oral replacement therapy for adrenal insufficiency
    • Low-dose maintenance steroid therapy (equivalent of prednisone 10 mg/day) for other conditions
    • Hormone replacement therapy