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AZD2171 in Treating Patients With Neurofibromatosis Type 1 and Plexiform Neurofibroma and/or Neurofibroma Near the Spine

Primary Purpose

Neurofibromatosis Type 1, Plexiform Neurofibroma, Spinal Cord Neurofibroma

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Cediranib Maleate
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Neurofibromatosis Type 1

Eligibility Criteria

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

Inclusion Criteria: Diagnosis* of neurofibromatosis type 1 (NF1) and extensive plexiform and/or paraspinal neurofibromasproducing pain (not controlled by use of over-the-counter medications), progressive neurologic deficit, or significant neurologic consequenceswith continuous tumor growth Extensive paraspinal neurofibroma defined as a neurofibroma that involves multiple neural roots at ≥ 3 spinal levels with connection between the levels or extending laterally along the nerves Symptomatic neurofibromas at < 3 spinal levels, but surgical treatment is not possible, allowed Meets ≥ 2 diagnostic criteria for NF1, including the following: Six or more café-au-lait spots (≥ 1.5 cm in postpubertal patients) Freckling in the axilla or groin Optic glioma Two or more Lisch nodules Distinctive bony lesion (dysplasia of the sphenoid bone or dysplasia orthinning of long-bone cortex) First-degree relative with NF1 Patients with documented mutation in neurofibromin gene with onlysymptomatic plexiform and/or paraspinal neurofibroma who do not fulfill the above clinical criteria are eligible Measurable disease, defined as ≥ 1 lesion whose longest diameter can beaccurately measured as 8.0 cm^3 with 3-dimensional (3D) MRI Skin lesions are consideredmeasurable (e.g., plexiform neurofibromas), but MRI imaging still required for 3D measurement Patients with symptomatic neurofibroma, in whom surgery is not feasible, who refuse surgery or are not goodsurgical candidates due to high risk of damage to vital structures or spinal cordinjury are eligible No evidence of progressive optic glioma, malignant glioma, malignant peripheralnerve sheath tumor, or other cancer requiring treatment with chemotherapy orradiotherapy ECOG performance status 0-3 WBC ≥ 3,000/mm^3 Absolute neutrophil count ≥ 1,500/mm^3 Platelet count ≥ 100,000/mm^3 Hemoglobin ≥ 8.0 g/dL Bilirubin normal (patients with Gilbert's syndrome allowed despite elevated bilirubin) Alkaline phosphatase normal AST and ALT ≤ 2.5 times upper limit of normal Thyroid-stimulating hormone and free thyroxin normal Creatinine normal OR creatinine clearance ≥ 60 mL/min Ejection fraction ≥ 50% by echocardiogram Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No other uncontrolled, serious medical condition that would preclude study participation, including any of the following: Cardiac arrhythmia Diabetes Serious infection Significant cardiac, pulmonary, hepatic, or other organ dysfunction No psychiatric illness or social situation that would preclude study compliance No history of allergic reactions attributed to compounds of similar chemical orbiologic composition to AZD2171 No New York Heart Association class III or IV disease Class II disease controlled with treatment and increased monitoring allowed No systolic blood pressure (BP) > 130 mm Hg and diastolic BP > 90 mm Hg No history of familial long QT syndrome Mean QTc ≤ 470 msec (with Bazett's correction) by EKG QTc prolongation ≤ 500 msec No other significant ECG abnormality within the past 14 days See Disease Characteristics More than 30 days since prior investigational agents More than 4 weeks since prior radiotherapy, chemotherapy, hormonal therapy directed at thetumor, immunotherapy, biologic therapy (e.g., interferon), or majorsurgery No concurrent medication that may markedly affect renal function (e.g., vancomycin, amphotericin, or pentamidine) No concurrent CYP interactive medications No concurrent combination antiretroviral therapy for HIV-positive patients No concurrent enzyme-inducing anticonvulsants (e.g., phenytoin, carbamazepine, or phenobarbital) No concurrent use of drugs or biologics with proarrhythmic potential

Sites / Locations

  • University of Alabama at Birmingham Cancer Center
  • Howard University Hospital
  • University of Chicago Comprehensive Cancer Center
  • Massachusetts General Hospital Cancer Center
  • Dana-Farber Cancer Institute
  • Wayne State University/Karmanos Cancer Institute
  • Mayo Clinic
  • Washington University School of Medicine
  • Case Western Reserve University

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (cediranib maleate)

Arm Description

Patients receive oral AZD2171 once daily on days 1-28. Treatment repeats every 28 days for 26 courses in the absence of disease progression or unacceptable toxicity. Patients with responding or stable disease may continue treatment beyond 26 courses in the absence of disease progression or unacceptable toxicity. Quality of life is assessed at baseline, prior to course 2, prior to course 4, and every 6 courses thereafter.

Outcomes

Primary Outcome Measures

Proportion of Patients With Tumor Response (Complete Response [CR] or Partial Response [PR])
Complete Response (CR): Disappearance of all target lesions. Partial Response (PR): At least a 30% decrease in the volume of target lesions taking as reference the baseline volume.

Secondary Outcome Measures

Survival Time as Measured Using Kaplan-Meier Method
Survival time is defined as the time from registration to death due to any cause.
Time to Disease Progression as Measured Using Kaplan-Meier Method
Progression (PD): At least a 20% increase in the sum of volumes of target lesions taking as reference the smallest volume recorded since the treatment started or the appearance of one or more new lesions. If a patient dies without documentation of disease progression, the patient will be considered to have had tumor progression at the time of their death unless there is sufficient documented evidence to conclude no progression occurred prior to death.
Duration of Response as Assessed Using the Method of Kaplan-Meier
Duration of response is defined for all evaluable patients who have achieved a confirmed tumor objective response as the date at which the patient's objective status is first noted to be either a CR or PR to the date progression is documented. Duration of response will be estimated using the method of Kaplan-Meier.
Time to Treatment Failure as Assessed Using the Method of Kaplan-Meier
Time to treatment failure is defined to be the time from the date of randomization to the date at which the patient is removed from treatment due to progression, toxicity, or refusal. If the patient is considered to be a major treatment violation or is taken off study as a non-protocol failure, the patient will be censored on the date they are removed from treatment. Time to treatment failure will be estimated using the method of Kaplan-Meier.
Reduction in Self Reported Worst Pain Per Cycle.
Reduction in self reported worst pain per cycle as measured by the Worst Pain scale from the North Central Cancer Treatment Group Brief Pain Inventory (short form). The worst pain scale is from 0-10 (10 is worst pain possible). The per-cycle average reduction in worst pain will be analyzed using generalized linear models to account for repeated measures within patients.

Full Information

First Posted
May 16, 2006
Last Updated
July 21, 2017
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00326872
Brief Title
AZD2171 in Treating Patients With Neurofibromatosis Type 1 and Plexiform Neurofibroma and/or Neurofibroma Near the Spine
Official Title
A Phase II Study of AZD2171 in Adult Patients With Neurofibromatosis Type 1 and Extensive Plexiform and Paraspinal Neurofibromas
Study Type
Interventional

2. Study Status

Record Verification Date
July 2017
Overall Recruitment Status
Terminated
Why Stopped
Closed due to slow accrual prior to interim analysis.
Study Start Date
May 2006 (undefined)
Primary Completion Date
August 21, 2011 (Actual)
Study Completion Date
May 31, 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
This phase II trial is studying how well AZD2171 works in treating patients with neurofibromatosis type 1 and plexiform neurofibroma and/or neurofibroma near the spine. AZD2171 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor.
Detailed Description
PRIMARY OBJECTIVES: I. Assess the efficacy of AZD2171, in terms of volume change in target tumors by 3-dimensional magnetic resonance imaging (3D MRI). II. Describe and define the toxicities of AZD2171 in these patients. SECONDARY OBJECTIVES: I. Assess the value of 3D MRI data analysis in evaluating plexiform or paraspinal neurofibromas compared to conventional 2-dimensional MRI data analysis. II. Assess the value of delayed contrast-enhanced MRI (DCE-MRI) in determining changes in vascularity of neurofibromas before and during treatment. III. Assess the quality of life of patients treated with AZD2171. IV. Evaluate the effect of AZD2171 on biological changes of human neurofibroma by comparing pre- and post-treatment specimens from patients involved in this trial or, alternatively, by evaluating the effect of AZD2171 on human tumor grafts in experimental animals. V. Evaluate relevant pharmacodynamic markers (circulating endothelial cells [CECs] and vascular endothelial growth factor-2 [VEGF2] levels) and pharmacogenetics analyses (variation in kdr/flk-1 and other genes) in response to AZD2171. OUTLINE: This is a multicenter study. Patients are stratified according to tumor location (peripheral vs paraspinal plexiform neurofibroma). Patients receive oral AZD2171 once daily on days 1-28. Treatment repeats every 28 days for 26 courses in the absence of disease progression or unacceptable toxicity. Patients with responding or stable disease may continue treatment beyond 26 courses in the absence of disease progression or unacceptable toxicity. Quality of life is assessed at baseline, prior to course 2, prior to course 4, and every 6 courses thereafter.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Neurofibromatosis Type 1, Plexiform Neurofibroma, Spinal Cord Neurofibroma

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Treatment (cediranib maleate)
Arm Type
Experimental
Arm Description
Patients receive oral AZD2171 once daily on days 1-28. Treatment repeats every 28 days for 26 courses in the absence of disease progression or unacceptable toxicity. Patients with responding or stable disease may continue treatment beyond 26 courses in the absence of disease progression or unacceptable toxicity. Quality of life is assessed at baseline, prior to course 2, prior to course 4, and every 6 courses thereafter.
Intervention Type
Drug
Intervention Name(s)
Cediranib Maleate
Other Intervention Name(s)
AZD2171, AZD2171 Maleate, Recentin
Primary Outcome Measure Information:
Title
Proportion of Patients With Tumor Response (Complete Response [CR] or Partial Response [PR])
Description
Complete Response (CR): Disappearance of all target lesions. Partial Response (PR): At least a 30% decrease in the volume of target lesions taking as reference the baseline volume.
Time Frame
Baseline to end of treatment, maximum of 26 cycles (28 days/cycle).
Secondary Outcome Measure Information:
Title
Survival Time as Measured Using Kaplan-Meier Method
Description
Survival time is defined as the time from registration to death due to any cause.
Time Frame
From registration to death (due to any cause) max 51 months
Title
Time to Disease Progression as Measured Using Kaplan-Meier Method
Description
Progression (PD): At least a 20% increase in the sum of volumes of target lesions taking as reference the smallest volume recorded since the treatment started or the appearance of one or more new lesions. If a patient dies without documentation of disease progression, the patient will be considered to have had tumor progression at the time of their death unless there is sufficient documented evidence to conclude no progression occurred prior to death.
Time Frame
From registration to documentation of disease progression up to 26 cycles (28 days/cycle).
Title
Duration of Response as Assessed Using the Method of Kaplan-Meier
Description
Duration of response is defined for all evaluable patients who have achieved a confirmed tumor objective response as the date at which the patient's objective status is first noted to be either a CR or PR to the date progression is documented. Duration of response will be estimated using the method of Kaplan-Meier.
Time Frame
From time of confirmed tumor objective response as CR or PR to the date of progression max 51 months
Title
Time to Treatment Failure as Assessed Using the Method of Kaplan-Meier
Description
Time to treatment failure is defined to be the time from the date of randomization to the date at which the patient is removed from treatment due to progression, toxicity, or refusal. If the patient is considered to be a major treatment violation or is taken off study as a non-protocol failure, the patient will be censored on the date they are removed from treatment. Time to treatment failure will be estimated using the method of Kaplan-Meier.
Time Frame
From the date of randomization to the date at which the patient is removed from treatment due to progression, toxicity, or refusal up to 51 months.
Title
Reduction in Self Reported Worst Pain Per Cycle.
Description
Reduction in self reported worst pain per cycle as measured by the Worst Pain scale from the North Central Cancer Treatment Group Brief Pain Inventory (short form). The worst pain scale is from 0-10 (10 is worst pain possible). The per-cycle average reduction in worst pain will be analyzed using generalized linear models to account for repeated measures within patients.
Time Frame
At baseline, prior to each subsequent course (q 28+/- 3 days), and at end of treatment up to 51 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis* of neurofibromatosis type 1 (NF1) and extensive plexiform and/or paraspinal neurofibromasproducing pain (not controlled by use of over-the-counter medications), progressive neurologic deficit, or significant neurologic consequenceswith continuous tumor growth Extensive paraspinal neurofibroma defined as a neurofibroma that involves multiple neural roots at ≥ 3 spinal levels with connection between the levels or extending laterally along the nerves Symptomatic neurofibromas at < 3 spinal levels, but surgical treatment is not possible, allowed Meets ≥ 2 diagnostic criteria for NF1, including the following: Six or more café-au-lait spots (≥ 1.5 cm in postpubertal patients) Freckling in the axilla or groin Optic glioma Two or more Lisch nodules Distinctive bony lesion (dysplasia of the sphenoid bone or dysplasia orthinning of long-bone cortex) First-degree relative with NF1 Patients with documented mutation in neurofibromin gene with onlysymptomatic plexiform and/or paraspinal neurofibroma who do not fulfill the above clinical criteria are eligible Measurable disease, defined as ≥ 1 lesion whose longest diameter can beaccurately measured as 8.0 cm^3 with 3-dimensional (3D) MRI Skin lesions are consideredmeasurable (e.g., plexiform neurofibromas), but MRI imaging still required for 3D measurement Patients with symptomatic neurofibroma, in whom surgery is not feasible, who refuse surgery or are not goodsurgical candidates due to high risk of damage to vital structures or spinal cordinjury are eligible No evidence of progressive optic glioma, malignant glioma, malignant peripheralnerve sheath tumor, or other cancer requiring treatment with chemotherapy orradiotherapy ECOG performance status 0-3 WBC ≥ 3,000/mm^3 Absolute neutrophil count ≥ 1,500/mm^3 Platelet count ≥ 100,000/mm^3 Hemoglobin ≥ 8.0 g/dL Bilirubin normal (patients with Gilbert's syndrome allowed despite elevated bilirubin) Alkaline phosphatase normal AST and ALT ≤ 2.5 times upper limit of normal Thyroid-stimulating hormone and free thyroxin normal Creatinine normal OR creatinine clearance ≥ 60 mL/min Ejection fraction ≥ 50% by echocardiogram Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No other uncontrolled, serious medical condition that would preclude study participation, including any of the following: Cardiac arrhythmia Diabetes Serious infection Significant cardiac, pulmonary, hepatic, or other organ dysfunction No psychiatric illness or social situation that would preclude study compliance No history of allergic reactions attributed to compounds of similar chemical orbiologic composition to AZD2171 No New York Heart Association class III or IV disease Class II disease controlled with treatment and increased monitoring allowed No systolic blood pressure (BP) > 130 mm Hg and diastolic BP > 90 mm Hg No history of familial long QT syndrome Mean QTc ≤ 470 msec (with Bazett's correction) by EKG QTc prolongation ≤ 500 msec No other significant ECG abnormality within the past 14 days See Disease Characteristics More than 30 days since prior investigational agents More than 4 weeks since prior radiotherapy, chemotherapy, hormonal therapy directed at thetumor, immunotherapy, biologic therapy (e.g., interferon), or majorsurgery No concurrent medication that may markedly affect renal function (e.g., vancomycin, amphotericin, or pentamidine) No concurrent CYP interactive medications No concurrent combination antiretroviral therapy for HIV-positive patients No concurrent enzyme-inducing anticonvulsants (e.g., phenytoin, carbamazepine, or phenobarbital) No concurrent use of drugs or biologics with proarrhythmic potential
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Dusica Babovic-Vuksanovic
Organizational Affiliation
Mayo Clinic
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Alabama at Birmingham Cancer Center
City
Birmingham
State/Province
Alabama
ZIP/Postal Code
35233
Country
United States
Facility Name
Howard University Hospital
City
Washington, D.C.
State/Province
District of Columbia
ZIP/Postal Code
20060
Country
United States
Facility Name
University of Chicago Comprehensive Cancer Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60637
Country
United States
Facility Name
Massachusetts General Hospital Cancer Center
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
02215
Country
United States
Facility Name
Wayne State University/Karmanos Cancer Institute
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48201
Country
United States
Facility Name
Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Facility Name
Washington University School of Medicine
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
Case Western Reserve University
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44106
Country
United States

12. IPD Sharing Statement

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AZD2171 in Treating Patients With Neurofibromatosis Type 1 and Plexiform Neurofibroma and/or Neurofibroma Near the Spine

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