Pazopanib and Vinflunine in Urothelial Cancer of the Bladder
Primary Purpose
Advanced Urothelial Cancer of Bladder After Failure of Platinum-containing Therapy.
Status
Completed
Phase
Phase 1
Locations
Germany
Study Type
Interventional
Intervention
Pazopanib as add-on to vinflunine
Sponsored by
About this trial
This is an interventional treatment trial for Advanced Urothelial Cancer of Bladder After Failure of Platinum-containing Therapy. focused on measuring bladder cancer, urothelial cancer, metastatic urothelial cancer, advanced urothelial cancer
Eligibility Criteria
Inclusion Criteria:
- Written informed consent
- Age ≥ 18 years
- Histologically confirmed Transitional Cell Carcinoma of the Urothelium (TCCU) with lymphatic (N-stage 2-3) and/or distant metastases (M-stage 1) not amenable to definitive regional/local therapy
- Progression of tumor disease after platinum containing systemic chemotherapy for advanced or metastatic disease
- Eastern Cooperative Oncology Group (ECOG) performance status of 1
- estimated minimal life expectancy of 3 months at screening
- At least one measurable tumor lesion according to RECIST 1.1 criteria
- Adequate organ system function at screening
- Adequate contraception
Exclusion Criteria:
- More than 1 prior chemotherapy, biologic therapy or hormonal therapy within 14 days prior to the first dose of study medication
- Prior malignancy within 5 years prior to inclusion (exception: successfully treated basal cell carcinoma or in situ carcinoma)
- History or clinical evidence of central nervous system (CNS) metastases or leptomeningeal carcinomatosis
Clinically significant gastrointestinal abnormalities that may increase the risk for gastrointestinal bleeding within 28 days prior to beginning study treatment, e.g
- 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 intraabdominal abscess
Clinically significant gastrointestinal abnormalities that may affect absorption of investigational product, e.g.
- Malabsorption syndrome
- Major resection of the stomach or small bowel
- Active infection requiring antibiotics within 14 days before registration
- Corrected QT interval (QTc) > 480 msecs using Bazett's formula at screening
- Screening-electrocardiogram (ECG) with any significant modifi¬cations suggesting a high risk of occurrence of an acute clinical event (such as signs of angina pectoris, high risk arrhythmia etc.)
History of one or more of the following cardiac / cardiovascular conditions within the past 6 months before registration:
- Cardiac angioplasty or stenting
- Myocardial infarction
- Unstable angina
- Coronary artery bypass graft surgery
- Symptomatic peripheral vascular disease
- NYHA Class II, III or IV congestive heart failure
- Uncontrolled cardiac arrhythmia
- Poorly controlled hypertension, defined as systolic blood pressure (SBP) of ≥140 mmHg or diastolic blood pressure (DBP) of ≥ 90 mmHg
- History of cerebrovascular accident including transient ischemic attack (TIA), pulmonary embolism or untreated deep venous thrombosis (DVT) within the past 6 months before registration
- Peripheral neuropathy grade ≥ 2 (NCI CTC v3.0)
- Unstable diabetes mellitus
- Uncontrolled hypercalcaemia > 2.9 mmol/L
- Prior major surgery or trauma within 28 days prior to registration and/or presence of any non-healing wound, fracture, or ulcer (procedures such as catheter placement not considered to be major)
- Evidence of active bleeding e.g. GI bleeding or bleeding diathesis at screening.
- Known endobronchial lesions and/or lesions infiltrating major pulmonary vessels
- Hemoptysis with bleeding of > 2.5 mL within 8 weeks before registration
- Any serious and/or unstable pre-existing medical, psychiatric/psychological, familial, sociological, geographical or other condition that could interfere with subject's safety, provision of informed consent, or compliance to study procedures
- prior to the first dose of study drug and for the duration of the study
- Radiation, surgery or tumor embolization or any investigational treatment within 14 days prior to the first dose of study medication
- Any ongoing toxicity from prior anti-cancer therapy that is > Grade 1 and/or progressing in severity, except nausea, vomiting, alopecia
- ASA 4
- Pre-treatment with Pazopanib or Vinflunine
- Pregnancy or lactation
Sites / Locations
- Lukaskrankenhaus
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Pazopanib + Vinflunine
Arm Description
Outcomes
Primary Outcome Measures
Phase I: Definition of the Maximum Tolerated Dose (MTD) of Pazopanib in combination with Vinflunine.
MTD ist defined as the dose level with dose-limiting toxicity occurring in maximum one out of six patients.
Phase II: Progression-free survival rate
Progression-free survival will be assessed by means of RECIST 1.1. methodology
Secondary Outcome Measures
Phase I: Progression-free survival rate, Phase II: Safety profile, overall survival
Progression-free survival will be assessed by means of RECIST 1.1. methodology
Full Information
NCT ID
NCT01265940
First Posted
December 22, 2010
Last Updated
October 9, 2012
Sponsor
Prof. Dr. Thomas Otto
1. Study Identification
Unique Protocol Identification Number
NCT01265940
Brief Title
Pazopanib and Vinflunine in Urothelial Cancer of the Bladder
Official Title
Target-specific Therapy With Pazopanib as Add-on to Vinflunine in Patients With Advanced or Metastatic Urothelial Carcinoma of the Bladder After Failure of Platinum-based Treatment
Study Type
Interventional
2. Study Status
Record Verification Date
October 2012
Overall Recruitment Status
Completed
Study Start Date
March 2011 (undefined)
Primary Completion Date
January 2012 (Actual)
Study Completion Date
August 2012 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Prof. Dr. Thomas Otto
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
Urothelial carcinoma of the bladder mostly is chemically induced and represents the second prevalent urooncological disease. About 20% of newly diagnosed urothelial carcinoma cases of the bladder are already advanced or metastasized. Before 2008 2009 no second line therapy after failure of primary systemic therapy of advanced / metastatic disease was established outside of clinical trials. The actual standard for this situation was a supportive, symptomatic therapy. Vinflunine has demonstrated improved survival from 4.3 to 6.9 months (p=0.04), with an adequate disease control, good symptom control and with acceptable toxicity. Based on these results, this compound became standard se¬cond line treatment for refractory metastatic bladder cancer disease after failure of platinum-containing therapy. As the prognosis still remains poor, new treatment opportunities have to be explored.
The target-specific therapy with Pazopanib suggests a positive influence of both inductive and perioperative treatment of solid tumors. Pazopanib has been approved by the FDA and the EMA for the treatment of advance renal cell carcinoma. Results for advanced urothelial carcinoma are missing so far as well as data on tolerability of the combination of both vinflunine and pazopanib. As the pharmacodynamic properties as well as the safety profile of both drugs are different, assumption is justified that there might occur additive efficacy effects without addition of adverse outcomes. Aim of the study thus is
To define the maximum tolerated dose (MTD) of Pazopanib in combination with Vinflunine in a phase-I-setting and
To further assess efficacy and safety of the combination at the MTD level in phase II.
During the pase-I-part of the study different doses of pazopanib will be added to the standard vinflunine scheme in groups of 6 patients maximum. Dose escalation will only be performed in the next patient group if not more than one out of six patients shows dose-limiting toxicity. Each patient will be treated with the drug combination for a duration of two vinflunine cycles, that is six weeks.
During the phase-II study new patients will be treated with the drug combination at maximum-tolerated dose until disease progression (assessed by RECIST 1.1 procedures).
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Advanced Urothelial Cancer of Bladder After Failure of Platinum-containing Therapy.
Keywords
bladder cancer, urothelial cancer, metastatic urothelial cancer, advanced urothelial cancer
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
5 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Pazopanib + Vinflunine
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Pazopanib as add-on to vinflunine
Other Intervention Name(s)
Pazopanib is marketed as Votrient., Vinflunine is marketed as Javlor.
Intervention Description
Patients will receive vinflunine standard regimen (intravenous infusion every three weeks) as specified per drug label plus additional pazopanib as daily oral medication. Doses of pazopanib will be escalated in 200 mg/d steps during phase I up to a maximum of 800 mg/d.
In Phase II the patients will be given pazopanib + vinflunine at maximum tolerated dose.
Primary Outcome Measure Information:
Title
Phase I: Definition of the Maximum Tolerated Dose (MTD) of Pazopanib in combination with Vinflunine.
Description
MTD ist defined as the dose level with dose-limiting toxicity occurring in maximum one out of six patients.
Time Frame
6 weeks (two cycles of vinflunine)
Title
Phase II: Progression-free survival rate
Description
Progression-free survival will be assessed by means of RECIST 1.1. methodology
Time Frame
3 months
Secondary Outcome Measure Information:
Title
Phase I: Progression-free survival rate, Phase II: Safety profile, overall survival
Description
Progression-free survival will be assessed by means of RECIST 1.1. methodology
Time Frame
Six weeks after first administration of study drug.
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Written informed consent
Age ≥ 18 years
Histologically confirmed Transitional Cell Carcinoma of the Urothelium (TCCU) with lymphatic (N-stage 2-3) and/or distant metastases (M-stage 1) not amenable to definitive regional/local therapy
Progression of tumor disease after platinum containing systemic chemotherapy for advanced or metastatic disease
Eastern Cooperative Oncology Group (ECOG) performance status of 1
estimated minimal life expectancy of 3 months at screening
At least one measurable tumor lesion according to RECIST 1.1 criteria
Adequate organ system function at screening
Adequate contraception
Exclusion Criteria:
More than 1 prior chemotherapy, biologic therapy or hormonal therapy within 14 days prior to the first dose of study medication
Prior malignancy within 5 years prior to inclusion (exception: successfully treated basal cell carcinoma or in situ carcinoma)
History or clinical evidence of central nervous system (CNS) metastases or leptomeningeal carcinomatosis
Clinically significant gastrointestinal abnormalities that may increase the risk for gastrointestinal bleeding within 28 days prior to beginning study treatment, e.g
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 intraabdominal abscess
Clinically significant gastrointestinal abnormalities that may affect absorption of investigational product, e.g.
Malabsorption syndrome
Major resection of the stomach or small bowel
Active infection requiring antibiotics within 14 days before registration
Corrected QT interval (QTc) > 480 msecs using Bazett's formula at screening
Screening-electrocardiogram (ECG) with any significant modifi¬cations suggesting a high risk of occurrence of an acute clinical event (such as signs of angina pectoris, high risk arrhythmia etc.)
History of one or more of the following cardiac / cardiovascular conditions within the past 6 months before registration:
Cardiac angioplasty or stenting
Myocardial infarction
Unstable angina
Coronary artery bypass graft surgery
Symptomatic peripheral vascular disease
NYHA Class II, III or IV congestive heart failure
Uncontrolled cardiac arrhythmia
Poorly controlled hypertension, defined as systolic blood pressure (SBP) of ≥140 mmHg or diastolic blood pressure (DBP) of ≥ 90 mmHg
History of cerebrovascular accident including transient ischemic attack (TIA), pulmonary embolism or untreated deep venous thrombosis (DVT) within the past 6 months before registration
Peripheral neuropathy grade ≥ 2 (NCI CTC v3.0)
Unstable diabetes mellitus
Uncontrolled hypercalcaemia > 2.9 mmol/L
Prior major surgery or trauma within 28 days prior to registration and/or presence of any non-healing wound, fracture, or ulcer (procedures such as catheter placement not considered to be major)
Evidence of active bleeding e.g. GI bleeding or bleeding diathesis at screening.
Known endobronchial lesions and/or lesions infiltrating major pulmonary vessels
Hemoptysis with bleeding of > 2.5 mL within 8 weeks before registration
Any serious and/or unstable pre-existing medical, psychiatric/psychological, familial, sociological, geographical or other condition that could interfere with subject's safety, provision of informed consent, or compliance to study procedures
prior to the first dose of study drug and for the duration of the study
Radiation, surgery or tumor embolization or any investigational treatment within 14 days prior to the first dose of study medication
Any ongoing toxicity from prior anti-cancer therapy that is > Grade 1 and/or progressing in severity, except nausea, vomiting, alopecia
ASA 4
Pre-treatment with Pazopanib or Vinflunine
Pregnancy or lactation
Facility Information:
Facility Name
Lukaskrankenhaus
City
Neuss
ZIP/Postal Code
41464
Country
Germany
12. IPD Sharing Statement
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Pazopanib and Vinflunine in Urothelial Cancer of the Bladder
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