Phase Ib Study of SUnitinib Alternating With REgorafenib in Patients With Metastatic and/or Unresectable GIST

NCT02164240

Last updated date
Study Location
Dana-Farber Cancer Institute
Boston, Massachusetts, 02115, United States
Contact
1-800-718-1021

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Eligibility Criteria
condition
The disease, disorder, syndrome, illness, or injury that is being studied.
Gastrointestinal Stromal Tumor
Sex
Females and Males
Age
Pediatric Trials: 0-17 Years
Adult Trials: 18+ Years
18 + years
Inclusion Criteria
The factors, or reasons, that allow a person to participate in a clinical study.
Show details

- At least 18 years of age at the time of study entry.

- Histologically confirmed metastatic and/or unresectable GIST. Patients must demonstrate prior failure to at least imatinib, sunitinib and regorafenib (4th line and beyond). Any number of previous therapies for GIST is allowed.

- Measurable disease per modified RECIST 1.1. A lesion in a previously irradiated area is ineligible to be considered as measurable disease unless there is objective evidence of progression of the lesion prior to study enrollment.

- ECOG performance status 0 or 1 (see Appendix A).

- Participants must have adequate organ and marrow function as outlined in the protocol.

- Patients must be able to swallow oral medication.

- Willingness to use effective means of birth control throughout the duration of clinical study and for at least 3 months after completion of study drug.

- Women of childbearing potential must have a negative pregnancy test performed within 7 days of the start of study drug administration.

- Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria
The factors, or reasons, that prevent a person from participating in a clinical study.
Show details


- Use of any approved tyrosine kinase inhibitors or investigational agents within 2
weeks or 6 half-lives of the agent, whichever is shorter, prior to receiving study
drugs.


- Patients with intolerance to sunitinib and/or regorafenib.


- Participants who have had radiotherapy within 4 weeks prior to study entry.


- Major surgery, or significant traumatic injury within 4 weeks prior to study entry.


- Presence of symptomatic or uncontrolled brain or central nervous system metastases.


- Known or suspected allergy to the investigational agent or any agent given in
association with this trial.


- Individuals with a history of a different malignancy, other than cervical cancer in
situ, basal cell or squamous cell carcinoma of the skin, are ineligible, except if
they have been disease-free for at least 5 years, and are deemed by the investigator
to be at low risk for recurrence of that malignancy OR other primary malignancy is
neither currently clinically significant nor requiring active intervention.


- Clinically significant cardiac arrhythmias and/or patients who require anti-arrhythmic
therapy (excluding beta blockers or digoxin). Patients with controlled atrial
fibrillation are not excluded.


- History of clinically significant cardiac disease or congestive heart failure > NYHA
class 2 (See Appendix C). Patients must not have unstable angina (anginal symptoms at
rest) or new-onset angina within the last 3 months or myocardial infarction within the
past 6 months.


- Hypertension as defined by systolic blood pressure >140 mmHg or diastolic blood
pressure > 90 mmH despite optimal medical management.


- Arterial or venous thrombotic or embolic events such as cerebrovascular accident
(including transient ischemic attacks), deep vein thrombosis or pulmonary embolism
within the 6 months before start of study medication (except for adequately treated
catheter-related venous thrombosis occurring more than 1 month before the start of
study medication).


- Patients with evidence or history of any bleeding diathesis, irrespective of severity.


- Ongoing infection ≥ Grade 2.


- Patients with any seizure disorder requiring medication.


- Non-healing wound, ulcer, or bone fracture.


- Persistent proteinuria Grade 2 or higher measured by urine protein:creatinine ratio on
a urine sample or during 24-hour assessment.


- HIV-positive individuals on combination antiretroviral therapy.


- Patients with active hepatitis B or C, or chronic hepatitis B or C requiring treatment
with antiviral therapy.


- Interstitial lung disease with ongoing signs and symptoms at the time of informed
consent.


- Uncontrolled intercurrent illness.


- Pregnant or lactating females.


- Presence of any psychological, familial, sociological or geographical condition
potentially hampering compliance with the study protocol.


- Strong CYP3A4 inhibitors within 28 days or 5 drug half-lives, whichever is longer,
before start of study drug.

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Advanced Information
Descriptive Information
Brief Title  ICMJE Phase Ib Study of SUnitinib Alternating With REgorafenib in Patients With Metastatic and/or Unresectable GIST
Official Title  ICMJE A Non-randomized, Open-label Phase Ib Study of SUnitinib Alternating With REgorafenib in Patients With Metastatic and/or Unresectable Gastrointestinal Stromal Tumors (GIST) Progressing After Prior Therapy With Tyrosine Kinase Inhibitors
Brief Summary The purpose of this research study is to determine the safety and tolerability of sunitinib alternating with regorafenib in participants with advanced gastrointestinal stromal tumor GIST, if the standard approved therapies (imatinib, sunitinib and regorafenib) have failed to control the disease. Additionally, this study seeks to determine the highest dose that can be given safely for this combination of drugs.
Detailed Description

This is a non-randomized, open label, single-center, single-arm, phase Ib study to evaluate the safety and the preliminary efficacy of short cycles of sunitinib alternated with regorafenib in participants with metastatic and/or unresectable gastrointestinal stromal tumor GISTs with prior failure of tyrosine kinase inhibitors (TKI). The study consists of two cohorts: a dose-escalation, dose-finding cohort, and dose-expansion cohort. Between 6 to 15 patients are expected to be included in the escalation cohort. A total of 20 eligible and evaluable patients will be included in the expansion cohort to further assess toxicity and evaluate preliminary efficacy.

Each treatment cycle lasts 28 days (4 weeks), during which time you will be taking the study drug, sunitinib, for the first 3 days of the week, followed by the study drug, regorafenib, for the last 4 days of the week. The study drugs will be taken continuously for 4 weeks each cycle, unless the study team instructs you otherwise. Each participant will receive a study diary. The diary will also include special instructions for taking the study drugs.

Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 1
Study Design  ICMJE Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Condition  ICMJE Gastrointestinal Stromal Tumor
Intervention  ICMJE
  • Drug: Sunitinib
    Intervention Description: 3 days of once daily sunitinib alternating with 4 days of once daily regorafenib throughout each 28 day cycle. The starting dose level (level 1) is sunitinib 37.5 mg/d and regorafenib 120 mg/d, and doses will be escalated in subsequent cohorts following a classical 3+3 design up to sunitinib 50 mg/d and regorafenib 160 mg/d or until maximum tolerable dosage (MTD) and recommended phase II dose (RP2D) is determined. Number of Cycles: until progression or unacceptable toxicity develops.
    Other Name: Sutent
  • Drug: Regorafenib
    Intervention Description: 3 days of once daily sunitinib alternating with 4 days of once daily regorafenib throughout each 28 day cycle. The starting dose level (level 1) is sunitinib 37.5 mg/d and regorafenib 120 mg/d, and doses will be escalated in subsequent cohorts following a classical 3+3 design up to sunitinib 50 mg/d and regorafenib 160 mg/d or until maximum tolerable dosage (MTD) and recommended phase II dose (RP2D) is determined. Number of Cycles: until progression or unacceptable toxicity develops.
    Other Name: Stivarga
Study Arms  ICMJE Experimental: Sunitinib alternated with Regorafenib
The treatment cycle is defined as 28 days. Treatment consists of 3 days of once daily sunitinib alternating with 4 days of once daily regorafenib throughout each cycle. The starting dose level is sunitinib 37.5 mg/d and regorafenib 120 mg/d, and doses will be escalated in subsequent cohorts following a classical 3+3 design up to sunitinib 50 mg/d and regorafenib 160 mg/d or until maximum tolerable dosage and recommended phase II dose is determined. An alternative scheme of 4-week cycles of the same regimen but with 21 days of dosing followed by 7 days of rest will be studied in case of toxicities during d 22-28 of the starting 4-weeks continuous cycles. Tumor assessments performed at baseline and after every two dosing cycles to assess response. Toxicity monitored throughout the study.
Interventions:
  • Drug: Sunitinib
  • Drug: Regorafenib
Publications * Serrano C, Leal A, Kuang Y, Morgan JA, Barysauskas CM, Phallen J, Triplett O, Mariño-Enríquez A, Wagner AJ, Demetri GD, Velculescu VE, Paweletz CP, Fletcher JA, George S. Phase I Study of Rapid Alternation of Sunitinib and Regorafenib for the Treatment of Tyrosine Kinase Inhibitor Refractory Gastrointestinal Stromal Tumors. Clin Cancer Res. 2019 Dec 15;25(24):7287-7293. doi: 10.1158/1078-0432.CCR-19-2150. Epub 2019 Aug 30.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Active, not recruiting
Actual Enrollment  ICMJE
 (submitted: August 1, 2019)
14
Original Estimated Enrollment  ICMJE
 (submitted: June 12, 2014)
35
Estimated Study Completion Date  ICMJE May 2021
Actual Primary Completion Date December 2016   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • At least 18 years of age at the time of study entry.
  • Histologically confirmed metastatic and/or unresectable GIST. Patients must demonstrate prior failure to at least imatinib, sunitinib and regorafenib (4th line and beyond). Any number of previous therapies for GIST is allowed.
  • Measurable disease per modified RECIST 1.1. A lesion in a previously irradiated area is ineligible to be considered as measurable disease unless there is objective evidence of progression of the lesion prior to study enrollment.
  • ECOG performance status 0 or 1 (see Appendix A).
  • Participants must have adequate organ and marrow function as outlined in the protocol.
  • Patients must be able to swallow oral medication.
  • Willingness to use effective means of birth control throughout the duration of clinical study and for at least 3 months after completion of study drug.
  • Women of childbearing potential must have a negative pregnancy test performed within 7 days of the start of study drug administration.
  • Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

  • Use of any approved tyrosine kinase inhibitors or investigational agents within 2 weeks or 6 half-lives of the agent, whichever is shorter, prior to receiving study drugs.
  • Patients with intolerance to sunitinib and/or regorafenib.
  • Participants who have had radiotherapy within 4 weeks prior to study entry.
  • Major surgery, or significant traumatic injury within 4 weeks prior to study entry.
  • Presence of symptomatic or uncontrolled brain or central nervous system metastases.
  • Known or suspected allergy to the investigational agent or any agent given in association with this trial.
  • Individuals with a history of a different malignancy, other than cervical cancer in situ, basal cell or squamous cell carcinoma of the skin, are ineligible, except if they have been disease-free for at least 5 years, and are deemed by the investigator to be at low risk for recurrence of that malignancy OR other primary malignancy is neither currently clinically significant nor requiring active intervention.
  • Clinically significant cardiac arrhythmias and/or patients who require anti-arrhythmic therapy (excluding beta blockers or digoxin). Patients with controlled atrial fibrillation are not excluded.
  • History of clinically significant cardiac disease or congestive heart failure > NYHA class 2 (See Appendix C). Patients must not have unstable angina (anginal symptoms at rest) or new-onset angina within the last 3 months or myocardial infarction within the past 6 months.
  • Hypertension as defined by systolic blood pressure >140 mmHg or diastolic blood pressure > 90 mmH despite optimal medical management.
  • Arterial or venous thrombotic or embolic events such as cerebrovascular accident (including transient ischemic attacks), deep vein thrombosis or pulmonary embolism within the 6 months before start of study medication (except for adequately treated catheter-related venous thrombosis occurring more than 1 month before the start of study medication).
  • Patients with evidence or history of any bleeding diathesis, irrespective of severity.
  • Ongoing infection ? Grade 2.
  • Patients with any seizure disorder requiring medication.
  • Non-healing wound, ulcer, or bone fracture.
  • Persistent proteinuria Grade 2 or higher measured by urine protein:creatinine ratio on a urine sample or during 24-hour assessment.
  • HIV-positive individuals on combination antiretroviral therapy.
  • Patients with active hepatitis B or C, or chronic hepatitis B or C requiring treatment with antiviral therapy.
  • Interstitial lung disease with ongoing signs and symptoms at the time of informed consent.
  • Uncontrolled intercurrent illness.
  • Pregnant or lactating females.
  • Presence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol.
  • Strong CYP3A4 inhibitors within 28 days or 5 drug half-lives, whichever is longer, before start of study drug.
Sex/Gender  ICMJE
Sexes Eligible for Study:All
Ages  ICMJE 18 Years and older   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE United States
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT02164240
Other Study ID Numbers  ICMJE 14-149
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product Not Provided
IPD Sharing Statement  ICMJE Not Provided
Responsible Party Suzanne George, MD, Dana-Farber Cancer Institute
Study Sponsor  ICMJE Dana-Farber Cancer Institute
Collaborators  ICMJE
  • Bayer
  • Pfizer
Investigators  ICMJE
Principal Investigator:Suzanne George, MDDana-Farber Cancer Institute
PRS Account Dana-Farber Cancer Institute
Verification Date August 2020

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP