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Erlotinib and Cetuximab With or Without Bevacizumab in Treating Patients With Metastatic or Unresectable Kidney, Colorectal, Head and Neck, Pancreatic, or Non-Small Cell Lung Cancer
This study has been completed.
Sponsors and Collaborators: Institute for Drug Development
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00101348
  Purpose

RATIONALE: Erlotinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Monoclonal antibodies, such as cetuximab and bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Cetuximab and bevacizumab may also stop the growth of tumor cells by blocking blood flow to the tumor. Giving erlotinib together with cetuximab and/or bevacizumab may kill more tumor cells.

PURPOSE: This randomized phase I trial is studying the side effects, best way to give, and best dose of erlotinib and bevacizumab when given with cetuximab and how well giving erlotinib and cetuximab together with or without bevacizumab works in treating patients with metastatic or unresectable kidney, colorectal, head and neck, pancreatic, or non-small cell lung cancer.


Condition Intervention Phase
Colorectal Cancer
Head and Neck Cancer
Kidney Cancer
Lung Cancer
Pancreatic Cancer
Drug: bevacizumab
Drug: cetuximab
Drug: erlotinib hydrochloride
Phase I

MedlinePlus related topics: Cancer Colorectal Cancer Head and Neck Cancer Kidney Cancer Lung Cancer Pancreatic Cancer Salivary Gland Disorders Tonsils and Adenoids
Drug Information available for: Erlotinib Erlotinib hydrochloride Bevacizumab Cetuximab
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Open Label
Official Title: A Phase I and Biologic Correlative Study of Erlotinib, in Combination With Cetuximab and Bevacizumab in Patients With Metastatic Renal Cell Carcinoma

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Objective response (complete, partial, and stable disease) as measured by RECIST criteria at 6 months. [ Designated as safety issue: No ]
  • Toxicity during study treatment [ Designated as safety issue: Yes ]
  • Adverse events [ Designated as safety issue: Yes ]

Estimated Enrollment: 66
Study Start Date: January 2005
Primary Completion Date: July 2008 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • Determine the maximum tolerated dose (MTD) of erlotinib when combined with cetuximab in patients with metastatic or unresectable renal cell, colorectal, head and neck, pancreatic, or non-small cell lung cancer (part 1).
  • Determine the MTD of bevacizumab when combined with cetuximab and erlotinib in these patients (part 2).
  • Determine the toxic effects, both quantitatively and qualitatively, of these regimens in these patients.
  • Determine the antitumor activity of these regimens, in terms of tumor response, short-term survival, and progression-free survival, in these patients.

Secondary

  • Compare, preliminarily, the toxicity and antitumor activity profiles of these regimens in these patients.

OUTLINE: This is an open-label, multicenter, dose-escalation study of erlotinib and bevacizumab.

  • Part 1: Patients receive oral erlotinib once daily on days 1-28. Patients also receive cetuximab IV over 3 hours on day 1 and over 1 hour on days 8, 15, and 22.

Cohorts of 3-6 patients receive escalating doses of erlotinib until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.

  • Part 2: Patients receive erlotinib as in part 1 at the MTD and cetuximab as in part 1. Patients also receive bevacizumab IV over 1½ hours on day 1 and over 1 hour on day 15.

Cohorts of 3-6 patients receive escalating doses of bevacizumab until the MTD is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.

In both groups, courses repeat every 28 days in the absence of unacceptable toxicity or disease progression.

After completion of study treatment, patients are followed at 1 month.

PROJECTED ACCRUAL: A total of 66 patients will be accrued within 12-18 months.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • One of the following histologically confirmed diagnoses:

    • Renal cell cancer

      • Clear cell histology
      • Metastatic or unresectable disease AND meets 1 of the following criteria:

        • Recurrent disease
        • Refractory to interleukin-2 (IL-2)- or interferon-based therapy
        • Previously untreated AND not a candidate for IL-2-based therapy
    • Colorectal, head and neck, pancreatic, or non-small cell lung cancer

      • Metastatic or unresectable disease
      • Progression after prior standard treatment
  • No evidence of CNS disease, including the following (part 2 only):

    • Primary brain tumor
    • Brain metastases
  • Paraffin embedded tumor blocks available

PATIENT CHARACTERISTICS:

Age

  • 18 and over

Performance status

  • ECOG 0-2 OR
  • Karnofsky 60-100%

Life expectancy

  • More than 12 weeks

Hematopoietic

  • Absolute neutrophil count ≥ 1,500 mm^3
  • Platelet count ≥ 100,000 mm^3

Hepatic

  • Bilirubin ≤ 1.5 mg/dL
  • AST and ALT ≤ 2.5 times upper limit of normal (ULN) (5 times ULN if liver metastasis is present)
  • PTT and INR ≤ 1.5, unless receiving full-dose warfarin (part 2 only)

Renal

  • Creatinine ≤ 1.5 times ULN OR
  • Creatinine clearance ≥ 60 mL/min
  • Calcium < 10 mg/dL (hypocalcemic agents allowed)
  • No proteinuria* OR
  • Protein < 1 g on 24-hour urine collection* NOTE: *For patients enrolled in part 2 only

Cardiovascular

  • No unstable angina pectoris
  • No cardiac arrhythmia
  • No symptomatic congestive heart failure
  • None of the following are allowed for part 2:

    • Myocardial infarction within the past 6 months
    • New York Heart Association class II-IV heart disease
    • Serious cardiac arrhythmia requiring medication
    • Peripheral vascular disease ≥ grade II
    • Recent history of cerebrovascular accident
    • Uncontrolled hypertension (blood pressure ≥ 150/85 mm Hg despite medication)
    • Other clinically significant cardiovascular disease

Gastrointestinal

  • No gastrointestinal (GI) tract disease resulting in an inability to take oral medication
  • No GI tract disease resulting in a requirement for IV alimentation
  • No active peptic ulcer disease

Immunologic

  • No history of allergic reaction attributed to compounds of similar chemical or biologic composition to study drugs
  • No known hypersensitivity to Chinese hamster ovary cell products or other recombinant human antibodies (part 2 only)
  • No ongoing or active infection
  • No active infection requiring parenteral antibiotics (part 2 only)

Other

  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for 2 months after study treatment
  • No significant traumatic injury within the past 28 days (part 2 only)
  • No history of abnormalities of the cornea (e.g., dry eye syndrome, Sjögren's syndrome, or congenital abnormality [e.g., Fuch's dystrophy])
  • No other malignancy within the past 3 years except nonmelanoma skin cancer or carcinoma in situ of the breast or cervix
  • No psychiatric illness or social situation that would preclude study compliance
  • No serious or non-healing wound ulcer or bone fracture (part 2 only)
  • No other uncontrolled illness

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • See Disease Characteristics
  • More than 4 weeks since prior immunotherapy
  • No prior cetuximab
  • No prior bevacizumab
  • Concurrent epoetin alfa or darbepoetin alfa allowed

Chemotherapy

  • More than 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin)

Endocrine therapy

  • Not specified

Radiotherapy

  • More than 4 weeks since prior radiotherapy

Surgery

  • No prior surgical procedures affecting absorption
  • Prior nephrectomy or resection of metastatic lesions allowed provided patient has fully recovered
  • More than 7 days since prior core biopsy*
  • More than 28 days since prior major surgery or open biopsy*
  • No concurrent major surgery* NOTE: *For patients enrolled in part 2 only

Other

  • Recovered from all prior therapy
  • No prior erlotinib
  • Concurrent bisphosphonates allowed
  • Concurrent full-dose anticoagulants allowed provided the following criteria are met (part 2 only):

    • In-range INR (usually between 2 and 3) AND on a stable dose of warfarin or low molecular weight heparin
    • No active bleeding
    • No pathological conditions that carry a high risk of bleeding (e.g., tumor involving major vessels or varices)
  • No other concurrent investigational agents
  • No concurrent combination antiretroviral therapy for HIV-positive patients
  • No other concurrent anticancer therapy
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00101348

Locations
United States, Texas
Brooke Army Medical Center
Fort Sam Houston, Texas, United States, 78234-6200
Institute for Drug Development
San Antonio, Texas, United States, 78245-3217
Veterans Affairs Medical Center - San Antonio (Murphy)
San Antonio, Texas, United States, 78229
Sponsors and Collaborators
Institute for Drug Development
Investigators
Study Chair: Alain Mita, MD Institute for Drug Development
  More Information

Clinical trial summary from the National Cancer Institute's PDQ® database  This link exits the ClinicalTrials.gov site

Study ID Numbers: CDR0000401514, CTRC-IDD-0332, NCI-6588
Study First Received: January 7, 2005
Last Updated: August 30, 2008
ClinicalTrials.gov Identifier: NCT00101348  
Health Authority: United States: Food and Drug Administration

Keywords provided by National Cancer Institute (NCI):
recurrent pancreatic cancer
stage III pancreatic cancer
recurrent colon cancer
stage III colon cancer
stage IV colon cancer
recurrent rectal cancer
stage III rectal cancer
stage IV rectal cancer
recurrent adenoid cystic carcinoma of the oral cavity
stage III adenoid cystic carcinoma of the oral cavity
stage IV adenoid cystic carcinoma of the oral cavity
recurrent basal cell carcinoma of the lip
stage III basal cell carcinoma of the lip
stage IV basal cell carcinoma of the lip
recurrent mucoepidermoid carcinoma of the oral cavity
stage III mucoepidermoid carcinoma of the oral cavity
stage IV mucoepidermoid carcinoma of the oral cavity
recurrent squamous cell carcinoma of the lip and oral cavity
stage III squamous cell carcinoma of the lip and oral cavity
stage IV squamous cell carcinoma of the lip and oral cavity
recurrent verrucous carcinoma of the oral cavity
stage III verrucous carcinoma of the oral cavity
stage IV verrucous carcinoma of the oral cavity
recurrent metastatic squamous neck cancer with occult primary
untreated metastatic squamous neck cancer with occult primary
recurrent lymphoepithelioma of the nasopharynx
recurrent squamous cell carcinoma of the nasopharynx
stage III lymphoepithelioma of the nasopharynx
stage III squamous cell carcinoma of the nasopharynx
stage IV lymphoepithelioma of the nasopharynx

Study placed in the following topic categories:
Thoracic Neoplasms
Rectal Neoplasms
Pancreatic Neoplasms
Colonic Diseases
Urogenital Neoplasms
Bevacizumab
Urologic Neoplasms
Rectal Diseases
Dental Caries
Carcinoma, Adenoid Cystic
Lung Neoplasms
Metastatic squamous neck cancer with occult primary
Laryngeal carcinoma
Kidney Diseases
Salivary Gland Diseases
Rectal cancer
Endocrine Gland Neoplasms
Erlotinib
Non-small cell lung cancer
Digestive System Neoplasms
Endocrine System Diseases
Carcinoma, Basal Cell
Renal cancer
Carcinoma
Lung Diseases
Gastrointestinal Neoplasms
Pancreatic Diseases
Carcinoma, Squamous Cell
Carcinoma, Non-Small-Cell Lung
Neoplasms, Glandular and Epithelial

Additional relevant MeSH terms:
Respiratory Tract Neoplasms
Neoplasms by Histologic Type
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Growth Substances
Physiological Effects of Drugs
Enzyme Inhibitors
Angiogenesis Inhibitors
Protein Kinase Inhibitors
Pharmacologic Actions
Neoplasms
Neoplasms by Site
Therapeutic Uses
Angiogenesis Modulating Agents
Growth Inhibitors

ClinicalTrials.gov processed this record on January 14, 2009