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Bevacizumab and Lapatinib in Children With Recurrent or Refractory Ependymoma
This study is not yet open for participant recruitment.
Verified by M.D. Anderson Cancer Center, April 2009
First Received: April 17, 2009   Last Updated: April 20, 2009   History of Changes
Sponsors and Collaborators: M.D. Anderson Cancer Center
Collaborative Ependymoma Research Network
Information provided by: M.D. Anderson Cancer Center
ClinicalTrials.gov Identifier: NCT00883688
  Purpose

Primary Objective:

To estimate the sustained objective response rates (complete response - CR plus partial response - PR) to lapatinib 900 mg/m2/dose bid, bevacizumab 10 mg/kg iv q 2 weeks in children with recurrent or refractory ependymoma.

Secondary Objectives:

  1. To estimate progression free survival (PFS), failure free survival (FFS), and overall survival (OS) in a group of pediatric patients with relapsed ependymoma.
  2. To estimate the incidence of ERBB1, ERBB2, ERBB3 and ERBB4 expression and pathway activation in recurrent or refractory ependymoma.
  3. To use microarray technologies (including gene expression and array CGH analysis) to identify additional genetic alterations that may correlate with disease response to the experimental treatment.
  4. To determine inhibition of the VEGFR2 signaling in peripheral blood mononuclear cells using BioPlex technology.
  5. To characterize lapatinib steady state concentrations in the presence of bevacizumab.
  6. To explore the pharmacogenetics of lapatinib in a group of patients with relapsed ependymoma.

Condition Intervention Phase
Brain Cancer
Pediatric Cancers
Drug: Bevacizumab
Drug: Lapatinib
Phase II

MedlinePlus related topics: Brain Cancer Cancer Childhood Brain Tumors
Drug Information available for: Bevacizumab Lapatinib Immunoglobulins Lapatinib Ditosylate Globulin, Immune
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Open Label, Single Group Assignment, Safety/Efficacy Study
Official Title: A Phase II Study of Bevacizumab and Lapatinib in Children With Recurrent or Refractory Ependymoma

Further study details as provided by M.D. Anderson Cancer Center:

Primary Outcome Measures:
  • Response Rates [ Time Frame: 4 Years ] [ Designated as safety issue: No ]

Estimated Enrollment: 40
Study Start Date: June 2009
Estimated Primary Completion Date: May 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Bevacizumab + Lapatinib: Experimental Drug: Bevacizumab
10 mg/kg given by vein over 90 minutes for first injection (30-60 minutes for subsequent doses) every 2 weeks while on study (2 times during each 4-week "study cycle").
Drug: Lapatinib
Pills of 900 mg/m^2/dose given orally 2 times each day.

  Show Detailed Description

  Eligibility

Ages Eligible for Study:   up to 21 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Age: Patient must be < or = 21 years of age.
  2. Tumor: Patients must have recurrent or refractory intracranial ependymoma, ependymoblastoma or subependymoma (including myxopapillary and clear cell and anaplastic ependymoma) with a histological diagnosis from either the initial presentation or the time of recurrence. Scrolls or paraffin embedded block from available prior brain tumor specimens must be submitted within 60 days of enrollment for central analysis.
  3. Patients must have measurable disease, defined as at least one measurable lesion that can be accurately measured in 2 planes. Diffuse leptomeningeal involvement will not be considered measurable disease.
  4. Patients may have a maximum of two prior salvage chemotherapy regimens after radiotherapy.
  5. Neurological Deficits: Patients with neurological deficits should have deficits that are stable or improving for a minimum of 1 week prior to registration.
  6. Performance Score: Karnofsky Performance Scale (KPS for > 16 years of age) or Lansky Performance Score (LPS for < or = 16 years of age) > or = 50 assessed within 2 weeks prior to registration.
  7. Prior/Concurrent Therapy: Chemo: Evidence of recovery from prior chemotherapy. No myelosuppressive anticancer chemotherapy or biological therapy within 3 weeks (6 weeks if a nitrosourea or mitomycin C agent) prior to registration.
  8. Prior/Concurrent Therapy: XRT: Patients must have had prior radiation therapy for treatment of their ependymoma. XRT must be > or = 3 months prior to registration for craniospinal irradiation (> or = 18 Gy); > or = 4 weeks for local radiation to primary tumor; and > or = 2 weeks prior to registration for focal irradiation to symptomatic metastatic sites.
  9. Prior/Concurrent Therapy: Bone Marrow Transplant: > or = 3 months prior to registration for autologous bone marrow/stem cell transplant.
  10. Prior/Concurrent Therapy: Anti-convulsants: Patients with seizure disorder may be enrolled if well controlled. Patients receiving enzyme-inducing anticonvulsants are not eligible for this study. Patients must be off EIACD for at least 2 weeks prior to registration.
  11. Prior/Concurrent Therapy: Corticosteroids: Patients who are receiving corticosteroids must be on a stable or decreasing dose for at least 1 week prior to registration.
  12. Prior/Concurrent Therapy: Growth Factors: Off all colony forming growth factor(s) > or = 2 weeks prior to registration (G-CSF, GM-CSF, Erythropoietin).
  13. Patients must not have received: CYP3A4 inhibitors within seven (7) days prior to registration on protocol and for the duration of the study.

    However, amiodarone, another CYP3A4 inhibitor, should have been discontinued 6 months prior to registration and for the duration of the study.

  14. Patient must not have received: CYP3A4 inducers within fourteen (14) days prior to registration and for the duration of the study.
  15. Patient must not have received: Cimetidine within 48 hours prior and for the duration of the study.
  16. Must have the following tests as defined by the following within 7 days prior to registration and again within 7 days prior to the start of therapy: Bone marrow: Absolute neutrophil count of > / = 1000/microliter, Platelets > / = 100,000/microliter (transfusion independent), Hemoglobin > or = 8.0 g/dL (transfusion independent); Renal: Serum creatinine < / = 1.5 times upper limit of institutional normal for age or GFR

    • / = 70 ml/min/1.73m2; Hepatic: Bilirubin < or = 1.5 times upper limit of normal for age: SGPT (ALT) < 2.5x institutional upper limit of normal for age and albumin > / = 2 g/dL.
  17. No overt renal, hepatic, cardiac or pulmonary disease.
  18. Adequate cardiac function, assessed within 2 weeks prior to registration, defined as: shortening fraction of > or = 27% by echocardiogram, or ejection fracture (LVEF) > or = 50% by gated radionuclide study.
  19. Adequate pulmonary function, assessed within 2 weeks prior to registration, defined as: no evidence of dyspnea at rest, no exercise intolerance, and a pulse oximetry > 94% if there is clinical indication for determination.
  20. Signed informed consent according to institutional guidelines must be obtained.
  21. 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 and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately and will be removed from the study.
  22. Patient must begin therapy within 7 calendar days of registration.

Exclusion Criteria:

  1. Patients with primary spinal cord tumors.
  2. Patients with any significant medical illnesses that, in the investigator's opinion, cannot be adequately controlled with appropriate therapy or would compromise the patient's ability to tolerate this therapy.
  3. Patients with any disease that would obscure toxicity or dangerously alter drug metabolism.
  4. Patients receiving any other anticancer or experimental drug therapy.
  5. Patients with uncontrolled infection.
  6. Patients on enzyme inducing anticonvulsants.
  7. Patients with > / = Grade 2 uncontrolled hypertension.
  8. History of a stroke, myocardial infarction, or unstable angina in the previous 6 months.
  9. Evidence of a bleeding diathesis, coagulopathy or PT INR>1.5.
  10. Patients on anticoagulant drugs: Patients must not have previously been treated with anticoagulants including systemic thrombolytic agents, heparin, low molecular weight heparins, or warfarin except as required to maintain patency of preexisting permanent vascular catheters.
  11. Pre-existing coagulopathy or thrombosis: Patients must not have been previously diagnosed with a deep venous or arterial thrombosis (including pulmonary embolism), and must not have a known thrombophilic condition.
  12. Major surgical procedure(s) (e.g., tumor resection or biopsy) within 4 weeks prior to study enrollment.
  13. Intermediate surgical procedures (e.g. vascular access device, G-tube placement) within 14 days prior to study enrollment.
  14. Minor surgical procedures (e.g. incision and drainage of abscess, skin wound suture, bone marrow aspirate) within 7 days prior to study enrollment.
  15. History of an abdominal fistula, GI perforation, or intra-abdominal abscess within previous 6 months.
  16. A serious, non-healing wound, ulcer, or bone fracture.
  17. Evidence of a new intracranial or intratumoral hemorrhage that is larger than a punctuate size on baseline MRI obtained within 14 days prior to study registration.
  18. If there is proteinuria present on dipstick, patients must have a 24 hour urine collection, Patients are excluded if they have >500 mg protein on 24 hour urine collection.
  19. Pregnancy: Females of childbearing potential must have negative serum or urine pregnancy test within 7 days prior to study entry. The effects of lapatinib on the developing human fetus are unknown. However, bevacizumab is known to be teratogenic and detrimental to fetal development in animal models. In addition, bevacizumab may alter corpus luteum development and endometrial proliferation, thereby having a negative effect on fertility.
  20. Breastfeeding: Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with lapatinib or bevacizumab, breastfeeding should be discontinued if the mother is treated on this study.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00883688

Contacts
Contact: Michael E. Rytting, MD 713-792-6620

Locations
United States, California
Stanford University Medical Center
Stanford, California, United States, 94305
United States, Illinois
Children's Memorial Hospital
Chicago, Illinois, United States, 60614
United States, Ohio
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States, 45229
United States, Pennsylvania
Children's Hospital of Pittsburgh
Pittsburgh, Pennsylvania, United States, 15213
United States, Tennessee
St. Jude Children's Research Hospital
Memphis, Tennessee, United States, 38105
United States, Texas
U.T. M.D. Anderson Cancer Center
Houston, Texas, United States, 77030
Sponsors and Collaborators
M.D. Anderson Cancer Center
Collaborative Ependymoma Research Network
Investigators
Principal Investigator: Michael E. Rytting, MD U.T. M.D. Anderson Cancer Center
  More Information

No publications provided

Responsible Party: UT MD Anderson Cancer Center ( Michael E. Rytting, MD / Professor )
Study ID Numbers: CERN08-01
Study First Received: April 17, 2009
Last Updated: April 20, 2009
ClinicalTrials.gov Identifier: NCT00883688     History of Changes
Health Authority: United States: Institutional Review Board

Keywords provided by M.D. Anderson Cancer Center:
Brain Tumor
Recurrent Ependymoma
Refractory Ependymoma
Intracranial ependymoma
Ependymoblastoma
Subependymoma
Myxopapillary
Clear cell
Anaplastic
Bevacizumab
Avastin
Anti-VEGF Monoclonal Antibody
rhuMAb-VEGF
Lapatinib
Tykerb
GW572016

Study placed in the following topic categories:
Immunologic Factors
Central Nervous System Diseases
Lapatinib
Central Nervous System Neoplasms
Bevacizumab
Brain Diseases
Protein Kinase Inhibitors
Angiogenesis Inhibitors
Ependymoma
Recurrence
Antibodies, Monoclonal
Brain Neoplasms
Neuroectodermal Tumors
Antibodies
Neoplasms, Germ Cell and Embryonal
Neuroepithelioma
Glioma
Nervous System Neoplasms
Immunoglobulins
Neoplasms, Glandular and Epithelial

Additional relevant MeSH terms:
Molecular Mechanisms of Pharmacological Action
Immunologic Factors
Antineoplastic Agents
Neoplasms, Nerve Tissue
Physiological Effects of Drugs
Central Nervous System Neoplasms
Bevacizumab
Brain Diseases
Protein Kinase Inhibitors
Ependymoma
Antibodies, Monoclonal
Neoplasms by Site
Therapeutic Uses
Neoplasms, Germ Cell and Embryonal
Growth Inhibitors
Glioma
Angiogenesis Modulating Agents
Nervous System Neoplasms
Neoplasms by Histologic Type
Growth Substances
Nervous System Diseases
Central Nervous System Diseases
Enzyme Inhibitors
Lapatinib
Angiogenesis Inhibitors
Pharmacologic Actions
Neuroectodermal Tumors
Brain Neoplasms
Neoplasms
Neoplasms, Neuroepithelial

ClinicalTrials.gov processed this record on May 06, 2009