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Study Summary
No. 2006-1025:.......Sarcoma......Robert S. Benjamin......Sarcoma Medical Oncology
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Study Summary Title
Study Summary
Number:
2006-1025
Study Title:A randomized, open-label, multi-center study to evaluate the efficacy of nilotinib versus best supportive care with or without a tyrosine kinase inhibitor (investigator's choice) in adult patients with gastrointestinal stromal tumors resistant to imatinib and sunitinib
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Physician New Patient Referral
Name:Robert S. BenjaminPatients Call:800-392-1611 (in U.S.A.) 713-792-6161 (outside U.S.A.)
Dept:Sarcoma Medical OncologyReferring MD
Call:
800-392-1611 (in U.S.A.) 713-792-6161 (outside U.S.A.)
Phone:713-792-3626
Contact us about clinical trials
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General Information
Disease Group:SarcomaSupported By:Novartis
Phase of Study:Phase IIIReturn
Visit:
Pre-study visit.
Day 1, day 15, day 28, day 56, then ongoing every 56 days.
Treatment
Agents:
AMN 107
Imatinib
Sunitinib Malate
Home Care:Patients will be randomized to either Imatinib or Nilotinib. Patients will self
administer Imanitib or Nilotinib at home.
Treatment Loc:Both at MDACC & outside MDACC at one or more Collaborating Sites or Institutions
Estimated
Length of Stay
in Houston:
N/A
Description/
Intervention:
The goal of this clinical research study is to learn if patients who have GIST
tumors that no longer respond to Gleevec (imatinib mesylate) and Sutent
(sunitinib) therapy will benefit from the drug nilotinib.
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Study Objectives / Outcomes
The primary, secondary and exploratory objectives will be tested on
the following patient population: patients with unresectable or
metastatic gastrointestinal stromal tumors showing progression of
disease on both imatinib and sunitinib or demonstrating intolerance to
imatinib and/or sunitinib

Primary
  • To evaluate whether the efficacy of nilotinib is superior to the control
arm (best supportive care with or without imatinib or sunitinib) as
measured by progression free survival

Secondary
  • To compare the response rate,time to response ,duration of
response and time to tumor progression of nilotinib with the
control arm using RECIST criteria to assess response
  • To compare overall survival of nilotinib with the control arm
  • To assess the safety and tolerability of nilotinib as measured by rate
and severity of adverse events
  • To evaluate the population pharmacokinetics of nilotinib

Exploratory
  • Patients enrolled in centers where FDG-PET is available
(approximately 60 patients) will undergo FDG-PET to evaluate the
tumor metabolic response to the two different treatment regimens
  • For patients where tumor tissue is available, to describe the relationship of tumor
characteristics (KIT and PDGFR mutations) as measured in tumor tissue with clinical outcome
  • For patients who consent to deoxyribose nucleic acid (DNA) testing, to
explore biomarkers of disease and the different inherited gene forms
in DNA that influence the different responses persons have to the
same drug
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Study Status Information
Study Activation / Registration Date:
IRB Review and Approval Date:04/19/2007
Study Type:Phase Iii
Recruitment Status:Closed
Projected Accrual:237
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Enrollment Eligibility
If you do not meet the enrollment eligibility, there may be other treatment options for you. Please Contact the Referral Office for more information.

Inclusion Criteria:1) Age > or = to 18 years at Visit 1

2) Histologically confirmed diagnosis of GIST that is unresectable and/or metastatic and therefore not amenable to surgery or combined modality with curative intent prior to or at Visit 1

3) Radiological (CT/MRI) confirmation of disease progression (RECIST criteria) during imatinib therapy at a dose of at least 400 mg daily and radiological confirmation of disease progression (RECIST criteria) during sunitinib therapy that was started at 50mg daily dose (even if progression of disease occurred at a reduced dose) OR documented intolerance (defined above in population) to imatinib and/or sunitinib

4) At least one measurable site of disease on CT/MRI scan at Visit 1, as defined by RECIST criteria

5) WHO Performance Status of 0, 1 or 2 at Visit 1 and 2

6) Patients must have normal organ, electrolyte, and marrow function at Visit 1 & Visit 2 as defined below: Absolute Neutrophil Count (ANC) >/= to 1.5 x 10^9/L; Platelets >/= to 100 x 10^9/L; ALT and AST </= 2.5 x upper limit of normal (ULN) or </= to 5.0 x ULN if considered due to tumor; Alkaline phosphatase </= to 2.5 x ULN unless considered due to tumor; Serum bilirubin </= to 1.5 x ULN; Serum lipase and amylase </= to 1.5 x ULN;Serum potassium WNL or correctable to WNL with supplements by Visit 2;Total calcium (corrected for serum albumin) WNL or correctable to WNL with supplements by Visit 2

7) Continued from #7 - Patients must have normal organ, electrolyte, and marrow function at Visit 1 and Visit 2 as defined below:Serum magnesium WNL or correctable to within normal limits with supplements by Visit 2; Serum phosphorous WNL or correctable to within normal limits with supplements by Visit 2;Serum creatinine </= to 1.5 x ULN or 24-hour creatinine clearance >/= to 50 ml/min.(calculated creatinine clearance using Cockroft formula is acceptable)

8) Ability to understand and willingness to sign a written informed consent

Exclusion Criteria:1) Prior treatment with nilotinib or any other tyrosine kinase inhibitors or targeted agents with exception of imatinib and sunitinib (targeted agents would include the drug perifosine)

2) Treatment with any cytotoxic and/or investigational cytotoxic drug less than or equal to 4 weeks (6 weeks for nitrosurea or mitomycin C) prior to Visit 1 with the exception of imatinib and sunitinib targeted therapy

3) Prior or concomitant malignancies (primary tumor or a relapse diagnosed and treated in the last 5 years) other than GIST with the exception of previous or concomitant basal cell skin cancer or previous cervical carcinoma in situ

4) Impaired cardiac function at Visit 1 or 2, including any one of the following:LVEF < 45% or below the institutional LLN range (whichever is higher) as determined by echocardiogram at Visit 1; Complete left bundle branch block; Use of a ventricular paced cardiac pacemaker ; Congenital long QT syndrome or family history of long QT syndrome; History of or presence of significant ventricular or atrial tachyarrhythmias; Clinically significant resting bradycardia (< 50 beats per minute)

5) Continued from #6 - Impaired cardiac function at Visit 1 or 2, including any one of the following:QTc > 450 msec on screening ECG (using the QTcF formula);If QTc > 450 msec and electrolytes are not within normal ranges (electrolytes should be corrected and then the patient rescreened for QTc; Right bundle branch block plus left anterior hemiblock, bifascicular block; Myocardial infarction within 12 months prior to Visit 1; Other clinically significant heart disease (e.g., unstable angina, congestive heart failure, or uncontrolled hypertension)

6) Patients with severe and/or uncontrolled concurrent medical disease that in the opinion of the investigator could cause unacceptable safety risks or compromise compliance with the protocol e.g. impairment of gastrointestinal (GI) function, or GI disease that may significantly alter the absorption of the study drugs, uncontrolled diabetes

7) For patients who undergo PET a. Inability to remain laying down in PET scanner for up to one hour, b. Absence of at least one metastatic lesion greater than or equal to 2 cm on pre-dose CT scan or other radiographic imaging as defined by RECIST criteria

8) Absence of at least one metastatic lesion greater than or equal to 2 cm on pre-dose CT scan or other radiographic imaging as defined by RECIST criteria

9) Use of therapeutic coumarin derivatives (i.e. warfarin, acenoucumarol, phenprocoumon)

10) Use of any medications that prolong the QT interval and CYP3A4 inhibitors if the treatment cannot be either safely discontinued or switched to a different medication prior to starting study drug administration. Please see http://www.torsades.org/medicalpros/ drug-lists/printable-drug-list.cfm for a comprehensive list of agents that prolong the QT interval as well as Post-Text Supplement 2.

11) Patients who have undergone major surgery < or equal to 2 weeks prior to Visit 1 or who have not recovered from side effects of such surgery

12) Patients who have received wide field radiotherapy < or equal to 4 weeks or limited field radiation for palliation < 2 weeks prior to Visit 1 or who have not recovered from side effects of such therapy

13) A history of noncompliance to medical regimens or inability or unwillingness to return for scheduled visits

14) Women who are pregnant, breast feeding or adults of reproductive potential not employing an effective method of birth control. Post menopausal women must be amenorrheic for at least 12 months to be considered of non-childbearing potential. Male or female patients must agree to employ an effective method of contraception during the study and for up to three months following discontinuation from the study. Effective methods of contraception are defined as those which result in a low failure rate (i.e. less than 1 % per year) when used consistently and correctly.

15) Patients unwilling or unable to comply with the protocol

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Links
Registration Number: NCT00471328
Study Information on Clinical Trials Registry (clinicaltrials.gov)

Other Links:
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Results


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