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| ID | Type | Description | Link |
|---|---|---|---|
| P30CA069533 | U.S. NIH Grant/Contract | View source | |
| OHSU-2683 | Other Identifier | Oregon Health & Science University IRB | |
| OHSU-SOL-06051-LM | Other Identifier | OHSU Knight Cancer Institute |
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| Name | Class |
|---|---|
| National Cancer Institute (NCI) | NIH |
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RATIONALE: Sunitinib and erlotinib may stop the growth of tumor cell by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. Giving sunitinib together with erlotinib may kill more tumor cells.
PURPOSE: This phase II trial is studying the best dose of erlotinib when given together with sunitinib and to see how well they work in treating patients with unresectable or metastatic kidney cancer.
OBJECTIVES:
Primary
Secondary
OUTLINE: This is an open-label, multicenter, dose-escalation study of erlotinib hydrochloride.
Patients receive oral sunitinib malate once daily on days 1-28 and oral erlotinib hydrochloride once daily on days 1-42. Treatment repeats every 6 weeks in the absence of disease progression or unacceptable toxicity.
Cohorts of 3-6 patients receive escalating doses of erlotinib hydrochloride until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose at which 33% of patients experience dose-limiting toxicity. Once the MTD is determined, patients are treated with erlotinib hydrochloride at the MTD and sunitinib malate.
Patients undergo blood and tumor specimen collection periodically during study for future correlative studies.
PROJECTED ACCRUAL: A total of 49 patients will be accrued for this study.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Erlotinib and Sunitinib | Experimental | Drug: erlotinib hydrochloride Dose Level 0 = 50 mg/day, continuous daily; 0.5= 75 mg/day, continuous daily;
Drug: sunitinib malate Will be administered at 50 mg daily, 4 weeks on, 2 weeks off |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| erlotinib hydrochloride | Drug | Dose Level 0 = 50 mg/day, continuous daily; 0.5= 75 mg/day, continuous daily;
|
| Measure | Description | Time Frame |
|---|---|---|
| Maximum Tolerated Dose (MTD) of Erlotinib Hydrochloride When Used in Combination With Sunitinib. | The MTD is defined as the dose that produces dose limiting toxicity (DLT) in 33% of the patients. | Participants assessed for DLTs weekly during the first cycle of treatment and every 3 weeks in subsequent cycles until at least one DLT occurs in 33% or more of participants at that dose; participants assessed for the duration of the study, up to 7 years |
| Progression-free Survival at 8 Months | Defined as the proportion of patients who are progression free (CR, PR and SD) at 8 months after initiating treatment with sunitinib in combination with erlotinib in patients with metastatic or unresectable clear cell or papillary carcinoma of the kidney. Complete Response (CR)= disappearance of all target lesions, Partial Response (PR)= At least a 30% decrease in the sum of the longest diameter of target lesions, and Stable Disease (SD)= Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for progressive disease (20% increase in the sum). | 8 months after initiating treatment with sunitinib in combination with erlotinib in patients with metastatic or unresectable clear cell or papillary carcinoma of the kidney |
| Measure | Description | Time Frame |
|---|---|---|
| To Determine the Safety of Sunitinib in Combination With Erlotinib | For the duration of the study, up to 7 years | |
| Median Time to Progression | The Kaplan-Meier method will be used to estimate the median time to progression. |
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DISEASE CHARACTERISTICS:
Histologically confirmed renal cell carcinoma with a component of clear cell or papillary carcinoma
Measurable disease (≥ 1 site)
No known brain metastasis that has not been adequately treated with radiotherapy and/or surgery
PATIENT CHARACTERISTICS:
Eastern Cooperative Oncology Group (ECOG) performance status 0-2
Absolute neutrophil count ≥ 1,500/mm³
Platelet count ≥ 100,000/mm³
No grade 3 hemorrhage within the past 4 weeks
Bilirubin ≤ 1.5 times upper limit of normal (ULN)
Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) ≤ 2.5 times ULN (< 5 times ULN if due to underlying disease)
No chronic liver disease (i.e., chronic active hepatitis or cirrhosis)
Creatinine ≤ 1.5 times ULN
None of the following cardiovascular conditions within the past 12 months:
Left Ventricular Ejection Fraction (LVEF) normal by Multigated Acquisition (MUGA) or echocardiogram
No hypertension uncontrolled with medical therapy
No other active malignancy within the past 5 years except basal cell skin cancer or cervical carcinoma in situ
No uncontrolled adrenal insufficiency
No uncontrolled hypothyroidism
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception during and for 3 months after completion of study treatment
No severe and/or uncontrolled medical disease (i.e., uncontrolled diabetes, chronic renal disease, or active uncontrolled infection)
No impaired gastrointestinal (GI) function or GI disease that may significantly alter the absorption of study drugs
No other severe acute or chronic medical or psychiatric condition or laboratory abnormality that would preclude study participation
PRIOR CONCURRENT THERAPY:
See Disease Characteristics
More than 4 weeks since prior major surgery
More than 4 weeks since prior cytotoxic chemotherapy (6 weeks for nitrosoureas or mitomycin C)
More than 4 weeks since prior radiotherapy
No prior radiotherapy to > 25% of the bone marrow
More than 28 days since prior investigational agents
No prior sunitinib malate
No prior anti-epidermal growth factor receptor therapy (e.g., erlotinib hydrochloride, panitumumab, cetuximab, or gefitinib)
No concurrent therapeutic warfarin
No concurrent Hypericum perforatum (St. John's wort)
No concurrent chemotherapy or biologic therapy
No other concurrent anticancer therapy
No other concurrent investigational agents
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| Name | Affiliation | Role |
|---|---|---|
| Christopher W. Ryan, MD | OHSU Knight Cancer Institute | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Southern California | Los Angeles | California | 90033 | United States | ||
| Providence Cancer Center at Providence Portland Medical Center |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Result | Ryan CW, Curti BD, Pattee KJ, et al.: A dose-escalation phase II study of sunitinib (S) plus erlotinib (E) in advanced renal carcinoma (RCC). [Abstract] American Society of Clinical Oncology 2008 Genitourinary Cancers Symposium, Feb 14-16, 2008, San Francisco, CA. A-361, 2008. | ||
| 35688679 | Derived | Feng Z, Curti BD, Quinn DI, Strother JM, Chen Z, Agnor R, Beer TM, Ryan CW. A Phase II, Single-arm Trial of Sunitinib and Erlotinib in Advanced Renal Cell Carcinoma. Clin Genitourin Cancer. 2022 Oct;20(5):415-422. doi: 10.1016/j.clgc.2022.04.018. Epub 2022 May 5. |
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The discrepancy between the number of participants enrolled (60) and the number of participants Started in the Participant Flow module (46) is due to screen failures and consent withdrawals.
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| ID | Title | Description |
|---|---|---|
| FG000 | Sunitinib and Erlotinib | Erlotinib: Dose Level 0 = 50 mg/day, continuous daily; 0.5= 75 mg/day, continuous daily;
Sunitinib: 50 mg daily, 4 weeks on, 2 weeks off |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
The discrepancy between the number of participants enrolled (60) and the number of participants Started in the Participant Flow module (46) is due to screen failures and consent withdrawals.
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| ID | Title | Description |
|---|---|---|
| BG000 | Sunitinib and Erlotinib | Erlotinib: Dose Level 0 = 50 mg/day, continuous daily; 0.5= 75 mg/day, continuous daily;
Sunitinib: 50 mg daily, 4 weeks on, 2 weeks off |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Maximum Tolerated Dose (MTD) of Erlotinib Hydrochloride When Used in Combination With Sunitinib. | The MTD is defined as the dose that produces dose limiting toxicity (DLT) in 33% of the patients. | Posted | Number | milligrams | Participants assessed for DLTs weekly during the first cycle of treatment and every 3 weeks in subsequent cycles until at least one DLT occurs in 33% or more of participants at that dose; participants assessed for the duration of the study, up to 7 years |
|
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Sunitinib and Erlotinib | Erlotinib: Dose Level 0 = 50 mg/day, continuous daily; 0.5= 75 mg/day, continuous daily;
Sunitinib: 50 mg daily, 4 weeks on, 2 weeks off |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Hematuria | Renal and urinary disorders | Systematic Assessment |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Diarrhea | Gastrointestinal disorders | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Christopher Ryan | OHSU Knight Cancer Institute | 5034946197 | ryanc@ohsu.edu |
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| ID | Term |
|---|---|
| D007680 | Kidney Neoplasms |
| D002292 | Carcinoma, Renal Cell |
| ID | Term |
|---|---|
| D014571 | Urologic Neoplasms |
| D014565 | Urogenital Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
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| ID | Term |
|---|---|
| D000069347 | Erlotinib Hydrochloride |
| D000077210 | Sunitinib |
| D001706 | Biopsy |
| ID | Term |
|---|---|
| D011799 | Quinazolines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
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| sunitinib malate | Drug | Will be administered at 50 mg daily, 4 weeks on, 2 weeks off |
|
| biopsy | Procedure | Paraffin block (or unstained slides) of the primary tumor and/or metastatic lesions (as available) and a plasma sample for future correlative studies will be collected. A paraffin block (or at least 10 unstained slides, each of 10 micromillimeter thickness) from the original paraffin-embedded biopsy material taken at the diagnosis will be stored at 4 degrees Celsius. |
|
| For the duration of the study, up to 7 years |
| Proportion of Patients Whose Best Overall Response is Complete Response, Partial Response, Stable Disease, or Progressive Disease | From the start of treatment until the criteria for response is met. |
| Maximum Percent Change in Tumor Measurement | The maximum percent change in Tumor Measurement is the greatest percent change in longest diameter (LD) for the target lesions from the baseline LD. For patients with no change in LD, the maximum percent change is the lowest increase in LD from the baseline LD. | Baseline through end of study, up to 7 years |
| Portland |
| Oregon |
| 97213-2967 |
| United States |
| OHSU Knight Cancer Institute | Portland | Oregon | 97239-3098 | United States |
| Salem Hospital | Salem | Oregon | 97301 | United States |
| Participants |
|
| Age, Continuous | Median | Full Range | years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| Units | Counts |
|---|
| Participants |
|
|
| Primary | Progression-free Survival at 8 Months | Defined as the proportion of patients who are progression free (CR, PR and SD) at 8 months after initiating treatment with sunitinib in combination with erlotinib in patients with metastatic or unresectable clear cell or papillary carcinoma of the kidney. Complete Response (CR)= disappearance of all target lesions, Partial Response (PR)= At least a 30% decrease in the sum of the longest diameter of target lesions, and Stable Disease (SD)= Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for progressive disease (20% increase in the sum). | Posted | Number | 95% Confidence Interval | percentage of participants | 8 months after initiating treatment with sunitinib in combination with erlotinib in patients with metastatic or unresectable clear cell or papillary carcinoma of the kidney |
|
|
|
| Secondary | To Determine the Safety of Sunitinib in Combination With Erlotinib | Posted | Number | participants | For the duration of the study, up to 7 years |
|
|
|
| Secondary | Median Time to Progression | The Kaplan-Meier method will be used to estimate the median time to progression. | Posted | Median | 95% Confidence Interval | months | For the duration of the study, up to 7 years |
|
|
|
| Secondary | Proportion of Patients Whose Best Overall Response is Complete Response, Partial Response, Stable Disease, or Progressive Disease | Posted | Number | percentage of participants | From the start of treatment until the criteria for response is met. |
|
|
|
| Secondary | Maximum Percent Change in Tumor Measurement | The maximum percent change in Tumor Measurement is the greatest percent change in longest diameter (LD) for the target lesions from the baseline LD. For patients with no change in LD, the maximum percent change is the lowest increase in LD from the baseline LD. | Posted | Mean | Full Range | percent change in size | Baseline through end of study, up to 7 years |
|
|
|
| 7 |
| 46 |
| 46 |
| 46 |
| Disease Progression | General disorders | Systematic Assessment |
|
| Spontaneous Pneumothorax | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Carcinoma of Prostatic Urethra | Renal and urinary disorders | Systematic Assessment |
|
| Angioedema | Skin and subcutaneous tissue disorders | Systematic Assessment |
|
| Hypomagnesemia | Blood and lymphatic system disorders | Systematic Assessment |
|
| Abdominal Aortic Aneurysm | Gastrointestinal disorders | Systematic Assessment |
|
| Rash | Skin and subcutaneous tissue disorders | Systematic Assessment |
|
| Fatigue | General disorders | Systematic Assessment |
|
| Dysguesia | Gastrointestinal disorders | Systematic Assessment |
|
| Nausea | Gastrointestinal disorders | Systematic Assessment |
|
| Anorexia | Gastrointestinal disorders | Systematic Assessment |
|
| Vomitting | Gastrointestinal disorders | Systematic Assessment |
|
| Hand-foot syndrome | Skin and subcutaneous tissue disorders | Systematic Assessment |
|
| Stomatitis | Gastrointestinal disorders | Systematic Assessment |
|
| Weight loss | General disorders | Systematic Assessment |
|
| Constipation | Gastrointestinal disorders | Systematic Assessment |
|
| Dyspepsia | Gastrointestinal disorders | Systematic Assessment |
|
| Dry skin | Skin and subcutaneous tissue disorders | Systematic Assessment |
|
| Alopecia | Skin and subcutaneous tissue disorders | Systematic Assessment |
|
| Pruritus | Skin and subcutaneous tissue disorders | Systematic Assessment |
|
| Other skin/hair changes | Skin and subcutaneous tissue disorders | Systematic Assessment |
|
| Dehydration | Gastrointestinal disorders | Systematic Assessment |
|
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| D052776 |
| Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052801 | Male Urogenital Diseases |
| D000230 | Adenocarcinoma |
| D002277 | Carcinoma |
| D009375 | Neoplasms, Glandular and Epithelial |
| D009370 | Neoplasms by Histologic Type |
| D011758 | Pyrroles |
| D001393 | Azoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D007211 | Indoles |
| D003581 | Cytodiagnosis |
| D003584 | Cytological Techniques |
| D019411 | Clinical Laboratory Techniques |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
| D013048 | Specimen Handling |
| D003949 | Diagnostic Techniques, Surgical |
| D013514 | Surgical Procedures, Operative |
| D008919 | Investigative Techniques |
| Dysguesia |
|
| Nausea |
|
| Anorexia |
|
| Vomitting |
|
| Hand-foot syndrome |
|
| Stomatitis |
|
| Weight loss |
|
| Constipation |
|
| Dyspepsia |
|
| Dry skin |
|
| Alopecia |
|
| Pruritus |
|
| Other skin/hair changes |
|
| Dehydration |
|
| Measurements |
|---|
|