Phase I Study of the Pharmacokinetics and Pharmacodynamics of ZD6474 in Combination With Docetaxel in Advanced Solid Tumors
Phase I Study of the Pharmacokinetics and Pharmacodynamics of ZD6474 in Combination With Docetaxel in Advanced Solid Tumors
RATIONALE: Vandetanib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. Drugs used in chemotherapy, such as docetaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving vandetanib together with docetaxel may kill more tumor cells.
PURPOSE: This phase I trial is studying the side effects and best dose of vandetanib given together with docetaxel in treating patients with advanced solid tumors.
OBJECTIVES:
Primary
Secondary
OUTLINE: This is a multicenter study.
Patients receive docetaxel IV over 1 hour on day 1 and oral vandetanib once daily on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. After 6 weeks of treatment, patients who experience clinical benefit but poor tolerance to docetaxel may continue treatment with vandetanib alone.
Plasma samples are collected periodically for pharmacokinetic analysis, measurement of vandetanib trough levels, serum biomarker analysis, and serum proteomics. Tumor tissue samples are collected at baseline and once between days 36-38 for pharmacodynamic analysis.
After completion of study treatment, patients are followed up for up to 28 days.
DISEASE CHARACTERISTICS:
Histologically or cytologically confirmed advanced solid tumor, including, but not limited to the following:
Disease for which no standard therapy exists
Tumor amenable to biopsy
Measurable or non-measurable disease
Brain metastases allowed provided patient has undergone brain irradiation (whole brain or gamma knife) AND the metastases have been clinically and radiologically stable for ≥ 6 weeks after completion of irradiation
PATIENT CHARACTERISTICS:
Zubrod performance status 0-1
ANC ≥ 1,500/mm^3
Platelet count ≥ 100,000/mm^3
SGOT or SGPT ≤ 2.5 times upper limit of normal (ULN)
Bilirubin ≤ 1.5 times ULN
PT/INR ≤ 1.1 times normal
Serum creatinine ≤ 1.8 times ULN OR measured or estimated creatinine clearance > 50 mL/min
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception during and for ≥ 3 months after completion of study treatment
Willing to undergo two tumor biopsies and blood and tissue sample submission for correlative laboratory studies
No clinically significant cardiovascular event, including any of the following:
No history of cardiac disease that, in the investigator's opinion, increases the risk of ventricular arrhythmia
No history of arrhythmia that is symptomatic or requires treatment (CTCAE grade 3), including any of the following:
Multifocal premature ventricular contractions (PVCs)
Bigeminy or trigeminy
Ventricular tachycardia
Uncontrolled atrial fibrillation
No asymptomatic sustained ventricular tachycardia
No history of or evidence of any of the following on ECG:
No uncontrolled hypertension, defined as consistent systolic BP > 160 mm Hg or consistent diastolic BP > 100 mm Hg despite medical management
No intractable nausea or vomiting
No concurrent active diarrhea that may affect the ability to absorb or tolerate vandetanib
No gastrointestinal (GI) tract disease resulting in malabsorption syndrome or a requirement for IV alimentation
No uncontrolled inflammatory GI disease (e.g., Crohn's disease or ulcerative colitis)
No history of allergic reactions attributed to docetaxel or compounds of similar chemical or biological composition to vandetanib, including other quinazoline compounds (e.g., gefitinib or erlotinib)
No history of deep venous thrombosis or pulmonary embolism requiring therapeutic anticoagulation
No known HIV positivity
No other concurrent uncontrolled illness, including, but not limited to the following:
Prior or concurrent malignancies of other histologies within the past 5 years allowed
PRIOR CONCURRENT THERAPY:
See Disease Characteristics
Recovered from prior therapy (i.e., ≤ grade 2 alopecia and ≤ grade 1 toxicity from all other adverse events)
Prior docetaxel as monotherapy or in combination with other chemotherapeutic agents allowed provided there is potential clinical benefit present, in the investigator's opinion, from the combination of docetaxel and vandetanib
No prior vandetanib
No prior surgical procedures affecting absorption
More than 14 days since prior drugs with a short half-life (e.g., sorafenib or sunitinib) (approval by study coordinator required)
More than 28 days since prior major surgery, chemotherapy, or radiotherapy
More than 28 days since prior investigational agents
More than 2 weeks since prior and no concurrent medications associated with a risk of causing Torsades de Pointes
No concurrent therapeutic anticoagulation (coumadin, warfarin, or low-molecular weight heparin)
No concurrent medication that may cause QTc prolongation
No other concurrent chemotherapy, hormonal therapy, radiotherapy, immunotherapy, or any other type of therapy for the treatment of cancer, except for the following: