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| ID | Type | Description | Link |
|---|---|---|---|
| NCI-14191 | Other Grant/Funding Number | National Cancer Institute |
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| Name | Class |
|---|---|
| National Cancer Institute (NCI) | NIH |
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RATIONALE: Pralatrexate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as fluorouracil, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving pralatrexate together with fluorouracil may kill more tumor cells.
PURPOSE: This phase I trial is studying the side effects and best dose of pralatrexate when given together with fluorouracil in treating patients with recurrent solid tumors
PRIMARY OBJECTIVES:
I. To determine the recommended dose of PDX (pralatrexate) given in combination with a fixed dose of 5-FU (fluorouracil) administered as a 48-hour infusion given every other week.
SECONDARY OBJECTIVES:
I. To assess clinical response to therapy in subjects with measurable disease and time to disease progression in all subjects.
II. To assess the toxicity profile of the combination of PDX and 5-FU. III. To determine the pharmacokinetics of PDX and 5-FU and correlate with clinical toxicity.
IV. To analyze polymorphisms in methylenetetrahydrofolate reductase and thymidylate synthase (TS) and correlate with clinical toxicity.
OUTLINE: This is a dose-escalation study of pralatrexate.
Patients receive pralatrexate intravenously (IV) over 5 minutes on day 1 and fluorouracil IV continuously over 48 hours on days 2 and 16. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up for 30 days.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Treatment (enzyme inhibitor therapy) | Experimental | Patients receive pralatrexate IV over 5 minutes on day 1 and fluorouracil IV continuously over 48 hours on days 2 and 16. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| pralatrexate | Drug | Given IV |
|
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| Measure | Description | Time Frame |
|---|---|---|
| Recommended Dose of PDX Given With a Fixed Dose of 5-FU | Recommended dose of PDX given in combination with a fixed dose of 5-FU administered as a 48-hour infusion given every other weekMaximum tolerated dose will have been exceeded when 2 patients entered at a given dose level experience specified dose-limiting toxicities in the initial cycle | During the initial course (day 1 & 15 of a 4 week schedule) |
| Measure | Description | Time Frame |
|---|---|---|
| Response to Therapy in Subjects With Measurable Disease | Number of Participants With Response to Therapy in Subjects With Measurable Disease | restaging imaging done after each two 4-week course until time of progression (the maximum duration of PFS = 588 days) |
| Number of Patients Experiencing Grade 3-4 Toxicity While Receiving the Combination of PDX and 5-FU |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jean Grem | University of Nebraska | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Nebraska Medical Center, Eppley Cancer Center | Omaha | Nebraska | 68198-6805 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26242208 | Result | Grem JL, Kos ME, Evande RE, Meza JL, Schwarz JK. A phase 1 clinical trial of sequential pralatrexate followed by a 48-hour infusion of 5-fluorouracil given every other week in adult patients with solid tumors. Cancer. 2015 Nov 1;121(21):3862-8. doi: 10.1002/cncr.29504. Epub 2015 Aug 4. |
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29 signed a consent form. Two patients never received any study drug: one became ineligible due to rise in bilirubin; another decided against participating.
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| ID | Title | Description |
|---|---|---|
| FG000 | 75 mg/m^2 | pralatrexate (PDX) dose level |
| FG001 | 94 mg/m^2 | pralatrexate (PDX) dose level |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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| fluorouracil | Drug | Given IV |
|
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| laboratory biomarker analysis | Other | Correlative studies |
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| DNA analysis | Genetic | Correlative studies |
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| high performance liquid chromatography | Other | Correlative studies |
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| polymerase chain reaction | Genetic | Correlative studies |
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| nucleic acid sequencing | Genetic | Correlative studies |
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| pharmacological study | Other | Correlative studies |
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| pharmacogenomic studies | Other | Correlative studies |
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| polymorphism analysis | Genetic | Correlative studies |
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Participants remained on study as long as they did not progress, and wished to continue on study (no limit on number of cycles) |
| ., "From the time the subject signs the consent form and ending 4 weeks following the final chemotherapy, an average of 3 years |
| Pharmacokinetics of PDX- AUClast | Plasma concentrations versus time (at all time points) | Pre-treatment, end of infusion, at 15, 30, and 60 min, and then at 2, 4, 6, 8, 12, 22, 23, 24, 45, and 46 hours for PDX. |
| Polymorphisms in Methylenetetrahydrofolate Reductase and Thymidylate Synthase | Number of Participants with Polymorphisms in Methylenetetrahydrofolate Reductase and Thymidylate Synthase | Prior to the first dose of protocol therapy |
| 5-FU Plasma Levels | Pharmacokinetics of 5-FU - Cmax plasma levels | 22, 23, 45 & 46 hours during the 48 hour infusion |
| Time to Disease Progression | Time to disease progression in all Participants | restaging imaging done after each two 4-week course until time of progression (longest time to progression = 588 days) |
| FG002 |
| 118 mg/m^2 |
pralatrexate (PDX) dose level |
| FG003 | 148 mg/m^2 | pralatrexate (PDX) dose level |
| FG004 | 185 mg/m^2 | pralatrexate (PDX) dose level |
| COMPLETED |
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| NOT COMPLETED |
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Analysis was performed on 27 patients who received study drug; 2 patients did not receive any study drug (1 changed mind after signing consent; 1 no longer eligible due to elevated bilirubin)
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| ID | Title | Description |
|---|---|---|
| BG000 | Treatment (Enzyme Inhibitor Therapy) | Patients receive pralatrexate IV over 5 minutes on day 1 and fluorouracil IV continuously over 48 hours on days 2 and 16. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Median | Full Range | years |
| |||||||||||||||||
| Sex: Female, Male | Count of Participants | Participants |
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| Race/Ethnicity, Customized | Count of Participants | Participants |
| ||||||||||||||||||
| Region of Enrollment | Number | participants |
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| 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 | Recommended Dose of PDX Given With a Fixed Dose of 5-FU | Recommended dose of PDX given in combination with a fixed dose of 5-FU administered as a 48-hour infusion given every other weekMaximum tolerated dose will have been exceeded when 2 patients entered at a given dose level experience specified dose-limiting toxicities in the initial cycle | All participants receive pralatrexate IV over 5 minutes on day 1 and fluorouracil IV continuously over 48 hours on days 2 and 16. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. | Posted | Number | mg per meter square | During the initial course (day 1 & 15 of a 4 week schedule) |
|
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| ||||||||||||||||||||||||||
| Secondary | Response to Therapy in Subjects With Measurable Disease | Number of Participants With Response to Therapy in Subjects With Measurable Disease | Posted | Count of Participants | Participants | restaging imaging done after each two 4-week course until time of progression (the maximum duration of PFS = 588 days) |
|
| ||||||||||||||||||||||||||||
| Secondary | Number of Patients Experiencing Grade 3-4 Toxicity While Receiving the Combination of PDX and 5-FU | Participants remained on study as long as they did not progress, and wished to continue on study (no limit on number of cycles) | All participants receive pralatrexate IV over 5 minutes on day 1 and fluorouracil IV continuously over 48 hours on days 2 and 16. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. | Posted | Number | participants | ., "From the time the subject signs the consent form and ending 4 weeks following the final chemotherapy, an average of 3 years |
|
| |||||||||||||||||||||||||||
| Secondary | Pharmacokinetics of PDX- AUClast | Plasma concentrations versus time (at all time points) | AUClast | Posted | Mean | Standard Deviation | ng/ml *hr | Pre-treatment, end of infusion, at 15, 30, and 60 min, and then at 2, 4, 6, 8, 12, 22, 23, 24, 45, and 46 hours for PDX. |
| |||||||||||||||||||||||||||
| Secondary | Polymorphisms in Methylenetetrahydrofolate Reductase and Thymidylate Synthase | Number of Participants with Polymorphisms in Methylenetetrahydrofolate Reductase and Thymidylate Synthase | Posted | Number | percentage of patients | Prior to the first dose of protocol therapy |
|
| ||||||||||||||||||||||||||||
| Secondary | 5-FU Plasma Levels | Pharmacokinetics of 5-FU - Cmax plasma levels | All participants receive pralatrexate IV over 5 minutes on day 1 and fluorouracil IV continuously over 48 hours on days 2 and 16. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. | Posted | Mean | Standard Deviation | mg/m^2 | 22, 23, 45 & 46 hours during the 48 hour infusion |
|
| ||||||||||||||||||||||||||
| Secondary | Time to Disease Progression | Time to disease progression in all Participants | All participants receive pralatrexate IV over 5 minutes on day 1 and fluorouracil IV continuously over 48 hours on days 2 and 16. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. | Posted | Median | Full Range | days | restaging imaging done after each two 4-week course until time of progression (longest time to progression = 588 days) |
|
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Adverse event data is collected on participants from the time of consent until 30 days after the participant is off study drug.
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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 | Treatment (Enzyme Inhibitor Therapy) | Patients receive pralatrexate IV over 5 minutes on day 1 and fluorouracil IV continuously over 48 hours on days 2 and 16. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. | 3 | 27 | 10 | 27 | 27 | 27 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Thromboembolic Event | Vascular disorders | CTCAE (3.0) | Systematic Assessment | Pulmonary emboli |
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| Pain | General disorders | CTCAE (3.0) | Systematic Assessment |
| |
| gastrointestinal disorders - Other | Gastrointestinal disorders | CTCAE (3.0) | Systematic Assessment | diverticulitis |
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| Nervous system disorders- Other | Nervous system disorders | CTCAE (3.0) | Systematic Assessment | mental status change |
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| Sepsis | Infections and infestations | CTCAE (3.0) | Systematic Assessment |
| |
| Abdominal pain | Gastrointestinal disorders | CTCAE (3.0) | Systematic Assessment |
| |
| Fracture | Injury, poisoning and procedural complications | CTCAE (3.0) | Systematic Assessment | tibia bone |
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| Wound complication | Injury, poisoning and procedural complications | CTCAE (3.0) | Systematic Assessment | surgery |
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| hypotension | Vascular disorders | CTCAE (3.0) | Systematic Assessment |
| |
| Infection and infestations- Other | Infections and infestations | CTCAE (3.0) | Systematic Assessment | related to mucositis |
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| Joint infection | Infections and infestations | CTCAE (3.0) | Systematic Assessment | knee |
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| Diarrhea | Gastrointestinal disorders | CTCAE (3.0) | Systematic Assessment |
| |
| Nausea | Gastrointestinal disorders | CTCAE (3.0) | Systematic Assessment |
| |
| Vomiting | Gastrointestinal disorders | CTCAE (3.0) | Systematic Assessment |
| |
| Dehydration | Metabolism and nutrition disorders | CTCAE (3.0) | Systematic Assessment |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Hemoglobinuria | Renal and urinary disorders | CTCAE (3.0) | Systematic Assessment |
| |
| Hypoalbuminemia | Metabolism and nutrition disorders | CTCAE (3.0) | Systematic Assessment |
| |
| Mucositis oral | Gastrointestinal disorders | CTCAE (3.0) | Systematic Assessment |
| |
| Ascites | Gastrointestinal disorders | CTCAE (3.0) | Systematic Assessment |
| |
| white blood cell decreased | Investigations | CTCAE (3.0) | Systematic Assessment |
| |
| Localized Edema | General disorders | CTCAE (3.0) | Systematic Assessment |
| |
| Hypokalemia | Metabolism and nutrition disorders | CTCAE (3.0) | Systematic Assessment |
| |
| Neutrophil count decreased | Investigations | CTCAE (3.0) | Systematic Assessment |
| |
| Platelet count decreased | Investigations | CTCAE (3.0) | Systematic Assessment |
| |
| Anemia | Blood and lymphatic system disorders | CTCAE (3.0) | Systematic Assessment |
| |
| Diarrhea | Gastrointestinal disorders | CTCAE (3.0) | Systematic Assessment |
| |
| dehydration | Metabolism and nutrition disorders | CTCAE (3.0) | Systematic Assessment |
| |
| Fatigue | General disorders | CTCAE (3.0) | Systematic Assessment |
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| rash, maculo-papular | Skin and subcutaneous tissue disorders | CTCAE (3.0) | Systematic Assessment |
| |
| Nausea | Gastrointestinal disorders | CTCAE (3.0) | Systematic Assessment |
| |
| constipation | Gastrointestinal disorders | CTCAE (3.0) | Systematic Assessment |
|
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Jean L Grem | University of Nebraska Medical Center | 402-559-5166 | jgrem@unmc.edu |
| ID | Term |
|---|---|
| C418863 | 10-propargyl-10-deazaaminopterin |
| D005472 | Fluorouracil |
| D002851 | Chromatography, High Pressure Liquid |
| D016133 | Polymerase Chain Reaction |
| D001483 | Base Sequence |
| D000071185 | Pharmacogenomic Testing |
| D054458 | Amplified Fragment Length Polymorphism Analysis |
| ID | Term |
|---|---|
| D014498 | Uracil |
| D011744 | Pyrimidinones |
| D011743 | Pyrimidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D002853 | Chromatography, Liquid |
| D002845 | Chromatography |
| D002623 | Chemistry Techniques, Analytical |
| D008919 | Investigative Techniques |
| D021141 | Nucleic Acid Amplification Techniques |
| D005821 | Genetic Techniques |
| D015394 | Molecular Structure |
| D001669 | Biochemical Phenomena |
| D055598 | Chemical Phenomena |
| D040342 | Genetic Structures |
| D055614 | Genetic Phenomena |
| D005820 | Genetic Testing |
| D019411 | Clinical Laboratory Techniques |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
| D033142 | Genetic Services |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |
| D003954 | Diagnostic Services |
| D011314 | Preventive Health Services |
| D016172 | DNA Fingerprinting |
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| Hispanic |
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| Asian |
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| Units | Counts |
|---|
| Participants |
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