Description:
This phase I trial studies the side effects and best dose of vemurafenib when given together
with cetuximab and irinotecan hydrochloride in treating patients with solid tumors that have
spread to other parts of the body or cannot be removed by surgery. Vemurafenib and irinotecan
hydrochloride may stop the growth of tumor cells by blocking some of the enzymes needed for
cell growth. Immunotherapy with monoclonal antibodies, such as cetuximab, may help the body's
immune system attack the cancer, and may interfere with the ability of tumor cells to grow
and spread. Giving vemurafenib with cetuximab and irinotecan hydrochloride may be a better
treatment for solid tumors.
Title
- Brief Title: Vemurafenib, Cetuximab, and Irinotecan Hydrochloride in Treating Patients With Solid Tumors That Are Metastatic or That Cannot Be Removed by Surgery
- Official Title: A Phase I Trial of Vemurafenib in Combination With Cetuximab and Irinotecan in Patients With BRAF V600 Mutant Advanced Solid Malignancies
Clinical Trial IDs
- ORG STUDY ID:
2012-0748
- SECONDARY ID:
NCI-2013-00541
- SECONDARY ID:
2012-0748
- SECONDARY ID:
P30CA016672
- SECONDARY ID:
R01CA187238
- NCT ID:
NCT01787500
Conditions
- BRAF NP_004324.2:p.V600X
- KRAS wt Allele
- Metastatic Malignant Solid Neoplasm
- Stage IV Colorectal Cancer AJCC v7
- Stage IVA Colorectal Cancer AJCC v7
- Stage IVB Colorectal Cancer AJCC v7
- Unresectable Solid Neoplasm
Interventions
Drug | Synonyms | Arms |
---|
Cetuximab | Cetuximab Biosimilar CMAB009, Chimeric Anti-EGFR Monoclonal Antibody, Chimeric MoAb C225, Chimeric Monoclonal Antibody C225, Erbitux, IMC-C225 | Treatment (vemurafenib, cetuximab, irinotecan hydrochloride) |
Irinotecan Hydrochloride | Campto, Camptosar, Camptothecin 11, Camptothecin-11, CPT 11, CPT-11, Irinomedac, U-101440E | Treatment (vemurafenib, cetuximab, irinotecan hydrochloride) |
Vemurafenib | BRAF (V600E) kinase inhibitor RO5185426, BRAF(V600E) Kinase Inhibitor RO5185426, PLX-4032, PLX4032, RG 7204, RG7204, RO 5185426, Zelboraf | Treatment (vemurafenib, cetuximab, irinotecan hydrochloride) |
Purpose
This phase I trial studies the side effects and best dose of vemurafenib when given together
with cetuximab and irinotecan hydrochloride in treating patients with solid tumors that have
spread to other parts of the body or cannot be removed by surgery. Vemurafenib and irinotecan
hydrochloride may stop the growth of tumor cells by blocking some of the enzymes needed for
cell growth. Immunotherapy with monoclonal antibodies, such as cetuximab, may help the body's
immune system attack the cancer, and may interfere with the ability of tumor cells to grow
and spread. Giving vemurafenib with cetuximab and irinotecan hydrochloride may be a better
treatment for solid tumors.
Detailed Description
PRIMARY OBJECTIVES:
I. To define the maximum tolerated dose (MTD) of vemurafenib when used in combination with
cetuximab and irinotecan (irinotecan hydrochloride).
II. To define the safety profile of this combination. III. To determine the antitumor
activity of this combination specifically in patients with advanced solid malignancies with
positive v-raf murine sarcoma viral oncogene homolog B (BRAF) (V600)/negative Kirsten rat
sarcoma viral oncogene homolog (K-RAS) mutation. (Part II-expanded cohort) IV. To determine
the antitumor activity of this combination in patients with metastatic colorectal cancer with
positive BRAF (V600)/negative K-RAS mutation. (Part II-expanded cohort)
SECONDARY OBJECTIVES:
I. To evaluate clinical response signals of the combination. II. To assess the
pharmacokinetic (PK) and pharmacodynamic (PD) profile of the combination.
OUTLINE: This is a dose-escalation study of vemurafenib.
Patients receive vemurafenib orally (PO) twice daily (BID) on days 1-14, cetuximab
intravenously (IV) over 90 minutes, and irinotecan hydrochloride IV over 90 minutes on day 1.
Courses repeat every 14 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 30 days.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment (vemurafenib, cetuximab, irinotecan hydrochloride) | Experimental | Patients receive vemurafenib PO BID on days 1-14, cetuximab IV over 90 minutes, and irinotecan hydrochloride IV over 90 minutes on day 1. Courses repeat every 14 days in the absence of disease progression or unacceptable toxicity. | - Cetuximab
- Irinotecan Hydrochloride
- Vemurafenib
|
Eligibility Criteria
Inclusion Criteria:
- Patients must have histologically confirmed malignancy that is metastatic or
unresectable
- Cancers with positive BRAF V600 mutation detected by a Clinical Laboratory Improvement
Act (CLIA)-certified laboratory
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2
- Life expectancy of greater than 3 months
- Patients must have measurable disease per Response Evaluation Criteria in Solid Tumors
(RECIST) 1.1 criteria
- Patients must have a K-RAS wild-type (WT) tumor
- Absolute neutrophils count >= 1500/mcl (within 14 days)
- Platelets >= 100000/mcl (within 14 days)
- Hemoglobin (Hb) >= 9 mg/dl (within 14 days)
- Total bilirubin =< 1.5 mg/dl (within 14 days)
- Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =< 5 x upper limit of
normal if liver metastases present; otherwise, then =< 2.5 x upper limit (within 14
days)
- Estimated creatinine clearance by Cockcroft-Gault equation > 30 mL/min (within 14
days)
- Current treatment may cause harm to the developing human fetus; for this reason women
of child-bearing age must have a negative pregnancy test at screening and both 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, and for 6 months after last dose; should a woman
become pregnant or suspect she is pregnant while she or her partner is participating
in this study, she should inform her treating physician immediately
- Signed informed consent approved by the Institutional Review Board prior to patient
entry
- Expansion cohort: We propose a final expansion cohort for this study in a subset of
interest utilizing the recommended dosing of combination; this cohort will include
patients harboring characteristics that may predict response of combination or with
clinical features that proved to derive most benefit of the study combination during
preclinical studies; cancers with positive BRAF (V600) mutation detected by a
CLIA-certified laboratory
Exclusion Criteria:
- Patient receiving any concurrent chemotherapy
- Concurrent severe and/or uncontrolled medical disease including, but not limited to,
ongoing or active infection requiring intravenous antibiotics, bowel obstruction
- Symptomatic congestive heart failure (New York Heart Association [NYHA] class III or
IV), or unstable angina pectoris
- Patients who have had a myocardial infarction, transient ischemic attack, unstable
angina, or cardiovascular symptoms (CVS) within 6 months before treatment
- Presence of symptomatic pleural and/or pericardial effusion not appropriately treated
- Prolonged corrected QT (QTc) interval (>= 450 msec) as calculated by Bazett's formula,
or patients with a history of congenital long QT syndrome or uncorrectable electrolyte
abnormalities
- Medical and/or psychiatric problems of sufficient severity to limit full compliance
with the study or expose patients to undue risk
- Known anaphylactic or severe hypersensitivity to the study drugs or their analogs
- Patient has failed to recover from any prior surgery within 4 weeks of study entry
- Patient is pregnant, lactating, or breastfeeding
- Patient has had any treatment specific for tumor control within 3 weeks of dosing with
investigational drugs and cytotoxic agents, or within 2 weeks of cytotoxic agent given
weekly, or within 6 weeks of nitrosoureas or mitomycin C, or within 5 half-lives of
biological targeted agents with half-lives and pharmacodynamic effects lasting less
than 5 days
- Patient is not able to swallow oral medication
- Patients receiving any medications or substances that are strong inhibitors or
inducers of cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4) complex are
ineligible
- Patients with known K-RAS mutant (codon 12 or 13) detected by a Food and Drug
Administration (FDA)-approved test in a CLIA-certified laboratory
- Patients with BRAF WT cancers
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Maximum tolerated dose of vemurafenib defined as the highest dose studied in which the incidence of dose limiting toxicity was less than 33% as graded by the National Cancer Institute Common Toxicity Criteria version 4.0 |
Time Frame: | Up to 4 weeks |
Safety Issue: | |
Description: | Descriptive statistics will be provided on the grade and type of toxicity by dose level. |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | M.D. Anderson Cancer Center |
Last Updated
December 2, 2020