Clinical Trials /

Combination Chemotherapy and Bevacizumab With the NovoTTF-100L(P) System in Treating Participants With Advanced, Recurrent, or Refractory Hepatic Metastatic Cancer

NCT03203525

Description:

This phase I trial studies the side effects and best dose of combination chemotherapy and bevacizumab, and to see how well they work with the NovoTTF-100L(P) system in treating participants with cancer that has come back or does not respond to treatment and has spread to the liver. Drugs used in chemotherapy, such as oxaliplatin, leucovorin, fluorouracil, pegylated liposomal doxorubicin hydrochloride, and temsirolimus, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Bevacizumab is a monoclonal antibody that may interfere with the ability of tumor cells to grow and spread. The NovoTTF-100L(P) system is a portable device that uses electrical fields to stop the growth of tumor cells. Giving combination chemotherapy and monoclonal antibody therapy while using the NovoTTF-100L(P) system may kill more tumor cells.

Related Conditions:
  • Colorectal Carcinoma
  • Hematopoietic and Lymphoid Malignancy
  • Malignant Solid Tumor
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Combination Chemotherapy and Bevacizumab With the NovoTTF-100L(P) System in Treating Participants With Advanced, Recurrent, or Refractory Hepatic Metastatic Cancer
  • Official Title: A Phase I Study of the NovoTTF-100L(P) System to Enhance Antitumor Activity in Patients With Predominant Hepatic Metastatic Cancer

Clinical Trial IDs

  • ORG STUDY ID: 2014-0357
  • SECONDARY ID: NCI-2018-01597
  • SECONDARY ID: 2014-0357
  • SECONDARY ID: P30CA016672
  • NCT ID: NCT03203525

Conditions

  • Advanced Malignant Neoplasm
  • Colorectal Carcinoma Metastatic in the Liver
  • Metastatic Malignant Neoplasm in the Liver
  • Refractory Malignant Neoplasm

Interventions

DrugSynonymsArms
BevacizumabAnti-VEGF, Anti-VEGF Humanized Monoclonal Antibody, Anti-VEGF rhuMAb, Avastin, Bevacizumab awwb, Bevacizumab Biosimilar BEVZ92, Bevacizumab Biosimilar BI 695502, Bevacizumab Biosimilar CBT 124, Bevacizumab Biosimilar CT-P16, Bevacizumab Biosimilar FKB238, Bevacizumab Biosimilar HD204, Bevacizumab Biosimilar HLX04, Bevacizumab Biosimilar IBI305, Bevacizumab Biosimilar LY01008, Bevacizumab Biosimilar MIL60, Bevacizumab Biosimilar QL 1101, Bevacizumab Biosimilar RPH-001, Bevacizumab Biosimilar SCT501, BP102, BP102 Biosimilar, HD204, Immunoglobulin G1 (Human-Mouse Monoclonal rhuMab-VEGF Gamma-Chain Anti-Human Vascular Endothelial Growth Factor), Disulfide With Human-Mouse Monoclonal rhuMab-VEGF Light Chain, Dimer, Recombinant Humanized Anti-VEGF Monoclonal Antibody, rhuMab-VEGF, SCT501Arm A (FOLFOX6, bevacizumab, NovoTTF-100L[P])
Fluorouracil5 Fluorouracil, 5 Fluorouracilum, 5 FU, 5-Fluoro-2,4(1H, 3H)-pyrimidinedione, 5-fluorouracil, 5-Fluracil, 5-FU, 5FU, AccuSite, Carac, Fluoro Uracil, Fluouracil, Flurablastin, Fluracedyl, Fluracil, Fluril, Fluroblastin, Ribofluor, Ro 2-9757, Ro-2-9757Arm A (FOLFOX6, bevacizumab, NovoTTF-100L[P])
Leucovorinfolinic acidArm A (FOLFOX6, bevacizumab, NovoTTF-100L[P])
Oxaliplatin1-OHP, Ai Heng, Aiheng, Dacotin, Dacplat, Diaminocyclohexane Oxalatoplatinum, Eloxatin, Eloxatine, JM-83, Oxalatoplatin, Oxalatoplatinum, RP 54780, RP-54780, SR-96669Arm A (FOLFOX6, bevacizumab, NovoTTF-100L[P])
Pegylated Liposomal Doxorubicin HydrochlorideATI-0918, Caelyx, DOX-SL, Doxil, Doxilen, Doxorubicin HCl Liposomal, Doxorubicin HCl Liposome, Doxorubicin Hydrochloride Liposome, Duomeisu, Evacet, LipoDox, Lipodox 50, Liposomal Adriamycin, Liposomal Doxorubicin Hydrochloride, Liposomal-Encapsulated Doxorubicin, Pegylated Doxorubicin HCl Liposome, S-Liposomal Doxorubicin, Stealth Liposomal Doxorubicin, TLC D-99Arm B(bevacizumab,liposomal doxorubicin, DAT, NovoTTF-100L[P])
TemsirolimusCCI-779, CCI-779 Rapamycin Analog, Cell Cycle Inhibitor 779, Rapamycin Analog, Rapamycin Analog CCI-779, ToriselArm B(bevacizumab,liposomal doxorubicin, DAT, NovoTTF-100L[P])

Purpose

This phase I trial studies the side effects and best dose of combination chemotherapy and bevacizumab, and to see how well they work with the NovoTTF-100L(P) system in treating participants with cancer that has come back or does not respond to treatment and has spread to the liver. Drugs used in chemotherapy, such as oxaliplatin, leucovorin, fluorouracil, pegylated liposomal doxorubicin hydrochloride, and temsirolimus, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Bevacizumab is a monoclonal antibody that may interfere with the ability of tumor cells to grow and spread. The NovoTTF-100L(P) system is a portable device that uses electrical fields to stop the growth of tumor cells. Giving combination chemotherapy and monoclonal antibody therapy while using the NovoTTF-100L(P) system may kill more tumor cells.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To define the maximum tolerated doses (MTD) of two established chemotherapy regimens (Arm
      A: FOLFOX6 [oxaliplatin, fluorouracil (5FU) and leucovorin (folinic acid)] plus bevacizumab;
      and Arm B: pegylated liposomal doxorubicin hydrochloride [liposomal doxorubicin] and
      bevacizumab plus temsirolimus [DAT]) in combination with the concurrent use of the
      NovoTTF-100L(P) system in patients with predominant hepatic metastases.

      II. To define the safety profiles of FOLFOX6 plus bevacizumab or DAT with concurrent
      NovoTTF-100L(P) in patients with predominant hepatic metastases.

      SECONDARY OBJECTIVES:

      I. To evaluate clinical response signals to the treatment with FOLFOX6 plus bevacizumab or
      DAT with concurrent NovoTTF-100L(P).

      II. To assess predictive biomarkers by analyzing baseline molecular mutation status, and
      resistant pathways by comparing molecular signatures at baseline versus at time of relapse in
      patients who have achieved objective responses.

      OUTLINE: This is a dose-escalation study. Participants are assigned to 1 of 2 arms.

      ARM A: Participants receive oxaliplatin, leucovorin, and fluorouracil via pump over 46 hours
      beginning on day 1, bevacizumab intravenously (IV) over 30-90 minutes on days 1 and 15, and
      use NovoTTF-100L(P) system over 18 hours daily. Courses repeat every 28 days in the absence
      of disease progression or unacceptable toxicity.

      ARM B: Participants receive bevacizumab IV over 90 minutes on days 1 and 15, pegylated
      liposomal doxorubicin hydrochloride IV over 30 minutes-3 hours on days 1 and 15, and
      temsirolimus IV over 60-90 minutes on days 1, 8, 15, and 22. Participants also use
      NovoTTF-100L(P) system over 18 hours daily. Courses repeat every 28 days in the absence of
      disease progression or unacceptable toxicity.

      After the completion of study treatment, patients are followed at 30 days.
    

Trial Arms

NameTypeDescriptionInterventions
Arm A (FOLFOX6, bevacizumab, NovoTTF-100L[P])ExperimentalParticipants receive oxaliplatin, leucovorin, and fluorouracil via pump over 46 hours on beginning on day 1, bevacizumab IV over 30-90 minutes on days 1 and 15, and use NovoTTF-100L(P) system over 18 hours daily. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
  • Bevacizumab
  • Fluorouracil
  • Leucovorin
  • Oxaliplatin
Arm B(bevacizumab,liposomal doxorubicin, DAT, NovoTTF-100L[P])ExperimentalParticipants receive bevacizumab IV over 90 minutes on days 1 and 15, pegylated liposomal doxorubicin hydrochloride IV over 30 minutes-3 hours on days 1 and 15, and temsirolimus IV over 60-90 minutes on days 1, 8, 15, and 22. Participants also use NovoTTF-100L(P) system over 18 hours daily. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
  • Bevacizumab
  • Pegylated Liposomal Doxorubicin Hydrochloride
  • Temsirolimus

Eligibility Criteria

        Inclusion Criteria:

          -  Patients with advanced malignancies, either refractory to standard therapy or for
             which no effective standard therapy is available, unless the drugs in the protocol are
             part of the standard of care for a specific diagnosis

               -  Predominant hepatic metastasis is defined as at least 50% of the total tumor
                  burden involving the liver

               -  An aberrant PI3K pathway such as PIK3CA mutations or PTEN loss, is detected in a
                  CLIA (Clinical Laboratory Improvement Amendments)-certified laboratory

               -  For patients who are enrolled into the arm of FOLFOX6 plus bevacizumab, they must
                  have metastatic colorectal cancer with predominant hepatic metastases

               -  For patients who are enrolled into the arm of DAT, they must have predominant
                  hepatic metastases harboring an aberrant PI3K pathway

          -  Patients must have measurable or evaluable disease, as defined by Response Evaluation
             Criteria in Solid Tumors (RECIST) 1.1

          -  Women of child-bearing potential (women who are not postmenopausal for at least one
             year or are not surgically sterile) and men must agree to use adequate contraception
             (e.g., hormonal, barrier device, or abstinence) prior to study entry, for the duration
             of study participation, and for 30 days after the last dose of the study agents

          -  Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of
             0 to 2

          -  Neutrophils >= 1,500/uL

          -  Platelets >= 100,000/uL

          -  Total bilirubin =< 1.5 x ULN (upper limit of normal) (except patients with Gilbert's
             syndrome, who must have a total bilirubin =< 3.0 mg/dL)

          -  Alanine aminotransferase (ALT) =< 3 x ULN or =< 5 x ULN if liver metastases persist

          -  Serum creatinine =< 1.5 mg/dL or calculated creatinine clearance >= 50 mL/minutes

          -  Patients should be able to read and fully understand the requirements of the trial, be
             willing to comply with all trial visits and assessments, and be willing and able to
             sign an Institutional Reviewed Board (IRB)-approved written informed consent document

          -  Patients may receive palliative radiation therapy immediately before or during the
             treatment if the radiation therapy is not delivered to the sole target lesions

        Exclusion Criteria:

          -  Uncontrolled intercurrent illness including, but not limited to, ongoing or active
             infection requiring intravenous antibiotics, symptomatic congestive heart failure (New
             York Heart Association [NYHA] class III or IV), unstable angina pectoris, uncontrolled
             systemic hypertension (systolic blood pressure [BP] > 140 mm Hg, diastolic BP > 90 mm
             Hg), left ventricular ejection fraction < 50%, active bleeding, or psychiatric
             illness/social situations that would limit compliance with study requirements

          -  Patients who have not recovered from major surgical procedure, or significant
             traumatic injury (i.e., patients still need additional medical care for these issues)

          -  History of allergic reactions to the study drugs or their analogs, or any component of
             the products, or sensitive to conductive hydrogels used on electrocardiogram (ECG)
             stickers or transcutaneous electrical nerve stimulation (TENS) electrodes

          -  Any treatment specific for tumor control within 3 weeks of drugs; or within 2 weeks if
             cytotoxic agents were given weekly (within 6 weeks for nitrosoureas or mitomycin C),
             or within 5 half-lives for targeted agents with half-lives and pharmacodynamic effects
             lasting fewer than 4 days (that includes, but is not limited to, erlotinib, sorafenib,
             sunitinib, bortezomib, and similar agents), or failure to recover from the toxic
             effect of any of these therapies prior to study entry

          -  Symptomatic primary tumors or metastasis of brain and/or central nervous system that
             are uncontrolled with antiepileptics and requiring high doses of steroids

          -  Implanted pacemaker, defibrillator, nerve stimulator or other active electronic
             medical devices

          -  Corrected QT interval (QTc) is greater than 480 milliseconds (msec) at screening, or
             documented clinically significant arrhythmias. The QTc formula Bazett will be used for
             assessing subject eligibility

          -  History of stroke or transient ischemic attack, peripheral vascular disease, active
             gastric or duodenal ulcer, abdominal fistula, gastrointestinal perforation, or
             intra-abdominal abscess within 6 months prior to study enrollment

          -  Patients with known human immunodeficiency virus infection, active hepatitis B or C

          -  Women who are pregnant will be excluded from the study
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Incidence of adverse events
Time Frame:Up to 3 years
Safety Issue:
Description:Descriptive statistics will be provided on the grade and type of toxicity by dose level.

Secondary Outcome Measures

Measure:Response
Time Frame:Up to 3 years
Safety Issue:
Description:Will be assessed by Response Evaluation Criteria in Solid Tumors 1.1. Wilcoxon's Signed-Rank Test and Fisher's exact test will be used for data analysis of continuous variables and categorical variables, respectively. A mixed model accounting for patient effects will be used to analyze longitudinal data (including biomarker data) over time.
Measure:Biomarker analysis
Time Frame:Up to 3 years
Safety Issue:
Description:Wilcoxon's Signed-Rank Test and Fisher's exact test will be used for data analysis of continuous variables and categorical variables, respectively. A mixed model accounting for patient effects will be used to analyze longitudinal data (including biomarker data) over time.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:M.D. Anderson Cancer Center

Last Updated

August 12, 2020