Clinical Trials /

Sunitinib in Sarcomas of the Central Nervous System

NCT03641326

Description:

Background: A sarcoma is a rare cancer. It grows in the body s connective tissue. Sarcomas in the brain and central nervous system are especially rare. The drug Sunitinib has been approved in many countries for treating other types of rare or advanced cancers. These include kidney, pancreas, and bowel cancer. Researchers want to see if it can help people with sarcomas of the central nervous system. Objective: To study the effects of Sunitinib on gliosarcomas or sarcomas of the central nervous system. Eligibility: Adults ages 18 and older with a gliosarcoma or sarcoma of the central nervous system Design: Participants will be screened with the following tests. Some may be done as part of their regular cancer care: Medical history Medication review Physical exam Blood, heart, and pregnancy tests Cranial scans to locate and measure their tumor Participants will take Sunitinib by mouth every day for 2 weeks and then take none of the drug for 1 week. These 3 weeks equal 1 cycle. Participants will have 2 study visits in cycle 1. They will have 1 visit in all other cycles. They will answer questions about quality of life and repeat some screening tests. Participants will take their blood pressure at home weekly. They keep a diary of each dose of Sunitinib and blood pressure reading. Participants can choose to share data about their physical activity levels and quality of sleep. These participants will wear a small, portable watch-sized accelerometer device on the wrist for 6 cycles. About 1 month after their last study drug dose, participants will have a final study visit. They will have a physical exam, blood tests, and scans.

Related Conditions:
  • Central Nervous System Sarcoma
  • Gliosarcoma
Recruiting Status:

Completed

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Sunitinib in Sarcomas of the Central Nervous System
  • Official Title: Phase II Clinical Trial of Sunitinib in Sarcomas of the Central Nervous System

Clinical Trial IDs

  • ORG STUDY ID: 180137
  • SECONDARY ID: 18-C-0137
  • NCT ID: NCT03641326

Conditions

  • Gliosarcoma
  • Central Nervous System Sarcoma

Interventions

DrugSynonymsArms
Sunitinib1

Purpose

Background: A sarcoma is a rare cancer. It grows in the body s connective tissue. Sarcomas in the brain and central nervous system are especially rare. The drug Sunitinib has been approved in many countries for treating other types of rare or advanced cancers. These include kidney, pancreas, and bowel cancer. Researchers want to see if it can help people with sarcomas of the central nervous system. Objective: To study the effects of Sunitinib on gliosarcomas or sarcomas of the central nervous system. Eligibility: Adults ages 18 and older with a gliosarcoma or sarcoma of the central nervous system Design: Participants will be screened with the following tests. Some may be done as part of their regular cancer care: Medical history Medication review Physical exam Blood, heart, and pregnancy tests Cranial scans to locate and measure their tumor Participants will take Sunitinib by mouth every day for 2 weeks and then take none of the drug for 1 week. These 3 weeks equal 1 cycle. Participants will have 2 study visits in cycle 1. They will have 1 visit in all other cycles. They will answer questions about quality of life and repeat some screening tests. Participants will take their blood pressure at home weekly. They keep a diary of each dose of Sunitinib and blood pressure reading. Participants can choose to share data about their physical activity levels and quality of sleep. These participants will wear a small, portable watch-sized accelerometer device on the wrist for 6 cycles. About 1 month after their last study drug dose, participants will have a final study visit. They will have a physical exam, blood tests, and scans.

Detailed Description

      Background:

        -  Gliosarcoma and primary CNS sarcomas are malignant brain tumors uniformly associated
           with poor outcome.

        -  There are no known effective medical therapies for these cancers.

        -  Sunitinib is an orally administered small molecule that inhibits signaling of multiple
           receptor tyrosine kinases including those known to be activated in CNS sarcomas.

      Objectives:

      To determine the anti-tumor effect of sunitinib in recurrent gliosarcomas and primary CNS
      sarcomas as assessed by objective response rate (ORR).

      Eligibility:

        -  Patients with histologically proven gliosarcoma and primary CNS sarcoma at disease
           relapse after failing standard therapy (surgery and irradiation).

        -  Tumor tissue blocks or 15 unstained slides should be available

        -  Subjects must be greater than or equal to 18 years old.

        -  Karnofsky performance status of greater than or equal to 60

        -  Patients must have adequate organ function.

        -  Patients must not have received tyrosine kinase inhibitor(s) in the past.

      Design:

        -  This is a prospective, single institution, single arm, multi-cohort phase II study of
           sunitinib in subjects with recurrent gliosarcoma and primary CNS sarcoma that have
           failed prior surgery and irradiation (unless radiation therapy was contraindicated).

        -  Subjects will be classified into three cohorts: 1) Primary gliosarcoma; 2) Secondary
           gliosarcoma; 3) Primary CNS sarcoma. Cohort expansion will be carried out at indication
           of promising response.

        -  Sunitinib will be administered orally using a continuous schedule at 50 mg per day (with
           dose adjustments allowed for toxicity) for 2 weeks with 1 week off to constitute a
           3-week cycle until disease progression or development of intolerable side-effects.

        -  Toxicity will be assessed every cycle by CTCAE version 5.0.
    

Trial Arms

NameTypeDescriptionInterventions
1ExperimentalSunitinib will be administered at a dose of 50 mg daily for 2 consecutive weeks followed by 1 week of rest.Participants will given a small, portable pager-type and watch accelerometers to wear at the hip or non-dominant wrist. Worn daily for 6 cycles
  • Sunitinib

Eligibility Criteria

        -  INCLUSION CRITERIA:

          -  Patients must have histologically confirmed gliosarcoma (primary or secondary) or
             primary central nervous system sarcoma confirmed by the Laboratory of Pathology, NCI.

          -  Patients must have measurable disease, defined as at least one lesion that can be
             accurately measured bidimensionally by MRI (or CT scan if MRI is contraindicated).

          -  Patients must have failed standard therapy consisting of surgery, irradiation, and
             chemotherapy if indicated.

          -  Age greater than or equal to 18 years.

          -  Karnofsky greater than or equal to 60%.

          -  Patients must have normal organ and marrow function as defined below:

               -  leukocytes greater than or equal to 3,000/mcL

               -  absolute neutrophil count greater than or equal to 1,500/mcL

               -  platelets greater than or equal to 100,000/mcL

               -  total bilirubin within normal institutional limits

               -  AST(SGOT)/ALT(SGPT) less than or equal to 2.5 times institutional upper limit of
                  normal

               -  creatinine within normal institutional limits OR creatinine clearance greater
                  than or equal to 60 mL/min/1.73 m(2) for patients with

        creatinine levels above institutional normal.

          -  Patients must have the ability to understand and the willingness to sign a written
             informed consent document indicating that they are aware of the investigational nature
             of this study.

          -  The effects of sunitinib on the developing human fetus are unknown. For this reason
             and because anti-angiogenic agents are known to be teratogenic, 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. 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.

          -  Tumor tissue blocks or at least 10-15 unstained slides from the diagnosis should be
             available.

          -  At the time of registration, all subjects must be removed greater than or equal to 28
             days from any investigational agents.

        EXCLUSION CRITERIA:

          -  Patients who are receiving any other investigational agents.

          -  Uncontrolled intercurrent illness including, but not limited to, ongoing or active
             infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
             arrhythmia, or psychiatric illness/social situations that would limit compliance with
             study requirements.

          -  Prior use of tyrosine kinase inhibitors or VEGF inhibition.

          -  Patients who are receiving strong CYP450 inducers or inhibitors are ineligible.

          -  Pregnant women are excluded from this study because sunitinib has potential for
             teratogenic or abortifacient effects. Because there is an unknown but potential risk
             for adverse events in nursing infants secondary to treatment of the mother with
             sunitinib, breastfeeding should be discontinued if the mother is treated with
             sunitinib.

          -  Patients with known HIV history on combination antiretroviral therapy are ineligible
             because of the potential for pharmacokinetic interactions with sunitinib. In addition,
             these patients are at increased risk of lethal infections when treated with
             marrow-suppressive therapy.

          -  Uncontrolled hypertension (> 150/100 mmHg) while on antihypertensive medications.

          -  New York Heart Association class II or greater congestive heart failure.

          -  Serious cardiac arrhythmia requiring medication.

          -  Baseline echocardiogram with ejection fraction < 50% or greater than or equal to 20%
             decrease from a prior study.

          -  QTc interval > 500 msec on baseline EKG

          -  Patients who require use of therapeutic doses of coumarin-derivative anticoagulants
             such as warfarin are excluded, although doses of up to 2 mg daily are permitted for
             prophylaxis of thrombosis. Note: Low molecular weight heparin is permitted provided
             the patient s INR is less than or equal to 1.5.

          -  Previous exposure to anthracyclines.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:objective response rate (ORR)
Time Frame:Enrollment of 16, 24, and 32 study subjects
Safety Issue:
Description:To determine anti-tumor effect of sunitinib in recurrent gliosarcomas and primary CNS sarcomas as assessed by objective response rate (ORR)

Secondary Outcome Measures

Measure:Proportion of patients that have progressive disease after 18 months and median amount of time subject survives after therapy
Time Frame:6 month and death
Safety Issue:
Description:To determine the 6-month and median progression-free survival rates.
Measure:adverse event frequency
Time Frame:end of study
Safety Issue:
Description:To determine the adverse event rate of sunitinib in patients with recurrent gliosarcoma and primary CNS sarcoma.
Measure:Evaluation of Tumor Tissue for Biomarkers
Time Frame:end of study
Safety Issue:
Description:To evaluate archival tumor tissue for activation of signaling pathways targeted by sunitinib to establish potential biomarkers of response.
Measure:Molecular Profiling of Tumor Tissue
Time Frame:end of study
Safety Issue:
Description:To perform broad unbiased molecular profiling of archival tumor tissues to identify potential novel biomarkers of response to sunitinib.
Measure:proportion of patients who
Time Frame:end of study
Safety Issue:
Description:To evaluate radiological parameters such as perfusion and dynamic contrast enhanced MRI before and during treatment with sunitinib.
Measure:Proportion of patients that have improvement in quality of life
Time Frame:at defined study timepoints and end of study
Safety Issue:
Description:To longitudinally evaluate patient reported outcome measures using self-reported symptom severity and interference with daily activities using the MDASI-BT

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Completed
Lead Sponsor:National Cancer Institute (NCI)

Trial Keywords

  • Gliosarcoma
  • Brain Tumor
  • MDASI

Last Updated

May 10, 2021