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AMG 706 and Octreotide in Tre...

AMG 706 and Octreotide in Treating Patients With Low-Grade Neuroendocrine Tumors

Last Updated: 2023-07-05

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

46 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-11-07

Study Completion Date

2015-04-30

Brief Summary

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RATIONALE: AMG 706 and octreotide 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.

PURPOSE: This phase II trial is studying how well AMG 706 and octreotide work in treating patients with low-grade neuroendocrine tumors.

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Detailed Description

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OBJECTIVES:

Primary

* Determine the 4-month progression-free survival (PFS) of patients with low-grade neuroendocrine tumors treated with AMG 706 and octreotide acetate.

Secondary

* Determine the response rate and overall survival of patients treated with these drugs.
* Determine the toxicity and tolerability of AMG 706 in these patients.
* Determine the effect of AMG 706 on tumor perfusion by functional computerized tomography (CT) scan.
* Determine the effect of AMG 706 on tumor markers (e.g., chromogranin A, 5-hydroxyindoleacetic acid, and gastrin) specific for neuroendocrine tumors.
* Determine the effect of AMG 706 on serum vascular endothelial growth factor (VEGF) levels.
* Determine the expression of VEGF, VEGF receptor-2 (VEGFR-2), chromogranin A, human achaete-scute homolog-1 (hASH1), and Notch1 markers of neuroendocrine tumors.

OUTLINE: This is a multicenter study.

Patients receive oral AMG 706 and octreotide acetate intramuscularly once daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.

Plasma samples are collected at baseline, periodically during study treatment, and at 4 weeks after the completion of study treatment. Samples are used to determine plasma VEGF levels. Gene expression of downstream markers of Raf kinase expression (raf, MEK, and ERK) as well as hASH1 and Notch1 are evaluated at baseline. Tumor tissue collected at diagnosis or prior surgery is examined by reverse transcriptase-polymerase chain reaction assay. Contrast CT scans are conducted at baseline, day 2 of course 1, and week 8 to assess tumor perfusion.

After the completion of study treatment, patients are followed periodically for 5 years.

PROJECTED ACCRUAL: A total of 44 patients will be accrued for this study.

Conditions

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Gastrointestinal Carcinoid Tumor Islet Cell Tumor Neoplastic Syndrome

Study Design

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Allocation Method

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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AMG 706+Octreotide

Patients receive oral AMG 706 and octreotide acetate intramuscularly (IM) once daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.

AMG 706 was administered on a flat scale of mg/day and not by weight or body surface area (BSA). AMG 706 was provided as a 25 mg tablet; the daily dose was 125 mg administered as five 25 mg tablets in the morning. AMG 706 was taken daily without breaks in treatment.

One dose consisted of octreotide-LAR 30 mg administered IM on day 1 of each cycle. The first octreotide-LAR injection would correspond with the first day of AMG 706 and then on day 1 of subsequent cycles.

Group Type EXPERIMENTAL

AMG 706

Intervention Type DRUG

AMG 706 was administered on a flat scale of mg/day and not by weight or body surface area (BSA). AMG 706 was provided as a 25 mg tablet; the daily dose was 125 mg administered as five 25 mg tablets in the AM. AMG 706 was taken daily without breaks in treatment

octreotide

Intervention Type DRUG

One dose consisted of octreotide-LAR 30 mg administered IM on day 1 of each cycle. The first octreotide-LAR injection would correspond with the first day of AMG 706 and then on day 1 of subsequent cycles.

Interventions

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AMG 706

Intervention Type DRUG

octreotide

Intervention Type DRUG

Other Intervention Names

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motesanib diphosphate L-cysteinamide Sandostatin SMS 201-995

Eligibility Criteria

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Inclusion Criteria

* Histologically confirmed low-grade neuroendocrine neoplasm
* Measurable disease
* Radiographic evidence of disease progression after any prior systemic therapy, chemoembolization, bland embolization, or observation, defined by either of the following:

* Appearance of a new lesion
* At least 20% increase in the longest diameter of any previously documented lesion or in the sum of the longest diameters of multiple lesions
* Tissue block from original diagnostic or surgical specimen required
* Concurrent stable-dose octreotide acetate required
* Eastern Cooperative Oncology Group (ECOG) performance status 0-2
* Negative pregnancy test
* Fertile patients must use effective contraception
* Must be able to receive a contrast-enhanced CT scan
* Absolute neutrophil count ≥ 1,000/mm³
* Platelet count ≥ 75,000/mm³
* Hemoglobin level ≥ 8.0 g/dL
* Bilirubin ≤ 2.0 times upper limit of normal (ULN)
* Aspartate aminotransferase (AST) ≤ 3 times ULN (5 times ULN if liver metastases are present)
* Left Ventricular Ejection Fraction (LVEF) ≥ institutional lower limit of normal as evaluated by echocardiography or multigated acquisition (MUGA) scan
* No history of uncontrolled hypertension (resting blood pressure \> 150/90 mm Hg)

* Antihypertensive medications allowed if patients is stable on their current dose
* One prior systemic chemotherapy regimen for low-grade neuroendocrine neoplasm allowed

* Chemoembolization is not considered systemic chemotherapy
* At least 4 weeks since prior major surgery, chemotherapy, radiation therapy, other systemic therapy, or local liver therapy

Exclusion Criteria

* Prior procedures that would adversely affect intestinal absorption
* Prior anti-vascular endothelial growth factors
* Concurrent chemotherapy or radiation therapy
* History of the following within the past 12 months:

* New York Heart Association class III or IV congestive heart failure
* Unstable angina pectoris
* Myocardial infarction
* Symptomatic cardiac arrhythmia
* Cerebrovascular accident or transient ischemic attack
* Arterial or venous thrombosis
* Known history of allergic reactions to AMG 706 or derivatives or to octreotide acetate injections
* Gastrointestinal tract disease resulting in an inability to take oral medication (i.e., ulcerative disease, uncontrolled nausea, vomiting, or diarrhea, bowel obstruction, or inability to swallow tablets)
* Pregnant or nursing
* Small cell lung cancer, medullary thyroid cancer, paraganglioma, or pheochromocytoma
* Requirement for intravenous alimentation

Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mary Mulcahy, MD

Role: STUDY_CHAIR

Robert H. Lurie Cancer Center

Locations

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Hematology Oncology Associates of Illinois - Berwyn

Berwyn, Illinois, United States

Site Status

Robert H. Lurie Comprehensive Cancer Center at Northwestern University

Chicago, Illinois, United States

Site Status

Hematology and Oncology Associates

Chicago, Illinois, United States

Site Status

Midwest Center for Hematology/Oncology

Joliet, Illinois, United States

Site Status

North Shore Oncology and Hematology Associates, Limited - Libertyville

Libertyville, Illinois, United States

Site Status

Trinity Cancer Center at Trinity Medical Center - 7th Street Campus

Moline, Illinois, United States

Site Status

La Grange Oncology Associates - Geneva

Naperville, Illinois, United States

Site Status

Cancer Care and Hematology Specialists of Chicagoland - Niles

Niles, Illinois, United States

Site Status

Hematology Oncology Associates - Skokie

Skokie, Illinois, United States

Site Status

McFarland Clinic, PC

Ames, Iowa, United States

Site Status

Hematology & Oncology Care

Bettendorf, Iowa, United States

Site Status

Cedar Rapids Oncology Associates

Cedar Rapids, Iowa, United States

Site Status

Mercy Regional Cancer Center at Mercy Medical Center

Cedar Rapids, Iowa, United States

Site Status