PTC299 in Treating Patients With HIV-Related Kaposi Sarcoma

NCT ID: NCT00686842

Last Updated: 2018-06-06

Study Results

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE1/PHASE2

Total Enrollment

17 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-09-30

Study Completion Date

2010-12-31

Brief Summary

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RATIONALE: PTC299 may stop the growth of Kaposi sarcoma by blocking blood flow to the tumor.

PURPOSE: This phase I/II trial is studying the side effects and best dose of PTC299 and to see how well it works in treating patients with HIV-related Kaposi sarcoma.

Detailed Description

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OBJECTIVES:

Primary

* To define the safety and toxicity of anti-VEGF small molecule PTC299 in patients with HIV-related Kaposi sarcoma.
* To establish the maximum tolerated dose of this drug in these patients.
* To estimate the response rate in patients treated with this drug.

Secondary

* To describe the pharmacokinetics of this drug in these patients.
* To describe the effects of this drug on serum and plasma VEGF, VEGFR, and cytokine profiles in these patients.
* To describe the effects of this drug on HIV and KSHV viral loads in these patients.
* To describe the effects of this drug on T-lymphocyte subsets (i.e., CD4 and CD8) in these patients.
* To describe the effects of this drug on VEGF, VEGFR-2 and -3, phospho-Akt, p53, and HIF-1α expression and tumor cell proliferation, as measured by Ki-67 staining, in tumor biopsy samples obtained from these patients.
* To describe the effects of this drug on viral gene expression and cellular gene transcription, as measured by real-time quantitative PCR-based profiling, in tumor biopsy samples obtained from these patients.

OUTLINE: This is a multicenter, phase I dose-escalation study of anti-VEGF small molecule PTC299 followed by a phase II study.

Patients receive oral anti-VEGF small molecule PTC299 twice daily on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. Patients who do not demonstrate an objective response of their Kaposi sarcoma (KS) lesions after 6 courses of treatment are removed from the study.

Patients undergo blood sample collection and punch biopsies periodically during study for correlative laboratory studies. Biopsy samples are assessed for VEGF, VEGFR-2, VEGFR-3, phospho-Akt, KSHV LANA, orf59, p53, and HIF-1α expression by IHC; tumor cell proliferation by Ki-67 staining; and viral gene expression at the messenger RNA level and KSHV transcription by real-time quantitative PCR-based profiling. Blood samples are assessed for pharmacokinetics and levels of secreted cytokines or other potential serum markers characteristic for KS.

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

Conditions

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Kaposi's Sarcoma

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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VEGF Inhibitor PTC299

Single arm study - all subjects received PTC299

Group Type EXPERIMENTAL

VEGF inhibitor PTC299

Intervention Type DRUG

20 mg capsules to be taken by mouth BID. Three dose levels will be evaluated: 40 mg, 80mg, and 100mg BID. Subjects will receive PTC299 in consecutive 28-day cycles for a maximum of 12 cycles.

gene expression analysis

Intervention Type GENETIC

To describe the effects of PTC299 on viral gene expression and cellular gene transcription in KS tumor biopsies using real-time QPCR-based profiling.

polymerase chain reaction

Intervention Type GENETIC

To describe the effects of PTC299 on viral gene expression and cellular gene transcription in KS tumor biopsies using real-time QPCR-based profiling.

protein expression analysis

Intervention Type GENETIC

To describe the effects of PTC299 on viral gene expression and cellular gene transcription in KS tumor biopsies using real-time QPCR-based profiling.

immunohistochemistry staining method

Intervention Type OTHER

To describe the effects of PTC299 on KS tumor biopsies with respect to expression of VEGF, the VEGFR-2 and -3, phospho-Akt, p53, HIF-1α and proliferation, measured by Ki-67 staining.

laboratory biomarker analysis

Intervention Type OTHER

To describe the effects of PTC299 on KS tumor biopsies with respect to expression of VEGF, the VEGFR-2 and -3, phospho-Akt, p53, HIF-1α and proliferation, measured by Ki-67 staining.

pharmacological study

Intervention Type OTHER

To describe the pharmacokinetics of PTC299 in patients with HIV-associated KS. To describe the effects of PTC299 on circulating VEGF, VEGFR and cytokine levels in patients with HIV-associated KS.

biopsy

Intervention Type PROCEDURE

To describe the effects of PTC299 on KS tumor biopsies with respect to expression of VEGF, the VEGFR-2 and -3, phospho-Akt, p53, HIF-1α and proliferation, measured by Ki-67 staining.

Interventions

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VEGF inhibitor PTC299

20 mg capsules to be taken by mouth BID. Three dose levels will be evaluated: 40 mg, 80mg, and 100mg BID. Subjects will receive PTC299 in consecutive 28-day cycles for a maximum of 12 cycles.

Intervention Type DRUG

gene expression analysis

To describe the effects of PTC299 on viral gene expression and cellular gene transcription in KS tumor biopsies using real-time QPCR-based profiling.

Intervention Type GENETIC

polymerase chain reaction

To describe the effects of PTC299 on viral gene expression and cellular gene transcription in KS tumor biopsies using real-time QPCR-based profiling.

Intervention Type GENETIC

protein expression analysis

To describe the effects of PTC299 on viral gene expression and cellular gene transcription in KS tumor biopsies using real-time QPCR-based profiling.

Intervention Type GENETIC

immunohistochemistry staining method

To describe the effects of PTC299 on KS tumor biopsies with respect to expression of VEGF, the VEGFR-2 and -3, phospho-Akt, p53, HIF-1α and proliferation, measured by Ki-67 staining.

Intervention Type OTHER

laboratory biomarker analysis

To describe the effects of PTC299 on KS tumor biopsies with respect to expression of VEGF, the VEGFR-2 and -3, phospho-Akt, p53, HIF-1α and proliferation, measured by Ki-67 staining.

Intervention Type OTHER

pharmacological study

To describe the pharmacokinetics of PTC299 in patients with HIV-associated KS. To describe the effects of PTC299 on circulating VEGF, VEGFR and cytokine levels in patients with HIV-associated KS.

Intervention Type OTHER

biopsy

To describe the effects of PTC299 on KS tumor biopsies with respect to expression of VEGF, the VEGFR-2 and -3, phospho-Akt, p53, HIF-1α and proliferation, measured by Ki-67 staining.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* No symptomatic visceral KS requiring cytotoxic therapy

PATIENT CHARACTERISTICS:

* Karnofsky performance status 60-100%
* Life expectancy ≥ 3 months
* Absolute neutrophil count ≥ 1,000/mm³
* Platelet count ≥ 75,000/mm³
* Hemoglobin ≥ 8 g/dL
* Creatinine ≤ 2.0 mg/dL
* Total bilirubin normal (grade 0)

* No specific limit of total serum bilirubin for patient receiveing indinavir or atazanavir therapy AND direct serum bilirubin ≤ 30% of total bilirubin
* AST and ALT ≤ 2.5 times upper limit of normal (grade 1)
* INR and aPTT normal
* Proteinuria \< 2+
* Not pregnant or nursing
* Negative pregnancy test
* Fertile patients must use effective barrier contraception during and for up to 3 months after completion of study treatment
* Capable of complying with the study, in the opinion of the investigator
* No acute, active opportunistic infection (other than oral thrush or genital herpes) within the past 14 days
* No other concurrent neoplasia requiring cytotoxic therapy
* No history of any of the following:

* Myocardial infarction
* Severe/unstable angina
* Coronary/peripheral artery bypass graft
* Symptomatic congestive heart failure
* Cerebrovascular accident
* Transient ischemic attack
* Pulmonary embolism
* Deep vein thrombosis
* Other significant thromboembolic event
* No known coagulopathy or bleeding diathesis
* No history of CNS, pulmonary, GI, or urinary bleeding
* No known history of drug-induced liver injury
* Resting systolic blood pressure ≤ 160 mm Hg or diastolic blood pressure ≤ 100 mm Hg
* No history of or ongoing clinically significant illness, medical condition, surgical history, physical finding, ECG finding, or laboratory abnormality that, in the opinion of the investigator, could affect the safety of the patient, alter the absorption of the study drug, or impair the assessment of study results

PRIOR CONCURRENT THERAPY:

* More than 4 weeks since prior and no other concurrent anti-neoplastic therapy for KS, including chemotherapy, radiotherapy, local therapy, or biological therapy
* More than 60 days since prior local therapy for any KS-indicator lesion unless the lesion has clearly progressed since treatment

* Any prior local therapy for indicator lesions (regardless of the elapsed time) should not be allowed unless there is evidence of clear-cut progression of that lesion
* More than 28 days since prior and no other concurrent investigational drugs or therapy (other than antiretroviral therapy or agents available on a treatment IND)
* More than 30 days since prior major surgery and recovered
* More than 14 days since prior treatment for an acute infection (other than oral thrush or genital herpes) or other serious medical illness
* No concurrent surgical procedures
* No concurrent systemic corticosteroid therapy, other than replacement doses
* No concurrent anticoagulant therapy, including warfarin, heparin (including low molecular weight heparin), or antiplatelet drugs (e.g., clopidogrel bisulfate)

* Concurrent aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) allowed provided the dose does not exceed the maximum recommended dose
Minimum Eligible Age

18 Years

Maximum Eligible Age

120 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

PTC Therapeutics

INDUSTRY

Sponsor Role collaborator

The Emmes Company, LLC

INDUSTRY

Sponsor Role collaborator

AIDS Malignancy Consortium

NETWORK

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Susan E. Krown, MD

Role: STUDY_CHAIR

Memorial Sloan Kettering Cancer Center

Locations

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Rebecca and John Moores UCSD Cancer Center

La Jolla, California, United States

Site Status

USC/Norris Comprehensive Cancer Center and Hospital

Los Angeles, California, United States

Site Status

UCLA Clinical AIDS Research and Education (CARE) Center

Los Angeles, California, United States

Site Status

Cancer Research Center of Hawaii

Honolulu, Hawaii, United States

Site Status

Beth Israel Deaconess Medical Center

Boston, Massachusetts, United States

Site Status

Memorial Sloan-Kettering Cancer Center

New York, New York, United States

Site Status

Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State University Comprehensive Cancer Center

Columbus, Ohio, United States

Site Status

Floyd and Delores Jones Cancer Institute at Virginia Mason Medical Center

Seattle, Washington, United States

Site Status

Countries

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United States

References

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Bender Ignacio RA, Lee JY, Rudek MA, Dittmer DP, Ambinder RF, Krown SE; AIDS Malignancy Consortium (AMC)-059 Study Team. Brief Report: A Phase 1b/Pharmacokinetic Trial of PTC299, a Novel PostTranscriptional VEGF Inhibitor, for AIDS-Related Kaposi's Sarcoma: AIDS Malignancy Consortium Trial 059. J Acquir Immune Defic Syndr. 2016 May 1;72(1):52-7. doi: 10.1097/QAI.0000000000000918.

Reference Type BACKGROUND
PMID: 26689971 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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U01CA121947

Identifier Type: NIH

Identifier Source: secondary_id

View Link

CDR0000596565

Identifier Type: OTHER

Identifier Source: secondary_id

PTC299-ONC-005-KS

Identifier Type: OTHER

Identifier Source: secondary_id

AMC-059

Identifier Type: -

Identifier Source: org_study_id

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