First-line Everolimus +/- Paclitaxel for Cisplatin-ineligible Patients With Advanced Urothelial Carcinoma

NCT ID: NCT01215136

Last Updated: 2023-11-24

Study Results

Results available

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE2

Total Enrollment

36 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-12-31

Study Completion Date

2018-04-24

Brief Summary

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The purpose of this trial is to explore the activity and safety of everolimus +/- paclitaxel as first-line therapy for cisplatin-ineligible patients with advanced urothelial carcinoma.

Detailed Description

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OUTLINE: This is a multi-center study

Patients will be enrolled into one of two parallel cohorts:

* Cohort 1: impaired renal function AND poor performance status (cycle length = 28 days). Everolimus 10 mg orally daily
* Cohort 2: impaired renal function OR poor performance status (cycle length = 28 days). Everolimus 10 mg orally daily + IV Paclitaxel 80 mg/m2 on D1, 8, 15

Restaging evaluations will be performed after every 2 cycles.

Treatment will continue until disease progression or unacceptable toxicity.

Karnofsky performance status 60-70%

Life Expectancy: Not specified

Hematopoietic:

* Absolute neutrophil count (ANC) ≥ 1.5 K/mm3
* Hemoglobin (Hgb) ≥ 9 g/dL
* Platelets ≥ 100 K/mm3
* INR ≤ 1.5 (Anticoagulants are allowed if target INR ≤ 1.5 on a stable dose of warfarin or on a stable dose of Low molecular weight (LMW) heparin for at least 2 weeks prior to registration for protocol therapy).
* Fasting serum cholesterol ≤300 mg/dL OR ≤7.75 mmol/L
* Fasting triglycerides ≤ 2.5 x ULN.
* Fasting serum glucose \< 1.5 x ULN

Hepatic:

* Bilirubin ≤ 1.5 x ULN
* Aminotransferases (AST and ALT) ≤ 2.5 x ULN (unless liver metastases, then ≤ 5 x ULN)

Renal:

* Calculated creatinine clearance of \< 60 using the Cockcroft-Gault formula

Cardiovascular:

* No symptomatic congestive heart failure of New York heart Association Class III or IV.
* No unstable angina pectoris, symptomatic congestive heart failure, myocardial infarction within 6 months of start of study drug, serious uncontrolled cardiac arrhythmia or any other clinically significant cardiac disease.

Conditions

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Transitional Cell Carcinoma Bladder Carcinoma Urothelial Carcinoma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Cohort 1

Single-agent everolimus (enrollment limited to patients with patients with creatinine clearance \< 60 ml/min AND Karnofsky performance status of 60-70%)

Group Type ACTIVE_COMPARATOR

Everolimus

Intervention Type DRUG

10 mg PO daily (continuously, without scheduled treatment interruptions). The cycle length will last 28 days. Everolimus will be dispensed on Day 1 of each cycle by the study center personnel on an outpatient basis.

Cohort 2

Everolimus plus paclitaxel (enrollment limited to patients with creatinine clearance \< 60 ml/min OR Karnofsky performance status of 60-70%)

Group Type ACTIVE_COMPARATOR

Everolimus

Intervention Type DRUG

10 mg PO daily (continuously, without scheduled treatment interruptions). The cycle length will last 28 days. Everolimus will be dispensed on Day 1 of each cycle by the study center personnel on an outpatient basis.

Paclitaxel

Intervention Type DRUG

Paclitaxel 80 mg/m2 IV as a 1 hour infusion on days 1, 8, and 15, of a 28-day cycle.

Interventions

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Everolimus

10 mg PO daily (continuously, without scheduled treatment interruptions). The cycle length will last 28 days. Everolimus will be dispensed on Day 1 of each cycle by the study center personnel on an outpatient basis.

Intervention Type DRUG

Everolimus

10 mg PO daily (continuously, without scheduled treatment interruptions). The cycle length will last 28 days. Everolimus will be dispensed on Day 1 of each cycle by the study center personnel on an outpatient basis.

Intervention Type DRUG

Paclitaxel

Paclitaxel 80 mg/m2 IV as a 1 hour infusion on days 1, 8, and 15, of a 28-day cycle.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Histological or cytological proof of transitional cell carcinoma (TCC) of the bladder, urethra, ureter, or renal pelvis (urothelial carcinoma). Histology may be mixed, but still requires a component of TCC.
* Measurable disease according to RECIST and obtained by imaging within 30 days prior to registration for protocol therapy.
* Must be ineligible for cisplatin, based on the following, within 30 days prior to registration for protocol therapy.
* Prior radiation therapy is allowed to \< 25% of the bone marrow.
* Written informed consent and HIPAA authorization for release of personal health information.
* Age \> 18 years at the time of consent.
* Females of childbearing potential and males must be willing to use an effective method of contraception (hormonal or barrier method of birth control; abstinence) from the time consent is signed until 8 weeks after treatment discontinuation.
* Females of childbearing potential must have a negative pregnancy test within 7 days prior to prior to registration for protocol therapy.
* Females must not be breastfeeding.

Exclusion Criteria

* No prior chemotherapy for metastatic disease. Prior chemotherapy in the neoadjuvant/adjuvant setting is allowed if completed at least 12 months prior to registration for protocol therapy.
* No active CNS metastases or leptomeningeal metastases. Patients with neurological symptoms must undergo a head CT scan or brain MRI to exclude brain metastasis.
* No prior malignancy is allowed except for adequately treated basal cell or adequately treated squamous cell skin cancer, in situ cervical cancer, Gleason ≤ grade 7 prostate cancers (treated definitively with no evidence of PSA progression), or other cancer for which the patient has been disease-free for at least 5 years.
* No treatment with any anticancer therapy or investigational agent within 30 days prior to registration for protocol therapy.
* No known hypersensitivity to any protocol treatment.
* No prior treatment with mTOR inhibitor (sirolimus, temsirolimus, everolimus).
* No history of immunization with attenuated live vaccines within one week prior to registration for protocol therapy or during study period.
* No severely impaired lung function as defined as spirometry and DLCO that is 50% of the normal predicted value and/or 02 saturation that is 88% or less at rest on room air.
* No uncontrolled diabetes as defined by fasting serum glucose \>1.5 x ULN.
* No active (acute or chronic) or uncontrolled severe infections.
* No liver disease such as cirrhosis, chronic active hepatitis or chronic persistent hepatitis.
* No known history of HIV seropositivity.
* No impairment of gastrointestinal function or gastrointestinal disease that may significantly alter the absorption of everolimus (e.g., ulcerative disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome or small bowel resection).
* No active, bleeding diathesis.
* No history of major surgery (defined as requiring general anesthesia) or significant traumatic injury within 30 days prior to registration for protocol therapy.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hoosier Cancer Research Network

OTHER

Sponsor Role collaborator

Novartis Pharmaceuticals

INDUSTRY

Sponsor Role collaborator

Matthew Galsky

OTHER

Sponsor Role lead

Responsible Party

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Matthew Galsky

Sponsor-Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Matthew Galsky, M.D.

Role: STUDY_CHAIR

Hoosier Cancer Research Network

Locations

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University of Alabama Hematology Oncology Clinic at Medical West

Birmingham, Alabama, United States

Site Status

Northwestern University, Robert H. Lurie Comprehensive Cancer Center

Chicago, Illinois, United States

Site Status

Cancer Care Center of Southern Indiana

Bloomington, Indiana, United States

Site Status

Indiana University Melvin and Bren Simon Cancer Center

Indianapolis, Indiana, United States

Site Status

IU Health Central Indiana Cancer Centers

Indianapolis, Indiana, United States

Site Status

Metro Health Cancer Care

Wyoming, Michigan, United States

Site Status

Nebraska Cancer Specialists

Omaha, Nebraska, United States

Site Status

Icahn School of Medicine: Tisch Cancer Institute at Mount Sinai Medical Center

New York, New York, United States

Site Status

MUSC Hollings Cancer Center

Charleston, South Carolina, United States

Site Status

University of Texas Medical Branch

Galveston, Texas, United States

Site Status

Virginia Oncology Associates

Norfolk, Virginia, United States

Site Status

Countries

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United States

References

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Jun T, Hahn NM, Sonpavde G, Albany C, MacVicar GR, Hauke R, Fleming M, Gourdin T, Jana B, Oh WK, Taik P, Wang H, Varadarajan AR, Uzilov A, Galsky MD. Phase II Clinical and Translational Study of Everolimus +/- Paclitaxel as First-Line Therapy in Cisplatin-Ineligible Advanced Urothelial Carcinoma. Oncologist. 2022 Jun 8;27(6):432-e452. doi: 10.1093/oncolo/oyab075.

Reference Type DERIVED
PMID: 35438782 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Related Links

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http://www.hoosieroncologygroup.org

Hoosier Oncology Group Homepage

Other Identifiers

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HCRN GU10-147

Identifier Type: -

Identifier Source: org_study_id