Individualizing Pazopanib Therapy by exploRing the Role of Early Metabolic responsE and Drug Exposure as a preDICTor for Treatment Outcome in Patients With STS (PREDICT)

This study is a phase IV post registration prospective observational feasibility study in patients with metastatic soft tissue sarcoma. Pazopanib is the registered treatment for patients with advanced soft tissue sarcoma after chemotherapy with doxorubicin or ifosfamide.

• This study looks at the possibility of using 18F-2-fluoro-2-deoxy-D-glucose fluorodeoxyglucose (FDG) positron emission tomography PET scans as an early biomarker of pazopanib treatment effect in patients.
• It also studies pazopanib pharmacokinetics to see if there are differences between elderly and younger patients.

The primary objectives are:

• To evaluate whether early metabolic response is correlated to clinical benefit.
• To evaluate the effect of age (≥ 70 years) on pazopanib pharmacokinetics.

The secondary objectives are:

• To evaluate whether early metabolic response (% decrease in FDG uptake due to pazopanib therapy) is correlated with pazopanib exposure.
• To evaluate whether early metabolic response (% decrease in FDG uptake due to pazopanib therapy) is correlated with the histological subtypes.

Study Overview

• Status: Completed
• Conditions: Sarcoma, Soft Tissue
• Intervention / Treatment: Drug: Pazopanib

• Study Type: Observational
• Enrollment (Actual): 22

Contacts and Locations

Study Locations

• Netherlands
  • Nijmegen, Netherlands, 6525 GA
    • Radboud University Nijmegen Medical Centre
• United Kingdom
  • London, United Kingdom
    • Royal Marsden Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients with advanced soft tissue sarcoma who have an indication for pazopanib treatment.

Description

Inclusion Criteria:

1. Subjects must provide written informed consent prior to performance of study-specific procedures or assessments and must be willing to comply with treatment and follow-up.
2. Age ≥ 18 years. Patients aged 66-69 are eligible for the imaging arm of the study, however they are excluded from the assessment of altered pharmacokinetic behavior in elderly.

3. Histological confirmed diagnosis of selective subtypes of advanced soft tissue sarcoma (STS) who have received prior chemotherapy for metastatic disease or who have progressed within 12 months after (neo) adjuvant therapy. The following subtypes are eligible:

   Fibroblastic, so-called fibrohistiocytic, leiomyosarcoma, malignant glomus tumours, skeletal muscles, vascular, uncertain differentiation. The following subtypes are NOT eligible: Adipocytic sarcoma (all subtypes), all rhabdomyosarcoma that were not alveolar or pleomorphic, chondrosarcoma, osteosarcoma, Ewing tumours/primitive neuroectodermal tumor, GIST, dermatofibrosarcoma protuberance, inflammatory myofibroblastic sarcoma, malignant mesothelioma and mixed mesodermal tumours of the uterus.

4. Eastern Cooperative Oncology Group (ECOG) performance status of 0-2.
5. Measurable disease criteria (RECIST 1.1).
6. No radio-, chemo- or tumor specific targeted therapy within the last 4 weeks prior to study entry.
7. Adequate organ system function as defined in the research protocol.
8. Minimal evaluable lesion of ≥ 15mm.

Exclusion Criteria:

1. Prior malignancy.
2. Central nervous system (CNS) metastases at baseline, with the exception of those subjects who have previously-treated CNS metastases and who meet both of the following criteria: a) are asymptomatic and b) have no requirement for steroids or enzyme-inducing anticonvulsants in prior 6 months time interval.
3. Clinically significant gastrointestinal abnormalities that may increase the risk for gastrointestinal bleeding including.
4. Clinically significant gastrointestinal abnormalities that may affect absorption of investigational product including.
5. Corrected QT interval (QTc) > 480msecs.

6. History of any one or more of the following cardiovascular conditions within the past 6 months:

   • Cardiac angioplasty or stenting
   • Myocardial infarction
   • Unstable angina
   • Coronary artery bypass graft surgery
   • Symptomatic peripheral vascular disease
   • Class III or IV congestive heart failure, as defined by the New York Heart Association (NYHA)
7. Poorly controlled hypertension
8. History of cerebrovascular accident including transient ischemic attack (TIA), pulmonary embolism or untreated deep venous thrombosis (DVT) within the past 6 months.
9. Major surgery or trauma within 28 days prior to first dose of investigational product and/or presence of any non-healing wound, fracture, or ulcer.
10. Evidence of active bleeding or bleeding diathesis.
11. Known endobronchial lesions and/or lesions infiltrating major pulmonary vessels that increase the risk of pulmonary hemorrhage.
12. Recent hemoptysis.
13. Any serious and/or unstable pre-existing medical, psychiatric, or other condition that could interfere with subject's safety, provision of informed consent, or compliance to study procedures.
14. Unable or unwilling to discontinue use of prohibited medications listed in the research protocol for at least 14 days or five half-lives of a drug (whichever is longer) prior to the first dose of study drug and for the duration of the study.
15. Concurrent use of other substances known or likely to interfere with the pharmacokinetics of pazopanib
16. Treatment with any of the following anti-cancer therapies: radiation therapy, surgery or tumor embolization within 14 days prior to the first dose of pazopanib OR chemotherapy, immunotherapy, biologic therapy, investigational therapy or hormonal therapy within 14 days or five half-lives of a drug (whichever is longer) prior to the first dose of Pazopanib.
17. Administration of any non-oncologic investigational drug within 30 days or 5 half lives whichever is longer prior to receiving the first dose of study treatment.
18. Any ongoing toxicity from prior anti-cancer therapy that is > Grade 1 and/or that is progressing in severity, except alopecia.

19. For FDG-PET imaging part of the study:

    • uncontrolled diabetes mellitus
    • only evaluable tumors in brain or urinary tract, as these cannot be evaluated by FDG-PET scan.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Advanced soft tissue sarcoma patients; Advanced soft tissue sarcoma patients, who have an indication for pazopanib treatment.	Drug: Pazopanib; Other Names: Votrient

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
FDG (18F-2-fluoro-2-deoxy-D-glucose fluorodeoxyglucose) uptake		baseline, 2 weeks and 8 weeks after start treatment
Pharmacokinetics (AUC)	This measurement is performed at 2 weeks and 8 weeks after start treatment	0, 1, 2, 3, 4, 6, 8, 10, 24 hours post-dose

Secondary Outcome Measures

Outcome Measure	Time Frame
Adverse events (CTCAE v4.0)	2 weeks and 8 weeks after start treatment

Collaborators and Investigators

• Sponsor: Radboud University Medical Center
• Collaborators: GlaxoSmithKline
• Investigators: Principal Investigator: Winette van der Graaf, prof. PhD. MD, Radboud University Medical Center; Principal Investigator: Wim Oyen, prof. PhD. MD, Radboud University Medical Center; Principal Investigator: Nielka van Erp, PharmD. PhD., Radboud University Medical Center

Publications and helpful links

General Publications

• van der Graaf WT, Blay JY, Chawla SP, Kim DW, Bui-Nguyen B, Casali PG, Schoffski P, Aglietta M, Staddon AP, Beppu Y, Le Cesne A, Gelderblom H, Judson IR, Araki N, Ouali M, Marreaud S, Hodge R, Dewji MR, Coens C, Demetri GD, Fletcher CD, Dei Tos AP, Hohenberger P; EORTC Soft Tissue and Bone Sarcoma Group; PALETTE study group. Pazopanib for metastatic soft-tissue sarcoma (PALETTE): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2012 May 19;379(9829):1879-86. doi: 10.1016/S0140-6736(12)60651-5. Epub 2012 May 16.

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2013
• Primary Completion (Actual): November 10, 2017
• Study Completion (Actual): November 10, 2017

Study Registration Dates

• First Submitted: November 21, 2013
• First Submitted That Met QC Criteria: November 26, 2013
• First Posted (Estimate): November 27, 2013

Study Record Updates

• Last Update Posted (Actual): December 19, 2017
• Last Update Submitted That Met QC Criteria: December 18, 2017
• Last Verified: June 1, 2015

More Information

Terms related to this study

• Keywords: Biomarker; Sarcoma, Soft Tissue; Pharmacokinetics; Positron-Emission Tomography; Pazopanib
• Additional Relevant MeSH Terms: Neoplasms, Connective and Soft Tissue; Neoplasms by Histologic Type; Neoplasms; Sarcoma
• Other Study ID Numbers: UMCN-ONCO-201303; 2013-003533-16 (EudraCT Number)