Phase II evaluation of sunitinib in the treatment of recurrent or refractory high-grade glioma or ependymoma in children: a children's Oncology Group Study ACNS1021

Cynthia Wetmore, Vinay M Daryani, Catherine A Billups, James M Boyett, Sarah Leary, Rachel Tanos, Kelly C Goldsmith, Clinton F Stewart, Susan M Blaney, Amar Gajjar, Cynthia Wetmore, Vinay M Daryani, Catherine A Billups, James M Boyett, Sarah Leary, Rachel Tanos, Kelly C Goldsmith, Clinton F Stewart, Susan M Blaney, Amar Gajjar

Abstract

Sunitinib malate is a small multi-targeted tyrosine kinase inhibitor that inhibits vascular endothelial growth factor receptor (VEGFR), platelet-derived growth factor receptor (PDGFR) and stem cell factor receptor (KIT), which are highly expressed by some high-grade brain tumors. We conducted a phase II study to estimate the efficacy and further characterize the pharmacokinetics of sunitinib in pediatric patients with recurrent or refractory high-grade glioma (Stratum A) or ependymoma (Stratum B). This was a prospective, multicenter Phase II trial conducted through the Children's Oncology Group (ClinicalTrials.gov Identifier NCT01462695). Sunitinib, 15 mg/m2, was orally administered once daily for 4 weeks every 6 weeks. The safety and tolerability of sunitinib, an estimate of progression-free survival (PFS), analyses of sunitinib pharmacokinetics (PK) and pharmacodynamics modulation of plasma VEGF and VEGFR2 were also assessed. Thirty eligible patients (17 patients on Stratum A, 13 patients on Stratum B) were enrolled and 29 patients were evaluable for response. Sunitinib was reasonably well tolerated in children with recurrent ependymoma or high-grade glioma. Most adverse events were of mild-to-moderate severity and manageable with supportive treatment. While there was a statistically significant modulation of plasma VEGFR2 with sunitinib exposure, there were no sustained tumor responses. Both strata were closed at time of planned interim analysis as there was not sufficient efficacy associated with sunitinib in children with recurrent brain tumors. Sunitinib was well tolerated in children and young adults with recurrent high-grade glioma or ependymoma but had no single agent objective antitumor activity in these patients.

Keywords: Ependymoma; Pediatric; recurrent brain tumor; tyrosine kinase inhibitor.

© 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Progression free (A) and Overall (B) survival.
Figure 2
Figure 2
(A) Sunitinib plasma concentration‐time profile; (o) represents observed concentrations and best fit line from the average parameter estimates of five patients on Cycle 1 Day 1. (B) SU012662 plasma concentration‐time profile; (o) represents observed concentrations and the line represents the average parameter estimates of 5 patients on Cycle 1 Day 1.
Figure 3
Figure 3
Quantification of plasma VEGF (A) and soluble VEGFR2 (B) in patient plasma prior to sunitinib (Day 1), and 14 and 28 days of continuous sunitinib therapy.

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