Vorinostat, Carboplatin and Gemcitabine in Women With Recurrent, Platinum-Sensitive Ovarian Cancer
Phase Ib/II Study of Combination of Vorinostat, Carboplatin and Gemcitabine + Vorinostat Maintenance in Women With Recurrent, Platinum-Sensitive Epithelial Ovarian, Fallopian Tube, or Peritoneal Cancer
調査の概要
詳細な説明
OBJECTIVES:
Primary
Phase Ib: Determine the maximally tolerated dose (MTD) of vorinostat when used in combination with standard (fixed) doses of carboplatin/gemcitabine during a 21 day cycle in patients with recurrent platinum-sensitive ovarian cancer
Phase II: Estimate the median progression-free survival (PFS) of patients treated with carboplatin/gemcitabine/vorinostat and vorinostat maintenance
Secondary
- Estimate the response rate of carboplatin/gemcitabine/vorinostat
- Assess the toxicities of carboplatin/gemcitabine/vorinostat
- Assess the toxicities of maintenance vorinostat
- Measure overall survival (OS) and progression-free survival (PFS)
STATISTICAL DESIGN:
The Phase Ib study was originally design to follow a standard 3+3 dose escalation design and evaluate 4 vorinostat dose levels.The DLT observation period was the 21-day cycle 1 length. Note: Ultimately 6 dose levels were evaluated as the protocol was amended to add dose levels, de-escalating cumulative vorinostat dose per cycle when 2 of 3 participants in dose level cohorts 2A, 1B and 1C experienced DLTs.
In the Phase II study, a median PFS of 13 months would be worthy of further study, representing a 66% improvement compared with the historical median of 8.6 months observed with carboplatin/gemcitabine. With 36 evaluable patients, there is 80% power to reject the null hypothesis in favor of the alternative at a 5% significance level.
研究の種類
入学 (実際)
段階
- フェーズ2
- フェーズ 1
連絡先と場所
研究場所
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Massachusetts
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Boston、Massachusetts、アメリカ、02115
- Dana-Farber Cancer Institute
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Boston、Massachusetts、アメリカ、02114
- Massachusetts General Hospital
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- Histologically confirmed recurrent epithelial ovarian cancer, fallopian tube cancer, or peritoneal cancer
- Must have received a platinum-based chemotherapy regimen at initial diagnosis
- Patients with primary platinum-sensitive (defined as a cancer initially platinum-sensitive followed by a progression-free interval from first exposure to platinum of 6 months or greater) recurrent ovarian, tubal or peritoneal cancer
- Must have an elevated CA125 (twice the ULN) within 2 weeks of enrolling on study (2 pretreatment measurements that are twice the upper limits of institutional normal and are drawn at least 1 day but not more than 14 days apart). At least one of the samples should be checked within one week of starting treatment. Measurable cancer via RECIST criteria via CT or MRI scan is not required but if clinically indicated will be monitored.
- For patients who do not have an elevated CA125 (twice the ULN), participants must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as 20mm or greater with conventional techniques or as 10mm or greater with spiral CT scan.
- 18 years of age or older
- Life expectancy of greater than 16 weeks
- ECOG Performance Status 0, 1, or 2
- Participants must have normal organ and marrow function as outlined in the protocol
- Patients could have received up to 1 prior non-platinum chemotherapy regimen in the recurrent setting (anti-angiogenic agents and other phase II non-hormonal therapies used to treat recurrent cancer count as a prior non-platinum therapy) but only one prior platinum (used to treat initial diagnosis). Patients may received up to 2 prior hormonal therapies.
- Women of child-bearing potential must agree to use adequate contraception prior to study entry and for the duration of study participation
- Must be able and willing to take oral medications
- No clinical nor radiographic evidence of an existing or impending bowel obstruction
- Should be at least 2 weeks from any surgical procedure, with the exception of minor surgery, such as port placement
- Patients who have known carboplatin hypersensitivity reaction can receive carboplatin if they are followed by an allergist, follow a published hypersensitivity desensitization protocol when receiving carboplatin, and agree to receive carboplatin under these circumstances
- Patients taking valproic acid for epilepsy may enroll if they discontinue valproic acid 30 days prior to enrolling for washout
- Patients must have a normal QTc interval and no history of QTc prolongation on EKG
Exclusion Criteria:
- Chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier
- May not be receiving any other investigational agent
- Participants with known brain metastases should be excluded from this clinical trial
- History of allergic reactions attributed to compounds of similar chemical or biologic composition to vorinostat
- Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, pulmonary disease, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
- Pregnant or breastfeeding women
- Individuals with a history of different malignancy are ineligible except for the following circumstances: disease-free for at least 5 years and are deemed by the investigator to be a low risk for recurrence of that malignancy; cervical cancer in situ, concurrent stage IA and grade I endometrial cancer, and basal cell or squamous cell carcinoma of the skin
- Patients taking valproic acid unless valproic acid is stopped at least 30 days prior to enrollment
- Receipt in the past of any other HDAC inhibitor for treatment of any malignancy
- Receipt of radiation therapy to >25% of bone marrow-bearing areas
- Patients who have gastrointestinal disorders likely to interfere with absorption of vorinostat
- Known active HIV or hepatitis viral infection
研究計画
研究はどのように設計されていますか？
デザインの詳細
- 主な目的：処理
- 割り当て：非ランダム化
- 介入モデル：単一グループの割り当て
- マスキング：なし（オープンラベル）
武器と介入
参加者グループ / アーム |
介入・治療 |
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実験的：Dose Level 1A
Vorinostat: 200 mg taken orally once a day for the first two weeks of each three-week cycle Carboplatin: AUC 4, given intravenously on day 1 of every three week cycle Gemcitabine: 100 mg/m2, given intravenously on day 1 and day 8 of every three week cycle Participants received up to 8 cycles of therapy without the occurrence of disease progression, unacceptable adverse events, patient withdrawal, or discontinuation per MD decision. |
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実験的：Dose Level 2A
Vorinostat: 300mg, taken orally once a day for the first two weeks of each three-week cycle Carboplatin: AUC 4, given intravenously on day 1 of every three week cycle Gemcitabine: 1000 mg/m2, given intravenously on day 1 and day 8 of every three week cycle Participants received up to 8 cycles of therapy without the occurrence of disease progression, unacceptable adverse events, patient withdrawal, or discontinuation per MD decision. |
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実験的：Dose Level 1B
Vorinostat: 200mg, taken orally twice a day for days 1-3 and days 8-10 of every three week cycle Carboplatin: AUC 4, given intravenously on day 1 of every three week cycle Gemcitabine: 1000 mg/m2, given intravenously on day 1 and day 8 of every three week cycle Participants received up to 8 cycles of therapy without the occurrence of disease progression, unacceptable adverse events, patient withdrawal, or discontinuation per MD decision. |
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実験的：Dose Level 1C
Vorinostat: 200mg, taken orally twice a day for days 1, 2, 8 and 9 of every three week cycle Carboplatin: AUC 4, given intravenously on day 2 of every three week cycle Gemcitabine: 1000 mg/m2, given intravenously on day 2 and day 9 of every three week cycle Participants received up to 8 cycles of therapy without the occurrence of disease progression, unacceptable adverse events, patient withdrawal, or discontinuation per MD decision. |
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実験的：Dose Level 1D
Vorinostat: 300mg, taken orally once a day for days 1 and 2 of every three week cycle Carboplatin: AUC 4, given intravenously on day 2 of every three week cycle Gemcitabine: 1000 mg/m2, given intravenously on day 2 and day 9 of every three week cycle Participants received up to 8 cycles of therapy without the occurrence of disease progression, unacceptable adverse events, patient withdrawal, or discontinuation per MD decision. |
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実験的：Dose Level 2D
Vorinostat: 400mg, taken orally once a day for days 1 and 2 of every three week cycle Carboplatin: AUC 4, given intravenously on day 2 of every three week cycle Gemcitabine: 1000 mg/m2, given intravenously on day 2 and day 9 of every three week cycle Participants received up to 8 cycles of therapy without the occurrence of disease progression, unacceptable adverse events, patient withdrawal, or discontinuation per MD decision. |
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この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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Vorinostat Maximum Tolerated Dose (MTD) [Phase Ib]
時間枠：The DLT observation period in determining the MTD was the 21-day cycle 1 length.
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The Vorinostat MTD is determined by the number of patients who experience a dose limiting toxicity (DLT).
See subsequent primary outcome measure for the DLT definition.
The MTD is defined as the highest dose at which fewer than one-third of patients experience a DLT.
If no DLTs are observed, the MTD is not reached.
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The DLT observation period in determining the MTD was the 21-day cycle 1 length.
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Dose Limiting Toxicity (DLT) [Phase Ib]
時間枠：The DLT observation period in determining the MTD was the 21-day cycle 1 length.
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Dose-limiting toxicity was based on the Common Terminology Criteria for Adverse Events version 3.0 (CTCAE v3.0) and defined as any of the following:
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The DLT observation period in determining the MTD was the 21-day cycle 1 length.
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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Response
時間枠：Disease was assessed radiographically (CT or MRI scan) every 2 cycles on treatment; Phase Ib participants received up to 8 cycles of treatment. The median number of cycles started was 2 (range 1-8).
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Response was based on RECIST 1.0 criteria.
Per RECIST 1.0 for target lesions, complete response (CR) is complete disappearance of all target lesions and partial response (PR) is at least a 30% decrease in the sum of longest diameter (LD) of target lesions, taking as reference baseline sum LD.
Progressive disease (PD) is at least a 20% increase in sum LD from the smallest LD recorded on treatment.
Stable disease (SD) is neither sufficient increase to qualify as PD nor sufficient shrinkage to qualify for PR.
For CR or PR, changes in tumor measurements must be confirmed by repeat assessments performed 4 weeks +/- 2 weeks after the response criteria are first met.
PR or better overall response assumes at a minimum incomplete response/stable disease (SD) for the evaluation of non-target lesions and absence of new lesions.
Participants who received therapy but did not have their disease re-evaluated were considered unevaluable.
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Disease was assessed radiographically (CT or MRI scan) every 2 cycles on treatment; Phase Ib participants received up to 8 cycles of treatment. The median number of cycles started was 2 (range 1-8).
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協力者と研究者
出版物と役立つリンク
研究記録日
主要日程の研究
研究開始
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
追加の関連 MeSH 用語
その他の研究ID番号
- 09-026
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卵巣がんの臨床試験
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