Patient case: 45-year-old female with medullary thyroid carcinoma; genetic feature: RET

Clinical trial: A Study of XL184 (Cabozantinib) With or Without Erlotinib in Adults With Non-Small Cell Lung Cancer

Summary: In Phase 1 of this study, the purpose is to evaluate the safety, tolerability, and highest safe dose of the multiple receptor tyrosine kinase inhibitor (including VEGFR2, MET, and RET) XL184 in combination with the EGFR inhibitor erlotinib administered to adults with Non-Small-Cell Lung Cancer (NSCLC). In Phase 2 of this study, the purpose is to evaluate the objective response rate of daily oral administration of XL184 with or without erlotinib in subjects with NSCLC who have progressed after responding to treatment with erlotinib.


Eligibility: Inclusion Criteria:
  -  Histologically confirmed NSCLC and Stage 3b or 4 NSCLC (Phase 1 only), Stage 3b or 4 NSCLC (Phase 2 only)
  -  Documented progressive disease following a prior RECIST response to monotherapy with erlotinib OR documented progressive disease following stable disease of at least 6 months on monotherapy with erlotinib (Phase 2 only)
  -  Must have tolerated erlotinib at the maximal dose that will be administered in Phase 2 only (or at a higher dose) for a minimum of 6 weeks
  -  Measurable disease per RECIST (Phase 2 only)
  -  At least 18 years old
  -  ECOG performance status of 0 or 1
  -  Adequate organ and marrow function
  -  Sexually active subjects must agree to use medically accepted methods of contraception during the course of the study and for 3 months following discontinuation of study treatment (excluding women who are not of child bearing potential and men who have been sterilized).
  -  Female subjects of childbearing potential must have a negative pregnancy test at enrollment
  -  No other diagnosis of malignancy (unless non-melanoma skin cancer, carcinoma in situ of the cervix or malignancy diagnosed ≥ 2 years previously, and currently with no evidence of disease).
  -  Capable of understanding and complying with the protocol, and written informed consent
  Exclusion Criteria:
  -  Received anti-cancer treatment within 4 weeks, except erlotinib, prior to first dose (Phase 1 only)
  -  In Phase 2 only: the subject has received:
  -  Small molecule inhibitors of VEGFR2/KDR OR
  -  An investigational anti-cancer agent within 4 weeks of the first dose of study drug OR
  -  An investigational agent that targets EGF or EGFR at any time OR
  -  An approved agent that targets EGF or EGFR (with the exception of erlotinib and gefitinib) at any time unless approved by Exelixis OR
  -  Anti-cancer therapy within 4 weeks (with the exception of gefitinib and erlotinib) of the first dose of study drug OR
  -  Prior therapy with a c-Met inhibitor
  -  Not recovered to NCI CTCAE v.3 Grade ≤1 from clinically significant adverse events due to antineoplastic agents, investigational drugs, or other medications administered prior to study enrollment
  -  Symptomatic or uncontrolled brain metastases requiring current treatment, including steroids and anticonvulsants
  -  History of significant hematemesis or recent history of hemoptysis
  -  Presence of cavitation, central lesion, or lesion abutting a major blood vessel
  -  Intercurrent illness such as hypertension or cardiac arrhythmias or recent history of significant disease such as congestive heart failure
  -  Pregnant or breastfeeding
  -  Active bacterial or viral infection requiring systemic treatment
  -  Allergy or hypersensitivity to components of either the XL184 or erlotinib formulations
  -  Incapable of understanding and complying with the protocol or unable to provide informed consent
  -  History of idiopathic pulmonary fibrosis or interstitial lung disease

Relevance to patient case: not relevant