Cabozantinib for Advanced Urothelial Cancer
Condition: Urothelial Carcinoma; Urethral Neoplasms; Urinary Bladder Neoplasms; Kidney Neoplasms
MeSH terms: Carcinoma; Neoplasms; Carcinoma, Transitional Cell; Urinary Bladder Neoplasms; Kidney Neoplasms; Urethral Neoplasms
Study type: Interventional
Phase: Phase 2

Summary: 
      Background:

      - Cabozantinib is a drug that slows the growth of blood vessels that feed tumors. It is
      approved for medullary thyroid cancer. However, studies have shown that prostate and ovarian
      tumors respond to it. Researchers want see if cabozantinib can be a safe and effective
      treatment for urothelial cancer.

      Objectives:

      - To test the safety and effectiveness of cabozantinib for advanced urothelial cancer.

      Eligibility:

      - Individuals at least 18 years of age who have advanced urothelial cancer that has not
      responded to standard treatments.

      Design:

        -  Participants will be screened with a physical exam and medical history. Blood and urine
           samples will be collected. Tumor tissue samples will also be collected. Imaging studies
           will also be performed.

        -  Participants will take cabozantinib by mouth once per day on each day of a 28-day cycle.

        -  Treatment will be monitored with frequent blood tests and imaging studies.

        -  Participants will continue to take the study drug for as long as their cancer does not
           worsen and side effects are not too severe.
    

Detailed description: 
      Background:

        -  In the United States, urothelial carcinoma (UC) of the bladder is the fourth most common
           malignancy in men and the ninth most common in women with an estimated 69,250 new cases
           and 14,990 deaths in the year 2011

        -  There is no Food and Drug Administration (FDA)-approved second line drug for patients
           with metastatic Urothelial Cancer (UC)

        -  Multiple lines of evidence support targeting angiogenesis in UC

        -  In human bladder cancer, overexpression of tyrosine-protein kinase (c-Met)/Axl/platelet
           derived growth factor receptor- (PDGFR)-alpha or c-Met alone showed significant
           correlation with poor survival

        -  Cabozantinib is a new chemical entity that inhibits multiple receptor tyrosine kinases
           with growth-promoting and angiogenic properties.

        -  The primary targets of cabozantinib are mesenchymal epithelial transition factor (MET),
           vascular endothelial factor receptor 2 (VEGFR2), and rearranged during transfection
           (RET)

      Objectives:

      - To determine the response rate of cabozantinib in patients with progressive urothelial
      cancer who have received prior cytotoxic chemotherapy

      Eligibility:

        -  Patients in cohort 1 must have a histologically confirmed diagnosis of metastatic,
           progressive urothelial carcinoma of the bladder, urethra, ureter, or renal pelvis.

        -  Patients in cohort 2 must have a histologically confirmed diagnosis of bone only
           metastatic, urothelial carcinoma of the bladder, urethra, ureter, or renal pelvis.

        -  Patients in cohort 3 must have a histologically confirmed diagnosis of non-transitional
           cell carcinoma cancer (including but not limited to squamous cell, neuroendocrine,
           adenocarcinoma including urachal and sarcomatoid) of the bladder, urethra, ureter, or
           renal pelvis.

        -  Patients must have been previously treated, as defined by treatment with at least one
           prior cytotoxic chemotherapy regimen or agent. Patients may have received any number of
           prior cytotoxic agents.

        -  18 years of age or older.

      Design:

        -  A maximum of 71subjects will be enrolled in this open label, non-randomized, phase II
           trial of 60 mg each day of cabozantinib. Up to 50 patients will be accrued to cohort 1
           (metastatic, progressive urothelial cancer. The remainder will be enrolled on
           exploratory cohorts 2 & 3, bone only metastatic urothelial disease and non transitional
           cell carcinoma (TCC) bladder cancer respectively, during the time the study is accruing
           patients for cohort 1. Note: Patients who tolerate cabozantinib at 60 mg daily during
           the first 2 cycles (first restaging time period) without (Bullet) grade 2 toxicity may
           undergo dose escalation to 80 mg daily at the discretion of the Principal Investigator.

        -  A Simon 2 stage design with alpha=0.05 and beta = 0.10 as acceptable error
           probabilities. Initially 21 subjects will be enrolled and followed for progression. If 2
           or more of cohort 1 subjects experiences a response, enrollment will continue until a
           total of 41 evaluable subjects with progressive urothelial cancer have been entered. 2-3
           patients per month may enroll on this trial; thus, 2 to 3 years is anticipated as the
           accrual period.

        -  Each patient will undergo response evaluation assessments with chest abdomen pelvis
           computed tomography (CAP CT) (or magnetic resonance imaging (MRI)) with or without
           18F-Sodium Fluoride (Na18F) positron emission tomography (PET CT) every 8 weeks while on
           active protocol therapy starting at baseline. Patients will undergo investigational
           Fludeoxyglucose, (FDG) PET/CT and PET/MRI (optional) at baseline, week 4 and week 8.
    

Intervention name(s): Cabozantinib
Intervention type(s): Drug
Intervention description(s): 60 mg by mouth (PO) daily each 28 day cycle. Treatment continues until toxicity or disease progression.
Other intervention name(s): Cometriq
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Kidney Cancer; Tyrosine Kinase Inhibitor; Bladder Cancer