A Phase II Trial of Sutent (Sunitinib; SU011248) for Recurrent Anaplastic Astrocytoma and Glioblastoma
Condition: Anaplastic Astrocytoma; Glioblastoma
MeSH terms: Glioblastoma; Astrocytoma
Intervention: Sunitinib Malate
Intervention description: Initially, patients were started on sunitinib at a dose of 50 mg daily. If 50 mg daily resulted in unacceptable toxicity, 2 dose modifications were allowed (to 37.5 and to 25 mg daily, if necessary). Study patients who could not tolerate 25 mg daily of sunitinib were taken off study.
Intervention MeSH terms: Sunitinib
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 30.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Sutent

Summary:

      We are asked patients to take part in this study because they had recurrent (returned) (1st
      or 2nd) anaplastic astrocytoma (AA) or glioblastoma multiforme (GBM).

      The purposes of this study are:

        -  To see if Sutent has any change on the patient and their cancer.

        -  To see if Sutent will slow or stop the growth of their tumor.

        -  To measure the safety of Sutent. Sutent is Food and Drug Administration (FDA) approved
           to treat patients with a gastrointestinal stromal tumor after the disease worsened while
           taking another medicine called imatinib mesylate or when imatinib mesylate cannot be
           taken. Sutent is also FDA approved to treat patients with advanced renal cell carcinoma.
           At this time, it is not known whether Sutent will improve symptoms, or help patients
           with this disease live longer.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Resolution of all acute toxic effects of prior chemotherapy or radiotherapy or
             surgical procedures to NCI CTCAE Version 3.0 grade ≤1.

          -  Adequate organ function as defined by the following criteria:

               -  Serum aspartate transaminase (AST; serum glutamic oxaloacetic transaminase
                  [SGOT]) and serum alanine transaminase (ALT; serum glutamic pyruvic transaminase
                  [SGPT]) ≤3 x local laboratory upper limit of normal (ULN), or AST and ALT ≤3 x
                  ULN if liver function abnormalities are due to underlying malignancy

               -  Total serum bilirubin ≤1.5 x ULN

               -  Absolute neutrophil count (ANC) ≥1500/µL

               -  Platelets ≥100,000/µL

               -  Hemoglobin ≥9.0 g/dL

               -  Serum calcium ≤12.0 mg/dL

               -  Serum creatinine ≤1.5 x ULN

          -  Patients must have histologically or neuroradiographically recurrent anaplastic
             astrocytoma (AA) or glioblastoma (GBM). Must have had prior pathologic confirmation of
             primary tumor histology.

          -  Must be ≥ 18 years old.

          -  Must have a Karnofsky performance status (KPS) ≥ 60%

          -  Measurable disease per MacDonald criteria required using contrast enhanced cranial
             MRI.

          -  Life expectancy ≥ 12 weeks.

          -  Must sign and date an Institutional Review Board (IRB) approved informed consent
             stating that he or she is aware of the neoplastic nature of the disease. Must
             willingly provide written consent after being informed of procedure to be followed,
             the experimental nature of the therapy, alternatives, potential benefits, side
             effects, risks, and discomforts.

          -  Willing and able to comply with scheduled visits, treatment plan, laboratory tests and
             accessible for follow-up.

          -  Have undergone surgery documenting tumor histology though repeat surgery at time of
             tumor recurrence is not mandatory.

          -  Have received prior external beam radiotherapy.

          -  Patients may have received one or two prior salvage chemotherapy and may have received
             adjuvant chemotherapy following initial surgery.

          -  May not have received prior stereotactic radiotherapy.

          -  May have been treated with Gliadel at initial surgery only.

        Exclusion Criteria:

          -  Major surgery or radiation therapy within 4 weeks of starting study treatment.

          -  NCI CTCAE grade 3 hemorrhage within 4 weeks of starting study treatment.

          -  History of or known spinal cord compression or carcinomatous meningitis, or evidence
             of leptomeningeal disease on screening CT or MRI scan.

          -  Any of the following within 6 months prior to study drug administration: myocardial
             infarction, severe/unstable angina, coronary/peripheral artery bypass graft,
             symptomatic congestive heart failure, cerebrovascular accident or transient ischemic
             attack, or pulmonary embolism.

          -  Ongoing cardiac dysrhythmias of NCI CTCAE grade ≥2.

          -  Prolonged QTc interval on baseline EKG.

          -  Hypertension that cannot be controlled by medications (>150/100 mm Hg despite optimal
             medical therapy).

          -  Pre-existing thyroid abnormality with thyroid function that cannot be maintained in
             normal range with medication.

          -  Known human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome
             (AIDS)-related illness or other active infection.

          -  Concurrent treatment on another clinical trial. Supportive care trials or
             non-treatment trials, e.g. QOL, are allowed.

          -  Concomitant use of ketoconazole and other agents known to inhibit Cytochrome P450 3A4
             (CYP3A4).

          -  Concomitant use of theophylline and phenobarbital and/or other agents metabolized by
             the cytochrome P450 system.

          -  Ongoing treatment with therapeutic doses of Coumadin (low dose up to 2 mg po daily for
             thrombo-prophylaxis is allowed).

          -  Pregnancy or breastfeeding. Female subjects must be surgically sterile,
             postmenopausal, or must agree to use effective contraception during the period of
             therapy. Female subjects with reproductive potential must have a negative pregnancy
             test (serum or urine) prior to enrollment. Male subjects must be surgically sterile or
             must agree to use effective contraception during the period of therapy.

          -  Other severe acute or chronic medical or psychiatric condition or laboratory
             abnormality that may increase the risk associated with study participation or study
             drug administration, or may interfere with interpretation of study results, and in the
             judgment of investigator would make patient inappropriate for entry into this study.

          -  Patients having been treated with 3 or more salvage regimens.

          -  Patients with a second active malignancy or diagnosis of other cancer within 3 years
             of enrollment, except for surgically cured basal cell carcinoma, or in situ carcinoma
             of the cervix.

          -  Mentally incapacitated patients or psychiatric illness that would prevent them from
             giving informed consent.

          -  Poorly controlled diabetes, hepatitis infection, uncontrolled high blood pressure,
             unstable angina, symptomatic congestive heart failure, and myocardial infarction
             within previous 6 months, or serious uncontrolled cardiac arrhythmia.

          -  Known to be HIV positive or to have an AIDS-related illness.

          -  Patients with an active infection that is not adequately controlled with antibiotics.

          -  Patients with other severe concurrent disease, which, in the judgment of the
             investigator, would make the patient inappropriate for entry into this study.

          -  Known sensitivity to any of the products to be administered during treatment.

          -  Currently enrolled in another clinical trial or patients who have participated in a
             trial of an investigational device or drug within the last 30 days.