VEGF Trap in Treating Patients With Recurrent or Persistent Endometrial Cancer
Condition: Recurrent Endometrial Carcinoma
MeSH terms: Carcinoma; Endometrial Neoplasms; Recurrence
Intervention: ziv-aflibercept
Intervention MeSH terms: Aflibercept; Endothelial Growth Factors
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 49.0
Sex: Female
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      This phase II trial is studying the side effects and how well VEGF Trap works in treating
      patients with recurrent or persistent endometrial cancer. VEGF Trap may stop the growth of
      endometrial cancer by blocking blood flow to the tumor and by carrying tumor-killing
      substances directly to endometrial cancer cells.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Histologically confirmed endometrial carcinoma, meeting both of the following
             criteria:

               -  Recurrent or persistent disease

               -  Refractory to curative therapy or established treatments

          -  Measurable disease, defined as ≥ 1 unidimensionally measurable lesion ≥ 20 mm by
             conventional techniques OR ≥ 10 mm by spiral CT scan

               -  Tumors within a previously irradiated field are designated as nontarget lesions
                  unless progression is documented or a biopsy is obtained to confirm persistence
                  at least 90 days after completion of radiotherapy

          -  Must have received one prior chemotherapeutic regimen for management of endometrial
             carcinoma (initial treatment may include high-dose therapy, consolidation therapy, or
             extended therapy administered after surgical or non-surgical assessment)

          -  Not a candidate for a higher priority GOG protocol

          -  No history or evidence of primary brain tumor or brain metastases

          -  GOG performance status (PS) 0-2 (patients who received 1 prior regimen) OR GOG PS 0-1
             (patients who received 2 prior regimens)

          -  Absolute neutrophil count ≥ 1,500/mm^3

          -  Platelet count ≥ 100,000/mm^3

          -  Urine protein:creatinine ratio < 1.0 OR urine protein < 1.0 g by 24-hour urine
             collection

          -  Creatinine ≤ 1.5 times upper limit of normal (ULN)

          -  Bilirubin ≤ 1.5 times ULN

          -  SGOT ≤ 2.5 times ULN

          -  Alkaline phosphatase ≤ 2.5 times ULN

          -  PT/PTT/INR ≤ 1.5 times ULN

               -  In-range INR (between 2 and 3) allowed if patient is on a stable dose of
                  therapeutic warfarin

          -  QTc < 500 msec

          -  No evidence of serious ventricular arrhythmia

               -  Ventricular tachycardia or ventricular fibrillation must be < 3 beats in a row

          -  LVEF normal

               -  Ejection fraction ≥ 50% (for patients who received prior anthracycline, including
                  doxorubicin hydrochloride and/or doxorubicin hydrochloride liposome)

          -  No clinically significant cardiovascular disease, including any of the following:

               -  Uncontrolled hypertension, defined as systolic blood pressure (BP) > 140 mm Hg or
                  diastolic BP > 90 mm Hg

               -  Myocardial infarction or unstable angina within the past 6 months

               -  NYHA class II-IV congestive heart failure

               -  Serious cardiac arrhythmia requiring medication

               -  Peripheral vascular disease ≥ grade 2

               -  Cerebrovascular accident (i.e., CVA or stroke), transient ischemic attack, or
                  subarachnoid hemorrhage within the past 6 months

          -  Not pregnant or nursing

          -  Negative pregnancy test

          -  Fertile patients must use effective contraception during and for ≥ 6 months after
             completion of study therapy

          -  No HIV positivity

          -  No neuropathy (sensory and motor) > grade 1

          -  No active infection requiring antibiotics

          -  No other invasive malignancies or any evidence of other cancer within the past 5 years
             except for nonmelanoma skin cancer

          -  No serious nonhealing wound, ulcer, or bone fracture

          -  No history of abdominal fistula or gastrointestinal perforation

          -  No history or evidence of seizures not controlled with standard medical therapy

          -  No intra-abdominal abscess within the past 28 days

          -  No active bleeding or pathologic conditions that carry a high risk of bleeding (e.g.,
             bleeding disorder, coagulopathy, or tumor involving major vessels)

          -  No known hypersensitivity to Chinese hamster ovary cell products or other recombinant
             human or humanized antibodies

          -  No significant traumatic injury within the past 28 days

          -  No concurrent combination antiretroviral therapy for HIV-positive patients

          -  Recovered from prior surgery

          -  More than 3 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C)
             or radiotherapy and recovered

          -  At least 1 week since prior hormonal therapy

               -  Concurrent hormone replacement therapy allowed

          -  At least 3 weeks since any other prior therapy, including immunologic agents

          -  One additional prior cytotoxic regimen for management of recurrent or persistent
             endometrial cancer allowed

               -  Cytotoxic regimens include any agent that targets the genetic and/or mitotic
                  apparatus of dividing cells, resulting in dose-limiting toxicity to the bone
                  marrow and/or gastrointestinal mucosa

          -  More than 28 days since prior major surgery or open biopsy

          -  More than 7 days since prior minor surgery, fine needle aspirates, or core biopsies

          -  No prior cancer treatment that would preclude study compliance

          -  No prior noncytotoxic chemotherapy for management of recurrent or persistent
             endometrial disease

          -  No prior VEGF Trap or other VEGF pathway-targeted therapy

          -  More than 5 years since prior radiotherapy to any portion of the abdominal cavity or
             pelvis except for the treatment of endometrial cancer

               -  More than 3 years since prior radiotherapy for localized cancer of the breast,
                  head and neck, or skin

                    -  Patient must remain free of recurrent or metastatic disease

          -  More than 5 years since prior chemotherapy for any abdominal or pelvic tumor except
             for the treatment of endometrial cancer

               -  More than 3 years since prior adjuvant chemotherapy for localized breast cancer

                    -  Patient must remain free of recurrent or metastatic disease

          -  Concurrent low-molecular weight heparin allowed for the prevention or treatment of
             venous thromboembolic disease if condition is considered clinically stable with
             treatment

          -  No other concurrent investigational agents

          -  No concurrent major surgery