Cediranib Maleate in Treating Patients With Recurrent or Persistent Endometrial Cancer
Condition: Endometrial Adenocarcinoma; Endometrial Adenosquamous Carcinoma; Endometrial Clear Cell Adenocarcinoma; Endometrial Serous Adenocarcinoma; Recurrent Uterine Corpus Carcinoma
MeSH terms: Carcinoma; Adenocarcinoma; Cystadenocarcinoma, Serous; Adenocarcinoma, Clear Cell; Carcinoma, Adenosquamous; Recurrence
Intervention: Cediranib Maleate; Laboratory Biomarker Analysis
Intervention description: Given PO; Correlative studies
Intervention MeSH terms: Cediranib; Maleic acid
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 53.0
Sex: Female
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      This phase II trial studies the side effects and how well cediranib maleate works in treating
      patients with endometrial cancer that has failed to respond to initial chemotherapy or has
      come back after surgery, radiation therapy, or other forms of treatment. Cediranib maleate
      may stop the growth of tumor cells by blocking proteins made by tumors that can stimulate
      growth of tumor cells as well as blood vessels in and around tumors.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients must have recurrent or persistent endometrial carcinoma, which is refractory
             to curative therapy or established treatments; histologic confirmation of the original
             primary tumor is required

               -  Patients with the following histologic epithelial cell types are eligible:
                  endometrioid adenocarcinoma, serous adenocarcinoma, undifferentiated carcinoma,
                  clear cell adenocarcinoma, mixed epithelial carcinoma, adenocarcinoma not
                  otherwise specified (N.O.S.), mucinous adenocarcinoma, squamous cell carcinoma,
                  and transitional cell carcinoma

          -  All patients must have measurable disease; measurable disease is defined by Response
             Evaluation Criteria in Solid Tumors (RECIST) (version 1.1); measurable disease is
             defined as at least one lesion that can be accurately measured in at least one
             dimension (longest diameter to be recorded); each lesion must be >= 10 mm when
             measured by computed tomography (CT), magnetic resonance imaging (MRI) or caliper
             measurement by clinical exam; or >= 20 mm when measured by chest x-ray; lymph nodes
             must be >= 15 mm in short axis when measured by CT or MRI

          -  Patients must have at least one "target lesion" to be used to assess response on this
             protocol as defined by RECIST version 1.1; tumors within a previously irradiated field
             will be designated as "non-target" lesions unless progression is documented or a
             biopsy is obtained to confirm persistence at least 90 days following completion of
             radiation therapy

          -  Patients must not be eligible for a higher priority Gynecologic Oncology Group (GOG)
             protocol, if one exists; in general, this would refer to any active GOG Phase III
             protocol or Rare Tumor protocol for the same patient population

          -  Patients who have received one prior regimen must have a GOG performance status of 0,
             1, or 2; patients who have received two prior regimens must have a GOG performance
             status of 0 or 1

          -  Recovery from effects of recent surgery, radiotherapy, or chemotherapy

               -  Patients should be free of active infection requiring antibiotics (with the
                  exception of uncomplicated urinary tract infection [UTI])

               -  Any hormonal therapy directed at the malignant tumor must be discontinued at
                  least one week prior to registration

               -  Any other prior therapy directed at the malignant tumor must be discontinued at
                  least three weeks prior to registration

          -  Patients must have had one prior chemotherapeutic regimen for management of
             endometrial carcinoma; initial treatment may include chemotherapy, chemotherapy and
             radiation therapy, and/or consolidation/maintenance therapy; chemotherapy administered
             in conjunction with primary radiation as a radio-sensitizer WILL be counted as a
             systemic chemotherapy regimen

          -  Patients are allowed to receive, but are not required to receive, one additional
             cytotoxic regimen for management of recurrent or persistent disease according to the
             following definition: 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

               -  Note: Patients on this non-cytotoxic study are allowed to receive one additional
                  cytotoxic chemotherapy regimen for management of recurrent or persistent disease,
                  as defined above; however, due to the novel nature of biologic compounds,
                  patients are encouraged to enroll on second-line non-cytotoxic studies prior to
                  receiving additional cytotoxic therapy

          -  Patients must have NOT received any non-cytotoxic chemotherapy for management of
             recurrent or persistent disease; prior hormonal therapy is allowed

          -  Absolute neutrophil count (ANC) greater than or equal to 1,500/mcl

          -  Platelets greater than or equal to 100,000/mcl

          -  Creatinine less than or equal to 1.5 x institutional upper limit normal (ULN) or
             creatinine (Cr) clearance >= 60 ml/min

          -  Bilirubin less than or equal to 1.5 x upper limit of normal (ULN)

          -  Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) less
             than or equal to 2.5 x ULN

          -  Alkaline phosphatase less than or equal to 2.5 x ULN

          -  Neuropathy (sensory and motor) less than or equal to grade 1

          -  Urine protein creatinine (UPC) ratio must be < 1.0 gm

               -  If UPC ratio >= 1, collection of 24-hour urine measurement of urine protein is
                  recommended

          -  Prothrombin time (PT) such that international normalized ratio (INR) is =< 1.5 x ULN
             (or an in-range INR, usually between 2 and 3, if a patient is on a stable dose of
             therapeutic warfarin) and a partial thromboplastin time (PTT) =< 1.5 x ULN

          -  Patients must have an amylase and lipase =< ULN

          -  Patients must have a thyroid stimulating hormone (TSH) level and a free thyroxine
             (free T4) level within the institutional normal limits

          -  Patients must have signed an approved informed consent and authorization permitting
             release of personal health information

          -  Patients must meet pre-entry requirements as specified

          -  Patients of childbearing potential must have a negative serum pregnancy test prior to
             the study entry and be practicing an effective form of contraception

        Exclusion Criteria:

          -  Patients who have had prior therapy with cediranib (AZD 2171) or other VEGF
             pathway-targeted therapy

          -  Patient with a history of other invasive malignancies, with the exception of
             non-melanoma skin cancer and other specific malignancies as noted, are excluded if
             there is any evidence of other malignancy being present within the last three years;
             patients are also excluded if their previous cancer treatment contraindicates this
             protocol therapy

          -  Patients who have received prior radiotherapy to any portion of the abdominal cavity
             or pelvis OTHER THAN for the treatment of endometrial cancer within the last three
             years are excluded; prior radiation for localized cancer of the breast, head and neck,
             or skin is permitted, provided that it was completed more than three years prior to
             registration, and the patient remains free of recurrent or metastatic disease

          -  Patients who have received prior chemotherapy for any abdominal or pelvic tumor OTHER
             THAN for the treatment of endometrial cancer within the last three years are excluded;
             patients may have received prior adjuvant chemotherapy for localized breast cancer,
             provided that it was completed more than three years prior to registration, and that
             the patient remains free of recurrent or metastatic disease

          -  Patients with serious, non-healing wound, ulcer, or bone fracture; this includes
             history of abdominal fistula, gastrointestinal perforation or intra-abdominal abscess
             within 28 days prior to the first date of cediranib (AZD 2171) therapy

          -  Patients with active bleeding or pathologic conditions that carry high risk of
             bleeding, such as known bleeding disorder, coagulopathy, or tumor involving major
             vessels

          -  Patients with history or evidence upon physical examination of central nervous system
             (CNS) disease, including primary brain tumor, seizures not controlled with standard
             medical therapy or any brain metastases

          -  Patients with clinically significant cardiovascular disease; this includes:

               -  Uncontrolled hypertension defined as systolic > 150 mmHg or diastolic > 100 mmHg
                  despite optimized antihypertensive therapy

               -  Myocardial infarction or unstable angina within 6 months of the first date of
                  cediranib (AZD 2171) therapy

               -  New York Heart Association (NYHA) grade II or greater congestive heart failure or
                  serious cardiac arrhythmia requiring medication; women who have received prior
                  treatment with an anthracycline (including doxorubicin and/or liposomal
                  doxorubicin) and have an ejection fraction < institutional lower limit of normal
                  (LLN) will be excluded from the study

               -  CTCAE grade 2 or greater peripheral vascular disease

               -  History of cerebrovascular accident (CVA, stroke), transient ischemic attack
                  (TIA) or subarachnoid hemorrhage within six months of the first date of cediranib
                  (AZD 2171) therapy

               -  Mean corrected QT interval (QTc) > 500 msec or history of familial long QT
                  syndrome

          -  Patients with known hypersensitivity to Chinese hamster ovary cell products or other
             recombinant human or humanized antibodies

          -  Patients undergoing invasive procedures as defined below:

               -  Major surgical procedure, open biopsy or significant traumatic injury within 28
                  days prior to the first date of cediranib (AZD 2171) therapy

               -  Major surgical procedure anticipated during the course of the study

               -  Minor surgical procedures, fine needle aspirates, or core biopsies within 7 days
                  prior to the first date of cediranib (AZD2171) therapy

          -  Patients who are pregnant or nursing