Sorafenib in Treating Patients With Relapsed Chronic Lymphocytic Leukemia
Condition: Refractory Chronic Lymphocytic Leukemia; Stage I Chronic Lymphocytic Leukemia; Stage II Chronic Lymphocytic Leukemia; Stage III Chronic Lymphocytic Leukemia; Stage IV Chronic Lymphocytic Leukemia
MeSH terms: Leukemia; Leukemia, Lymphoid; Leukemia, Lymphocytic, Chronic, B-Cell
Intervention: sorafenib tosylate
Intervention description: Given orally
Intervention MeSH terms: Sorafenib
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 5.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      Sorafenib may stop the growth of cancer cells by blocking some of the enzymes needed for cell
      growth and by blocking blood flow to the cancer. This phase II trial is studying how well
      sorafenib works in treating patients with relapsed chronic lymphocytic leukemia.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Histologically or cytologically confirmed chronic lymphocytic leukemia (CLL) by NCI-WG
             immunophenotype and blood criteria

               -  Documentation of current or prior peripheral blood (PB) or bone marrow (BM)
                  immunophenotype compatible with CLL

                    -  Patients who currently do not have > 5,000/mm³ absolute lymphocytosis are
                       eligible if they have previously met PB lymphocytosis criteria and have a
                       current immunophenotype documenting monoclonal B lymphocytosis
                       morphologically and immunophenotypically compatible with CLL

          -  Intermediate-risk (Rai stage I or II) or high-risk (Rai stage III or IV) disease,
             including any of the following:

               -  Rai stage I disease with lymphocytosis and enlarged nodes

               -  Rai stage II disease with lymphocytosis plus splenomegaly and/or hepatomegaly
                  (nodes positive or negative)

               -  Rai stage III disease with lymphocytosis plus anemia

               -  Rai stage IV disease with lymphocytosis and thrombocytopenia

          -  Must require treatment with active disease, experiencing disease related symptoms, or
             having deterioration of blood counts, meeting ≥ 1 of the following criteria:

               -  Presence of ≥ 1 of the following disease-related symptoms:

                    -  Weight loss > 10% within the past 6 months

                    -  Extreme fatigue (i.e., ECOG performance status 2: cannot work or unable to
                       perform usual activities)

                    -  Fever > 100.5°F for 2 weeks without evidence of infection

                    -  Night sweats without evidence of infection

               -  Evidence of progressive marrow failure, as manifested by worsening of anemia
                  (hemoglobin < 10 g/dL), thrombocytopenia (platelet count < 100,000/mm³), and/or
                  neutropenia (neutrophil count < 2,000/mm³)

               -  Massive (i.e., > 6 cm below left costal margin) or progressive splenomegaly or
                  discomfort from splenomegaly

               -  Massive nodes or clusters (i.e., > 10 cm in longest diameter), progressive
                  adenopathy, or discomfort from lymphadenopathy

               -  Deterioration of blood counts and/or progressive lymphocytosis, with an increase
                  of ≥ 10% documented over a 2-month period OR an anticipated doubling time < 6
                  months

          -  Relapsed disease

               -  Must receive at least 1, but no more than 3, prior chemotherapy regimens with any
                  cytotoxic agent or antibody therapy

                    -  No fludarabine refractory disease

                         -  Responded to prior fludarabine without relapse or disease progression
                            for at least 6 months

          -  Patients with a history of Coombs-positive hemolytic anemia are eligible provided
             recovery from treatment of hemolysis and off steroids

          -  No stage 0 CLL

          -  No known CNS involvement

          -  Life expectancy > 6 months

          -  ECOG performance status 0-2 OR Karnofsky performance status 70-100%

          -  Absolute neutrophil count ≥ 1,000/mm³

          -  Platelets ≥ 30,000/mm³

          -  Bilirubin ≤ 2 mg/dL

          -  AST/ALT ≤ 2.5 times upper limit of normal (ULN)

          -  Creatinine ≤ 1.5 times ULN OR creatinine clearance ≥ 60 mL/min (for patients with
             creatinine levels above normal)

          -  No currently active second malignancy

          -  Not pregnant or nursing

          -  Negative pregnancy test

          -  Fertile patient must use effective contraception prior to and during study
             participation

          -  No uncontrolled hypertension, defined as blood pressure (BP) > 150/100 mm Hg on 2
             different measurements at least 1 day apart with either systolic or diastolic number
             meeting this definition

               -  Patients may later enter the study, if they have achieved stable BP (i.e., <
                  140/90 mm Hg) on a regimen of ≤ 2 drugs after 6-8 weeks of therapy

          -  No history of allergic reactions attributed to compounds of similar chemical or
             biologic composition to sorafenib

          -  No uncontrolled intercurrent illness including, but not limited to, any of the
             following:

               -  Symptomatic congestive heart failure

               -  Unstable angina pectoris

               -  Cardiac arrhythmia

               -  Psychiatric illness or social situations that would limit compliance with the
                  study requirements

          -  No active infection requiring systemic antibiotics

          -  No evidence of bleeding diathesis

          -  No evidence of bowel perforation or obstruction risk

          -  No swallowing dysfunction leading to difficulty taking the study drug

          -  See Disease Characteristics

          -  Recovered from prior therapy

          -  At least 2 weeks since prior antibiotic therapy

          -  At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C) or
             radiotherapy

          -  At least 12 weeks since prior monoclonal antibody

          -  Concurrent warfarin for anticoagulation allowed provided all of the following are met:

               -  On a stable therapeutic dose

               -  INR ≤ 3

               -  No active bleeding or pathological condition that carries high-risk of bleeding

          -  No prior MAPK signaling inhibitor agents or anti-angiogenesis agents

          -  No concurrent combination anti-retroviral therapy for HIV-positive patients

          -  No concurrent cytochrome P450 enzyme-inducing antiepileptic drugs (phenytoin,
             carbamazepine, or phenobarbital), rifampin, or Hypericum perforatum (St. John's wort)

          -  No other concurrent investigational agents