VEG113971: An Open-Label Study of the Effects of Ketoconazole or Esomeprazole on Pazopanib PK
Condition: Cancer
Intervention: pazopanib
Intervention description: Adenosine triphosphate (ATP)-competitive tyrosine kinase inhibitor of vascular endothelial growth factor receptor (VEGFR)-1, -2, and -3, platelet derivative growth factor receptor (PDGFR)
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 34.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Esomeprazole; Pharmacogenetics; Pharmacokinetics; Ketoconazole; Pazopanib; Drug Interaction; Safety; Solid Tumors

Summary:

      The purpose of this study is to determine how dosing with ketoconazole (Nizoral) or
      esomeprazole (Nexium) affects the pharmacokinetics of oral pazopanib. The study will also
      test for safety of pazopanib when administered with ketoconazole or esomeprazole.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Signed, written informed consent

          -  18 years of age or legal age of consent if greater than 18 years at the time of
             signing consent

          -  Histologically confirmed diagnosis of refractory or relapsed advanced solid tumor
             malignancy after standard therapy OR for which there is no standard therapy OR for
             which subject opts not to receive standard therapy

          -  Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1

          -  Adequate baseline organ function

          -  Subjects may not have had a transfusion within 7 days of screening assessment.

          -  Subjects receiving anticoagulant therapy are eligible if their INR is stable and
             within the protocol recommended range.

          -  Male OR

          -  Female of non-childbearing potential (i.e., physiologically incapable of becoming
             pregnant), including any female who has had: a hysterectomy, a bilateral oophorectomy
             (ovariectomy), a bilateral tubal ligation, or is post-menopausal OR

          -  Non-pregnant Female of childbearing potential, including any female who has had a
             negative serum pregnancy test within 14 days prior to the first dose of study
             treatment, agrees to use acceptable contraceptive methods, used consistently and in
             accordance with both the product label and the instructions of the study physician. OR

          -  Female, if lactating, agrees to stop nursing prior to first dose until 14 days after
             last dose of study drug

          -  Able to swallow and retain orally administered medication

        Exclusion Criteria:

          -  History or clinical evidence of central nervous system (CNS) metastases or
             leptomeningeal carcinomatosis, except for individuals who have previously-treated CNS
             metastases, are asymptomatic, and have had no requirement for steroids or anti-seizure
             medication for 2 months prior to first dose of study drug

          -  Clinically significant GI abnormalities that may increase the risk for GI bleeding
             including, but not limited to: active peptic ulcer disease, known intraluminal
             metastatic lesion/s with risk of bleeding inflammatory bowel disease (e.g., ulcerative
             colitis, Crohn's disease), or other GI conditions with increased risk of perforation,
             history of abdominal fistula, GI perforation, or intra abdominal abscess within 28
             days prior to beginning study treatment.

          -  Clinically significant GI abnormalities that may affect absorption of investigational
             product including, but not limited to: malabsorption syndrome, major resection of the
             stomach or small bowel.

          -  Presence of uncontrolled infection.

          -  Corrected QT interval (QTc) >480 msec.

          -  History of any one or more of the following cardiovascular conditions within the past
             6 months:

        cardiac angioplasty or stenting, myocardial infarction,unstable angina,coronary artery
        bypass graft surgery, symptomatic peripheral vascular disease, Class III or IV congestive
        heart failure, as defined by the New York Heart Association (NYHA).

          -  Poorly controlled hypertension Note: Initiation or adjustment of antihypertensive
             medication(s) is permitted prior to study entry.

          -  History of cerebrovascular accident including transient ischemic attack, pulmonary
             embolism or untreated deep venous thrombosis (DVT) within the past 6 months. Note:
             Subjects with recent DVT who have been treated with therapeutic anti-coagulating
             agents for at least 6 weeks are eligible.

          -  Prior major surgery or trauma within 28 days prior to first dose of study drug and/or
             presence of any non-healing wound, fracture, or ulcer (procedures such as catheter
             placement not considered to be major).

          -  Evidence of active bleeding or bleeding diathesis.

          -  Known endobronchial lesions and/or lesions infiltrating major pulmonary vessels.

          -  Hemoptysis in excess of 2.5 mL (or one-half teaspoon) within 8 weeks of first dose of
             study drug.

          -  Any serious and/or unstable pre-existing medical, psychiatric, or other condition that
             could interfere with subject's safety, provision of informed consent, or compliance to
             study procedures.

          -  Treatment with any of the following anti-cancer therapies: radiation therapy, surgery
             or tumor embolization within 14 days prior to the first dose of pazopanib OR
             chemotherapy, immunotherapy, biologic therapy, investigational therapy or hormonal
             therapy within 14 days or 5 half-lives of a drug (whichever is longer) prior to the
             first dose of pazopanib.

          -  Any ongoing toxicity from prior anti-cancer therapy that is > Grade 1 (graded by
             NCI-CTCAE, version 4.0), at the time of enrollment and/or that is progressing in
             severity, except alopecia as well as stable (>4 weeks) ≤Grade 2 neuropathy or rash.

        -Unable or unwilling to discontinue use of protocol-prohibited medications for at least 14
        days or 5 half- lives of a drug (whichever is longer) prior to the first dose of study drug
        and for the duration of the study.

        -Use of HRT prior to study enrollment due to the potential for inhibition of cytochrome
        P450 enzymes that metabolize estrogens and progestins (Arm A female subjects only).