Bevacizumab and Sunitinib in Treating Patients With Solid Tumors

Study Overview
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Brief Summary
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This phase I trial is studying the side effects and best dose of bevacizumab and sunitinib in treating patients with solid tumors. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Sunitinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Bevacizumab and sunitinib may also stop the growth of tumor cells by blocking blood flow to the tumor. Giving bevacizumab together with sunitinib may kill more tumor cells.

Detailed Description
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PRIMARY OBJECTIVES: I. Determine the maximum tolerated dose of bevacizumab in combination with sunitinib malate (SU11248) in patients with solid tumors. SECONDARY OBJECTIVES: I. Evaluate the objective response rate, time to disease progression, and overall survival of these patients. OUTLINE: This is a multicenter, dose-escalation study. Patients receive bevacizumab IV over 30-90 minutes on days 1, 15, and 29 and oral sunitinib malate (SU11248) once daily on days 1-28. Courses repeat every 42 days in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of bevacizumab and SU11248 until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. At least 10 patients are treated at the MTD. After completion of study therapy, patients are followed for 30 days.

Official Title
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A Phase I Study of Bevacizumab in Combination With SU11248

Conditions
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Unspecified Adult Solid Tumor, Protocol Specific

Intervention / Treatment
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* Drug: sunitinib malate
* Biological: bevacizumab
* Other: pharmacological study
* Other: laboratory biomarker analysis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Histologically proven metastatic/unresectable adrenocortical carcinoma or melanoma not amenable to curative surgical or radiation therapy. Accrual closed as of 5/27/2009 to patients with renal cell carcinoma No squamous cell histology No histology in close proximity to a major blood vessel No history of or known brain metastases, spinal cord compression, or carcinomatous meningitis No new evidence of brain or leptomeningeal disease on screening CT scan or MRI ECOG performance status (PS) 0-1 OR Karnofsky PS 60-100% AST and ALT ≤ 2.5 times upper limit of normal (ULN) Bilirubin ≤ 1.5 times ULN Creatinine ≤ 1.5 times ULN Absolute neutrophil count ≥ 1,500/mm³ Platelet count ≥100,000/mm³ Hemoglobin ≥ 10.0 g/dL Calcium ≤ 12.0 mg/dL Urine protein:creatinine ratio ≤ 0.5 by urinalysis Patients with urine protein:creatinine ratio > 0.5 must have proteinuria < 1,000 mg by 24-hour urine collection Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for ≥ 6 months after completion of study therapy None of the following within the past 12 months: Myocardial infarction Severe/unstable angina Severe peripheral vascular disease (claudication) or procedure on peripheral vasculature Coronary/peripheral artery bypass graft New York Heart Association (NYHA) grade III-IV congestive heart failure Cerebrovascular accident or transient ischemic attack Clinically significant bleeding Deep venous thrombosis Pulmonary embolism No ongoing cardiac dysrhythmias of NCI CTCAE ≥ grade 2, atrial fibrillation of any grade, or prolongation of the QTc interval to > 450 msec (males) or > 470 msec (females) No history of serious ventricular arrhythmia (i.e., ventricular tachycardia or ventricular fibrillation ≥ 3 beats in a row) No condition classified as NYHA grade III or IV No hypertension that cannot be controlled by medications Blood pressure < 140/90 mm Hg No evidence of bleeding diathesis or coagulopathy No history of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 28 days No history of or known brain metastases, spinal cord compression or carcinomatous meningitis, or new evidence of brain or leptomeningeal disease on screening CT or MRI scan unless without progression on * MRI or CT for 3 months. No significant traumatic injury within the past 28 days No serious, non-healing wound, ulcer, or bone fracture No known hypersensitivity to Chinese hamster ovary cell products or other recombinant human antibodies No known HIV or AIDS-related illness No other severe acute or chronic medical or psychiatric condition or laboratory abnormality that would preclude study participation. Recovered from prior radiation therapy, surgery, or other prior therapy No prior bevacizumab or sunitinib malate (SU11248) Other antiangiogenic therapies allowed No prior tyrosine kinase inhibitor of the VEGF receptor or bevacizumab for patients with metastatic renal cell carcinoma No major surgical procedures or open biopsy within the past 28 days No core biopsy within the past 7 days No radiation therapy or systemic therapy within the past 4 weeks No concurrent full-dose anticoagulants (e.g., warfarin) Concurrent low-dose anticoagulation (e.g., prophylactic port patency) allowed No concurrent treatment on another clinical trial No other concurrent investigational drugs No concurrent major surgery No other concurrent anticancer agents or therapies, including chemotherapy, biological response modifiers, hormonal therapy, surgery, palliative radiation therapy, or immunotherapy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Treatment (sunitinib malate, bevacizumab)<br>Patients receive bevacizumab IV over 30-90 minutes on days 1, 15, and 29 and oral sunitinib malate (SU11248) once daily on days 1-28. Courses repeat every 42 days in the absence of disease progression or unacceptable toxicity. | Drug: sunitinib malate<br>* Given PO<br>* Other names: Sutent;Biological: bevacizumab<br>* Given IV<br>* Other names: rhuMAb VEGF;Other: pharmacological study<br>* Correlative studies<br>* Other names: pharmacological studies;Other: laboratory biomarker analysis<br>* Correlative studies<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximum tolerated dose (MTD) of bevacizumab in combination with sunitinib malate determined according to dose-limiting toxicities (DLTs) graded using Common Terminology Criteria for Adverse Events version 3.0 (CTCAE v3.0) |  | 42 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Objective response rate assessed by RECIST |  | Up to 5 years | 
| Overall survival | Will be summarized using the method of Kaplan and Meier. 95% confidence intervals will be reported when appropriate. | Up to 5 years | 
| Progression-free survival | Will be summarized using the method of Kaplan and Meier. 95% confidence intervals will be reported when appropriate. | Up to 5 years |