Dasatinib in Treating Patients With Previously Treated Malignant Mesothelioma

Study Overview
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Brief Summary
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RATIONALE: Dasatinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. PURPOSE: This phase II trial is studying how well dasatinib works in treating patients with previously treated malignant mesothelioma.

Detailed Description
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OBJECTIVES: Primary To determine the rate of progression-free survival (PFS) at 24 weeks (or 5.5 months) in patients with malignant mesothelioma treated with dasatinib. Secondary To determine the response rate (partial response [PR] and complete response [CR]) in patients with malignant mesothelioma treated with dasatinib. To determine the response duration in patients with malignant mesothelioma treated with dasatinib. To describe the overall survival (OS) of patients with malignant mesothelioma treated with dasatinib. To describe the toxicity profile of dasatinib in patients with malignant mesothelioma. To determine whether the amount of expression of EphA2 and PDGFRβ, as measured by immunohistochemistry from tumor specimens, correlates with PFS in patients with malignant mesothelioma. To determine whether plasma levels of VEGF and PDGFRβ, serum levels of CSF-1, and soluble mesothelin-related protein correlate with PFS in patients with malignant mesothelioma. To determine whether inhibition of Src phosphorylation in PBMC correlates with PFS. To assess inhibition of phosphorylation of Src, EphA2, and PDGFRβ in tumor tissue by dasatinib. OUTLINE: Patients receive oral dasatinib twice daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo tumor tissue and blood sample collection periodically for correlative studies. Tumor tissue samples are analyzed for EphA2 and PDGFRβ expression by immunohistochemistry. Tumor tissue samples may also be analyzed for phosphorylation of Src, EphA2, and PDGFRβ by western blot. Blood samples are analyzed for concentration of VEGF and PDGF by quantitative sandwich enzyme immunoassay technique; mesothelin-related protein level by Mesomark® assay; CSF-1 level by ELISA assay; and phosphorylation of Src by phospho-Src (pTyr418) human ELISA. After completion of study treatment, patients are followed at least every 2 months for 1 year, then every 4 months for 1 year, then every 6 months for 1 year.

Official Title
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A Phase II Study of Dasatinib (NSC #732517) in Patients With Previously Treated Malignant Mesothelioma

Conditions
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Malignant Mesothelioma

Intervention / Treatment
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* Drug: dasatinib


Participation Criteria
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Eligibility Criteria
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DISEASE CHARACTERISTICS: Histologically confirmed malignant mesothelioma of any of the following subtypes: Epithelial Sarcomatoid Mixed Any site of origin of malignant mesothelioma allowed including, but not limited to, any of the following: Pleura Peritoneum Pericardium Tunica vaginalis Pathology blocks or slides from a core surgical biopsy must be available Not amenable to curative surgery Measurable disease, defined as lesions that can be accurately measured in at least one dimension (longest diameter to be recorded) as ≥ 20 mm with conventional techniques (CT scan , MRI, or x-ray) or as ≥ 10 mm with spiral CT scan Patients with pleural rind only disease must have at least one level with one rind measurement ≥ 1.5 cm Lesions that are considered nonmeasurable include the following: Bone lesions Leptomeningeal disease Ascites Pleural/pericardial effusion Lymphangitis cutis/pulmonis Abdominal masses that are not confirmed and followed by imaging techniques Cystic lesions Prior treatment with one and only one systemic chemotherapy regimen, which must have included pemetrexed disodium required Treatment may have been with pemetrexed disodium alone or in combination with any other agent No symptomatic pleural effusions, unless the patient undergoes a therapeutic thoracentesis Patients with pleural effusions who have had a pleurodesis are eligible No known brain metastases May be registered on CALGB-150707 companion study PATIENT CHARACTERISTICS: ECOG performance status 0-1 Granulocytes ≥ 1,500/μL Platelet count ≥ 100,000/μL Total bilirubin ≤ 2 x upper limit of normal (ULN) AST (SGOT) ≤ 2.5 x ULN Creatinine clearance ≥ 60 mL/min INR < 1.5 PTT < 40 seconds QTc < 450 msec Not pregnant or nursing Fertile patients must use effective contraception No significant cardiac disease, including any of the following: New York Heart Association (NYHA) class III-IV congestive heart failure (CHF) Unstable angina Myocardial infarction or ventricular tachyarrhythmia within 6 months of study entry Ejection fraction less than institutional normal (in patients with a history of CHF or currently with NYHA class I or II CHF) Prolonged QTc > 450 msec (Fridericia correction) Major conduction abnormality, unless a cardiac pacemaker is present Hypokalemia or hypomagnesemia that cannot be corrected No history of significant bleeding disorder unrelated to cancer, including any of the following: Congenital bleeding disorder (e.g., von Willebrand disease) Acquired bleeding disorder within the past year (e.g., acquired anti-factor VIII antibodies) Ongoing or recent (≤ 3 months) significant GI bleeding or hemoptysis No requirement for supplemental oxygen (i.e., pulse oximetry < 89% at rest) PRIOR CONCURRENT THERAPY: At least 4 weeks since prior pemetrexed disodium-containing chemotherapy At least 4 weeks since prior major surgery At least 4 weeks since prior radiation therapy Measurable disease must be outside the radiation port Prior intracavitary cytotoxic or sclerosing therapy (including bleomycin) allowed Intrapleural cytotoxic chemotherapy will not be considered systemic chemotherapy At least 7 days since prior and no concurrent antithrombotic or anti-platelet agents, including any of the following: Aspirin or aspirin-containing combinations Clopidogrel Dipyridamole Tirofiban Epoprostenol Eptifibatide Cilostazol Abciximab Ticlopidine Warfarin Low-dose warfarin for prophylaxis to prevent catheter thrombosis allowed Heparin or low molecular weight heparin Heparin for IV line flush allowed At least 7 days since prior and no concurrent use of the following drugs: Itraconazole Ketoconazole (at doses > 200 mg/day) Miconazole Voriconazole Telithromycin Primidone Rifabutin Rifampin St. John's wort Carbamazepine Oxcarbazepine Rifapentine Phenobarbital Phenytoin Quinidine Procainamide Disopyramide Amiodarone Sotalol Ibutilide Dofetilide Erythromycin Clarithromycin Chlorpromazine Haloperidol Mesoridazine Thioridazine Pimozide Bepridil Droperidol Halofantrine Levomethadyl Sparfloxacin No concurrent H2 blockers or proton pump inhibitors No bisphosphonate therapy during the first 8 weeks of study treatment No concurrent hormones or other chemotherapeutic agents except for steroids administered for dasatinib-related pleural effusion or hormones administered for non-disease-related conditions (e.g., insulin for diabetes) No concurrent palliative radiation therapy

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: Dasatinib<br>Use of dasatinib in treatment of pts with previously treated malignant mesothelioma | Drug: dasatinib<br>* 50 mg PO bid<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 24 Week Progression Free Survival | Percentage of participants who were alive and progression free at 24 weeks. The 24 week progression free survival, with 95% confidence interval, was estimated using the Kaplan Meier method. | 24 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With Overall Tumor Response | Response was defined using Response Evaluation Criteria In Solid Tumors (RECIST) criteria: Complete Response (CR): disappearance of all target lesions; Partial Response (PR) 30% decrease in sum of longest diameter of target lesions; Progressive Disease (PD): 20% increase in sum of longest diameter of target lesions; Stable Disease (SD): small changes that do not meet above criteria. Overall tumor response is the total number of CR and PRs. | Duration of study until progression (up to 3 years) | 
| Overall Survival | Overall survival (OS) was defined as the time from registration to death of any cause. Surviving patients were censored at the date of last follow-up. The median OS with 95% CI was estimated using the Kaplan Meier method. | Time from registration to death (up to 3 years) | 
| Progression Free Survival | Progression free survival (PFS) was defined as the time from registration to progression or death of any cause. Progression free and alive patients were censored at the date of last follow-up. The median PFS with 95% CI was estimated using the Kaplan Meier method. | Time from registration to progression or death (up to 3 years) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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advanced malignant mesothelioma, epithelial mesothelioma, recurrent malignant mesothelioma, sarcomatous mesothelioma