Sunitinib Malate After Stereotactic Radiosurgery in Treating Patients With Newly Diagnosed Brain Metastases

Study Overview
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Brief Summary
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RATIONALE: Sunitinib malate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. PURPOSE: This phase II trial is studying how well sunitinib malate works after stereotactic radiosurgery in treating patients with newly diagnosed brain metastases.

Detailed Description
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OBJECTIVES: Primary Determine the CNS progression-free survival rate in patients with 1-3 newly diagnosed brain metastases treated with sunitinib malate after stereotactic radiosurgery (SRS). Secondary Determine the rate of local (site of SRS treatment) failure at 12 months in these patients. Determine the median time to CNS disease progression in these patients. Determine the overall survival of these patients. Determine the time to progression of systemic disease in these patients. Evaluate the safety of sunitinib malate when administered after SRS in these patients. Assess the neurocognitive effects of SRS followed by sunitinib malate in these patients. OUTLINE: Patients receive oral sunitinib malate once daily on days 1-28. Courses repeat every 42 days in the absence of disease progression or unacceptable toxicity. Patients undergo neuropsychological battery testing at baseline and periodically during study to assess cognitive function (memory, verbal fluency, visual-motor speed, executive function, and motor dexterity), activities of daily living, and quality of life.

Official Title
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SUNDANCE Trial: Phase II Trial of Sunitinib as Maintenance Therapy After Stereotactic Radiosurgery in Patients With 1-3 Newly Diagnosed Brain Metastases

Conditions
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Cognitive/Functional Effects, Metastatic Cancer, Unspecified Adult Solid Tumor, Protocol Specific

Intervention / Treatment
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* Drug: sunitinib malate
* Other: cognitive assessment


Participation Criteria
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Eligibility Criteria
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DISEASE CHARACTERISTICS: Histologically or cytologically confirmed carcinoma Has 1-3 newly diagnosed brain metastases amenable to stereotactic radiosurgery Patients may enroll up to 1 month after the completion of stereotactic radiosurgery provided they can undergo the required neuropsychiatric battery before beginning treatment. Patients must begin treatment within 1 month of stereotactic radiosurgery. No CNS metastases from lymphoma or small cell lung cancer No leptomeningeal metastases No CNS complications requiring urgent neurosurgical intervention (e.g., resection or shunt placement) PATIENT CHARACTERISTICS: Karnofsky performance status 70-100% (RTOG RPA class I or II) Life expectancy > 6 weeks ANC ≥ 1,500/mm^3 Platelet count ≥ 100,000/mm^3 Hemoglobin ≥ 9.0 g/dL (transfusion allowed) AST and ALT ≤ 2.5 times upper limit of normal (ULN) Total serum bilirubin ≤ 1.5 times ULN Serum calcium ≤ 12.0 mg/dL Serum creatinine ≤ 2.5 mg/dL Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception Willing and able to comply with schedule visits, treatment plans, laboratory tests, and other study procedures No medical problem (unrelated to the malignancy) that would pose an undue risk or that would limit full compliance with the study No unresolved bowel obstruction No uncontrolled infectious process No evidence of bleeding diathesis or coagulopathy Hematuria from a primary renal tumor is allowed provided all other eligibility criteria are met No hypertension that cannot be controlled by medications to a blood pressure of < 160/90 mm Hg None of the following within the past 6 months: Myocardial infarction Severe/unstable angina Severe peripheral vascular disease (claudication) or procedure on peripheral vasculature Coronary/peripheral artery bypass graft NYHA class II-IV congestive heart failure Cerebrovascular accident or transient ischemic attack Clinically significant bleeding Deep venous thrombosis or pulmonary embolism No other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or study drug administration, or that may interfere with the interpretation of study results and, in the judgement of the investigator, would make the patient inappropriate for entry into this study PRIOR CONCURRENT THERAPY: See Disease Characteristics No prior sunitinib malate No prior cranial external beam radiotherapy No concurrent coumadin or other agents containing warfarin, except for low-dose coumadin (≤ 1 mg) administered prophylactically for maintenance of in-dwelling lines or ports No concurrent hepatic enzyme-inducing anticonvulsants No concurrent participation in another clinical trial No other concurrent investigational agents Concurrent steroids allowed provided dose is stable for ≥ 1 week Concurrent systemic therapy for management of stable systemic disease allowed

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: Sunitinib malate<br>Oral sunitinib malate once daily on days 1-28. Courses repeat every 42 days in the absence of disease progression or unacceptable toxicity. Patients undergo neuropsychological battery testing at baseline and periodically during study to assess cognitive function (memory, verbal fluency, visual-motor speed, executive function, and motor dexterity), activities of daily living, and quality of life. | Drug: sunitinib malate<br>* Treatment will be administered on an outpatient basis. Patients will receive sunitinib 37.5mg once daily in the morning without regard to meals in repeated 6-week cycles comprising daily therapy for 4 weeks followed by a 2-week rest period. Patients who tolerate this dose may increase the dose to 50 mg once daily.<br>* Other names: SUNITINIB;Other: cognitive assessment<br>* The memory test has six alternate forms. The other tests measure motor and information processing speed and are relatively resistant to the effects of practice. The total time for test administration, including the QOL and symptom measures, is 40 minutes.The difference between the pre-treatment baseline and follow-up assessment scores will be determined by the reliable change (RC) index. This index is derived from the standard error of measurement (SEM) for each test in the battery: 1 (deterioration), 2 (no change), or and 3 (improved).<br>* Other names: Quality of life (QOL) was evaluated with a self-report measure (FACT-BRREF).;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Central Nervous System (CNS) Progression-free Survival Rate | The number of subjects surviving at least six months from SRS without progressive disease anywhere in the brain (local or regional failure), assessed by the McDonald's standard criteria.Progressive neurologic abnormalities not explained by causes unrelated to tumor progression (e.g. anticonvulsant or corticosteroid toxicity, electrolyte abnormalities, hyperglycemia, etc.) or a greater than 25% increase in the size of the tumor by MRI/CT scan. | 6 months after stereotactic radiosurgery (SRS) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Central Nervous System (CNS) Progression-free Survival Rate | The number of subjects surviving at least 12 months from SRS without progressive disease anywhere in the brain (local or regional failure), assessed by the McDonald's standard criteria. Progressive neurologic abnormalities not explained by causes unrelated to tumor progression (e.g. anticonvulsant or corticosteroid toxicity, electrolyte abnormalities, hyperglycemia, etc.) or a greater than 25% increase in the size of the tumor by MRI/CT scan. | 12 months after stereotactic radiosurgery (SRS) | 
| Median Time to CNS Disease Progression | Time to disease progression will be recorded from the first day of protocol therapy until the criteria for disease progression are met, patient death from any cause or removal of the patient from study for any reason, whichever comes first. | up to12 months from SRS | 
| Overall Survival | The number of subjects surviving at least 12 months from stereotactic radiosurgery. | 12 months from SRS | 
| Time to Progression | Time to progression (all sites of disease) - interval between stereotactic radiosurgery and the earliest date of progression (systemic or CNS) or death due to any cause. | at 3 yrs from SRS | 
| Rate of Local Failure at 12 Months | Rate of local vs regional failure -rates of progression at site of stereotactic radiosurgery (local failure)vs progression anywhere else in CNS (regional failure). | 12 months | 
| Neurocognitive Effects | The number of patients that had statistically significant change (p's > 0.05) in their neurocognitive assessment (improvement or decline) from baseline. Neurocognitive function was assessed in several domains, including memory, verbal fluency, visual-motor speed, executive function and motor dexterity.The difference between the pre-treatment baseline and follow-up assessment scores were determined by the reliable change (RC) index. RC Index: 1=deterioration, 2=no change, 3=improved | at 2 months after treatment | 
| Safety and Tolerability | Number of patients that experienced treatment-related G 3-4 adverse events. | 3 years from study start | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cognitive/functional effects, tumors metastatic to brain, unspecified adult solid tumor, protocol specific