Topotecan, Cisplatin and Bevacizumab for Recurrent/Persistent Cervical Cancer

Study Overview
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Brief Summary
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The purpose of this study is to determine whether the combination of topotecan, cisplatin and bevacizumab is effective in the treatment of recurrent or persistent cervical cancer

Detailed Description
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Cervical cancer remains a major cause of morbidity and mortality in women. Chemoradiation has led to improvements in survival, but the prognosis for patients with recurrent, metastatic cervical cancer remains poor. There is the need for more effective treatments for the management of recurrent/persistent cervical cancer. Angiogenesis appears to play an important role in cervical cancer development and progression, therefore VEGF inhibition appears to be a rationale therapeutic strategy for cervical cancer. There is increasing evidence that combining an anti-angiogenic agent with either cytotoxic chemotherapy or radiation enhances anti-tumor activity. This study combines the current most active chemotheraputic regimen for cervical cancer (cisplatin + topotecan) with an anti-angiogenic agent.

Official Title
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Phase II Trial of Topotecan, Cisplatin and Bevacizumab for Recurrent/Persistent Cervical Cancer

Conditions
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Cervical Cancer

Intervention / Treatment
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* Drug: Topotecan
* Drug: Cisplatin
* Drug: Bevacizumab


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Recurrent or persistent squamous, adenosquamous or adenocarcinoma of the uterine cervix not amenable to curative treatment with surgery and/or radiotherapy No prior therapy (radiation, chemotherapy, hormonal therapy or immunotherapy) for recurrence or persistence. May have received platinum in combination with radiation as part of up-front treatment or adjuvant treatment Must have measurable disease as defined by RECIST criteria Must have at least one target lesion to assess response Performance status of 0 or 1 Patients with ureteral obstruction must undergo stent or nephrostomy tube placement prior to study entry At least 4 weeks must have elapsed since prior treatment Age >= 18 years Patients of childbearing potential must have a negative pregnancy test, use effective means of contraception Signed informed consent Bone marrow function: ANC >= 1500/ul; platelets >= 100,000 /ul Renal function: creatinine <= 1,5 X ULN (if > 1.5 creatinine clearance must be > 60 ml/min) Hepatic function: bilirubin <= 1.5 X ULN, AST and alkaline phosphatase <= 2.5 X ULN Neurologic function: neuropathy < CTC grade 1 Coagulation: PT INR <= 1.5 Exclusion Criteria: Evidence of sepsis or severe infection Prior therapy for recurrence Patients with serious, non-healing wound, ulcer or bone fracture Patients with history or evidence of nervous system disease, including primary brain tumor, brain metastases, seizure not controlled with standard medical therapy, CVA, stroke, TIA or subarachnoid hemorrhage within 6 months of 1st date of treatment on study Patients with history of other invasive malignancy (treatment within last 5 years) other than non-melanoma skin cancer Patient with clinically significant cardiovascular disease defined as: Inadequately controlled hypertension (systolic > 150 and/or diastolic > 100 on antihypertensive medications); prior history of hypertensive crisis or hypertensive encephalopathy Unstable angina within 6 months of enrollment NYHA Grade II or greater congestive heart failure Serious cardiac arrythmia requiring medication Grade 2 or greater peripheral vascular disease; claudication within 6 months History of myocardial infarction within 6 months Previously diagnosed coagulopathy, disseminated intravascular coagulopathy, immune thrombocytopenia purpura, thrombotic thrombocytopenia purpura or tumor involving major vessels Significant vascular disease: aortic aneurysm, aortic dissection Active thromboembolic disease: pulmonary embolism, deep venous thrombosis Major surgical procedure, open biopsy or significant traumatic injury within 28 days prior to day 1 of study; anticipation of need for major surgical procedure during course of the study Minor surgical procedure other than central venous access placement, within 7 days prior to day 1 of study Patients with proteinuria - patients with urine protein of 1+ on dipstick or >=30 mg/dl at baseline should undergo UPCR; patients with UPCR of >=1.0 should be excluded Patients who are pregnant or lactating No prior investigational agent within 30 days or planned participation in an experimental drug study Patients whose circumstances do not permit completion of study or required follow-up Prior therapy with bevacizumab or topotecan. Prior platinum therapy allowed as part of initial treatment History of abdominal fistula, GI perforation or intra-abdominal abscess within 6 months prior to study enrollment. Known hypersensitivity to any component of bevacizumab

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

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
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: I<br>Cisplatin 50 mg/m2 IV day 1 of a 21 day cycle Topotecan 0.75 mg/m2 IV Days 1, 2, 3 of a 21 day cycle Bevacizumab 15 mg/kg day 1 of a 21 day cycle | Drug: Topotecan<br> <br> * Other names: Hycamtin;Drug: Cisplatin<br> <br> * Other names: Platin;Drug: Bevacizumab<br> <br> * Other names: Avastin;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Anti-tumor Activity as Measured by Surviving Progression-free | Defined as the period from study entry until documentation of disease progression, death, or date of last contact, whichever occurred first. | Progression-free survival at 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall Survival | Defined as time from study entry until death from any cause or date of last contaqct. | Until death (follow-up ranged from 1.7 months to 33.4 months) | 
| Frequency of Response as Measured by RECIST Criteria (Imaging) | RECIST criteria: Complete response is disappearance of all target and non-target lesions and no evidence of new lesions documented by two disease assessments at least 4 weeks apart. Partial Response is at least a 30% decrease in the sum of longest dimensions (LD) of all target measurable lesions taking as reference the baseline sum of LD. Progression is defined as ANY of the following - 20% increase in the sum of LD target lesions, the appearance of one or more new lesions, death due to disease without prior objective documentation of progression, global deterioration in health status attributable to the disease, progression of existing non-target lesions Stable disease is any condition not meeting the above criteria | Tumor response measured prior to every other cycle of therapy (range of follow-up to measure overall response was 1.6-9.5 months) | 
| Correlate Patterns of Gene Expression as Assessed by Microarrays |  | Correlative studies when specimens available | 
| Correlate Hypoxia Inducible Factor 1 (HIF-1) and Hypoxia Induced Gene Expression as Measured by Laboratory Studies |  | When specimens available |