Clinical trial NCT02874651: ADjuVant Apatinib in Nasopharyngeal Carcinoma Patients With Residual Epstein-Barr Virus (EBV) DNA Following Radiotherapy
Official title: ADjuVant Apatinib in Nasopharyngeal Carcinoma Patients With Residual Epstein-Barr Virus (EBV) DNA Following Radiotherapy With or Without Chemotherapy
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: PHASE2
Conditions: Nasopharyngeal Neoplasms
Keywords: Nasopharyngeal Carcinoma
EB Virus
DNA
vascular endothecial growth factor receptor inhibitor
Apatinib
Lead sponsor: Sun Yat-sen University
Sponsor class: OTHER
Collaborators: name: First People's Hospital of Foshan
name: Guilin Medical University, China
First posted: 2016-08-22
Enrollment: 25
Sex: ALL
Minimum age (years): 18
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This study will enroll patients with non-metastatic nasopharyngeal carcinoma (NPC) that have residual Epstein-Barr virus (EBV) DNA after curative radiotherapy or chemoradiotherapy. The purpose is to evaluate the survival in these patients treated with apatinib (YN968D1), an inhibitor of vascular endothelial growth factor receptor (phase IIa) and to compare the survival in these patients treated with apatinib versus placebo (phase IIb).

Detailed description: This study has two parts. In the single arm phase IIa part, we will enroll 25 patients that have residual Epstein-Barr virus (EBV) DNA after curative radiotherapy or chemoradiotherapy. All patients will receive apatinib. The purpose is to evaluate the disease free-survival (DFS) in these patients treated with apatinib. In the phase IIb part, patients will be randomized to apatinib or placebo in a ratio of 1:1. The estimated sample size is 78 in phase IIb. However, the final sample size in phase IIb will be determined based on results of the phase IIa part.

Eligibility criteria: Inclusion Criteria:

1. Biopsy proven nasopharyngeal carcinoma, with detectable pretreatment plasma EBV DNA
2. Have detectable plasma EBV DNA at the end of (+/- 1 week) curative radiotherapy or chemoradiotherapy (radiation dose \> 66Gy), determined by the central lab
3. No clinical evidence of persistent loco-regional disease
4. No evidence of distant metastasis, based upon skeletal scintigraphy, chest X-ray examination, and liver ultrasound or other appropriate workup (e.g., CT, MRI or positron emission tomography (PET)/CT\]) within 21 days prior to registration
5. Eastern Cooperative Oncology Group (ECOG) performance status 0-1
6. Anticipated survival \>= 3 months
7. Absolute neutrophil count (ANC) \>= 1,500 cells/mm\^3
8. Platelets \> 80,000 cells/mm\^3
9. Hemoglobin \>= 8.0 g/dl (no transfusion within the last 14 days)
10. Total bilirubin =\< 1.5 x institutional upper limit of normal (ULN)
11. Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) =\< 2.5 x institutional ULN
12. Creatinine clearance (CC) \>= 50 ml/min estimated by Cockcroft-Gault formula

Exclusion Criteria:

1. Patients with stage III-IV disease (American Joint Committee On Cancer/Union for International Cancer Control 7th) and no contraindication to chemotherapy that didn't receive platinum based concurrent chemotherapy during radiation
2. Patients with tumor possibly invaded main vessels (e.g. encasement of the internal jugular artery/vein) at diagnosis; or tumor that, in the judgment of the investigator, likely to invade main vessels and cause life-threatening hemorrhage events during study
3. History of serious hemorrhage events or grade 3 or higher hemorrhage within 4 weeks prior to registration
4. Hypertension that couldn't be well controlled with single medication; unstable angina; angina diagnosed within the last 3 months; myocardial infarction within the last 6 months; cardiac arrhythmia that need long-term medication; grade 2 or higher cardiac dysfunction (NYHA)
5. Proteinuria
6. Coagulation dysfunction or predisposition to hemorrhage; on treatment of anticoagulation medication or vitamin K antagonist; low dose warfarin (1mg po qd) or aspirin (less than 100mg daily) were permitted as long as the international normalized ratio (INR) = \< 1.5
7. Thrombosis within the last 1 year, except cured vein thrombosis related to vein indwelling catheter
8. Unhealed bone fracture or chronic unhealed wound
9. Illness that would interfere with oral medication, including dysphagia, chronic diarrhea, or ileus
10. Pregnant or lactating women
11. Women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception during and within 6 months after study
12. Current drug abuse or mentally disabled
13. History of congenital or acquired immune deficiency disease or organ transplantation
14. Major medical illness, which in the investigator's opinion would endanger the patients or interfere with the completion of therapy and follow up

Primary outcomes:
measure: Disease-free survival
timeFrame: 3 years
Secondary outcomes:
measure: overall survival
timeFrame: 5 years
measure: Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
timeFrame: 2 years
measure: Changes in quality of life (QOL) as assessed by EORTC QLQ-C30
timeFrame: 2 years
measure: Distance Metastasis Free Survival
timeFrame: 3 years
measure: locoregional relapse free survival
timeFrame: 3 years
measure: Correlation of plasma EBV DNA load with the effect of apatinib on survival
timeFrame: 3 years
measure: Correlation of pretreatment serum VEGF level with the effect of apatinib on survival
timeFrame: 3 years
measure: Correlation of pretreatment serum VEGFR-2 level with the effect of apatinib on survival
timeFrame: 3 years
measure: Correlation of adverse event (hypertension) with the effect of apatinib on survival
timeFrame: 3 years
measure: Correlation of adverse event (hand-foot syndrome) with the effect of apatinib on survival
timeFrame: 3 years
measure: Correlation of the change from baseline in serum VEGF level at 4 weeks with the effect of apatinib on survival
timeFrame: 3 years
measure: Correlation of the change from baseline in serum VEGFR-2 level at 4 weeks with the effect of apatinib on survival
timeFrame: 3 years
Other outcomes:
Locations:
city: Foshan
country: China
facility: Affiliated Foshan Hospital of Sun Yat-sen University
state: Guangdong
city: Guangzhou
country: China
facility: Sun Yat-sen University Cancer Center
state: Guangdong
city: Guilin
country: China
facility: Affiliated Hospital of Guilin Medical University
state: Guangxi
Study officials:
affiliation: Sun Yat-sen University
name: Jun Ma, M.D.
role: STUDY_CHAIR
References: