A Phase Ib Multicenter Trial To Determine The Safety, Tolerance And Preliminary Antineoplastic Activity Of Gemcitabine Administered In Combination With Escalating Oral Doses Of OSI-774 To Patient Cohorts With Recently Diagnosed, Gemcitabine-Naive, Advanced Pancreatic Carcinoma Or Other Potentially Responsive Malignancies
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Histologically or cytologically confirmed locally advanced or metastatic epithelial
carcinoma of the pancreas or other malignancy considered to be potentially responsive
to gemcitabine
- Newly diagnosed or gemcitabine naive
- Measurable or evaluable disease
- Not amenable to surgical intervention due to medical contraindications or
non-resectability of the tumor
- No islet cell tumors or other non-epithelial cell carcinomas of the pancreas
- No active CNS metastases or leptomeningeal disease
- Treated or asymptomatic brain metastases are allowed if on a stable dose of
corticosteroids and/or there is no change in brain disease status for at least 4
weeks after related therapy (e.g., whole-brain radiotherapy)
PATIENT CHARACTERISTICS:
Age:
- 18 and over
Performance status:
- Karnofsky 70-100%
Life expectancy:
- Not specified
Hematopoietic:
- Absolute neutrophil count at least 1,500/mm^3
- Platelet count at least 100,000/mm^3
Hepatic:
- Bilirubin no greater than 2.0 mg/dL (except for documented Gilbert's syndrome)
- AST or ALT less than 2 times upper limit of normal (ULN) (no greater than 5 times ULN
if hepatic obstruction or metastases present)
- Albumin at least 2.5 g/dL
Renal:
- Creatinine less than 1.5 times ULN OR
- Creatinine clearance at least 60 mL/min
Cardiovascular:
- No significant cardiovascular disease
- No history of congestive heart failure currently requiring therapy
- No ventricular arrhythmia requiring anti-arrhythmic therapy
- No severe conduction disturbances
- No angina pectoris requiring therapy
- No myocardial infarction within the past 6 months
Gastrointestinal:
- No significant gastrointestinal abnormalities including:
- Requirement for IV alimentation
- Active peptic ulcer disease
Ophthalmic:
- No significant ophthalmologic abnormalities including:
- Severe dry eye syndrome
- Keratoconjunctivitis sicca
- Sjogren's syndrome
- Severe exposure keratopathy
- Disorders that would increase the risk for epithelium-related complications
(e.g., bullous keratopathy, aniridia, severe chemical burns, or neutrophilic
keratitis)
- Abnormal Schirmer test (less than 2 mm) allowed provided there is no evidence of
clinically significant corneal surface abnormalities
Other:
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- No known or suspected hypersensitivity to gemcitabine
- No uncontrolled infection
- HIV negative
- No other malignancy within the past 5 years except treated non-melanoma skin cancer
or carcinoma in situ of the breast or cervix
- No other life-threatening illness
- No psychiatric disorders or altered mental status the would preclude informed consent
or study
PRIOR CONCURRENT THERAPY:
Biologic therapy:
- At least 28 days since prior immunotherapy or biological response modified therapy
for the primary malignancy
- No concurrent immunotherapy or biologic response modifier therapy for the primary
malignancy
Chemotherapy:
- See Disease Characteristics
- At least 28 days since prior chemotherapy for the primary malignancy
- No prior mitomycin or nitrosoureas for the primary malignancy
- No more than 6 prior courses of chemotherapy with an alkylating agent for the primary
malignancy
- No prior gemcitabine for the primary malignancy except as a low-dose (less than 500
mg/m^2) radiosensitizer administered concurrently with or within 2 weeks after
radiotherapy at least 3 months ago
- No other concurrent chemotherapy for the primary malignancy
Endocrine therapy:
- See Disease Characteristics
- At least 28 days since prior systemic hormonal therapy (except LH-RH agonists) for
the primary malignancy
- No concurrent systemic hormonal therapy (except LH-RH agonists) for the primary
malignancy
- Other concurrent endocrine therapy is allowed as follows:
- Hormonal therapy (e.g., megestrol) for appetite stimulation
- Nasal, ophthalmic, or topical glucocorticoids
- Oral glucocorticoids for adrenal insufficiency
- Low-dose maintenance steroids
Radiotherapy:
- See Disease Characteristics
- At least 28 days since prior radiotherapy for the primary malignancy or metastases
and recovered
- No prior wide-field radiotherapy to 25% or more of marrow-bearing bone
- No prior pelvic irradiation
- No concurrent radiotherapy for the primary malignancy or metastases
- No concurrent wide-field radiotherapy for pain management
Surgery:
- See Disease Characteristics
- Recovered from any prior surgery
- No prior surgical procedures affecting absorption
Other:
- No prior agent for the primary malignancy targeting the epidermal growth factor
receptor (EGFR) or EGFR-specific tyrosine kinase activity