A Phase II Study of Sunitinib Malate in Recurrent or Metastatic Endometrial Carcinoma
Inclusion Criteria
Criteria:
- At least 4 weeks since prior and no other concurrent investigational treatment
- At least 7 days since prior and no concurrent CYP3A4 inhibitors
- At least 12 days since prior and no concurrent CYP3A4 inducers
- No prior antiangiogenic agents (e.g., bevacizumab, sorafenib, pazopanib, AZD2171,
vatalanib, VEGF Trap)
- No concurrent coumadin-derivative anticoagulants (e.g., warfarin) Thrombosis
prophylaxis therapy (2 mg daily) allowed Low molecular weight heparin allowed
provided PT/INR is =< 1.5
- No concurrent combination antiretroviral therapy for HIV-positive patients
- No other concurrent anticancer agents or therapies
- No concurrent agents with proarrhythmic potential including, but not limited to, the
following
- Histologically or cytologically confirmed endometrial cancer [Adenocarcinoma (e.g.,
endometrioid, serous, or papillary serous) or carcinosarcoma (e.g., malignant mixed
mullerian tumor of the uterus), no other histologies (e.g., squamous cell carcinoma
or leiomyosarcoma)]
- Patients meeting any of the following criteria are eligible provided they have normal
LVEF on ECHO or MUGA scan:
- History of congestive heart failure with NYHA =< class I and on treatment
- Prior anthracycline exposure
- Received prior central thoracic radiation that included the heart in the
radiotherapy port
- Patients with previously treated disease must have clinical or radiographic evidence
of progressive disease
- Measurable disease, defined as >= 1 unidimensionally measurable lesion >= 20 mm with
conventional techniques or >= 10 mm with spiral CT scan (No indicator lesions
previously treated with surgery, radiotherapy, or radiofrequency ablation)
- No known brain metastases
- ECOG performance status (PS) 0-2 OR Karnofsky PS 60-100%
- Life expectancy > 3 months
- WBC >= 3,000/mm^3
- ANC >= 1,500/mm^3
- Platelet count >= 100,000/mm^3
- Hemoglobin >= 100 mg/dL
- Calcium =< 12.0 mg/dL
- Bilirubin normal
- AST and ALT =< 2.5 times upper limit of normal
- Creatinine normal OR creatinine clearance >= 60 mL/min
- Serum lipase or serum amylase =< 1.5 times upper limit of normal
- Magnesium >= 0.5 mmol/L
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- QTc < 500 msec
- No significant ECG abnormalities
- No serious or non-healing wound, ulcer, or bone fracture
- No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within
the past 28 days
- No pulmonary embolism within the past 12 months
- No NYHA class III or IV heart failure
- No pre-existing adrenal insufficiency (primary or secondary)
- No condition that impairs the ability to swallow and retain sunitinib malate tablets
(e.g., gastrointestinal tract disease resulting in an inability to take oral
medication; requirement for IV alimentation; prior surgical procedures affecting
absorption; or active peptic ulcer disease)
- No history of allergic reactions to compounds of similar chemical or biological
composition to sunitinib malate
- No pre-existing thyroid abnormality unable to maintain normal range thyroid function
with medication
- No concurrent uncontrolled illness including, but not limited to, ongoing or active
infection, psychiatric illness, or social situation that would preclude study
compliance
- No uncontrolled hypertension (i.e., systolic blood pressure [BP] >= 140 mm Hg or
diastolic BP >= 90 mm Hg)
- More than 4 weeks since prior chemotherapy (6 weeks for carmustine, nitrosoureas or
mitomycin C) and recovered
- No more than 6 prior courses of anthracycline chemotherapy (or < 450 mg/m^2 of
doxorubicin hydrochloride)
- No more than 1 prior cytotoxic chemotherapy regimen for recurrent, locally advanced,
or metastatic disease
- More than 4 weeks since prior radiotherapy and recovered
- At least 4 weeks since prior major surgery
- TSH, T3, or T4 normal
- No cerebrovascular accident or transient ischemic attack within the past 12 months
- No myocardial infarction, cardiac arrhythmia, stable or unstable angina, symptomatic
congestive heart failure, or coronary/peripheral artery bypass graft or stenting
within the past 12 months
- Histologically or cytologically confirmed endometrial cancer
- Adenocarcinoma (e.g., endometrioid, serous, or papillary serous) or carcinosarcoma
(e.g., malignant mixed müllerian tumor of the uterus)
- No other histologies (e.g., squamous cell carcinoma or leiomyosarcoma)
- Patients with previously treated disease must have clinical or radiographic evidence
of progressive disease
- Measurable disease, defined as ≥ 1 unidimensionally measurable lesion ≥ 20 mm with
conventional techniques or ≥ 10 mm with spiral CT scan
- No indicator lesions previously treated with surgery, radiotherapy, or radiofrequency
ablation
- No known brain metastases
- Patients meeting any of the following criteria are eligible provided they have normal
LVEF on ECHO or MUGA scan:
- History of congestive heart failure with NYHA ≤ class I and on treatment
- Prior anthracycline exposure
- Received prior central thoracic radiation that included the heart in the radiotherapy
port
- At least 4 weeks since prior and no other concurrent investigational treatment
- At least 7 days since prior and no concurrent CYP3A4 inhibitors, including the
following:
- Azole antifungals (ketoconazole, itraconazole)
- Clarithromycin
- Erythromycin
- Diltiazem
- Verapamil
- HIV protease inhibitors (indinavir, saquinavir, ritonavir, atazanavir,
nelfinavir)
- Delavirdine
- At least 12 days since prior and no concurrent CYP3A4 inducers, including the
following:
- Rifampin
- Rifabutin
- Carbamazepine
- Phenobarbital
- Phenytoin
- Hypericum perforatum (St. John's wort)
- Efavirenz
- Tipranavir
- No prior antiangiogenic agents (e.g., bevacizumab, sorafenib, pazopanib,
AZD2171, vatalanib, VEGF Trap)
- No concurrent coumadin-derivative anticoagulants (e.g., warfarin)
- Thrombosis prophylaxis therapy (2 mg daily) allowed
- Low molecular weight heparin allowed provided PT/INR is ≤ 1.5
- No concurrent combination antiretroviral therapy for HIV-positive patients
- No other concurrent anticancer agents or therapies
- No concurrent agents with proarrhythmic potential including, but not limited to, the
following:
- Terfenadine
- Quinidine
- Procainamide
- Disopyramide
- Sotalol
- Probucol
- Bepridil
- Haloperidol
- Risperidone
- Indapamide
- Flecainide