Pharmacodynamic Study of Sunitinib Malate in Patients With Renal Cell Cancer and Other Advanced Solid Malignancies
Inclusion Criteria:
- Patients must have histologically or cytologically confirmed renal cell cancer; or
other solid malignancy (excluding lymphoma) that is metastatic or unresectable and
for which no standard curative therapy exists
- For the renal cell cancer subset, a component of clear cell histology is
required
- Measurable disease, defined as >= 1 unidimensionally measurable lesion >= 20 mm by
conventional techniques or >= 10 mm by spiral CT scan
- Life expectancy > 12 weeks
- Eastern Cooperative Oncology Group (ECOG) performance status 0-2
- Leukocytes >= 3,000/mm^3
- Absolute neutrophil count (ANC) >= 1,500/mm^3
- Platelet count >= 100,000/mm^3
- Hemoglobin >= 9 g/dL
- Serum calcium =< 12.0 mg/dL
- Total bilirubin normal
- Aspartate aminotransferase (AST) (serum glutamic oxalo-acetic transaminase [SGOT])
and alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =<
2.5 times upper limit of normal (ULN), unless subjects have liver metastases, in
which case both AST and ALT must be =< 5 x ULN
- Creatinine =< 2 times ULN OR creatinine clearance >= 40 mL/min for patients with
creatinine levels above 2 x institutional normal
- All patients need to be willing to undergo planned pharmacodynamic assessments,
including serial PET imaging, plasma markers, and pharmacokinetic sampling
- Women of childbearing potential and men must agree to use adequate contraception
(hormonal or barrier method of birth control; abstinence) prior to study entry and
for the duration of study participation
- Ability to understand and the willingness to sign a written informed consent document
Exclusion Criteria:
- Patients who have had chemotherapy, radiotherapy, experimental therapy or major
surgery within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering
the study or those who have not recovered (to grade < 1 or baseline) from clinically
significant adverse events due to agents administered more than 4 weeks earlier
(alopecia and fatigue excluded); clinical significance to be determined by
investigator
- Patients may not be receiving any other investigational agents
- No prior treatment with an anti-VEGF agent allowed
- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to sunitinib malate
- Patients with QTc prolongation (defined as a QTc interval greater than 500 msec) or
other significant ECG abnormalities (per investigator discretion) are excluded
- Patients with poorly controlled hypertension (systolic blood pressure of 140 mm Hg or
higher or diastolic blood pressure of 90 mm Hg or higher) are ineligible
- Patients with any condition (e.g., gastrointestinal tract disease resulting in an
inability to take oral medication or a requirement for IV alimentation, prior
surgical procedures affecting absorption, or active peptic ulcer disease) that
impairs their ability to swallow and retain sunitinib tablets are excluded
- Patients with any of the following conditions are excluded:
- Serious or nonhealing wound, ulcer, or bone fracture
- Abdominal fistula, GI perforation, or intra-abdominal abscess within the past 28
days
- Cerebrovascular accident (CVA) or transient ischemic attack within 12 months
prior to study entry
- History of myocardial infarction, cardiac arrhythmia, stable/unstable angina,
symptomatic congestive heart failure, or coronary/peripheral artery bypass graft
or stenting within the past 12 months
- History of pulmonary embolism within the past 12 months
- Class III or IV heart failure as defined by the New York Heart Association
(NYHA) functional classification system
- Patients with a pre-existing thyroid abnormality who are unable to maintain thyroid
function in the normal range with medication are ineligible; patients with a history
of hypothyroidism are eligible provided they are currently euthyroid
- Patients with known brain metastases
- Patients with uncontrolled intercurrent illness including, but not limited to,
ongoing or active infections or psychiatric illness/social situations that would
limit compliance with study requirements are ineligible
- Pregnant or breastfeeding
- No concurrent therapeutic doses of coumarin-derivative anticoagulants, such as
warfarin; Concurrent doses =< 2 mg/day allowed for prophylaxis of thrombosis,
Concurrent low molecular weight heparin allowed provided PT INR =< 1.5
- No concurrent agents with proarrhythmic potential (terfenadine, quinidine,
procainamide, disopyramide, sotalol, probucol, bepridil, haloperidol, risperidone,
indapamide, and flecainide acetate)
- HIV-positive patients on combination antiretroviral therapy are ineligible